Scientific Merit Action Research template (Smart) Form

Leadership Effectiveness in Healthcare Human Resource and Patient Management

Ashlie Burnett

Capella University

Leadership Effectiveness in Healthcare Human Resource and Patient Management

Background

The healthcare system in the United States is undergoing major changes because of the need to reduce the high costs associated with the system. These high costs are associated with the treatment rather than prevention approach that has characterized the system, thereby leading to a rise in treatment costs for chronic illnesses such as heart-related problems and cancer, which are preventable illnesses that result from poor lifestyle choices and improper delivery of preventive care. Healthcare reform is therefore tending towards preventive healthcare delivery and long-term primary care for patients. This reform approach to healthcare delivery poses various challenges to quality healthcare delivery. One of these challenges is leadership in employee and patient engagement. Delivery of long-term primary care and preventive care through more engaging delivery of healthcare services requires a leadership model and leadership competencies that will lead to long-term health of patients and human resource practices that create a favorable working environment for quality of care delivery. This is very important because of the changes in the healthcare system.

One of the changes that will affect leadership effectiveness and human resource management is the aging American population, which will create a dependent population in need of long-term healthcare delivery. In addition, the healthcare reforms are expected to lead to increases in the number of patients accessing healthcare services, necessitating new models of leadership. The increasing number of patients means that there will be increased the need for more healthcare practitioners. According to the American Hospital Association (2013), the number of healthcare professionals in the system might not be enough to handle the higher number of patients who will enter into the healthcare system as part of the healthcare reform process. The association estimates that this surplus number of patients might be in the millions. This creates a potential human resource problem in that workers might suffer from workplace burnout or experience psychological problems because of overstrain. These problems need addressing in order to ensure that there is the quality of care in healthcare organizations and that the employees are motivated. The action research project is therefore designed to advance scientific knowledge on leadership effectiveness in healthcare institutions on various aspects.

Leadership effectiveness in the action research encompasses various components of effectiveness that are deemed important for healthcare organizations operating in an environment where healthcare reform has a significant influence on employee and patient outcomes. These components include job satisfaction, employee and patient quality of care, and managing employee burnout and the psychological health of the patients and the employees. The focus of the advancement of research is on appropriate leadership model for the healthcare organizations and the qualities a leader should embody in such an environment. The action research is based on a case study of Hospital Corporation of America (HCA) in Houston, Texas.

The HCA is a chain of hospitals with a unique operating environment as shown in the hospitals’ financial success during the recession when most hospitals were having financial difficulties. According to Creswell and Abelson (2012) who were writing to the New York Times, the hospital has engaged in practices that could be potentially harmful to the patient and the healthcare professional in order to make higher earning through the healthcare system. The hospital’s dealings with private equity firms, including Bain Capital has produced the $33 billion increase in investment between 2006 and 2012 (Creswell and Abelson, 2012). The hospital has not been ethical in obtaining the high financial results.

Creswell and Abelson (2012) point out that the hospital was involved in various lawsuits such as the Medicare fraud from which the hospital disentangled itself through a $1.7 billion settlement. One of the strategies the hospital has used is the high billing it passes on to patients, Medicare and insurance companies for the services offered at the hospital. In addition to patient reduction strategies such as reducing the number of in-patients, the hospital also instituted measures to cut costs of payroll expenditure for its medical staff (Creswell and Abelson, 2012). This undoubtedly put pressure on the medical staff. Interviews conducted and presented by the Creswell, and Abelson (2012) show that there is the potential for reduced job satisfaction and psychological problems in the hospital's different branches because of the human resource policies. HCA doctors say that there is pressure in the hospitals to increase the profits because the hospitals are linked to private equity funds (Creswell and Abelson, 2012). This could create significant workplace strain that could negatively influence patient and employee outcomes. A study of the practices at the hospital could provide a clearer picture of state of the employee and patient quality of care at the hospitals and advance knowledge on the leadership competencies and models that could lead to improvements in the system.

