Managing in Health and Human Services
Managing in Health and Human Services
Cultural Diversity in Healthcare
Traditionally, cultural diversity held little significance in the health sector. However, with the discovery that there were cases of imbalanced delivery of healthcare, higher cases of critical diseases among African Americans and Hispanics as well as economic disparities, cultural diversity has been categorized as an important element. Within Heritage Valley Medical Center, the management reflected the contemporary cultural diversity concepts such as affirmative action illustrated by the recruitment of a large number of African Americans and even one Hispanic (Hollins, 2009). Modern definitions of cultural diversity have allowed these majorities to ascend to influential positions within the establishment (Kavanagh & Knowlden, 2004).
The report presented by Ms. Harper that illustrated the discontentment expressed by most minority patients revealed several things about the organizational culture and competency at Heritage Valley Medical Center. First, the report illustrated that the management were still operating with outdated practices such as racially profiling patients. The information also illustrated the shift in priority from serving all patients to securing class and cadre interests. This is because, among the managers, there was a consensus that minority patients were troublesome and difficult to treat (Knipper, Akinci & Soydan, 2010). This unanimous decision was made by African American and Caucasian individuals. Lastly, Mrs. Harper exposed the weak advisory and monitoring capability within the establishment. If I were Mrs. Harper, I would present all the information relayed by the discontentedminority clients and recommend that urgent measures to standardize the racial policies and ethical practices among the hospital staff. The establishment was in dire need of a revision of the ethical regulations that would satisfactorily curb the racial profiling and unfair delivery of service in the hospital.
Mrs. Harper and her issues
Mrs. Harper was the vice president who represented the community relations interests. In her presentation, she revealed several statistics that indicated that about 80% of Caucasians were satisfied with the health services they were offered compared to a meager 30% satisfaction for Black Americans, 20% of Asians and 10% of Hispanics. These statistics were worrying as they pointed towards racial discrimination in the provision of quality healthcare. The reasons given by the respondents who were interviewed in her study pointed towards disrespect and lack of objectivity in handling patients by nurses, poor communication and poor reception by the hospital staff. The nurses and other workers made racial and derogatory remarks about the minority groups including comments on their illiteracy, dependence, sloth and discontent. These extreme remarks about patients formed the major part of the report.
In her report, Mrs. Harper illustrated the different opinions expressed by the managers. It was surprising to see that several other managers at the same establishment also supported the stand declared by the nursing director. It was interesting to note that while the Caucasian and Black American managers were very content with blaming the illiterate minority patients for their poor service, the Hispanic managers felt that both white and black managers needlessly targeted minority patients who were highly vulnerable (Aspinall, 2007). Conversely, the Hispanic manager reiterated that the alliance between white and black hospital managers was largely driven by economic incentives. One of the Hispanic managers mentioned that African American managers were employed mostly because of affirmative action and, therefore, agreed with their Caucasian counterparts. If this information were released to other departments in the health sector, it would serve to disrepute the staff, the establishment and the profession (Mannion et al, 2011). These were the main concerns for Mrs. Harper during the evaluation of the minority cases.
Diversity of the Heritage Valley workers
There was enough evidence to conclude that the attitudes and approaches taken by the hospital staff conflicted with the need to provide objective services to the public. When approached, the nursing director backed the conduct and competence of her subordinates and instead placed the blame on the inability by minorities to cooperate with healthcare providers. Some of the major issues that the nursing director mentioned included the low level English spoken by most minorities, little or no education, and miscommunication. From the reactions made by the director, it was evident that she blamed the minorities for the poor services they received at Heritage Valley. The distrust was two ways as the minority patients also doubted the final treatment and advice given to them by the providers. This disjointed relationship serves to worsen the provision of healthcare, as well as the health status of the public (Tseng & Streltzer, 2008).
Amid the misconstrued perceptions concerning patients such as the notion that patients from different cultural backgrounds have a poor understanding of their symptoms, most practitioners make up their mind about multi-cultural clients long before the actual diagnosis is performed (Dreachslin, Gilbert & Malone, 2013). For the employees of Heritage Valley, this was a serious problem that had reached critical levels, and that had caught the attention of several authorities such as Mrs. Harper. From the results of the study and the opinions of the managers, it was evident that the staff at Heritage Valley required an urgent exercise to realign their understanding of diverse cultures. Currently, the staff at the healthcare establishment has a poor understanding and tolerance for other cultures besides the American culture. The skewed cultural diversity in the top management, in Heritage Valley, was partly the reason behind the poor response and treatment of minority patients. The management was largely Caucasian and African American with only one Hispanic. From this breakdown, it is evident that the institution favored particular racial alliance and disregarded the rest of the minorities.
