DB1

CHAPTER 5

The Manager–Employee Relationship

Chapter Objectives

After reading this chapter, readers will be able to:

• Recognize that groups composing the majority of healthcare organization departments are typically

heterogeneous

• Appreciate the value and importance of employee participation and input

• Compare and contrast production-centered management and people-centered management,

recognizing that most healthcare activities require people-centered management

• Understand the importance of having a department manager remain visible and available to the staff

• Explain the value of a true open-door policy

• Describe a manager’s essential downward (toward the employees) orientation as opposed to an

upward (toward higher management) orientation

• Appreciate the importance of establishing and maintaining a solid one-to-one relationship with each

employee in the department and the need to know each as a whole person to be an effective people-

centered manager

• Understand the department manager’s key role in employee retention

CHAPTER SUMMARY

This chapter advances the belief that every manager is truly a coordinator of human resources (HR).

Furthermore, this essential coordination is played out within a one-to-one relationship that an effective

manager should have with each employee. However, all work groups are composed of individuals, most

of whom are different from one another in some way, so that a manager’s relationship with each

employee may likewise be different in some respect from all other such relationships. All healthcare

activities must be more people-focused than production-focused. Managers must lead by example,

remaining visible and available to employees while encouraging employees yet depending on their

participation and input. A healthcare manager must cultivate a genuine open-door attitude toward

employees and must exhibit the essential downward orientation that says, “Although a member of

management, the department manager’s primary concern must be for the organization’s clientele and

the employees who provide services.” A manager’s task is to ensure that all employees are valued for

what they can contribute.

Case Study: “She Knows It All, Just Ask Her”

Two or three months ago, occupational therapist Alice Walters said to Kelly Miller, her manager and the

director of rehabilitation services, “Kelly, it’s obvious to me that we’re not approaching the

departmental budget sensibly. All we do is carry last year’s actual expenditures forward, tack on some

amount for an inflation factor and pile on some other guesses. We should be budgeting from a zero

base, building up every line item and making each one justify itself every year.”

Kelly replied something about simply following the budgeting instructions issued by the finance

department and doing it the way they were told to do it.

Within a few days of the budget question, Alice approached Kelly with another question. “Shouldn’t we

change the way we perform performance evaluations? Surely most smart managers know that it’s

better to evaluate employees on their anniversary dates than it is to evaluate them all at the same time,

on the same day, as we do it.”

Kelly responded as before. As a manager, she was simply complying with the policies and practices of

the organization. They discussed the matter for another five minutes. Although Kelly was not willing to

take on higher management and work to change the evaluation system, she conceded that Alice had

brought up a number of good points. To Kelly, it seemed as if Alice were picturing an idealized

evaluation system in textbook-like terms. It was flawless but only in theory.

In the following weeks, Alice said more and more to Kelly about how both the organization and the

department should be managed. It had taken Alice only a matter of days to get beyond generalized

techniques such as budgeting and evaluation and to start offering specific advice on the management of

rehabilitation services.

Kelly soon realized she could expect Alice to offer some critique related to most of her actions in running

the department and many of executive management’s policies in managing the organization. Kelly was

disappointed with this annoying change in her relationship with an otherwise good employee. Kelly had

always seen Alice as a better-than-average performer as a therapist and somewhat opinionated but not

to any harmful extent. Recently, however, she had come to regard Alice as a sort of abrasive conscience,

a critical presence who monitored her every move.

The worsening situation came to a head one day when Alice tried to intercede in a squabble between

two employees. When Alice entered the situation, she proceeded to criticize Kelly’s handling of the

matter in the presence of the other employees. Kelly immediately took Alice into her office for a one-on-

one discussion. She first told Alice that although she was free to offer suggestions, opinions, and

criticisms regarding management, she was never again to do so in the presence of others. Kelly then

said, “Lately, it seems that you have a lot to say about management in general and about how I run this

department in particular. Why this sudden interest?”

Alice responded, “Last month I finished my first course in the management program at Community

College, Introduction to Management Theory. Now I’m in the second course, Supervisory Practice. The

concepts are not difficult. When I see things that aren’t being done right, I feel that I have an obligation

to speak up.”

Kelly ended the discussion by again telling Alice that she expected all such commentary to be offered in

private and never again in front of others. Overall, the conversation did not go well. On one or two

occasions, Kelly felt that Alice’s remarks were edging toward insubordination. Because of the uneasy

feelings left after the discussion, Kelly requested a meeting with Carl Mason, the organization’s director

of human resources.

After describing her relationship with Alice in some detail, with a gesture of helplessness Kelly said, “She

knows everything, I guess. Just ask her, she’ll tell you. On the strength of a course or two of textbook

management, she suddenly has all the answers. What can I do with her?”

