Description
Discussion QuestionsREQUIRED: Post a 300 word post, describing an example from your experiences using the situational approach, or that of your immediate supervisor. (Everyone must answer this).What is the impact of the leadership styles identified in figure 5.1 on organizational outcomes and your performance? (Is there a match between the leadership style and your development level?)Identify your leadership style. What traits or characteristics helped you identify your dominant leadership style?In 25 words or less, using your own words (no references), explain what is situational leadership. Make sure you integrate the concept of development levels and styles.When would you choose not to use the situational approach? Please provide an example.see attachment for complete assignment.
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Leading Thoughts
Empower, Trust & Resource
The Role of Executive Leaders in Safety
By Rosa Antonia Carrillo
Leadership
in the safety
arena is
the same
as it is in
the overall
organization.
Yet, safety
leadership
has come
to be seen
ȱȱęȱ
unto itself.
he impetus for this article was an experience
with the top leadership team of a 3,000-employee company. The team had decided that the injury
level was unacceptable and wanted to improve the
safety culture. When asked in a confidential survey
what they saw as their biggest challenge to succeeding, these leaders responded, “lack of bandwidth.” There was palpable anxiety over adding yet
another initiative to their 70-hour workweeks.
Leadership in the safety arena is the same as it
is in the overall organization. Yet, safety leadership
has come to be seen as a field unto itself, an additional set of tasks that must be added to an already
full plate. Why might that be?
Could the reason be related to the predominant
perception that leaders have
to put safety first or hold safety as a priority over production? The intention of such
phrases, clearly, is to highlight
safety’s importance. But, is
separating safety from the rest
of the organization a realistic
and viable approach to ensuring that it is an integral part
of work? Or do these phrases
put safety and production into
competition?
The apparent conflict
between safety and production can become an emotional
divide between employees and
managers because it is entwined with the question
of which is more important, people or profit. This
conflict extends far beyond incident prevention
to other issues facing companies such as ethics,
quality and customer care. Managing each of these
areas effectively requires robust, streamlined processes. Safety is no different.
All of these areas also require the same level of
dedicated participation from executive management. But, from a leadership perspective they are
not separate initiatives. Would it be possible for
a food manufacturer to create safe products that
meet customer expectations and have employees
with unsafe work practices? Your experience is
probably responding that it is not possible. A food
manufacturing plant with a high incident rate
probably has poor housekeeping, which leads to
potential contaminations that lead to rework or
excessive waste and unhappy customers.
Let’s look first at the overall leadership competencies displayed by successful executives (these
Rosa Carrillo, M.S.O.D., is president of Carrillo & Associates Inc. specializing in safety leadership consulting. Her
clients include AES, NRG, SCE, GE, Honeywell, Nuclear
Regulatory Commission and World Bank. Rosa is a frequently published author in Professional Safety and Journal
of Safety Research.
32 ProfessionalSafety
MAY 2015
www.asse.org
competencies are derived from interviewing the
direct reports of more than 100 executives during
360 assessments).
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t(SPVOEUIFWJTJPOJOBDUJPOBCMFEJSFDUJWFT
t’VMmMMZPVSSFTQPOTJCJMJUZBTBSPMFNPEFM
coach and mentor in alignment with the vision.
t$SFBUFPQQPSUVOJUJFTGPSDPOWFSTBUJPOUPFOcourage the open exchange of information.
t.BLFJUPLBZUPGBJMBOEUSZBHBJO
t&NQPXFS USVTU TVQQPSUBOEQSPWJEFSFTPVSDFT
t1SPWJEFUJNFMZGFFECBDLUPEFWFMPQZPVSEJSFDU
reports.
These leadership competencies are required at
every level of the organization. But, they are especially critical at the executive
level because these leaders are
the source of all other messages about what is important
that will transmit throughout
the organization.
The executive team is not
responsible for designing or
implementing programs. It
sets direction and operational
principles, then it empowers
and resources the appropriate
people to design and impleNFOU’PSFYBNQMF QSPHSBNT
that involve supervisor coaching should not be designed
without supervisor input.
‘SPOUMJOFFNQMPZFFTLOPXUIFIB[BSETBOECBSSJers better than anyone, thus they must be included in any efforts to engage employees.
An excellent format for the executive team to
use in setting direction is the purpose statement
using the following format:
1) The purpose of our focus on safety is to
______________.
2) Our goals are to ______________.
3) We will support the achievements of these
goals by ______________.
