Powerpoint

Throughout history, nursing has been required to respond to changing technological and social forces. The new managerial responsibilities placed on organized nursing services require nurse administrators who are knowledgeable, skilled, and competent in all aspects of management. Now more than ever there is a greater emphasis on the business of health care, with managers being involved in the financial and marketing aspects of their respective departments. To confront expanding responsibilities and demands, the manager’s role must take on new dimensions to facilitate quality out- comes in patient care and meet other strategic institutional goals and objectives.

Although, management functions are similar in every discipline and across soci- eties, changes in the healthcare industry in the last 20 years have been so dramatic that nurse managers have had to bring a new cadre of skills into a dynamic and rap- idly changing managerial role (Kleinman, 2003).

The relationship between leadership and management continues to prompt some debate, although the literature demonstrates the need for both (Trent, 2003; Zaleznik, 2004). Whereas management emphasizes control–control of hours, costs, salaries, overtime, use of sick leave, inventory, and supplies–leadership increases productivity by maximizing work force effectiveness.

Leadership is viewed by some as one of management’s many functions; others maintain that leadership requires more complex skills than management and that management is only one role of leadership; still others delineate between the two. But if a manager guides, directs, and motivates others and a leader empowers oth- ers, then it could be said that every manager is a leader.

Management and leadership are, however, first artificially separated in this chapter so that there is a full understanding of the functions of management. The following are some of the characteristics of managers:

• Have an assigned position within the formal organization • Have a legitimate source of power due to the delegated authority that

accompanies their position • Are expected to carry out specific functions, duties, and responsibilities • Emphasize control, decision making, decision analysis, and results • Manipulate people, the environment, money, time, and other resources to

achieve organizational goals • Have a greater formal responsibility and accountability for rationality and

control than leaders • Direct willing and unwilling subordinates

Historically, strong management skills were valued more than strong leadership skills in the healthcare industry. This was true not only in nursing and health care but throughout businesses in Western society. Only in the last 50 years has the world shifted much of its research and interest onto leadership. Effective managers need to be well grounded in management theory and to understand management decision making. Leadership without management results in chaos and failure for both the organization and the individual executive. The ultimate goal for all execu- tives is to integrate management functions and leadership roles. This chapter will focus on providing an historical overview of management theory development and provide some tools for management decision making.

25CHAPTER 2 � Introduction to Management and Management Decision Making

HISTORICAL DEVELOPMENT OF MANAGEMENT THEORY

Management science, like nursing, develops a theory base from many disciplines, such as business, psychology, sociology, and anthropology. Because organizations are complex and varied, theorists’ views of what successful management is and what it should be have changed repeatedly in the last 100 years.

Scientific Management (1900–1930)

Frederick W. Taylor, the “father of scientific management,” was a mechanical engi- neer in the Midvale and Bethlehem Steel plants in Pennsylvania in the late 1800s. Frustrated with what he called “systematic soldiering,” where workers achieved minimum standards doing the least amount of work possible, Taylor postulated that if workers could be taught the “one best way to accomplish a task,” productivity would increase. Borrowing a term coined by Louis Brandeis, a colleague of Taylor’s, Taylor called these principles “scientific management.” The four overriding principles of scientific management as identified by Taylor (1911) are:

1. Traditional “rule-of-thumb” means of organizing work must be replaced with scientific methods. In other words, by using time and motion studies and the expertise of experienced workers, work could be scientifically designed to promote greatest efficiency of time and energy.

2. A scientific personnel system must be established so workers can be hired, trained, and promoted based on their technical competence and abilities. Taylor thought each employee’s abilities and limitations could be identified so the worker could be best matched to the most appropriate job.

3. Workers should be able to view how they “fit” into the organization and how they contribute to overall organizational productivity. This provides common goals and a sharing of the organizational mission. One way in which Taylor thought this could be accomplished was by the use of financial incentives as a reward for work accomplished. Because Taylor viewed humans as “economic animals” motivated solely by money, workers were reimbursed according to their level of production, rather than by an hourly wage.

4. The relationship between managers and workers should be cooperative and interdependent, and the work should be shared equally. Their roles, however, were not the same. The role of managers, or “functional foremen” as they were called, was to plan, prepare, and supervise. The worker was to do the work.

What was the result of scientific management? Productivity and profits rose dramatically. Organizations were provided with a rational means of harnessing the energy of the industrial revolution. Some experts have argued that Taylor was not a humanist and that his scientific principles were not in the best interest of unions or workers. However, it is important to remember the era in which Taylor did his work. During the industrial revolution, laissez-faire economics prevailed, optimism was high, and a Puritan work ethic was prevalent. Taylor maintained that he truly believed managers and workers would be satisfied if increased productivity resulted in adequate financial rewards.

