Contingency Theory in Hospital Management by qzv14288

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									History of Management
Definition of Management
   Traditionally, the term "management" refers to the activities
    (and often the group of people) involved in the four general
    functions: planning, organizing, leading and coordinating of
    resources. Note that the four functions recur throughout the
    organization and are highly integrated. Emerging trends in
    management include assertions that leading is different than
    managing, and that the nature of how the four functions are
    carried out must change to accommodate a "new paradigm" in
    management. This topic in the library helps the reader
    accomplish broad understanding of management (including
    traditional and emerging views), and the areas of knowledge
    and skills required to carry out the major functions of
Traditional Interpretations of
   There are a variety of views about this term.
    Traditionally, the term "management" refers
    to the activities (and often the group of
    people) involved in the four general functions
    listed below. (Note that the four functions
    recur throughout the organization and are
    highly integrated):
Interpretations of Management
   Another common view is that "management" is getting things
    done through others. Yet another view, quite apart from the
    traditional view, asserts that the job of management is to
    support employee's efforts to be fully productive members of
    the organizations and citizens of the community.
   To most employees, the term "management" probably means
    the group of people (executives and other managers) who are
    primarily responsible for making decisions in the
    organization. In a nonprofit, the term "management" might
    refer to all or any of the activities of the board, executive
    director and/or program directors.
Interpretations of Management
   Some writers, teachers and practitioners assert that
    the above view is rather outmoded and that
    management needs to focus more on leadership
    skills, e.g., establishing vision and goals,
    communicating the vision and goals, and guiding
    others to accomplish them. They also assert that
    leadership must be more facilitative, participative
    and empowering in how visions and goals are
    established and carried out. Some people assert that
    this really isn't a change in the management
    functions, rather it's re-emphasizing certain aspects
    of management.
Scientific Management Theory
   At the turn of the century, the most notable organizations
    were large and industrialized. Often they included ongoing,
    routine tasks that manufactured a variety of products. The
    United States highly prized scientific and technical matters,
    including careful measurement and specification of activities
    and results. Management tended to be the same. Frederick
    Taylor developed the :scientific management theory” which
    espoused this careful specification and measurement of all
    organizational tasks. Tasks were standardized as much as
    possible. Workers were rewarded and punished. This
    approach appeared to work well for organizations with
    assembly lines and other mechanistic, routinized activities.
Bureaucratic Management Theory
   Max Weber embellished the scientific
    management theory with his bureaucratic
    theory. Weber focused on dividing
    organizations into hierarchies, establishing
    strong lines of authority and control. He
    suggested organizations develop
    comprehensive and detailed standard
    operating procedures for all routinized tasks.
Human Relations Movement
   Eventually, unions and government regulations
    reacted to the rather dehumanizing effects of these
    theories. More attention was given to individuals and
    their unique capabilities in the organization. A major
    belief included that the organization would prosper if
    its workers prospered as well. Human Resource
    departments were added to organizations. The
    behavioral sciences played a strong role in helping to
    understand the needs of workers and how the needs
    of the organization and its workers could be better
    aligned. Various new theories were spawned, many
    based on the behavioral sciences (some had name
    like theory “X”, “Y” and “Z”).
Contemporary Theories in
   Contingency Theory
   Basically, contingency theory asserts that when managers
    make a decision, they must take into account all aspects of the
    current situation and act on those aspects that are key to the
    situation at hand. Basically, it’s the approach that “it
    depends.” For example, the continuing effort to identify the
    best leadership or management style might now conclude that
    the best style depends on the situation. If one is leading
    troops in the Persian Gulf, an autocratic style is probably best
    (of course, many might argue here, too). If one is leading a
    hospital or university, a more participative and facilitative
    leadership style is probably best.
Systems Theory
   Systems theory has had a significant effect on management
    science and understanding organizations. First, let’s look at
    “what is a system?” A system is a collection of part unified to
    accomplish an overall goal. If one part of the system is
    removed, the nature of the system is changed as well. For
    example, a pile of sand is not a system. If one removes a sand
    particle, you’ve still got a pile of sand. However, a
    functioning car is a system. Remove the carburetor and
    you’ve no longer got a working car. A system can be looked
    at as having inputs, processes, outputs and outcomes. Systems
    share feedback among each of these four aspects of the
Systems Theory
   The effect of systems theory in management is that writers,
    educators, consultants, etc. are helping managers to look at
    the organization from a broader perspective. Systems theory
    has brought a new perspective for managers to interpret
    patterns and events in the workplace. They recognize the
    various parts of the organization, and, in particular, the
    interrelations of the parts, e.g., the coordination of central
    administration with its programs, engineering with
    manufacturing, supervisors with workers, etc. This is a major
    development. In the past, managers typically took one part
    and focused on that. Then they moved all attention to another
    part. The problem was that an organization could, e.g., have a
    wonderful central administration and wonderful set of
    teachers, but the departments didn’t synchronize at all.
    Chaos Theory
   As chaotic and random as world events seem today, they seem as
    chaotic in organizations, too. Yet for decades, managers have acted
    on the basis that organizational events can always be controlled. A
    new theory (or some say “science”), chaos theory, recognizes that
    events indeed are rarely controlled. Many chaos theorists (as do
    systems theorists) refer to biological systems when explaining their
    theory. They suggest that systems naturally go to more complexity,
    and as they do so, these systems become more volatile (or
    susceptible to cataclysmic events) and must expend more energy to
    maintain that complexity. As they expend more energy, they seek
    more structure to maintain stability. This trend continues until the
    system splits, combines with another complex system or falls apart
    entirely. Sound familiar? This trend is what many see as the trend
    in life, in organizations and the world in general.
4 Functions of Management
   Planning, including identifying goals,
    objectives, methods, resources needed to
    carry out methods, responsibilities and dates
    for completion of tasks. Examples of planning
    are strategic planning, business planning,
    project planning, staffing planning,
    advertising and promotions planning, etc.
