Management in Healthcare- Powerpoint Presentation

Chapter 13 Management Organization

INTRODUCTION

Management is both an art and a science. The art of management addresses both the exercise of judgment in given situations and the learning that managers gain from experience and use to mold future behavior. The science of management involves the principles that can be learned from textbooks and guides and applied to specific situations. This chapter focuses on the science of management, with references to the art of management used sparingly.

 Management is the process of using activities to create objectives and of teaming with people to meet those objectives through the efficient and effective use of resources. In analyzing this definition, three basic components are at play. First, management is a process generally defined to include planning, organizing, directing, controlling, and leading. Second, management requires resources both external and internal to the manager. Third, management must meet objectives, attain goals, and produce results.

   This chapter attempts to explain the principles of management from an overview perspective. The level of information necessary to give the reader a thorough understanding of management is beyond the scope of this book. Nonetheless, it is possible to gain an awareness and understanding of management principles from the materials presented. This level of awareness and understanding will assist those who plan to move into the management ranks by laying the groundwork for future study, and it will assist those who in the future will be managed by others by giving them a basis from which to identify clearly the manager's role in an organization.

PRINCIPLES OF MANAGEMENT

As with many frequently used words, the word management is familiar to most people. On an individual level, people manage their own homes and budgets. On a group level, people learn of management through their exposure to organizations in various contexts. Regardless of the orientation people bring to the word management, the classic approach to management provides a useful basis from which to begin discussion. This approach involves understanding the following abstract concepts or functions: planning, organizing, directing, and controlling. In more recent years, the concept of leadership has been introduced into the management discussion.

Planning

In a broad sense, planning refers to those activities that outline what needs to be done and how to accomplish that effort. By taking such actions, planning results in better use of both time and money. Planning encompasses the establishment of a basic mission through strategic planning, goal setting through management planning, and method identification through operational planning. The relationship of these three planning approaches is illustrated in Figure 13-1. Additionally, disaster planning encompasses efforts to minimize the effect that disruptions or destructions may have upon organizations. Several planning tools exist and are explained in detail in the following sections.

Strategic Planning Strategic planning is defined as “the process of determining the long-term vision and goals of an enterprise and how to fulfill them.”1 It involves looking beyond the day-to-day operations of an organization to a larger vision of the organization's future and deciding how to create and implement the goals necessary to achieve that future. Strategic planning focuses on the “why” element of planning, providing those individuals and groups internal and external to the organization with a clear understanding of the organization's purpose.

Figure 13-1 | Relationship of planning approaches

   Central to the strategic planning process are mission and vision statements. A mission statement is the documentation and confirmation of the purpose of the organization. The mission statement should describe the fundamental reason an organization exists, inspire and direct change, connect and motivate people, and serve as the reference point for the strategic planning process. The three elements of a mission statement are described in Table 13-1. An example of a mission statement containing these three elements is found in Figure 13-2. A vision statement is an idealized goal that proposes a new future for an organization. Long-range objectives are then developed from the mission and vision statements. Together, the mission and vision statements will help create the strategy to be employed in transforming the long-range objectives into action and reality. In turn, the vision, goals, and implementation strategy developed in strategic planning should lead to optimal business results.

Table 13-1 | Elements of a Mission Statement

· 1. The purpose or ultimate outcome of the organization · 2. The critical functions performed to achieve the organization's purpose · 3. The core values or guides to behavior used when engaging in the critical functions

The strategic planning process involves both key elements and multiple steps. The key elements of strategic planning—constants, catalysts, choices, content, contract, and continuity—are defined in Table 13-2. The steps in the strategic planning process include: (1) assessing the organization's competitive position; (2) determining the alternatives that allow the organization to move ahead; (3) assessing the feasibility of these alternatives; and (4) selecting the alternatives and implementing them. Both the key elements and steps lead to the development of a plan that sets the future direction of the organization.

Table 13-2 | Key Elements of Strategic Planning

Constants	Articulation of the organization's vision and mission
Catalysts	Identification of emerging trends and assessment of stakeholder expectations
Choices	Selection of key results areas
Content	Development of priority goals
Contract	Design of implementation strategies and measures of success
Continuity	Documentation of achievement, the monitoring of the plan, and the refinement of the process

   The success of strategic planning efforts can generally be traced to the effort put into organizing resources to support the planning process and completing analyses of the organization. When organizing resources, it is important that senior management demonstrate support for the strategic planning effort, thereby sending a message to employees that strategic planning is essential to the well-being and survival of the organization. A planning team approach is typically used, relying on members of senior-level management to staff the team. Often a facilitator from outside the organization is used if the organization has no internal expertise to call upon to coordinate the planning process. Finally, task groups are formed to assist the planning process, completing the data gathering and analysis present in the planning function.

   Analyses of the organization generally are of two types. Environmental analysis is an assessment of the organization's external environment, including an evaluation of national, political, economic, social, legal, geographical, and technological forces that may affect the organization. Internal analysis is an assessment of the organization's internal environment in order to gain an understanding of the organization's functions and to develop a factual portrait of the organization. These two analyses are combined in a summary report, designed to identify areas of agreement and disagreement and to indicate trends for the future direction and success of the organization.

   In assessing the results of the environmental and internal analyses, managers frequently use the SWOT technique. The SWOT technique is actually another form of analysis used to identify strengths, weaknesses, opportunities, and threats an organization may face in relation to the competitive marketplace. When using this technique, managers typically review the strengths and weaknesses as the first step and then move to opportunities and threats. When used in concert, the components of the SWOT technique can support the basis of the strategic plan developed by the organization.

Management Planning Management planning focuses on the results to be achieved through the planning process; it is the answer to the “what” element of planning. Objectives and goals are the foundation of management planning. Although sometimes used interchangeably, subtle differences exist between them. Objectives are the broad statements defining the future, whether of the organization or department. Objectives cover a long period of time—for example, 1, 5, or 10 years—and are not reformulated each time a problem arises. Goals are statements of the process by which the future will be reached. Goals specify a course of action in support of the objectives. Used in conjunction, objectives and goals provide a definition of the future and how the organization or department will get there.

   One popular approach to management planning is management by objectives. Under the management by objectives (MBO) approach, performance objectives are jointly planned by managers and employees, with periodic reviews of progress and rewards based on this progress. MBO works well in environments composed of highly motivated staff. It involves the following elements: (1) specific objectives created at each organizational level; (2) participatory decision making in creating and meeting goals; (3) target dates included in the objectives; (4) communication and feedback at all levels; (5) performance evaluation and feedback; and (6) rewards and recognition of results achieved. 2 As these elements indicate, MBO is results oriented, clarifying who is to perform what function, within what time frame, with the appropriate level of recognition provided.

   In practice, management by objectives involves a flow of planning that moves both upward from the bottom of the organizational hierarchy and downward from the top management. In this fashion, everyone in the organization participates in management by creating objectives.

 Certain characteristics are typically present in objectives and goals. First, they are consistent with the organization's mission and vision as defined in the strategic plan. Second, the objectives 325326and goals are measurable by established criteria, allowing the organization to determine whether it has met its objectives and goals. Third, they are fully stated, meaning that they require little or no explanation to understand them. Fourth, they may result in a challenge to the status quo within the organization. In sum, these characteristics define the results that the organization wishes to achieve.

Operational Planning Not every organization subscribes to the view that strategic planning is necessary; some rely instead upon operational planning as the planning method of choice. Alternatively, operational planning may be used as an outgrowth or extension of strategic and management planning. During strategic planning, focus rests on the reason the organization exists, or its so-called purpose. During management planning, goals and objectives that are consistent with this purpose are chosen for the organization. During operational planning, the manager's focus narrows to creating specific plans for a department or cost center. In other words, operational planning is concerned with creating short-term plans that specify the details of how the strategic plans will be implemented. As such, operational planning answers the “how” element of planning.

   One of the first steps of the operational planning function is the budgeting process. Budget involves all money matters, including the planning for, allocation of, requests for, accountings of, and control of financial resources. In the operational planning process, these resources are external to the manager and must be harnessed if the objectives and goals are to be met. In essence, the budgeting process supports planning by allocating resources through a financial plan. Additional information concerning budgets can be found in Chapter 15 , “Financial Management.”

   Once the specific objectives and budget are in place, the manager creates policies and procedures so that the plan may be implemented. A policy is a decision-making guide that establishes the parameters for taking action and meeting objectives. By definition, a policy establishes boundaries or limitations on the direction the organization will take in the future. A procedure is a series of interrelated steps that are documented and used to provide standardization to routine tasks or structured problems. A procedure provides the necessary detail for meeting one aspect of an objective or goal.

   Operational planning sometimes relates to an unanticipated event or condition, such as the implementation of a new and unexpected policy change, an adjustment to an emergency, or the realization of an aspect of strategic planning. Because of the immediacy of operational planning, more detailed information is usually available, and, as a result, the plans can and should become more specific. For example, an organization's strategic plan to remain competitive in its marketplace may call for a move to a new building. The realization of this move identified in the strategic plan involves the use of operational planning. The operational planning aspect of the move involves making the plan more detailed and specific. Multiple questions must be answered. Where will the space be located? How will it be subdivided? What technical services will be required? What equipment, furniture, and furnishings are required? What funding is needed and available? What temporary or permanent staffing changes will be required? Accurate and specific answers to these and many other questions will determine the efficacy and relevance of the operational planning process in this scenario.

Disaster Planning During the past few decades, health care organizations have increased their reliance on technology and automated systems to improve patient care and increase productivity. While these benefits are very real, this increased reliance is accompanied by the potential for financial loss or threats to organizational survival if these technologies or systems are disrupted or destroyed. Disaster planning focuses on how to minimize the effect these disruptions or destructions may have on organizations through the use of a disaster recovery plan . A disaster recovery plan is a comprehensive written statement of consistent actions to be taken before, during, and after a disaster, with the goal to ensure continuity of operations and availability of critical resources. Disaster recovery plans address not only technology and automated systems, they also incorporate the broader areas of operations, finance, and administration.