Statement of the Problem

The HCA hospital branches and the Houston Texas branch, in particular, might need to change its human resource and patient management policies in order to adapt to the changing healthcare environment. There is no clear indication on how the reform process geared towards long-term preventive care could influence the hospital's operations. The hospital has approached health care with the aim of making profits through outpatient treatment where the patients are treated and discharged. With the healthcare reforms focused on long-term care and more involvement with the patient, the human resource and patient practices at the hospital might not be adaptive to the new healthcare environment. In addition, there are provisions in the new legislations on healthcare; patients will have much more influence in the healthcare system than the hospitals, creating the need for a new form of leadership where the doctors are more engaged with the patients.

The Affordable Care Act (ACA) provides various provisions that could hurt the current human resource and patient practices at the HCA. The ACA aims to ensure that there is a reduction of healthcare costs relative to administrative costs. This means that hospitals cannot charge patients for administration but strictly on treatment and preventive care. Preventive care is another change brought by the ACA that could potentially influence the HCA. The ACA covers preventive care freely at no additional charges for the patient. It also gives the patient the ability to choose the doctor they prefer from the list of doctors offered under the different coverage (HHS, 2015). This means that if the HCA wants to remain competitive, as it has been in the past in terms of generation of profits, it should engage in practices that lead to the creation and maintenance of the best human resource and access to quality of care for the patients. The human resource and the patients need the attention of the hospital in terms of leadership practices in order for the hospital to remain successful in the new healthcare reform environment.

There needs to be recognition that in the healthcare environment where long-term engagement with the patient is the focus of care, the organization should ensure that it preserves employee welfare so that it can have access to an engaging and cooperative workforce that is able to diligently follow-up on patient cases in the long-term. Patients and doctor interaction needs to occur in an environment where the leadership is concerned about the employee and patient welfare to produce the best possible results in healthcare. The management needs to engage more with the two aforementioned stakeholders in management and leadership. There needs to be research on participatory leadership and other similar leadership models for implementation in the new healthcare environment where patient and employee engagement are increasing in importance. Since the healthcare reforms will progressively usher in a new era of healthcare where the patient gains prominence as a stakeholder, organizations need to change their leadership to more engagement with the stakeholders, especially those with private equity firm backing such as the HCA.

Contribution to Society

The research hopes to provide data that can lead to the improvement of patient engagement and more accountability in health care organizations, especially those with private interests such as those aligned with private equity firms such as the HCA. By conducting research on the leadership effectiveness at the HCA, Houston, the action research will provide insights on the means such hospitals could use to manage effectively their human resources and patients in order to improve healthcare outcomes. This will lead to ethical and more patient-centered hospital practices that are consonant with the healthcare reform initiatives instituted by the government. In addition, the action research will aid in the complex and long-term process of institutionalizing the healthcare reform through providing leadership models and approaches to leadership in healthcare that produce the best quality of care outcomes for employees and the patients.

Need for Change

The American Hospital Association (2013) report points out various issues regarding leadership in American hospitals that highlight the much-needed changes in human resources considering the changing healthcare environment due to reforms. The report notes that hospitals should engage in workforce planning. This is the process of estimating the future needs of the hospital in terms of employee talent and expertise. The process involves evaluating the current workforce competencies, then creating a future workforce profile according to changing needs, and finally closing the gaps that exist between the current and the future workforce profile (American Hospital Association, 2013). The action research follows a similar format where the paper conducts research to find out how the changing healthcare environment is creating changes in the leadership of healthcare organizations and its interaction with the employee and patient stakeholders.

Various researches and studies justify the need for current action research. According to a 2010 report by the Bureau of Labor Statistics, the number of professionals working in the healthcare profession is set to increase in number. There is also set to be increased diversification in terms of healthcare delivery. These changes are expected to occur between 2008 and 2018, which is a higher rate than all of the professions. (Bureau of Labor Statistics, 2010). The increase in some professionals working in the healthcare industry means healthcare institutions will need leadership and management competencies more than before to manage effectively the large human resource. The HCA has engaged in employee downsizing but will have to reconsider such approaches to leadership and management in the future if it wants to remain competitive and offer the quality of care to employees and patients. This brings to question on considerations on management and leadership.