4) We want these goals to be accomplished
in a way that ______________.
5) We believe that accomplishing these goals
would result in ______________.
A completed purpose statement might read:
1) The purpose of our focus on safety is to
make (organization name) one of the safest
places to work.
2) Our goals are to prevent injury and death,
provide a safe and healthy workplace.
3) We will support the achievement of these
goals by providing resources, empowering the
right people to design and implement the best
processes and procedures, setting the example
and promoting open communication through
mindful conversation.
©ISTOCKPHOTO.COM/DESIGNAART
T
4) We want these goals to be accomplished in a way that promotes
trust, open communication, mutual
respect and caring about each other.
5) We believe that accomplishing
these goals would result in a safer
workplace and a great place to work.
Once the executive team is on the
same page about the desired direction
for safety, each leader can fulfill his/
her responsibility by focusing on a few
critical activities to leverage his/her
influence:
t#VJMESFMBUJPOTIJQT
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t-JTUFO
t”TL EPOUUFMM
t$IBSUFSBOEFNQPXFSUFBNT
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to build streamlined, robust processes.
8IZBSFUIFTFDSJUJDBMBDUJWJUJFT (PPE
working relationships are the foundation of organizational effectiveness.
Without them, communication fails
resulting in missed sales, production,
RVBMJUZBOETBGFUZUBSHFUT(PPEXPSLJOH
relationships are founded on a common
purpose, mutual respect and shared
understanding of each other’s work.
Therefore, communicating face to
face and listening accompanied by
in-depth questioning become critical.
“Ask, don’t tell” can become a mantra
to avoid a range of problems such as
jumping to conclusions, or appearing
disrespectful or intimidating. It means
to ask questions before offering advice
or correcting someone’s behavior unless that person is in imminent danger.
It is important for everyone to practice listening and inquiry to achieve
excellence. Chartering and empowering
teams to solve problems also means
training them in communication skills.
Using the executive purpose statement,
the teams need to create their own
charter that can be approved and supported by the executive team.
‘JOBMMZ BEEJOHOFXJOJUJBUJWFTXJUIout deleting or streamlining existing
ones creates resistance and overload
UISPVHIPVUUIFPSHBOJ[BUJPO(&IBTB
successful process called “Work-Out,”
initiated by Jack Welch when he eliminated most of middle management.
&OUJSFQMBOUTXPVMEHFUUPHFUIFSBOE
each function would recommend ways
to streamline the workload. These were
presented to the whole system so that
functions could alert each other on any
potential negative impact on them.
An overflowing workload at the
executive level presents a significant
barrier to leaders’ involvement in improving safety performance. The suggested leadership activities to improve
safety are essential to achieve excellence in every aspect of the organization. Instituting these practices in safety
and extending them to include quality,
production and customer service will
transform the way work is done so long
as emphasis is also placed on eliminating nonvalue-added activities. Conversely, if these practices already exist,
then including safety will also produce
the desired results without adding
to the administrative burden of most
executive calendars.
COMFORT
EXPLAINED
®
S
C
R i
O
C
f
C
i
t
”
s
:
“Our reputation is no Accident”
Rockford, Michigan 1-800-635-4536
www.asse.org
www.hytest.com
MAY 2015
ProfessionalSafety 33
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Journal of Business Research 65 (2012) 555–561
Contents lists available at ScienceDirect
Journal of Business Research
Collaborative leadership model in the management of health care☆,☆☆
Jerry D. VanVactor
DHA, FAHRMM, USA
a r t i c l e
i n f o
Article history:
Received 1 July 2009
Received in revised form 1 November 2010
Accepted 1 January 2011
Available online 23 March 2011
Keywords:
Leadership
Collaboration
Work
Healthcare
Communications
a b s t r a c t
Leadership is both a science and an art; how one chooses to employ it is relevant within the context of a given
situation. Leadership exists within relationships that are present throughout an organization. Encouraging a
collaborative environment promotes an ongoing integration of ideas and interdependency among multiple
stakeholders throughout an organization. The purpose of this work is to provide an overview and analysis of
collaborative leadership and shared management tactics. The overview includes an identification of
differences between leadership and management, and applies the concepts to collaborative management
practices. Analysis occurs in the form of a scholastic discussion related to the pragmatic application and
inculcation of collaborative management strategies throughout a health care organization. One issue
discussed relates to the lack of a common definition for collaborative management. A definition of
collaborative management is based upon an extensive doctoral-level study that was conducted between
January and February 2009. Collaboration is a synergistic work environment wherein multiple parties must
work together toward the enhancement of health care management practices and processes. The discussion
culminates with the presentation of a collaborative communications model developed through the conduct of
an academic study. While not an end all document, the information contained within this work is applicable
for practitioners of management processes through a pragmatic view of leadership. Health care management
practices are changing and leaders must embrace change to remain successful in the management of health
care.