Top of Form

 Creating a disaster recovery plan involves multiple steps, as illustrated in Figure 13-3. Among the first steps is the performance of a risk assessment. A risk assessment is a method used to measure an organization's level of preparedness to prevent and recover from a disaster. While no person can predict when a disaster will occur, one can assess the probability of a disaster occurring by examining potential exposures to natural, technical, and human threats. Examples of natural, technical, and human threats are illustrated in Table 13-3. Once risks are identified, the impact of these risks upon the organization or a given department must be measured.

Steps in a disaster recovery plan

1. Ensure top management support

2. Establish a planning committee

3. Perform a risk assessment

4. Prioritize processing and operations

5. Identify practical alternatives

6. Collect Data

7. Drat a written plan

8. Develop testing criteria

9. Test the plan

10. Evaluate/revise the plan

11. Approve and distribute the plan

Table 13-3 | Threat Examples

Natural Threats	Flooding, Earthquake, Fire, Storms, Tornado
Technical	Threats Power failure/fluctuation, Electromagnetic interference, Telecommunication failure, Software/hardware malfunction
Human Threats	Improper handling of data, Malicious destruction of assets, Unauthorized access to data, Sabotage, Toxic waste/chemical spill, Theft, Bomb threats

 Disaster recovery planning incorporates two specific components: an occupant emergency plan and a continuity of operations plan. The occupant emergency plan (OEP) addresses short-term procedures for evacuation, shelter-in-place, and specific emergency situations. The purpose of an OEP is to minimize loss of life and property damage from hazards potentially affecting the worksite. A continuity of operations plan (COOP) addresses longterm procedures for returning to operations once an emergency has subsided. The purpose of a COOP is for essential work functions to be resumed as quickly as possible after an emergency. A comparison between an OEP and a COOP is listed in Table 13-4 . It is with the existence of both component plans that an organization can state it has created a comprehensive disaster recovery plan.

   Among the most significant steps in creating a comprehensive disaster recovery plan is the prioritization of processes and operations. As part of the prioritization effort, managers should identify the critical needs of their department, including the necessary functions, procedures, and equipment needed to continue operations should there be any form of disaster. To do so, managers must have first documented all of the functions performed in the department and identified the necessary equipment, applications, and reports necessary to complete these functions. From there, managers can rank the functions in priority order: essential, important, and nonessential. This ranking will allow managers to determine the minimum number of staff necessary to perform each ranked function, the minimum size of off-premise facility if one is needed to continue operations, and the minimum type and number of pieces of equipment to be available in an off-premise facility.

   During the course of developing the plan, managers must identify and evaluate alternative methods for conducting business. These methods often include backup plans to support data replication and other automation efforts; communication strategies for employees, customers, and suppliers to use; and the availability of vendor- or organization-supplied equipment at alternate sites. After each department within the organization identifies and evaluates those methods that may assist their functioning in the event of a disaster, a higher level of review is conducted. This review is designed to eliminate duplications or contradictions, align each department's methods with the organization as a whole, and assign responsibilities to individuals and teams to coordinate the recovery process. From this point, a comprehensive written document can be developed that outlines how the organization will address the numerous unpredictable and sometimes unpreventable hazards that might endanger its operation or survival.

   It is essential that any disaster recovery plan be tested upon its formation and on a periodic basis. Testing offers many benefits, including verifying the feasibility, compatibility, and adequacy of the measures identified and incorporated into the plan. To the extent that testing identifies deficiencies in the plan, measures to modify or improve the plan can be taken. Testing also provides the organization, as well as those external customers who rely upon the organization, with assurance that the organization can recover in the event of a disaster.

   Many different testing approaches exist. Some managers employ a checklist approach, comparing the essential elements contained in the plan against the reality of what is available to the organization. Other managers employ a structured walk-through approach, leading a discussion of the responsibilities of the parties involved and the steps to be followed for each essential element of the plan. Some managers simulate a disaster during non-business hours, testing as many of the essential elements of the plan as possible. Other managers employ a parallel testing approach, conducting business at a parallel site using an organization's historical transactions (i.e., yesterday's transactions) and comparing the reports generated at the alternate site against the organization's backup files. Finally, some managers conduct full-interruption testing, during which they purposefully disrupt an organization's operations for a short time period to determine whether the entire plan will allow the organization to recover smoothly. Full-interruption testing is costly, making it a less viable choice for many managers. Each of these approaches can be employed separately or in combination with one another to determine the effectiveness of a disaster recovery plan.

After completing testing and curing any deficiencies, the highest level of the organization should approve the disaster recovery plan. This level could be the highest level of an organization's management or an organization's oversight board. Proper dissemination of the plan follows, with educational sessions conducted as needed. Such dissemination may include notification and distribution of the plan to regulatory agencies and insurance companies, both of which may have established requirements for an organization to meet.

Table 13-4 | Comparison between Occupant Emergency Plans and Continuity of Operation Plans

Title	Occupant Emergency Plan (OEP)	Continuity of Operations Plan (COOP)
Purpose	Minimize loss of life and property damage from hazards potentially affecting the worksite.	Resume essential work functions as quickly as possible after an emergency.
Focus	Short term	Long term
Elements	Evacuation · • Emergency notifications · • Evacuation routes/exits · • Personnel accountability · • Emergency personnel responsibilities	Essential Functions · • Resources (people and materials) required to perform identified functions · • Prioritized functions to facilitate rapid recovery
	Shelter-in-Place · • Emergency notifications · • Evacuation routes/exits · • Personnel accountability · • Emergency personnel responsibilities	COOP Personnel · • Relocation teams performing essential functions at alternate sites · • Other employees telework or travel to alternate facility as necessary
	Emergencies · • Fires · • Elevator entrapments · • Power outages · • Bomb threats · • Explosions · • Workplace violence · • Medical emergencies · • Natural disasters	Delegations of Authority/Orders of Succession · • Listed by position in order of seniority · • Conditions for decision-making specified per successor · • Communications · • Systems and equipment to be used, intended audience, timing, and responsibilities · • Backup methods identified if primary systems unavailable · • Emergency contact information available in advance (electronic and hard copy)
		Alternate Facilities · • Primary and secondary locations identified · • Memoranda of understanding in place to specify level of resource support to be provided · • Telework used to the fullest extent possible
	Vital Records and Information Systems · • Identified and steps in place to ensure access at work and home · • IT disaster recovery plan in place for protecting, restoring, and replacing electronic data, systems, and equipment
		Recovery/Reconstitution · • Transition from alternate sites to primary facility · • Permanent replacement facility identified if primary site damaged beyond repair

While each of these steps applies to any organization or entity, it is important to note that additional requirements may be imposed in specific industries based on laws, rules, and regulations. In the health care context, the implementing regulations of the Health Insurance Portability and Accountability Act (HIPAA) specifically address the contents of a covered entity's disaster recovery plan. 3 Found under the administrative safeguards section of the Security Rule, these provisions address who is responsible for the information systems and various business operations in the event of a disaster; which information systems, protected health information, and business functions are involved; and when the disaster recovery plan should be invoked. The plan must establish procedures to restore any data lost through a disaster, whether the loss is from server-based systems, computer infrastructure, or communications systems such as faxes, electronic mail, and voice mail. The plan must also be reviewed and tested on a periodic basis.

HIPAA

Covered entities must comply with the administrative safeguard provisions of the Security Rule when formulating their disaster recovery plans.

Planning Tools One challenging aspect of the planning function is scheduling the time needed to accomplish objectives and goals and to follow policies and procedures. Many scheduling tools exist, including calendars, agendas, and charts. This section concentrates on two of the most commonly used planning tools, the Gantt chart and the PERT network.

   The Gantt chart is an outgrowth of the work of an engineer named Henry Gantt. As part of his work in studying ways to increase worker efficiency, Gantt created a mechanism for comparing the progress of a project at different points in time. A Gantt chart is defined as a graphic representation of the time relationships in a project. The chart lists different activities in the project on one axis and lists time periods on the other axis.

   Gantt charts are particularly applicable to projects that pose limited changes to the process; involve simple, repetitive tasks; or require simple and direct communication. Gantt charts are less applicable if the steps involved are highly interdependent. Gantt charts allow the supervisor to readily identify which activities precede one another, which should occur simultaneously, and which should follow one another. They also can be used to determine whether projects are running ahead of, behind, or on schedule. A sample Gantt chart is illustrated in Figure 13-4. Where a Gantt chart uses different colors to identify the actual and proposed start and completion dates, the color difference can assist the manager in assessing whether an activity is on schedule.

Figure 13-4 | Sample Gantt chart

 A second planning tool is the Program Evaluation and Review Technique, or PERT . PERT is the outgrowth of work performed by the U.S. Navy to reduce the time frame projected to complete the Polaris Ballistic Missile Project in 1958. PERT is particularly applicable to projects that have multiple variables.

   Like a Gantt chart, PERT tracks activities according to a time sequence. It differs from a Gantt chart in that it shows the interdependence between activities. On a PERT network, the longest sequence of events to be completed will have the largest effect upon the project. This longest sequence is called the critical path and requires the most attention from the manager. A sample PERT network is illustrated in Figure 13-5. As the illustration indicates, a network of interrelated activities must be planned to accomplish the goal.

Organizing

Organizing refers to determining what tasks should be done and who will do them, establishing the reporting structure, and deciding at what level decisions will be made. In other words, it means to bring together basic resources in an orderly manner and arrange them in an acceptable fashion to ensure that the goals and objectives identified in the planning function are achieved. Organizing focuses on design and structure, the people involved, the type of work, the procedures used in performing the work, and the environment in which the work is performed.

Figure 13-5 | Sample PERT network

Design and Structure Considerable changes have occurred in the business and health care communities during the last decade, as organizations have merged, restructured, and—in some cases— ceased to exist. With all of these changes taking place, considerable focus has been brought upon the question of how to design and structure organizations that will survive tumultuous business cycles, respond to customer needs, and allow organizations to grow and thrive. Organizational design refers to “the planning and fitting together of the people and activities involved in doing the work of an organization.” 4 An organization greatly influences its level of performance when it creates a design that aligns with its vision, strategy, and systems, including decision support systems, reward systems, and human resource systems.

