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© 2019 AHIMA
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Health Information
Management: Concepts,
Principles, and Practice
Fifth Edition
Chapter 21
Managing and Leading During Organization
Change
© 2019 AHIMA
ahima.org
Landmarks in Management
as a Discipline
• Scientific management
• Max Weber—Bureaucracy
• Frederick Taylor—Production efficiency
• Frank and Lillian Gilbreth—Time and motion studies
• Henry Gantt—Task scheduling/project management
• Administrative management
• Henry Fayol—4 functions and 14 principles of management
• Chester Barnard—Communication, efficiency, levels of
authority
• Mary Parker Follett—Empowered employees; work groups
© 2019 AHIMA
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Landmarks in Management
as a Discipline (continued)
• Humanistic management
• Hawthorne studies
• Human resources management
• Douglas McGregor—X and Y theory of management
• Operations management
• Scheduling and queuing systems
• Logistics
• Data mining
• Contemporary management
• Peter Drucker (management by objectives)
• W. Edwards Deming (total quality management)
• Business process reengineering
© 2019 AHIMA
ahima.org
Foundations of Management Timeline
© 2019 AHIMA
ahima.org
Gantt chart showing sequence of initial EHR implementation
timeline.
© 2019 AHIMA
ahima.org
[
Fayol’s Fourteen Principles
1. Specialization of labor: Work allocation and specialization allow
concentrated activities, deeper understanding, and better efficiency.
2. Authority: The person to whom responsibilities are given has the
right to give direction and expect obedience.
3. Discipline: The smooth operation of a business requires standards,
rules, and values for consistency of action.
4. Unity of command: Every employee receives direction and
instructions from only one boss.
5. Unity of direction: All workers are aligned in their efforts toward a
single outcome.
6. Subordination of individual interests: Accomplishing shared values
and organizational goals take priority over individual agendas.
7. Remuneration: Employees should receive fair pay for work.
© 2019 AHIMA
ahima.org
8. Centralization: Decisions are made at the top.
9. Scalar chain: Everyone is clearly included in the chain of command and
line of authority from top to bottom of the organization.
10.Order: People should clearly understand where they fit in the
organization, and all people and material have a place.
11.Equity: People are treated fairly, and a sense of justice should pervade
the organization.
12.Tenure: Turnover is undesirable, and loyalty to the organization is sought.
13. Initiative: Personal initiative should be encouraged.
14. Esprit de corps: Harmony, cohesion, teamwork, and good interpersonal
relationships should be encouraged.
Fayol’s Fourteen Principles
© 2019 AHIMA
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Deming’s Fourteen Principles
1. Create a constancy of purpose toward continual improvement of products and services, with
the objectives to stay in business, be competitive, and provide jobs.
2. Adopt the new philosophy for a new economic age by correcting superstitious learning, calling
for a major change, and looking at the customer rather than competition.
3. Cease dependence on inspection to achieve quality by eliminating emphasis on mass
inspection and building quality in from the beginning.
4. Don’t award business based on price tag alone, and minimize total costs by developing trusting
and loyal long-term relationships with single suppliers.
5. Constantly and continually improve production and service systems and thereby improve
quality and decrease costs.
© 2019 AHIMA
ahima.org
Deming’s Fourteen Principles (continued)
6. Institute training on the job, where barriers to good work are removed and
managers provide a setting that promotes worker success.
7. Institute leadership with the aim of revising supervision to better help people,
machines, and processes do a better job.
8. Drive out fear so everyone can work effectively toward company goals.
9. Break down barriers between departments so that various departments can
work as a team and anticipate problems of production or use of a product or
service.
10. Avoid asking for new levels of productivity and zero defects through slogans
and targets because most problems of low productivity lie with the system
rather than the worker.
© 2019 AHIMA
ahima.org
Deming’s Fourteen Principles
• 11. Replace work standards such as quotas, numerical
goals, and MBO with good leadership.
• 12. Remove barriers that rob people at all levels of their
pride of workmanship; shift from numbers to quality.