26 UNIT 1 � A New Approach to Leadership and Management

As the cost of labor rose in the United States, many organizations took a new look at scientific management. Healthcare organizations are using new technology, such as video cameras and computers for time and motion studies, to enable indi- viduals to find ways to “work smarter” (Russell, 2000). The implication is that managers need to think of new ways to do traditional tasks so that work is more efficient. Meltzer (1999) maintains that time and motion studies can be used to improve performance, cut costs significantly, and improve the quality of care.

27CHAPTER 2 � Introduction to Management and Management Decision Making

Strategies for Efficiency In small groups, discuss some work routines carried out in healthcare organizations that seem to be inefficient. Could such routines or the time and motion involved to carry out a task be altered to improve efficiency without jeopardizing quality of care? Make a list of ways that nurses could work more efficiently. Don’t limit your examination only to nursing procedures and routines, but examine the impact other departments or the arrangement of the nurse’s work area may have on preventing nurses from working more efficiently. Share your ideas with your peers.

Learning Exercise 2.1

Managers need to think of new ways to do traditional tasks so that work is more efficient.

Bureaucracy

About the same time that Taylor was examining worker tasks, Max Weber, a well-known German sociologist, began to study large-scale organizations to determine what made some more efficient than others. Weber saw the need for legalized, formal authority and consistent rules and regulations for personnel in different positions; he thus proposed bureaucracy as an organizational design. His essay, “Bureaucracy,” was written in 1922 in response to what he perceived as a need to provide more rules, regulations, and structure within organizations to increase efficiency. Much of Weber’s work and bureaucratic organizational design are still evident today in many healthcare institutions. His work is discussed further in Chapter 12.

Management Functions Identified (1925)

Henri Fayol (1925) first identified the management functions of planning, organiza- tion, command, coordination, and control. Luther Gulick (1937) expanded on Fayol’s management functions in his introduction of the seven activities of management— planning, organizing, staffing, directing, coordinating, reporting, and budgeting—as denoted by the mnemonic POSDCORB. Although often modified (either by includ- ing staffing as a management function or renaming elements), these functions or activities have changed little over time. Eventually, theorists began to refer to these functions as the management process.

The management process, shown in Figure 2.1, is this book’s organizing frame- work. Brief descriptions of the five functions for each phase of the management process follow:

1. Planning encompasses determining philosophy, goals, objectives, policies, procedures, and rules; carrying out long- and short-range projections; deter- mining a fiscal course of action; and managing planned change.

2. Organizing includes establishing the structure to carry out plans, determining the most appropriate type of patient care delivery, and grouping activities to meet unit goals. Other functions involve working within the structure of the organization and understanding and using power and authority appropriately.

3. Staffing functions consist of recruiting, interviewing, hiring, and orienting staff. Scheduling, staff development, employee socialization, and team building are also often included as staffing functions.

4. Directing sometimes includes several staffing functions. However, this phase’s functions usually entail human resource management responsibili- ties, such as motivating, managing conflict, delegating, communicating, and facilitating collaboration.

5. Controlling functions include performance appraisals, fiscal accountability, quality control, legal and ethical control, and professional and collegial control.

In many ways, the management process is similar to the nursing process, as shown in Figure 2.2. Both processes are cyclic, and many different functions may occur simultaneously. Suppose that a nurse-manager spent part of the day working on the budget (planning), met with the staff about changing the patient care man- agement delivery system from primary care to team nursing (organizing), altered the staffing policy to include 12-hour shifts (staffing), held a meeting to resolve a con- flict between nurses and physicians (directing), and gave an employee a job perform- ance evaluation (controlling). Not only would the nurse-manager be performing all phases of the management process, but each function has a planning, implementing, and controlling phase.

28 UNIT 1 � A New Approach to Leadership and Management

Planning

Controlling

Directing

Organizing

Staffing

Figure 2.1 The management process.

Just as nursing practice requires that all nursing care has a plan and an evaluation, so too does each function of management.

Human Relations Management (1930–1970)

During the 1920s, worker unrest developed. The industrial revolution had resulted in great numbers of relatively unskilled laborers working in large factories on spe- cialized tasks. Thus, management scientists and organizational theorists began to look at the role of worker satisfaction in production. This human relations era developed the concepts of participatory and humanistic management, emphasizing people rather than machines.

Participative Management Mary Parker Follett was one of the first theorists to suggest basic principles of what today would be called participative decision making or participative management. In her essay “The Giving of Orders” (1926), Follett espoused her belief that managers should have authority with, rather than over, employees. Follett stated that to do so, a need existed for collective decision making.

The human relations era also attempted to correct what was perceived as the major shortcoming of the bureaucratic system—a failure to include the “human element.” Studies done at the Hawthorne Works of the Western Electric Com- pany near Chicago between 1927 and 1932 played a major role in this shifting focus. The studies, conducted by Elton Mayo and his Harvard associates, began as an attempt to look at the relationship between light illumination in the factory and productivity.

