Professional blog

FOURTH EDITION

Organizational Behavior in HEALTH CARE

Nancy Borkowski, DBA, FACHE, FHFMA Professor

Department of Health Services Administration School of Health Professions

University of Alabama at Birmingham Birmingham, AL

Katherine A. Meese, PhD Assistant Professor

Department of Health Services Administration School of Health Professions

University of Alabama at Birmingham Birmingham, AL

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Brief Contents Preface About the Authors

PART I Introduction CHAPTER 1 Overview and History

of Organizational Behavior

CHAPTER 2 Diversity, Equity, and Inclusion in Health Care

CHAPTER 3 Diversity Management and Cultural Competency in Health Care

CHAPTER 4 Attitudes and Perceptions

CHAPTER 5 Workplace Communication

PART II Understanding Individual Behaviors CHAPTER 6 Content Theories of

Motivation

CHAPTER 7 Process Theories of Motivation

CHAPTER 8 Attribution Theory and Motivation

PART III Leadership CHAPTER 9 Power, Politics, and

Influence

CHAPTER 10 Trait and Behavioral Theories of Leadership

CHAPTER 11 Contingency Theories and Situational Models of Leadership

CHAPTER 12 Contemporary Leadership Theories

PART IV Intrapersonal and Interpersonal Issues

CHAPTER 13 Stress in the Workplace and Stress Management

CHAPTER 14 Decision Making

CHAPTER 15 Conflict Management and Negotiation Skills

PART V Groups and Teams CHAPTER 16 Overview of Group

Dynamics

CHAPTER 17 Groups

CHAPTER 18 Work Teams and Team Building

PART VI Managing Organizational Change CHAPTER 19 Organization

Development

CHAPTER 20 Managing Resistance to Change

Index

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Contents Preface About the Authors

PART I Introduction

CHAPTER 1 Overview and History of Organizational Behavior Overview Why Study Organizational Behavior in Health

Care? The Health Care Industry History of Organizational Behavior The Hawthorne Studies Theories X and Y Related Disciplines Discussion Questions What Do You Know About Organizational

Behavior? Scoring Interpretation References

CHAPTER 2 Diversity, Equity, and Inclusion in Health Care Overview Diversity, Equity, and Inclusion Defined Changing U.S. Population

Race/Ethnicity

Age

Gender

Sexual Orientation, Gender Identity, and Gender Expression

Implications for the Health Care Industry Summary Discussion Questions Exercise 2-1 Exercise 2-2 Exercise 2-3 References Other Suggested Readings

CHAPTER 3 Diversity Management and Cultural Competency in Health Care Diversity Management The Future Workforce Diversity in Health Care Leadership Cultural Competency Summary

Discussion Questions Exercise 3-1 Exercise 3-2 Exercise 3-3 References

CHAPTER 4 Attitudes and Perceptions Overview Attitudes Cognitive Dissonance Formation of Attitudes

Measurement of Attitudes

Changing Attitudes

Perception Attribution Theory Social Perception

Halo Effect

Contrast Effects

Projection

Stereotyping

Pygmalion Effect

Impression Management Employee Selection Summary Discussion Questions

Case Study and Exercises References Other Suggested Readings

CHAPTER 5 Workplace Communication Overview Communication Process Feedback

The Johari Window

Communication Channels Verbal Communication

Electronic Communication

Nonverbal Communication

Barriers to Communication Environmental Barriers

Personal Barriers

Overcoming Barriers to Improve Communication

Effective Communication for Knowledge Management Strategic Communication

Flows of Intraorganizational Communication Upward Flow

Downward Flow

Horizontal Flow

Diagonal Flow

Communication Networks Informal Communication Cross-Cultural Communication Communicating with External Stakeholders Summary Discussion Questions Case Studies References

PART II Understanding Individual Behaviors

CHAPTER 6 Content Theories of Motivation Overview Maslow’s Hierarchy of Needs Theory Alderfer’s ERG Theory Herzberg’s Two-Factor Theory Job Design McClelland’s Three-Needs Theory

Achievement

Power

Affiliation

Summary Discussion Questions Case Studies and Exercises

References Other Suggested Readings

CHAPTER 7 Process Theories of Motivation Overview Expectancy Theory Equity Theory Satisfaction–Performance Theory Goal-Setting Theory Reinforcement Theory Summary Discussion Questions Case Studies References