Consider how Kelly Miller might address the problem presented by Alice Walters. Can Kelly do anything

to curb the intrusions of an apparent know-it-all employee? If you were in Kelly’s position, how could

you encourage Alice to modify her apparently superior attitude? What suggestions would you offer to

Kelly as she attempts to move her relationship with Alice to a more productive level?

...........................

EVERY SUPERVISOR A MANAGER OF HUMAN RESOURCES

Some managers, particularly those who cling to apparently old-fashioned and inappropriately narrow

views of management, regard many employee-related concerns as something called “employee

relations” rather than management. Their concepts of management may be described as production-

centered. They are concerned first, foremost, and always with getting the work done.

In organizations where HR practitioners are utilized to the maximum possible extent or nearly so, some

managers have come to rely on them so heavily that, by default, they have transferred the primary

responsibility for addressing all people-related issues to the HR department. Regardless of HR’s strength

and relative position in an organization, local departmental managers should retain responsibility for

day-to-day employee concerns and remain involved with employee problems. However, HR should

always be available for advice and assistance. By definition, this is an important role for HR. Many issues

involving employees should not automatically default to HR. Most recurring, common people-related

tasks should be part of a manager’s job and should not be referred to HR.

In the minds of some people, HR is an unnecessarily elaborate and stuffy title encompassing activities

that were formerly called personnel. Remember, however, that “personnel” means people. In some

modern organizations, the department that many refer to as HR is known by other names such as

“people systems” or “employee affairs.” In no way should HR manage the people who perform the tasks

in an organization. In providing the people systems, literally the processes and procedures for serving all

employees, HR simply provides a framework within which relations with employees should be

conducted.

THE HETEROGENEOUS WORK GROUP

Workers in healthcare organizations bring with them an extremely broad range of educational

backgrounds and levels of sophistication. Within a single group of direct reporting employees, a

manager may have employees who require regular or even constant supervision (virtual hand-holding).

In contrast, they may supervise employees, such as health professionals, who have been trained to act

independently, make most of their own decisions, and determine most of their own behavior. These

persons often require only the most general of directions.

Consider some examples appearing in many hospital organizations. Food service personnel can vary

widely, from entry-level employees who are hired without any specialized skills or training to

therapeutic dietitians who possess master’s degrees. A manager in such a setting may be responsible for

several levels of staff, each of which may have different needs. Diagnostic imaging (radiology)

employees may range from entry-level clerks and transporters to highly skilled special-procedures

technologists and even physicians with whom a department supervisor must maintain working

relationships even though they do not report directly to the manager. The manager in this venue may be

responsible for as many levels of staff as a food service manager while additionally relating to physicians

who can be either medical staff members or employees of the organization.

Other possible scenarios involve patient billing and housekeeping. In either activity, a single manager

may be responsible for a number of personnel, all of whom are at the same level of education and

sophistication (depending on how the activity is organized). In a modestly sized nursing unit, a nurse

manager may have several levels of staff, such as nursing assistants and unit clerks, licensed practical

nurses (LPNs), registered nurses (RNs), and nurse clinicians. Managing people with such diverse

backgrounds requires skill.

In addition to multiple levels of education and sophistication, a heterogeneous work group can present

its manager with another potentially troublesome condition—namely, differences among employees

regarding their work ethic. For instance, significant differences in work ethic sometimes appear between

newer employees and more established (experienced) employees or between older (in years) members

of a group and younger workers. Although peoples’ attitudes toward work and employment have

shifted over the course of several generations, not all problems related to work ethic can be attributed

simply to younger or newer workers having less experience.

Variations in work ethic suggest that within a single working unit or group, a manager may have some

employees who would never willingly miss a day’s work or never intentionally shirk a responsibility, and

some employees who think nothing of missing work on a whim and allowing responsibilities to go

unfulfilled. In addition to working on bringing out the best in each employee, a department manager

must provide an example of a continually positive work ethic for others.

EMPLOYEE PARTICIPATION AND INPUT

An anonymous person—more likely several such anonymous people—claimed that, “When all is said

and done, there’s much more said than done.” In few circumstances does this hold to be truer than it is

concerning employee participation. Most managers claim they believe in employee participation and

remain open to input from their employees; however, for the majority, their behavior contradicts their

words. Managers repeat words they believe ought to be said or are politically correct because that is

what “experts” are saying about contemporary management, especially in best-selling management

books. Although such managers may repeat phrases and buzzwords from “Management 101,” and say

what they believe they are expected to say, on a day-to-day basis they continue to function as they have

for years.

Some managers speak of their belief in participation, but in practice, they only superficially tolerate it.

Rather than participative, their style is consultative. A consultative manager is usually honest,

conscientious, and completely well intended. However, such a person can rarely relinquish enough

control to allow employees to participate or realize their full potential. For managers who behave in this

fashion, any experience or process that involves sharing authority or control with employees smacks of

abrogating responsibility and is perceived as weakness. Too often, this streak of authoritarianism

remaining in modern management stifles employee participation.

