9.1 A Brief Introduction

In my experience, one of the most difficult tasks for any administrator, in healthcare or another field, is in properly developing and applying rules for the office. This individual must try to implement and enforce key mandates without harming the workplace culture or impeding the staff’s ability to meet corporate objectives. In this chapter, I will provide readers with information that they can use to help them achieve this balancing act. I will begin by delineating the four types of regulations and pointing out the ways in which a department’s policies help to shape and mediate its culture. I will then demonstrate how a supervisor can properly administer externally created rules. Next, I will proffer tips that a person can utilize to help him or her to craft fair and effective office-level directives. Finally, I will identify some tactics that an administrator can use to enable him or her to successfully implement and apply these policies.

9.2 Four Types of Rules

Before I discuss key issues related to departmental rules, I believe it is important for me to briefly list the four types of directives. Almost every policy will incorporate two of these features. They include:

• Departmental-Level Rules: These are rules that a particular office follows. Staff in other units within the same company might not adhere to these guidelines. In most cases, when I use this term, I am referring to regulations that the unit’s administrator (or that person’s predecessor) has crafted.
• Externally Created Regulations: Either the office-level leader’s higher-ups or an external agency, such as an accrediting firm or a governmental body, requires the supervisor’s staff to adhere to these regulations. As part of this process, the administrator must enforce these directives whether or not this person wants to do so.
• Written Rules: These are the official rules that guide employee actions and behaviors. In almost every case, management has written them down somewhere (e.g., in the employee manual or in some other official text).
• Unwritten Rules: The employees in a particular department will sometimes follow unofficial rules. In these instances, the administrator and/or the unit’s staff enforce these informal policies via ostracizing offenders or by utilizing some type of off-the-record penalty system.

Most readers would consider this information to be common knowledge. Nonetheless, I think it is important to delineate these features before progressing further. In this narrative, I will not spend time discussing the unwritten regulations that mediate employees’ behaviors and actions. I will instead focus all of my attention on issues that relate to a department’s (or organization’s) official policies.

9.3 A Healthcare Department’s Regulations Help to Define and Influence Its Culture

Although most people recognize that a healthcare department’s regulations influence employee behaviors and actions, they might not realize just how much of an impact these policies have on its culture. These directives not only play a significant role in delineating staff-related boundaries but also in affirming the office’s values and beliefs, determining employee morale levels, and in building (or destroying) intraoffice relationships (Amico, 2017; Bosworth, 2017; Martinuzzi, n.d.). More specifically, these mandates can:

• Define and Affirm the Department’s Ideals and Values: To an extent, the administrator and his or her subordinates can rely upon both externally created and office-level regulations to help them define and affirm their workplace’s core values and beliefs. The directives perform this function in part by delineating which employee-related actions or behaviors are rewarded and which ones are frowned upon. For instance, if the department has a policy in place to penalize staff who lie, then, assuming the supervisor applies this mandate, one can expect that the unit places a heavy emphasis on truth telling. At the same time, a workplace might transmit key information about its ideals if it does not have procedures in place to deal with certain issues or if these regulations are not enforced. As an example, an office culture might covertly support bullying if there are no rules to prevent these types of employee-related behaviors.

  This information is common knowledge. However, healthcare executives and administrators too often fail to account for the powerful influence that rules have on an office culture’s values and beliefs. As a result, they create regulations that run counter to the ideals they want the organization or department to espouse. In other cases, they fail to craft mandates to govern certain pernicious employee-related behaviors or neglect to enforce the protocols that are in place, thereby harming the workplace environment.

• Help to Demarcate Boundaries: Employees can refer to their department’s rules (the ones that are internally created as well as externally mandated) to help these people demarcate certain boundaries. On the one hand, staff members can review their office’s policies to determine how much job-related autonomy they possess. These individuals can also rely on these mandates to help them identify their places in the “pecking order”; they can ascertain how much power they have vis-à-vis others. In some cases, a unit’s rules will control the ways in which workers communicate with each other. For instance, an office’s stated policy might allow a frontline employee to directly interact with coworkers; however, it requires him or her to contact nondepartmental personnel via email.

