Social Science Assignment 4 and 5

The Impact of Participative Management Perceptions on Customer Service, iVledical Errors, Burnout, and Turnover Intentions Ingo Angermeier, FACHE, chief executive officer, Spartanburg Regional Healthcare System, Spartanburg, South Carolina; Benjamin B. Dunford, PhD, assistant professor, Krannert School of Management, Purdue University, West Lafayette, Indiana; Alan D. Boss, PhD candidate, Robert H. Smith School of Business, University of Mar^'land, College Park, Maryland; and R. Wayne Boss, PhD, professor, Leeds School of Business, University of Colorado at Boulder

E X E C U T I V E S U M M A R Y Numerous challenges confront managers in the healthcare industry, making it increasingly difficult for healthcare organizations to gain and sustain a competi- tive advantage. Contemporary management challenges in the industry have many different origins (e.g., economic, financial, clinical, and legal), but there is growing recognition that some of management's greatest problems have organizational roots. Thus, healthcare organizations must examine their personnel management strategies to ensure that they are optimized for fostering a highly committed and productive workforce. Drawing on a sample of 2,522 employees spread across 312 departments within a large U.S. healthcare organization, this article examines the impact of a par- ticipative management climate on four employee-level outcomes that represent some of the greatest challenges in the healthcare industry; customer service, medical errors, burnout, and turnover intentions.

This study provides clear evidence that employee perceptions of the extent to which their work climate is participative rather than authoritarian have important implications for critical work attitudes and behavior. Specifically, employees in highly participative work climates provided 14 percent better customer service, com- mitted 26 percent fewer clinical errors, demonstrated 79 percent lower burnout, and felt 61 percent lower likelihood of leaving the organization than employees in more authoritarian work climates. These findings suggest that participative management initiatives have a significant impact on the commitment and productivity of indi- vidual employees, likely improving the patient care and effectiveness of healthcare organizations as a whole.

For more information on the concepts in this article, please contact Dr. Boss at [email protected].

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I n today's era of rapidly changing technology, an aging and less-insured

population, and a flurtuating economy, healthcare organizations face more chal- lenges than ever. A survey indicates that healthcare executives are constrained to do more with fewer resources, which makes it difficult to sustain their orga- nization's viability and mission (Prybil 2003). One industry observer aptly notes that "it would be difficult to con- ceive of a field that is and will be subject to greater scrutiny, greater demands and greater changes than the American healthcare system" (Litch 2005, 20).

Many factors underlie contemporary challenges in healthcare management, but there is growing awareness among scholars and practitioners that the greatest challenges have organizational, rather than clinical or financial, roots (Ramanujam and Rousseau 2006). For instance, in one study, more than three quarters of CEOs identified "workforce issues" as a primary challenge in man- aging healthcare organizations (Prybil 2003). Improvements in patient safety, employee performance, and retention of key talent have become more difficult as healthcare personnel confront greater demands and heavier workloads (Ra- manujam and Rousseau 2006).

In response to these challenges, healthcare executives must implement management strategies that will enable them to optimize investments in hu- man capital to sustain a competitive advantage, Two archetypal management strategies have been previously identi- fied by organizational scholars (Arthur 1994). First, autocratic (or authoritarian) management strategies endeavor to re- duce labor costs by emphasizing control and efficiency through specialized roles

and strict rule enforcement. In contrast, participative management strategies en- deavor to increase employee productiv- ity by rewarding performance, fostering employee commitment, and decentral- izing decision making to give employees more voice in work decisions (Arthur 1994). Two decades' worth of research in the United States and abroad dem- onstrates that while autocratic manage- ment strategies are effective in certain conditions, participative approaches are typically associated with greater long- term corporate performance (Arthur 1994; Delaney and Huselid 1996; Miah and Bird 2007). Yet to date, little partici- pative management research has been conducted in healthcare, and fewer stud- ies have examined the sorts of employ- ee-level outcomes that are indicative ofthe industry's greatest contemporary challenges.