Management has evolved for decades and will continue to do so. At the start of the 1900s,

management, for all practical purposes, was largely authoritarian. In most settings, the boss was the

only person in charge, and was to be obeyed without question. During the same era, the top manager

was likely to be the owner or major stockholder of the organization. The human relations movement in

management, a 20th-century phenomenon, began to take hold in the 1930s. It expanded steadily

throughout the 1940s and 1950s. Today, many managers have been educated specifically for

management. Like their supervisors and others who have preceded them, however, they have acquired

much of their managerial perspective from role models they have observed and for whom they have

worked. It is not surprising to find residual authoritarianism among many who manage today; remember

that their role models have been at least partly authoritarian. Authoritarianism in management is

progressively weakening, but it is far from gone.

Department managers should always make it clear to subordinates that employees’ ideas are valued and

that their input is not only welcome but also needed. Employee participation should be valued and

promoted. Even consultative managers who reserve the right of final decision are well advised to solicit

employee input, consider it carefully, and occasionally use employee ideas. In the end, such an approach

or strategy usually pays dividends for both individuals and organizations.

When it comes to sources of knowledge about how to perform work better, faster, or more

economically, the person who knows the inner workings of a job best is someone who performs the

duties day in and day out. Successful department managers remember this fact; the most successful

managers are those who have learned how to tap into this source of knowledge.

THE PEOPLE-CENTERED MANAGER

Depending on the particular work environment and kinds of work performed, most managers will tend

to be either production-centered or people-centered. Because of the nature of some tasks, such as

manufacturing, a manager is required to be production-centered. In production-centered situations, the

work is ordinarily highly repetitive, many units of output are similar, output can be scheduled with some

accuracy, and jobs can be rigidly defined in considerable detail. In a production-centered situation,

employees are ordinarily assigned to workstations. Other than keeping up with the pace of an assembly

line or a sequence of related activities, they have little control over how they complete their jobs. In an

assembly environment, the speed of the line determines the rate of output. If a particular employee

does not keep pace, then another employee is substituted at that workstation. In a production-centered

situation, a manager’s priority concerns are usually keeping supplies and services entering the process

and thus keeping the output flowing. In a production-centered environment, processes control the

people and a manager’s primary focus is on output.

In a people-centered environment, the willingness of employees to work maintains output rather than

the pace at which the work arrives or the manner of supplying the processes. In people-centered

situations, the work is often irregular and varied. Rarely are two units of output identical. For this

reason, scheduling output with true accuracy is very difficult. Jobs cannot be rigidly defined because

demand on workers can be so highly variable. In people-centered environments, employees control the

processes. A manager’s primary focus is on people, who are the producers, rather than machines.

Most situations found in a healthcare organization require people-centered management. In a

healthcare organization, people primarily control the processes. Thus, people must be the primary focus

of a successful manager. The following sections discuss some of the principal requirements of an

effective people-centered manager of healthcare workers.

Exhibit 5-1 compares and contrasts several dimensions of production-centered management and

people-centered management. Based on the characteristics encountered in the majority of healthcare

delivery settings, it is evident that a manager using a people-centered approach to supervision best

handles most situations that exist in healthcare settings.

Exhibit 5-1 Comparison of Production-Centered and People-Centered Management

Production-Centered

People-Centered

Nature of the work

Repetitive

Variable

Nature of the output

Homogeneous

Heterogeneous

Pace controlled by

The process

Employees

Character of labor

More manual

More intellectual

Manager’s primary focus

The process

Employees

Arrival of work

More predictable

Less predictable

Completion of work

Predictable intervals

Irregular Intervals

VISIBILITY AND AVAILABILITY: REALITY AND PERCEPTION

A healthcare department supervisor must be generally visible to employees and must be both perceived

as available and actually available. The matter of perception is stressed because, as far as employees are

concerned, much of a manager’s state of being visible and available is psychological. Although

employees may never articulate the thought, seeing a manager around in a department and knowing

that the manager can be accessed should the need arise provides most people with a level of comfort.

Many employees are able to work independently for prolonged stretches; some may even prefer to do

so. On those occasions when a manager’s judgment or expertise is required, however, the employees

should know how to reach the manager in a reasonably short amount of time. Even though only a few

employees may be affected, a manager’s presence in and around a work group will tend to limit

inappropriate behaviors.

Consider the case of a manager who looked forward to moving from her small, glass-encased cubicle in

the corner of the department to new and larger quarters some distance away from her staff. Formerly,

all employees in the department could see that the manager was available. After the move, it was

impossible to know her availability without leaving the department and traveling through 300 feet of

corridor. Within weeks following the move, complaints about the manager had noticeably increased.

“Now she’s hard to find when we need her.” “She pays more attention to higher management than to

us.” “She no longer cares about us and our needs. Just look how she couldn’t wait to get away from us.”