What ethical principles relate to this case scenario?
Several legal issues in the textbook and on a personal level can apply to the situation. Beneficence relates to the situation concerning the pregnant woman and the OB-GYN physician. It can be defined as the obligation by professionals to put the welfare of the client first (Beauchamp & Childress, 2009). Violation of this ethical obligation results in malfeasance that is the refusal to cater to the welfare needs of a patient. The expectant woman needed to be immediately taken care of by a gynecologist who insisted that she be transferred to another facility. All healthcare providers are expected to assist patients without assessing their financial competence. They are obligated to do whatever they can to alleviate the condition of the client. Closely related to beneficence is the principle of non-malfeasance that demands that medical professionals should put the clients’ safety first before any other priority, financial or otherwise (Ashcroft, 2007).
The OB-GYN physician was also violating the justice principle that demands an evaluation and choice of individuals who can be treated despite their resources. In this case, the physician should have quickly assessed the expectant woman’s financial status, accepted her as a patient, and assisted her to deliver the child. The legal consequences in this case include holding the hospital responsible for any pain and suffering that the mother or baby underwent during the period. The staff at the medical institution can be sued for medical negligence or malpractice. This is where medical experts fails to act or deliberately refuses to act and thereby, causing grave physical or mental distress to the client. In the scenario, the OB-GYN physician deliberately refused to help an expectant woman even though he was fully competent and had the opportunity to do so. Under the banner of never events, the expectant woman could also sue the OB-GYN physician and the hospital for allowing her to be referred even though she was in a critical condition (Wear & Aultman, 2006).
Moral, legal, and ethical dilemmas of the patient
The first moral dilemma for the patient would be an obligation of non-malfeasance. When a patient is sick, he / she face a dilemma in that they have to be treated by a physician who may not be skilled. In this situation, the patient may have to settle for the medical professional and ignore the non-malfeasance provision. Being an expectant woman, she was ready to deliver the child at any time and would benefit from the services of any physician despite there are of expertise. Legally, the expectant woman might decide to sue the hospital and the physician for refusing to serve her in her time of need. In the event that she goes to court, the physician might be compelled to reimburse the woman for the damages. However, if the baby died before or during delivery, it would be pointless for the woman to starting suing the physician in the first place. Her main interest was the safe delivery of the baby, and once this was lost, it would be useless to waste resources in the pursuit of malpractices done by the OB-GYN physician.
The pregnant woman and her husband were also in an ethical dilemma, as they knew little English. To start with, there was little communication between the clients and the hospital administration as one of the parties did not understand English completely. Therefore, they did not understand the situation in which they were. Furthermore, even if their dismissal would have been explained, they would have had a difficult time in finding another medical institution where they could take care of the pregnant woman. Ethically, medical practitioners are mandated to be considerate to disadvantaged and minority people because of communication issues that may cause disagreements and a denial of essential services.
Moral, legal and ethical consequences for the physician
Ethically, theOB-GYN physician can be sued for several malpractices. One of these malpractices is negligence to perform one’s duties or malfeasance. Doctors, nurses and physicians, are obligated to offer medical assistance to all patients in the best way that they can. When he avoided assessing the condition in which the patient is in, the physician violated the principle of non- malfeasance. Because of his actions, the pregnant woman and the baby suffered a lot of pain and distress. Closely related to malfeasance is beneficence that can be defined as the obligation by professionals to put the welfare of the client first. Ethically, physicians are trained to alleviate pain and discomfort for patients. Using these skills, they are obligated to place the patient’s welfare before any other hospital or individual priorities. When the physician refused to show up at the hospital and cater to the patient because of her financial status, he was in clear violation of these two ethical principles that apply to all medical professionals (Reilly & Markenson, 2011).