  Most healthcare administrators would likely consider this information to be common knowledge. However, in my experience, office-level leaders sometimes forget the power that departmental, organizational, and other policies have in setting employee-related boundaries. They are thus surprised when a staff member refuses to take an action because he or she does not want to “break the rules.”

• Build or Destroy Bonds of Trust: As I have discussed in detail in other parts of this book, in a vibrant workplace culture, employees trust one another as well as their office-level leader. A healthcare administrator can help to foster these bonds by ensuring that all of his or her workers understand the relevant departmental regulations and by consistently enforcing these mandates. By taking these actions, the supervisor implies that he or she is honest. Staff assume that the office-level leader is a person of integrity because he or she interprets and implements the rules in a fair manner. By contrast, employees will tend to distrust “the system” when their administrator arbitrarily enforces departmental policies (Kramer, 1999, pp. 579–580). It goes without saying that individuals who labor in this type of environment will find it harder to cooperate with each other, to treat coworkers with respect, to give full effort, and to do the other things that allow their particular unit to meet or exceed stake holders’ needs.
• Reinforce Important Employee-Related Behaviors: A healthcare administrator needs to ensure that his or her employees perform certain tasks and exhibit specific behaviors, such as treating customers or patients with respect, if the leader wants to foster a high-performing workplace culture. It is common knowledge that a supervisor can leverage office-level rules and externally created regulations to help him or her achieve these objectives. On the one hand, this individual can use the guidelines to help him or her communicate to staff what jobs they need to complete and which goals they should strive for. Workers also rely on the department’s regulations to help them when interacting with others and in deciding which actions are ethical. At the same time, an administrator can utilize a rules-specific rewards and punishments system to encourage—or in some cases to force—employees to adhere to specific norms (Sadri, 2015).
• Provide a Sense of Stability: In my experience, a healthcare administrator will have the best chance of fostering a high-performing office culture when he or she ensures that the departmental rules are clear to staff, consistently enforces edicts, and rarely changes these guidelines. Employees who work in this type of place, all other things being equal, are calmer and more productive than peers who labor in less-structured environments because they are cognizant of the department’s key regulations and know what the penalties are for breaking these mandates. For instance, these people rarely have to devote time to figuring out if an action is “okay or not,” which allows them to focus more attention on their jobs (Ashe-Edmunds, 2017). They are also less anxious than peers at other locations because they know what behaviors and actions are acceptable (Bish, Newton, & Johnston, 2015, pp. 530–531).
• Break Down Barriers: Perhaps ironically, a healthcare administrator can leverage office-level regulations to help him or her foster a workplace culture that empowers all individuals and emphasizes values centered on mutual respect and dignity. For instance, by enforcing policies against bullying and other forms of employee-related harassment, a supervisor can cultivate a departmental environment that allows staff members to reach their potential, enables these people to work more productively, and encourages them to cooperate with coworkers to achieve shared goals (Glasø & Notelaers, 2012, pp. 360–361; Wiedmer, 2011, pp. 35–36, 40–41). As another example, the office-level leader can create robust employee-related feedback loops at meetings or other events by establishing rules that promote these types of behaviors. Finally, an administrator, by applying mandates against discrimination in the workplace, can create an atmosphere that “is conducive to better morale, greater cohesiveness[,] and higher production” (Mooney, n.d.).
• Create an Aura of Permanence: In many cases, the rules and regulations that govern a particular department are transcendent; they survive leadership transitions intact. As a result, these mandates help the office culture’s ideals and norms to endure over the long term. Of course, each administrator will to some extent control the influence of these policies via his or her enforcement methods. Nonetheless, even in cases where this person chooses not to apply a directive with as much rigor as his or her predecessor, this rule retains some of its power simply because “it’s still on the books.”

9.4 Office-Level Mandates: Bulwarks Against Negative Outside Influences

At some point in their careers, readers might oversee departments that are part of dysfunctional organizations. In these instances, they must find ways to ward their office cultures against negative influences, which might emanate from other units, the c-suite, or the external environment. In my experience, a healthcare administrator who finds himself or herself in this type of situation can leverage departmental rules to encourage staff to remain true to the work-place culture’s ideals and goals. For one thing, both the supervisor and his or her employees can use these mandates as guides to help them remember their proper duties and objectives (Kerns, 2003). They can also utilize these directives as shields to aid them in rebuffing unethical or illegal orders from nondepart-mental personnel. Finally, the office-level leader can enforce the rules in such a way that he or she is able to keep everyone focused on (what should be) the company’s or unit’s mission, vision, and values (Kerns, 2003).

