2

C H A P T E R

2

Introduction to Management and Management Decision Making

The roles of the nurse manager and nurse

executive have evolved significantly in response

to changes in the healthcare industry in the last

20 years.

—Carol S. Kleinman

24

Throughout history, nursing has been required to respond to changing technologicaland social forces. The new managerial responsibilities placed on organized nursingservices require nurse administrators who are knowledgeable, skilled, and competentin all aspects of management. Now more than ever there is a greater emphasis on thebusiness of health care, with managers being involved in the financial and marketingaspects of their respective departments. To confront expanding responsibilities anddemands, 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 dramaticthat 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 promptsome 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 increasesproductivity by maximizing work force effectiveness.

Leadership is viewed by some as one of management’s many functions; othersmaintain that leadership requires more complex skills than management and thatmanagement 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 thischapter so that there is a full understanding of the functions of management. Thefollowing 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 leadershipskills in the healthcare industry. This was true not only in nursing and health carebut throughout businesses in Western society. Only in the last 50 years has theworld shifted much of its research and interest onto leadership. Effective managersneed to be well grounded in management theory and to understand managementdecision making. Leadership without management results in chaos and failure forboth the organization and the individual executive. The ultimate goal for all execu-tives is to integrate management functions and leadership roles. This chapter willfocus on providing an historical overview of management theory development andprovide 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 organizationsare complex and varied, theorists’ views of what successful management is and whatit 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 achievedminimum standards doing the least amount of work possible, Taylor postulatedthat if workers could be taught the “one best way to accomplish a task,” productivitywould increase. Borrowing a term coined by Louis Brandeis, a colleague of Taylor’s,Taylor called these principles “scientific management.”The four overriding principlesof scientific management as identified by Taylor (1911) are:

1. Traditional “rule-of-thumb” means of organizing work must be replacedwith scientific methods. In other words, by using time and motion studiesand the expertise of experienced workers, work could be scientificallydesigned 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 identifiedso 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 howthey contribute to overall organizational productivity. This provides commongoals and a sharing of the organizational mission. One way in which Taylorthought this could be accomplished was by the use of financial incentives as areward for work accomplished. Because Taylor viewed humans as “economicanimals” motivated solely by money, workers were reimbursed according totheir level of production, rather than by an hourly wage.

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

What was the result of scientific management? Productivity and profits rosedramatically. Organizations were provided with a rational means of harnessing theenergy of the industrial revolution. Some experts have argued that Taylor was not ahumanist and that his scientific principles were not in the best interest of unions orworkers. However, it is important to remember the era in which Taylor did hiswork. During the industrial revolution, laissez-faire economics prevailed, optimismwas high, and a Puritan work ethic was prevalent. Taylor maintained that he trulybelieved managers and workers would be satisfied if increased productivity resultedin 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 newlook 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 thatmanagers need to think of new ways to do traditional tasks so that work is moreefficient. Meltzer (1999) maintains that time and motion studies can be used toimprove performance, cut costs significantly, and improve the quality of care.


Strategies for EfficiencyIn small groups, discuss some work routines carried out in healthcareorganizations that seem to be inefficient. Could such routines or the timeand motion involved to carry out a task be altered to improve efficiencywithout jeopardizing quality of care? Make a list of ways that nursescould work more efficiently. Don’t limit your examination only to nursingprocedures and routines, but examine the impact other departments orthe arrangement of the nurse’s work area may have on preventing nursesfrom working more efficiently. Share your ideas with your peers.

Learning Exercise 2.1

Managers need to thinkof new ways to dotraditional tasks so thatwork is more efficient.

Bureaucracy

About the same time that Taylor was examining worker tasks, Max Weber, awell-known German sociologist, began to study large-scale organizations todetermine what made some more efficient than others. Weber saw the need forlegalized, formal authority and consistent rules and regulations for personnel indifferent positions; he thus proposed bureaucracy as an organizational design.His essay, “Bureaucracy,” was written in 1922 in response to what he perceivedas a need to provide more rules, regulations, and structure within organizationsto increase efficiency. Much of Weber’s work and bureaucratic organizationaldesign are still evident today in many healthcare institutions. His work is discussedfurther 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’smanagement functions in his introduction of the seven activities of management—planning, organizing, staffing, directing, coordinating, reporting, and budgeting—asdenoted by the mnemonic POSDCORB. Although often modified (either by includ-ing staffing as a management function or renaming elements), these functions oractivities have changed little over time. Eventually, theorists began to refer to thesefunctions 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 managementprocess 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, determiningthe most appropriate type of patient care delivery, and grouping activities tomeet unit goals. Other functions involve working within the structure of theorganization and understanding and using power and authority appropriately.

