2.1 A Brief Introduction

I believe that management experts often do a poor job when it comes to understanding their target audiences, which consist of present and future leaders. More specifically, these researchers focus almost solely on demonstrating how administrators can use a certain method or strategy to improve a team’s (or a department’s) operational capabilities. However, the pundits do not answer their readers’ most important question: “How do I benefit by adopting best practices leadership strategies?”

With that realization in mind, I will look at some of the key factors that influence office-level healthcare leaders’ decisions. I will assume that these individuals do not have a myopic focus, which centers only on departmental or corporate goals. Rather, I believe that they are motivated by their own self-interests as well as by their perceived obligations to family, friends, their company, their customers (or patients), and the community. I will describe the key drivers that I feel influence a typical supervisor’s workplace and career-oriented decisions.

I will also provide a brief overview of the contemporary healthcare work-place. Although employees’ individual personalities and views will differ, it is worth noting that, as a group, they have become more outspoken in the last few decades on issues tied to personal privacy and autonomy. I will delineate key aspects of this trend and tie it to changes in American culture. I will use this discussion to help me, later in the narrative, to delineate the benefits that might accrue to an office-level healthcare leader who utilizes best practices management techniques.

Next, I will compare old-style authoritarian management philosophies with ones that are more people focused (and which I endorse). I will argue that today’s healthcare administrators should adopt the latter group of ideas. As a part of this process, I will touch on key aspects of best practices leadership systems, including, among other things, issues related to workplace culture and the treatment of employees, transparency, and emotional intelligence. I will use this conversation to help me demonstrate how healthcare supervisors can use best practices management strategies to motivate staffand foster office environments that support continuous improvement (CI) methodologies.

2.2 Understanding Office-Level Healthcare Leaders by Analyzing the Forces That Motivate Them

I have perused a number of books and articles that deal with management-related topics. Most of them do a good job when it comes to delineating the key aspects of best practices leadership theories. Some of the texts also provide valuable information on human beings’ personalities, interests, and tendencies. However, few of these works spend much time in attempting to discern the full array of factors that influence healthcare administrators’ workplace and career-related decisions. Instead, they implicitly or explicitly choose to focus on one or two of these aspects and ignore the other ones. This situation is unfortunate given the fact that one must know what motivates managers and professionals with de facto power if he or she hopes to convince these people to adopt a particular leadership strategy.

I believe that someone writing a book that includes a discussion of leadership-focused themes should try to ascertain the key interests and obligations that motivate the typical healthcare administrator’s company-related decisions. By taking this step, the writer can tailor his or her conversation to fit that group’s particular needs. At the same time, the author can use this knowledge to help him or her convince frontline administrators and professionals with de facto power to adopt best practices leadership strategies.

With that fact in mind, I will briefly describe some of the key factors I believe help to shape office-level healthcare leaders’ management strategies and career decisions. For the most part, I will limit my discussion to basic, common knowledge–level information that is derived from my own observations. That is because I want to focus on topics that are helpful to readers without distracting attention from the book’s more important issues, which center on management and organizational concepts.

I feel that one can place the factors that help to shape a typical office-level healthcare leader’s company-focused decisions into three categories. The first series of drivers center on that person’s self-interests or desires. The average administrator will also rely on perceived obligations to various stakeholders to help him or her in making key career-oriented and staff-related choices. Finally, this supervisor will likely follow two other guideposts—relating to his or her ethical beliefs and a desire to “leave a legacy behind”—that represent a mixture of self-interested and obligatory-based motives.

2.3 A Typical Administrator’s Ethical Beliefs: An Amalgam of Self-Interests and Duties

Academicians might posit separate definitions for the terms, “ethical beliefs” and “moral views” (Morrison, 2011, p. 269). However, for the purposes of this book, I will assume that both of the phrases refer to one’s beliefs regarding right and wrong. I think it is worthwhile to note that a person makes an ethically important choice whenever his or her decision has a noticeable impact on other human beings. In other words, if someone steals a valuable item from the workplace, his or her action has ethical ramifications, even if the individual acted out of pure self-interest (e.g., did not consider the interests or rights of other stakeholders).