9.5 A Guide to Enforcing Externally Created Regulations

office-level leaders who work in the healthcare field will likely have to enforce numerous externally created regulations. In some instances, higher-ups in the company will draft mandates and require the frontline supervisor to apply them to his or her department. At other times, governmental or accrediting agencies will promulgate these directives. A unit-level administrator will often have little to no input regarding the creation of these rules but will nonetheless be expected to enforce them.

The supervisor’s employees often might like or at least be agnostic to these externally created regulations. The administrator will therefore have little difficulty in enforcing these directives. However, in my experience, staff sometimes are not fond of these rules and are loathe to follow them. Their frustration or anger in these instances can cause a lot of problems for the unit, including issues related to employee morale and higher-than-normal personnel turnover rates. At the same time, these mandates may reduce the workers’ productivity levels or negatively impact their ability to provide high-quality patient care or customer-related services.

To make matters more complex, the healthcare administrator’s superiors might have differing views towards these externally created mandates. In some cases, these people might not care whether the supervisor enforces the regulations, or they may even suggest that the frontline leader not apply them in his or her department. At the other end of the spectrum, the higher-ups might expect this office-level leader to ensure that every employee, without exception, adheres to these rules. Sometimes, these individuals’ views on the matter are fluid; they will change their opinions from month to month or even from one week to the next.

If an administrator wants to sustain a vibrant office culture, he or she must find a way to successfully enforce externally created regulations while at the same time meeting key stakeholder-related needs. Below, I posit some suggestions based on my own experiences that readers can use to help them successfully enforce these types of mandates while also satisfying the requirements of key interest groups. They include:

• Go Over the Regulations with Employees: Before enforcing an externally created rule, especially an important one, the administrator must explain to his or her staff what the regulation is. As part of this process, the supervisor should also tell employees who created the mandate and discuss why that group or individual did so. Additionally, he or she needs to delineate the penalties that workers will incur for violating the protocol. The office-level leader should then try to answer the staff members’ questions regarding the directive (Mayhew, 2017).

  In my experience, an administrator will have less difficulty in enforcing an externally created rule if he or she follows the steps that I outlined in the previous paragraph. For one thing, the supervisor will have an easier time in convincing employees to adhere to this directive, especially if it is unpopular, when he or she explains the regulation and its purpose to them in advance. These people will also likely be more willing to accept any penalties they incur for violating the mandate if they clearly understand what the consequences are for breaking it. Although this advice is common knowledge, healthcare leaders too often fail to follow it. Instead, administrators post the policy on a wall, paste it into an email, or put it in a staff manual without following up to see if their subordinates have read and understood the mandate.

• Actively Enforce All Governmental or Accreditation-Related Rules: In my opinion, a healthcare administrator should try to enforce all relevant governmental or accreditation-related regulations. This individual should maintain this stance even if his or her superiors show a disinterest or distaste for one or more of these rules. The supervisor never knows when a federal, state, local, or accrediting agency might pay a visit to his or her office. These groups may penalize the corporation for even minor department-related breaches of protocol. When this happens, the company’s executives are likely to take their ire out on the office-level leader. They might punish this person even if they initially suggested that he or she disregard the mandate. It is therefore in the administrator’s best interests to enforce any relevant directives that are promulgated by local, state, federal, or accrediting organizations.

• Enforce Corporate-Level Policies but Advocate for Change When Necessary: I would suggest that a healthcare administrator enforce most corporate-level policies, even ones that higher-ups do not care about or that are unpopular with the department’s employees. In my experience, executives can sometimes, seemingly without warning, change their minds regarding the application of a mandate. When this happens, they will often punish any supervisor who has not been administering the rule despite their previous indifference on the matter. At the same time, the frontline leader will incur his or her workers’ ire if this person begins to enforce a regulation that he or she heretofore had ignored. Therefore, it is best for the administrator to insist “from the get go” that staff follow most company-related mandates. Others agree with me on this one (Green, 2010).

