Amid change, management undergoes a redefinition - Management Issues

Healthcare Financial Management, Oct, 1991 by Edward A. Kazemek

What is management? During this century, writers have devoted millions of words to the question. In spite of intense efforts to understand and develop the science of management, experts and students continue to debate what management is and what it is not.

Customary definition

The most common traditional definition of management emphasizes some key functions:

* Planning an organization's tasks;

* Organizing tasks and resources;

* Directing the efforts of employees expected to perform those tasks;

* Controlling and monitoring work process; and

* Solving problems as they arise.

This definition places management in the driver's seat, leaving employees in neutral until management puts them in gear. For the past 25 years, many experts have argued against this management paradigm, saying it runs counter to human motivation and is a gross waste of resources.

Further, top-performing, high-quality organizations simply do not function this way. Organizations (including healthcare facilities) that consistently lead the pack, regardless of the comparative measures used, see management in an entirely different light.

Quality trigger

The quality movement sweeping through health care, coupled with constant pressure for greater productivity and cost control, have forced healthcare management to redefine its role and relationships with employees. Hierarchical power is giving way to collegial power, and top-down problem solving is being replaced by bottom-up innovations.

The emerging definition of management departs radically from the traditional view. Management increasingly involves performance of a different set of functions, such as:

Leading. Managers provide leadership rather than intervention in the work of people who report to them. They create a team-oriented culture that prevents problems and strives for continuous improvement.

Management make certain that the right things are being done and assumes that people are motivated to contribute to the organization and do those things right. Control is achieved by shared values and beliefs, a deep awareness of an organization's mission, vision, and goals.

Facilitating. Managers ensure that formal and informal mechanisms are in place to encourage and facilitate team work and team development throughout an organization. Using participative management, they facilitate the operations of interdependent systems and processes. Problems are identified and solved by people who "own" them, not by management. Understanding organizational change and how to guide it requires a major time commitment from managers.

Communicating. Management links disparate but interdependent parts of an organization. Each person becomes a manager of his or her work processes, seeking to provide increased value for an organization and its customers. The flow of communication among parts of an organization serves as a vital lubricant to keep the process running smoothly. Little is kept from employees, with financial results and other data shared freely to help measure improvement.

Supporting. Management sees its employees as "customers" who must be served to allow them to succeed in their jobs. Blaming people for problems is considered a waste of time and energy. Instead, management provides support and resources to employees so they can develop innovative processes, products, and services. In this way, problems become opportunities for improvement, with managers and employees working together.

Celebrating. Management ensures that successes and attempts at success are recognized, rewarded, and enjoyed. Reward systems are modified to recognize team and individual contributions. Good management drives out fear and eliminates "win/lose" approaches. Management-supported systems allow people to feel like winners and have fun on the job.

These functions taken together paint a picture that differs markedly from today's view of management. Interestingly, winners of the Malcolm A. Baldridge National Quality Award (Motorola, Xerox, Wallace Co., and others) often attribute much of their success to fundamental shifts in roles played by managers and their relationships to employees.

As winds of change continue to blow across health care, the knowledge, skills, and attitudes required of managers are far more complex than many management theorists ever envisioned.

Edward A. Kazemek is chairman and chief executive officer of ACCORD Limited, a healthcare management consulting firm in Chicago, Ill. Reader's comments and questions encouraged and, whenever possible, will be addressed in future articles. Address to Edward Kazemek, ACCORD Limited, 919 N. Michigan Ave., Suite 1200, Chicago, IL 60611.