29CHAPTER 2 � Introduction to Management and Management Decision Making

Planning

Simplified Nursing Process Management Process Functions

Controlling

Directing

Organizing

Staffing

Planning

ASSESSING

PLANNING

IMPLEMENTING

EVALUATING

Figure 2.2 Integrating nursing and management processes.

Recognition of Workers Mayo and his colleagues discovered that when management paid special attention to workers, productivity was likely to increase, regardless of the environmental working conditions. This Hawthorne effect indicated that people respond to being studied, attempting to increase whatever behavior they feel will continue to warrant the attention. Mayo (1953) also found that informal work groups and a socially informal work environment were factors in determining productivity, and Mayo recommended more employee participation in decision making.

Employee Satisfaction Douglas McGregor (1960) reinforced these ideas by theorizing that managerial attitudes about employees (and, hence, how managers treat those employees) can be directly correlated with employee satisfaction. He labeled this Theory X and Theory Y. Theory X managers believe that their employees are basically lazy, need constant supervision and direction, and are indifferent to organizational needs. Theory Y managers believe that their workers enjoy their work, are self-motivated, and are willing to work hard to meet personal and organizational goals.

Flexibility and Employee Participation Chris Argyris (1964) supported McGregor and Mayo by saying that managerial domination causes workers to become discouraged and passive. He believed that if self-esteem and independence needs are not met, employees will become discour- aged and troublesome or may leave the organization. Argyris stressed the need for flexibility within the organization and employee participation in decision making.

The human relations era of management science brought about a great interest in the study of workers. Many sociologists and psychologists took up this challenge, and their work in management theory contributed to our understanding about worker motivation, which will be discussed in Chapter 18. Table 2.1 summarizes the development of management theory up to 1970.

By the late 1960s, there was growing concern that the human relations approach to management was not without its problems. Most people continued to work in a bureaucratic environment, making it difficult to always apply a participatory

Table 2.1 Developers of Management Theory

Theorist Theory

Taylor Scientific management Weber Bureaucratic organizations Fayol Management functions Gulick Activities of management Follett Participative management Mayo Hawthorne effect McGregor Theory X and Theory Y Argyris Employee participation

30 UNIT 1 � A New Approach to Leadership and Management

approach to management. The human relations approach was time-consuming and often resulted in unmet organizational goals. In addition, not every employee liked working in a less-structured environment.

The evolution of management theory has affected how managers address workers’ concerns and needs. The early management theorists discounted workers’ needs and focused on productivity and efficiency. Later the needs and motivation of workers became the focal point of the work of the human relation theorist’s research into man- agement science. It was not until the 1960s that it became apparent that management was a complex issue that was intertwined with leadership. The following chapter will focus on leadership and the relationship between leadership and management.

MANAGEMENT DECISION-MAKING TECHNOLOGY

As was discussed in Chapter 1, decision making is one of a manager’s primary functions. Clancy (2003) maintains that even the most experienced manager can- not eliminate all uncertainty when making decisions. However, to assist the man- ager in making decisions, management analysts have developed tools that provide order and direction in obtaining and using information or that are helpful in select- ing who should be involved in making the decision. Because there are so many of these decision aids, this chapter presents selected technology that would be most helpful to a beginning manager. Some of these aids encourage analytical thinking, others are designed to increase intuitive reasoning, and a few encourage use of both hemispheres of the brain.

Quantitative Decision-Making Tools

Some management authors label management decision-making aids as models; others use the term “tools.” It is only important to remember that any decision- making aid always results in the need for the person to make a final decision and that all aids are subject to human error.

Decision Grids A decision grid allows one to visually examine the alternatives and compare each against the same criteria. Although any criteria may be selected, the same criteria are used to analyze each alternative. An example of a decision grid is depicted in Figure 2.3. When many alternatives have been generated or a group or committee is collaborating on the decision, these grids are particularly helpful to the process. This tool, for instance, would be useful when changing the method of managing care on a unit or when selecting a candidate to hire from a large interview pool. The unit manager or the committee of nursing staff would evaluate all the alter- natives available using a decision grid. In this manner, every alternative is evalu- ated using the same criteria. It is possible to weight some of the criteria more heavily than others if some are more important. To do this, it is usually necessary to assign a number value to each criterion. The result would be a numeric value for each alternative considered.

31CHAPTER 2 � Introduction to Management and Management Decision Making

Payoff Tables The decision aids that fall in this category have a cost-profit-volume relationship and are very helpful when some quantitative information is available, such as the item’s cost or predicted use. To use payoff tables, one must determine probabilities and use historical data, such as a hospital census or a report on the number of oper- ating procedures performed. To illustrate, a payoff table might be appropriately used in determining how many participants it would take to make an in-service program break even.