Her formerly happy employees uttered these phrases. Over the weeks and months that followed, staff

absenteeism and tardiness increased, productivity decreased, and interpersonal problems among staff

members increased. Absentee management may be appropriate in some retail business situations, but it

is rarely appropriate when managing a department of people in an organizational setting.

Absence Impedes Communication

A manager often creates communication problems by not being reasonably accessible. When employees

are forced either to wait to get answers or to take chances and act independently, time and material

resources are wasted through delay and error. This may be especially troublesome in emergencies when

time must be devoted to tracking down a missing manager.

Employees should perceive a department manager as the employees’ direct conduit when

communicating with other organizational elements or supervisors. This is especially true for interactions

with higher management. Employees may perceive a manager who is not readily visible or available as

being uninterested and uncaring. This is true for supervisors who seem dedicated primarily to activities

such as meetings, committee work, conferences, and the like that occur outside of a department. Such

activities put strain on the relationship between supervisor and employees, and the employees begin to

see such a supervisor as indifferent and impersonal. For many members of a working group, their

department manager is a representative of the organization itself. This supervisor is the member of

management that these employees know best and may be the only member of management with

whom they have a speaking relationship. If employees perceive their supervisor as being cold, uncaring,

and impersonal, then they are likely to perceive the entire organization in the same manner. In most

instances, a first-line manager is a worker as well as a manager. These supervisory responsibilities

provide an additional resource for a department. When a manager is unavailable, a potentially

productive resource is lost.

A Genuine Open Door: Attitude and Actuality

Managers may occasionally use phrases picked up from “Management 101.” But words alone are not

sufficient; managers must back up the words with actions. Few managers have not said, “My door is

always open.” Unless the door is, in fact, usually open, employees quickly perceive reality. Few

supervisors or managers are able to maintain a truly open-door policy. Supervisors are usually busy

people, especially in times of shrinking managerial hierarchies and expanding responsibilities for

individual managers. Contemporary managers must wrestle with problems, attend a myriad of

meetings, make and take telephone calls, and generally engage in many time-consuming activities. The

effect of these responsibilities is that it is nearly impossible for supervisors to sit behind desks, inside

rooms with physically open doors just waiting for employees to drop in.

Some managers are not easily accessible at any time because they are genuinely too busy. Even though

a manager has said, “My door is always open,” the manager’s attitude says, “The door may stand open,

but I dislike interruptions and you should not consider entering without an appointment.” The reality of

an open-door policy depends as much on a supervisor’s attitude as on the position of the door. Even

managers who are generally visible and available to their employees most of the time can discourage

contact by projecting an attitude that discourages employees from approaching.

Easier for a First-Line Manager

An honest open-door policy, or a condition approaching that goal, is easier for a first-line supervisor to

maintain than it is for someone at a higher level of management. A first-line supervisor can usually

address many problems and issues that enter via an open door in a direct manner. Persons in more

senior managerial positions, however, usually must exert greater care when addressing issues brought

directly to them by rank-and-file employees because of an espoused open-door policy. The actions of

higher management must not subvert the authority of an employee’s immediate supervisor. Thus, a

higher manager’s response must often consist of referring the matter down to the first-line supervisor

or other source of assistance, such as the HR department or another intermediary.

A policy of easy access to first-line supervisors is often successful. First-line managers should remain

appropriately visible and available and should strive to offer reasonably accessible open doors. They

should maintain an open-door policy whenever possible. When other tasks require them to restrict

access, they should have an alternative means for employees to schedule specific appointments. Barring

an emergency, managers should always keep these appointments.

Show, Don’t Tell

As suggested, many supervisors trap themselves with their own words by saying, “My door is always

open.” It quickly becomes obvious that, in most instances, employees cannot have direct access to their

manager, and employees immediately realize the inconsistency between the manager’s words and

actions. A similar dilemma sometimes develops when supervisors claim to believe in participative

management. Immediately following the very first instance in which a manager fails or is unable to allow

employee participation, employees perceive the inconsistency between the supervisor’s words and

actions.

Contemporary supervisors are subject to the nearly constant temptation to say the right things—that is,

to repeat phrases that are well intentioned, trendy, and intended to convey the impression that

employees always stand high among the manager’s concerns. These proper statements represent

people-centered management right out of textbooks. No matter how well intentioned a supervisor may

be, however, it is not always possible for the supervisor to completely live up to words even though he

or she may speak them with utmost sincerity. Such statements create inconsistencies that most

employees eventually recognize. When inconsistencies between what one says and what one does

become evident, contradictory perceptions result. The majority of employees see only that the leader

has claimed to have one guiding belief but has acted contrary to that belief. When this occurs, a leader’s

credibility suffers.

Individual employees’ perceptions of their manager’s behavior may be correct, partly correct, or not at

all correct. The actual degree of correctness is irrelevant. The perception itself is relevant, because to

the perceiver perception is reality. If an employee perceives a leader or supervisor to be untruthful for

saying one thing and acting contrary to it, then the perception becomes the truth.