CHAPTER 8 Attribution Theory and Motivation Overview Attribution Theory Attribution Style Attributions and Motivational States

Learned Helplessness

Aggression

Empowerment

Resilience

Promoting Motivational Attribution Processes Screening for Resilience

Attributional Training

Immunization

Increasing Psychological Closeness

Multiple Raters of Performance

Conclusion Discussion Questions Case Studies and Exercise References Other Suggested Reading

PART III Leadership

CHAPTER 9 Power, Politics, and Influence Overview

Sources of Power

Other Sources of Power in an Organization Uses of Power Developing a Power Base Organizational Politics Upward Influence Conclusion Discussion Questions Case Studies

References

CHAPTER 10 Trait and Behavioral Theories of Leadership Overview Trait Theory Lewin’s Behavioral Study Ohio State Leadership Studies University of Michigan Studies

Blake and Mouton’s Leadership Grid

Conclusion Discussion Questions Case Study and Exercises Exercise 10-1 Exercise 10-2 Exercise 10-3 Exercise 10-4 Exercise 10-5 Leadership Questionnaire References

CHAPTER 11 Contingency Theories and Situational Models of Leadership Overview Fiedler’s Contingency Theory House’s Path–Goal Leadership Theory

Tannenbaum and Schmidt’s Continuum of Leadership Behavior

Hersey and Blanchard’s Situational Leadership Model

Leader–Member Exchange Theory Conclusion Discussion Questions Exercise 11-1 References

CHAPTER 12 Contemporary Leadership Theories Overview Transformational Versus Transactional

Leadership Transactional Leadership

Transformational Leadership

Transformational Leadership: A Contradictory View

The Implications of Transformational Leadership for the Health Care Industry

Other Contemporary Leadership Approaches The Charismatic Leader

Servant Leadership

Collaborative Leadership

Another Look at Traits and Behavior Big Five Personality Factors

Emotional Intelligence

Behavioral Competencies

Summary Discussion Questions Exercise 12-1 Exercise 12-2 Are You a Charismatic Leader? Exercise 12-3 What Is Your EQ? Exercise 12-4 Appendix 12-A Traits and Skills of Collaborative

Leaders Appendix 12-B Six Key Practices and Necessary

Steps for Leaders to Guide Successful Collaborations

References Other Suggested Readings

PART IV Intrapersonal and Interpersonal Issues

CHAPTER 13 Stress in the Workplace and Stress Management Overview Work-Related Stress

Workplace Violence

Stressors

Positive and Negative Stressors

Internal or External Stressors/Acute or Chronic

Individuals and Stress

Personalities

Underrepresented Populations

Gender

Beliefs About Stress

Burnout

Presenteeism

Causes of Workplace Stress Coping with Stress

Organizational Coping Strategies

Joy in Work Job Design

Individual Coping Strategies Learned Optimism

Stress Management Programs Summary Discussion Questions References Other Suggested Readings

CHAPTER 14 Decision Making Overview

Rational Approach

Bounded Rationality Model

Intuition

Heuristics or Biases Approach

Escalation of Commitment and Framing Heuristics

Decision-Style Model

Vroom-Yetton Decision-Making Model Conclusion Discussion Questions Exercise 14-1 Exercise 14-2 Exercise 14-3 References Other Suggested Readings

CHAPTER 15 Conflict Management and Negotiation Skills Overview Types of Conflict Levels of Conflict

Intrapersonal Conflict

Interpersonal Conflict

Intragroup Conflict

Intergroup Conflict

Interorganizational Conflict

Conflict Management Conflict Negotiation Models

Distributive Model

Integrative Model

Interactive Model

Benefits of Skilled Conflict Resolution and Negotiation

Conclusion Discussion Questions Case Studies References Other Suggested Readings

PART V Groups and Teams

CHAPTER 16 Overview of Group Dynamics Overview What Is a Group? Group Interaction Why Do People Join Groups? Roles of Group Members Group Norms Cohesiveness

