Structure, empowerment and decision making in health

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Decentralization creates a higher employee satisfaction and supports faster responses to different type of issues. Decentralization helps in the on- the- job training of employees for higher positions. Several firms are pushing accountability down the chain of authority, in a bid to improve quality performance and organizational responsiveness. Employees want to be involved in making those decisions that affect them. Therefore managers should delegate decision making especially when it affects the employees in order to involve them in the choice process. Queensland case in a perfect example of the contrary in that the structure is much formalized. This centralized organizational structure leads to centralized decision making which prevents an immediate healthcare delivery. A major risk involved in implementing this may include delegation of duties and responsibilities. The Director of health services is expected to relinquish some of the duties to others who can perform. This may be a potential of conflicts in the sector before a consensus is reached (Nancy, 2010).

Impersonal means of coordination create synergy by stressing uniformity and standardization so that individual pieces fit together. Impersonal management methods are frequently refinements and extensions of practice controls with an emphasis on formalization and standardization. Most large firms have written policies and measures, such as schedules, plans and budgets that are designed to interconnect the operations of several departments into a whole by providing certainty and consistency. In Queensland this is however not the case as the Executive Director of health services controls almost all the operations. This should be restructured to allow more coordination of various units within the health system to give room or rather empower the clinicians to deliver quality services to the patients (John, 2006).

Bureaucracies depend on the talent of an individual; this makes them very vulnerable in that they are much likely to fail should the leader be left out. In the long term this will inhibit innovation, often unfair and blocks efficiency. This kind of bureaucracy is well shown in the case of Queensland health system where the director of health services makes almost all decisions concerning health. It could be very fair to employees if bureaucracy is minimized to give them freedom to express themselves in a bid to deliver better health care to the patients. Organizations have realized that to achieve success in all they intend to do they must have capabilities for implementation in an environment that facilitates success. It is clear that if an organization wants efficiency it should adopt machine bureaucracy. The Queensland Health structure is over bureaucratized hence leading to the frustration of employees and the patients. A lot of the Queensland Health staff felt angry, frustrated and resentful towards their seniors. Some staff members went to the extent of facing intimidation and bullying especially those who tried to get more funds to deliver patient care. The structural design of the organization should facilitate the type of achievements desired by the senior management, and also give individuals to develop, experiment competencies so that the strategy of the organizational can grow (Leban, & Stone, 2008). With time organizations can develop exact technical and administrative skills as middle and other lower level managers put in place minor changes to solve particular problems. The firms will be expected to grow to greater heights the employees are given the chance to learn and if it is transferred up and across the organization hierarchy.

Dealing with bureaucracy might introduce an extra cost in the health care because the machines needed would strain the health care budget but in the long run it would be beneficial to the whole process.

Empowerment is the process by which managers help others to acquire and use the power needed to make decisions affecting themselves and their work. More than ever before, managers in progressive organizations are expected to be good at (and highly comfortable with) empowering the people with whom they work. Rather than considering power to be something to be held only at higher levels in the traditional "pyramid" of organizations, this view considers power to be something that can be shared by everyone working in flatter and more collegial structures (Grizzel, 2007). In the Queensland case study there is need to empower the clinicians and other clinical staff in order to achieve high levels of healthcare services. The hierarchy must be flattened. The managers must share power in their daily tasks.

When an organization attempts to move power down the hierarchy, it must also alter the existing pattern of position power. Changing this pattern raises some important questions. Can "empowered" individuals give rewards and sanctions based on task accomplishment? Has their new right to act been legitimized with formal authority? All too often, attempts at empowerment disrupt well-established patterns of position power and threaten middle and lower level managers. As one supervisor said, "All this empowerment stuff sounds great for top management. They don't have to run around trying to get the necessary clearances to implement the suggestions from my group. In our context, all these may pose as risks that will be brought about by the empowerment of those who deliver healthcare at Queensland.

