Leadership, Culture and Ethics: How Trends in Organizational Behavior Will Impact the Health of America

When medical students graduate, they typically swear an oath of good, ethical treatment for their patients. The oath is symbolic and not required in order for a doctor to be licensed, but it makes explicit that the practice of medicine is to benefit humanity and is a solemn duty. Indeed, healthcare is one of the most important industries in America, and it is growing rapidly and changing rapidly, two conditions that require excellent management and productivity in order to function viably. Understanding and analyzing organizational behavior in the medical field is important for a number of reasons. Both healthcare costs for employers and employment in the healthcare industry itself are rising significantly faster than other business costs and other job markets (Bureau of Labor Statistics, 2009). It is a sector of the economy that has the potential to either grow or drag the whole economy, and one of the deciding factors for either outcome is how well hospital employees are trained and managed and how well the management creates a diverse culture that empowers its employees and is diverse enough to handle the changes and emerging trends in America’s ethnography in order to provide proper, effective and efficient healthcare.  

To begin to understand why organizational behavioral theories about leadership and diversity are critical for hospitals, it is important to understand the conditions of the organization and the behavior and expectations of key employees, particularly patient care managers and providers. Supervising nurses and physicians responsible for patient care are the patient care managers for the service providers, such as orderlies, nurses, and physical therapists. These patient care managers are in turn managed by an administrator within their department, such as orthopedics, and the central core management of chief officers, such as chief medical officer, chief information officer, and sometimes the chief operating officer (Feigenbaum, n.d.). Because the patient care managers and providers must respond to changing crisis conditions, such as receiving a dozen people in a bus accident or an aggressive outbreak of a virus, they must be given a certain level of autonomy and discretion for making decisions. They must also be allowed to develop and draw upon the intimate patient-care provider relationship in order to be motivated to provide the best level of care and employee performance. 

At odds with this environment are factors such as shrinking budgets, rising costs, a changing demographic, and political issues and legislation. According to Glickman, Baggett, Krubert, Peterson, and Schulman (2007): “Clinical care is ultimately delivered to patients along relatively autonomous service lines (i.e. cardiology services, oncology services), and strategies need to be developed to achieve fit and synergy among these diverse groups.”

In Organizational Behavior (2010), the authors succinctly describe the healthcare manager’s job as consisting of four functions: planning, organizing, leading, and controlling (Griffin & Moorehead, 2010, p. 22). For the healthcare industry in particular, organizing and controlling are two essential and complicated functions to manage effectively. Organizing in this case means, “designing jobs, grouping jobs into manageable units, and establishing patterns of authority among jobs and groups of jobs” while controlling is “monitoring and correcting the actions of the organization and its people to keep them headed toward their goal” (p. 22). In healthcare, in order for a manager to be successful, he or she must create an atmosphere of leadership for the employees. 

Nancy Barkowski (2011) refers to an important piece of work from theorist Douglas McGregor on management ideology, Theory X and Theory Y: “Theory Y states that employees are creative and competent; they want meaningful work; they want to contribute; and they want to participate in decision-making and leadership functions” (p.8). Furthermore, Barkowski claims that managers using Theory Y, “created opportunities, removed obstacles, and encouraged growth for their employees… [and] supported decentralization and delegation of decision making, job enlargement, and participative management because they allowed employees degrees of freedom to direct their own activities and assume responsibility” (2011, p. 9). While all of these outcomes are desirable to any company, they are necessary for healthcare managers because of the dynamic and challenging nature of the day-to-day business and the turbulent conditions for the industry as a whole. In other words, it is impossible for healthcare organizations to viably survive if they do not allow their employees, especially those with specialized or technical skills, to assume leadership and goal-setting roles within the organization.

In Institutional Change and Healthcare Organizations (2010), Richard Scott explains the classic mindset of people within an organization: “Most of us tend to buy into the liberal conceit that individual persons are the primary actors in modern society and…. we neglect the extent to which all of us are more often the agents of organizations, working to achieve not our own personal but organizational objectives” (p. 2). For many doctors, this belief is reified by the training, responsibility, autonomy, and cultural worth their position entails. Health care providers are required to use their best judgment in patient treatment and care, which is at potential conflict with the manager’s need to organize and control the doctor’s roles and outcomes to maximize profitability and maintain a routine level of care. 