Size of the Group

Social Loafing

Experience of Success

Group Status

Outside Threats to the Group

Conformity Groupthink Conclusion

Discussion Questions Exercise 16-1 Exercise 16-2

Be the Best We Can Be Team Norms

Exercise 16-3 References

CHAPTER 17 Groups Overview Types of Groups

Primary Groups

Secondary Groups

Reference Groups

Informal or Formal Group Structure Informal Groups

Formal Groups

Group Development Group Decision Making Rational Decision-Making Processes

Brainstorming

Nominal Group Technique

The Delphi Technique

Irrational Decision-Making Processes The “Garbage Can” Decision-Making Process

Conclusion Discussion Questions

Exercise 17-1 Exercise 17-2 References

CHAPTER 18 Work Teams and Team Building Overview Teams and Teaming Types of Teams Virtual Teams Building Team Performance Common Characteristics of Successful Teams Barriers to Effective Teamwork Conclusion Discussion Questions Exercise 18-1 Exercise 18-2 Exercise 18-3 References Other Suggested Readings

PART VI Managing Organizational Change

CHAPTER 19 Organization Development Overview

Organization Development The Organization Development Professional Action Research Steps in the Organization Development Process

Entering and Contracting

Diagnosis

Planning and Implementing Change

Evaluating and Institutionalizing Change

Organization Development Interventions Appreciative Inquiry Conclusion Discussion Questions References

CHAPTER 20 Managing Resistance to Change Overview Drivers of Change Resistance to Change

Individuals’ Barriers to Change

Discomfort with Uncertainty

Perceived Negative Effects on Interests

Perceived Breach of Psychological Contract

Lack of Clarity as to What Is Expected

Excessive Change

Lewin’s Change Model

Transformation of Health Care Organizations Summary Discussion Questions Case Study References Other Suggested Readings

Index

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Preface In the first edition of this book, Chapter 1 stated that “the U.S. health care industry has grown and changed dramatically over the past twenty-five years.” That was an understatement! Since that time, the industry has experienced some of the most dynamic changes that health care managers have seen. In the coming years, more system-wide changes will occur as we continue our push forward to achieve patient-centered, value-based health care. Health care managers are quickly learning that what worked in the past might not work in the future. This was the compelling reason to write an organizational behavior book specifically for health care managers who are on the front lines every day, motivating and leading others in a constantly changing, complex environment. This is not an easy task, as we know firsthand!

The purpose of this book is to provide health care managers and other professionals with an in-depth analysis of the theories and concepts of organizational behavior while embracing the uniqueness and complexity of the industry. Although health care is similar to other industries, it is also

very different. As the nation’s largest industry, health care employs more than 16 million people in numerous interrelated and interdependent segments.

Using an applied focus, this book provides a clear and concise overview of the essential topics in organizational behavior from the health care manager’s perspective. It is our goal to give you a greater understanding of why and how people and groups behave as they do in the workplace. With this knowledge, you will be able to predict and effectively influence the behavior of the people you lead. Please let me know if we accomplish our goal! You can reach us at [email protected] or [email protected].

We have tried to ensure that we referenced all the individuals whose work contributed to the development of this book. However, if by chance we failed to give credit to someone along the way, please contact us so that we can make the necessary correction.

At this time, we wish to thank our families for their patience, understanding, and support over the years. Finally, we wish to thank the many wonderful and caring people employed throughout the health care industry with whom we have had and will continue to have the opportunity to work with. Our

lives continue to be blessed by these dedicated individuals!

Thank you for purchasing (and reading) our book. We welcome your comments and suggestions, and we wish you the best on your health care management and leadership journey.

With personal regards, Nancy Borkowski, DBA, FACHE, FHFMA

Katherine A. Meese, PhD

© Valex/Shutterstock

About the Authors Nancy Borkowski, DBA, FACHE, FHFMA, is Professor in the Department of Health Services Administration at the University of Alabama at Birmingham. She received her DBA with specializations in health services administration and accounting from Nova Southeastern University. Dr. Borkowski has over 25 years’ experience in the health care industry and is a two-time past recipient of the American College of Healthcare Executives’ (ACHE) Southern Florida Senior Career Healthcare Executive Award, which recognizes individuals who have made significant contributions to the advancement of health management excellence.

A nationally recognized author, Dr. Borkowski is also board certified in health management and is a Fellow of both the American College of Healthcare Executives and the Healthcare Financial Management Association. The first edition of her book, Organizational Behavior in Health Care, referred to as “one of the most significant advances in the field of health services administration,” was honored with the American Journal of Nursing’s 2005 Book of the Year Award for nursing leadership

and management. Dr. Borkowski is the author of three textbooks that are widely used in graduate and undergraduate health administration and nursing programs both nationally and internationally.