• 13. Institute a program of education and self-improvement
by emphasizing lifelong learning and employment.
• 14. Transformation of the workplace occurs through
everyone’s action.
© 2019 AHIMA
ahima.org
Characteristics of Highly Successful Firms
1. A bias for action: They establish a value for action and implementation
rather than overanalyzing and delaying with endless committees.
2. Close to the customer: They listen and respond to customers to satisfy
their needs.
3. Autonomy and entrepreneurship: They empower people and encourage
innovation and risk taking.
4. Productivity through people: They increase employees’ awareness that
everyone’s contributions lead to shared success.
5. Hands on, value driven: Their managers should be visible, involved, and
know what is going on.
© 2019 AHIMA
ahima.org
Characteristics of Highly Successful Firms
6. Stick to the knitting: They stay with the core business,
what they do well, and avoid wide diversification.
7. Simple form, lean staff: They have fewer
administrative layers and keep the structure simple.
8. Simultaneous loose–tight properties: They maintain
dedication to core principles but encourage flexibility
and experimentation in reaching goals.
© 2019 AHIMA
ahima.org
Management Functions
• Planning—determining what should be accomplished
• Mission and values statement
• Strategic plan
• Tactical plans
• Operational plans
• Organizing—deciding how resources can be allocated
• Organization chart
• Line authority and staff authority
• Span of control
• Delegation
© 2019 AHIMA
ahima.org
Sample Hospital Organizational Chart
© 2019 AHIMA
ahima.org
Management Functions (continued)
• Directing/leading—influencing behavior;
motivating and inspiring other to high performance
• Sources of influence (Power)
• Authority
• Reward
• Coercive
• Referent
• Expert
• Information
• Controlling/evaluating—monitoring performance
and making course corrections
• Dashboards and the balanced score card
© 2019 AHIMA
ahima.org
Management Functions by Organization Level
© 2019 AHIMA
ahima.org
Levels of Management and Skills
• Supervisory management (frontline management)
—Significant use of technical skills
• Middle management—Significant use of
interpersonal skills, including emotional intelligence
(EI)
• Top Management—Significant use of conceptual
skills
• Executive management
• Governing boards
© 2019 AHIMA
ahima.org
Functional Skills by Level in the Organization
© 2019 AHIMA
ahima.org
 Self-awareness
 Self-regulation
 Motivation
 Empathy
 Social skills
Attributes of Emotional Intelligence
© 2019 AHIMA
ahima.org
Managerial Activities and Associated Roles
• Interpersonal activities
• Figurehead—liaison—leader
• Informational activities
• Monitor—disseminator—spokesperson
• Decisional activities
• Entrepreneur
• Disturbance handler
• Resource allocator
• Negotiator
© 2019 AHIMA
ahima.org
Managerial
Activity Related Roles
Interpersonal  Figurehead: The manager represents the organization and is a symbol
for ceremonial, social, legal, and inspirational duties.
 Liaison: The manager maintains networks of relationships outside his
or her organizational unit to gather information and favors.
 Leader: The manager directs, guides, motivates, and develops
subordinates.
Informational  Monitor: The manager oversees internal and external information
sources.
 Disseminator: The manager communicates facts and values to others
in the organization.
 Spokesperson: The manager communicates with others outside the
organization.
Mintzberg’s Managerial Roles
© 2019 AHIMA
ahima.org
Decisional  Entrepreneur: The manager promotes development and planned change
in the organization.
 Disturbance handler: The manager resolves crises and unexpected
problems.
 Resource allocator: The manager uses authority to allocate budget,
personnel, equipment, services, and facilities.
 Negotiator: The manager resolves dilemmas and disputes and
determines the use of resources.