   A number of forces influence what type of design an organization needs and when or whether the organization needs to change its design. Among those forces are changes in technology; the need to modernize work processes; a desire to save costs, increase efficiencies, and make the organization more flexible; increased emphasis upon customer service; and recognition of the need to take into consideration quality-of-life issues in the workplace. A more comprehensive listing of influences is illustrated in Figure 13-6 .

    Organizational structure refers to the manner in which the work and responsibilities are divided within the organization. Organizations may be structured in multiple ways, with some organizations combining structures to form hybrids. Structures that are common to organizations include those based on function, product or service, teams, or customer orientation. Functional structure divides work and responsibilities according to the major technical or professional functions performed by those within the organizational units. Product or service structure divides work and responsibilities around the organization's products or services. Team-based structure divides work and responsibilities around the organization's major work processes, allowing team members to perform all major activities within a business process from beginning to end. Customer-oriented structure divides work and responsibilities around the characteristics of an organization's customers or markets. The strengths and weaknesses of these structures are illustrated in Figure 13-7 .

Figure 13-6 | Forces influencing organizational design

Organizing People Organizing people to accomplish goals and objectives requires establishing the divisions and subdivisions of the organization, including the assignment of teams and the interdependencies of divisions, subdivisions, and teams. Most often, this structure is illustrated by an organizational chart . An organizational chart is a document—paper based or electronic—that maps how positions within a department or organization are tied together along the principal lines of authority. This document reflects formal reporting relationships as opposed to the significant informal and informational relationships present in organizations.

   Organizational charts take various forms, including topdown, left-to-right, and circular. The top-down organizational chart, illustrated in Figure 13-8 , is the chart familiar to most managers. The top-down chart places the major positions of the organization at the top, with subordinate positions placed in lower levels. By contrast, a left-to-right organizational chart places the major positions of the organization in the middle left section of the page, thereby suggesting that the so-called top position is not supreme. Although not as familiar as the top-down chart, left-toright charts primarily facilitate reading, as the normal reading pattern is from left to right. This type of chart is illustrated in Figure 13-9 . Finally, the circular organizational chart places the so-called top position in the center, with subordinate positions surrounding the center. The circular chart suggests that all of the positions within the organization are of equal importance, thereby discouraging the view of a top and bottom to the organization.

This type of chart is illustrated in Figure 13-10.

Figure 13-7 | Strengths and weaknesses of organizational structures

Figure 13-8 | Top-down organizational chart (U.S. Department of Health and Human Services)

Despite their helpfulness, organizational charts possess certain limitations. Organizational charts do not reflect clearly what authority is delegated from one level to another, nor do these charts always reflect the organization's structure as it really is. Managers do not always update the organizational chart to reflect changes within the organization as they should, thus rendering the organizational chart obsolete. Additionally, some confuse the authority relationships shown on an organizational chart with status in the organization. Although charts attempt to conform to levels of importance, issues such as salary and bonus levels make it almost impossible to reflect status on an organizational chart.

Figure 13-9 | Left-to-right organizational chart (U.S. Environmental Protection Agency, Office of Water)

   Organizing people is also accomplished through the identification of a job and through job analysis. A job refers to the tasks and responsibilities that, on the whole, are regarded as the regular assignment of an individual. Job analysis determines the content of a job. Job analysis is accomplished by examining each of the tasks that makes up a job and by determining the requirements for successful performance of each task. The job analysis in turn leads to the development of a job evaluation and a job description.

Figure 13-10 | Circular organizational chart (National Institute of Standards and Technology)

 A job evaluation compares tasks within jobs to one another and provides a basis for grading or ranking jobs. It helps to place the job in an accurate position on the organizational chart and establishes the basis for salary structure. A job description is a written statement summarizing what an employee does, how it is done, and why it is done. In other words, it identifies the activities, skills, and performance requirements for a particular position. Job descriptions are used in a multitude of ways, including to recruit, to orient employees, to clarify relationships within an organization, and to serve as a basis for a performance evaluation. An example of a job description is given in Figure 13-11.

Further information concerning job descriptions can be found in Chapter 14 , “Human Resource Management.”

   Organizing people also includes the delegation of authority. Delegating authority means to transfer some of a manager's decision-making authority to subordinates. Note that not all of the manager's decision-making authority is given away; some is retained so that the manager can evaluate the subordinates' decisions and exercise veto authority where necessary. Delegation works well if the manager shares information with the subordinates, enabling the subordinates to successfully solve problems.

Figure 13-11 | Sample job description

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Organizing the Type of Work Organizing the type of work involved may be done in several ways: by function, by location, by product, by client, by project, or by process. The manager may choose one of these ways or a combination of ways. In many organizations, the top level is organized by function; the middle level by product, client, or location; and the lower level by the process to be followed in completing the work.

   One tool used in organizing work is the work distribution chart. A work distribution chart records the work activities performed, the time it takes to perform the work, the individual performing the work, and the amount of time each individual spends on each activity. This information can then be used to analyze what work takes the most time, whether there is any misdirected effort or improper use of skills, whether tasks are spread evenly or too thinly, and whether employees perform too many unrelated tasks. Armed with this analysis, the manager can then determine whether work should be redistributed among staff or remain the same.

Organizing Work Performance The act of organizing work performance concentrates on the development of procedures. Procedures are the series of interrelated steps that are documented and used to give standardization to routine tasks or structured problems. They flow from the policies described in the “Planning” section of this chapter. Within a department, procedures are gathered into a manual or handbook, which is then made available to each employee for his use.

Two common formats for written procedures are the narrative style and the flowchart style. The narrative style describes the interrelated steps in sentences or paragraphs. One disadvantage of this style is that the employee will need to read the entire procedure, even if the employee is only searching for one specific point. An example of a narrative style procedure is illustrated in Figure 13-12. By contrast, the flowchart style describes the interrelated steps in a visual manner, using standard systems flowchart symbols. Becoming familiar with the symbols may be a disadvantage, but, once learned, the flowchart is easy to follow. An example of a flowchart style procedure is illustrated in Figure 13-13.

Organizing the Work Environment Organizing the work environment involves both the physical layout of the space where the work is performed and the ergonomics associated therein. When organized successfully, the work environment will comply with the requirements of both the Americans with Disabilities Act (ADA) and the Occupational Safety and Health Administration (OSHA).

   A physical layout is a model of space in actual miniaturized detail of the physical environment at issue. It illustrates the people and objects involved in the process of work and should support the work flow.

    Ergonomics refers to the design of products, processes, and systems to meet the requirements and capacities of those people who use them. Ergonomics focuses on such areas as furniture, noise control, lighting, high-technology equipment, and aesthetics. Ergonomics is particularly important in a technologically intensive environment, where stress on the human body may result in workplace injuries. Through the use of ergonomic principles, manufacturers may design equipment—such as workstations—to fit human anatomy and physiology, with the desired result of eliminating stressors that reduce productivity and quality.

Figure 13-12 | Narrative style procedure

   Organization of the work environment is not limited to the considerations present in a traditional work space. With the advent of nontraditional work environments, such as those involving teleworkers, employers have learned that questions of physical layout, ergonomics, and safety hazards apply in any context in which the employee performs the work. This realization arises from the fact that employees are being paid to perform their functions and duties under their employer's direction and control, whether that performance occurs in a traditional setting or not. Accordingly, those burdens imposed by law upon employers to maintain a safe working environment in a traditional setting also have application in a nontraditional setting. For example, if an employee performs work at home pursuant to a teleworking policy, and the employer knows or has reason to know that the home environment presents safety hazards (e.g., no clear method of egress in the event of a fire), the employer should insist on action by the employee to create and maintain a safe work environment at home if telework is to be employed. Employers who permit teleworking have handled questions relating to physical layout, ergonomics, and safety in several ways, ranging from the use of checklists that are reviewed and signed by employees to the performance of home inspections.

Figure 13-13 | Flowchart style procedure

An example of a safety checklist employed in a teleworking environment is illustrated in Figure 13-14.

Directing

Directing is the continuous process of decision making, instructing others, and giving orders. The directing activity involves the translation of planning into specific behaviors and activities. The focus of directing is on the functional component, as opposed to the interpersonal aspects, of an activity.

Decision Making Organizations benefit enormously when employees at all levels are skilled at decision making. It is especially important for managers and supervisors to possess this skill, as their decisions affect so many individuals and groups. While the amount of decision-making responsibility possessed by managers and supervisors may vary, the effectiveness of the decisions they make influences greatly the organization's success.

Figure 13-14 | Telecommuting safety checklist

    Decision making is the act of reaching a conclusion. While some managers and supervisors may reach decisions as a result of instinct, impulse, or whim, the skill involved in decision making generally follows a logical thought process. This process involves answering a series of questions: why should a decision be made, what are the alternative solutions, which solution is the best, when and how should the solution be implemented, and what are the results of the decision?

 A number of factors must be considered when identifying why a decision needs to be made. The individual making the decision must understand the context from which the need for the decision arises. For example, it is important to know that an event has taken place that requires a response, or that a situation is developing that may alter the status quo, requiring a proactive approach. It is also necessary for the decision maker to understand who else should be involved in the process and how he will approach the task at hand. Finally, it is helpful for the individual to know the kinds and amounts of resources that will be invested in making the decision.

   Armed with this information, the individual can then develop alternative solutions. Some alternatives are identified through the use of selected criteria while others may be identified pursuant to a brainstorming technique. Some constraints exist in developing these alternatives, such as considering organizational strategy, policy, or values. For example, organizational policy may dictate the limits within which certain alternatives are possible and which ones are considered off-limits, while overall organizational strategies or values may compel the development of some alternatives over others.

