Written by:
Chairperson, Department of Health Administration and Human Resource, College of Health, Education and Human, Resources, University of Scranton, Scranton, Pa, USA 18510, Phone: 717-941-4128, FAX: 717-941-4201, E-mail: georgem1@uofs.edu
An improved balance must be brought to the quality dimensions that are considered to be important within the health care delivery system. Consideration for customer needs, financial requirements, internal delivery systems and plans for continual growth and change allow for such a balance and stretch the organization beyond operational issues to strategic initiatives. For this balance to be achieved, effective managerial behavior must be demonstrated. Health care managers must therefore function out of a multitude of roles that are best exemplified through a combination of transactional and transformational leadership behaviors. This paper emphasizes the linkages among quality dimensions, managerial roles and human resource management systems.
Health care managers play a critical role to ensure the provision of quality health care. This mandate cannot be delegated to another department or division of the health care delivery system, instead a shared responsibility among everyone in the organization needs to prevail. A stronger linkage between long and short term objectives is required to fulfill this mandate for quality care.
Total quality management practices have provided an impetus to health care systems by expanding the jurisdiction of quality concerns beyond one office or department. However such practices may only focus on short term quality measures, such as patient complaints, complications or injuries.1 Long term measures of quality such as new patient delivery systems, increased access to health care and affordable health care insurance are critical to the realization of the organization’s vision and mission. Kaplan’s balanced score card details four areas that enable organizations to strategically and operationally address complex quality dimensions.2 When applied to health care, the score card requires leaders to balance financial requirements, internal delivery systems, stakeholder needs and plans for growth and change.
From a human resources management perspective, what is required for health care managers to facilitate this link between strategic and operational quality care issues? They must be capable of balancing - the vision with the practical, patience with urgency, and expansion with contraction. Health care managers must be both transformational as well as transactional leaders.3
As transformational leaders, health care managers must seize opportunities that will bring about fundamental change, growth and development. All resources, internal and external resources, must be considered.4 As transactional leaders, accountability for results must be continually assessed. To delineate further, the competing values framework identifies eight roles, which balance managerial behavior in either a transformational or transactional manner. Transformational roles include broker, innovator, facilitator, and mentor. Transactional roles encompass producer, director, coordinator and monitor. Although all eight roles are necessary for managerial effectiveness, the emphasis may be greater in the transformational behaviors when the organization is in a growth cycle whereas a greater emphasis may be placed upon transactional behaviors during times of retrenchment.5
The competing values framework can be utilized to train and develop health care managers. The eight roles provide a basis for identifying required competencies and performance expectations.6
In the quest for quality care, human resource management systems must be established ranging from the selection of new employees to the compensation of current employees. Those systems must support the long and short term goals of the organization and therefore require transformational [developmental] and transactional [control] facets to their design and implementation. When referring to McLagan’s human resource wheel7, eleven human resource management functions are identified: training and development, organizational development, career development, organization/job design, human resource planning, performance management systems, selection and staffing, compensation and benefits, employee assistance, union/labor relations, and information systems.
The first five functions of the wheel emphasize the transformational needs of the organization whereas the latter six are more transactional in nature. An interface among the functions must be designed into the health care system so as to achieve balance between the transformational and transactional needs of the organization. For example, the accountability demands of the health care system are on-going and human resource management systems must support and facilitate such requirements. The performance appraisal process is sometimes equated with the performance management system, but when balancing transformational and transactional needs it is only one component to be considered. Job re-design considerations, such as cross training and job enrichment, may modify performance expectations and timelines. Therefore several functions of the human resource wheel are additionally factored into the design of the performance management system to include, for example, training, career planning and compensation.
The 3600 degree performance appraisal process, which is gaining in popularity, requires a formative as well as summative evaluative dimension. This form of evaluation appears ideally suited to the health care delivery system since it requires input from the full circle of customers with whom the health care employee’s job interfaces. Since most of the work of health care professionals are delivered outside the visual scope of the reporting supervisor, the 3600 evaluation requires feedback from all internal and external customers. Such a wide range of input is unique to this type of appraisal process. Depending upon the employee’s job, feedback on the employee’s performance may be solicited from patients, family, physicians, vendors, community organizations as well as co-workers. Such diverse feedback is collected routinely and becomes the basis for discussion in employee-supervisor meetings.
At the onset of implementing 3600 evaluation, a developmental perspective is utilized to review progress towards goals, identify training needs and reach mutual agreement on job expectations.8 The final documentation of performance, which follows at a later time, utilizes the employee’s self assessment and supervisor assessment. It is at this documentation stage that the familiar transactional perspective completes the balance within the performance management system. This process can of course be tailored and modified to fit the organizational culture but of critical importance is the balance between the transformational and transactional elements of the system.
Each of the human resource management systems within a health care organization must be reviewed and aligned to provide for quality health care. This alignment can be tested by returning to the eight roles required for effective managerial behavior. Does the human resource management system enable health care managers to behave as innovators, brokers, facilitators, and mentors? Are managers additionally able to monitor, coordinate, direct and produce the results required of them? As health care delivery systems increasingly become reevaluated against quality care requirements, the human resource management systems must be aligned and supportive of such endeavors.
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