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Participative management lifts lab productivity.

Participative management lifts lab productivity

Participative management increases productivity in clinical laboratories. I reached that conclusion recently after analyzing the relationship between management style and productivity in labs at 12 medium-size community hospitals in a large Southern metropolitan area.

As part of the study, nearly 300 medical technologists evaluated the management style of their laboratory managers--synonymous here with a variety of lab titles, including director, administrator, chief technologist, or supervisor. Lab managers, management engineers, and chief financial officers provided the productivity data.

The research clearly demonstrated productivity improvements, measured in tests per employee hour, as management style became less authoritarian and more participative--or as employees were allowed to provide input into management decisions. These improvements came about with no change in quality of work.

Productivity, of course, is the primary issue as hospitals and their laboratories respond to the changing financial environment in health care. Cutbacks in personnel, revenue constraints imposed by government and private payers, and higher costs make increased productivity more than a management goal. It is essential for survival.1

The literature is filled with reports on ways to increase productivity, including management engineering techniques, workload scheduling, staffing for peak workload hours, quality circles, automated systems, and computerized staffing controls. Very little, however, is currently being reported on management style as an effective tool for improving productivity.

Historically, management research has indicated a definite relationship between productivity and management style. The problem is that some researchers have determined that authoritarian management is more productive, while others have found that democratic-participative management leads to increased productivity. Let's review some of the conflicting information that motivated me to perform my own study.

A 1953 examination of several boys' clubs concluded that productivity was somewhat greater under autocratic rather than democratic leadership.2 The opposite finding was reported in 1955: A manufacturer's productivity and profits rose while costs fell considerably one year after implementation of group-centered leadership.3 But field research described in 1956 showed hierarchically controlled groups achieving a greater increase in productivity than participatively controlled groups.4

George P. Schultz, our current Secretary of State, made a contribution to the literature in the 1950s. He reported a 41 per cent productivity gain during the first year of increased employee participation in one company.5

The author of a book published in 1957 pointed out that employees for the most part have few needs related to greater productivity. He said this might explain why production increases more under directive than under participative leadership.6 A decade later, another author cited a 30 per cent productivity increase and a 20 per cent cost decline in a clothing factory over a two-year period as management style shifted from an authoritarian to a democratic-participative approach.7

Yet another researcher reported that participative leaders have the best-performing groups in some cases, but that directive, controlling leaders do better in other cases.8 In other words, appropriate leadership style depends on the situation.

The debate continued. A 1973 study found that humanistic management generated high productivity, motivation, morale, and job satisfaction in 15 firms ranging from airlines and banks to heavy manufacturing.9 In contrast, a 1976 study focused on the effectiveness of three management styles: managers with a need for affiliation, managers with a need for personal powr, and managers with a need for power for the good of the institution. Employees of managers in the last category were more productive and had a higher sense of responsibility and organizational clarity.10

Experience with a hospital productivity improvement model developed in 1984 and implemented in a respiratory therapy department supported the notion that participative management is a vehicle for productivity improvement.11 Later in 1984, an extensive analysis of research data comparing participative management and productivity in Germany, Japan, and the United States found little evidence that a participative style resulted in any productivity increase--at least in the United States.12

There appears to be no end to conflicting research results and conflicting opinions about which management style to choose. When faced with this dilemma, an investigator cited earlier8 concluded from his extensive research that group performance (productivity) depended upon matching leadership style to the particular situation.13 What, then, is the right style for the situation under discussion here--clinical laboratory operations?

The simplest way to answer that would be to take a large number of hospital laboratories at a fixed point in time, measure each lab chief's management style and the lab's productivity, and analyze the data to determine the most productive style. Rather than attempt a random sampling of laboratories across the nation, I chose to survey clinical laboratories in a group of 12 medium-size homogeneous acute-care community hospitals. This is known as a convenience sample and is a generally accepted nonrandom sampling method.14

All of the hospitals and professional administrators, JCAH accreditation, no affiliation with a medical school, a great deal of overlapping medical staff membership, similar goals and objectives, similar salary structures, comparable occupancy rates, comparable policies and procedures, and patients with nearly the same intensity-of-care requirements. Their clinical laboratories provided comparable testing and were staffed with a similar mix of four-year and two-year college-educated staff members and personnel trained on the job. The purpose of this sample selection technique was to limit as much as possible any wide differences among institutions and laboratories that could contaminate the results.

The research was based on the analysis of two questionnaires-- one measuring managerial style, the other laboratory productivity. Rensis Likert's questionnaire entitled "Profile of Organizational Characteristics.' Form S. was used to measure the laboratory manager's management style.7

This approach asks employees to evaluate how their manager runs the organization. The authoritarian manager is at the low end of a scale of 1 to 20, and the participative manager is at the high end. Aspects of management style that are measured include confidence and trust in subordinates; open communication; a focus on organizational goals; seeking out ideas; use of rewards and punishment; promotion of teamwork; free information flow; knowledge of employee problems; and where, how, and by whom decisions are made.