   Once the alternatives are identified and developed, the decision maker must choose the one solution that offers the best advantages to the organization. Optimally, the chosen solution will offer the best results at the least cost. In selecting between competing alternatives, the decision maker must remain consistent with the organization's objectives. For example, an organization's objectives may include maximizing long-term profits or increasing market share within a short time frame. With the organization's objectives in mind, the alternatives are compared against multiple criteria, such as performance, durability, reliability, and cost, with each criterion considered equally or given different weight, depending on the circumstances present. The manager or supervisor then chooses the alternative solution that correlates most closely to the organization's objectives and identified criteria.

   Implementation of the selected solution can be as difficult a task as arriving at the optimum solution itself. Obstacles may not have been anticipated nor adequate measures to resolve the obstacles discussed. To increase the likelihood of implementation success, the decision maker must decide when to begin the implementation process. Some decisions require a minimum amount of time and effort to implement, while others require extraordinary effort over a lengthy period of time. The decision maker must also decide how to conduct the implementation process. As a first step, the decision maker may assign responsibility for follow-through, charging an individual with the job of championing the decision within and beyond the organization. The decision maker may provide incentives for staff within the organization to make the implementation process work smoothly. Finally, the decision maker must make the required resources readily available.

   The end of the decision-making process involves an evaluation. This evaluation should include measures that were identified at the beginning of the decision-making process to represent success. Using these measures, the manager or supervisor may evaluate the actual results and, where appropriate, make adjustments as needed.

Instructing Others Among the most basic of directional activities is the instruction of others. Generally, managers instruct others either by assigning or delegating work activities.

    Assigning work means matching an individual employee with specific work that needs to be performed. Work assignments depend largely on the nature of the task involved, varying from routine repetitive assignments to variable routine assignments to special project assignments. Routine repetitive assignments work well in large office environments where employees perform specialized functions. Variable routine assignments work well in smaller office environments where employees are often generalists who deliver different services or perform different tasks during a single shift. Special project assignments work well in environments where employees possess specialized knowledge or where the work performed lends itself to a project orientation.

Top of Form

The likelihood that a given assignment will achieve the desired result is directly related to the manner in which the assignment is made. Among the first considerations is the selection of the right person for the job. Suggested criteria include the employee's knowledge, skills, experience, and maturity. These criteria may lead to the selection of an employee with proven strengths or may lead to the selection of an employee who needs to overcome obstacles and improve performance. Additionally, consideration is given to the level of detail to be provided in the instruction. Such detail includes identifying the activities required of each task, the resources available, the methods the employee should use or avoid, any product or performance standards, and deadlines for work completion.

   While assigning work involves asking an employee to perform work that is within the scope of his employment, delegating involves asking an employee to perform work that falls within the scope of the manager's own job description and position level. Delegating means to entrust another person with selected powers and functions; that person then acts on behalf of the person making the request. When delegating, the manager decides what work can be delegated and to whom. While some tasks require skills that are unique to the manager or involve proprietary or confidential information, other tasks do not require unique skills or involve these forms of information and therefore are appropriate for delegating. Rather, these tasks may involve operational detail, such as data collection, proofreading, or making calculations, or they may involve representation duties, such as delegating a staff member to attend a meeting on the manager's behalf. Choosing the person to 337338whom to delegate a task often requires use of the same criteria as the assignment of work: evaluating an employee's knowledge, skills, experience, and maturity. It also involves consideration of that employee's current workload, since what is being delegated is in addition to the employee's current level of work and may require redistribution of the chosen employee's work to others.

   Delegating can involve risks and rewards for both the manager and the employee. Managers are sometimes concerned that the amount of time necessary to provide instructions, perform periodic checks, and review final work products delegated to an employee will outweigh the amount of time the manager would expend if performing the work himself. Employees are sometimes concerned that any failure to perform the delegated work accurately and timely will result in the loss of trust or opportunity for advancement, or even in permanent damage to the working relationship. While risks certainly exist, delegating also offers rewards to both the manager and employee. Delegating offers the manager the opportunity to handle higher-level assignments and responsibilities when his routine tasks are delegated to others. Delegating offers the employee the opportunity to broaden his range of skills and experiences, thereby placing his in a better position for future advancement and promotion.

Work Simplification One example of directing is work simplification. Work simplification is a method used to find easier and better ways of doing work. It focuses on the most effective way to eliminate waste of time, energy, materials, and cost while still maintaining safety. Although sometimes confused with the process of speeding up work, work simplification focuses on the methods used to accomplish the work, not merely on the time it takes to accomplish the work.

E-HIM

Work simplification performed before conversion to an electronic health record system can identify inefficiencies in paper-based processes and prevent those inefficiencies from being adapted to and repeated in an electronic world.

Many steps are involved in work simplification; these are illustrated in Table 13-5 In determining which work should be the subject of work simplification, the manager may focus on some very obvious problems, such as backlogs, unfinished work, and the use of overtime. The manager may also focus on less obvious problems, such as the activities associated with beginning or ending a specific job, to see if they can be streamlined into the process. Managers may also apply work simplification steps when converting to an electronic health record system as a way to avoid adapting inefficient paper-based processes to an electronic world. When collecting data from those involved, the manager should not merely rely on a supervisor's description of the process but, rather, should study the process himself as it is performed by the employee.

Table 13-5 | Steps to Work Simplification

1. Choosing the work to be improved

2. Collecting data from those involved

3. Recording the data on work-process flowcharts

4. Analyzing the details to select the improvements

5. Incorporating the improvements into the work process

2014 Cengage Learning, All Rights Reserved.

   When the data is collected, the manager should record it on a work-process flowchart. Once only available in manual form, flowcharts are now available via computer programs. Regardless of which form is chosen, the flowchart includes the following elements: (1) an identification section stating what process is being studied, when the study begins and ends, and who is the person performing the process; and (2) a body containing work classification symbols and a brief description of each step in the process, and any time or quantity measurements.

   After the flowchart has been completed, the manager should analyze the data collected to determine improvements. The analysis should examine the necessity of each step in the process flow and seek opportunities to eliminate, combine, change, or simplify the process. In conducting this analysis, the guiding principle should be to determine whether there is a better way to perform the process, not to change the process merely for the sake of change.

   Finally, the manager should incorporate the improvements into the work process. First, the flowchart should be revised to include the improvement. Second, the improved procedure should be tested by an employee. Assuming that the test is successful, the written procedure should be modified and distributed to the affected staff. Finally, the manager should check the revised work process periodically to determine whether the improvement as actually implemented improved the process.

Controlling

Controlling refers to the act of ensuring that activities are accomplished as planned and correcting any significant deviations from the plan. While controlling may be among the least exciting principles of management, it is arguably the most critical because, when done well, the manager can identify a problem and take action before the problem becomes uncorrectable. It is directly related to the planning function, in that controlling measures whether the planning has been effective; it differs from the planning function, however, in that controlling requires managers to react quickly and appropriately to unexpected deviations from the plan and to correct any planning errors previously made. Managers perform the controlling function by identifying the types of controls to be used, setting standards, and monitoring performance.

Types of Controls As a general matter, managers employ any or all of three types of controls in the workplace: input controls, process controls, and output controls. Input controls are designed to 338339anticipate problems and prevent them from occurring. Examples include employing routine maintenance on costly equipment at periodic intervals to avoid equipment failure or downtime and employing internal inventory control systems to ensure that supplies needed to support daily operations are readily available. Process controls are designed to measure and evaluate work in progress. Examples include formal and informal assessments, through periodic checking or sampling, of employee performance according to established standards for quality and timeliness. Output controls are designed to evaluate final results. Output controls are not designed necessarily to correct past work but are designed to serve as guides to future activities by highlighting problems in work efficiency or effectiveness. A classic example of an output control is an employee performance appraisal. Most employee performance appraisal systems measure past performance against established standards. Therefore, the content of an employee performance appraisal cannot change past performance, but it can serve as a feedback mechanism for improving the employee's future performance by identifying areas of solid and weak performance and opportunities for improvement.

   Implementation of any of these controls varies according to individual situations and circumstances. Some controls may need to be used continuously, such as standing plans for use in emergency or disaster situations. When developed, standing plans are considered input controls. When implemented, standing plans become process controls. Other controls, such as audits or budget reviews, should be employed on a periodic basis. Still other controls should be used only when needed, for example, when a special report is necessary to identify the cause of a problem and an attendant solution or to identify an opportunity and the mechanism to take advantage of it.

Setting Standards Setting standards ensures that work is performed—and performed properly. Issues of quality and quantity are central to setting productivity and performance standards. In setting standards, managers must first measure the work.

   Quality of work can be measured through inspection, incident reports, and audits. Under the inspection approach, a manager inspects all or selected work performed (“spot-checking”) and notes deviations. The number or type of deviations will help to determine the quality of work performed.

   Quality can also be measured through incident reports. Incident reports are records made of deviations from the norm. These reports do not require observation by the manager; rather, they can be made merely through awareness of a deviation from a norm. Ideally, incident reports contain only factual information and not opinions or interpretations of an event noted as a deviation from the norm.

   Quality can also be measured by audits. Audits are techniques used to look retrospectively at a specific activity, measure it, and compare it to established guidelines. When a pattern emerges indicating that established guidelines were not met, the manager determines what further action should be taken, including the education and training of staff and work simplification of processes.

   Quantity of work can be measured both manually and electronically. In a manual system, work may be measured by work sampling or employee logs. In work sampling, a sample is taken at random from a large group or from an individual, based on the theory that the sample will tend to resemble the distribution pattern of the group as a whole or the total work of the individual. The accuracy or validity of a work sampling increases with the number of observations. The higher the number of observations involved in the sample, the higher the accuracy or validity of the sample.

   Using the employee-log approach, a log is set up for each type of work that is performed. The employee notes on the log each work unit in which he is engaged. The information is tallied and can then be plotted on a graph.

   Quantity can also be measured electronically. Integrated computerized information systems can provide managers with comprehensive data about the quantity of work performed by staff. Depending on the type of data maintained in the database and how the programming query is developed, managers can obtain reports that provide quantity totals for each employee or team. One such example is the employee log; in addition to tallying information manually, an employee log can be created using an integrated computerized information system.