If the instructor for the class costs $400, the in-service director would need to charge each of the 20 participants $20 for the class, but for 40 participants, the class would cost only $10 each. The in-service director would use attendance data from past classes and the number of nurses potentially available to attend to determine probable class size and thus how much to charge for the class. Payoff tables do not guarantee that a correct decision will be made, but they assist in visualizing data.

Decision Trees Because decisions are often tied to the outcome of other events, management analysts have developed decision trees. Used to plot a decision over time, decision trees allow visualization of various outcomes. The decision tree in Figure 2.4 compares the cost of hiring regular staff to the cost of hiring temporary employ- ees. Here the decision is whether to hire extra nurses at regular salary to perform outpatient procedures on an oncology floor or to have nurses available to the unit on an on-call basis and pay them on-call and overtime wages. The possible con- sequences of a decreased and an increased volume of procedures must both be considered. Initially, costs would increase in hiring a regular staff, but over a longer period of time, this move would mean greater savings if the volume of procedures does not dramatically decrease.

Consequence Tables Clancy (2003) used a consequence table to demonstrate how various alternatives create different consequences. A consequence table lists the objectives for solving a

32 UNIT 1 � A New Approach to Leadership and Management

Financial effect

Political effect

Departmental effect Time DecisionAlternative

Figure 2.3 A decision grid.

problem down one side of a grid and rates how each alternative would meet the desired objective. For example, consider this problem: The number of patient falls has exceeded the benchmark rate for two consecutive quarters. After a period of analysis the following alternatives were selected as solutions:

• Provide a new educational program to instruct staff on how to prevent falls. • Implement a night check to ensure that patients have side rails up and beds

are in a low position. • Implement a policy requiring soft restraints orders on all confused

patients.

The decision maker then lists each alternative opposite the objectives for solving the problem, which for this problem might be:

• Reduces the number of falls • Meets regulatory standards • Is cost effective • Fits present policy guidelines.

The decision maker(s) then ranks each desired objective and examines each of the alternatives through a standardized key, which allows a fair comparison between alternatives and assists in eliminating undesirable choices. It is important

33CHAPTER 2 � Introduction to Management and Management Decision Making

POSSIBLE EVENTS

Increased demand for procedures

Decreased demand for procedures

Increased demand for staff

Decreased demand for staff

Pay overtime and on-call wages

Decision point (Last event to occur)

ALTERNATIVE ACTIONS

Hire regular staff

Variable affecting the direction of the decision tree: • Revenue from procedures • Net cash flow

• Costs • First year expected value

Figure 2.4 A decision tree.

to examine long-term effects of each alternative as well as how the decision will affect others. See Table 2.2 for an example of a consequence table.

Program Evaluation and Review Technique

Program evaluation and review technique (PERT) is a popular tool to determine the timing of decisions. Developed by the Booz-Allen-Hamilton organization and the United States Navy in connection with the Polaris missile program, PERT is essentially a flowchart that predicts when events and activities must take place if a final event is to occur. Figure 2.5 shows a PERT chart for devel- oping a new outpatient treatment room for oncology procedures. The number of weeks to complete tasks is listed in optimistic time, most likely time, and pes- simistic time. The critical path shows something that must occur in the sequence before one may proceed. PERT is especially helpful when a group of people are working on a project. The flowchart keeps everyone up-to-date, and problems are easily identified when they first occur. Flowcharts are popular, and many people use them in their personal lives.

34 UNIT 1 � A New Approach to Leadership and Management

Table 2.2 Consequence Table: An Example

Objectives for Problem Solving Alternative 1 Alternative 2 Alternative 3

1. Reduces the number X X X of falls

2. Meets regulatory X X X standards

3. Is cost effective X X

4. Fits present policy X guidelines

Decision Score

35CHAPTER 2 � Introduction to Management and Management Decision Making

Decision to develop a staffed outpatient treatment

room

5-7-9 2-3-42-3-4 Renovation complete

Staff recruited

Staff hired

2-3-4 Staff

trained

4-5-6

1-2-3

Equipment installed

Equipment received

Equipment ordered

Equipment and staff

ready

3-4-5

1-2-3

2-3-4

10-12-14

Critical path

Number of weeks to complete task ranked from most optimistic, to most likely, to most pessimistic finish times

Planning complete

Room gutted

Figure 2.5 An example of a PERT flow diagram.

Charting Workflow Think of some project you’re working on; it could be a dance, a picnic, remodeling your bathroom, or a semester schedule of activities in a class. Assignment: Draw a flowchart, inserting at the bottom the date activities for the event are to be completed. Working backward, insert critical tasks and their completion dates. Refer to your flowchart throughout the project to see if you stay on target.