This growing disconnect between existing empirical research and cur- rent problems in healthcare manage- ment represents an important gap in the literature. Therefore, the purpose of our study was to examine the impact of participative-management employee perceptions on four critical employee- level outcomes: customer service, medical errors, burnout, and turnover intentions. To that end, the study drew on a large sample of employees spread across more than 300 departments in a large healthcare organization based in the southeastern United States. -L,

P A R T I C I P A T I V E C L I M A T E : THE L I K E R T O R G A N I Z A T I O N A L P R O F I L E Participative management practices have existed for more than a century, but they expanded in scope and in practice

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during the 1970s as organizations recognized the benefits of redesigning manufaauring jobs to minimize rep- etition and give employees input into matters tbat influenced their work (Katz, Kochan, and Colvin 2007). As more organizations experimented witb par- ticipative management, organizational theorists sought to understand tbe process by wbicb tbey could improve organizational effectiveness. Subsequent research bigbligbted two employee perceptions tbat are fundamental to tbe success of participative management ini- tiatives (Pierce, Rubenfeld, and Morgan 1991). First, information must flow freely to and from employees in tbe organiza- tion, sucb tbat tbey are given adequate information about tbeir work and tbat tbeir upward input on work-related mat- ters is given legitimate consideration (Rosen and Quarrey 1987). Second, employees must perceive tbat tbey bave an adequate degree o( control over tbeir work and the decisions tbat affect tbeir well-being (Pierce, Rubenfeld, and Morgan 1991). Wben employees feel empowered, tbey will perform better, be more committed to the organization, and be less likely to leave, all of wbicb collectively influence tbe effectiveness of tbe organization (Kanter 1993).

Ukert (1967) developed a typology and measurement scale (see Metbods section) of organizations based on tbe autboritarian-participative climate continuum. Tbe Liken Profile of Organi- zations draws on employee perceptions of six climate dimensions (leadersbip, motivation, communication, decision making, goal setting, and control) tbat are aggregated to determine tbe degree to wbicb an organization is participative in its climate. System 1 organizations

are considered to bave an exploitive, coercive, and "autboritarian" manage- ment style, wbereby information flows only from tbe top down and is viewed with suspicion by employees. System 2 organizations are labeled "benevolent autboritarian," wbereby some degree of bottom-up communication is al- lowed but "only [tbe information tbatj tbe boss wants to hear." System 3 organizations are "consultative" in tbat they set goals and issue directives after discussing tbe matter witb subor- dinates. Finally, System 4 organizations are considered "participative," wbereby communication is completely open and flows upward and downward and tbe decision making is sbared between em- ployees and management (see Figure 1 for additional description).

Researcb has demonstrated tbat employees form distinct participative- climate perceptions and tbat tbese per- ceptions are associated witb outcomes tbat include organizational structure results (Reigle 2001 ) and corporate performance (Miab and Bird 2007). However, to date, little if any researcb bas linked participative-climate percep- tions to employee-level outcomes. In tbe following section, we examine bow participative-climate perceptions affect customer service, medical errors, burn- out, and turnover intentions.

Customer Service Customer service is central to organi- zational effectiveness, particularly in bealtbcare institutions wbere employees' interactions witb patients bave a strong effect on patient satisfaction, bealtbcare quality, and brand loyalty (McManus 2007). Researcb demonstrates tbat cus- tomer service bas a stronger impact on

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FIGURE 1 Likert's Profile of Organizations

u

Participative—System 4 lotivation accomplished tliroiigh group panicipalion and involvement in

setting goals, improving methods, and appraising progress Extensive interaction exists with a high degree of confidence and trust Communication down, up. and with peers is extensive and accurate Decision making Is widely done throughout the organization, based upon complete and accurate information Goals are established by group participation

Consultative—System 3 Motivation accomplished through reward, occasional punishment, and some involvement Moderate interaction exists between subordinates and superiors with a fair amount oí confidence and trust Quite a hit of communication tlowing down and up Goals are set and orders are issued after discussion with subordinates

Benevolent Authoritarian—System 2 Motivation accomplished through reward and potential punishment Little interaction between subordinates and superiors Fear and caution on the part of subordinates Communication is mostly downward Information the boss wants to hear flows upward Policy decisions are made at the top, orders are issued, and the opportunity to comment may exist

