Bad hospital management equals bad medicine
Archived article from Apr 24, 2006
By Michael Sepanic
What makes a hospital better? Count employee management among new technology, drugs and medical procedures, says Alok Baveja, an associate professor of management at the School of Business-Camden. According to Baveja, hospital employee morale has a direct impact on the quality of patient care and safety, which translates into life-and-death numbers: The Institute of Medicine reports that 44,000 to 98,000 patients in the United States die each year from medical mistakes – more than the number of people who die from car accidents or breast cancer.
In a paper to be published in the spring 2006 issue of the California Management Review, Baveja, along with Abate Mammo of the New Jersey Department of Health and Senior Services and researchers from the University of Missouri,relate two management styles – control-based and commitment-based – to medical errors and quality of care.
“The control-based culture in place in most U.S. hospitals doesn’t work and contributes to medical mistakes,” Baveja says. “The control-based style emphasizes lower-level needs, such as basic pay, and does not allow for the fulfillment of higher-level needs like the need for independence, achievement, self-confidence and recognition. Consequently, it makes workers ‘sick’ – not physically but intellectually. Employee turnover is high and morale low in such organizations.”
The control-based environment translates into medical errors by affecting the detection and reporting of errors and by hampering employee motivation, satisfaction and morale. “It does not allow any learning to take place in the health-care delivery process as it sets in motion a vicious cycle in which greater incidence of medical errors leads to greater control and regulation of employee behaviors, further strengthening the blame culture and finger pointing,” Baveja says.
The research team argues that a commitment-based approach, where management assumes that people are capable of self-discipline and can work autonomously, works better for both hospital employees and patients. “Employees take initiative and are actively engaged in their work in a commitment-based organization. They cooperate and trust each other, thus overcoming communication barriers and enhancing coordination and teamwork,” Baveja says. “High employee morale generates a positive emotional energy,” he says. This type of management culture results in low employee turnover.
Changing the management structure in health care organizations is a difficult transition. Most hospitals have managers used to the control-based style, Baveja says. He cites existing clinical culture and the difficulty of changing the belief that “new technology solves all woes” as hurdles in implementing commitment-based management.
Return to the Apr 24, 2006 issue