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

4. Directing sometimes includes several staffing functions. However, thisphase’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, asshown in Figure 2.2. Both processes are cyclic, and many different functions mayoccur simultaneously. Suppose that a nurse-manager spent part of the day workingon the budget (planning), met with the staff about changing the patient care man-agement delivery system from primary care to team nursing (organizing), altered thestaffing 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 allphases of the management process, but each function has a planning, implementing,and controlling phase.


Planning

Controlling

Directing

Organizing

Staffing

Figure 2.1 The managementprocess.

Just as nursing practicerequires that all nursingcare has a plan and anevaluation, so too doeseach function ofmanagement.

Human Relations Management (1930–1970)

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

Participative ManagementMary Parker Follett was one of the first theorists to suggest basic principles of whattoday would be called participative decision making or participative management. Inher essay “The Giving of Orders” (1926), Follett espoused her belief that managersshould 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 themajor shortcoming of the bureaucratic system—a failure to include the “humanelement.” Studies done at the Hawthorne Works of the Western Electric Com-pany near Chicago between 1927 and 1932 played a major role in this shiftingfocus. The studies, conducted by Elton Mayo and his Harvard associates, beganas an attempt to look at the relationship between light illumination in the factoryand productivity.


Planning

Simplified Nursing Process Management Process Functions

Controlling

Directing

Organizing

Organizing

Staffing

Planning

ASSESSING

PLANNING

IMPLEMENTING

EVALUATING

Figure 2.2 Integrating nursing and management processes.

Recognition of WorkersMayo and his colleagues discovered that when management paid special attentionto workers, productivity was likely to increase, regardless of the environmentalworking conditions. This Hawthorne effect indicated that people respond to beingstudied, attempting to increase whatever behavior they feel will continue to warrantthe attention. Mayo (1953) also found that informal work groups and a sociallyinformal work environment were factors in determining productivity, and Mayorecommended more employee participation in decision making.

Employee Satisfaction Douglas McGregor (1960) reinforced these ideas by theorizing that managerialattitudes about employees (and, hence, how managers treat those employees) canbe directly correlated with employee satisfaction. He labeled this Theory X andTheory Y. Theory X managers believe that their employees are basically lazy, needconstant 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 ParticipationChris Argyris (1964) supported McGregor and Mayo by saying that managerialdomination causes workers to become discouraged and passive. He believed that ifself-esteem and independence needs are not met, employees will become discour-aged and troublesome or may leave the organization. Argyris stressed the need forflexibility within the organization and employee participation in decision making.

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

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

Table 2.1 Developers of Management Theory

Theorist Theory

Taylor Scientific managementWeber Bureaucratic organizationsFayol Management functionsGulick Activities of managementFollett Participative managementMayo Hawthorne effectMcGregor Theory X and Theory YArgyris Employee participation


approach to management. The human relations approach was time-consuming andoften resulted in unmet organizational goals. In addition, not every employee likedworking 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 andfocused on productivity and efficiency. Later the needs and motivation of workersbecame 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 managementwas a complex issue that was intertwined with leadership. The following chapter willfocus 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 primaryfunctions. 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 provideorder 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 ofthese decision aids, this chapter presents selected technology that would be mosthelpful to a beginning manager. Some of these aids encourage analytical thinking,others are designed to increase intuitive reasoning, and a few encourage use of bothhemispheres 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 andthat all aids are subject to human error.

Decision GridsA decision grid allows one to visually examine the alternatives and compare eachagainst the same criteria. Although any criteria may be selected, the same criteriaare used to analyze each alternative. An example of a decision grid is depicted inFigure 2.3. When many alternatives have been generated or a group or committeeis collaborating on the decision, these grids are particularly helpful to the process.This tool, for instance, would be useful when changing the method of managingcare 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 moreheavily than others if some are more important. To do this, it is usually necessaryto assign a number value to each criterion. The result would be a numeric valuefor each alternative considered.


Payoff TablesThe decision aids that fall in this category have a cost-profit-volume relationshipand are very helpful when some quantitative information is available, such as theitem’s cost or predicted use. To use payoff tables, one must determine probabilitiesand 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 appropriatelyused in determining how many participants it would take to make an in-serviceprogram break even.

If the instructor for the class costs $400, the in-service director would need tocharge each of the 20 participants $20 for the class, but for 40 participants, the classwould cost only $10 each. The in-service director would use attendance data frompast classes and the number of nurses potentially available to attend to determineprobable class size and thus how much to charge for the class. Payoff tables do notguarantee that a correct decision will be made, but they assist in visualizing data.