Exploitive Authoritarian—System 1 Motivation accomplished through fear, threat, punishment, and occasional reward Low trtist and dissatisfaction with the organization Information from the top down is viewed with suspicion Information is withheld by subordinates

Adapted from Liken (1967).

patients' "likelihood of recommending services" than clinical performance (c.f. McManus 2007). Participative-climate perceptions are likely to influence em- ployees' customer service performance

in healthcare organizations because employees in participative climates tend to be more engaged in and more satis- fied with their jobs (Spreitzer 1995) and thus are more likely to be motivated

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THE IMPACT OF PARTICIPATIVE MANAGEMENT PERCEPTIONS

to go the extra mile for their patients. Moreover, employees in participative climates generally face fewer organiza- tional constraints and personal risks that may prevent them from providing high levels of customer service. Thus, we hy- pothesized that employees who report higher participative-climate perceptions will have higher customer service ratings by their supervisors.

Medical Errors As noted earlier, patient safety has be- - ome a key concern among healthcare organizations and is often considered a key performance indicator in orga- nizations (Ramanujam and Rousseau 2006). Poor nurse (and other caregiver) performance has been linked to patient medical complications following sur- gery, falls from injuries, and death rates (Evans 2008). Estimates suggest that between 44,000 and 98,000 patients in the united States die each year because of treatment errors, costing healthcare organizations between $17 and $29 bil- lion (Kohn, Corrigan, and Donaldson 1999). Participative-climate perceptions are likely to influence medical error rates in healthcare organizations because many medical errors stem from mis- communications (Pepper and Towsley 2007). Indeed, one study indicates that poor employee communication is the most common cause for surgical er- rors that result in patient injuries and death {Materials Management in Health

Care 2007). In more participative work climates, information is more likely to flow among employee groups, thus re- ducing the prohability of medical errors (Zacharatos, Barling, and Iverson 2005). Hence, we hypothesized that employees

who report higher participative-climate perceptions will have committed fewer medical errors.

) . ' • .

Burnout Burnout is a widespread problem among nurses and other caregivers in the healthcare profession because of the nature of healthcare work and the increasing demands placed on these professionals (Ramanujam and Rous- seau 2006). Burnout is problematic because it has been linked to numerous negative outcomes, including reduced performance, turnover, absenteeism, and patient care quality (Taris 2006). Healthcare employees in highly par- ticipative work climates are less likely to burn out because they have more decision-making authority to reduce job demands, more resources to buffer stress, and a greater access to informa- tion that may reduce tbeir workloads. Therefore, we hypothesized that em- ployees who report higher participative- climate perceptions will experience lower levels of burnout.

Turnover Intentions Healthcare organizations are facing an unprecedented shortage of nurses, phy- sicians, specialists, and other caregivers as a result of an aging workforce and the stressful nature of healthcare work (Prybil 2003).Turnoverof key talent not only diminishes healthcare quality but is also costly. Replacement of de- parted nurses can range from $90,000 to $145,000 per nurse, depending on skill levels and specialties (Atencio, Cohen, and Gorenberg2003). Participative- management climates are likely to be strongly related to employees' intentions

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to stay in the organization because participative management practices provide employees with more access to information, more support, and a greater ability to influence decisions that affect them. Employees in participative work climates, thus, are more likely to be satisfied by their work, more resistant to work strain, and less likely to look for employment elsewhere (l^schinger et al. 2002). In fact, participative manage- ment has been linked to lower turnover rates in previous research (Arthur 1994; Delaney and Huselid 1996). Thus, we hypothesized that employees who re- port higher participative-climate percep- tions will be less likely to have inten- tions to leave the organization.

METHODS

Participants and Procedure Large healthcare organizations are a well-suited laboratory in which to study participative management because of their multiple departments that have unique identities and cultures. A health- care system in the southeastern United States with 5,000 employees and 312 departments provided the participants for our study. We used multiple sources of data for this project, including employee-opinion surveys and other archival data.