  If the healthcare administrator determines that a corporate rule does not benefit his or her department, this person needs to bring the topic up with his or her superiors. When discussing the issue with management, the office-level leader should delineate the specific flaws in the mandate and demonstrate ways in which the enforcement of this regulation impedes the staff’s ability to meet company-related goals (Green, 2010). Ideally, the supervisor can quantify the directive’s negative impacts on his or her workplace without coming across as a whiner. This individual might have to bring the topic up several times before he or she can get someone to review the corporate policy (or learn that executives are unwilling to change the regulation). Assuming that the administrator’s employees do not like the rule, this person should let them know that he or she has transmitted their concerns to higher-ups once the supervisor has spoken to these executives.

  By applying the directive while at the same time advocating for its change, the administrator, to some extent anyway, can satisfy all stake-holders. Management will not punish the supervisor for failing to follow orders. At the same time, this individual can deflect any blame for the mandate’s negative impacts because he or she advocated for its alteration or elimination. Finally, the office-level leader, by demonstrating to employees that he or she is trying to remove or at least adjust the externally created regulation, will be less likely to incur their anger (or create other personnel-related problems) when he or she enforces the policy.

• Refrain from Enforcing Corporate-Level Edicts Only as a Last Resort: In some cases, higher-ups will issue a mandate that the frontline supervisor finds almost impossible to enforce at the departmental level. In other instances, this individual will significantly impair the work of his or her office if he or she administers a corporate-level rule. When these situations occur, the administrator might be justified in ignoring the edict if this person has broached the subject on more than one occasion with management, and he or she has received tacit approval from a superior to ignore the regulation. The office-level leader, to protect himself or herself from any penalties, needs to ensure that he or she can defend the decision.

Every healthcare administrator will have to adopt a slightly different strategy when deciding how to enforce externally created regulations. As part of this process, each supervisor will need to account for the unique aspects of his or her particular organization and department. Nonetheless, I think that readers can utilize the suggestions in this section to help them in successfully enforcing these policies.

9.6 Suggestions for Creating Effective and Fair Office-Level Policies

When they have the opportunity to create their own rules, healthcare administrators ideally want to draft ones that accomplish key office-related objectives without negatively impacting employee morale, harming intradepartmental relationships, or limiting the workers’ ability to do their jobs efficiently and effectively. In this section, I will provide readers with some tips that they can use to help them achieve these goals. They can utilize my suggestions in coordination with other best practices guidelines to help them craft fair and effective workplace mandates.

• Do Not Create Regulations Unless They Are Necessary: In my experience, a healthcare administrator should not attempt to regulate employee-related activities or behaviors unless he or she has to do so. If the staff generally behave well, meet departmental goals, and work in a high-performing office culture, then it does not usually behoove the supervisor to create additional rules. In doing so, the individual will achieve little of substance (apart from perhaps reaffirming his or her positional power), while running the risk of angering employees and impeding their ability to accomplish key tasks in an effective and efficient manner.
• Plan Carefully: A healthcare administrator should spend time developing any new rule for the office. He or she wants to review the potential regulation to ascertain its possible impact on items such as employee morale and departmental-productivity metrics. The supervisor must seek to craft a mandate that achieves a key objective without leading to many unintended consequences. At the same time, this individual should try to make sure that the policy can help him or her achieve secondary goals related to culture building (see Section 9.3). The office-level leader also needs to ensure that the directive is comprehensive. In other words, he or she should make certain that it does not contain any unexpected loopholes.
• Ensure That the Rule Is Enforceable: In my experience, healthcare administrators occasionally promulgate regulations that they never plan to enforce in the hope that some employees will follow these guidelines. From what I have seen, although an office-level leader might achieve some objectives by utilizing this technique, this person stands to lose a lot more than he or she will gain. For one thing, the supervisor runs the risk of angering the perpetual rule followers. These staffmembers adhere to every mandate and become frustrated or angry when others get away with disobeying the department’s protocols. Perpetual rule followers are often the supervisor’s best workers. Hence, he or she wants to try to keep these people happy. Additionally, the office-level leader can sometimes create accrediting or regulatory-related problems when he or she drafts policies but does not consistently administer them (Irving, 2014).
• Ask for Help in Creating New Rules: A healthcare administrator, depending on the particular company that he or she works for, might have varying degrees of latitude when it comes to creating and promulgating office-level regulations. Regardless of how much autonomy the supervisor has in relation to this issue, he or she should consult with human resources (HR), legal counsel, risk management, upper management, or some other appropriate entity before implementing any new policy. Ideally, the office-level leader will obtain “the greenlight” from one or more of these groups before putting a departmental edict into place. Almost all healthcare organizations, including nonclinical ones, are heavily regulated, and a manager or professional with de facto power could make a mistake that ends up costing his or her firm dearly if that person does not seek guidance from a knowledgeable authority before promulgating a new protocol (Irving, 2014).