Learning Exercise 2.2

PITFALLS IN USING DECISION-MAKING TOOLS

Clancy (2003) maintains that there is a strong tendency for managers to favor first impressions when making a decision and a second tendency called confirmation biases often follows. A confirmation bias has a tendency to affirm one’s initial impression and preferences as other alternatives are evaluated. So even using conse- quence tables, decision trees and other quantitative decision tools will not guaran- tee a successful decision.

It is also human nature to focus on an event that leaves a strong impression so individuals may have preconceived notions or biases that influence decisions. Too often managers allow the past to influence current decisions. Lastly, managers often become too confident about their decision making ability and remember their good decisions and forget the negative outcomes that resulted from some of their other decisions (Clancy, 2003).

Minimizing Pitfalls

Many of these pitfalls can be reduced by choosing the correct decision making style and involving others when appropriate. It is not always necessary to involve others in decision making and frequently a manager does not have time to involve a large group, but it is important to separate out decisions needing others from those a manager can make alone.

In addition to quantitative decision technology, management analysts have developed models that assist managers in choosing the correct decision-making style. A manager can be autocratic in making decisions and have little or no input from others or can be democratic and involve others in the process. Some managers develop patterns and use the same methods, rather than looking at the particular situation and then concluding which type of decision making is needed. Vroom and Yetton (1973) developed a useful approach in selecting an appropriate decision- making style. They have identified five decision-making methods (Table 2.3).

Variables to Determine Decision-Making Style

Seven situation variables were identified by Vroom (1973). These situation vari- ables determine which of the five decision-making styles is appropriate in a situa- tion (Table 2.4).

1. The information rule. If the quality of the decision is important and the leader does not possess enough information or expertise to solve the prob- lem by himself or herself, AI is eliminated from the feasible set. (Its use risks a low-quality decision.)

2. The goal congruence rule. If the quality of the decision is important and the subordinates do not share the organizational goals to be obtained in solving the problem, GII is eliminated from the feasible set. (Alternatives that elim- inate the leader’s final control over the decision reached may jeopardize the quality of the decision.)

36 UNIT 1 � A New Approach to Leadership and Management

3. The unstructured problem rule. When the quality of the decision is important, if the leader lacks the necessary information or expertise to solve the prob- lem alone, and if the problem is unstructured (i.e., he or she does not know exactly what information is needed and where it is located), the method used must provide a means not only to collect the information, but also to do so in an efficient and effective manner. Methods that involve interaction among all subordinates with full knowledge of the problem are likely to be both more efficient and more likely to generate a high-quality solution to the problem. Under these conditions, AI, AII, and CI are eliminated from the feasible set. (AI does not provide for collection of the necessary information; AII and CI represent more cumbersome, less-effective, and less-efficient means of bringing the necessary information to bear on the solution of the problem than methods that do permit those with the necessary information to interact.)

4. The acceptance rule. If the acceptance of the decision by subordinates is critical to effective implementation and it is not certain that an autocratic decision made by the leader would receive that acceptance, AI and AII are eliminated from the feasible set. (Neither provides an opportunity for subordinates to participate in the decision, and both risk the necessary acceptance.)

5. The conflict rule. If the acceptance of the decision is critical, an autocratic decision is not certain to be accepted, and/or subordinates are likely to be in

37CHAPTER 2 � Introduction to Management and Management Decision Making

Table 2.3 Types of Management Decision Styles

A1 You solve the problem or make the decision yourself, using information available to you at that time.

A11 You obtain the necessary information from your subordinate(s), then decide on the solution to the problem yourself. You may or may not tell your subordinates what the problem is when getting the information from them. The role played by your subordinates in making the decision is clearly one of providing the necessary information to you, rather than generating or evaluating alternative solutions.

C1 You share the problem with relevant subordinates individually, getting their ideas and suggestions without bringing them together as a group. Then you make the decision that may or may not reflect your subordinates’ influence.

C11 You share the problem with your subordinates as a group, collectively obtaining their ideas and suggestions. Then you make the decision that may or may not reflect your subordinates’ influence.

G11 You share a problem with your subordinates as a group. Together you generate and evaluate alternatives and attempt to reach agreement (consensus) on a solution. Your role is much like that of chairman. You do not try to influence the group to adopt “your” solution, and you are willing to accept and implement any solution that has the support of the entire group.

conflict or disagreement over the appropriate solution, AI, AII, and CI are eliminated from the feasible set. (The method used in solving the problem should enable those who disagree to resolve their differences with full knowledge of the problem. AI, AII, and CI involve no interaction or only “one-on-one” relationships and therefore provide no opportunity for those in conflict to resolve their differences. Their use runs the risk of leaving some of the subordinates with less than the necessary commitment to the final decision.)

6. The fairness rule. If the quality of the decision is unimportant and accept- ance is critical and not certain to result from an autocratic decision, AI, AII, CI, and CII are eliminated from the feasible set. (The method used should maximize the probability of acceptance because this is the only relevant consideration in determining the effectiveness of the decision. In these cir- cumstances, AI, AII, CI, and CII create less acceptance or commitment than GII. To use them is to run the risk of getting less than the needed acceptance of the decision.)