Decision making

Firms' success largely depends on the daily decisions made by the members. The excellence of these decisions determines the long-term success of an organization and its day to day image in the eyes of employees, customers, and community at large. The current challenging environments also call for even more strictness and creativity in the decision-making. New products and service processes are brought about by ideas. Firms must provide for decision making that allow the free flow of new ideas and give support to the efforts of employees who want to make their ideas real. And just like organizations themselves, success of our individual careers relies on the quality of the decisions we make concerning our jobs and employment conditions. Queensland Health organization has a hierarchy of layers in decision making. This however does not give chance to an efficient and responsive health care system. The Queensland Health's resources responsibilities are under the Director of Health Services, this contributes dearly in stifling the decision making process within the organization. However, empowering those who deliver health care to make decision will allow clinicians and other clinical staff who got the direct contact with the patients to directly deal with the issues that affect the patients. This would play a significant role in improving the quality if healthcare services.

Empowerment would also improve information sharing among all the people involved in healthcare. This would disintegrate the 'silos' that build around occupational groupings, majorly because it would ease workloads and the budget constraints.

Question 4

Behaviour modification strategies

Organization behaviour is pattern exhibited by both the employees and the management in an organization. A good understanding of organizational behaviour enables one to learn more on how to interact with people from diverse fields and capacities, especially at the work place. Research indicates that, effective organization behaviour contributes in a big way to the success of an organization (Steven, 2008). Good organization enables the team to work in a good environment where despite their varying tasks, eventually, they achieve a common goal. The Queensland Health Care is a good example for the need of organizational behaviour modification. There are so many problems within the organization that calls for an immediate change in the behaviour strategies employed. For example the bullying, frustration, resentment towards the seniors, intimidation and stress must be dealt with if the clinicians are to deliver quality health care to the patients.

Diversity: Diversity refers to the differences and/or similarities that exist among people in an organization setting. The four levels of diversity are personality, internal dimensions, external dimensions and organizational dimensions. Personality is the sum of all the attributes that an individual possesses i.e. behavioural, emotional, mental and temperamental. Personality influences an individual's unique behaviour. The internal dimensions include factors such as age, education level, and income among others. External dimensions refer to the factors such as marital status and position held at work among others. Organizational dimensions are those factors that relate to the organization itself e.g. revenues generated, employee turn-over, organizational beliefs and practises among others. The theory of managing diversity in firms lays emphasis on appreciation of differences in building a setting where each one feels respected and accepted. An organization's success in managing diversity can be examined by organizational surveys of perceptions and attitudes. Managing diversity at Queensland health system means that the clinicians will keep their own personality and will shape the organization as well as be shaped by it, and as such help in creating a general set of values that will reinforce ties with customers, improve health care delivery, and so on. Diversity management will help alleviate some of the current problems at Queensland health system. Once the clinicians feel appreciated and respected by the organization the level of their morale is expected to raise, their stress reduced and the absenteeism become a thing of the past.

Communication: Communication refers to exchange of information from one person to another, where both parties understand the intended message. Individuals in an organization communicate to influence, inform or enquire within the course of their day to day operations. The basic communication channel has a source of the message, a channel through which the message is carried and the recipient of the message. Functions of communication are to inform, regulate, interrogate, manage, persuade and socialize (Richmond, McCroskey, & Linda, 2009). Opportunities to give feedback and question are very important in improving the effectiveness of communication. Leaders may decide to visit every employee and explain any new change in the operation process, although this may guarantee that each and every employee understands what is expected of him/her this may however, be very expensive in terms of time. Queensland health has so far not given room for either efficient neither effective communication. Due to the bureaucracy in the health system, most of the communication is top down from the director of health services to the subordinates with no feedback. This type of organization behaviour only magnifies other problems, for example this cause stress, absenteeism and loss of morale among the clinicians. Creating a two way flow of information would help solve all the problems and make management efforts even easier. The clinicians would also be empowered to offer high quality services to the patients. This would also play a big role in cost reduction as efficiency would increase within the organization.