With that fact in mind, it is obvious that office-level healthcare leaders routinely make workplace choices that have ethical consequences. The supervisors who I know will almost always rely on their personal moral codes to help guide these decisions. Sometimes this process takes place unconsciously. For example, a person who lives by the “golden rule” will often intuitively use respectful language when talking to subordinates. At other times, the administrator might knowingly weigh the costs and benefits to various stakeholders (including himself or herself) before choosing a particular outcome or engaging in a specific action.

When taken as a group, healthcare supervisors—and for that matter, all employees—probably hold a wide range of ethical beliefs. However, in each case, their moral views have likely been shaped by, among other things, their particular self-interests and their perceived obligations. (Andre & Velasquez, 2015; Velasquez, Andre, Shanks, & Meyer, 2015). Granted, administrators might not consciously rely on these norms to guide them in making daily office decisions. Nonetheless, an office-level healthcare leader’s self-interests and perceived responsibilities to family, coworkers, and other stakeholders will have an important indirect impact on the choices that this person makes during the workday. This is because these beliefs factor prominently in helping to shape his or her worldview.

I am not sure what psychologists would say on the matter. However, most of the healthcare administrators who I have encountered generally try to “do the right thing.” Granted, some of these people might have sported serious character flaws, possessed myopic views, or shouldered other issues that have hindered their efforts to meet their obligations to stakeholders. At the same time, others might have utilized management techniques that limited their ability to “do the right thing.” Nonetheless, in almost every case, these individuals espoused a moral code that countenanced the rights of others, the authority of contractual obligations, the viability of legal codes, and all of the key things that set normal human beings apart from narcissistic animals.

2.4 The Intense Desire to Leave a Legacy

In my experience, the vast majority of human beings, even the most self-centered or narrow-minded ones, want to leave the world a better place than they found it—whatever that might specifically entail. As a result, they will often work to meet their obligations to stakeholders, to provide aid to peers, to adhere to a code of ethics, and generally to do things that benefit others more than themselves. Further, individuals will engage in these somewhat altruistic actions even when there is no authority figure watching over them. Importantly, people of all faiths and backgrounds take part in these types of activities.

Psychologists, ethicists, religious thinkers, and other experts have long pondered this issue and have proposed an innumerable array of potential reasons to explain these behaviors, which range from the fear of a god to the natural instinct to internalize societal norms. While many of those ideas partially, or perhaps even fully, explain the phenomenon, they rely on theories that are too complex for me to present here. Additionally, I do not think that most office-level healthcare leaders, if they were to explain why they adhere to the aforementioned ethical views, would rely on these psychological or epistemological theories. Instead, the supervisors might sum the whole thing up in a few simple words: “I want to leave a legacy behind.”

Over the years, I have heard adults of all ages and backgrounds talk about the need “to leave a legacy behind.” They might refer to it by different names including “to make a name for myself,” “to carve out my place in history,” or “to leave something for people to remember me by.” When speaking about this, individuals are referring both to their present reputations and to the ones that they assume they will, upon their passing, leave in the social (and perhaps supernatural) consciousness. These men and women try to perform good deeds (however that term is defined) and adhere to certain ethical codes in the hopes that, in both the here and now as well as in the future, “people” will think highly of them. This is the case even if they are unable to identify who these “people” will be. The desire to be remembered cuts across gender, ethnic, religious, social, and economic lines. Indeed, some groups, such as the ancient Egyptians, placed so much emphasis on this longing that they made “being remembered” a prerequisite for continuing on in the afterlife (Ikram, 2005).

