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«13TH INTERNATIONAL PUBLIC RELATIONS RESEARCH CONFERENCE “Ethical Issues for Public Relations Practice in a Multicultural World” Holiday Inn ...»

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The director's role in the dominant coalition provides the CPRD with more respect and latitude than other departments within the hospital. The department is perceived as valuable because O'Grady is seen as valuable. Her role in the dominant coalition positively affects her staff. As the hospital continues to make necessary financial and structural changes, O'Grady is viewed as a pivotal figure to explain those sometimes difficult changes to others throughout the hospital personnel structure. The hospital is changing course and O'Grady is helping captain some of that change.

What is intriguing about O'Grady's role as the director of this department is her nursing background. She has no formal training in writing, editing or working with the media. However, as this case study will show, she has these skills and other non-technical skills that actually are more important. "...technical expertise alone is not what makes excellent programs excellent: the best communication programs achieve excellence through strategic use of such craft expertise to solve important problems or create important opportunities for senior management" (Dozier et al., 1995, p. 22). Grunig (1992) preceded this statement when he said, "Strategically managed public relations, therefore, is designed to build relationships with the most important stakeholders of an organization" (p. 123). This is precisely what O'Grady strives to achieve.

Research Questions This case study examined Q'Grady's role within the dominant coalition and how this affects her style and communication practices. Based on the three theoretical emphases of the

literature review, the research questions are:

1. Is the organizational culture of the CPRD more participative than authoritative?

2. Do the communication practices tend to be more asymmetrical than symmetrical?

3. Is the director of the CPRD not a member of the dominant coalition but does she have significant influence on that coalition?

Methodology Although there are many types of research studies, this paper focused on the case study because as Yin (2009) said, "In brief, the case study allows an investigator to retain the holistic and meaningful characteristics of real-life events-such as...organizational and managerial process..." (p. 3). The case study helps answer the "how" and "why" through qualitative methods of evidence instead of statistical data. In an effort to answer the three research questions for this case study, several sources of evidence will be used. According to Yin (2009), "...the various sources are highly complimentary, and a good case study will therefore want to use as many sources as possible" (p. 80). Four sources of evidence were used: documentation, archival records, interviews, and participant observation.

637 Documentation According to Yin (2009), documents have three main purposes: verifying correct spelling and titles or names of organizations, providing specific details to corroborate information from other sources, and helping the researcher make inferences. In an organization the size of Packard Children's Hospital, there is a tremendous amount of documentation that could be obtained.

However, those most relevant to the issues of the Community and Physician Relations Department (CPRD) were meeting agendas and year end reports of the hospital and the CPRD.

The CPRD was established as a separate department two years prior to this time. These documents helped show the overall mission of the hospital and the role of the CPRD to help fulfill this mission. In this time of massive changes in the health care facility, these documents also showed an historical progression of the hospital's role in the community.

Archival Records Although archival records are an important source of information, Yin (2009) warned that, "Most archival records were produced for a specific purpose and a specific audience...and these conditions must be fully appreciated in order to interpret the usefulness of any archival records" (p. 84). Keeping this in mind, it was still helpful to look at some of the budget information and organizational charts for the CPRD. These financial documents were not audited and the time period for which they were examined was the same as for the documents listed above. The budget information was especially interesting in discussing the Pediatric Telecenter, which has a high salary budget, but the Telecenter also helps in fundraising for the hospital. The Community Outreach budget is not as large, but also does not have the same measure of fundraising to evaluate its success.

Personal Interviews The bulk of evidence for this case study came from three personal interviews with the aforementioned O'Grady, Director of CPRD; Deb Zwahlen, Pediatric Telecenter Coordinator;

and Ellen Corman, Community Outreach Manager. The individuals were selected because of their positions and length of time with CPRD. O'Grady was in charge of the department and the others were chosen because they were both managers who had worked for O'Grady since the inception of CPRD. O’Grady provided an overall view of the entire department and was vital in answering questions regarding her role in the dominant coalition. Zwahlen leads the Pediatric Telecenter, which is the medical outreach program of the CPRD and Corman leads the Community Outreach department whose efforts are primarily of a non-medical nature.

