How subordinates exert pressure on their managers : Anglo and Confucian-Asian comparisons

Purpose - The purpose of this paper is to investigate in an Anglo and a Confucian-Asian nation how pressure is exerted on middle managers by their subordinate staff, and the managerial activities affected. Design/methodology/approach - In a survey, Australian (n=251) and Singaporean (n=340) health managers rated the degree of pressure exerted on them by subordinate staff to devote additional time to various managerial activities. They described the influence strategies employed. Findings - Ratings of the average pressure experienced regarding nine managerial activities were identical in both cultures. Australian managers reported significantly greater pressure affecting people and general organisational management. Singaporeans experienced more pressure affecting their quality and data management tasks. Australian subordinates used more direct-assertive and direct-persuasive influence strategies. Singaporeans employed more indirect-assertive tactics, particularly poor work performance. Research limitations/implications - The generalisability of the findings may be limited by having convenience samples from one occupational sector. Practical implications - The cultural differences found are relevant to the increasing numbers of multinational organisations and expatriate and migrant workers. The information will inform discussions on factors affecting the assignment of managers' priorities, which can be at variance with their aspirations. Originality/value - Managers' experiences of pressure from subordinates and how pressure is conveyed have been under-researched, particularly cross-culturally.14 page(s

Pressures exerted on managers by their superior and peer managers : Australian-Singaporean comparisons

Purpose - The purpose of this paper is to investigate how, and the degree to which, superior and peer managers exerted pressure on middle managers' work cross-culturally. Design/methodology/approach - Australian (n = 251) and Singaporean (n = 340) health managers, respectively of Anglo and Confucian-Asian cultures, rated the pressures exerted on them by managers, superior and peer (managers at the same level), regarding nine work pursuits, and described the nature of this pressure. Findings - Singaporeans reportedgreater pressure from superiors regarding people, customer, process and quality management. Australians and Singaporeans experienced similar pressure from superiors concerning financial, organisational, data, planning and external relations management. Singaporeans reported more pressure from peers in all work domains. In Singapore superior and peer managers applied pressure to similar activities but areas targeted by Australian peer and superior managers were not significantly related. Singaporean superiors were more likely to apply pressure through deadlines and appraisals. Research limitations/implications - Convenience samples from one occupational sector may limit the generalisability of the results. Practical implications - Knowledge of the degree and sources of stress encountered by middle managers in an Anglo and a Confucian-Asian culture may enhance organisational communication both within and between these cultures. Originality/value - Although it is a crucial issue, pressuresexerted on managers by superior and particularly peer managers regarding specific managerial work pursuits has received little attention, particularly from a cross-cultural perspective.30 page(s

Experiences of health professionals who conducted root cause analyses after undergoing a safety improvement programme

Background: Research on root cause analysis (RCA), a pivotal component of many patient safety improvement programmes, is limited. Objective: To study a cohort of health professionals who conducted RCAs after completing the NSW Safety Improvement Program (SIP). Hypothesis: Participants in RCAs would: (1) differ in demographic profile from non-participants, (2) encounter problems conducting RCAs as a result of insufficient system support, (3) encounter more problems if they had conducted fewer RCAs and (4) have positive attitudes regarding RCA and safety. Design, setting and participants: Anonymous questionnaire survey of 252 health professionals, drawn from a larger sample, who attended 2-day SIP courses across New South Wales, Australia. Outcome measures: Demographic variables, experiences conducting RCAs, attitudes and safety skills acquired. Results: No demographic variables differentiated RCA participants from non-participants. The difficulties experienced while conducting RCAs were lack of time (75.0%), resources (45.0%) and feedback (38.3%), and difficulties with colleagues (44.5%), RCA teams (34.2%), other professions (26.9%) and management (16.7%). Respondents reported benefits from RCAs, including improved patient safety (87.9%) and communication about patient care (79.8%). SIP courses had given participants skills to conduct RCAs (92.8%) and improve their safety practices (79.6%). Benefits from the SIP were thought to justify the investment by New South Wales Health (74.6%) and committing staff resources (72.6%). Most (84.8%) of the participants wanted additional RCA training. Conclusions: RCA participants reported improved skills and commitment to safety, but greater support from the workplace and health system are necessary to maintain momentum.7 page(s

A tale of two hospitals: assessing cultural landscapes and compositions

Clinical directorate service structures (CDs) have been widely implemented in acute settings in the belief that they will enhance efficiency and patient care by bringing teams together and involving clinicians in management. We argue that the achievement of such goals depends not only on changing its formalised structural arrangements but also the culture of the organisation concerned. We conducted comparative observational studies and questionnaire surveys of two large Australian teaching hospitals similar in size, role and CD structure. Martin's conceptualisation of culture in terms of integration, differentiation and fragmentation was applied in the analysis of the data. The ethnographic work revealed that compared to Metropolitan Hospital, Royal Hospital was better supported and more favourably viewed by its staff across six categories identified in both settings: leadership, structure, communication, change, finance and human resource management. Royal staff were more optimistic about their organisation's ability to meet future challenges. The surveys revealed that both staff groups preferred CD to traditional structures and shared some favourable and critical views of them. However Royal staff were significantly more positive, reporting many more benefits from CDs e.g. improved working relations, greater accountability and efficiency, better cost management, more devolvement of management to clinicians and a hospital more strategically placed and patient focused. Metropolitan staff were more likely to claim that CDs failed to solve problems and created a range of others including disunity and poor working relationships. There was greater consensus of views among Royal staff and more fragmentation at Metropolitan where both intensely held and uncertain attitudes were more common. The outcomes of implementing CDs in these two similar organisations differed considerably indicating the need to address cultural issues when introducing structural change. Martin's framework provides a useful antidote to researchers' tendency to focus at only one level of culture.Hospitals Organisational culture Clinical directorates Australia

The Hierarchy of work pursuits of public health managers

How public health is managed in various settings is an important but under-examined issue. We examine themes in the management literature, contextualize issues facing public health managers and investigate the relative importance placed on their various work pursuits using a 14-activity management model empirically derived from studies of clinician-managers in hospitals. Ethnographic case studies of 10 managers in nine diverse public health settings were conducted. The case study accounts of managers' activities were content analysed, and substantive words encapsulating their work were categorized using the model. Managerial activities of the nine public health managers were ranked according to the number of words describing each activity. Kendall's coefficient of concordance yielded W = 0.710, P < 0.000, revealing significant similarity between the activity patterns of the public health managers. A rank order correlation between the activity patterns of the average ranks for the public health sample and for the hospital clinician-managers (n = 52) was R = 0.420, P = 0.131, indicating no significant relationship between relative activity priorities of the two groups. Public health managers put less emphasis on pursuits associated with structure, hierarchy and education, and more on external relations and decision-making. The model of hospital clinician-managers' managerial activities is applicable to public health managers while identifying differences in the way the two groups manage. The findings suggest that public health management work is more managerialist than previously thought.13 page(s