There might be many reasons why large numbers of people desire to leave a legacy behind. However, the truth is that they do have this strong need to be remembered, which only grows more intense as they get older (Matthiessen, n.d.). At the same time, they want society to think of them as good people and not as tyrants or misanthropes. With regard to office-level healthcare leaders, I believe that this longing plays a key role in helping them to adhere to ethical norms and to strive to meet stakeholder obligations (or, at least, to make it appear like they are working to meet stakeholder demands).

Figure 2.1 The image provides a graphical representation of the interrelationships between an administrator’s self-interests, obligations, ethical beliefs, and desire to leave a legacy. The leader’s self-interests and duties provide the basic impetus for his or her decisions. As such, they help to shape and guide the person’s ethical beliefs. In turn, the professional relies upon his or her self-interests, loyalties, and notions of right and wrong to help determine what type of legacy to leave behind.

In Figure 2.1, I provide a graphical representation of some of the key factors that I believe influence a typical office-level healthcare leader’s management and career decisions. The most basic driver is the supervisor’s self-interests followed by his or her obligations to family, friends, coworkers, and other stakeholders. These influences help, along with other factors, to shape the administrator’s ethical views. In my experience, a manager or professional with de facto power will draw on the aforementioned aspects to help him or her discern the type of legacy to leave behind.

2.5 Office-Level Healthcare Leaders Can Help Themselves When They Use Best Practices Management and Organizational Techniques

In the first part of this chapter, I briefly touched on some of the self-interests and obligations that underlie office-level healthcare leaders’ management and career decisions. I realize that, relatively speaking, I did not spend much time discussing these topics. I planned it that way. My narrative does not focus primarily on ethics issues. Instead, I hope that readers use the behavioral information that I provided earlier to help them see how they can personally benefit from using the best practices management and organizational strategies that I discuss in this book.

To wit, many people will find it difficult to incorporate some of these best practices management and organizational strategies into their daily routines. For instance, it is challenging for someone who has always favored an autocratic leadership approach to transition to a more participatory style of oversight. It is just as hard for an administrator to empathize with people who possess beliefs and views that are very different from those that he or she espouses. At the same time, a supervisor who has never utilized CI methods might have to expend a great deal of effort in learning how to use (and how to convince other employees to utilize) these systems. With these facts in mind, I feel that office-level health-care leaders are more likely to put forth the effort necessary to adopt the techniques discussed in this book if they see how these actions can help them to achieve their personal and professional goals.

In other words, I hope that the reader will peruse the management and organizational strategies in this book and say, “I realize how they can help me to improve my department’s or team’s operational efficiency and effectiveness. However, I also see how I can satiate my own self-interests, better meet my personal obligations, and create a more enduring legacy by adopting these practices.” A reader who can envision himself or herself stating those things is more likely to incorporate the best practices methods that are discussed in this text into his or her everyday routines. This fact is especially true when an individual does not have any corporate-level incentives to push him or her to adopt participatory management strategies or strive to create a CI-supportive office culture.

2.6 Strict Autocratic Management Styles

Before I discuss best practices management styles and office cultures, I think it is worthwhile to quickly look at suboptimal ones that rely on hierarchical, paternalistic leadership methods. They are not the only flawed supervisory or organizational systems; however, leaders, in healthcare and other industries have most often used autocratic techniques to control and motivate their workers (Fallon & McConnell, 2007, p. 97).

In my experience, an autocratic leader often fosters a work environment that exhibits certain hierarchical, paternalistic characteristics. As such, one needs to consider both the management style and the office culture as a synergistic unit. With that fact in mind, I would argue that an authoritarian system includes these key elements:

