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The CPRD at Packard Children's Hospital is an important link in the continued viability of the hospital. After reading this case study, the department's purpose, style of management, and role within the community and hospital should be more evident.
Literature Review This case study compares the theories of authoritarian and participative management, asymmetrical and symmetrical communication, and looks at the concept of dominant coalitions.
These theories will be discussed to show that the Community and Physicians Relations Department (CPRD) is managed in a mostly participative fashion that focuses on both asymmetrical and symmetrical communication and is directed by a manager who, although not part of senior management, is definitely a player in the dominant coalition of the, organization.
Authoritarian and Participative Organizational Cultures An organizational structure is "the sum total of shared values, symbols, meanings, beliefs, assumptions, and expectations that organize and integrate a group of people who work together" (Grunig, Grunig, & Dozier, 2002, p. 482). There are two main types of organizational structure: authoritarian and participative.
Authoritarian organizational cultures are marked by centralized control and authority.
According to Dozier et al. (1995), "The various departments in authoritative organizational cultures do not share a common mission. Employees say managers act as if the employees they supervise don't have initiative and require constant direction" (p. 140). In this type of department, decisions are made by the manager without consulting staff members. These staff members are then expected to follow through on whatever decision the manager has decreed.
On the other extreme is the participative organizational culture. Dozier et al. (1995) said:
Feeling part of the team, working together, fostering interdepartmental coordination, and maintaining team-level responsibility for getting the job done are values and beliefs central to participative organizational cultures. These types of cultures also share 633 decision-making authority, fostering a sense of equality, because decisions are made with the involvement of those most affected by the decision. (p. 138) Based on these definitions, the Community and Physicians Relations Department (CPRD) seems to have a mostly participative organizational culture based on preliminary observations. Terry O'Grady, Director of CPRD, oversees a diverse array of programs, managers and staff. As the director of medical and non-medical outreach programs, O'Grady must understand all the publics involved, but must also rely heavily on the managerial staff who specialize in these areas.
Likert's (1961) research proved that the participative management approach was most successful because increasing participation by organizational members at all levels helped build more productive organizations. House and Dessler (1974) said managers could enhance the psychological state of employees, giving them greater motivation to perform and increasing job satisfaction. Matejko (1986) said, "Participation implies a situation in which all interested parties exercise some legitimate control over these decisions which are of vital interest to them" (p.
Yeung’s (2004) research posits that the control exercised in facilitation lies in providing a structure for collaborative rational inquiry, channeling different ideas and allowing for negotiation of different interests. The discourse strategies are thus differently oriented and often show features which are opposite those of top-down control.
O'Grady, from the Children's Hospital, scheduled regular meetings with her staff; weekly individual meetings with managers, and monthly group meetings with all other staff. She encouraged staff members at personal and professional levels, and helped them focus on their strengths and improve on their weaknesses. She seemed to have realized the importance of teamwork in getting things done and in making the most people satisfied with their jobs.
Fleishman (1956) characterized managers in two categories: relationship-oriented and task-oriented. The relationship-oriented behavior was one of friendship, mutual trust and good relations between the manager and group. The task-oriented behavior was noted by defining relationships within a group, listing ways a job can get done, scheduling and criticizing. As a director, O'Grady is much more relationship-oriented. She even used this word herself to explain many aspects of her role in the department. Schriesheim and Schreisheim (1980) said this relationship-oriented behavior has the most positive impact on satisfaction and production of those employees who work on stressful and frustrating tasks. The Pediatric Telecenter deals with medical calls and emergencies so there can be a high level of stress in those jobs. Community Outreach has had to deal with a number of cutbacks in recent months that can make the situation frustrating. As a result, both of these departments benefit from O'Grady's relationship-oriented management style.
According to Etzioni (1960), a less formalized structure is appropriate in organizations where change is occurring. This statement is reflective of the current environment experienced in the CPRD. As a conglomeration of different staff people from completely different backgrounds, everyone has had to learn how to best work with, and relate to the diverse areas covered by the department. This type of diversity would not lend itself well to a highly structured environment.
With all individuals having such different roles there are a variety of approaches for each job. A structured environment would hinder personnel from performing these diverse tasks in the best way possible.
One other aspect of participative management is to "empower employees, giving them sufficient control over needed resources to complete the job. The empowerment value runs deep 634 in participative culture" (Dozier et al., 1995, p. 77). Leher (1982) also discussed empowerment and said, "it is being recognized throughout the world that productivity and quality of work like can both be enhanced by involving those who do work in solving problems associated with their work" (p. 1).
Although O'Grady leans heavily towards the participative management style, she is still in charge of an entire department and all parties involved do not always agree with her decisions.
Barnard (1938) said that although goals were imposed from the top down, attainment of these goals depended on the willingness to comply from the bottom up. In times of disagreement amongst staff members, O'Grady makes the final decision and personnel, whose respect she has earned, perform accordingly. Barnard said authority depends on the subordinate's approval, which goes hand-in-hand with the issues of teamwork emphasized in this department.
Two other researchers also had ideas on this theme of conflict. House (1977) characterized effective leaders as using the authoritative style when resistance is encountered, but encouraging employee participation in decision-making when compliance is assured.