Several legal consequences also apply to the physician and the establishment where he is employed. In the event that the pregnant woman decides to sue the physician and the hospital for negligence, she may have a solid case. This is because the employee in the hospital was doing a work-related activity, therefore, the hospital was responsible for the employee and his actions, and when being sued, they shall both be liable for the cases presented to them. Within negligence, abandonment fully applies to the pregnant woman in that she was abandoned without even receiving care. In the course of suing a medical practitioner, the pregnant woman can claim any of the following damages: suffering, pain and injuries. These would be typically calculated and paid out to the victim.
Leadership and Management Traits and Theories
It is evident that good management and leadership can have an actual considerable impact on organizational performance in the short and long term. Some of the immediate advantages of efficient management and leadership include an increase in employee engagement, invested capital and a growth in the labor force. Evaluating and discussing the several leadership and management traits and approaches is a significant step towards achieving organizational success. Possibly company success is pegged on the ability of managers to display their managerial, leadership and administration skills in handling the obstacles, challenges and objectives that face the organization. Many establishments may have highly efficient structures, skilled employees and good reimbursement packages but still fail to operate efficiently because of poor leadership and management. Managers assist in determining the immediate performance, organizational culture and practices. While this definition brings together several managerial responsibilities, the next section categorizes each of these common tasks awarded to managers in an organization.
In addressing these leadership and management issues and approaches, the scope of the paper shall concentrate strictly on the healthcare industry. Therefore, all documentation, case studies and references in the document are relevant to the medical industry. There shall be a constant reference to the international and national healthcare institutions in America and the rest of the world, but a particular stress will be placed on Heritage Valley Medical Center as an institution that urgently requires intervention in leadership and managerial sectors. The paper shall be organized into four sections. The introduction contains the issue at hand and the scope of the study. The statement of problem addresses the issue that affects most healthcare organization in as far as management and leadership is concerned. The section on research sources provides a summary of the material used to research on the topic. Lastly, the conclusion summaries all the discussions and provides the viewpoint as well as the recommendations that managers can adopt.
Statement of the Issue to be investigated
Valuable leadership is vital in practically any category of organization. When organization managers become deficient in the ability to offer bearing, instruction and schooling and drive among staff, the organizational culture and energy are affected the most. Poor management and leadership can have several adverse effects on the company and the employees. The most obvious impact of poor management is poor financial performance. A significant outcome of poor leadership is often dismal financial results and objective accomplishment (Buchbinder & Shanks, 2007). To maximize sales, efficiency and production, an organization needs employees who can work at optimum to produce sufficient results. Incompetent leaders fail to motivate workers to provide their best efforts and search for training and advancement chances.
Poor management and leadership are also characterized by lack of synergy in the workplace. Successful managers synchronize duties within their divisions and encourage an ambiance that supports thought sharing and deliberations. They realign employees with the quest for common goals. Poor management may bring about disjointed departments and work responsibilities. Other impacts of poor leadership and management include higher turnover rates and low employee morale (Dreachslin, 2007). In the organization, employees might feel confused over their future within the company if managers are incompetent. This may result in demoralized staff that offers their minimum effort towards the organization. Poor management also makes the employees likely to seek for other sources of income, satisfaction and job security. To the organization, this is detrimental as it translates into lower productivity. Leadership and management are central in the delivery of first-class health services. Although the two aspects share several traits, they may entail diverse types of attitudes, capabilities, and conduct. Efficient managers should endeavor to be excellent leaders. Conversely, excellent leaders require management expertise to be successful. Leaders will have a visualization of what can be accomplished, then relay this vision to the subordinates, and formulate approaches for accomplishing the vision (Nelson & Donnellan, 2009). They inspire employees and are capable of bargaining for capital and other facilities to realize their objectives. Leadership and management approaches and traits form a large and part of most organizations and, therefore, addressing the flaws, elements and techniques of improving them will definitely go a long way in improving organization delivery and performance.
Approaches and Traits in Leadership
Respect is a fundamental trait among leaders and cannot be separated from leadership itself. Leadership and respect go hand in hand and cannot exist on their own. Therefore, it is imperative to gain respect, and sustain high morale using excellent leadership skills. Leaders need to be respected if they expect their leadership to have an influence on the organization and its employees. While leadership may include physical traits such as the official attire, outer look and status, the innate characteristics also serve to entrench a manager as a leader (Fottler et al., 2011). These traits include rationality, wisdom, good temperance and hindsight (Weinstein, 2010). Respected leaders can have a large influence over the staff in an organization. Achieving voluntary cooperation from employees is an achievement for managers as they will be ready to offer their best in their positions, and such people can be used to realize the organization’s goals. Effective leaders are also accountable in that they take the blame and credit for whatever happens under their jurisdiction. Other qualities include having a mission, being disciplined and wielding impressive communication skills (Storey & Corbett-Nolan, 2011).