• The Manager Is the Absolute Boss: The administrator of the team or department has complete authority over the actions of his or her subordinates. The employees can either obey their supervisor’s directives or they can quit (Fallon & McConnell, 2007, pp. 373–374).
• Paternalistic Notions: Whether or not an autocratic administrator actually believes in the tenets of paternalism, he or she will usually oversee a culture that espouses these ideals. If an office-level leader adheres to strict authoritarian management techniques, that person will rely almost exclusively on using threats or direct incentives to motivate employees; the supervisor feels that these methods are the only ones that will motivate workers to perform their required tasks (Fallon & McConnell, 2007, p. 373; Stone & Patterson, 2005, p. 1). Following this logic, an autocratic manager or professional with de facto power will not attempt to engage staff by providing them with some autonomy or by appealing to their intrinsic needs for self-fulfillment. As a result, authoritarian leaders in the healthcare field (and in other industries as well) will likely have difficulty in fully inspiring the vast majority of today’s workers, who are driven by both internal and extrinsic factors (Shanks & Dore, 2012, p. 49).
• Strict, Task-Based Systems: In the autocratic office environment that I envision, employees have very little if any creative freedom. Their administrators require them to follow a scripted series of steps in performing their daily tasks (Sirota, Mischkind, & Meltzer, 2005, pp. 175–176). Think of the assembly line worker whose only job is to bolt in four screws on each wheel that comes his or her way. The person uses the same exact four-step process each time he or she places the bolts into the wheels. Staff members who labor in this type of system must consistently meet certain efficiency-related and productivity-related goals in order to secure a raise or, sometimes, to even keep their jobs. Additionally, office-level leaders not only often judge these employees on what they produce and how fast they do it, but they also place a heavy emphasis on whether the workers perform their tasks in the preordained patterns (Mintzburg, 1981, n. p.). I have heard of companies who fired staff members because these individuals did not strictly adhere to their preset routines. This was the case even if these workers were more efficient and productive than their peers.
• Hierarchical Structures: I have had some experience with authoritarian systems or, at least, ones that approximated that type of culture. I have noticed that the hierarchical structures do not end with management. Rather, the frontline employees usually fall into some approximation of a pecking order based on seniority or on another characteristic.
• Abusive Environments: Technically, workplaces that are run by autocratic leaders can be places in which staff generally respect the dignity and worth of each individual. However, in my experience, they more often are environments in which bullying and abuse by managers and employees is tolerated if not encouraged.

Until the second half of the 20^th century, a large majority of administrators working for U.S. companies, in healthcare and in other fields, used autocratic techniques to motivate and discipline their workers (Fallon & McConnell, 2007, p. 97). Their management styles reflected the general culture in which they lived at the time. While not indicative of everyone, American society during this period fostered paternalistic, caste-like notions that ranked individuals according to things like status, wealth, ethnicity, and gender. For the most part, the people in power expected their peers to follow certain social norms that reinforced the aforementioned stratifications (History, n.d.; Trachtenberg, 2000, pp. 144–152; Young & Young, 2004, pp. 21–22). Americans who strayed from these ideals might find themselves ostracized from key social circles or (much more worrying to a blue-collar worker) barred from any of the good paying jobs (Martin, 2011, pp. 173–174; Minchin, 2013, p. 30; Public Broadcasting Service, 2006).

In the aforementioned culture and time period, an office-level healthcare leader, usually a male, might have felt justified in using autocratic methods to supervise his employees. The individual could take comfort in the fact that his peers would approve of the tactics. The administrator might in fact perceive himself as the fatherly protector of his staff. After all, he was helping the workers to make an honest living. This person’s leadership style was a simple one; he gave orders and his employees obeyed him. He did not have to worry about the more nuanced issues that might arise when using more participatory methods of managing staff. His subordinates, whatever they might have said about him in private, paid deference to him in public. They also gave their supervisor his “due respect” when they met him outside of work—at the shopping mall or the grocery store. This professional was also happy to “bear the burden of leadership” in other areas of his life—as the patriarch of his household and as the president of his social club. The leader conformed to all of the perceived norms for his socioeconomic group. He was proud of the paternalistic legacy that he was creating.