We obtained employee person- nel records from the human resources department, which provided individual performance ratings, demographic vari- ables, e-mail addresses, and employee identification (ID) numbers. Employee ID numbers were needed for several rea- sons. First, we used them to verify, for security purposes, that participants who

logged into the independent and secure server were indeed employees of the healthcare system, as they used their ID as a username to access the online sur- vey. Second, because we could identify particular responses, we would be able to provide employees with their indi- vidual results, should they desire to see them. We assured participants that their responses would be kept strictly confi- dential and that under no circumstances would anyone inside the organization have access to their data or be able to individually identify them.

The survey was administered online over a two-week period during lune 2007, and all employees were solicited for participation. One week before the survey link was sent, a "pre-notice" (Dillman 2000) e-mail was sent to all employees. This e-mail came from the chief executive officer and briefly de- saibed the upcoming study (noting that its purposes were to better understand employee opinions and to help improve the quality of work life), encouraged employees to participate, and assured employees that the data would go directly to the researchers and that the healthcare systeiTi would not have access to individual responses. One week later, the e-mail that contained a link to the online survey was sent to all employees. Three e-mail reminders were sent over the subsequent two weeks to employees who had not yet completed the survey.

We obtained responses from a total of 3,757 employees, resulting in a response rate of 75.1 percent. For the purpose of testing our hypotheses regarding medical errors, we excluded managers and administrative personnel who did not have contact with patients.

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We also excluded observations with incomplete employee-opinion survey data or missing customer service evalu- ations, resulting in a final sample that consisted of 2,522 employees. On aver- age, respondents to the survey were 42.4 years old, with a mean organizational tenure of 8.8 years. Approximately 84 percent ofthe respondents were female and 77 percent were Caucasian. In terms of education, 13 percent of participants had a high school diploma or less, 59 percent had some college but no four- year degree, 20 percent had a four-year college degree, and 7 percent either were in graduate school or had received a master's, professional, or doaoral degree. The positions represented in the sample were nonmanagerial with direct patient contact, including nurses, nurse assistants (e.g., licensed practical nurse, nurse tech, personal care aide), technical services personnel (from medical labo- ratory, rehabilitation, radiology, respira- tory therapy, etc.), professional services personnel (from speech therapy, phar- macy, physical therapy, occupational therapy, etc.), and physicians.

Measures Independent variable. Participative management was measured using the Likert Profile, an 18-item questionnaire designed to measure organizational cli- mate along six dimensions: leadership, motivation, communication, decision making, goal setting, and control pro- cesses. The possible scores on each ques- tion range from 0 to 20. Scores were averaged across all measures (a = .97). The average score on the Likert Profile falls into one ofthe four typologies of organizations; System 1—expioitive

authoritarian (0-4.99), System 2— benevolent authoritarian (5.00-9.99), System 3—consultative (10.00-14.99), and System 4—participative (15.00- 20.00). The number of employees who represented each category was as fol- lows: System 1 (n = 33), System 2 (n = 509), System 3 (n = 1,193), and System 4(n = 787).

Dependent variables. Employee customer service scores were taken from the 2007 annual performance evaluation con- ducted by the organization in August of each year. Employees are rated by their managers on a series of perfor- mance standards, ranging from "falls significantly below the standard" (1) to "exceeds the standard" (10). Perfor- mance standards for customer service include Integrity: doing the right thing and responding to customer needs promptly; Friendliness: showing that you care, being polite, and respecting others; Appreciation: praising, thank- ing, and acknowledging customers and coworkers; Trust: relying on each other, working as a team, and being loyal; Excellence: identifying opportunities for improvement and developing solutions; and Openness; being available to others and listening carefully to concerns.

Medical errors were measured using a single question from the loint Com- mission: "Have you ever made a sig- nificant medical error?" Participants answered this question with either no (O)oryes(l).

Burnout was assessed using Maslach's Burnout Inventory (Maslach and Jackson 1982), a 23-item scale that measures three subdimensions of burnout, including depersonalization.