Decision TreesBecause decisions are often tied to the outcome of other events, managementanalysts have developed decision trees. Used to plot a decision over time, decisiontrees allow visualization of various outcomes. The decision tree in Figure 2.4compares 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 performoutpatient procedures on an oncology floor or to have nurses available to the uniton 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 beconsidered. Initially, costs would increase in hiring a regular staff, but over alonger period of time, this move would mean greater savings if the volume ofprocedures does not dramatically decrease.

Consequence TablesClancy (2003) used a consequence table to demonstrate how various alternativescreate different consequences. A consequence table lists the objectives for solving a


#1

#2

#3

#4

Financialeffect

Politicaleffect

Departmentaleffect Time DecisionAlternative

Figure 2.3 A decision grid.

problem down one side of a grid and rates how each alternative would meet thedesired objective. For example, consider this problem: The number of patient falls hasexceeded the benchmark rate for two consecutive quarters. After a period of analysis thefollowing 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 solvingthe 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 ofthe alternatives through a standardized key, which allows a fair comparisonbetween alternatives and assists in eliminating undesirable choices. It is important


POSSIBLE EVENTS

Increased demandfor procedures

Decreased demandfor procedures

Increased demandfor staff

Decreased demandfor staff

Pay overtime andon-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 willaffect 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 determinethe timing of decisions. Developed by the Booz-Allen-Hamilton organizationand the United States Navy in connection with the Polaris missile program,PERT is essentially a flowchart that predicts when events and activities musttake 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 ofweeks 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 sequencebefore one may proceed. PERT is especially helpful when a group of people areworking on a project. The flowchart keeps everyone up-to-date, and problems areeasily identified when they first occur. Flowcharts are popular, and many peopleuse them in their personal lives.


Table 2.2 Consequence Table: An Example

Objectives for Problem Solving Alternative 1 Alternative 2 Alternative 3

1. Reduces the number X X Xof falls

2. Meets regulatory X X Xstandards

3. Is cost effective X X

4. Fits present policy Xguidelines

Decision Score


Decisionto develop a staffedoutpatienttreatment

room

5-7-9 2-3-42-3-4Renovationcomplete

Staffrecruited

Staffhired

2-3-4Staff

trained

4-5-6

1-2-3

Equipmentinstalled

Equipmentreceived

Equipmentordered

Equipmentand 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

Planningcomplete

Roomgutted

Figure 2.5 An example of a PERT flow diagram.

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


PITFALLS IN USING DECISION-MAKING TOOLS

Clancy (2003) maintains that there is a strong tendency for managers to favor firstimpressions when making a decision and a second tendency called confirmationbiases often follows. A confirmation bias has a tendency to affirm one’s initialimpression 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 soindividuals may have preconceived notions or biases that influence decisions. Toooften managers allow the past to influence current decisions. Lastly, managers oftenbecome too confident about their decision making ability and remember their gooddecisions and forget the negative outcomes that resulted from some of their otherdecisions (Clancy, 2003).

Minimizing Pitfalls

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

In addition to quantitative decision technology, management analysts havedeveloped models that assist managers in choosing the correct decision-makingstyle. A manager can be autocratic in making decisions and have little or no inputfrom others or can be democratic and involve others in the process. Some managersdevelop patterns and use the same methods, rather than looking at the particularsituation and then concluding which type of decision making is needed. Vroom andYetton (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 theleader does not possess enough information or expertise to solve the prob-lem by himself or herself, AI is eliminated from the feasible set. (Its userisks a low-quality decision.)

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


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 knowexactly what information is needed and where it is located), the methodused must provide a means not only to collect the information, but also todo so in an efficient and effective manner. Methods that involve interactionamong all subordinates with full knowledge of the problem are likely to beboth more efficient and more likely to generate a high-quality solution tothe problem. Under these conditions, AI, AII, and CI are eliminated from thefeasible set. (AI does not provide for collection of the necessary information;AII and CI represent more cumbersome, less-effective, and less-efficientmeans of bringing the necessary information to bear on the solution of theproblem than methods that do permit those with the necessary informationto interact.)

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

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


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 ideasand 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.

Reprinted by permission of publisher from Organizational Dynamics. Spring 1973. p. 74. New York: American Man-agement Association. All rights reserved.

conflict or disagreement over the appropriate solution, AI, AII, and CI areeliminated from the feasible set. (The method used in solving the problemshould enable those who disagree to resolve their differences with fullknowledge of the problem. AI, AII, and CI involve no interaction or only“one-on-one” relationships and therefore provide no opportunity for thosein conflict to resolve their differences. Their use runs the risk of leavingsome of the subordinates with less than the necessary commitment to thefinal 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 shouldmaximize the probability of acceptance because this is the only relevantconsideration in determining the effectiveness of the decision. In these cir-cumstances, AI, AII, CI, and CII create less acceptance or commitmentthan GII. To use them is to run the risk of getting less than the neededacceptance of the decision.)