Dr. Borkowski’s work has been published in the Journal of Ambulatory Care Management, Leadership in Health Services, Group & Organization Management, Organizational Behavior and Human Decision Processes, Health Care Management Review, Journal of Health Administration Education, Journal of Health and Human Services Administration, International Journal of Public Administration, and various other journals.

Her teaching interests are leadership, organizational behavior, and strategic management. Dr. Borkowski is a past recipient of the ACHE’s Excellence in Teaching Award, which is given to faculty who engage in furthering academic excellence and the professional development of health management students.

Over the past three decades, Dr. Borkowski has served in various leadership roles for the Association of University Programs in Health Administration, Academy of Management’s Health Care Management Division, the American College of Healthcare Executives’ Southern Florida Regent’s

Advisory Council, the South Florida Healthcare Executive Forum, the Alabama Healthcare Executive Forum, and various other health-related organizations. In 2013, Dr. Borkowski received the Jessie Trice Hero Award for her leadership and commitment to improving the lives of underserved and minority populations. She has also been honored with the Exemplary Service Award from the American College of Healthcare Executives (2012) and the Frederick T. Muncie Gold Award from the Healthcare Financial Management Association (2017).

Katherine A. Meese, PhD, is an Assistant Professor in the Department of Health Services Administration at the University of Alabama at Birmingham. She earned her PhD in Health Services Administration with a specialization in strategic management from the University of Alabama at Birmingham in 2019. Dr. Meese has seven years of industry experience, encompassing work in ten countries on four continents, including management positions for a large academic medical center. Her work has been published in Anesthesia & Analgesia, Health Services Management Research, Journal of Health Administration Education, and various other journals. Her research interests are in wellness, burnout, quality and

safety, and delivery models that enhance organizational learning.

PART I

Introduction

Part I includes four different but related topics. In Chapter 1, the history of organizational behavior and its importance to today’s health care managers are discussed. Chapter 2 describes the changing environment in which health care managers find themselves. The chapter examines the numerous issues that have emerged within the health care industry because of the nation’s changing demographics. Chapter 3 focuses specifically on cultural competency and the skills that managers need to adapt to the changing environment explored in Chapter 2. Chapter 4 deals with attitudes and perceptions, which are the foundation for understanding organizational behavior. You will find the terms “attitude” and “perception” frequently referred to in the various organizational behavior theories. Finally, Chapter 5 discusses the importance of communication. Recent surveys have revealed that 70% of small- to medium-sized businesses claim that ineffective communication is

their primary problem. Sentinel event data from The Joint Commission estimated that communication failure was the root cause for patient harm 70% of the time in 2400 reported negative outcomes studied. No wonder the ability to communicate effectively is considered an essential job skill for today’s health care managers and leaders.

CHAPTER 1

Overview and History of Organizational Behavior

LEARNING OUTCOMES

After completing this chapter, the student should understand:

The definition of organizational behavior. The major challenges facing today’s and tomorrow’s health care organizations and health care managers. The importance of the Hawthorne Studies to the study of organizational behavior. The importance of McGregor’s Theory X and Theory Y to the study of organizational behavior. The differences between organizational behavior, organization theory, organizational development, and human resources management.

▶ Overview Organizational behavior (OB) is an applied behavioral science that emerged from the disciplines of psychology, sociology, anthropology, political science, and economics. OB is the study of individual and group dynamics in an organizational setting. Whenever people work together, numerous and complex factors interact. The discipline of OB attempts to understand these interactions so that managers can predict behavioral responses and, as a result, manage the resulting outcomes.

According to Ott (1996, p. 1), OB asks the following questions:

1. Why do people behave the way they do when they are in organizations?

2. Under what circumstances will people’s behavior in organizations change?

3. What impacts do organizations have on the behavior of individuals, formal groups (such as departments), and informal groups (such as people from several departments who have lunch together regularly)?

4. Why do different groups in the same organization develop different behavior

norms?

From Ott. Classic Readings in Organizational Behavior, 2E. © 1996

South-Western, a part of Cengage Learni

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