2.7 Today’s Office-Level Healthcare Leaders: The Old Management Styles No Longer Work as Well

Perhaps at one point in time, healthcare managers and professionals with de facto power could have felt justified in utilizing strict authoritarian management styles. However, in today’s environment, it no longer makes sense for office-level healthcare leaders to do so. That is because administrators who use strict autocratic methods, especially the exploitative versions of these practices, create work environments that hinder their teams’ and departments’ efficiency and effectiveness. At the same time, these individuals impede their own self-interests and risk harming their legacies.

In my experience, contemporary American healthcare employees as a whole strongly believe in their rights as individuals, especially ones related to autonomy, respect, dignity, and privacy. They tend to balk when asked to work for authoritarian managers or professionals with de facto power (Sirota, Mischkind, & Meltzer, 2005, p. 176). Staffmembers might not openly revolt against autocratic supervisory practices, but they will often protest in subtle, sometimes destructive ways. Even the ones who tacitly accept their places in the hierarchical structure may lack the necessary motivation to give 100 percent (or even 70 percent) effort on a daily basis (Bolman & Deal, 2008, pp. 80–81). As important, a host of federal and state laws protect healthcare employees’ individual rights (Fallon & McConnell, 2007, pp. 41–57). Administrators who utilize “strongman” tactics to manage subordinates might find themselves on the wrong end of one or more lawsuits. Their companies might also suffer as a result of these missteps.

Strict autocratic, top-down management structures—and even ones that are only moderately authoritarian (using my description in the previous section)—probably suffer from a number of weaknesses that have nothing to do with employee satisfaction metrics. For instance, both management and frontline staff working in these systems are slow to react to changes in the environment. At the same time, they are often resistant to anything that alters their daily routines (Robbins, 2015, p. 58). Administrators who utilize authoritarian styles will have difficulty in getting subordinates to perform well in situations that require team-based or cooperative methods. At the same time, frontline employees working in these systems will stumble badly when they are confronted with situations that require creative solutions (Anonymous, n.d.).

A healthcare administrator who primarily relies on autocratic techniques to manage employees might not only be harming employees and the organization. That individual may also be doing things that impede his or her own personal self-interests and obligations. An office-level healthcare leader who espouses autocratic methods and thus impedes his or her department’s performance will likely find it difficult to move up the corporate ladder. This person may also be complicit in fostering an antagonistic work environment that renders it impossible for him or her to maintain amicable relations with employees. In my experience, a manager or professional with de facto power who uses “strongman” tactics at the workplace is also likely to espouse the same methods in dealing with friends, acquaintances, and family members, thereby leading to strife away from the office as well as in it. Perhaps most importantly, at least from what I have seen, a person who principally utilizes authoritarian methods will often do or say things that hurt his or her legacy.

Of course, some clinical and administrative healthcare jobs require workers to perform repetitive tasks using structured guidelines. At the same time, managers and professionals with de facto power have to utilize top-down approaches to ensure that employees accomplish certain tasks. Sometimes, they have to rely on these methods to make sure that staffprovide quality care, follow regulatory guidelines, or implement Six Sigma, Lean, or other efficiency-focused processes.

However, I do not know of any situation in healthcare today that requires administrators to use strict authoritarian methods. In today’s health services workplace, it does not behoove a supervisor to treat employees like automatons. At the same time, no office-level healthcare leader should foster an office culture that encourages bullying or otherwise leaves staff open to exploitation by higher-ups or peers.

In the final part of this chapter, I will highlight some of the best practices management techniques that I feel administrators can employ to help them get the most out of their workers. Importantly, people who adhere to a variety of leadership styles can nonetheless utilize aspects of these techniques. As long as a manager or professional with de facto power does not rely on strict authoritarian methods to supervise staff, he or she should be able to make use of the information on best practices, which I posit in the upcoming sections.