   Once quality and quantity determinations are made, a standard can be established for all employees who perform the same work. For example, a manager may establish that a certain number of deviations relating to quality and quantity are acceptable for the work performed. An employee whose work shows a higher number of deviations than the one established in the standard may receive the attention of management.

   Effective performance standards can also be based on cost or time. Cost standards address the total cost or cost per unit limits within which a product is produced or a service is delivered. Time standards address the deadlines by which results are to be accomplished or the amount of time, as measured by minutes, hours, or days, that it should take to produce the desired results.

Monitoring Performance As with setting standards, monitoring performance involves a series of steps. The first step is to capture data by measuring the actual activity. Managers capture data manually using work sheets, survey forms, and questionnaires, and electronically through the extraction of data stored in an electronic database. Once the data are captured, managers analyze and compare the data against the standard that has been set for the activity. Historically, managers used manual systems to analyze the data. With the advent of integrated computerized information systems, raw data can be examined electronically and exceptions to the standards can be recorded on exception reports. These exceptions form what is called the variation or deviation.

Because actual performance will not always conform to the standard that has been set for an activity, variations or deviations are to be expected. Evaluating whether the variation or deviation 339340between the analyzed data and the standard are significant is the next step in controlling. Depending on the circumstances involved, it may be relatively easy to determine whether the variation is significant; under some circumstances, however, managers must exercise considerable judgment. Once the manager has determined the significance of the variance, he should take appropriate action. Constant attention must be paid to variations or deviations, since failure to take appropriate action, early enough in time, may result in a problem that is uncorrectable.

Leading

Leading is the management function involved in motivating employees, directing others, resolving conflicts, and selecting effective communication channels. Leading emphasizes the role of setting the tone for the organization and encouraging staff by example. It differs from the directing function described previously in that leading focuses on the interpersonal aspects of an activity. By contrast, the directing function focuses on the functional component of an activity.

    Leadership refers to the ability to get work done with and through others while simultaneously winning their respect, confidence, loyalty, and willing cooperation. Leadership is both an ability and a process. As an ability, leadership means to inspire and influence others to receive a positive result. This inspiration and influence motivates others to follow a leader, setting the leader apart from non-leaders. As a process, leadership means to influence the behavior of group members in accomplishing the planned objectives. Both aspects can be seen in the description of a leader found in Table 13-6.

   A leader's power derives from either the leader's position in the organization or the perception of others. Positional power rests on the authority inherent in the job status, title, or rank. This type of power is accorded to those with a higher status in an organization and is limited by the individual's rank or job title. Personal power rests on the positive regard that others accord an individual. This type of power emphasizes perception and belief. Those individuals who possess the skills, expertise, breadth of experience, or additional qualities that others believe are valuable and important possess personal power. Unlike positional power, which is given to an individual, personal power is earned and recognized by others. Neither type of power is necessarily related to the other; some individuals who possess positional power lack personal power, while others who are relatively low in positional power may possess a high level of personal power. Figure 13-15 compares both types of power.

Table 13-6 | Leader

L	Legal Responsibility	Compliance
E	Ethics	Integrity
A	Accountability	Trust; checks and balances
D	Direction	Strategic and operational planning
E	Education	Education and training
R	Resource Management	Stewardship of available resources

Figure 13-15 | Power type comparison

Motivating Successful leaders must understand motivation theory in order to encourage others to achieve and foster their enthusiasm and feelings of investment in the organization. Motivation is the need or drive that stimulates a person to some action or behavior. Abraham Maslow's hierarchy of needs theory is among the best known of the motivation theories. This theory posits that human needs exist in a hierarchical fashion. If viewed from the perspective of a pyramid, the hierarchy would be explained as follows, with the most elementary need listed first: (1) physiological; (2) safety; (3) social; (4) esteem; and (5) self-actualization. One moves up the pyramid as each lower need is satisfied. Using this reasoning, an employee's need for self-actualization does not become active until after those needs listed in lower order are satisfied. Maslow's hierarchy of needs theory is illustrated in Figure 13-16.

Figure 13-16 | Maslow's hierarchy of needs

In applying this hierarchy of needs to motivation, it is important to understand that motivation springs from needs not yet fulfilled. As one need is fulfilled, another need emerges that must be fulfilled. To the extent that needs are interrelated, it may be important to attempt to fulfill, at the same time, more than one need or parts of more than one need combined with an entirely separate need.

   Scientist Frederick Herzberg refined Maslow's hierarchy of needs theory further, developing what is often referred to as the “two-factor theory.” The two-factor theory separates work motivation and job satisfaction into two entities. Under this theory, work motivation includes those things that stimulate an employee to exceed basic performance expectations. When motivated to work, an employee works better, faster, or more accurately than the minimum required by a supervisor. Job satisfaction refers to those things that keep an employee from actively seeking other employment. The concept that the two entities are separate is illustrated by the employee who is satisfied with his job but does not work above and beyond the minimum level required under the job performance standards.

   To succeed in developing work motivation and job satisfaction among staff, a leader must understand two factors: motivators and maintenance. Motivators are those forces that cause people to do more than just get by. Motivators are internal to the nature of work and include opportunities for personal or professional growth, achievement, autonomy, advancement, responsibility, and recognition. Under Herzberg's theory, motivators are what affect the attitude and performance of employees, making the difference in job satisfaction. By contrast, maintenance factors are those forces that help people who are performing at acceptable levels continue to do so. Maintenance factors are external to the nature of work, meaning that they relate more to the circumstances surrounding how the work is performed and less to the nature of the work itself. Some examples of maintenance factors include interpersonal relationships, job security, organizational policies and procedures, working conditions, technical supervision, and salary and benefits. Under Herzberg's theory, maintenance factors can be the source of job dissatisfaction, leading to reduced work motivation and poor job performance.

   Herzberg applied both the motivators and maintenance factors to Maslow's hierarchy of needs, concluding that motivators relate to higher-order needs while maintenance factors relate to lower-order needs. A comparative table illustrating this application is shown in Figure 13-17 . According to Herzberg's theory, a leader should concentrate on motivators, rather than maintenance factors, to improve employee work performance.

   The challenge for a leader is to develop situations that permit all employees to satisfy their needs within the work environment without frustrating the needs of one or more members of a team. One method of answering this challenge is through job enrichment. Job enrichment entails modifying the job itself by introducing into it additional motivating factors that meet an employee's higher-order needs, making the job more meaningful and rewarding. This increase in meaning and reward enhances the employee's commitment and involvement in the work performed. Where circumstances make modifying the job itself difficult, a leader can concentrate on changing the way an employee looks at the job. For example, a leader can heighten the perceived importance of the work performed by increasing the employee's amount of direct contact with internal and external customers or by providing more information to the employee on what meaning the organization, customers, or regulatory bodies give to the work. Other job enrichment strategies include: increasing the amount of autonomy and freedom an employee has, increasing the degree to which the employee sees the results of his labor in terms of the end product or intended service, and increasing the degree to which the employee can identify with the product or service he provides.

Figure 13-17 | Comparison of Maslow and Herzberg

Directing Others One thing that sets leaders apart from managers is the clear focus and direction that leaders provide an organization. Leaders accomplish this by fostering the development of a common vision that is understood and accepted by everyone in the organization. This clear focus logically leads to the development of a mission, which identifies what an organization needs to accomplish and how to measure its success. The leader provides direction by making clear to employees what is expected of them, both on a daily basis and over the longer term, and what organizational priorities exist so that employees may make appropriate decisions about the work they are to perform.

   Providing clear focus and direction also includes taking additional action. By clarifying roles and responsibilities, a leader increases ownership, helps to alleviate conflicts, and eliminates unnecessary ambiguity. By linking an employee group or team to the organization's mission, the leader helps employees understand how their work ties into that of the organization and its objectives. This link also educates others who may be important to the 341342organization's success about the employee group's or team's work, thereby increasing the understanding and support needed to accomplish the organization's objectives.

Resolving Conflicts One of a leader's major tasks is to manage or resolve conflicts. The leader succeeds in this task by anticipating and trying to resolve conflicts, disagreements, and confrontations in a constructive manner. Conflict is an inevitable part of an organization, because interpersonal relationships are involved. Although most people consider conflict uncomfortable, it may be a necessary part of an organization's method of avoiding stagnation.

   Conflict may be categorized in two ways. First, conflict may be considered functional. Functional conflicts are conflicts of a constructive nature that support the goals of the organization. Functional conflict can occur when teams or groups possess conflicting priorities or activities. The focus of functional conflict is upon the priority or activity, not the interpersonal relationships. Second, conflict may be considered dysfunctional. Dysfunctional conflicts are conflicts that result in destructive behavior and prevent the organization from achieving its goals. Dysfunctional conflict can occur when personality differences cause conflicts among teams or groups. The focus of dysfunctional conflict is upon the interpersonal relationships, not the priority or activity.

   It is generally easier for managers to handle functional conflict than dysfunctional conflict, since managing personal chemistry differences among employees is inherently more problematic. Conflict resolution options can be effective mechanisms to employ when resolving both functional and dysfunctional conflicts. Several standard conflict resolution options are illustrated in Table 13-7 .

   Among the most effective mechanisms used to resolve conflicts is negotiation. Negotiation refers to the process of conferring, discussing, or bargaining to reach an agreement. Negotiation methods vary widely, from taking hard-bargaining positions to seeking reciprocity through favors and keeping score to issuing threats. Principled negotiation, however, has proven to be the most successful method, because it focuses on principles as the means to reach outcomes rather than forcing outcomes through the use of power. The seven principles of this form of negotiation are illustrated in Table 13-8.

Table 13-7 | Conflict Resolution Options

Accommodation	Encourages participants to place another individual's concerns and needs above their own
Force	Satisfies one participant's needs at the expense of another participant's needs
Compromise	Encourages participants to relinquish something of value
Collaboration	Attempts to gain advantage for all participants; a so-called “win-win situation”
Avoidance	Resolution is not attempted for a certain period of time if high emotions are involved and a cooling-off period is needed, or if insufficient information is available to make a discussion of value

Table 13-8 | Principles of Negotiation

Focus on the interests

Protect the relationship

Use good communication

Rely on legitimacy

Consider the options

Weigh the alternatives

Make commitments

© 2014 Cengage Learning, All Rights Reserved.