High performance leadership: leadership is the interpersonal influence that gets an individual or a group to do what the leader or manager wants done. There are two forms of leadership formal and informal. Formal leadership is exerted by individuals elected or appointed to positions of formal authority in firms. Informal leadership is exerted by individuals who end up being influential because of their special skills.

In the Queensland context it is evident that leaders, supervisors and managers frequently failed to tackle problems, failed to engage staff, did not encourage staff participation in solving problems and also didn't manage non-performing staff properly. All these problems clearly show that there is a need for the organization to change its strategies regarding appointment and development of its leaders. Queensland health organization requires leaders who can lead by example, inspire subordinates, and develop their attitudes, beliefs and culture. The type of leadership current at the Queensland Health organization is directive leadership where the leaders determine what the employee's duties are. To curb the existing problems this is however expected to shift to supportive leadership which emphasizes on employees' needs and well being and further promote a good working environment.Supportive leadership is expected to increase the satisfaction of employees who work on exceedingly recurring tasks or on tasks considered to be unlikable, stressful, or exasperating; the leader's supportive behavior helps compensate for these adverse conditions. A supportive manager could assist make these tasks more pleasant.

Values: Values can be described as wide range of preferences regarding suitable courses of action or outcomes. Values reveal a person's sense of what is right and what is wrong. Valued emphasize on equal rights for everyone. People should be treated with respect and dignity. Values have a tendency of influencing attitudes and behavior. For example, in our Queensland health organization example, those employees who value equal rights for all will not be comfortable working as clinicians where the leaders enjoy much higher privileges. Such employees end up developing the attitude that the organization is an unfair place to work in, and as a result such clinicians will not perform as expected and may fall victim of absenteeism, lose morale or even end up quitting. It is likely that if the Queensland health organization had had a more equalitarian policy, then the employee's attitude and behaviours would be different. Cases of absenteeism and stress would not be there.

In conclusion, the strategies given above are examples of how organizational behavior can be managed in order to achieve success. These behaviors develop overtime and for that reason, they should be natured by the organization if it wishes to succeed. Some organizational behaviors if allowed to continue may in the end seriously affect the structure and the operations of the organization as a whole. Managers must learn how to manage diversity. With globalization in the 21st century, managing diversity has come along with its challenges. However, organization that will manage diversity to their advantage will obvious be competitive than those that fail. Communication has also posed so many challenges but if well managed, for example giving room for decision making may change the way firms operate. Innovation and creativity will be encouraged which will see new product and services processes.

Question 6

Job design, team work and power

In the course of job design, managers plan and specify job tasks and the work arrangements through which they are accomplished. Alternative job design approaches vary in the way the required duties are laid out and in the amount of inherent incentive provided for the worker. A good job design is one that meets organizational needs for excellent performance, gives a good fit with individual skills and needs, and provides opportunities for job satisfaction. For example from the Queensland perspective a surgeon's task are very different from those of a radiographer or a theater nurse.

Job rotation increases task variety by occasionally shifting employees among jobs concerning different tasks; the responsibility intensity of the tasks does not change. The rotation can be arranged according to almost any time schedule, such as hourly, daily, or weekly schedules. An important benefit of job rotation is training. It allows workers to become more familiar with different tasks and increases the flexibility with which they can be moved from one job to another. This concept may be applied in Queensland for several reasons one of such reasons may be to help restructure the work organization that has been based on the traditional Monday to Friday schedule that is not realistic for the health care. The other reason would be to give room to the clinicians to take part in training.

Job enrichment is the process of enhancing the content of a job by input of motivating factors for example achievement, recognition responsibility, personal growth, and recognition. This process helps the employees to increase their performance and motivation. This should be employed in Queensland health care by enhancing the job content of the clinicians and other clinical staff will help increase the level of quality in health care. Alternative work arrangements methods may also be employed to help reshape the Monday to Friday work schedule this will help the clinicians to strike a balance between work and non work lives.