2.8 Today’s Office-Level Healthcare Leaders Wear Many Hats

Contemporary office-level healthcare leaders might work for organizations whose management structures run the gamut from ones that favor bureaucratic, top-down systems to others that are relatively flat. These administrators might oversee staff who are semiautonomous, or they may supervise employees who perform tasks that are highly structured and repetitive. Healthcare managers and professionals with de facto power might have a lot of freedom when it comes to controlling and motivating their workers. On the other hand, they may have to closely adhere to corporate guidelines or follow detailed instructions from higher-ups when making decisions.

Regardless of the situations they find themselves in or the types of organizations that they work for, all office-level healthcare leaders have to spend at least part of their time supervising employees. More specifically, they will likely help to identify the tasks that their staff members need to perform and set department or team goals. Healthcare administrators, regardless of any other limitations on their power, also play a part in motivating their subordinates to achieve, and hopefully to exceed, work targets. Most managers and professionals with de facto power probably also strive to maintain high employee satisfaction rates and to create a work environment that is amicable. This is the case even if some of these individuals, due to poor leadership practices or for other reasons, fail to achieve these goals.

I think that most readers, without having to review any literature on the subject, would agree that a healthcare administrator has to be able to connect with his or her workers in order to achieve the aforementioned aims. As I previously noted, a leader who treats employees like automatons or children, who exploits them, or who fosters an abusive work culture is going to have a difficult time managing and motivating employees. Supervisors who possess myopic points of view or who have limited contact with staff might also fail to properly inspire many of their staff members. Due to these limitations, the administrators will not know (or care enough to know) their subordinates well enough to actuate these workers’ unique intrinsic impulses (Shanks & Dore, 2012, p. 49).

I believe that to be truly successful in today’s healthcare workplace, a manager or professional with de facto power needs to be able to wear a number of different hats when interacting with employees. Victor Lipman (2013), a business expert, lists a few of these functions, including those of a psychiatrist, a coach, a law enforcement officer, and a diplomat. From my experiences in the health-care field, I would add a number of other ones, such as being a cheerleader, a friend and comforter, a liaison between employees and other key stake holders, a facilitator of ideas, an older brother or sister, a colleague, and a coworker. I have posited the list again in Figure 2.2. Readers of this book can probably come up with many more roles.

In short, today’s office-level healthcare leaders have to wear many different hats if they want to properly to motivate, supervise, and retain their employees. They must be able to accomplish these tasks while overseeing a diverse group of workers who hail from a variety of backgrounds, espouse a range of beliefs, and encompass a diverse array of personalities. It can be a difficult job. One business researcher captures the right visual when he compares leading a team to conducting an orchestra (Mintzberg, 1998, p. 140). Given these facts, I think readers can easily see why an autocratic manager or professional with de facto power might find it difficult, if not impossible, to get the most out of his or her workforce. In the next sections, I will provide healthcare administrators with some best practices tools that they can use to help them achieve their office-related goals.

Figure 2.2 As the graphic demonstrates, contemporary office-level healthcare leaders have to wear a number of different hats. Some of these terms come from Victor Lipman’s article (Lipman, 2013).

2.9 Best Practices Leadership Ideas

Business mavens have written a large number of books and articles that seek to delineate best practices management methods. In this case, I do not think there is much that I can add to their discussions. Instead, I will briefly summarize some of the leadership-related ideas that I think are most important for the reader to be familiar with. I will refer to some of these concepts at later points in the book when I chat about issues centering on, among other things, CI philosophies, CI-supportive office cultures, split-second decision-making techniques, and office-level rules and regulations.

2.10 Good Healthcare Administrators Possess Strong Emotional Intelligence Skills

Anyone who has taken a management class in college has probably heard of emotional intelligence (EI). Psychologist, Daniel Goleman, coined the term to describe some of the key interpersonal and communications-related abilities that today’s leaders need in order to successfully motivate and manage their employees, as well as to maximize interactions with other key stakeholders (Goleman, 2016; Rubino, 2012, p. 22). I think that healthcare administrators can use Goleman’s EI domains as a guide to help them mediate their interactions with staff and others. One can find numerous articles and books that discuss these topics. Hence, I will only briefly touch on the core EI categories in the proceeding narrative.