38 UNIT 1 � A New Approach to Leadership and Management

Table 2.4 Problem Attributes Used in the Vroom Decision-Making Model

Problem Attributes Diagnostic Questions

A. The importance of the quality of the Is there a quality requirement such that decision one solution is likely to be more rational

than another? B. The extent to which the leader possesses Do you have sufficient information

sufficient information/expertise to make to make a high-quality decision? a high-quality decision by himself or herself

C. The extent to which the problem is Is the problem structured? structured

D. The extent to which acceptance or Is acceptance of the decision by commitment on the part of subordinates subordinates critical to effective is critical to the effective implementation implementation? of the decision

E. The prior probability that the leader’s If you were to make the decision by autocratic decision will receive acceptance yourself, is it reasonably certain that by subordinates your subordinates would accept it?

F. The extent to which subordinates are Do subordinates share the organizational motivated to attain the organizational goals to be obtained in solving goals as represented in the objectives this problem? explicit in the statement of the problem

G. The extent to which subordinates are Is conflict among subordinates likely likely to be in conflict over preferred in preferred solutions? solution

7. The acceptance priority rule. If acceptance is critical and not ensured by an autocratic decision, and subordinates can be trusted, AI, AII, CI, and CII are eliminated from the feasible set. (Methods that provide equal partner- ship in the decision-making process can provide greater acceptance without risking decision quality. Use of any method other than GII results in an unnecessary risk that the decision will not be fully accepted or receive the necessary commitment on the part of subordinates.

In later work, Vroom and associates (1976) demonstrated how a decision tree could assist managers in deciding which decision-making style to use (Figure 2.6). Vroom and Jago (1988) maintain that this model is able to deal with complexities in situational demands more effectively than either McGregor’s Theory Y or Blake and Mouton’s managerial grid, and they demonstrated its mathematical attributes when the model was revised in the 1980s. Later work also demonstrated the effec- tive use of a modified model for solving individual rather than group decisions. However, the earlier model is less complex to use and for novice managers provides a good basis for determining decision-making style appropriate for a manager working with a group.

MANAGEMENT FUNCTIONS

No clear-cut lists of management functions are found in the current literature. Kleinman (2003) lists the basic components of management functions to include planning, organizing, delegating, problem solving, evaluating, and enforcing policies

39CHAPTER 2 � Introduction to Management and Management Decision Making

STATE THE

PROBLEM

DOES THE PROBLEM POSSESS A QUALITY REQUIREMENT? DO YOU HAVE SUFFICIENT INFORMATION TO MAKE A HIGH-QUALITY DECISION? IS THE PROBLEM STRUCTURED? IS ACCEPTANCE OF DECISION BY SUBORDINATES IMPORTANT FOR EFFECTIVE IMPLEMENTATION? IF YOU WERE TO MAKE THE DECISION BY YOURSELF, IS IT REASONABLY CERTAIN THAT IT WOULD BE ACCEPTED BY YOUR SUBORDINATES? DO SUBORDINATES SHARE THE ORGANIZATIONAL GOALS TO BE ATTAINED IN SOLVING THIS PROBLEM? IS CONFLICT AMONG SUBORDINATES OVER PREFERRED SOLUTIONS LIKELY?

A. B. C. D. E.

F. G.

YES YES

YES

YES YES

YES

YES YE

YES

NO NO

1: AI 2: GII

3: AI

4: AI

5: GII

6A: CII

6B: CI7: AII

9: CII 8: AII

10: CII

11: GII

12: CII

G C

Figure 2.6 Decision tree governing group problems—Model A: Time efficient (Vroom, Yetton, & Jago, 1976. Reprinted by permission of publisher from Organizational Dynamics. Spring 1973. p. 74. New York: American Management Association. All rights reserved.)

and procedures. Nurse managers are expected to also manage day-to-day opera- tions, empower staff, build productive work teams, maintain quality, and satisfy customers. However, others describe empowerment as a role for nurse leaders (Tourangeau, 2003; Trent, 2003 ) See Display 2.1 for a list of some of the functions of management.

What soon becomes evident in reviewing the literature is that there is some overlap in management functions with leadership roles. It does seem to become increasing clear, however, that management functions are more concerned with the day-to-day activity of the organization and with maintaining the status quo, and therefore stability, for the organization while the role of leadership is more focused on moving the organization forward toward the future and thereby changing the status quo (Trent, 2003).

Throughout this text, leadership and management—the two very necessary elements—are combined. Leadership is not merely one function of management, nor management only one role of leadership. The two are forever symbiotic. How- ever, by artificially separating the two components, leadership roles and manage- ment functions, readers can see the differences in the two but also see the need for an integrated leader manager. Zakeznik (2004) maintains that businesses must find ways to train good managers and develop leaders at the same time. Adoption of the integrated leader manager is critical for the healthcare industry.