Readers can utilize my suggestions, in coordination with company-sponsored directives as well as other best practices guidelines, to help them create office-level rules that achieve key objectives while limiting any potential negative impacts. As always, they should also consider any factors that are unique to their particular organization or department when drafting these policies.

9.7 Tips for Successfully Implementing and Enforcing Office-Level Rules

Readers who are interested in learning how to successfully implement and enforce office-level rules can peruse numerous books and articles that deal with this topic. I will only posit a few suggestions that I think add value to this narrative. It is worth mentioning that individuals can use the information in this section to help them administer externally created regulations as well as departmental-level ones. I believe that supervisors should:

• Ensure That Employees Can Easily Review the Department’s Key Regulations: Many healthcare and business experts suggest that administrators provide their employees with easy access to copies of the departmental rules (Mayhew, 2017). However, from my experiences working in the field and talking to peers, a number of office-level leaders do not take this step. Although these supervisors might include the mandates in staff-related documents, they do not make it convenient for workers to obtain these items. Additionally, these administrators do not utilize alternative ways to publicize these directives, such as placing them on the unit’s walls.

  A supervisor might gain something from keeping employees in the dark about the department’s official rules. For instance, an office-level leader may increase his or her power vis-à-vis subordinates when only this person knows what the “real regulations” are (Hoff & Rockmann, 2012, p. 194). However, when an administrator employs this tactic, the costs—to all stakeholders—usually outweigh the benefits. In my experience, an individual who does not publicize the office-level mandates risks hindering employees’ efficiency and productivity; these people will devote precious time to worrying about the penalty for an action or in griping to coworkers about proposed inequities in enforcement. At the same time, the supervisor, by taking these steps, may damage the intradepartmental bonds of trust that not only help him or her manage and motivate workers but also serve as one of the key building blocks of a vibrant office culture (DeMers, 2016).

  By contrast, a healthcare administrator who makes sure that employees have easy access to departmental (and externally created) regulations can achieve several objectives. For one thing, workers will likely not spend as much time trying to figure out which behaviors or actions are appropriate because they can quickly find and review the office’s rules. These people can therefore devote more of their attention to helping patients and customers or in completing other job-related tasks. Along the same lines, the supervisor who posts the mandates in easy-to-find places will demonstrate a penchant for transparency that will benefit both the office culture and his or her relationships with staff (DeMers, 2016).

• Explain All of the Important Rules to Staff: I discussed this one in Section 9.5, so I will not rehash the information here. However, I do want to emphasize that an administrator should always find the time to explain new office-level regulations to his or her employees and solicit any questions from them regarding these rules. At the same time, this supervisor must make sure that all recently hired staff members understand the purpose for and details of any departmental policies (Ashe-Edmunds, 2017; Mayhew, 2017).

• Consistently Enforce office-level Mandates: Most business and health-care experts would probably suggest that an administrator consistently enforce any office-level rules. However, from what I have seen, they do not always delineate the reasons why this leader should do so. A supervisor needs to treat everyone equally when applying departmental policies, in part to meet legal requirements. An individual can run afoul of discrimination-related laws when he or she arbitrarily punishes staff members for violating mandates (Meinert, 2014a). As important, in my experience anyway, an administrator runs the risk of impeding his or her ability to manage employees and might also harm the departmental culture when this person fails to consistently enforce his or her unit’s directives.