Flexible working hours may be of much help to the Queensland health care issue where the clinical staff may have a schedule where some may start early and leave early or start later and leave later. This would be very useful because the nature of their job requires them to work around the clock.

A team is a group of individuals who got complementary skills, and who work together to achieve a common goal for which they hold themselves accountable collectively. High performance teams have unusual characteristics that let them do extremely well at teamwork and attain special performance advantages. First, high performance teams comprise of strong core values that direct their attitudes and behaviors in guidelines consistent with the team's principle. Such values work as the internal control system for the team that can alternate for outside direction and supervisory notice creativity. In the new workplace, teams must use their creativity to assist organizations in continuous improvement of operations and in continuous development of new products, services, and markets. Creating teams with diverse members in terms of experiences, cultures, demography and talents can help improve creativity and increase problem solving. For example, in Queensland context creating a team of different clinical staff such as surgeon, radiographer, general practitioner, nurses and clerks create long term gains in performance and creativity. This can be one of the greatest advantages of high performance within the health care.

Power can be referred to as the ability to get someone to do something you want or the ability to make things happen in the way you want them to. The importance of power is control over the behavior of others. Influence on the other hand is what you have when you exercise power, and it is expressed by others' behavioral response to your exercise of power. Mangers can derive power from both

Expert power is the ability to control another person's behavior through the possession of knowledge, experience, or judgment that the other person does not have but needs. A subordinate obeys a supervisor possessing expert power because the boss ordinarily knows more about what is to be done or how it is to be done than does the subordinate. Expert power is relative, not absolute. A Queensland healthcare surgeon or radiographer will possess this type of power because of his/her expertise in the field. As such is expected to have influence to the team as result of his/her position.

Rational persuasion is the ability to control another's behavior because through the individual's efforts, the person accepts the desirability of an offered goal and a reasonable way of achieving it. Much of what a supervisor does day to day involves rational persuasion up, down, and across the organization. Rational persuasion involves both explaining the desirability of expected outcomes and showing how specific actions will achieve these outcomes. The general practitioner wills posses this type of power because of his flexibility across several departments.

Referent power is the ability to control another's behavior because the person wants to identify with the power source. In this case, a subordinate obeys the boss because he or she wants to behave, perceive, or believe as the boss does. This obedience may occur, for example, because the subordinate likes the boss personally and therefore tries to do things the way the boss wants them done. In a sense, the subordinate attempts to avoid doing anything that would interfere with the pleasing boss-subordinate relationship. A person's referent power can be enhanced when the individual taps into the moral order or show a clearer long-term path to a morally desirable end. In common language, individuals with the ability to tap into these more esoteric aspects of corporate life have "charisma" and "the vision thing". Followership is not based on what the subordinate will get for specific actions or specific levels of performance, but on what the individual represents-a path toward a loftier future organizational and individual sources. The ward and theater nurses will possess this type of power in that they will want to identify themselves with the surgeon or radiographer or other senior doctors in the ward or the theater respectively (Robbins, 2008).

Creating such a high performance team would affect communication in several ways. One it would encourage free and open communication within the health organization and empower the employees to air their problems or ideas that they may be having. This helps makes the organisation a transparent one, where everyone's innovative ideas are appreciated. The healthcare organization would also open room for an efficient feedback system where there is a constant flow of information between the management and employees. This helps propel the organisation forward since the goals to be achieved are always clearly communicated.

A high performance team like the one suggested in Queensland health care would create interdepartmental communication. This communication would also help promote decision making process across various departments. This would spur creativity that would lead innovation in the healthcare. The team would also enhance a two way flow of information which would help solve all the problems and make supervision efforts much easier. The clinical staff would also be more effective in delivering high quality services to the patients.