It is rarely beneficial for supervisors to tell employees what kind of leaders they are. This invariably leads

to negative perceptions at the first sign of contradictory behavior. Successful managers do not attempt

to verbalize their supposed leadership style to employees. Subordinates are quite capable of deducing a

leader’s style from actions and behavior on the job. In other words, supervisors should show others their

leadership styles and traits rather than talking about them.

THE ESSENTIAL DOWNWARD ORIENTATION

Strongly related to visibility and availability is the perception of whether a departmental manager or

area supervisor is oriented upward or downward in the organizational structure. There is a strong and

natural inclination for individual managers to be upwardly oriented—that is, spending more time being

oriented to organizational superiors and executives than being focused on their subordinates.

Contemporary college students use the term “sucking up” to describe such an orientation. To a degree,

such behavior is needed because persons higher in an organizational hierarchy control the resources

that an individual seeks or desires. Supervisors receive praise and rewards from their own managers.

Such an upward orientation may lead to some increased organizational status and promotional visibility.

Associations with organizational superiors and executives often provide managers with enhanced

feelings of importance and self-worth.

The forces encouraging people to embrace an upward orientation can be relatively strong. Pressures to

maintain a downward orientation toward members of the immediate work group and their needs may

not be nearly as strong. Downward is the direction in which the department supervisors must look,

however, because successfully leading subordinates is the primary reason for the existence of this

particular managerial position. A first-line manager or supervisor is the leader of a group of people who

perform the hands-on work for an organization. They depend on their leader for guidance. Therefore,

supervisors should have an orientation that is primarily downward toward their own departments and

to their own employees and the persons that they serve or the services that they provide. The manager

is primarily the leader of a department’s employees and is only secondarily a member of a greater

organizational hierarchy called management.

A manager who is career minded and who wishes to advance within an organization is often inclined to

seek the visibility obtained by maintaining an upward orientation. Although it may appear

counterintuitive, supervisors who display an obvious interest in accomplishing the work of the

department and who remain solidly oriented in a downward direction are most successful over time.

Managers whose primary orientation is to their subordinates gain the most valuable experience for

themselves and turn out the best work. They also build a reputation of caring for their subordinates.

Simple visibility coupled with an ability to talk in a convincing manner has led to the promotion of many

supervisors with limited people skills and capability. However, truly effective individuals in upper

management are more likely to make promotions based on actual operating results rather than on

superficial indicators. Quality leaders and managers require time to mature. Reputations require time to

be established. Once they are exposed as shallow, they are rarely rebuilt without changing employers.

As with other elements of leadership, employees will readily perceive the fundamental orientation of

their supervisor. A manager who employees view as having an upward, self-serving orientation is likely

to be seen as being separate from the working group and insulated from other employees by virtue of

trying to belong to upper management. A downward-oriented supervisor is not only more readily

accepted by subordinates but also more respected by employees as an advocate. Subordinates generally

view such a person as a full-fledged team member for whom they will willingly produce.

ESSENTIAL INDIVIDUAL RELATIONSHIPS

A successful department manager must assiduously cultivate and maintain a one-to-one relationship

with each employee. Doing so requires conscious effort. Effective avenues of communication are

essential, but they are not formed automatically. Establishing and maintaining such a relationship with

each employee should be a key concern of every department supervisor. This activity may receive

higher-priority treatment than departmental productivity for brief periods. Maintaining a department’s

productive capacity is an ongoing priority. In labor-intensive working environments such as health care

organizations, a department’s productive capacity resides in its people.

Managers should treat each employee as a full-fledged, contributing member of a team. This is one of

the most effective means of maintaining a labor-intensive department’s productive capacity. This

requires deliberate action to forge and maintain relationships between the supervisor and each

employee. Managers should ensure that no one is excluded, although individuals will occasionally

exclude themselves.

Most department managers are busy people, often having more demands placed on them than can

reasonably be met on any given work day. This being the case, many supervisors tend to ignore

employees who simply perform their job duties in an acceptable manner, never complaining or causing

difficulties. Troublesome employees are relatively uncommon, but they often consume inordinate

amounts of a manager’s time.

In any work group, consider who is noticed and who is not. Employees who perform at an outstanding

level or who exceed the expectations of their positions are usually noticed. They often do not require

much of a manager’s time, although they surely do attract a supervisor’s attention. Troublesome

employees get a manager’s attention and they consume the manager’s time. These people consistently

make mistakes, have performance problems, violate work rules or policies, or do not meet the minimum

expectations of their positions. The majority of employees, positioned between the outstanding

performers and the troublesome ones, frequently go unnoticed and thus receive little or none of their

manager’s time and attention.

The 80–20 rule nicely summarizes this relationship. The rule states that 20% or fewer of employees

consume 80% or more of a supervisor’s time. The majority of employees in the middle group produce

acceptable work day after day. They are neither outstanding nor problematic. They are the quiet ones

who, for all practical purposes, managers ignore.