  From what I have seen, a healthcare administrator, by inconsistently applying office-level rules, can harm his or her department in several ways. First, this individual might damage his or her relationships with subordinates. That is because many of the supervisor’s employees will view his or her enforcement policies as unfair, and they will become angry or at least grow frustrated as a result (Meinert, 2014b). The person’s actions will also impair the bonds of trust that he or she has with workers. As a result, some of these personnel might be less willing to follow the office-level leader’s orders and might not work as productively as possible (Llopis, 2013). At the same time, in my experience anyway, an administrator who arbitrarily or whimsically enforces workplace regulations runs the risk of impairing the office culture. The disenchanted staff members might not only lack faith in their supervisor but might also lose confidence in their coworkers—especially ones who appear to “receive special treatment.” Along the same lines, these employees may have a harder time working with each other to accomplish shared goals.

  These are likely only a few of the many problems that might occur when an administrator arbitrarily enforces office-level regulations. Therefore, a supervisor who wants to oversee a vibrant workplace environment should strive to consistently apply any departmental rules. As a bonus, an individual who reliably enforces mandates will generate goodwill with his or her employees that builds over time. The office-level leader can leverage this store of “friendliness” to help him or her promote a better workplace culture and to more easily manage and motivate staff.

• Use Positive-Reinforcement Techniques: Sometimes, good employees break a rule. In my experience, a savvy healthcare administrator will refrain from harshly critiquing or punishing these people for these foibles. Instead, the supervisor is better off using nonpunitive techniques to let the staff members know that he or she witnessed the violation and to encourage these individuals not to do the same thing again. The office-level leader can, for example, convey this message with a gesture (e.g., a raised eyebrow) or a supposedly off hand comment that most personnel will overlook but that the offenders will recognize is meant for them. As important, the administrator can utilize these “light” disciplinary techniques and still consistently enforce the department’s mandates. If these tactics do not work in convincing workers to change their behaviors, the supervisor can then employ more punitive measures.
• Be Willing to Change or Eliminate Rules When They Do Not Work: It goes without saying that a healthcare administrator should be open to adjusting or removing office-level rules that do not achieve their core objectives or lead to significant, unintended consequences. The reasons for this are obvious, so I will not describe them in detail here. However, even though most supervisors would readily agree with me on this issue, some of them (in my experience anyway) nonetheless refuse to alter or eliminate poorly working regulations, especially ones that they have created and implemented themselves. It does take courage for an office-level leader to make these adjustments (e.g., to admit that he or she was wrong). However, I would encourage all readers to be willing to change or delete ineffective or pernicious mandates, as the benefits of doing so usually far outweigh any costs.

9.8 Summing Things Up and Looking Ahead to Chapter 10—A Recap

A healthcare administrator needs to do a good job in developing and enforcing rules for his or her office if that person is going to succeed in creating a high-performing culture, as well effectively manage and motivate employees. In this chapter, I posited suggestions that will help readers to successfully handle these important tasks. I started off by delineating the four types of regulations. I then discussed some of the key ways in which office-level and externally created mandates influence departmental cultures. Next, I delineated methods that supervisors could use to aid them in properly enforcing directives from government authorities, accrediting agencies, and higher-ups in their companies. I ended the narrative by providing guidelines that office-level leaders could utilize to help them develop, implement, and enforce department-level policies.

In the final entry in this book, I will revisit some of the most important topics that I discussed in each chapter. I will start off by delineating the key aspects of healthcare management. I will also identify my target audience, pinpoint some of their key job-related roles and tasks, locate their place in the organizational hierarchy, and determine what factors influence their office-level decisions. Additionally, I will define continuous improvement (CI) and delineate some of the aspects of CI methods, such as Lean and Six Sigma. I will then provide readers with information that they can use to help them create corporate and departmental cultures that are amenable to CI principles. Next, I will discuss techniques that office-level healthcare leaders can utilize to plan, implement, and monitor quality improvement initiatives. In the latter part of the chapter, I will suggest tactics that readers can use to help them make the right split-second decisions, foster vibrant office cultures, and develop and enforce departmental rules and regulations.