Various changes should occur in an evolving healthcare environment. Thompson (2007) says that there are internal and external domains that comprise the healthcare environment that should influence management decisions (Thompson, 2007; Atkinson, 2011). The management should, therefore, ensure that it has leadership that considers both domains of influence on the organization, such as the policy and regulatory environment as external factors and patient and employee engagement as internal factors. Atkinson (2011) says that the new healthcare environment requires leaders that can transform the organization because the healthcare environment in the United States is a dynamic environment. As Thompson (2007) has already pointed out, there is a need for managers in leadership roles to consider how internal and external factors interact dynamically to produce changes in the healthcare environment.

The action research will, therefore, highlight the issues in the HCA concerning employee and patient outcomes. The research will investigate leadership effectiveness at the organization to ascertain to provide leadership models and qualities that should comprise the management in a dynamic healthcare environment. The action research project is necessary considering the HCA's record of malpractices concerning patient and employee conduct and treatment.

Theoretical Foundation

In dealing with the identified problem of organizational leadership effectiveness problem identified at HCA, it is important to consider that the organizational environment in healthcare, and in many other organizations in diverse sectors, is changing towards systems architecture. As Thompson (2007) has pointed out, the interaction of internal and external environment factors determine the nature of the operating environment in healthcare. Luckett and Grossenbacher (2003) also expressed similar views in that they adopted systems thinking in their work on action research projects. The healthcare environment is one where there is increasing dynamism, which requires a different style of leadership model that promotes qualities that lead to adaptation to the dynamic operating environment. Atkinson (2011) proposed transformational leadership as one of the means that healthcare organizations can thrive in a changing and challenging healthcare environment where the reform process is going to influence significantly the activities of hospitals and employees.

Based on the dynamic nature of the healthcare environment already established in the preceding sections, the theory endorsed for the action project is the shared leadership model. This leadership model is deemed consonant for the health care environment of the near future because of its capacity to elicit the networked working environment that is necessary for the long-term patient environment. The American Hospital Association (2013) highlights one essential component of the human resource management in healthcare organizations that are relevant for the current action research project. The organization states that hospitals need to ensure that their hospital workforce-planning model is up to date concerning the changing operating environment. The American Hospital Association (2013) echoes the sentiments made by Thompson (2007), Atkinson (2011) on the internal and external environmental factors that leadership should consider when making decisions. American Hospital Association (2013) states that the organization’s strategic direction, which is the internal environment, is important in healthcare leadership but the organization also needs to consider the ‘big picture’, which is the external environment, in its workforce-planning process. The organization recommends that healthcare organizations should ensure that they track the changes in legislation such as the Affordable Care Act in order to understand how the external environment is going to influence their internal operations. This is a good example of the dynamism required in the healthcare environment. In addition, the increase in number of healthcare professionals predicted by the Bureau of Statistics (2010) means that teamwork is going to be a key consideration in leadership models in healthcare. Before delving into the shared leadership model and the research conducted to establish its empirical significance as an evidence-based theory, it is important to consider first the various characteristics that make an effective leader in a dynamic healthcare environment.

Atkinson (2011) and Robbins and Davidhizar (2007) provide various roles that a leader should play in a dynamic environment. The researchers state that leaders have a large role to play in the healthcare organization in terms of engendering teamwork, improving self-esteem and ensuring that the work environment is one that engenders job satisfaction, thereby leading to feelings of well-being. Other researchers express similar sentiments and suggest that transformational leadership could lead to operating environments that promote employee and, therefore, patient well-being through quality of care delivery (Atkinson, 2011; Robbins and Davidhizar, 2007; Marshall, 2011; Trossman, 2010). Employees in a hospital environment need a leader concerned with their psychological health. This means that the patients also benefit from the quality of care made possible by employees who feel like they work in an environment where the leadership cares about their wellbeing.