   Each principle adds value to the negotiating process. By focusing on interests, the dynamic changes from one of staking positions to one of seeking out the interests that underlie a given position. In this manner, the focus rests on what is really sought by each party rather than on what may be expressed on the surface level. The principle of protecting the relationship centers on the issue of respect for those persons involved in the negotiation. This demonstration of respect works to build a partnership around solving the problem. By using good communication techniques, the expression of different points of view and persuasion can be injected into the negotiation process. The legitimacy principle focuses on the fairness aspect of negotiation. Use of an established external standard or criterion can allow the parties to measure the fairness of any given proposal. By exploring the full range of options, more creative solutions may be identified. Once identified, each option or alternative can be weighed, leading to the identification of the best viable alternative. Finally, the making of commitments allows the parties to formalize the results of their negotiations and convey those results to others.

Effective Communication Managers cannot lead without being able to communicate their ideas well. Because of the time constraints facing all leaders, everything that is said and done must count. Ultimately, the leader is responsible for the success or failure of the communication effort. Communication is the process of sharing meaning through the intentional or unintentional sending and receiving of messages. Communication involves many facets, including: (1) knowing who needs what information and communicating that information in a concise and timely way; (2) choosing the most appropriate communication medium, oral or written, for the recipient's use; (3) knowing how to listen effectively; and (4) helping others to communicate effectively, so that communication occurs at all levels of the organization and with all needed people.

   Leaders may communicate with others efficiently without communicating effectively. Effective communication is measured by looking at whether the communication produced the desired results. To be effective, the leader must put time and effort into 342343making certain that the communication is received by those for whom it was intended, is understood to mean what it was intended to mean, is remembered for a reasonably long period of time, and is used the way the leader intended the message to be used. Leaders who master these elements of communication can be both effective and efficient.

   In exercising communication skills, the leader works to ensure a consistent and timely flow of high-quality information within the organization and to all of its internal and external stakeholders. The leader accomplishes this by employing multiple behaviors. First, the leader represents and articulates viewpoints in a manner that influences the dialogue positively. The viewpoints and ideas expressed should be focused messages that inspire support or action from others. Second, the leader relates to all internal and external stakeholders, communicating with individuals up, down, across, and beyond the organization. Third, the leader maximizes his listening skills, increasing the possibility of problems being solved in a timely fashion. Fourth, the leader conveys information in a clear, organized, and understandable manner while maintaining quality standards in all forms of communication. Finally, the leader provides continuous, constructive feedback to internal and external stakeholders by employing descriptive language and separating facts from opinions, inferences, and assumptions.

MANAGEMENT THEORIES

The theories used by managers to direct and control the activities of subordinates greatly determine the climate of that portion of an organization for which the managers are responsible. A historical overview of these theories provides a basis for discussion of specialized management theories. A chart showing the progression of various management theories is found in Figure 13-18.

Figure 13-18 | Progression of management theories

Historical Overview

The first efforts toward a management approach or theory originated in the early part of the 20th century. At that time, individuals such as Frederick Taylor, Henri Fayol, Frank and Lillian Gilbreth, and Henry Gantt began studying management from a scientific perspective. They conducted extensive studies of aspects of production by observing, measuring, and relating the contributions of each aspect. In these studies, they attempted to prove or disprove a particular hypothesis or assumption by means of controlled experimentation. In doing so, they sought to increase efficiency and productivity of an operation through scientific means. Their approach is referred to as scientific management; it became widely accepted by managers and influenced the academic community.

   While the scientific management approach gained acceptance in America, a different approach developed in Europe. Based on the work of sociologist Max Weber and others, the classical management approach focused on the organization as a whole, rather than on individual functions, to improve performance. The organizational focus was on a well-run bureaucracy, where managers were expected to make decisions to enhance the organization and workers were expected to follow orders. This approach posited that workers were merely cogs in a wheel or one more function to be managed, and that attention to sentiment or emotion was unnecessary because both were irrelevant in the workplace. Although it was not entirely accepted, numerous managers thought this approach appropriate for the work environment.

   Although scientific and classical management efforts often resulted in higher productivity and efficiency, neither focused on the human aspect of management. The failure to address the human aspect of management led to the development of the humanistic management approach. Under the leadership of Elton Mayo in his famous Hawthorne studies for Western Electric in the 1930s, managers became more aware of the need to focus on social Scientific 343344relationships in the workplace. Humanistic management supports the proposition that an organization's objectives can be achieved and productivity increased when managers use human relations skills to work with people. The emphasis is placed on satisfying the needs of employees, motivating employees to improve productivity, and using communication tools and work groups effectively. Through cooperative efforts rather than mere engineering of products, the humanistic management approach stressed the importance of social relationships to work productivity.

   During the 1950s, behavioral scientists developed a bridge between the scientific, classical, and humanistic management approaches through the concept of participatory management. Participatory management involves the use of expectations and information within an organization to motivate people to work. Proponents of participatory management include Douglas McGregor (Theory X and Theory Y) and Peter Drucker (management by objectives, addressed earlier in this chapter).

   McGregor's theories held that the nature of a manager's expectations of employees influences the way the manager treats employees and how employees respond to the manager. He developed two alternate theories to test his assumptions. Theory X holds that the average employee dislikes work, possesses relatively little ambition, wishes to avoid responsibility, prefers to be directed by others, and wants security above everything else. Consequently, managers who subscribe to this theory use fear as a motivator and keep close surveillance over their employees to achieve organizational objectives. Alternatively, Theory Y holds that work may be a source of employee satisfaction and that employees, under proper conditions, will not only accept but seek responsibility. Theory Y emphasizes an employee's potential to act maturely and show self-motivation. Consequently, managers who subscribe to this theory emphasize motivation through objectives and permit employees to experience personal satisfaction as they contribute to the achievement of objectives. More recently, Theory Z has emerged as an advancement of Theory Y.

Theory Z holds that the responsibilities sought by employees, and over which they are capable of self-control, are culturally related. As societal needs and goals change, those things that motivate employees will change as well. Consequently, managers who subscribe to this theory look to individual and aggregate quality-of-life issues when developing motivators for employees. While these theories can be considered generalizations, and no one theory applies to every situation, the three theories illustrate the concept that employees will live up to—or down to—the expectations of the managers in their organization.

   Another theory that has gained wide credence in the last two decades is total quality management (TQM). TQM is a customerfocused management philosophy that challenges an organization to exceed customer expectations while still maintaining a costcompetitive market position. It involves continuous improvement of processes and the entire organization's participation to be successful. With TQM, emphasis is placed on measuring the customer's needs and expectations and measuring the capability of the organization to meet those needs and expectations.

   TQM originated from the statistical control theories and evaluation of production processes introduced by Americans W. Edwards Deming, Walter Shewhart, and Joseph Juran. These theories and processes were further developed in Japan, by Kaoru Ishikawa, which led to numerous organizational success stories. Corporate America later embraced TQM, applying its principles to both manufacturing and health care settings.

Specialized Management Theories

While management as a discipline is a relatively recent academic development, the late 20th and early 21st centuries have seen newer management theories and practices emerge. These newer management theories and practices attempt to respond to the striking changes occurring in the workplace, including those resulting from technological innovations, the availability of information, and the increase in global competitiveness. While more theories and practices exist than can be addressed in one textbook, this section focuses on those theories that have greatly impacted the health care environment during the last two decades. All are subsets of management theory and practice, and they are addressed separately because of the differences they pose with one another and with general management principles.

Change Management The change management theory developed as a result of the magnitude and frequency of changes in the health care and business environments, and the need to anticipate and respond to those changes. Change management generally refers to a large-scale change in an organization's operation or structure. It involves numerous management activities such as planning, designing, and implementing, and focuses on developing procedures, processes, systems, routines, or tools that require a change in human performance. The end result of change management in an organization is that people will perform their jobs differently in order to achieve a stated goal or objective.

   Change management can be broken into two parts: the change and the transition. The change addresses the outcome sought by the organization, for example, moving to a customer service orientation or a flatter organizational structure. The transition addresses the psychology the organization must deal with, for example, letting go of the reality and identity that previously existed within the organization so that a new reality and identity can be forged. The transition to change poses the most difficult challenge to managers and organizations. Organizations who focus on both aspects of change management increase their potential for success. Examples of reasons for organizational change are listed in Table 13-9.

   It is important to understand that people react to change much as they react to other significant events and activities in their lives. For some, change is welcome; for others, change is somewhat difficult; for still others, change is catastrophic. Many who find change difficult or worse are experiencing the loss of something familiar and are faced with something unfamiliar. They must go through the stages of denial, resistance, bargaining, and depression before they reach the stage of acceptance. Recognizing these stages is the first step to managing the change successfully.

Table 13-9 | Reasons for Organizational Change

External Pressures	Reimbursement issues; government regulation; demands of accreditation agencies
Leadership	Vacancy, retirement, or replacement of key personnel
Policies and Procedures	Influence of new information or strategic approach
Structure	Reorganization or privatization of services
Technology	Advances in the field affecting private industry and government; new applications for existing technology

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   Managing change requires activity at multiple levels of operation. At the individual level, managers find that the individual's history and personality, along with the type and consequences of change, will influence the response to change. At the team level, managers find that the team's purpose and the composition of its members will influence the response to change. At the organizational level, managers find that the complexity level is great and that multiple models and approaches may be used, depending on the particular circumstances.

Change is an ongoing phenomenon; changes may overlap with one another, occur simultaneously, or occur in a rapid series. Without proper planning, change can lead to dysfunction or even crisis in an organization. Employing life-cycle management, worstcase scenarios, and the theory of change as normal may assist in handling the reaction. In life-cycle management, a life expectancy is given to a product or process. Within the life cycle, the manager can begin to acclimate staff to the need for future change, so that it is not seen as unexpected or poorly understood. Worst-case scenarios allow the manager to build contingency clauses into change management plans. These contingencies can include alternate methods and procedures in the event of unforeseen circumstances. Because these alternatives are developed before they are actually employed, they permit the manager to change plans smoothly or to minimize difficulties facing staff and the organization. The “change as normal” theory requires managers to educate staff that organizational change is a constant and that the status quo is only temporary until a better way of performing work or doing business is discovered. Using this approach, the organization's values remain unchanged; it is the procedures and processes the organization employs that will remain in constant transition.