40 UNIT 1 � A New Approach to Leadership and Management

Planning Empower staff Satisfy customers Directing Maintain quality Organizing Problem-solving Staffing Delegating Enforcing policies Controlling

and procedures Evaluating Manage day-to-day Build productive

operations work teams

Functions of ManagementDisplay 2.1

Questions on Management Examine Display 2.1 and then recall your own experiences as a manager or the experiences you have had working for a manager. Assignment: Write a one-page essay, or discuss in a group, the following questions.

What functions of management do you feel are the most critical? What additional functions of management should be added to this list? Do you feel empowering staff is a function of management or a

leadership role?

Learning Exercise 2.3 A

SUMMARY

Management has a unique purpose and outcome that is needed to maintain a healthy organization. The history of management science provides managers with a background into what came before so they are well grounded in the past. Man- agers continue to use some past theories in coping with management problems today. Since the earliest management studies, theorists have learned much about human behavior; additionally society has changed remarkably, providing current management theorists with new insights and challenges.

However, even today one of the most important functions for the manager remains that of being a successful decision maker. Decision making takes place throughout the management process and is one of the most critical functions of management

The use of management tools and models to guide decision making will assist the manager in making more effective decisions. Although there are many such tools available, the successful manger knows that they are not foolproof and often do not allow for the human element in management. Lastly, the manager is cog- nizant that selecting the appropriate decision making style will influence the suc- cess of the decision making.

❊ Key Concepts • Management functions include planning, organizing, staffing, directing, and

controlling. These are incorporated into what is known as the management process.

• Each management function has a planning and controlling phase. • Classical, or traditional, management science focused on production in the

workplace and on delineating organizational barriers to productivity. Work- ers were assumed to be motivated solely by economic rewards, and little attention was given to worker job satisfaction.

• The human relations era of management science grew out of the Hawthorne studies, which emphasized the needs of the worker for recognition. Concepts of participatory and humanistic management emerged during this era.

• Management science has produced many tools to assist in management decision making but all are subject to human error.

• Selecting an appropriate decision making style is critical in decision making. • Management functions are not clear cut and are sometimes merged with

leadership roles.

41CHAPTER 2 � Introduction to Management and Management Decision Making

42 UNIT 1 � A New Approach to Leadership and Management

What’s Your Management Style? Recall times when you have been a manager. This does not only mean a nursing manager. Perhaps you were a head lifeguard or an evening shift manager at a fast-food restaurant. During those times, do you think you were a good manager? Did you involve others in your management deci- sion making appropriately? How would you evaluate your decision-making ability? What style of decision-making (from the Vroom and Yetton model) did you use? Assignment: Make a list of your management strengths and make a list of management skills that you felt you were lacking.

Learning Exercise 2.4

What’s Your Decision Making Style? You are the manager of a 30-bed medical unit. After consultation, you recently implemented a system for incorporating nursing diagnoses on the patient care plans. Although the system was expected to reduce report time between shifts and improve the quality of patient care, to everyone’s surprise, including your own, you find that the system is not working. You do not think there is anything wrong with your idea. Many other hospitals in the areas are using nursing diagnoses with success. You had a consultant come from another hospital and give an update to your nurses on use of the system. The consultant reported that your staff seemed knowledge- able and appeared to understand their responsibilities in implementing the system. You suspect that a few nurses might be sabotaging your efforts for planned change, but your charge nurses do not agree; they believe the failure may be lack of proper incentives or poor staff morale.

Your nursing administrator is anxious to implement the system in other patient care units but wants it to be working well in your unit first. You have just come from a manager’s meeting where your administrator told you to solve the problem and report back to her within one week regard- ing the steps you had taken to solve your problem. You share your admin- istrator’s concern, but how should you solve this problem? Select the most appropriate decision style.

Learning Exercise 2.5

More Learning Exercises and Applications

These exercises may be discussed individually or in groups, or used as written assignments.

Using the decision-making guidelines developed by Vroom and Yetton, decide what type of decision-making style should be selected for Learning Exercises 2.5, 2.6, and 2.7.

43CHAPTER 2 � Introduction to Management and Management Decision Making

Gathering the Facts—Stat! You are the day shift charge nurse on a surgical unit. Because of your related expertise, your supervisor has asked you to select a new type of blood-warming unit. You want to be sure that you select the right one. Several companies have provided your staff with trial units. You have not received much feedback from the staff regarding their preferences. Today, your supervisor tells you that your selection and its price must be ready to accompany her budget, which is due in two days. What do you do? Select the most appropriate decision style.