Based on the considerations made thus far, the shared leadership model appears to be a robust leadership model that enables the manifestation of the leadership qualities and characteristics identified in the preceding paragraph. Shared leadership is an idea that is in contrast with the attitudes of most American organizations where the top-down approach is the most favored. Leaders are seen as individuals who manage other individuals in a hierarchical model. This model is rather rigid for an environment where there are constant changes in the internal and external environment. For a more dynamic leadership approach that does not involve a strict hierarchical structure, the shared leadership model might provide improvements to the current leadership at HCA and hospitals around the country that are feeling the changes of the healthcare reforms.

Shared leadership is important in organizations such as knowledge organizations such as those in healthcare because of the teamwork required to manage the knowledge generation and archival process. Avolio, Walumbwa, and Weber (2009) point out that in organizations where hierarchy is not as important as effective leadership in teamwork, then shared leadership is a more effective model for the organization’s leadership process (O’Toole et al., 2002; Avolio, Walumbwa, and Weber, 2009; ). Within teams, organizations are able to reach the goals of the organization and individual goals in a manner that produces the best results for the organization (Bennis, 1999). There are various psychological advantages to the employee and consequently the quality of care to the patient when shared leadership is employed.

Shared leadership leads to reduced competition between employees, thereby reducing the feelings of stress that come from working in an overly competitive working environment (Hooker and Csikszentmihalyi, 2003). Other benefits of shared leadership that increases employee motivation and job satisfaction include social support and the shared purpose that is characteristic of teams (Wood, 2005). Shared leadership, according to Wood (2005), is inseparable from teams. Wood (2005) found that the structure of the team is not important when it comes to the success of shared leadership models. This means that the shared leadership model leads to a fluid management style that allows amorphous and dynamic structures to exist alongside the rigid structures of the organization.

Finally, the shared leadership model supports the knowledge management aspect of healthcare organizations, which is an important aspect of ensuring that patients get high quality of care in healthcare institutions. Knowledge management requires teamwork to generate the intellectual capital that makes a healthcare organization more successful (Pearce and Manz, 2005). Other researchers, Greenberg-Walt and Robertson (2001), state that in organizations where knowledge is a significant aspect of the operations of the organizations, shared leadership will increase in importance since it contains the framework for the management of such knowledge within the teams that generate such knowledge. Jackson (2000) carried out research in a hospital setting. His study provides important empirical research on the potential for application of the shared leadership model in the healthcare setting. According to his study at St. Joseph’s Healthcare Hospital, horizontal rather than vertical team structures that promote the shared burden of the healthcare environment based on teamwork, ownership, equity and accountability would produce better results in terms of knowledge management and other functions (Jackson, 2000). The shared leadership model, therefore, appears as the best model for the dynamic, knowledge-driven and teamwork-based hospital environment.

Shared leadership is the selected model for the action research project at HCA in Houston, Texas. The hospital’s management could benefit from the implementation of a leadership model that considers the changing operating environment where patient engagement will become more important in healthcare delivery. In addition, the expected increase in healthcare professionals means that the hospital will have to institute better human resource measures that lead to employee motivation, job satisfaction and psychological well-being to ensure quality of care delivery to the patient. These considerations and the other ones mentioned in the preceding sections on the theoretical foundation will form the basis of the research objectives and questions.

Investigator Position

The role of the researcher is to act as an outside and independent observer that will analyze the internal environment through the case study in order to evaluate whether it is consonant with the external environment. The researcher will develop the questionnaires for the research based on the theoretical model developed for the case study. This will ensure that the research collects relevant data for evaluation on whether the hospital’s leadership is working effectively and make required recommendations based on the findings.

The action researcher will also offer recommendations on sample selection of the employees and the management in order to obtain insights into the leadership effectiveness from different perspectives. Data on patient outcomes might be obtained from the hospital database, and the action researcher is supposed to organize these efforts to ensure access to such data.

Research Questions and Objectives

The main objectives of the action research project, which are used in the development of the research question, include finding out how well the hospital's internal environment fits with the changing external environment of the healthcare system. HCA is a hospital that has benefitted financially from the previous healthcare system through the various human resource and patient practices conducted by the organization as shown by Creswell and Abelson (2012). The new healthcare reforms such as affordable care and the focus on the patient's long-term health might cause problems for the hospital in terms of income-generating activities. The hospital needs to ensure that it adapts to this new environment to remain as one of the top hospitals in the country and deliver the quality of care to the patients and the employees.