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 thatdecision 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 thatby subordinates your subordinates would accept it?

F. The extent to which subordinates are Do subordinates share the organizationalmotivated 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 likelylikely to be in conflict over preferred in preferred solutions?solution

Reprinted by permission of publisher from Organizational Dynamics. Spring 1973. p. 74. New York: American Manage-ment Association. All rights reserved.

7. The acceptance priority rule. If acceptance is critical and not ensured by anautocratic decision, and subordinates can be trusted, AI, AII, CI, and CIIare eliminated from the feasible set. (Methods that provide equal partner-ship in the decision-making process can provide greater acceptance withoutrisking decision quality. Use of any method other than GII results in anunnecessary risk that the decision will not be fully accepted or receive thenecessary commitment on the part of subordinates.

In later work, Vroom and associates (1976) demonstrated how a decision treecould 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 complexitiesin situational demands more effectively than either McGregor’s Theory Y or Blakeand Mouton’s managerial grid, and they demonstrated its mathematical attributeswhen 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 providesa good basis for determining decision-making style appropriate for a managerworking 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 includeplanning, organizing, delegating, problem solving, evaluating, and enforcing policies


STATETHE

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 CERTAINTHAT 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.

YESYES

YES

YES

YES

YES

YES YES

YES

YES

YES

YES

YESYES

YES

YES

YES

NO

NO

NO

NO

NO

NONO

NO

NO

NO

NO

NONO

NO

NO

NO

NO

1: AI2: GII

3: AI

4: AI

5: GII

6A: CII

6B: CI7: AII

9: CII8: AII

10: CII

11: GII

12: CII

A

B

D

D

D

D

E

E

E

E

F

F

F

F

F

GC

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 satisfycustomers. 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 functionsof management.

What soon becomes evident in reviewing the literature is that there is someoverlap in management functions with leadership roles. It does seem to becomeincreasing clear, however, that management functions are more concerned with theday-to-day activity of the organization and with maintaining the status quo, andtherefore stability, for the organization while the role of leadership is more focusedon moving the organization forward toward the future and thereby changing thestatus quo (Trent, 2003).

Throughout this text, leadership and management—the two very necessaryelements—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 foran integrated leader manager. Zakeznik (2004) maintains that businesses mustfind ways to train good managers and develop leaders at the same time. Adoptionof the integrated leader manager is critical for the healthcare industry.


Planning Empower staff Satisfy customersDirecting Maintain quality OrganizingProblem-solving Staffing DelegatingEnforcing policies Controlling

and procedures EvaluatingManage day-to-day Build productive

operations work teams

Functions of ManagementDisplay 2.1

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

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 2.3A

SUMMARY

Management has a unique purpose and outcome that is needed to maintain ahealthy organization. The history of management science provides managers witha 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 problemstoday. Since the earliest management studies, theorists have learned much abouthuman behavior; additionally society has changed remarkably, providing currentmanagement theorists with new insights and challenges.

However, even today one of the most important functions for the managerremains that of being a successful decision maker. Decision making takes placethroughout 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 assistthe manager in making more effective decisions. Although there are many suchtools available, the successful manger knows that they are not foolproof and oftendo 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, andcontrolling. These are incorporated into what is known as the managementprocess.

• 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 littleattention was given to worker job satisfaction.

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

• Management science has produced many tools to assist in managementdecision 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.



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


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

Your nursing administrator is anxious to implement the system in otherpatient care units but wants it to be working well in your unit first. Youhave just come from a manager’s meeting where your administrator toldyou 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 themost appropriate decision style.


More Learning Exercises and Applications

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

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


Gathering the Facts—Stat!You are the day shift charge nurse on a surgical unit. Because of yourrelated expertise, your supervisor has asked you to select a new type ofblood-warming unit. You want to be sure that you select the right one.Several companies have provided your staff with trial units. You have notreceived much feedback from the staff regarding their preferences.Today, your supervisor tells you that your selection and its price must beready to accompany her budget, which is due in two days. What do youdo? Select the most appropriate decision style.


Who Should Go?You are the evening shift charge nurse of the intensive care unit. Yoursupervisor is sending two nurses from each shift to an upcoming criticalcare conference in a nearby city. The supervisor wants each charge nurseto 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 youresolve this situation? Select the most appropriate decision style.


Teamwork in HiringSix nurses have just applied for a position in the open heart unit. Workingwith a group, develop an appropriate decision grid for selecting whichnurse to hire. Identify six criteria for hiring. You may give each criterionweighted 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.


Web Links

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

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

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