Theories and Approaches in Leadership
Situational Leadership Theory
The situational leadership theory was formulated by Paul Hersey and Ken Blanchard. The theory was first launched as Life Cycle Theory before being renamed the situational leadership theory in the mid 1970s (Johnson & Paton, 2007). The essential foundation of the situational leadership theory is that there is no one perfect approach towards leadership. Successful leadership is dependent on the type of responsibility. Therefore, the most effective leaders constantly adapt and adjust their leadership approaches to the capacity, complexity and condition, of the employee or team they need to influence. Effective leadership depends on the kind of employee or team being influenced as well as the duty, work or occupation that needs to be achieved. The situational leadership model depends on two elementary notions: leadership style and the teams’ capabilities (Johnson & Paton, 2007).
The two proponents, Ken Blanchard and Paul Hersey developed four levels of leadership styles namely S1 to S4. S1 involved one-way communication that was top-down in nature and came from the leader to his subordinates. S2 involved selling an idea or proposal to employees by strategically convincing them to cooperate. S3 was called participating and involved the leader sharing the decision making process with the team while S4 was delegating and involved passing on the responsibility and several processes to the team members (Walshe & Smith, 2011).
The contingency theory asserts that there is no best way to structure an organization, to lead a corporation, or to arrive at decisions. In its place, the most favorable course of action is dependent (contingent) on the external and internal environments and conditions. Several contingency theories were created at the same time in the 1960s (Carney, 2007). They argued that earlier theories, for example, Weber’s bureaucracy model had not succeeded as they ignored the fact that management approaches and organizational constitution were largely influenced by different aspects in the surroundings and these aspects were later identified as ‘contingency factors’. It was impossible to come up with one best way of managing and leading an organization. In the past, contingency theory sought to create over-generalizations on the prescribed structures that are normally linked to or best serve the use of different things. The most common contingencies include changes that happen among suppliers, consumer groups, and the government and in technology (Darr, 2011). The contingency theory of leadership seeks to describe the success of a leader as a product of various elements that might be task, team or subordinate variables. While highly effective, the contingency theory has come under sharp criticism in the random and general manner in which it handles different organizational issues. The critiques argue that this random fashion is unpredictable and lacks a systematic structure and to that extent, the contingency theory lacks credibility.
Approaches and Traits in Management
Leadership is a central part of any successful management. All manages are expected to be good leaders if they expect to administer their institutions without resistance and reluctance from the employees. Some of the common leadership qualities that managers should have include self-motivation, creativity, confidence, reliability and calmness. While personal traits are difficult to grasp or transform, business traits are easy to learn and which are important to the success of the department and the whole organization (Preker & Harding, 2003). These business characteristics influence the daily activities in the department and affect both the manager and the employees. They include an in-depth knowledge of the industry in which they are operating. In this way, the manager can understand the industry dynamics and be prepared for any changes. Mangers should also know situations that require delegation, as this would take off pressure from their offices and get the work completed faster and more efficiently. Other business skills that a good manager should have are money management skills, legal considerations and organization.
Communication and relationship traits are equally important for managers. Communication qualities allow the managers to relay their opinion, interests and orders to the subordinates and superiors. Mangers should be able to create reports, documents and briefs effectively in proper language and good grammar. Publicly, the managers should also be able to convey their message effortlessly and effectively. Other communication aspects include positive feedback, listening skills and specificity. In terms of relationship qualities, a manager should know how to build networks and connections. These tasks require skills such as top-notch customer service that allows managers to relate with customers. Managers should also be good team players and be willing to mediate between employees.