Another objective is to find out the leadership practices in the hospital, how adaptive they are in ensuring that employees and patients have the well-being that is required for better quality of care outcomes. Employee well-being is a major concern at the hospital based on the profile of the hospital. Based on the objectives, the following are the research questions developed for the study:

· How adaptive are the hospital’s human resource and patient outcomes to the changing healthcare environment?

· Is the hierarchical leadership model at the hospital conducive to best practices in terms of human resource and patient outcomes?

· What is the employee rating of well-being at the company?

· Do business considerations trump quality of care for patients?

Action Plan

Look

Information gathering will involve the acquisition of interview information from the respondents. In addition, the research team will observe the surroundings of the hospital to pick up qualitative information such nonverbal cues that might provide information about the nature of leadership at the hospital. The researchers will also look at secondary sources to get multiple perspectives on the effective leadership issue.

Think

This phase will involve the analysis and evaluation of the primary, and secondary information gathered. The analysis will involve a synthesis of the various perspectives observed to acquire an objective and empirically valid analysis of the leadership situation at the hospital.

Act

Finally, the researcher will demonstrate the findings from primary and secondary data sources that there need to be improvements to the system to ensure that it is in tandem with the changes in the healthcare environment. The main aim is to show the need for a leadership model that is dynamic and adaptive enough to ensure that the hospital has favorable outcomes in the future.

Dissemination Plan

The information acquired will be published in reputable journals where it will advance knowledge on leadership. Informal articles meant for blogs and news outlets such as government agencies associated with healthcare reform will form additional outlets for dissemination for the public that might not have access to professional journals.

Action Research Data Collection Methods

The data collection method for the action research is the case study method where the research will collect qualitative data through questionnaires and surveys. This will provide the primary data needed for the research. In addition, the case study will require secondary data as well to augment the primary data. The synthesis of primary and secondary data will provide a more comprehensive analysis of the organization's internal and external environment and, therefore, provide a better basis for recommendations and interventions.

Assumptions

The following are the major assumptions made for the paper:

· The action research assumes that the healthcare environment predictions made will come into effect

· The project assumes that private hospitals will be equally affected by the healthcare reform process as government hospitals

· The HCA at Houston is assumed to have similar organizational structure and practices as other branches of the HCA

Limitations

The following are the limitations of the research:

· The qualitative research design means that the data obtained from the research is not easily generalizable to other hospital institutions

· The HCA is a hospital with private equity firm financing and, therefore, might not be representative of the other hospitals without such funding

· The future of health care reform might change in case of changes in government during elections shortly

Summary

The action research project is supposed to ensure that there is an effective leadership model in place for hospital institutions that can produce the best outcomes in terms of patient and employee well-being. The case chose for the study, which is HCA in Houston Texas is a good example because of the malpractices involving patients and employees such as excessive billing and employee downsizing. These practices might not be adaptive for the future healthcare environment that is one destined to focus more on the patient. In addition, the focus on long-term preventive care means that the hospitals will have to engage more with patients, necessitating a workforce that can work in teams to ensure the quality of care for the patients.

Bibliography

Alvarez, J. L. & Svejenova, S., (2005). Sharing Executive Power Roles and Relationships at the Top.

Cambridge: Cambridge University Press.

American Hospital Association. (2013). Developing an Effective Health Care Workforce

Planning Model. Retrieved July 16, 2015, from

http://www.aha.org/content/13/13wpmwhitepaperfinal.pdf

Atkinson, S. (2011). Are you a transformational leader? Nursing Management, (September,

2011). DOI:10.1097/01.NUMA.0000403279.04379.6a

Avolio, B., Walumbwa, F., and Weber, T. (2009). Leadership: Current theories, research, and future

directions. Annual Review of Psychology, 60(1), 421-449.

Bennis, W. (1999). The end of leadership: Exemplary leadership is impossible without full inclusion,

initiatives, and cooperation of followers. Organizational Dynamics, 28(1), 71-80.