Tannenbaum and Schmidt (1973) said successful leaders are flexible and cognizant of their choices; directing when necessary and allowing freedom when possible. This second theory is most reflective of the overall management of CPRD.
This case study looked at the empowerment of the CPRD staff and the control they were given to complete their jobs. It was important to find out if the management style of O'Grady is considered to be participative by two of her managers and herself. The type of management style is important in discussing the functions of the department -- is the asymmetrical or symmetrical form of communication practiced?
Two-way Communication Theories Asymmetrical and symmetrical or two-way models of communications make a major contribution to this case study. "In asymmetrical practices, communicators use attitude theory, persuasion, and manipulation to shape public attitudes and behaviors. In symmetrical practices communicators use theories and techniques of conflict resolution and negotiation to increase dominant coaliton understanding of publics" (Dozier et al., 1995, p. 46). This case study will show that in many ways the CPRD is functioning in an asymmetrical fashion because its ultimate goal is to raise funds for the hospital and convince parents that this hospital will provide the best care for their children. The tasks of a department's function in asymmetrical communication are
• Persuade a public that your organization is right on an issue
• Get publics to behave as your organization wants
• Manipulates publics scientifically
• Use attitude theory in a campaign (Dozier et al., 1995. p. 46) Looking at the functions of the CPRD will show that asymmetrical tasks are performed often. Getting the public (general community and physicians) to choose Packard Children's Hospital over any other hospital is the department's main goal. Showing a strong stance for advocacy of children is a method to persuade the public that the organization is right on an issue, i.e. child safety seats, health care reform, and injury prevention. Convincing physicians that the nurses are the most qualified to provide triage services is another important message. However, the CPRD is not completely asymmetrical because it does not try to manipulate the public scientifically and it does not launch any full public relations campaigns. The task for a
symmetrical communicator is:
• Negotiate with an activist public 635
• Use theories of conflict resolution in dealing with publics
• Help management to understand the opinion of particular publics
• Determine how publics react to the organization (Dozier et al., 1995, p. 46) Based on this list of criteria, the CPRD also participates in symmetrical communication.
It is an important role of the department to communicate with its publics to find out what their interests are to serve them better in the future. Spending so much time in the community is an important way to find out what the organization's publics think about it and ensures that top management understands those publics. One of those publics is the patients and families who have returned home after a visit at LPCH. Patient satisfaction surveys are sent to all the families to track the type of care they received. It is important that hospital management know what its customers think and make changes accordingly. This theory is important to the entire hospital organization because it is easy to forget about the publics served on the outside when so many people must face patients (another public) needing attention on the inside.
"Symmetrical practices emphasize change in the management opinions and behavior, as well as those of publics. Asymmetrical practices, on the other hand, emphasize changing the opinions and behavior of publics, without similar changes in the opinions and behavior of dominant coalitions" (Dozier et al., 1995, p. 95).
The two main publics served by the CPRD are the community of physicians and the community at large. These are two very distinct groups, but each is important to the role of the CPRD and it is important that the role of these publics is clearly defined to hospital management.
Without either of these publics, the hospital could not exist. Keeping good relations with the physicians and creating win/win situations are vital to the continued care of the patients at LPCH. The continued tracking of the community to see where they hear about outreach programs, what their attitude is toward them, and whether they would bring their children to LPCH are important factors for hospital management to understand. Although the CPRD serves to educate and serve the community, the ultimate goal is to have the publics think of LPCH when they need care for their child or want to refer a patient.
Using both symmetrical and asymmetrical communication is not unusual. Murphy (1991) developed the term mixed motives from game theory that suggest both sides pursue their own interests, but both sides also realize that the game's outcome must be satisfactory to both parties.
Because the majority of the communication is asymmetrical in this situation, the new model of symmetry as two-way practices (Dozier et al., 1995) does not seem to apply to this department.
The new model of symmetry applies when "...communicators try to persuade dominant coalitions to move towards the public's position" (p. 49). In the case of the CPRD, the majority of persuasion is to the external publics, not the internal. Also, the hospital's dominant coalition (top management) is well aware of its publics' issues so there is not much urgency to convince them of their positions. Plowman (2008), however, expanded on the Dozier et al. model and encompassed both the asymmetrical and symmetrical communications within a mixed motive model for public relations.
Having examined the authoritative and participative management styles and the combined asymmetrical and symmetrical communication practices in mixed motives for CPRD, the next step is to evaluate the director of the department's role in the dominant coalition of the hospital.
Dominant Coalition The director of the CPRD is not only key because of her role in the department but also because of her role with the dominant coalition of the hospital. "The dominant coalition is the 636 group of individuals within an organization who have the power to determine its mission and goals.” (Grunig, Grunig, & Dozier, 2002, p. 141). O’Grady is not a member of the senior management team, but her management style of negotiating a win/win for all sides has made her a valuable member of the dominant coalition.
Although not the director for the actual Communications Department, O'Grady does have an impact on many of the story ideas sent to the media and promotional tools used for her various programs. She also has the respect and trust of those in senior management. After more than 20 years at LPCH, O'Grady has the reputation as someone who cares about the hospital—its patients and staff. However, through these many years she also has been progressive in creating new programs for the hospital. All of these programs have been successful in bringing revenue or creating strong relationships with the community physicians and other publics.