Mintzberg’s Managerial Roles (continued)
© 2019 AHIMA
ahima.org
Traditional Management Paradigm New Management Paradigm
Multilevel hierarchical organization Flatter, distributed organization
Centralized decision making Decentralized decision making
Status measured by amount of turf
controlled
Status measured by success in achieving
outcomes
Funding inputs and intentions Funding outcomes
Face-to-face interaction
Telecommunication and virtual
interaction
Homogenous staffing Workforce diversity
Paradigm Shift in Management
© 2019 AHIMA
ahima.org
Paradigm Shift in Management (continued)
24
Job description Skill portfolio
Annual strategic plan Learning organization
Financial bottom line Triple bottom line
Efficiency and stability Ongoing innovation
Mass services Market segmentation
Work at central office Work at satellite and home offices
© 2019 AHIMA
ahima.org
Trends in Leadership Theory
• Classical leadership theories
• Great person theory
• Trait approach
• Autocratic versus democratic leadership
• Behavioral theories of leadership
• Ohio and Michigan studies
• Leadership grid
• Contingency and situational theories of leadership
• Hersey and Blanchard’s situational model
• Path-Goal theory
• Dyadic relationship theory
• Values-based leadership theory—Servant leadership model
© 2019 AHIMA
ahima.org
Tannenbaum and Schmidt’s
Leadership Continuum
© 2019 AHIMA
ahima.org
Leadership Matrix Models
© 2019 AHIMA
ahima.org
Worker Immaturity—Maturity Continuum
© 2019 AHIMA
ahima.org
Path–Goal Theory
© 2019 AHIMA
ahima.org
Source: Swenson 2014
A Systems View Of Overtime Effects
© 2019 AHIMA
ahima.org
Diffusion of Innovations
• Categories of adopter groups
• Innovators—risk takers
• Inventor
• Champion
• Sponsor
• Critic
• Early adopters—local opinion leaders
• Early majority—nonleaders; natural bridge between
early and late adopters
• Late majority—respond to economic and social pressure
• Laggards—suspicious of change
• Diffusion curve
© 2019 AHIMA
ahima.org
Characteristics of Innovation Stakeholders
© 2019 AHIMA
ahima.org
Innovation Diffusion S-curve
© 2019 AHIMA
ahima.org
Change Management
• Change agents
• Internal change agents
• External change agents
• Stages of change
• Lewin’s stages of change—unfreezing, change, and
refreezing
• Kubler’s theory of loss and grief
© 2019 AHIMA
ahima.org
Change Management (continued)
• Resistance to change
• Facilitation of change
• Bridges’s stages of transition
• Kotter’s 8-step change model
© 2019 AHIMA
ahima.org
Differences between Managers and Leaders
© 2019 AHIMA
ahima.org
Internal Change Agent External Change Agent
Advantages
1. Knows the environment, culture,
people, issues, and hidden agendas
2. Develops and keeps expertise and
resources internal
3. Creates and maintains norms of
organization renewal from within
4. Provides higher security and
confidentiality
5. May have trust and respect of others
6. Has strong personal investment in
success
1. Provides fresh, outside, objective
perspective
2. Is willing to assert, challenge, and
question norms
3. May have more legitimacy to insiders by
not taking sides
4. Brings skills and techniques not
available from within organization
5. Brings diverse organizational
experiences to bear; benchmarks
comparisons
Advantages and Disadvantages of Internal and
External Change Agents
© 2019 AHIMA
ahima.org
Disadvantages 1. May be biased; has already taken
sides, or may be disliked or
mistrusted by some stakeholders
2. May have previous relationships
that contribute to subgrouping or
fragmentation
3. Takes change agent away from
other duties
4. May be enculturated and is “part of
the problem” or does not see it
5. Is subject to organizational
sanctions and pressures as an
employee
1. May or may not be available
when needed by the
organization; may split time
and commitments with
other clients
2. Incurs high expense
3. Takes time to become
familiar with the system
4. May create codependency
or may abandon the system
Advantages and Disadvantages of Internal and
External Change Agents (continued)
© 2019 AHIMA
ahima.org
Force Field Analysis of Forces for the Balanced
Scorecard
© 2019 AHIMA
ahima.org
Kotter’s Phases of Change
© 2019 AHIMA
ahima.org
Variable Impact of Change on Different
Stakeholders

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HM480 Ab103318 ch21

  • 1. © 2019 AHIMA ahima.orgahima.org Health Information Management: Concepts, Principles, and Practice Fifth Edition Chapter 21 Managing and Leading During Organization Change
  • 2. © 2019 AHIMA ahima.org Landmarks in Management as a Discipline • Scientific management • Max Weber—Bureaucracy • Frederick Taylor—Production efficiency • Frank and Lillian Gilbreth—Time and motion studies • Henry Gantt—Task scheduling/project management • Administrative management • Henry Fayol—4 functions and 14 principles of management • Chester Barnard—Communication, efficiency, levels of authority • Mary Parker Follett—Empowered employees; work groups
  • 3. © 2019 AHIMA ahima.org Landmarks in Management as a Discipline (continued) • Humanistic management • Hawthorne studies • Human resources management • Douglas McGregor—X and Y theory of management • Operations management • Scheduling and queuing systems • Logistics • Data mining • Contemporary management • Peter Drucker (management by objectives) • W. Edwards Deming (total quality management) • Business process reengineering
  • 4. © 2019 AHIMA ahima.org Foundations of Management Timeline
  • 5. © 2019 AHIMA ahima.org Gantt chart showing sequence of initial EHR implementation timeline.