Question 7:

Organizational culture, beliefs and behaviours

Ravisi and Schulz (2006) define organizational culture as 'a set of shared mental assumptions that guide interpretation of actions in organizations, by describing appropriate behaviour for various situations. In short, organization culture tries to harmonize individuals' view of the world with what the organization beliefs to be the right form of behaviour if it is to achieve its goals. The importance of positive culture in organizations can never be overemphasized as demonstrated in Queensland Health Care. This is a government body mandated with the task of providing both inpatient and outpatient emergency care and community health care among others. A recent research indicates a number of flows in the organization culture exhibited by the management, where employee bullying, secrecy and staff intimidation was a common phenomenon. This was to the detriment of the smooth running of the health care. For an organization to achieve its goals, a positive culture must exist which is supportive of the organization's pursuit.

Bullying within the organization is a vice that has evolved over time in the organization. This can be traced from the organization's culture of bureaucracy where employees are required to operate within a fixed budget, yet the responsibilities and the patient list keep on growing longer and longer. It is clear that, human beings are more productive when they work with people who value and respect them. As much as culture may be diverse across the social cultural, geographical and economic divide, the baseline is that any culture observed by an organization should respect basic human rights while at the same time contributing positively towards achievement of the organization's vision. By bulling employees, the culture of secrecy has emerged as no single employee who is willing to jeopardize his or her career by questioning the management. All this is to the detriment of the patient's welfare as well as the entire society (George, 2007).

The culture of secrecy has emerged under the Queens land health body. This culture can be traced from both conscious and unconscious response to the work environment in which both the managers of the healthy facilities and their employees operate in, both internally and externally. The management operates under very close scrutiny of other government bodies and institutions as well as the general public. They are forced to operate within fixed budgets, yet the number of patients expecting to be attended to in the healthy facilities keep on growing day by day. As a result of this, they end up concealing vital information both from the public, the government and the media in fear or facing their wrath. On the other hand, employees are pressured by the frustrated managers to deliver more with in sufficient resources. This has eroded trust of employees on their employer, thus finding it hard to blow the whistle on the system failure to avoid victimization. In the past, whistle blowers around the world have faced legal charges, loss of their jobs as well as physical and mental disturbance. This is totally in contravention with principles of effective communication, where information is viewed as an asset in an organization (Jan, Susan, & Mark, 2005). Unless such an asset is harnessed and disseminated to the relevant parties on the right time, smooth running of the organization remains a mileage. Effective communication in organization foster sharing of information in organization's thus boosting their efficiency as well as effectiveness, where timely feedback enable the organization to improve it s operations.

Taking of responsibility is a key element of an effective team work, where the members accept their weaknesses and work together as a team to boost their productive capacity. The culture of failing to take responsibility by employees on their action is traced from the intimidating factors facing the organization both internally and externally. To break this chain, the government should allocate enough resources to the healthy facilities. It is only by providing such resources that they can now be able to boost performance in the healthy facilities. This will stop the propagation of this destructive culture. Culture dictates how employees carry themselves in an organization. When a new employee comes into the organization, he will eventually adapt to the culture that is generally accepted. According to Schein (1985, 1992), an organization has three levels of culture. The first level is reflected in artefacts, technology and behavioural patterns. This may include machines in use in the organization, the methods employed to get work done, the time employees break for lunch, how they relate with each other among others. It is on this premise that the players in the medical sector should ensure that enough resources are allocated to the healthy sector to facilitate acquisition of the right equipments and staffing in order to handle the rising medical cases (Wiggins, 2006).

The second level constitutes the shared values present in the organization. Such values bind the employees and employers together and anyone not sharing such values becomes a misfit in the organization. Unfortunately, employees and employers under Queensland are sharing a culture that most of the employees and employers are not willing to associate with. It is not a culture emanating from shared values but rather it's a culture emanating from intimidation both internally and from external sources (Swartz, & Watkins, 2003). This leaves the employer employee relationship in the medical facilities severed in a big way. This has the chances of reducing coordination within the organization, thus hindering effective service delivery.