4 Functions of Management
   Organizing resources to achieve the goals in an
    optimum fashion. Examples are organizing new
    departments, human resources, office and file
    systems, re-organizing businesses, etc
   Leading, including to set direction for the
    organization, groups and individuals and also
    influence people to follow that direction. Examples
    are establishing strategic direction (vision, values,
    mission and / or goals) and championing methods of
    organizational performance management to pursue
    that direction.
4 Functions of Management
   Controlling, or coordinating, the organization's
    systems, processes and structures to reach effectively
    and efficiently reach goals and objectives. This
    includes ongoing collection of feedback, and
    monitoring and adjustment of systems, processes and
    structures accordingly. Examples include use of
    financial controls, policies and procedures,
    performance management processes, measures to
    avoid risks etc.
Management Styles
   Managers have to perform many roles in an
    organization and how they handle various situations
    will depend on their style of management. A
    management style is an overall method of leadership
    used by a manager. There are two sharply
    contrasting styles that will be broken down into
    smaller subsets later:
   Autocratic
   Permissive
Characteristics of Management Styles
   Autocratic: Leader makes all decisions unilaterally.
   Permissive: Leader permits subordinates to take part
    in decision making and also gives them a
    considerable degree of autonomy in completing
    routine work activities.
   Combining these categories with democratic
    (subordinates are allowed to participate in decision
    making) and directive (subordinates are told exactly
    how to do their jobs) styles gives us four distinct
    ways to manage:
Characteristics of Management Styles
   Directive Democrat: Makes decisions
    participatively; closely supervises subordinates.
   Directive Autocrat: Makes decisions unilaterally;
    closely supervises subordinates.
   Permissive Democrat: Makes decisions
    participatively; gives subordinates latitude in
    carrying out their work.
   Permissive Autocrat: Makes decisions unilaterally;
    gives subordinates latitude in carrying out their
In what situations would each style
be appropriate? Inappropriate?
   Managers must also adjust their styles
    according to the situation that they are
    presented with. Below are four quadrants of
    situational leadership that depend on the
    amount of support and guidance needed:
   Telling: Works best when employees are
    neither willing nor able to do the job (high
    need of support and high need of guidance).
In what situations would each style
be appropriate? Inappropriate?
  Delegating: Works best when the employees are willing to do
   the job and know how to go about it (low need of support and
   low need of guidance).
 Participating: Works best when employees have the ability to
   do the job, but need a high amount of support (low need of
   guidance but high need of support).
 Selling: Works best when employees are willing to do the job,
   but don’t know how to do it (low need of support but high
   need of guidance).
The different styles depend on the situation and the relationship
   behavior (amount of support required) and task behavior
   (amount of guidance required).
Decide NOW
   Below are a few situations and options for
    what you would do. Try to decide which of
    the four situational styles would work best in
    each situation. Then pick the option that best
    fits that style.
Situation 1
   The employees in your program appear to be having serious
    problems getting the job done. Their performance has been
    going downhill rapidly. They have not responded to your
    efforts to be friendly or to your expressions of concern for
    their welfare. Which style would you pick? What would
    you do?
   Reestablish the need for following program procedures and
    meeting the expectations for task accomplishment.
   Be sure that staff members know you are available for
    discussion, but don’t pressure them.
   Talk with your employees and then set performance goals.
   Wait and see what happens.
Situation 2
   During the past few months, the quality of work done by staff
    members has been increasing. Record keeping is accurate and
    up to date. You have been careful to make sure that the staff
    members are aware of your performance expectations.Which
    style would you pick? What would you do?
   Stay uninvolved.
   Continue to emphasize the importance of completing tasks
    and meeting deadlines.
   Be supportive and provide clear feedback. Continue to make
    sure that staff members are aware of performance
   Make every effort to let staff members feel important and
    involved in the decision making process.
Situation 3
   Performance and interpersonal relations among your staff
    have been good. You have normally left them alone.
    However, a new situation has developed, and it appears that
    staff members are unable to solve the problem themselves.
    Which style would you pick? What would you do?
   Bring the group together and work as a team to solve the
   Continue to leave them alone to work it out.
   Act quickly and firmly to identify the problem and establish
    procedures to correct it
   Encourage the staff to work on the problem, letting them
    know you are available as a resource and for discussion if
    they need you.
Situation 4
   You are considering a major change in your program. Your
    staff has a fine record of accomplishment and a strong
    commitment to excellence. They are supportive of the need for
    change and have been involved in the planning.Which style
    would you pick? What would you do?
   Continue to involve the staff in the planning, but direct the
   Announce the changes and then implement them with close
   Allow the group to be involved in developing the change, but
    don’t push the process.
   Let the staff manage the change process.
    Organizational Life Cycles and
    Management Styles
   Based on the book "Barbarians to Bureaucrats"
    by Lawrence Miller, published by C.N. Potter: New York.
    Edited by Carter McNamara, MBA, PhD
    In this very enlightening book, Miller suggests there is a strong relationship
    between the life-cycle stage of an organization and the nature of its leadership. He
    asserts this evolutionary life-cycle is typical to cultures as well as organizations.
    His work shows powerful insights to the nature of organizations and their
    management and matches the experiences of many practitioners. His work can be
    referenced to explain much of the wide variation in management styles, yet close
    association between styles of management and stages of an organization's life.
    Miller suggests that the life of an organization is similar to the shape of a bell
    curve, that is, the organization experiences a rise of health, it peaks, and then
    gradually declines. The life-cycle stages of Prophet, Barbarian, Builder, Explorer
    stages are on the way up the curve of health, the Synergist is at the peak, and the
    Administrator, Bureaucrat, and Aristocrat stages are on the way back down the
    curve of health.
   Miller says a synergist is "... a leader who has
    escaped his or her own conditioned tendencies
    toward one style and incorporated,
    appreciated and unified each of the styles of
    leadership on the life-cycle curve. The best
    managed companies are synergistic." Miller
    asserts that the synergist is a synergy of the
    other management styles, and therefore, is
    best described by a set of principles.
   1. Spirit - Corporations are both spiritual and material in nature. In their youth,
    they possess spiritual rather than material assets. In decline, this is reverse. Health
    is maintained by unifying the spiritual and material assets.