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personal accomplisbment, and emo- tional exbaustion. Depersonalization (D) reflects a tendency to view individu- als as tbings or objerts and to distance self from otbers. Personal accomplish- ment (PA) indicates tbat an individual sees self as doing poorly on work tbat is wortb doing. Lastly, emotional ex- baustion (EE) reveals individuals wbo are exposed to Stressors at or beyond tbeir comfortable coping limits. Tbese subdimensions are combined to pro- duce burnout "pbases," ranging from 1 (low burnout) to 8 (bigb burnout) (see Goodman and Boss 2002 and Golembiewski and Munzenrider 1988 for a tborougb explanation of bumout phase calculation). Low burnout con- sists of phases 1 to 3, medium burnout is pbases 4 and 5, and bigh bumout includes phases 6 to 8. A high burnout score (bigb scores in all tbree bumout subdimensions) means tbat an individ- ual is considered to bave an advanced form of burnout. A low burnout score means tbat an individual is considered to feel only a single subdimension of burnout or none at all. Our alpba reli- ability for burnout is .78.

We measured employees' turn- over intentions using Rosse and Hulin's (1985) scale. The scale includes one question and two statements: "How likely is it tbat you will actively look for a new job in the next year?" (1 = not at all likely; 7 = extremely likely), "I often tbink about quitting," and "I will probably look for a new job in tbe next year" ( 1 = strongly disagree; 7 = strongly agree). Responses to tbese three items were summed to aeate a total score, ranging from 3 to 21, witb a bigber score suggesting a greater intention to quit (a =.88).

Control variables. To address tbe pos- sibility of spurious relationsbips, we controlled for age and tenure, inasmucb as customer service, medical errors, burnout, and turnover intentions may be related to botb participative man- agement climate and tbe demographic variables.

RESULTS Tbe descriptive statistics and correlations among all study variables are shown in Table 1. Tbe correlational results indi- cate tbat participative management was positively related to customer service performance and was negatively related to medical errors, bumout, and turnover intentions, providing some prelimi- nary support for our bypotbeses. We conducted additional analyses, includ- ing analysis of variance (ANOVA) and binary logistic regression analysis.

Tlie distinction between a participative-management climate and an exploitive autboritarian system can be seen clearly in Figures 2 tbrougb 5. Tbe ANOVA results confirmed tbat a significant difference exists between participative-management systems for the dependent variables customer service (F = 35.75, p< .01), burnout (F = 126.28, p < .01), and turnover inten- tions (F= 146. 67, p<.01). Bonferroni post boc analysis sbowed that the differ- ences between eacb of tbe four systems were significant at tbe .05 level for customer service, bumout, and turnover intentions, except between levels 1 and 2 for burnout and customer service, wbich is likely caused by the small num- ber of individuals witbin tbe System 1 category.

Inasmucb as medical errors were measured witb a binary variable, we

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TABLE 1 Means, Standard Deviations,

Variable

and

THE IMPACT OF

intercorrelations for

M s.d.

PARTICIPATIVE

Study Variables

1 2

MANAGEMENT

3

PERCEPTIONS

4 5

1. Participative management 2. Customer service

3. Medical error

4. Intention to quit

5. Burnout

12.79 7.71

.20

7.62

3.81

3.50 1.43

.40

4.88

2.59

.97

. 21* '

-.07**

-.41**

-.40* •

—

-.07**

-.12**

-.12**

— .05*

.06**

.88

.46** .78

N = 2.522 with lislwise deletion of missing data. Scale reliabilities appear along the diagonal in italics

* p< .05 (two tailed).

•* p< .01 (two-tailed),

used logistic regression rather than ANOVA to test our prediction that participative-management climate would be negatively related to medical errors. Logistic regression results sup- ported our predictions (B = -.046, p < .01), controlling for age and tenure.

The likelihood of having committed a significant medical error was lowest among employees who rated their work climate as Participative (System 4) and was highest among employees who rated their work climate as Exploitive Authoritarian (System 1). We found that

FIGURE 2 Average Participant Customer Service Scores, by Management System

Exploitive Benevolent Consultative Participative Authoritarian Authoritarian

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FIGURE 3

Percentage of Respondents Who Have Committed a Significant Medical Error, by Management System