The third level is the basic beliefs and assumptions prevalent within the organization. These beliefs and assumptions help the members of the organization to align their efforts towards achievement of a common goal. They also help in reducing friction within the organization (Steven, 2008). Towards this end, it is clear that both the employees and the employer in the Queensland medical network are strongly convince that any form of whistle blowing at any level of the organization structure would lead to them being subjected to adverse pressure from both the public (Sison, 2008).

In conclusion it is important to note that organizational culture, values and beliefs come along with so many advantages but still the carry with them negative implications on the organization. Shrewd managers should manage the diversity in organizational culture to benefit the organization. Managers must therefore learn the strategies on how to manage diversity. Mangers should recognize the fact that organizational culture takes time to build, and is much influenced by their actions and how they treat their employees (Alexander, & Britton, 2004). Cultivating a positive culture within the organization should be a priority in the management. When some negative culture is allowed build the cost of reverting the same may be too high for the organization, and should thus be prevented.

New employees should also be aligned into the organization culture once they are recruited. This will play a big role in achieving success in the firm. However it must be noted that where the odds have happened then the best way to get rid of such a culture should mean restructuring the organization, especially the management (Gray, & Larson, 2006). This helps create the demand for a change into something new hence giving birth to a new culture in the firm. Team work can help so much in creating a good positive organizational culture especially if they are build on diversity grounds

Question 9

Organizational change

The first step in the reform process would be initiate frame breaking change. This is a transformational change which will result in a major reorganization of the firm or its component system. This will help the Queensland health care to undergo important shifts in basic characteristic features including the overall mission and purpose, underlying beliefs and values, structures and supporting strategies (Kim, Hornung, & Rousseau, 2010). However for this to succeed there are several agents who can lead and support this change process. These include the groups and persons who take liability for changing the current behavior patterns of another person or social system. Even though change agents every now and then are hired as consultants from outside the firm, any leader in today's dynamic times is likely to act in a change agent capacity. Really, this responsibility is increasingly defined even more particularly as vital to the leadership role.

The first step in changing the healthcare would be to change the current organization behaviour; this would mean changing the leadership. For any type of change to take place, the organizational culture must first be rewritten. Employees must be appreciate and recognized for any other change to start taking effect. Some of the Queensland healthcare areas to target include organizational purpose, strategy, structure, and people, as well as objectives, culture, tasks, and technology. When taking into account these targets, however, it must be acknowledged that they are highly tangled in the workplace. Changes in any one are likely to necessitate or involve changes in others. For example, a change in the basic employees' job is almost unavoidably accompanied by a change in technology the way in which tasks are accomplished (Spector, 2010). Changes in tasks and technology usually call for changes in structures, including changes in the patterns of authority and communication, as well as in the roles of workers. These technological and structural changes can, in turn, necessitate changes in the knowledge, skills, and behaviors of employees' the members of the firm. In all cases, of course, tendencies to accept easy-to-implement, but questionable, "quick fixes" to problems should be avoided. If the organizational behavior is expected to change then long term effects should be emphasized, rather than wasting resources on short term strategies.

One major task in improving the chances of success in change initiatives first understands the core processes of social change in firms. Unfreezing which should be the initial phase is the work of the managers to create an environment for change. It comprises disconfirming the existing attitudes and behaviours to initiate the demand for a change. Queensland healthcare will involve a change in the management who will in turn disconfirm the existing attitudes and behaviours among the clinicians. This will create an environment whereby the employees feel appreciated and recognized by the organization, this will create a demand for something new that will in effect bring change (Steven, 2008).

Once that has been achieved then the next step would be to take action and revert a situation by changing things such as structure, technology, people, and the tasks. Managers plus other agents use different means to mobilize power, exerts influence over others to support the planned change strategies (John, 2009).