Doctors (and nurses) are the front line of care and part of their responsibility and job function is to make independent decisions and manage patient healthcare, often under crisis or emergency. It would therefore be impractical to try to prescribe behavior for doctors, and it would be counterproductive to the organization’s need for adaptive responses to patient care. Therefore, the culture of the organization needs to focus on collaborative leadership whereby managers effectively motivate all employees to become problem solvers for a number of issues, including making the organization more productive and efficient.

This need for productivity and efficiency is not just shared by the organization; it has a self-serving interest for all citizens, as they are part of the system, too, as patients. According to a paper on organizational behavioral management in health care, when some of the traits of Y Theory management were implemented in the workforce, including feedback and goal setting, there were better patient outcomes across departments where patient care was provided (Cunningham & Geller, n.d., pp. 5–8). These outcomes are good for the public health and the health of the organization, as fewer patient complications means less expense for the hospital, a higher level of satisfaction among employees and better employee/management relationships as a result of fewer issues of conflict over the quality of patient care. A study by Koberg, Boss, and Senjem (1999) noted similar results when employees felt empowered: “Empowerment perceptions also were associated with increased job satisfaction and work productivity/effectiveness, as well as a decreased propensity to leave the organization.”

In addition to adopting current theories of leadership, hospital managers must also work to create a culture of diversity in order to increase the effectiveness, adaptability, and sustainability of the organization. Jean Gordon cites statistics from the U.S. Census Bureau and others that the demographic makeup of the United States over the last 10 years that shows there are more older Americans, more minorities, especially those who identify as Latino or Hispanic, and fewer whites. Gordon surmises: “The changing demographics of America’s population affects the healthcare industry twofold. First, healthcare professionals need to have cultural competence to provide effective and efficient health services to diverse patient populations… Second… the healthcare industry needs to ensure the healthcare workforce mirrors the patient population it serves, both clinically and managerially” (Barkowski, 2011, pp. 20–21). Both of these effects on the healthcare are important to consider.

It is important to understand that a hospital has its culture—the behaviors, practices, rules, and expectations unique to itself. As Nancy Adler (2008) states, “At every level, culture profoundly influences the behavior of organizations as well as the behavior of people within organizations.” For example, consider the dedicated birthing centers for parents expecting an uncomplicated delivery over traditional hospitals. The culture of the birthing center focuses on a more “natural” experience, and each member of the organization that is delivering or managing patient care has skill specialization in childbirth and infant care. Birthing centers are cultural places for specific patients and employees that try to balance standards of American medical care with the cultural expectations of giving birth. Private rooms, individual whirlpool tubs, room service for family members, and other amenities exist to provide a different cultural experience than the busier, more diverse hospital. 

Of course, when there is a homogenous goal or population, such as a birthing center that only has one function, it is easier to create a working culture because there is a lack of diversity inherent. However, as a model organization, it shows the opportunity for the industry to be dynamic and the potential success of a business model that focuses on a patient’s cultural expectations as well as care. What is unique to hospitals is that they are places of profound human experience—healing, grieving, birth, and death. It is necessary for the organization to deliver good care in the context of cultural differences for these human events. Because patient care is also a human enterprise, the influence of emotion in employee job performance and patient outcomes must be considered. Ashkanasy, Härtel, and Daus (2002) describe the need for more research in emotional intelligence because of its implications to improve organization culture and environment. Industries that are people-centered and have such cultural importance are excellent environments for more inquiry into emotional intelligence as an important component of a diverse culture. Just as medical school graduates learn skills for correct diagnosis and treatment, they have an opportunity to develop emotional intelligence—the proverbial “bedside manner” that is required of any good doctor. 

The second argument for diversity that Gordon describes is business oriented—the staff and managerial makeup of an organization should reflect the diversity of the population it serves. This is a concern of culture and of good business operation. If hospitals employ the Y Theory of management, they must trust their patient care providers and managers to use their judgment for how to serve the population effectively. Diversity among that group as well as among the executive management enables a plurality of thought and experience that broadens the skills, knowledge, and experience of the entire workforce. Issues of communication, behavior, and expectations can all be managed effectively with a more culturally diverse workforce. And as the demographics of the country changes rapidly, a culturally diverse organization will be in a position to apply forethought and problem solving ahead of the wave, rather than being a reactionary, and thus less viable, mode of operation.