One can divide EI into five main categories that relate to the self (e.g., self-control) as well as to a person’s interactions with others. The five domains are:

• Self-Awareness: Healthcare administrators who are self-aware have “a deep understanding of [their] emotions, strengths, weaknesses, interests, and drives” (Rubino, 2012, p. 22). In other words, these supervisors know what “makes them tick.” They are cognizant of their emotional responses to certain situations, as well as their own moods and impulses. Ideally, self-aware office-level healthcare leaders also know what they do well and where they perform poorly.
• Self-Regulation: Once an administrator is cognizant of his or her behavioral tendencies, that individual can work to control them. The self-regulating supervisor does just this. The person consciously tries to manage his or her emotions, impulses, and the like. This type of leader also occasionally (or perhaps more often) engages in self-reflection in an effort to identify and further regulate or change any negative tendencies (Rubino, 2012, p. 22).
• Motivation: These administrators like challenges and are “passionate about [their] professions” (Rubino, 2012, p. 22). To put it another way, a motivated office-level healthcare leader is energized by his or her work experiences and wants to give 100 percent effort on a daily basis.
• Empathy: Healthcare administrators who are empathetic are able, to borrow an old cliché, “to put themselves in others’ shoes.” They work to understand, at an intuitive level, their employees’ needs, feelings, and perceptions (Rubino, 2012, p. 22). In my experience, it is very difficult for most people to accomplish this feat on a routine basis. Hence, this might be one of the more difficult tasks for EI-focused supervisors to master.
• Social Skills: From an administrator’s standpoint, it means “moving people in the direction you desire by your ability to interact effectively” (Rubino, 2012, p. 22).

2.11 Managing and Motivating Workers: A Focus on Contracts

In my experience, many healthcare administrators do not rely on any particular methodology when it comes to managing and motivating employees. Instead, they utilize what I would term a “throw it up against the wall and see what sticks” strategy. These supervisors will try a wide array of approaches on any given day to convince staff to follow directives, increase productivity, and so forth. For instance, a manager might, in the span of a few hours, vacillate from acting like a dictator to trying to be “everyone’s friend.” office-level healthcare leaders might be able to achieve some of their aims using these tactics; however, I think that they can utilize better ones, which center on the observance of contractual obligations.

In my opinion, an office-level healthcare leader who is committed to the “first among equals” ideal, should use a contracts-based strategy when managing and motivating employees. Using this approach, the administrator operates under the assumption that all employees under his or her control have agreed to certain conditions. More specifically, staff, by their continued employment with their organizations, have agreed to perform the duties stated in their job descriptions to the best of their abilities, to follow corporate rules and regulations, to (usually) obey orders from their supervisors, and to treat each other with respect (see my previous discussion on self-interests, obligations, and ethics).

By the same token, the office-level healthcare leader also has obligations to his or her employees (as does the company itself), which center on written/stated responsibilities as well as those established by social contract. The manager or professional with de facto power might utilize a number of different strategies to motivate and manage staff; however, the individual will make a conscious effort to ensure that these tactics derive from his or her contractual duties. As a part of this process, the administrator should occasionally remind employees of these contracts and demonstrate how his or her management style relates back to these obligations.

I feel that office-level healthcare leaders derive several benefits by adhering to these methods. For one thing, administrators who make conscious efforts to rule via contract come across (to employees and others) as more authentic. Their decision making is also more consistent. In both instances, they conform to best practices management techniques (Lipman, 2013; Rubino, 2012, p. 23). Most importantly, I believe that people who consciously seek to rule via contract will exhibit more self-control and often make better decisions than their peers.