Published by Elsevier Inc.
In this work, a discussion concerning leadership within a health
care environment takes place. The discussion occurs not from the
ordinary macro-level of managerial oversight or the mere supervision
of employees during the normal course of their day, but from a
conceptual approach in the context of developing a management
model for leaders within a 21st century health care organization.
Included in this paper is a detailed description of a proposed model
with a rationale for implementation and supported by evidence from
existing literature.
The information contained within this work is applicable for
practitioners of health care management processes within a pragmatic view of leadership and not as a catalyst for paradigmatic
shifting. The author’s prerogative is to believe that some elements of
this information are necessary, at times long overdue, in today’s
operational health care service-oriented environment. Manion (2005)
relates that an operational and evolving health care environment
needs leaders who can create direction, win commitment from
followers and key stakeholders, and influence employees to perform
☆ The author extends a special thanks to CAPT Donald R. Bennett, M.D., US Navy
Medical Corps, and COL Walt Hinton, R.N., US Army Nurse Corps, for providing feedback
related to this article.
☆☆ The views in this article are those of the author and do not reflect the official
policy or position of the Departments of Defense, Army, Navy, or the U.S. Government.
E-mail address: [email protected].
0148-2963/$ – see front matter. Published by Elsevier Inc.
doi:10.1016/j.jbusres.2011.02.021
tasks related to the achievement of future strategic vision. Some of
these leadership factors appear to be missing from many types of
multidisciplinary organizations and is not restricted to just health
care.
The purpose of this paper is to provide an overview and analysis of
collaborative leadership and shared management tactics. Leadership
exists as an element among relationships. A collaborative environment promotes an ongoing integration of ideas and interdependency
among multiple stakeholders (Atchison and Bujak, 2001; Bolman and
Deal, 2003; Henry and Gilkey, 1999; Kotter, 2003; Manion, 2005). If
managers want others to act like leaders within an organization, they
must first model the kind of behavior that is expected. Communication is always two-way; leaders, therefore, must remain cognizant of
the messages they send to subordinates.
Leadership emphasizing collaboration exists when one or more
people within an organization engage one another in such a way that
leaders and followers raise one another’s levels of motivation and
morality and nurture interdependencies among multiple parties. This
type of emphasis does not always occur from the top down (Harrison,
1999). Collaborative communication strategies involve an unimpeded,
continual cycle of information flowing freely among the members of a
team and organization. Bossidy and Charan (2002) relate that an ability
to collaborate effectively is a critical shortfall in many health care arenas.
Due to inter-organizational barriers and intra-organizational silos, each
leader owns a set of resources—control of those resources is the key to
556
J.D. VanVactor / Journal of Business Research 65 (2012) 555–561
perceptible success. With this type of mindset, collaboration is virtually
impossible; however, if employed effectively, can be a key to success
throughout an organization.
Change is upon health care and with change comes a need to
reevaluate management styles and processes occasionally (Autry
et al., 2008; Blanchard, 2007; Burton and Boeder, 2003; Schneller and
Smeltzer, 2006; Stadtler, 2009). One area of change could involve the
way management views human capital and manages talent within an
organization. Much like Johnson (1998) relates, sometimes the
biggest inhibitor to change lies within the organization itself. Part of
the problem stems from traditional approaches to managing health
care and change not being readily acceptable among existing
practices, processes, or practitioner acumen. Determining the best
approach to change is an ongoing dilemma that will not soon
disappear.
According to Ledlow et al. (2007), health care organizations like
tradition and following past practices. Churchill relates, “… when it is
not necessary to change, it is necessary not to change” (in Manion,
2005). Change is necessary among health care in situ and future
leaders will have to initiate progress if progress is ever to occur.
Practitioners of leadership and management are encouraged to seek
opportunities to use or not use the information contained within a
variety of leadership papers based on one’s own feelings toward the
subject—each individual will not view leadership through the same
lens.
1. Mindfulness
Mindfulness, in a business context, is a relatively new concept and
lies in the ability to bridge diverse disciplines and divergent thinking.