A benefit that Gordon does not touch on is the alternatives to the type of care that is given. Western medicine is aggressive in many ways—people go to the hospital to combat whatever is afflicting them. It is also increasingly expensive and increasingly ineffective—for example, consider the new strains of bacteria that are antibiotic resistant and could eventually lead to a “pre antibiotic” system of medicine (Shrestha, 2013). While no sane medical director interested in organizational behavior would advocate trading penicillin for ginseng, looking at how healthcare is delivered in other countries, often with similar patient outcomes at a lower cost, is worthwhile for the viability of the business. What can hospitals learn from health care providers and administrators who have worked in European or Asian hospitals? Is there a place in American healthcare for acupuncture or yoga as part of the plan for patient wellness? Hospital administrators and executive managers must embrace the diversity of healthcare in other cultures. Patient care and hospital business practices must be dynamic and synergistic in order to meet the needs of a growing and changing demographic, or else there will be a literal public health crisis.

Few industries today are facing the same challenges that healthcare is facing. From rapid expansion to intense outside pressure, healthcare organizations, particularly those that provide direct patient care, are challenged to find a way to be viable and provide a level of service that has literal implications for the health of the nation’s economy and populace. Organizational behavior theories on leadership and diversity must be integrated in how these organizations operate. Managers must empower their staff, particularly those who have specialized training or skill, to make decisions, set goals, and have open access to communication and feedback in order to adequately and effectively respond to the population it serves. Furthermore, these organizations must recognize the human element and the cultural and national significance of healthcare as an industry, and seek to provide relevant and quality care to the population it serves through diversity as part of the organization’s culture and the workforce population. A culturally diverse organization or even a large number of unique but specialized organizations within the industry are necessary in order for the healthcare industry to grow healthily. 

References

Adler, J. & Gunderson, A. (2008). International dimensions of organizational behavior (5th ed.). New York: Thomson South-Western.

Ashkanasy, N., Härtel, C., & Dause, C. (2002). Diversity and emotion: The new frontiers in organizational behavioral research. Retrieved from http://jom.sagepub.com/content/28/3/307.full.pdf+html.

Barkowski, N. (2011). Organizational behavior in health care. New York: Jones and Bartlett Publishers.

Cunningham, T. & Geller, S. (n.d.). Organizational behavior management in health care: Applications for large-scale improvements in patient safety. Retrieved from http://www.ahrq.gov/downloads/pub/advances2/vol2/advances-cunningham_11.pdf.

Department of Labor, Bureau of Labor Statistics. (2009, November). Health care. Retrieved from http://www.bls.gov/spotlight/2009/health_care/.

Feigenbaum, E. (n.d.) Organizational structure of hospitals. Houston Chronicle. Retrieved from http://smallbusiness.chron.com/organizational-structure-hospitals-3811.html.

Koberg, C., Boss, R. W., & Senjem, J. (1999). Antecedents and outcomes of empowerment: Empirical evidence from the health care industry. Retrieved from http://gom.sagepub.com/content/24/1/71.full.pdf+html.

Glickman, S., Bagget, A., Krubert, C., Peterson, E. & Schulman, K. (2007). Promoting quality: The health-care organization from a management perspective. Retrieved from http://intqhc.oxfordjournals.org/content/19/6/341.full.

Griffin, R. & Moorehead, G. (2010). Organizational behavior: Managing people and organizations (9th ed.). Canada: South-Western, Cengage Learning.

Scott, W. R., Rueff, M., Mendel, P., & Caronna, C. (2000). Institutional change and healthcare organizations from professional dominance to managed care. Chicago: The University of Chicago Press.

Shrestha, S. (2013, June). Are we headed back to the pre-antibiotic era? Retrieved from http://ekantipur.com/2013/06/03/national/are-we-headed-back-to-the-pre-antibiotic-era/372664.html.