The document discusses the need for organizations, particularly healthcare organizations, to balance the practical and inspirational aspects of their vision or purpose. It explains that an effective vision must be both realistic and motivational. It then introduces the "binocular model" which visualizes the relationship between an organization's purpose, processes, and people. The model helps leaders understand how balancing these three elements can create an optimal culture where employees are productive and motivated.

1. Abstract: The vision or purpose of an organisation is made up of practical
and motivational aspects. If the focus on either aspect is unbalanced it
becomes impossible to motivate employees and realise the vision. This
article explains how understanding and communicating the need for this
balance, and aligning the requisite processes that support it, is essential for
producing a motivated and productive workforce.
Keywords
Motivation, workforce
Correspondence
Matthew.merrill@va.gov
Date of acceptance
October 1 2012
Start: Healthcare organisations need a clear and powerful purpose or vision
to inspire and motivate their employees. However, to influence and initiate
positive change it is important that executives and nurse managers
understand the dual nature of these visions.
Berson et al (2001) touch on this dual nature in a discussion of the way in
which transformational leaders communicate their visions, and suggest that:
‘Effective transformational leaders may emphasize both instrumental and
inspirational themes in their visions. Why? Simply articulating an audacious
vision may not energize followers to higher levels of effort and performance.
If a vision is not grounded in some level of practicality, followers may view
it as unrealistic or wishful thinking.’
This infers that it is essential to differentiate between the inspirational and
practical aspects of a vision or purpose to create positive change. These two
aspects must be aligned and balanced to create and foster a healthy and
vibrant culture and productive and motivated employees.
According to Jim Womack (2006) there are three elements that combine to
create and influence an organisation’s culture: purpose, processes, and
people. Nurse leaders need to assess and actively influence each element to
achieve optimal performance and culture. Proper focus on these three
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2. elements is required to provide the direction and motivation to accomplish
the desired goals. One method of achieving this is described below.
Binocular model
To aid in the understanding of how these three elements balance and assist
one another I have developed the binocular model of nursing vision This
model can help nurse managers and other leaders visualize and understand
the dual nature of their organization’s vision. It also highlights the
importance of finding a balance between each of the elements to gain a
comprehensive and accurate view of how they are addressing each of the
three elements. (Figure 1).
Figure 1: Binocular model of nursing vision
The model can help leaders visualise the relationship between the answers to
the following questions:
Is our focus on investing in and developing our employees? (High
Involvement)
Do we seek out and try to import the best talent available to work on
the problems we face? (Global Competitor) (Lawler 2008)
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3. Do we measure the effectiveness of our efforts by asking our
customers and external stakeholders?
Do we evaluate our efforts based on numbers and measurements of
internal processes, for example number of patient falls, employee
turnover rates? (Johnson and Hall 2009)
Do we try to motivate and inspire when we communicate with our
employees or do we try and lay out the actions we would like to see
and guidelines in which they need to work?
Often nurse leaders and managers are drawn into focusing predominantly on
the practical aspects of achieving their vision at the expense of the
inspirational. For example, a nurse executive might suggest a noble and
inspirational vision such as the provision of quality, holistic care to patients.
This is a perfectly reasonable and inspirational vision for the organisation.
However, realising this vision involves various practical tasks which can
expose managers to certain difficulties described by Edgar Schein (1996):
‘(Executives) learn that to manage large numbers of people, departments and
divisions, one must rely increasingly on rules, procedures and divisions,
most notably reward and control systems.’ He goes on to say that although
these executives might have ‘come up’ through the ranks ‘they increasingly
have to abandon those insights and replace them with perceptions that in a
tough competitive world, compromises have to be made.’
What we sometimes end up with in nursing are processes put in place by
executives that are in direct conflict with the inspirational aspect of the
organisation’s purpose, for example when nurses are given patient loads
based on achieving maximum efficiency and cost control rather than
optimum quality patient care.
This is linked to the ‘reward and control systems’ mentioned by Schein;
managers or executives have incentive plans based largely on completion of
the practical aspects of an organisation’s vision. This includes elements such
as labour, overtime costs or nursing patient loads which are easier to
measure and report on than concepts such as ‘care’ and ‘wellness’.
Effects on employees When there is imbalance between the inspirational
and practical aspects of a vision, employees can feel a ‘disconnect’; in other
words they see or feel the incongruence between their organisation’s stated
purpose and what they perceive the organisation really values .