Mindfulness implies that an individual is living in a state of conscious
awareness of self, others, and the environment; getting to know the
unknown through other people’s experience, thinking, and ideas.
Being mindful enables a leader to make choices concerning how to
respond to others and situations while remaining consistent in the
decisions that are being made (McKee et al., 2006). Mindfulness
allows a leader to take a step back, remove oneself from an anxietyladen situation, and provide feedback to subordinates in a more
conscientious manner that is appropriate and defined for specified
situations faced by management.
In the process of ongoing interactions among multifaceted, crossfunctional stakeholders, context among participants and through a
variety of interpretations creating potential misperceptions
concerning effective health care services and operations can be
changed (Cohn, 2007). Unfortunately, according to Ledlow et al.
(2007), health care organizations have often been a decade or more
behind other industries in the development and understanding of
effective service and support ideologies. Organizations should
embrace the dynamics of an ever-changing world and remain flexible
and adaptive to change through a constant review of processes and
the inculcation of organizational development and learning. Mindfulness provides a window of opportunity that examines events through
other people’s lenses in a structured, larger social context.
Change becomes problematic for many health care leaders; the
tendency of many managers of health care is to await a perfect
solution prior to moving ahead with new approaches and technology
(Birk, 2008). Recent changes are occurring and indicate, “…today’s
health care leaders are well aware of the mounting pressures to
provide documented, positive outcomes of patient care” (Ledlow
et al., p. 2). Efforts to reduce costs whenever possible while providing
a continuance of efficient care—establishing resilience among the
health care community.
Organizational mindfulness involves an awareness of individual
complexities and the faculties involved in decision-making, evaluating circumstances, and considering alternatives (Weick and Sutcliffe,
2006). Remaining aware of how each factor interrelates can be
problematic in organizations continually exposed to potential crises.
Being organizationally mindful provides a vital sense of situational
awareness and potentially transforms habitual unconscious reactions
into original, leader-driven conscious actions (Bryant and Wildi,
2008).
To encourage collaborative interdependencies, organizational
leaders must be mindful of employees’ concerns, skills, aptitudes,
and the environment in which they work. Mindfulness, according to
Bryant and Wildi (2008), permits a more responsible exercise of
leadership, opportunistic decision-making, and creative problem
solving through the elimination of habitual patterns and employment
of more critical thinking. Mindfulness allows more emphasis on such
concepts as social resilience and aids leaders in stressing the
importance of social networking, reciprocity, and interpersonal
trust. Resilience creates a more synergistic environment among the
complex world of health care operations, processes, and procedures.
Opposite to mindfulness, mindless routines cause managers to
seem more effective because each scenario can fall within an
identifiable algorithmic resolution strategy without any emphasis
placed against nuanced idiosyncratic behavior inherent in most new
situations. Organizational mindfulness is distinct and permits a
manager or an organization subtle clues that may have gone
previously unnoticed. Organizational resiliency depends on a continued questioning and learning complemented by innovation. The focus
of these concepts extend well beyond the existing, present systems of
thinking and encourages subordinate employees to question if
existing systems are a part of larger problems that can be resolved
with simplified changes. By being mindful of collaborative input,
managers recognize that each member of a team has input into the
development of solutions to perceived problems.
Health care organizations can present a different set of circumstances due to potential continual exposure to crises. By working
collaboratively with other individuals and entities, a broader
perspective of a perceived problem is observable. The inclusion of
multiple stakeholders’ insights can yield a more creative solution to
an issue than a singular perception. Mindfulness allows managers to
focus on an overarching comprehension of emerging threats and on
factors that may interfere with such comprehension and permits the
manager to consider problems through an inter-relational perspective
(Weick and Sutcliffe, 2006).
2. Management versus leadership review
For many people, the terms management and leadership are the
same; both so intertwined that dissimilarities are not dissolvable from
the similarities. According to many authors, however, the two terms
are unique concepts and as critical for leaders of health care
organizations as any other multidisciplinary institution. Leaders
must understand the difference for the effective incorporation of
either. Management is about the how, whereas leadership defines
what and why a task is accomplished. Management emphasizes
systems, controls, procedures and policies employed in a process
(Manion, 2005). Management within an organization tends to focus
strongly on the status quo; leadership evolves with change and
embraces innovative thinking and the continual creation of new
processes for the future of an organization (Manion, 2005).
Management theory and the study of management have taken place
since time immemorial (Robbins and Coulter, 1996; Wren, 1994).