30%

25%

20%

23.6%

18.4%

0%

Exploitive Benevolent Consultative Participative Authoritarian Authoritarian

11.2

31.3

54.5 48.5

FIGURE 4

Percentage of Respondents in Different Levels of Burnout, by Management System

100%

80%

60%

40%

20%

High Medium Low

Expioitive Benevoient Consultative Participative Autiioritarian Authoritarian

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THE IMPACT OF PARTICIPATIVE MANAGEMENT PERCEPTIONS

FIGURE 5 Average Participant Scores on Turnover Intentions, by Management System

Exploftive Benevolent Consultative Participative Authoritarian Authoritarian

the odds of committing a significant medical error for employees in Benevo- lent Authoritarian (System 2) climates were 1.3 times larger than the odds of committing an error for employees in Participative (System 4) climates.

In summary, our ANOVA and logistic regression results supported each of our hypotheses. Employees who reported higher participative climate perceptions received higher customer service ratings from their supervisors, reported committing fewer significant medical errors, experienced lower levels of burnout, and were less likely to have intentions to leave the organization. Specifically, employees in highly partici- pative work climates provided 14 per- cent better customer service,' committed 26 percent fewer errors, demonstrated 79 percent lower burnout, and felt 61 percent lower likelihood of leaving the

organization than employees in more authoritarian work climates.

D I S C U S S I O N In an era of uncertainty where demands often outnumber organizational re- sources, healthcare organizations may be inclined to adopt authoritarian management systems in an effort to cut costs, maximize efficiency, and central- ize authority. Participative management systems offer an alternative approach, focusing instead on improving the commitment and productivity of em- ployees through pay for performance, open-book management, decentralized decision making, and job enhance- ment. Studies have linked participa- tive management systems to corporate performance and other corpora te-1 eve I outcomes, but little research has been conducted to examine the impact of

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participative management on employee- level outcomes, particularly in health- care organizations.

The results of our study clearly show that employee perceptions about par- ticipative management have a favorable impact on customer service, medical error rates, burnout, and turnover inten- tions. On each ofthe four outcomes in this study, employees who believed they work in climates that are more participa- tive in nature far surpassed their coun- terparts who perceived they work in au- thoritative climates. These findings add to the existing literature that indicates participative management improves corporate performance (Arthur 1994) and extend the role of participative management to include employee-level outcomes in a healthcare setting.

Our findings give rise to a number of practical implications. The most important prescription to follow from our analysis is that organizations should endeavor to enhance the likelihood that their employees perceive their work climates as participative rather than au- thoritarian. Organizations can develop more participative work climates in several ways. First, providing meaning- ful information and control to employ- ees can enhance employee participation {Rosen and Quarrey 1987). Open-book management practices entail sharing organizational performance metrics with employees on a regular basis, making them more cognizant of prog- ress and more motivated to help reach organizational goals. Employee involve- ment programs enable employees to have a voice in decisions that affect their work and thus encourage them to suggest ways to improve services and

production processes. Sharing meaning- ful organizational information sends a signal that management trusts employ- ees, which in turn motivates employees to use the information to benefit the company (Ferrante and Rousseau 2001). Second, allowing employees to par- ticipate in decision making regarding day-to-day work practices and to have some control over operational processes engages employees and persuades them to share tacit knowledge they might otherwise withhold (Rousseau and Shperling2003). Finally, performance- based rewards (such as merit pay and gain-sharing plans) that are linked to both individual and organizational per- formance metrics motivate employees to work hard on behalf of the organization and to perform tasks that may be above and beyond their job descriptions.

Limitations Although our research has a number of strengths, in terms of both contributions to the literature and methodology, it has some limitations. First, this study's focus on a single organization places constraints on the generalizability of its findings. We acknowledge that the findings may be different in other types of organizations or may be a function of unknown characteristics unique to the particular organization in this study. Future research should investigate the relative importance of different dimen- sions of ownership across a broad range of healthcare organizations and among a broad range of employee groups.

Second, the study did not spe- cifically investigate the organizational practices that lead to employee percep- tions of participative management.

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THE IMPACT OF PARTICIPATIVE MANAGEMENT PERCEPTIONS

Tbus, altbough our results provide evidence that perceptions of participa- tive climates are dominant predictors of employee attitudes and behaviors, tbese data do not offer specific explanations on bow those perceptions can be en- hanced. Future researcb sbould examine tbe impact of specific types of participa- tive practices on outcomes such as infor- mation sharing, decentralized structures, and autonomous job design.