  • 6. © 2019 AHIMA ahima.org [ Fayol’s Fourteen Principles 1. Specialization of labor: Work allocation and specialization allow concentrated activities, deeper understanding, and better efficiency. 2. Authority: The person to whom responsibilities are given has the right to give direction and expect obedience. 3. Discipline: The smooth operation of a business requires standards, rules, and values for consistency of action. 4. Unity of command: Every employee receives direction and instructions from only one boss. 5. Unity of direction: All workers are aligned in their efforts toward a single outcome. 6. Subordination of individual interests: Accomplishing shared values and organizational goals take priority over individual agendas. 7. Remuneration: Employees should receive fair pay for work.
  • 7. © 2019 AHIMA ahima.org 8. Centralization: Decisions are made at the top. 9. Scalar chain: Everyone is clearly included in the chain of command and line of authority from top to bottom of the organization. 10.Order: People should clearly understand where they fit in the organization, and all people and material have a place. 11.Equity: People are treated fairly, and a sense of justice should pervade the organization. 12.Tenure: Turnover is undesirable, and loyalty to the organization is sought. 13. Initiative: Personal initiative should be encouraged. 14. Esprit de corps: Harmony, cohesion, teamwork, and good interpersonal relationships should be encouraged. Fayol’s Fourteen Principles
  • 8. © 2019 AHIMA ahima.org Deming’s Fourteen Principles 1. Create a constancy of purpose toward continual improvement of products and services, with the objectives to stay in business, be competitive, and provide jobs. 2. Adopt the new philosophy for a new economic age by correcting superstitious learning, calling for a major change, and looking at the customer rather than competition. 3. Cease dependence on inspection to achieve quality by eliminating emphasis on mass inspection and building quality in from the beginning. 4. Don’t award business based on price tag alone, and minimize total costs by developing trusting and loyal long-term relationships with single suppliers. 5. Constantly and continually improve production and service systems and thereby improve quality and decrease costs.
  • 9. © 2019 AHIMA ahima.org Deming’s Fourteen Principles (continued) 6. Institute training on the job, where barriers to good work are removed and managers provide a setting that promotes worker success. 7. Institute leadership with the aim of revising supervision to better help people, machines, and processes do a better job. 8. Drive out fear so everyone can work effectively toward company goals. 9. Break down barriers between departments so that various departments can work as a team and anticipate problems of production or use of a product or service. 10. Avoid asking for new levels of productivity and zero defects through slogans and targets because most problems of low productivity lie with the system rather than the worker.
  • 10. © 2019 AHIMA ahima.org Deming’s Fourteen Principles • 11. Replace work standards such as quotas, numerical goals, and MBO with good leadership. • 12. Remove barriers that rob people at all levels of their pride of workmanship; shift from numbers to quality. • 13. Institute a program of education and self-improvement by emphasizing lifelong learning and employment. • 14. Transformation of the workplace occurs through everyone’s action.