However, even the quiet ones should receive some attention from the supervisor if they are to maintain

their output at an acceptable level and not become troublesome employees. Unless supervisors

maintain relationships with these subordinates, their productivity often spontaneously deteriorates.

Other than addressing task-related matters, some supervisors convene face-to-face meetings with

subordinates only on two occasions. The first is to appraise performance, usually once each year. The

second is to address problems, via counseling, disciplinary action, or other corrective processes. The

invitation “Come into my office” raises considerable apprehension under such circumstances.

It is a good idea to meet with each employee periodically even in the absence of a pressing reason or

need to do so. The agenda can be conversation about the job or some discussion about the

department’s role or the organization and its future. Such meetings foster open environments and

create opportunities for employees to ask questions and air perceived problems or complaints. These

meetings can be instrumental to maintaining positive relationships with individuals. An occasional few

minutes of ordinary social conversation that is totally unrelated to work can nurture essential

relationships.

For managers, knowing each subordinate as a whole person, not simply as a producer of services or

output, is important. Doing so not only ensures continued steady performance from an employee but

also provides additional advantages for a supervisor. By knowing and understanding each employee, a

supervisor will acquire knowledge other than that normally associated with individual capabilities. A

manager will learn who occasionally needs more guidance or assistance. A supervisor will understand

which subordinates are sufficiently motivated to take on additional tasks or learn new skills.

Understanding employees allows a manager to evaluate potential candidates for promotion.

Regular communication with employees is a necessity for persons aspiring to be effective employee-

centered managers. This means communication in a variety of settings and personnel combinations.

Regular staff meetings should include the entire department. Project teams, work-improvement

committees, and ad hoc working groups allow subordinates opportunities to experience and develop

leadership skills. Against a backdrop of regular meetings and interactions, formal or semiformal one-on-

one meetings such as appraisal interviews and counseling or disciplinary sessions become less

threatening. Frequent informal or one-on-one conversations facilitate positive employee relations.

To elevate one’s visibility and availability and to promote informal channels of communication with

subordinates, supervisors should simply walk around and talk with their workers. Employees appreciate

meeting on their own territory. Managers can also visit mobile persons on their job sites to exchange a

few words. Some experts refer to this as “management by walking around.” This is an extremely

effective employee relations practice.

A Team Is Composed of Individuals

The necessity for teamwork in the effective delivery of health care as well as in other endeavors is a

topic for conversation in many locations. However, strong departmental teams do not survive without

being attentive to the needs of individual employees. It is essential that a department manager strive to

create a team environment in which all individuals feel that they are important elements of the group.

People who feel they are on the inside, that they are included, knowledgeable, and appreciated parts of

the team, will be more satisfied and productive than if they feel they are excluded or otherwise left out.

A supervisor’s treatment of subordinates and the relationship with each employee are the most

important factors in determining whether an individual worker feels included or excluded.

THE COST OF IGNORED EMPLOYEES

Regarding their employees, some managers have adopted an attitude that can be summarized by, “If

this person doesn’t work out, there’s no problem—I can always hire another one.” However, associated

with such an approach are costs that are not always readily apparent. Employees who are ignored or

taken for granted contribute to turnover. Costs associated with turnover are both obvious and hidden

(direct and indirect).

Aspects of turnover that contribute to the overall cost of doing business include the diminishing

efficiency of an individual who is preparing to leave. Each departing employee should be interviewed (in

what is called an “exit interview”) to gather information about the reasons for leaving. Such data can

help to avoid problem situations in the future. The employee may be entitled to severance pay. Some

departing employees may be eligible for unemployment compensation. The company may offer

outplacement services. Such services are relatively uncommon at lower organizational levels, but

companies generally provide them to senior managers and executives. Outplacement services are often

costly. In addition, clerical time is required to modify benefits and close out company records. While

these costs are unavoidable and may be difficult to quantify accurately, they do represent real expense

to any organization.

Other costs associated with losing an employee include the value of output that is lost while a position

remains vacant. A new replacement employee is not as efficient in executing the duties of a position.

The employee must take time to learn the new job. New employees require orientation and initial

training. Until they have acquired proficiency, most people require additional supervision. The

organization must supply new persons with equipment such as an identification badge, an employee

handbook, and keys. The HR department frequently coordinates these activities. The HR department

routinely processes paperwork and a myriad of forms.

Less obvious expenses related to employee acquisition include attending job fairs and developing and

producing recruitment literature. The cost of a pre-employment physical and other testing is often

allocated to the HR department. Recruiting for executive and senior managerial positions may involve

travel and relocation fees. If an external source is involved, then an agency or finder’s fee may be due.

Costs related to turnover are easily overlooked because so many of them are hidden. In summary,

turnover is important to an organization because it is both costly and disruptive. Much turnover stems

from how employees feel about their employment milieu, their supervisors, and how they are treated.