Most readers will probably agree that my arguments in this section are based on common knowledge; however, I am surprised by the fact that many health-care administrators do not adhere to these dictums. They might publicly state that everyone, including themselves, needs to follow corporate rules and behavioral norms. However, these supervisors are quick to abandon this methodology and try other tactics. By using a “do what I say and not as I do” approach to managing the office, these office-level healthcare leaders, over the long term, impede their staff members’ effectiveness and efficiency.

2.12 The Benefits of Using Best Practices Management Techniques

Healthcare administrators may benefit in a number of ways if they utilize the best practices leadership strategies that I have discussed in this chapter. For one thing, supervisors who use these practices will likely employ staff who, on the whole, feel more empowered than they otherwise might be. At the same time, employees who work in cultures that are based on respect for individual rights and dignity are likely going to be happier than their counterparts who labor in more restrictive or exploitative environments. Perhaps most importantly, managers and professionals with de facto power who follow best practice leadership guidelines should oversee staff who, on the whole, are more motivated and engaged than their colleagues who work in more autocratic or abusive systems (DeMers, 2015; Quast, 2012).

It goes without saying that healthcare employees who are engaged, motivated, and empowered tend to work harder, produce higher-quality goods, and provide better patient care than their counterparts who lack these traits. The former individuals are also more likely to stay with their respective companies as opposed to seeking other job opportunities. At the same time, they are less likely to misbehave, steal from their organizations, or engage in other disruptive or destructive activities (Shanks & Dore, 2012, p. 40). Additionally, people who feel like they have a voice in the department or on the team are much more likely to let their supervisors know of important quality- or patient safety–related issues, of changing customer or resident demands, and any other important information that is pertinent to the organization (Hegwer, 2017; Pomeroy et al., 2004, n.p.). Just as important, office-level leaders who utilize best practices management styles will find that their employees tend to perform well in team-based formats. This is especially important, given that many healthcare-related environments require staff to work together in a cooperative manner in order to complete at least some of their tasks (Fried & Carpenter, 2013, pp. 122, 137).

Importantly, office-level healthcare leaders will find it much easier to create cultures that espouse CI ideals if they utilize best practices management techniques. In order to create a successful CI environment, they will need to employ people who are engaged, motivated, and self-confidant. These leaders must also possess workers who are able to identify and ameliorate deficiencies in tasks, processes, and systems. Finally, in order for CI to work, the staff needs to communicate openly and clearly with each other as well as with management. I will discuss these issues in more detail in a later part of this text.

2.13 Summing Things Up and Looking Ahead to Chapter 3—A Primer on Continuous Improvement, Lean, and Six Sigma in the Healthcare Workplace

In this chapter, I illustrated some techniques that healthcare administrators can use to help them properly oversee and motivate their employees. As a part of this process, I demonstrated why it is usually in an office-level healthcare leader’s interests to favor these methods over ones that rely on more antiquated philo sophies. Specifically, I argued that supervisors who adhere to best practices management strategies tend to do a better job in meeting their self-interests, obligations to key stakeholders, and ethical imperatives. I then turned my attention to delineating some of the key principles that undergird my preferred leadership beliefs, including ideas related to participatory management, the treatment of employees, honesty, consistent decisions, outlook, and interpersonal skills. Finally, I argued that individuals who utilize best practices management techniques will be more likely than others to foster high-performing office cultures that support CI-related goals.

In the next chapter, I will discuss CI methodologies. I will define the term and denote some of the key steps that undergird almost all CI processes. I will also briefly touch on some reasons why healthcare executives and administrators might want to adopt these philosophies. While I will devote some attention to analyzing CI’s general aspects, I will spend more time reviewing Six Sigma and Lean; these two CI systems are important components of many healthcare-related quality-improvement initiatives. I will end the chapter by focusing on some of the pivotal struggles that resource-challenged institutions face when they try to incorporate CI thinking into their business and clinical practices.