  • 11. © 2019 AHIMA ahima.org Characteristics of Highly Successful Firms 1. A bias for action: They establish a value for action and implementation rather than overanalyzing and delaying with endless committees. 2. Close to the customer: They listen and respond to customers to satisfy their needs. 3. Autonomy and entrepreneurship: They empower people and encourage innovation and risk taking. 4. Productivity through people: They increase employees’ awareness that everyone’s contributions lead to shared success. 5. Hands on, value driven: Their managers should be visible, involved, and know what is going on.
  • 12. © 2019 AHIMA ahima.org Characteristics of Highly Successful Firms 6. Stick to the knitting: They stay with the core business, what they do well, and avoid wide diversification. 7. Simple form, lean staff: They have fewer administrative layers and keep the structure simple. 8. Simultaneous loose–tight properties: They maintain dedication to core principles but encourage flexibility and experimentation in reaching goals.
  • 13. © 2019 AHIMA ahima.org Management Functions • Planning—determining what should be accomplished • Mission and values statement • Strategic plan • Tactical plans • Operational plans • Organizing—deciding how resources can be allocated • Organization chart • Line authority and staff authority • Span of control • Delegation
  • 14. © 2019 AHIMA ahima.org Sample Hospital Organizational Chart
  • 15. © 2019 AHIMA ahima.org Management Functions (continued) • Directing/leading—influencing behavior; motivating and inspiring other to high performance • Sources of influence (Power) • Authority • Reward • Coercive • Referent • Expert • Information • Controlling/evaluating—monitoring performance and making course corrections • Dashboards and the balanced score card
  • 16. © 2019 AHIMA ahima.org Management Functions by Organization Level
  • 17. © 2019 AHIMA ahima.org Levels of Management and Skills • Supervisory management (frontline management) —Significant use of technical skills • Middle management—Significant use of interpersonal skills, including emotional intelligence (EI) • Top Management—Significant use of conceptual skills • Executive management • Governing boards
  • 18. © 2019 AHIMA ahima.org Functional Skills by Level in the Organization
  • 19. © 2019 AHIMA ahima.org  Self-awareness  Self-regulation  Motivation  Empathy  Social skills Attributes of Emotional Intelligence
  • 20. © 2019 AHIMA ahima.org Managerial Activities and Associated Roles • Interpersonal activities • Figurehead—liaison—leader • Informational activities • Monitor—disseminator—spokesperson • Decisional activities • Entrepreneur • Disturbance handler • Resource allocator • Negotiator
  • 21. © 2019 AHIMA ahima.org Managerial Activity Related Roles Interpersonal  Figurehead: The manager represents the organization and is a symbol for ceremonial, social, legal, and inspirational duties.  Liaison: The manager maintains networks of relationships outside his or her organizational unit to gather information and favors.  Leader: The manager directs, guides, motivates, and develops subordinates. Informational  Monitor: The manager oversees internal and external information sources.  Disseminator: The manager communicates facts and values to others in the organization.  Spokesperson: The manager communicates with others outside the organization. Mintzberg’s Managerial Roles
  • 22. © 2019 AHIMA ahima.org Decisional  Entrepreneur: The manager promotes development and planned change in the organization.  Disturbance handler: The manager resolves crises and unexpected problems.  Resource allocator: The manager uses authority to allocate budget, personnel, equipment, services, and facilities.  Negotiator: The manager resolves dilemmas and disputes and determines the use of resources. Mintzberg’s Managerial Roles (continued)
  • 23. © 2019 AHIMA ahima.org Traditional Management Paradigm New Management Paradigm Multilevel hierarchical organization Flatter, distributed organization Centralized decision making Decentralized decision making Status measured by amount of turf controlled Status measured by success in achieving outcomes Funding inputs and intentions Funding outcomes Face-to-face interaction Telecommunication and virtual interaction Homogenous staffing Workforce diversity Paradigm Shift in Management