Project Management One discipline within the larger framework of management is project management (PM). Project management refers to temporary endeavors undertaken to produce a definite product or service. PM differs from the general definition of management in that it focuses on complex projects that require a more intensive effort to manage, are of a limited duration, involve a sponsor and specific staff, and generally involve something new or unique. Elements typically associated with project management are listed in Figure 13-19.

Figure 13-19 | Elements of project management

   Managers use PM to solve problems, identify opportunities, define what needs to be done, and commit to achieving a specific goal. Projects can be of a substantial nature, such as converting to and implementing a new software program affecting multiple users, or of a less substantial nature, such as developing an archive shipment for records to be stored off-site. Project management is most successfully used in situations where upper management support is present, clear goals and objectives exist, adequate resources are available, communication is clear and precise, team members are knowledgeable and committed to one another, and priorities and politics are not conflicting.

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Project management encompasses many functions. Initially, the project manager must understand the scope function. This requires knowledge of all activities to be performed, the end product that will result, and the resources needed to achieve this result. Project integration is one of the most significant functions, because it requires the project manager to integrate people, resources, and technologies effectively and efficiently within both time and financial limits. Also important is strategic planning. By creating an overall strategy or vision, the project manager facilitates integration and controls actions. The project manager must also be able to allocate resources effectively, assigning the right resources to the right tasks. Functional areas concerning quality, time, and cost require management attention, as do identifying, analyzing, and responding to risk factors associated with the project. Finally, the project manager must attend to the communication function. The project manager routinely works to build consensus or confidence in decisions at critical junctions in a project by practicing active communication skills. This communication may involve individuals and groups at many levels, including upper management, members of the project team, and other stakeholders.

   Project management software applications can aid the project manager greatly. Software programs can help identify which activities are most critical, the number of resource units required (by day) under the schedule, and the activities for which a critical resource is required. Many project managers use software 345346scheduling programs to plot the time frame needed to complete the project, the time frame for activities within the project, and the windows of time when activities may overlap. Many of these software-scheduling programs create a physical representation of the project timeline using Gantt charts.

   The successful management of projects can be measured in several ways, including whether they were completed on time and within cost, produced the desired performance or technology level, were achieved using the assigned resources effectively and efficiently, involved minimum if any scope changes, did not disturb the main work flow of an organization, or did not change the corporate culture but served to enhance it. Essential to successful completion are accurate estimates of time, resources, and cost. The easiest way to determine the sequence and time needed to complete a project is through the use of a Gantt chart or PERT network. Estimates of resources and cost may be obtained by including others—beyond the project manager—since many individuals and departments may be involved in a project.

   Project management is not without its obstacles, and many constraints may affect a project. At times, the project's complexity can overwhelm the effort. The special requirements of customers or changes in technology may impact the project adversely. Some risks may not be detected soon enough or avoided adequately, increasing the chance of a poor outcome. Pricing of the goods needed may rise beyond what was planned for, or the scope of the project may change drastically.

   Management support may disappear or organizational restructuring may obviate the need for the project completely. While contingency plans can be developed to cover some uncertainties, the project manager must retain flexibility, practice active communication skills, and be prepared to make concessions or trade-offs in order to overcome obstacles.

   In summary, project management must assist an organization's competitiveness. PM can accomplish this if projects are aligned with the organization's strategic plan, goals, and objectives; if they demonstrate a return on the effort expended; if they balance an organization's needs with its desired levels of risk and growth; and if they are staffed and supplied with the resources required for the task at hand.

Process Improvement In many respects, an organization's processes demonstrate its effectiveness. Where processes follow a logical pattern, they can support an organization's goals and improve performance. Conversely, processes that stumble along without attention from management and staff cost the organization in terms of efficiency and effectiveness. The realization of these and other costs have resulted in the development of process improvement theory as a subset of management.

   Process improvement refers to the efforts to implement changes to business processes as a means to improve performance. Sometimes referred to as process reengineering, process redesign, or process innovation, the goal of process improvement is to facilitate some form of change, focusing on the business processes and various activities within each process and eliminating those activities that do not add value to the business. Process improvement has been shown to increase the speed, productivity, and profitability of organizations. It differs from performance improvement in that performance improvement focuses on patient care, whereas process improvement can apply to any business process, regardless of its connection to patient care. It is similar to total quality management in that both deal with process improvement; TQM, however, focuses on continuous improvement as opposed to improvement on a one-time basis. Both management theories employ the Plan-Do-Study-Act (PDSA) cycle as a model for action.

   Under the PDSA cycle, one begins the planning stage by identifying, evaluating, and analyzing the process appropriate for improvement. Next is the doing stage, which involves implementing actions that correct the root cause(s) of a process problem. This is followed by the study stage, which measures and reviews the results of the actions taken to determine if they achieved the target sought. Finally, focus rests on the act stage, where successful improvement efforts are integrated into daily operations and, where appropriate, are transferred or shared with other organizations. The activity that occurs in each of these stages is critical to the success of the process improvement effort.

   The need for creativity is present at each of these stages, with idea generation often used as a means to boost creativity. Ideas may be generated through several methods. With brainstorming , ideas are offered about a particular process or topic in an unrestrained manner by all members of a group. All ideas are recorded, with analysis and editing waiting until a later stage. The strength of this method is that it allows for gathering a variety of ideas in a short time frame. With mental imaging , the group visualizes a detailed picture of an ideal situation, identifying both the key relationships and obstacles that will need to be addressed in order to influence eventual success. The strength of this method is that the desired outcome—and the conditions needed to make that happen—is clearly identified for everyone in the group to share. Using the five “whys” method, the root causes of a problem are discovered by asking the question “why” at least five times in a given discussion. The strength of this method is that it assists in understanding how different causes might be related and focuses on the process rather than the personalities involved.

   Once ideas are generated, they must be prioritized in some fashion. Several decision-making tools can assist in this prioritizing process, including multivoting, nominal group technique, force field analysis, and a paired-choice matrix. In multivoting , the highest priority items are determined by allowing each group member to vote for items he believes have the highest priority. The number of votes per group member is determined by halving the total number of ideas or items on a list, for example, by allowing fifteen votes for a thirty-item list. Those items on the list with the highest number of votes are then pursued by the group. This tool is illustrated in Figure 13-20 . Multivoting is particularly applicable to large groups who wish to participate in the decision-making process or to long lists that require separations between vital and trivial ideas or items.

Figure 13-20 | Multivoting tool

   Nominal group technique is more appropriate for smaller groups or smaller lists of ideas or items. Using this technique, a list of ideas is labeled alphabetically, and each group member prioritizes the list by writing a number beside each lettered idea. The group computes a tally of the numbers given to each lettered idea, identifying by score the priority from highest to lowest. This tool is illustrated in Figure 13-21.

    Force field analysis is a tool applicable to identifying and visualizing the relationships of significant influencing forces. Once the problem or process to analyze is identified, the group lists the key forces that promote or hinder solving or streamlining the process, with promoting and hindering forces listed separately. The group then prioritizes each force according to the impact it possesses. Then the group tries to strengthen those forces that promote solving the problem or streamlining the process and tries to weaken those forces that hinder the desired outcome. This tool is illustrated in Figure 13-22.

   A paired-choice matrix is a decision making tool which compares pairs of alternatives until the comparison produces a single solution. A paired-choice matrix is most often used when multiple alternatives are available, the alternatives are relatively similar, or when an objective process is required to ensure that each alternative receives fair and equal consideration. Some analogize this tool to sports league play-offs where a series of games or matches are played between teams, one pair at a time, to determine a champion. This tool is illustrated in Figure 13-23.

   Where the root cause of a problem is particularly difficult to understand, analysis tools may be used, such as flowcharts, affinity diagrams, cause-and-effect diagrams, and Pareto charts. A flowchart is a diagram, often using geometric symbols, that shows the steps in a sequence of operations. This graphical representation of a process can identify both critical stages and problem areas. Standard flowchart symbols exist and are used as shown in Figure 13-24. An affinity diagram organizes information into a visual pattern to show the relationship between factors in a problem. Affinity diagrams begin with specific ideas and move toward broad categories; an affinity diagram is illustrated in Figure 13-25.

   A cause-and-effect diagram , sometimes referred to as a fishbone diagram, identifies major categories of factors that influence an effect, along with the subfactors within each major category. The cause-and-effect diagram begins with broad causes and works toward specifics, often using the categories of 4Ms (methods/ manpower/materials/machinery) or 4Ps (policies/procedures/ people/plant). One such diagram is illustrated in Figure 13-26. A Pareto chart is a bar graph used to identify and separate major and minor problems. It is based on the Pareto principle, which posits that 20% of problems pose 80% of the impact. This chart orders categories according to frequency, in descending order from left to right, and is illustrated in Figure 13-27.

   Armed with these ideas and tools for analysis and decision making, processes can be transformed from their present “as is” state to a “should be” state. This involves addressing those areas of disconnect found in the process review that impede efficiency or effectiveness, such as missing or unnecessary steps, substandard equipment or materials, assignment of work to the wrong group or person, or performing work at the wrong time—for example, in a series rather than on parallel tracks. At times, the efficiency to be gained is the result of improving the execution of the work through additional training or by automating a previously manual process. A series of 347348recommendations that address these impediments, supported by cost-benefit analyses and a timeline, form the design of the implementation plan.

Figure 13-21 | Nominal group technique tool

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Figure 13-22 | Force field analysis tool

   The transition to implementation of a particular process improvement may vary according to the challenges involved. Widespread resistance to change may exist, or special expertise in certain areas may be needed. The impact upon staff and systems may be substantial, and new infrastructure may be necessary. Finally, the depth and breadth of communication requirements necessary to ensure that the improvement is accepted in the work environment can be formidable. Each of these challenges can be met and overcome with proper planning, attention to detail, and wise use of resources. The results are improved processes, which can be measured and integrated into an organization's daily operation.