Berger, P. L. & Luckmann, T. (1966). The social construction of reality: a treatise in the sociology of

knowledge. New York: Anchor books.

Bureau of Labor Statistics. (2010). Occupational Outlook Handbook 2010-2011. Retrieved July

16, 2015 from www.bls.org/oco/ocos014.htm

Carson J.B., Tesluk P. & Marrone J.A., (2007). Shared leadership in teams: An investigation of

antecedent conditions and performance. Academy of Management Journal, 50(5), 1217–1234.

Creswell, J. and Abelson, R. (2012). A Giant Hospital Chain Is Blazing a Profit Trail.

Retrieved July 16, 2015 from http://www.nytimes.com/2012/08/15/business/hca-giant-hospital-chain-creates-a-windfall-for-private-equity.html?_r=1

Court, M. (2003). Towards democratic leadership: Co-principal initiatives. International Journal of

Leadership in Education, 6(2), 161.

DiMaggio, P.J. & Powell, W.W., (1983). The Iron Cage Revisited: Institutional Isomorphism and Collective

Rationality in Organizational Fields. American Sociological Review, 48(2), 147-160.

Ensley, M. D., Hmieleski, K. M., and Pearce, C. L. (2006). The importance of vertical and shared

leadership within new venture top management teams: Implications for the performance of

startups. The Leadership Quarterly, 17(3), 217-231.

Greenberg-Walt, C.L. and Robertson, A.G. (2001). The Evolving Role of Executive Leadership. San

Francisco: Jossey-Bass.

HHS. (2015). About the Law. Retrieved July 16, 2015 from

http://www.hhs.gov/healthcare/rights/

Hsu, P. S., & Sharma, P. (2008). A case study of enabling factors in the technology integration change

process. Educational Technology & Society, 11(4) 213-228.

Hooker, C. and Csikszentmihalyi, M. (2003). Flow, Creativity, and Shared Leadership. London: Sage

publications.

Jackson, S. (2000). A qualitative evaluation of shared leadership barriers, drivers and recommendations.

Journal of Management in Medicine, 14(3/4), 166-178.

Jackson, B. and Parry, K., (2008). A very short, fairly interesting and reasonably cheap book about

studying leadership. Los Angeles; London : SAGE.

Luckett S, Grossenbacher K (2003). A critical systems intervention to improve the implementation

of a District Health System in Kwa Zulu-Natal. Systems Research and Behavioural Science,

20,147–162.

O’Toole, J., Galbraith, J., and Lawler, E. E. (2002). When two (or more) heads are better than one: The

promise and pitfalls of shared leadership. California Management Review, 44(4), 65-83.

Pearce, C. and Manz, C. (2004). Shared leadership. Executive Excellence, 21(7), 6-8.

Pearce, C. and Manz, C. (2005). The New Silver Bullets of Leadership: The Importance of Self and

Shared Leadership in Knowledge Work. Organizational Dynamics, 34(2), 130–140.

Marshall, E. (2011). Transformational Leadership in Nursing. New York, NY: Springer Publishing.

McIntyre, M. G. (1999). Five ways to turn your management team into a leadership team. The Journal for

Quality and Participation, 22(4) 40-44.

Meyer, J.W. & Rowan, B. (1977). Institutionalized Organizations: Formal Structure as Myth and

Ceremony. The American Journal of Sociology, 83(2), 340-363.

Meyers, R. A., & Johnson, J. R. (2008). Facilitating the design of a campus leadership team.

Communication Education, 57(4), 472-481.

Robbins, B., Davidhizar, R. (2007). Transformational leadership in health care today. Health Care Manag.

26(3),234-239.

Thompson, J.M. (2007). Health Services Administration. Sudbury, MA: Jones and Bartlett.

Trossman, S. (2010). IOM report calls for more nurse leaders through-out health care. Am Nurse,

42(6),14.

Wood, M. (2005). Determinants of shared leadership in management teams. International Journal of

Leadership Studies, 1(1), 64-85.