  • 24. © 2019 AHIMA ahima.org Paradigm Shift in Management (continued) 24 Job description Skill portfolio Annual strategic plan Learning organization Financial bottom line Triple bottom line Efficiency and stability Ongoing innovation Mass services Market segmentation Work at central office Work at satellite and home offices
  • 25. © 2019 AHIMA ahima.org Trends in Leadership Theory • Classical leadership theories • Great person theory • Trait approach • Autocratic versus democratic leadership • Behavioral theories of leadership • Ohio and Michigan studies • Leadership grid • Contingency and situational theories of leadership • Hersey and Blanchard’s situational model • Path-Goal theory • Dyadic relationship theory • Values-based leadership theory—Servant leadership model
  • 26. © 2019 AHIMA ahima.org Tannenbaum and Schmidt’s Leadership Continuum
  • 28. © 2019 AHIMA ahima.org Worker Immaturity—Maturity Continuum
  • 30. © 2019 AHIMA ahima.org Source: Swenson 2014 A Systems View Of Overtime Effects
  • 31. © 2019 AHIMA ahima.org Diffusion of Innovations • Categories of adopter groups • Innovators—risk takers • Inventor • Champion • Sponsor • Critic • Early adopters—local opinion leaders • Early majority—nonleaders; natural bridge between early and late adopters • Late majority—respond to economic and social pressure • Laggards—suspicious of change • Diffusion curve
  • 32. © 2019 AHIMA ahima.org Characteristics of Innovation Stakeholders
  • 34. © 2019 AHIMA ahima.org Change Management • Change agents • Internal change agents • External change agents • Stages of change • Lewin’s stages of change—unfreezing, change, and refreezing • Kubler’s theory of loss and grief
  • 35. © 2019 AHIMA ahima.org Change Management (continued) • Resistance to change • Facilitation of change • Bridges’s stages of transition • Kotter’s 8-step change model
  • 36. © 2019 AHIMA ahima.org Differences between Managers and Leaders
  • 37. © 2019 AHIMA ahima.org Internal Change Agent External Change Agent Advantages 1. Knows the environment, culture, people, issues, and hidden agendas 2. Develops and keeps expertise and resources internal 3. Creates and maintains norms of organization renewal from within 4. Provides higher security and confidentiality 5. May have trust and respect of others 6. Has strong personal investment in success 1. Provides fresh, outside, objective perspective 2. Is willing to assert, challenge, and question norms 3. May have more legitimacy to insiders by not taking sides 4. Brings skills and techniques not available from within organization 5. Brings diverse organizational experiences to bear; benchmarks comparisons Advantages and Disadvantages of Internal and External Change Agents
  • 38. © 2019 AHIMA ahima.org Disadvantages 1. May be biased; has already taken sides, or may be disliked or mistrusted by some stakeholders 2. May have previous relationships that contribute to subgrouping or fragmentation 3. Takes change agent away from other duties 4. May be enculturated and is “part of the problem” or does not see it 5. Is subject to organizational sanctions and pressures as an employee 1. May or may not be available when needed by the organization; may split time and commitments with other clients 2. Incurs high expense 3. Takes time to become familiar with the system 4. May create codependency or may abandon the system Advantages and Disadvantages of Internal and External Change Agents (continued)
  • 39. © 2019 AHIMA ahima.org Force Field Analysis of Forces for the Balanced Scorecard
  • 41. © 2019 AHIMA ahima.org Variable Impact of Change on Different Stakeholders

Editor's Notes

  1. Self-awareness: The ability to monitor, notice, and label one’s feelings as they occur. This allows one to be more certain about feelings and to identify early vague feelings. Self-regulation: The ability to manage one’s emotions and impulses. A person with this skill is often viewed as being reflective, comfortable with change and ambiguity, and able to control impulsiveness. Motivation: Being highly motivated is essential for focusing attention, mastering situations, showing creativity, and being productive and successful. Empathy: The ability to recognize emotions in others. This is important for teamwork as well as for helping adjust one’s behavior to the emerging reactions of others. Social skills: The ability to handle relationships with others is central to being perceived as popular, effective with others, and having the qualities of a leader.