Employees are more likely to remain if they feel valued as individuals and as producers and if they feel

accepted as part of a group. Employees who remain loyal to their employers find acceptable amounts of

challenge and interest in their work and see opportunities for personal growth and advancement.

Programmatic options to retain employees are available. However, generous benefits and employee-

friendly programs alone will not retain all employees. Among the strongest influences in determining

whether particular employees will remain or depart are the relationships that employees have with their

direct supervisors or department managers.

Consider that an individual’s feelings of being accepted and valued, of being challenged and finding

interest in the work, are entirely controllable by a manager. Depending on organizational policies, a

manager may exert some influence on opportunities for growth and advancement. In the contemporary

labor market, top performers, especially professional and technical employees, rarely encounter much

difficulty finding new employment when they want it. For some occupations, such as those in nursing

and medical technology, competing organizations are ready and willing to recruit good employees.

Two aspects of supervisor–employee relationships critically influence the likelihood of continued

employment: how employees are treated and how employees are used. Treatment as individuals is

equally important to all employees. Generally, fair and respectful treatment has a positive influence on

all employees, while the opposite makes negative impressions. The effect of employee utilization varies

with individual levels of enthusiasm and motivation. It is extremely important for employees to be used

effectively, be continually challenged, have their ideas heard, be given responsibility, and have

opportunities for growth. Top organizational performers find positive and encouraging responses from

managers to be motivating. Managers strive to retain these people. Some of them will leave an

organization for other opportunities to advance their careers. While organizationally challenging, such

actions are preferable to premature departures because of dissatisfaction.

Individuals are unlikely to remain loyal or maintain their employment if they feel unwelcome, excluded,

or otherwise think that they have few opportunities to excel or advance. Moreover, one of the most

important factors in determining whether valued employees will choose to remain or depart is an

individual relationship with their immediate supervisors or the department manager.

CONCLUSION

Every supervisor has responsibilities in the realm of human resources. Local supervisors work as

extensions of regular HR personnel. Healthcare workers and providers have broad and varied

backgrounds. Their need for active supervision varies. Their individual work ethics vary.

The words and actions of supervisors and other managers must be consistent. Supervisors must support

open-door policies with time that can be devoted to listening to employees. They must forward and act

upon solicited input. Persons making suggestions or providing input should receive feedback from the

supervisor to whom the suggestion was initially made. Workers often know more about production

processes and problems than do specialist engineers. Prudent supervisors listen to suggestions that

subordinates offer.

The willingness of employees to work is crucial in a people-centered working environment. Successful

supervisors are perceived to be available. Not being present is detrimental to a supervisor’s

effectiveness. The perception of absence may be due to a closed door, physical separation from a

working environment, or a reputation for not listening. The result is similar: ineffectiveness and

decreased productivity.

Effective managers and supervisors have bidirectional orientations rather than simply being fixated on

upper management and personal advancement. Supervisors who earn reputations for personal gain

have extreme difficulty overcoming them. In many cases, starting over in another organization is the

only way to shed a poor reputation.

Most people appreciate some individual attention. Supervisors who take the time for one-on-one

relationships are usually rewarded with positive employee attitudes and increases in productivity that

far exceed the time invested in employee interactions. Though 20% of employees require 80% of

supervisory time, effective managers are able to devote some time and attention to all subordinates.

Understanding employees as persons usually facilitates earning their loyalty and respect. Regular

communication with all employees, even if it means walking around and having brief conversations,

promotes respect for supervisors by their subordinates.

Teams are composed of individuals. The weakest member limits a team’s strength. Conscientious and

caring supervision can augment a team’s strength and utility to an organization. Ignored workers

become unhappy employees. In time, they may leave.

Recruitment and replacement are costly. Avoiding these expenses by effective supervision contributes

to an organization’s financial vitality and success.

Case Study Resolution

Returning to Kelly and Alice, to moderate a disruptive influence in the department (and contribute to

her own peace of mind), Kelly should make a serious effort to curb Alice’s know-it-all intrusions. Kelly

could benefit by working with Alice in a one-to-one situation. Alice’s superior attitude is based on book

learning and some common sense. Kelly should put Alice into situations in which she is compelled to use

the knowledge that she claims to have. This may require some thoughtful delegation on Kelly’s part.

However, people who must act on their claims of knowledge and expertise often learn how reality

tempers abstract learning. If Alice is successful, then the organization may identify a potentially effective

manager. If the situation is not critical, then Alice can have an opportunity to fail without incurring

serious costs to the organization. Alice should learn and benefit from either outcome. Alice may discover

that the gap between classroom and workstation is much greater than she may have imagined. Giving

Alice a structured opportunity has a high probability of succeeding for all concerned. Kelly, Alice, and the

organization will learn more about Alice and her true capabilities.