Learning Exercise 2.7

Who Should Go? You are the evening shift charge nurse of the intensive care unit. Your supervisor is sending two nurses from each shift to an upcoming critical care conference in a nearby city. The supervisor wants each charge nurse to submit names of the selected nurses in two weeks. All 12 of the full- time evening shift nurses would like to go. From a staffing standpoint, any of them could go. All are active in the local critical care organization. Financial resources, however, limit your choice to two. How do you resolve this situation? Select the most appropriate decision style.

Learning Exercise 2.6

Teamwork in Hiring Six nurses have just applied for a position in the open heart unit. Working with a group, develop an appropriate decision grid for selecting which nurse to hire. Identify six criteria for hiring. You may give each criterion weighted points so that the decision is a quantitative solution. For exam- ple, level of education could be weighted 5 to 10 points and experience, 10 to 30 points.

Learning Exercise 2.8

Web Links

Guide to project management research sites: http://www.amanet.org/index.htm A Web site of the American Management Associates. They offer many free learning resources.

Management Skills and Development: Interview with Warren Bennis. http://www.managementskills.co.uk/articles.htm (under Leadership) An interview with Leadership theorist Warren Bennis.

References Argyris, C. (1964). Integrating the individual and the organization. New York: John Wiley

and Sons. Clancy, T. R. (2003). The art of decision-making. Journal of Nursing Administration, 33(6),

343–349. Fayol, H. (1925). General and industrial management. London: Pittman and Sons. Follett, M. P. (1926). The giving of orders. In H. C. Metcalf (Ed.), Scientific foundations of

business administration. Baltimore: Williams & Wilkins. Gulick, L. (1937). Notes on the theory of the organization. In L. Gulick & L. Urwick

(Eds.), Papers on the science of administration (pp. 3–13). New York: Institute of Public Administration.

Kleinman, C. S. (2003). Leadership roles, competencies, and education. Journal of Nursing Administration, 33(9), 451–455.

Mayo, E. (1953). The human problems of an industrialized civilization. New York: Macmillan. McGregor, D. (1960). The human side of enterprise. New York: McGraw-Hill. Meltzer, W. (1999). Time and motion study of total hip replacement: A tool to improve

surgical team performance. Presented at the Annual Meeting of American Academy of Orthopaedic Surgeons in Anaheim, CA, February. Report found at http://www.aaos.org/wordhtml/anmeet99/sciexh/se054.htm on 07/25/2001.

Russell, V. C. (2000). Working smart. Journal of Management in Engineering, 16(6), 5. Taylor, F. W. (1911). The principles of scientific management. New York: Harper & Row. Trent, B. A. (2003). Leadership myths. Reflections on Nursing Leadership, 29(3), 8–9. Tourangeau, A. E. (2003). Building nurse leader capacity. Journal of Nursing Administra-

tion, 33(12), 624–626. Vroom, V. H. (1973). A new look at managerial decision-making: Organizational decision-

making. Organizational Dynamics, 1(4), 66–80. Vroom, V., & Jago, A. G. (1988). The new leadership. Englewood Cliffs, NJ: Prentice Hall. Vroom, V., & Yetton, P. W. (1973). Leadership and decision-making. Pittsburgh: University of

Pittsburgh Press. Vroom, V., Yetton, P. W., & Jago, A. G. (1976). Leadership and decision making: Cases and

manuals for use in leadership training (3rd ed.). New Haven, CT: Authors. Zakeznik, A. (2004). Managers and leaders: Are they different? Harvard Business Review,

82(1), 74–81, 113.

Bibliography Boswell, J. (2001). The missing link. Nursing Management, 32(5), 34. Connelly, L. M. (2003). A qualitative study of charge nurse competencies. Medical Surgical

Nursing, 12(5), 298–306. Curran, C. R. (2000). Musings on managerial excellence. Nursing Economic$, 15(6), 277.

44 UNIT 1 � A New Approach to Leadership and Management

Grindel, C. G. (2003). Mentoring managers. Nephrology Nursing Journal, 30(5), 517–522. Lord, R. G. (2000). Thinking outside the box by looking inside the box. Leadership Quar-

terly, 11(4), 551–580. Middaugh, D. J. (2001). The physics of management. Medical Surgical Nursing, 13(4),

268–269. Ohman, K. A. (2000). Critical care managers, change views, change lives. Nursing Man-

agement, 31(9), 32–35. Seden, J. (2003). Managing mistakes and challenges. Journal of Nursing Management (Lon-

don), 10(5), 26–29. Thomas, D. O. (2003). Management decisions help line. RN, 66(10), 26. Thompson, J. (2003). What perioperative and emerging work force nurses want in a

manager. Journal of American Operating Room Nurses, 78(2), 246–249, 252–256. Zimmermann, P. G. (2003). Advice for the new manager. Journal of Clinical Systems Man-

agement, 1(8/9), 10.

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