Finally, the study was primarily cross-sectional in nature, although some study measures were taken at different time periods (e.g., customer service mea- sures lagged the survey variables by two montbs). Tbus, we cannot completely rule out tbe possibility of reverse causal- ity in relationsbips between participative climate and employee outcomes. Better- performing employees (in terms of good customer service and fewer errors) and employees wbo are less bumed out and less likely to leave are possibly more inclined to perceive tbat tbey work in participative work climates. Future researcb using longitudinal designs is needed to clarify tbe direction of causal- ity between tbese variables. Time-series designs may also be belpful in exploring bow employees' participative manage- ment perceptions cbange over time.

C O N C L U S I O N Healtbcare organizations face an in- creasingly competitive and resource- constrained environment tbat makes sustaining a competitive advantage more difficult. Agrowingbody of practition- ers and researcbers bas acknowledged tbat many of tbe industry's most vexing problems bave organizational ratber tban clinical or financial origins (Prybil

2003; Ramanujam and Rousseau 2006). Tlius, it bebooves bealtbcare organiza- tions to adopt personnel management practices tbat foster a committed and bigbly productive workforce. Tbis study provides strong evidence tbat employees who perceive that their workplace cli- mate is participative demonstrate better customer service, commit fewer medicai errors, are less burned out, and are less likely to leave tbe organization. As noted earlier, employees in bigbly participa- tive work climates sbowed 14 percent better customer service, 26 percent fewer errors, 79 percent lower burnout, and 61 percent lower likelibood of leaving tbe organization tban employees in autbori- tarian work climates. Tbese findings pro- vide empirical support tbat participative management is an effective approacb to building a bigbly committed and productive workforce. Creating a culture of empowerment is pivotal to overcom- ing tbe many cballenges tbat confront bealtbcare organizations today.

I

N O T E S 1. Percentage change was calculated using

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Tm; IMPACT OF PARTICIPATIVH MANAGEMENT PERCEPTIONS

P R A C T I T I O N E R A P P L I C A T I O

John A. Miller ¡r., FACHE, president and chief executive officer, AnMed Health System, Anderson, South Carolina

I n more than three decades of being a healthcare executive, 1 have been blessed to work with colleagues who believe the key to organizational success is a nurturing

culture. Our executive team has always endeavored to effectively communicate and encourage participation and involvement by employees. I lowever, this article emphasizes in vivid empirical terms that efforts to "encourage" participative manage- ment may not be enough.

Most organizations conduct employee satisfaction surveys. I am not aware, however, of efforts to correlate results from these employee surveys to improved customer satisfaction, reduced medical errors, decreased employee stress, and in- creased employee retention. This study has taken intuitive employee hypotheses and effectively demonstrated their implications for key organizational outcomes (i.e., customer service, medical errors, burnout, and intention lo quit) that are desirable, if not critical, in today's environment.

Many "autocratic" managers may not even realize how they are being perceived by their staff. "Participative" managers may have this leadership style primar- ily because oftheir own personality traits. In either case, I suspect that neither of the two styles has been addressed or developed by their organizations. This article demonstrates the benefits of having participative interaction with employees. If this management strategy is successfijl, employee perceptions (and, we hope, real practice as well) will help promote all aspects of productivity improvement and the overall success ofthe organization's mission.

Many healthcare organizations have actively engaged in various quality improve- ment initiatives (e.g.. Six Sigma, Lean). For each of these quality tools to work, the desire to constantly improve must be instilled in the labor force. In my organization, we have decision support systems for our finance and other quantifiable processes. This article illustrates that having a system for culture management—an approach to providing eniployee support—has a significant impact on many desirable operation- al and clinical quality outcomes.

The authors readily admit that one of the limitations of their study is that it did not specifically investigate management practices that lead to employee perceptions of participation. Nevertheless, this study is an excellent step forward. I am optimistic that this effort will inspire healthcare executives to proactively pursue culture man- agement, which supports participative leadership.

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