Kelly must directly address Alice’s know-it-all attitude and behavior. Alice must understand how others

in the department perceive her actions and attitude. However, Kelly must acknowledge Alice’s initiative

and willingness to learn. This requires some care and good judgment by Kelly. If Alice demonstrates that

she is indeed knowledgeable, then Kelly could profit by using Alice as a sounding board for ideas and

potential solutions to problems. Alice may have plenty to offer, but Kelly must learn to guide Alice so

that the outcome is beneficial for the department and organization.

...........................

SPOTLIGHT ON CUSTOMER SERVICE

Customer Service and the Manager–Employee Relationship

Relationships between employees and first-line supervisors take on a variety of forms. An important

factor is experience. People generally become more comfortable with their job duties as they perform

them for longer periods of time.

While the experience factor is relevant for first-line supervisors, another aspect is also important. First-

line supervisors are the interface between management and nonmanagement employees. Their job

duties may be further complicated by the presence of a collective bargaining agreement (CBA). The net

effect of these factors is to produce stress for all concerned.

Reducing stress should be a primary objective for all employees, as this contributes to productivity and

is beneficial for any organization. Time is a prime antidote for insufficient experience. Acceptance may

be the best course of action for accommodating a CBA. Because an organizational interface must exist

somewhere, it is resistant to change.

Common goals and activities have the potential to reduce stress between managers and employees.

Providing customer service should be an activity that is shared by all employees. In addition to providing

good customer service, stress between workers and managers can be reduced. Few activities have that

potential.

Discussion Points

1. Why does this chapter advance the idea that every manager is, or should be, a manager of human

resources?

2. Describe a healthcare organization or department that has a heterogeneous work group consisting

of at least three levels of staff that differ in their educational backgrounds and job responsibilities.

3. Explain what the following statement means: The streak of authoritarianism remaining in modern

management stifles participation.

4. Provide two or three examples each of activities that you believe could thrive under production-

centered management or proceed most appropriately under people-centered management. Are these

related to health care? Why or why not?

5. In your opinion, what is usually the major problem associated with a manager’s claim to having an

open-door policy? Why?

6. Why should it be necessary for a department manager to pay any particular attention to employees

who steadily fulfill their responsibilities and cause no problems?

7. “This is a simple job we’re filling. It is a no-brainer,” the department manager said, “so just send me

a warm body. If the first person doesn’t work out, we can always get someone else, and we’ve lost

nothing.” Comment on this statement. Why do you feel as you do?

8. Why is a department manager’s visibility and availability to employees considered to be important?

9. How does a department manager come to know which employees require what kinds of attention

at what times?

10. If teamwork is so critically important in contemporary healthcare organizations, then why does this

chapter place such strong emphasis on one-to-one relationships between supervisors and each of their

employees?

Resources

Books

Borkowski, N. (2005). Organizational behavior in health care. Sudbury, MA: Jones and Bartlett

Publishers.

Cranwell-Ward, J., & Abbey, A. (2005). Organizational stress. New York: Palgrave Macmillan.

Furnham, A. (2005). People business: Psychological reflections of management. New York: Palgrave

Macmillan.

Kenton, B., & Yarnall, J. (2005). HR: The business partner. Burlington, MA: Butterworth-Heinemann.

Kulik, C. T. (2004). Human resources for the non-HR manager. Mahwah, NJ: Lawrence Erlbaum

Associates.

MacLennon, N. (2005). Coaching and mentoring. London: Ashgate.

McConnell, C. R., & Umiker, W. O. (2005). Umiker’s management skills for the new health care

supervisor (4th ed.). Sudbury, MA: Jones and Bartlett Publishers.

Ulrich, D. (2005). The HR value proposition. Cambridge, MA: Harvard University Press.

VanDeVeer, R., Sinclair, G., & Menefee, M. L. (2005). Human behavior in organizations. Upper Saddle

River, NJ: Prentice Hall.

Periodicals

Barrick, M. R., Patton, G. K., & Haugland, S. N. (2000). Accuracy of interview judgments of job applicant

personality traits. Personnel Psychology, 53, 925–951.

Chang, E. (2005). Employees’ overall perception of HRM effectiveness. Human Relations, 58(4), 523–

544.

Parker-Oliver, D., Bronstein, L. R., & Kurzejeski, L. (2005). Examining variables related to successful

collaboration on the hospice team. Health Social Work, 30(4), 279–286.

Sy, T., Cote, S., & Saavedra, R. (2005). The contagious leader: Impact of the leader’s mood on the mood

of group members, group affective tone, and group processes. Journal of Applied Psychology, 90(2),

295–305.

Varma, A. (2005). The workforce scorecard: Managing human capital to execute strategy. Human

Resource Management, 44(3), 359–361.

References

Fallon L., & McConnell C. (2014). Human resource management in health care. (2nd ed). Jones &

Bartlett Publishers. Sudbury, MA. ISBN: 978-1-449-68883-7.