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4. This disconnect can destroy the motivational and inspirational aspects of the
organisation’s vision as it only focuses on the practical tasks involved,
therefore creating a culture in which employees, particularly nurses, feel
they are ‘just robots there to do the nursing things’ (Scott and Pollock 2008).
Nursing leaders needs to weigh the benefits and costs of being highly
involved in their employees’ development and growth through assessment
and training. Leaders need to determine if further investment in their
employees is subject to the law of diminishing returns. If they are going to
be getting less and less in return while continuing to invest the same time,
money and effort. The processes that are put in place for employee
improvement and development may actual lead to a decrease in productivity.
This is a balance that the manager is uniquely positioned to assess and
responsible to make.
Striking a balance between an organisation’s purpose, its employees and
processes is essential to achieving its vision; leave out the practical aspects
and there remains only ‘wishful thinking’, while the lack of inspirational
motivation results in ‘robots’ rather than engaged employees.
So how can nurse executives and managers assess how their organisation is
doing in achieving the optimal balance of these elements? How can they
ensure that the purpose that justifies their employment, and the employment
of those they supervise, is being accomplished in the right way?
The following three steps, which correspond to the concepts of people,
processes and purpose, can help diagnose potential problems.
Step one Establish what an organisation’s purpose is and who knows about
it. It is not enough for executives and management to be aware of the
purpose, executive teams must communicate the purpose to everyone else.
Do frontline employees know the vision and has it been communicated to
them effectively?
Managers can ask employees about this informally simply by working
alongside frontline colleagues and talking to them. This invokes the
Heisenberg uncertainty principle (Leung 2012) from the world of physics,
which says that ‘the act of observing alters whatever reality is being
observed’; in other words, managers can influence their colleagues simply
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5. by observing them, and often this observational influence will have a
positive effect on culture, perspective and performance.
Step Two Determine whether your processes and systems reflect, and are
balanced and aligned with, your organisation’s vision and purpose. For
example, it is not realistic or practical to assign each patient their own nurse,
but a balance can be struck between the practical side of caring for patients
and the inspirational and intrinsically motivating aspects of caring and
helping people.
Changing processes must be undertaken on with the understanding that if,
for example, patient loads are altered to give nurses more ‘time to care’ they
may use that time to do things other than ‘care’ for their patients. The most
likely alternative to patient care would be to spend their new found time to
socialize with other nurses and members of the healthcare team. They may
also use this additional time to surf the internet or text their family and
friends. The processes can be altered, but the culture created by the old
processes must also be changed.
Step Three Employees should be involved in the creation of, and
communication of, their organisation’s purpose, and the ‘human capital’
should be accessed and used. Managers should try to elicit ideas from staff,
and empower them to contribute to realising the vision.
Staff at all levels will have good ideas that address the inspirational and
practical aspects of their organisation’s purpose, and if managers can help
them communicate their ideas and put them into practice then staff are more
likely to develop a sense of control and ownership of their work and work
environment.
Conclusion
The creation, communication, and co-ordination of an organisation’s vision
and purpose is the responsibility of its leadership. To be a truly
transformational leader and help realise the vision it is essential to
understand and balance the practical and inspirational aspects of an
organisation’s purpose to develop a culture that can meet the demands of the
ever changing healthcare environment.
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6. References
Berson Y, Shamir B, Avolio B et al (2001) The relationship between vision
strength, leadership style, and context. The Leadership Quarterly. 12, 1, 53-
73.
Johnson M, Hall J (2009) When should a process be art, not science?
Harvard Business Review. 87, 3, 58-65.
Lawler III, E (2008) Talent: Making People Your Competitive Advantage.
Jossey Bass, San Francisco CA.
Leung S (2012) Making time at human resources.
http://arcdirector.blogspot.com/2012/02/arts-research-center-at-uc-berkeley-
is.html (Last accessed: October 8 2012.)
Schein E (1996) Culture: the missing concept in organization studies.
Administrative Science Quarterly. 41, 2, 229-240.
Scott S, Pollock C (2008) The role of nursing unit culture in shaping
research utilization behaviors. Research in Nursing & Health. 31, 4, 298-
309.
Womack, Jim.(2006) "Purpose, Process, People."
http://www.leanuk.org/downloads/jim/purpose_process_people.pdf.
(Last accessed: October 9 2012.)
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