Management, according to Kotter (2003), involves an ability to cope
with complexity throughout an organization. The practices and
procedures related to managing an organization are largely emergent
and responsive to organizational development (Kotter, 2003). Definitively, management, regardless of which definition one chooses to
employ, involves accomplishing organizational goals and tasks efficiently and effectively with and through people (Robbins and Coulter,
1996). While seemingly two unique idealisms, an amalgamation occurs
J.D. VanVactor / Journal of Business Research 65 (2012) 555–561
wherein management and leadership are commonly viewed as the
same concept. Arguably, one must possess some degree of leadership
skill to manage within an organization; one must be able to lead to
manage effectively. Where the dichotomy occurs is in relating a person’s
positional authority. A member of an organizational team can be a leader
without being in a formalized position of management (Bolman and
Deal, 2003).
A health care setting is a complex network of communications and
relationships and, much like other industries, has an idiosyncratic
nature of organizational design (Litch, 2007). This is significant,
according to Herzlinger (as cited in Kovner and Neuhauser, 2004;
Porter and Teisberg, 2006), because America spends more of its gross
national product on the development and delivery of health care
services than any other nation in history; the citizens get less care for
every dollar spent.
Little is known about the relationship between collaborative
communication initiatives and the impact on health care performance
(Agan, 2005); however, a shift toward collaborative processes in
health care management is becoming more prevalent (Hofstetter,
2006; Potocan, 2009; Stadtler, 2009). Agan described four capabilities
a manager should possess: (a) partner selection, (b) collaboration, (c)
lessons learned, and (d) employee knowledge and skill sets.
According to Agan, we know that collaboration provides a significant
operational capability related directly to positive stakeholder
integration.
A leader, according to U.S. Army doctrine (2006), is anyone who
inspires and influences people to accomplish organizational goals.
Leaders have an ability to motivate others both internal and external
to an organization to pursue initiatives, focus ideas, and shape
decisions toward more positive outcomes (DA, FM 6–22, 2006).
Leadership defined most commonly, in terms that reflect a degree of
intangibility and exists in the relationships and perception of
individual stakeholders (Bolman and Deal, 2003).
Leadership fits into management theory, according to Wren
(1994) in that it focuses on the attainment of organizational goals
by effectively employing relationships and resources. Despite a vast
amount of literature concerning the subject, limited tangible evidence
exists concerning what leadership truly is and how much less it
applies strictly to the management of health care. A simple search of
books, isolated linguistically to the English language and depending
upon the day one were to initiate the query, on a website such as
Amazon.com yields over 345,000 results bearing the word leadership;
health care leadership yields a meager 1000 titles. Regardless of the
evaluation criteria, scrolling through the titles, one can easily
ascertain the disparate nature of the terms and how many ways
they can be employed.
The literature provides a foundation concerning collaborative
communication and the overall impact on effective management by
evaluating, comparing, and contrasting respective views from
extended enterprise. The literature served as a catalyst in establishing
parameters for multidisciplinary problems associated with communications within health care organizations and established a model
based upon extended enterprise best practices as a foundation for the
management of efficient health care processes. Each individual
medical community is a unique entity and there is a very diverse
and wide range of regulatory environments with which each must
contend (Byrne, 2007).
The expression of principles and characteristics of leadership are a
super-human idealistic approach to accomplishing tasks throughout an
organization. Leadership is not a specialized capability that only a limited
few possess, but characteristics that many people possess and that remain
untapped as resources every day. Manion (2005) relates that leadership is
the ability of a person to mobilize interest, energy, and commitment by
people within an organization and is a means to an end—not the end itself.
Leadership provides subordinate employees with the purpose for
accomplishing a task or striving to achieve a goal.
557
Management is essential to organized endeavors and relates to
activities involved in facilitating organizational function, purpose, and
scope directly impacted by situations (Wren, 1994). Leadership
involves achieving success through the instilling of commitment to
that success by others. As the health care industry becomes more
competitive and volatile with ever changing polemics and regulatory
guidelines, leadership will become the mainstay for setting the future
direction, aligning people, motivating, and inspiring change (Kotter,
2003). Leadership encourages employees to act in ways that are
creative and intuitive when being forced out of comfort zones and
encouraged to change routine and accepted behaviors.