The bureaucratic theory of management is used by most organizations. It entails several managers who are responsible for decisions making processes, and a hierarchy of middle-level managers and other subordinates who are tasked with the responsibility of implementing precise functions with restricted power. Instructions originate from the top down in a manner similar to the armed forces. Health care organizations such as insurance companies have conventionally adopted this style of management because it produces reliability and accuracy (Carney, 2007). When combined with specialization, each employee in the organization performs a partial number of tasks regularly and seemingly efficiently. For instance, the main responsibility of nurses is to take care of patients and cannot engage in thrashing out larger organizational problems. Likewise, managers adopt a supervisory and advisory role in the institutions and cannot engage in matters concerning the medical staff. First developed by Max Weber, the theory initially focused on subdividing employees within organizations based on their area of specialization and merit. He aimed at restructuring organizations using the hierarchy system and introducing a standardized method of conducting all official procedures. This type of management is especially effective in medical establishments that have fallen to chaos due to mismanagement. It is also the best approach for a manager having certain reforms and approaches that are not shared by the rest of the management team.
The patient-centered approach promotes dynamic participation of patients and their relatives in the development of personalized care models and in making choices about individual alternatives in treatment. The four main elements of the patient-centered care approach are coordination and communication, set access, patient support and all-round care. Apart from educating patients on the diagnosis or treatment, the approach focuses on guiding patients about their alternatives, risks and benefits in their different settings. This approach also focuses on the cultural backgrounds, individual preferences and principles, family circumstances and lifestyles. This approach has been proved to result in positive health outcomes (Preker & Harding, 2003).
A benefit of patient-centered management (PCM) is its capacity to transform patient actions and settings that have commonly influenced the care negatively and resulted in avoidable expenses (Weinstein, 2010). The changing approaches toward patient issues and the health care industry setting have coerced many healthcare organizations to assume a patient-centered approach in managing healthcare provision. Instead of the conventional systems where managers adopt the easiest or the cheapest approach in administering an establishment, health care providers restructure themselves to allow for the delivery of excellent patient care. The notion is that, through service and medical superiority, organizations can attain the highest financial outcomes. This close collaboration between managers and other staff is seldom seen in bureaucratic models. This approach towards handling management issues within the medical sector is relatively new and has not yet received extensive review form academicians and other researchers (Weinstein, 2010). However, the existing research into patient-centered management is sufficient to warrant its use in public and private hospitals.
Scientific Management Theory
The scientific management theory was first developed by Frederick Winslow Taylor after closely studying the work process using scientific methods. After this study, Taylor proposed a system that would optimize and make simpler the tasks and in the process, increase the productivity. He also suggested the idea of increased cooperation between employees and managers. Taylor also stressed on the importance of identifying skilled employees and placing them in the areas where their skills can produce optimum results. The scientific management theory was based on four major principles. One principle was discarding the ‘rule of thumb’ approach in working, and adopting a scientific approach that would seek out the most efficient way of doing a task. The second principle involved placing employees in positions where they are most qualified and competent to work. Taylor also suggested that workers needed to be constantly supervised and instructed on the proper working methods. The last principles stated that work allocation between managers and employees should be carefully done to ensure that both staff could do their tasks without problems.
Within the hospital situation, any of these leadership styles can be applicable. However to ensure that maximum performance and productivity is realized, a combination of two leadership styles will be required. Hospitals are typically pressure zones where employee-manager relations are influenced by emergencies, spot decisions and complex situations (Carney, 2007). However, they are also environments where there are numerous employees working at different levels. A combination of telling and delegating will enable a manager to handle the activities in a medical facility efficiently.
In the medical field, the scientific management theory has been applied extensively with positive results. Most medical institutions handle a large number of patients with different conditions. The scientific management approach easily allows managers to develop the most efficient techniques to serve them. Nearly all healthcare organizations have adopted meritocracy when choosing new employees to fill their vacancies. This is why, specialized areas of healthcare such as nursing, dentistry, pediatrics and orthopedics were developed. At the managerial levels, there are similar specializations (Ziegenfuss & Sassani, 2004). In modern hospitals, there are aspects of monitoring and evaluation such as employee appraisals that constantly assess the productivity of the workers. Workers are also awarded supervisors that instruct them regularly. While this approach is somewhat efficient, its proposal that there is one proper way to manage an organization is its main weakness.