   2. Purpose - The purpose of the business organization is to create real wealth by
    serving its [stakeholder!]. It is a function of leadership to instill and reinforce social

   3. Creativity - The first and most important act of business is the creative act: the
    creation of new and improve products, services, selling and means of production.
    Change, youthfulness and energy are requirements until death. (Those who lean
    toward creativity will be required to sacrifice for the sake of administrative sanity.)

   4. Challenge and response - The task of leaders is to create or recognize the
    current challenge, respond creatively, and avoid a condition of ease. Reliance on
    yesterday's successful response in the face of new challenges leads to decline. (It is
    an irony of life that satisfaction and security are the enemies of excellence.)
   5. Planned urgency - The urgency to decide and act promptly leads to expansion
    and advance. Prompt action must be balanced by deliberate planning. There will
    always be conflict between promptness and planning.
   6. Unity and diversity - Advancing cultures are socially unifying and become
    diverse in character. Leaders must act to unify diverse talents and traits. Leaders
    must actively resist the tendency to attract and promote like personalities and
   7. Specialized competence - Specialized knowledge and skills and the integration
    of those competencies must be pursued vigorously. Efficient methods are derived
    from specialized competence; however, specialized competence leads to
    inefficient methods.
   8. Efficient administration - Efficient administration is required to achieve
    integration and performance as differentiation increases. Unchecked
    administration inevitably leads to bureaucracy and the decline of creativity and
    wealth creation.
   9. On-the-Spot Decisions - Decisions should be made by those on-the-spot,
    close to the customer, product or service. The further decisions are removed
    from the point of action and knowledge, the worse the quality and the higher the
    cost. Consensus is a sign of maturity and health.

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