At each hospital, I met with the laboratory manager and as many technologists, technicians, and support staff members as were available immediately before and after the 3 p.m. shift change. These meetings were held to explain the study and to distribute the questionnaire. It took three weeks to canvass all 12 hospitals.

A few days after each meeting, I returned to pick up the employees' confidential responses to the 18 questions on management style. Out of 303 questionnaires distributed, 281 were properly completed and returned, for a 92.7 per cent response rate.

The productivity questionnaire used management engineering standards to measure clinical laboratory output in CAP workload units per productive employee hour. Laboratory managers, management engineers, and hospital chief financial officers provided the necessary data.

Next, the laboratories were ranked according to productivity, and the laboratory managers were ranked from the one with the most authoritarian management style to the one with the most participative style. Relationships between two different kinds of rankings can be determined with a nonparametric statistical method called Spearman's Correlation Coefficient.15 This is probably the most commonly used correlation formula.

Figure I demonstrates a definite relationship between management style and laboratory productivity. The statistical test, significant at the .05 level, supports the idea that productivity goes up in clinical laboratories as management becomes more participative.

In any study of this nature, several precautions are necessary. The questionnaire response rate of 92.7 per cent is high enough to support conclusions. However, employees who did not respond might have altered the results somewhat. A .01 statistical level of significance would have been more desirable. One criticism of this study is the lack of measurement of other factors that may cause variations in productivity, even though an effort was made to limit wide differences among the institutions and laboratories.

In addition, the typical lack of rendom sampling in this kind of field study prohibits statistical inference from the sample to a larger population. Yet to invalidate any kind of inference other than statistical inference would eliminate most scientific research.16

In the final analysis, you can look at the trends and say there is a relationship between management style and productivity-- even if correlation analysis does not permit you to say there is a cause-and-effect relationship.

Another precaution concerns management behavior. Laboratory managers should interpret this study as a basis for allowing input and participation in decisions, but they alone ultimately make management decision.

Participative management--together with a firm. Consistent, fair, and reasonable style--is the key to increased productivity. A laboratory manager who uses participative management can expect to have a more productive staff and lower costs, and to make a greater contribution to the institution's success.

1. American College of Hospital Administrators "Productivity: The New Health Care Challenge (1983-84 annual report). Chicago, ACHA, 1984.

2. White, R., and Lippett, R. Leader behavior and member reaction in three social climates. "Group Dynamics, Research, and Theory.' Cartwright, D., and Zander, A., eds. Evanston, Ill., Row Peterson, 1953.

3. Gordon, T. "Group-Centered Leadership' New York, Houghton Mifflin, 1955.

4. Morse, N., and Reimer, E. The experimenta change of a major organizational variable J. Abnormal and Social Psych. 52: 120-129, January 1956.

5. Schultz, G.P. Worker participation on production problems, pp. 50-55 in "The Scanlan Plan . . . A Frontier in Labor-Management Cooperation,' Lesieur, F.G., ed. Boston, MIT Press, 1958.

6. Argyris, C. "Personality and Organization,' p. 121. New York, Harper & Row, 1957.

7. Likert, R. "The Human Organization,' pp. 29-38. New York, McGraw-Hill, 1967.

8. Fiedler, F.E. Situational factors related to leadership effectiveness, pp. 428-429 in "Studies in Personnel and Industrial Psychological Fleishman, E.A., ed. Homewood, Ill., Dorse, Press, 1967.

9. Swart, C. The worth of humanistic management. Business Horizons 16: 41-50, June 1973.

10. McClelland, D.C., and Burnham, D.H. Power is the great motivator. Harv. Bus. Rev. 54: 100-110, March-April 1976.

11. Margulies, N., and Duval, J. Productivity management: A model for participative management in health care organizations. Health Care Management Review 9: 61-70, Winter 1984.

12. Levitan, S.A., and Werneke, D. Worker participation and productivity change. Monthly Labor Review 107: 28-33, September 1984.

13. Fiedler, F.E. "A Theory of Leadership Effectiveness.' New York, McGraw-Hill, 1967.

14. Parsons, R. "Statistical Analysis: A Decision Making Approach,' pp. 296-297. New York, Harper & Row, 1974.

15. Daniel, W.W. "Biostatistics: A Foundation for Analysis in the Health Sciences,' pp. 303-356. New York, John Wiley & Sons, 1974.

16. Remington, R.D., and Schork, M.A. "Statistics with Applications to the Biological and Health Sciences,' pp. 92-93 Englewood Cliffs, N.J., Prentice-Hall, 1970.

Table: Figure I How labs rank on management style, productivity
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Author:Taylor, Joe K.
Publication:Medical Laboratory Observer
Date:Apr 1, 1986
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