Figure 13-25 | Sample affinity diagram

Figure 13-26 | Sample cause-and-effect diagram

Figure 13-27 | Sample Pareto chart

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Leaders have applied their expertise and operational knowledge to reach decisions and take action. Workers have applied their knowledge to carry out these decisions and make decisions of their own. During the last half-century, the concept of managing knowledge has been formally recognized as a subset of management theory and practice. Knowledge management refers to the strategies, policies, actions, and tools involved in creating an environment that facilitates the creation, transfer, and sharing of knowledge within an organization. By managing knowledge, the organization stands to gain a competitive advantage and sustain that advantage over time.

   Before one can understand the concept of knowledge management, one must first understand the definition of knowledge. Knowledge is the understanding and use—often in the forms of mental models, scripts, and schemata—of a range of information. Knowledge can be thought of as one element in a continuum, moving from signals to data to information to knowledge to wisdom. Figure 13-28 illustrates this continuum. Signals refer to objects serving to convey data , whereas data generally refer to raw facts and figures. Considered by themselves, these raw facts and figures are meaningless. By contrast, information refers to organized and classified data put into context, or so-called meaningful data. A full understanding and use of this information is referred to as knowledge. Wisdom , in turn, refers to the ability to judge matters soundly, especially as they relate to life, conduct, and practical affairs. It is at the knowledge stage of the continuum that the principles of knowledge management apply.

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Figure 13-28 | The knowledge continuum

   A basic principle of knowledge management is the concept of capturing and categorizing knowledge into one of two categories: explicit and tacit. Explicit knowledge refers to knowledge that can be recorded, archived, codified, or embedded into products. Patents, trademarks, business plans, customer lists, organizational charts, procedures, formulas, and marketing research are all examples of explicit knowledge. Tacit knowledge refers to personal knowledge, or that knowledge contained in people's heads. For example, an individual's learning or experiences are classified as tacit knowledge. Both of these forms of knowledge are sometimes referred to as intellectual capital or knowledge assets.

   Once identified as explicit or tacit, the value of the knowledge is then determined. Valuable explicit knowledge is channeled into some form of recorded, archived, codified, or embedded structure. This contrasts with valuable tacit knowledge, which resides with a given individual. To the extent that tacit knowledge can be readily articulated, it can be transformed into explicit knowledge, available for dissemination. To the extent that tacit knowledge cannot be readily articulated, however, strategies to provide infrastructure support, empowerment management support, and retention and replacement support are used to leverage that knowledge for the organization's benefit.

 Consider the knowledge associated with the concepts of innovation and leadership. Both concepts are highly tacit and complex, and they are not readily articulated or easily transferable to others. Nonetheless, they are highly valued by individuals and organizations. Because of this high value given to the concepts of innovation and leadership, knowledge management theory would support efforts to record an individual's innovation and leadership experiences for sharing with others. To the extent that these experiences cannot be articulated and shared, knowledge management theory would support efforts to retain and empower the individual who holds this knowledge.

   By contrast, consider the knowledge associated with business processes. These processes are generally explicit, may or may not be complex, and are often readily articulated and easily transferable to others. Because of the high value given to business processes, knowledge management theory would support recording them for sharing with others. To the extent that these business processes can be improved, resulting in greater efficiencies for the organization, knowledge management theory would support this process improvement action.

   It is at this point that the principle of knowledge transfer applies. Mechanisms and processes—whether formal or informal— are put into place that allow other individuals and groups, both within and beyond the organization, to integrate this knowledge with their own knowledge. The actions involved with knowledge transfer or sharing are often referred to as knowledge management systems. A knowledge management system (KMS) is a mechanism or process that captures knowledge, uses and refines that knowledge to assist understanding, and transfers or shares that knowledge with others. These systems may work to address entirely new problems or address old problems in new ways, or they may be useful for circumstances that could occur in the future.

   Some knowledge management systems use technology, while other systems do not. The type of technology used varies with the type of knowledge to be transferred. Document management systems, data-mining tools, automated alert systems, searching and indexing software programs, and online analytical processing systems are examples of technologies that are useful for facilitating the transfer of explicit knowledge. Electronic mail, groupware, instant messaging, and related technologies are examples of technologies 350351that are helpful for facilitating the transfer of tacit knowledge. To justify its use and expense, the type of technology chosen should relate to an organization's strategic plan, goals, and objectives.

   While technology often facilitates knowledge management, technology is not required for a successful knowledge management system. In fact, some knowledge management systems do not use technology at all or do so sparingly. These systems focus on peoplerelated or other “soft” issues of management, including organizational behaviors or culture (tacit knowledge) or business practices and processes (explicit knowledge) that do not readily lend themselves to technology solutions. For example, to transfer tacit knowledge, an organization may facilitate joint activities between employees who currently possess the valued knowledge with those who do not, allowing for dialogue and reflection to share knowledge and direct experiences to create new knowledge. To transfer explicit knowledge, an organization may have employees who currently possess the valued knowledge exchange documents or engage in simulations or experiments with those employees who do not. For either tacit or explicit knowledge, an organization may engage in a best practices analysis, using flowcharts and benchmarking approaches as guides. While all of these activities can be aided by technology, they can just as easily be conducted without it.

   As this discussion shows, knowledge management encompasses a broad range of principles, tools, and techniques. This broadness is a strength, since knowledge management can be applied to any discipline, business, or organization. Aligning knowledge management systems to organizational strategies, goals, and objectives serves to maximize the organization's effectiveness and positions the organization for competitive advantage.

Effective Meeting Management One constant in every form of management is the need to conduct meetings. A meeting is a purposeful coming together of people. The purposes of meetings vary, ranging from transmitting information or announcing a decision to serving as forums for sharing ideas, making joint decisions, and planning actions to achieve results. Because meetings have become more frequent, the topics discussed at them more complex, and the categories of persons attending them more broad, it is important that managers understand how to manage meetings effectively.

   Among the first considerations in meeting management is assisting the attendees in understanding the focus of the meeting. The focus can be developed by defining the purpose and desired outcome(s) of the meeting. The purpose is the intention or aim of the meeting (specific purposes were listed earlier in this discussion). Desired outcomes are the tangible results that can be achieved by the end of the meeting. Examples include a better understanding of a topic, a plan with assigned action items, a list of recommendations, or a decision. The focus is further developed by determining the topics to be covered; the best format in which to discuss each topic; the length, time, and place of the meeting; and who should participate. Once these elements are determined, an agenda can be created and distributed to the participants in advance of the meeting. When the meeting begins, the focus can be reemphasized through a restatement of the purpose and desired outcome(s) and a review of the agenda. Ground rules for how the meeting will be managed (e.g., the structure or climate), key information to be delivered (e.g., what precipitated a need for the meeting or what budget amount is involved), and who will handle note taking are often discussed at this stage.

   The heart of meeting management involves concentrating on the content and process of the meeting while encouraging the participation of attendees. Concentrating on the content requires paying attention to what participants contribute to the discussion and relating it to the desired outcome(s) of the meeting. Using techniques that address content, such as periodically summarizing key points or reinforcing constructive contributions, can help the participants reach consensus on the meeting's topic. Concentrating on the process requires attention to format or how the meeting is flowing. Employing techniques that address process, such as quickening or slowing the meeting's pace or reminding the participants of the progress made to date, can help the participants remain focused on the meeting's topic. Encouraging participation requires the use of a variety of techniques, including clarifying or paraphrasing ideas, employing messages of positive reinforcement, and encouraging diverse points of view. The end result of this concentration should be that the participants reach some form of a decision or result.

   Once the decision or result is reached, the next stage involves action. This stage is among the most critical, because participants may find that they have expended enormous amounts of time and energy only to leave the meeting without a clear understanding of what should occur next. To avoid this problem, it is important that participants understand before they leave the meeting how to bring the decision or result to the action level. This can be accomplished by assigning action items as soon as possible, identifying who is accountable for each action, setting deadlines, and establishing methods for monitoring progress. By memorializing in meeting minutes or summaries both the decision or results reached and the manner of accomplishing them, participants can gauge how effective the meeting was and evaluate how to improve future meeting effectiveness.

CONCLUSION

Whether management principles serve as the basis for an individual's work as a manager or as the basis for an awareness of how an organization conducts its business, the theories and practices supporting these principles provide the foundation for lifelong understanding and knowledge. Planning, organizing, directing, controlling, and leading all play a role in successful management. 351352 The development of management theory over time, particularly the development of specialized management theories, shows a response to the striking changes that have occurred in the workplace during the past century, as well as to the changes that will occur in the future.

CHAPTER SUMMARY

The principles of management—planning, organizing, directing, controlling, and leading—are central to the success of each manager within an organization and to the organization itself. Managers use planning to outline what needs to be done and how to actually do it. They organize all identified tasks and assign them to individuals or groups. They direct work through decision making, instructing others, and simplifying work processes. They control work to ensure that activities are accomplished as planned and correct any significant deviations from the plan. They lead by focusing on the interpersonal aspects of an activity, thereby motivating employees and reducing conflicts. When engaging in these activities, managers follow any number of management theories, including specialized theories such as change management, project management, process improvement, knowledge management, and effective meeting management. These management theories largely determine the climate of that portion of an organization for which the managers are responsible.

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Organizing People Organizing people to accomplish goals and objectives requires establishing the divisions and subdivisions of the organization, including the assignment of teams and the interdependencies of divisions, subdivisions, and teams. Most often, this structure is illustrated by an Organizing People Organizing people to accomplish goals and objectives requires establishing the divisions and subdivisions of the organization, including the assignment of teams and the interdependencies of divisions, subdivisions, and teams. Most often, this structure is illustrated by an Figure 13-4. Where a Gantt chart uses different colors to identify the actual and proposed start and completion dates, the color difference can assist the manager in assessing whether an activity is on schedule.Top of Form