Leadership is not a monologue or a solo act of unilateral thought
but is a process that involves the input, assistance, and feedback of
others. Leaders at multiple levels within organizations should begin to
comprehend and instill collaborative communication strategies in a
variety of management practices and processes. Health care management is applicable from a systems perspective with multifaceted
components working to support future goals of reducing the burden
of illness and improving the health and functioning of residents
within communities. As Detmer (2004) indicates, leadership decisions must be evidence-based and sensible in multiple areas of health
care—not just in clinical settings, but among many of the indirect
aspects of care. Regardless of the level of leadership in the
organization, every manager within a health care environment can
incorporate collaborative communication strategies into the operational environment. The effects of collaborative communications
extend across traditional departmental silos and organizational
boundaries.
3. Overview of collaboration
In establishing a model for collaborative management strategies,
one must recognize that there are multiple definitions for the term
collaboration. Definitions include a wide array of messages implicating
multiple elements that can involve simple coordination, synergistic
behavior, mutual work processes, partnerships, and so on. Atchison
and Bujak (2001) relate that collaboration is a mutually beneficial
relationship with clearly defined roles among multiple parties for the
attainment of a common organizational goal. The list could continue
with any range of possibilities concerning the use of the term
collaboration; no common definition seems to exist.
Collaborative management techniques involve a synergistic work
environment wherein multiple parties work together toward the
enhancement of health care management practices and processes
(VanVactor, 2010). Leaders understand that to involve a spirit of
collaboration among team members they must determine what a
group needs in order to do their work and build the team around a
common organizational purpose engrained with mutual respect for
everyone involved (Kouzes and Posner, 2007). When a leader and
followers work together toward a common goal, there is a realistic
assumption that more and better solutions and alternatives can be
generated versus working alone and commanding followers which is
common among strictly linear organizations (Manion, 2005).
Health care is a very personal and service-oriented industry
(Beckman and Katz, 2000). Coile (2000) relates that excellence in
service is an achievable goal within today’s health care services
organizations, despite tight budgets and staffing. A set of acceptable
organizational values that require a high performance standard from
every employee throughout the system can be a springboard for
effective process management. Collaborative leadership can be a
catalyst for achieving effective change. An organization’s service
culture can be the point at which providers, administrators, and
ancillary staffs collaborate to employ effective communications
strategies. By introducing change systemically, management can
monitor successes and shortfalls through the employees and
consumer feedback.
558
J.D. VanVactor / Journal of Business Research 65 (2012) 555–561
Collaboration permits a strengthening of social networks (interpersonal relationships), facilitating an environment of trust and
granting access to diverse skill sets that can aid in nurturing creative
problem solving strategies (Uzzi and Dunlap, 2005). As indicated by
Kouzes and Posner (2007), when the leader creates a climate of trust,
the climate removes controls and employees have the freedom to
innovate and contribute to the organization’s overall purpose and
goals. Leaders who nurture trust in their subordinates involve shared
decision-making processes, permit personal satisfaction, and encourage high levels of personal satisfaction with an overarching
commitment to excellence in a job well done.
Collaborative communication strategies promote an understanding of separate cultures, integration, and interdependencies by
sharing common vision, values, and business purposes (Atchison
and Bujak, 2001). Sytch and Gulati (2008) relate that interdependencies among multifaceted partners be embraced and not avoided in
business practices. The strengthened relationship is merely one aspect
of a multifaceted approach to sustaining and achieving organizational
success. A collaborative relationship serves as the means for creating
better business acumen among multiple stakeholders throughout an
organization and can aid in removing traditional organizational silos
and interdepartmental barriers.
While identifying management issues and concerns is rarely
difficult, the communication strategies employed throughout the
management of a health care organization can have a positive or
adverse effect on the interdependent relationships interdepartmentally. Leaders understand that everyone is a sender of messages about
what is valued and they set the example for others to follow. Kouzes
and Posner (2007) relate that part of leadership responsibility
involves making sure that the actions taken within an organization
are aligned with shared values among multiple team-members.
Regardless of how well an organization executes tasks, the risk of
error or failure increases markedly when ideas developed for an
organization do not fit within existing institutional capabilities when
not communicated effectively.
A health care organization receives input from multiple sources
concerning best business practices related to the provision of services
for the needs of a wide array of customers (see Fig. 1). That feedback can
involve multifaceted, multidisciplined input that ranges between a
variety of individual patient and customer needs to managers and
corporate partners that are both internal and external to an organization. Management in health care organizations becomes challenging
when, as Schneller and Smeltzer (2006) indicate, the stakeholder within
a health care organization (internal) can assume numerous