In the dynamic field of health care, top-level managers constantly have to strive to accomplish all the needs in their companies (Greenhalgh¸2005). New problems generate the need for new managerial techniques and approaches. With the hindsight that there is no one sure method to tackle health care management challenges, leaders need to assess the several organizational theories that are pertinent to health care organizations in particular. Healthcare managers have the vital responsibility of running the full health care systems, for example, a hospital. Contradictory perspectives exist on the best way to administer these health care systems (Storey & Corbett-Nolan, 2011). The success of a health care facility greatly depends on the type of health care management approach it adopts and the extent of implementation of the theory.
Best practices are very essential in boosting the outcomes for healthcare workers and organizations. These best practices concentrate on the safe, cost-efficient and effective methods of doing any task. Excellent managers are fundamental to the success of an organization. An extremely good manager produces a diligent, productive and efficient labor force that constantly produces excellent performance. Achieving the balance between leadership and management is an important aspect of any organization and most companies that accomplish this feat benefit from the qualities of the joint effort. For healthcare organizations that fail to achieve either managerial or leadership excellence, it becomes very difficult to achieve the organization’s objectives such as providing quality healthcare.
Ashcroft, R. E. (2007). Principles of health care ethics. Chichester, West Sussex, England: John Wiley & Sons.
Aspinall, P.J. (2007). Language ability: a neglected dimension in the profiling of populations and health service users. Language Ability: a Neglected Dimension in the Profiling of Populations and Health Service Users.
Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics. New York, NY: Oxford Univ. Press.
Buchbinder, S. B., & Shanks, N. H. (2007). Introduction to health care management. Sudbury, Mass: Jones and Bartlett Publishers.
Carney, M. (2007). Health service management: Culture consensus & the middle manager. New Delhi: Prentice-Hall of India.
Darr, K. (2011). Ethics in health services management. Baltimore: Health Professions Press.
Dreachslin, J. L. (2007). Diversity management and cultural competence: research, practice, and the business case. Journal of Healthcare Management, 52(2).
Dreachslin, J. L., Gilbert, M. J., & Malone, B. (2013). Diversity and cultural competence in health care: A systems approach. San Francisco: Jossey-Bass.
Fottler, M. D., Khatri, N., & Savage, G. T. (2010). Strategic human resource management in health care. Bingley, UK: Emerald.
Greenhalgh, T. (2005). Diffusion of innovations in health service organisations: A systematic literature review. Malden, Mass: Blackwell.
Hollins, S. (2009). Religions, culture, and healthcare: A practical handbook for use in healthcare environments. Oxford: Radcliffe Publishing.
Johnson, A., & Paton, K. (2007). Health promotion and health services: Management for change. South Melbourne, Australia: Oxford University Press.
Kavanagh, K. H., & Knowlden, V. (2004). Many voices: Toward caring culture in healthcare and healing. Madison, Wis: University of Wisconsin Press.
Knipper, M, Akinci, S, & Soydan, N. (2010). Culture and Healthcare in Medical Education: Migrants’ Health and Beyond. German Medical Science GMS Publishing House; Düsseldorf
Mannion, R., Brown, S., Beck, M., & Lunt, N. (2011). Managing cultural diversity in healthcare partnerships: the case of LIFT. Journal of Health Organization and Management, 25, 6, 645-657.
Nelson, W. A., & Donnellan, J. (2009). An Executive-Driven Ethical Culture. Healthcare Executive, 24, 6, 44-49
Preker, A. S., & Harding, A. (2003). Innovations in health service delivery: The corporatization of public hospitals. Washington, D.C: World Bank.
Reilly, M. J., & Markenson, D. S. (2011). Health care emergency management: Principles and practice. Sudbury, Mass: Jones and Bartlett Learning.
Storey, J., Bullivant, J. R. N., & Corbett-Nolan, A. (2011). Governing the new NHS: Issues and tensions in health service management. Milton Park, Abingdon, Oxon: Routledge.
Tseng, W.-S., & Streltzer, J. (2008). Cultural competence in health care. New York: Springer.
Walshe, K., & Smith, J. (2011). Healthcare management. Maidenhead, Berkshire, England: McGraw Hill/Open University Press.
Wear, D., & Aultman, J. M. (2006). Professionalism in medicine: Critical perspectives. New York: Springer.
Weinstein, J. (2010). Mental health, service user involvement and recovery. London: Jessica Kingsley Publishers.
Ziegenfuss, J. T., & Sassani, J. W. (2004). The portable health administration. Amsterdam: Academic Press.