Focused interviews were conducted in which"...the interviews may still remain openended and assume a conversational manner, but you are more likely to be following a certain set of questions derived from case study protocol" (Yin, 2009, p. 85). The focused interview was developed "... to provide some basis for interpreting statistically significant effects of mass communications" (Merton, Fiske & Kendall, 1956, p. 5). The focused interviews worked better for this case study for two reasons. First, the schedules of these three individuals were known so it was easier to capturing an hour of their valuable time. Secondly, and more importantly, because of the close relationship of the primary researcher and first author with each of these individuals it was quite easy for the interview to shift directions and discuss numerous issues other than the case study.

Participant Observation There are several obvious benefits to being a participant observer in a case study. The researcher had access to all the documentation and archival records. The researcher worked closely with those being interviewed so scheduling time with them was easier than with an 638 outsider. And finally, the researcher had an understanding of the hospital, the department, and the community it serves -- moreso than a direct observer.

Concerns of being a participant observer included innate bias from the researcher's viewpoint of job, department, staff, etc. Becker (1958) said this was a main problem of this research method because the investigator has to assume positions or advocacy roles at certain times that may interfere with the interest of good scientific practice. Trying to discount these biases while doing the case study was a challenge. What this department does for the patients, families, physicians and communities is so important that those values cannot be discounted in doing this case study. However, this strong disposition toward the organization worked to the benefit of this case study because of the depth of research that was accomplished.

Using these multiple sources of evidence represents the process of triangulation that is an important advantage. It means that "...any finding or conclusion in a case study is likely to be more convincing and accurate if it is based on several different sources of information, following a corroboratory mode” (Yin, 2009, p. 92). Again, the basis for collection of the information for this study was guided by the parameters of the research questions. It was evaluated and analyzed according to pattern-matching analysis mentioned later and in accord with the stated mission of the hospital. For example, financial documents were used to show how much of a budget O'Grady had to work with in the Pediatric Telecenter. This was a costly program because of the large size of the nursing staff. That same budget did, however, show the projections of profit for u'1e Telecenter allowing O'Grady to justify the program.

Now that methods of evidence have been determined, some predictions can be made about the information expected to be found in the research. The management style of O'Grady will have strong overtones of the participatory style with many meetings and inclusion of staff in making departmental decisions. However, as with any organization, someone still has to make an ultimate decision so there will be some authoritative effects as well. The documentation, archival records and interviews should all be able to help justify these guiding hypotheses (Marshall & Rossman, 2006). The varied publics of the CPRD dictate that both asymmetrical and symmetrical communication systems will likely be implemented. The archival records will help corroborate this information as well as the interviews. And, all the interviews should confirm O'Grady's unofficial role in the hospital's dominant coalition. It is not expected that any written information will be found substantiating this guiding hypothesis because that information is unofficial, but the interviews should bring it out quite distinctly.

There are some limitations to the sources of evidence. The interviews were all conducted at the office and although a quiet place to interview was sought, there were occasional interruptions from other staff. The interview with O'Grady was done on the phone while she was on vacation in Hawaii. Time constraints on everyone's part required that less than perfect conditions be taken advantage of for these interviews to occur at all. There were no limitations to the archival records or documentation. In fact, the second author limited herself to just a few items of when more items began to restate the same information.

Stages of Analysis In order to analyze all of the information obtained, the pattern-matching technique was implemented that Yin (2009) considered the most desirable strategy for case study analysis.

According to Trochim (1989), this pattern-matching logic compares an empirically based logic with a predicted one. If the patterns coincide, the results strengthen the case study's validity.

First, interview transcripts were compared with the literature review to make sure the theories were adequately discussed and conclusions could be drawn from them. Then, the archival and 639 document information was compared to the literature review for the same purpose. Since the ultimate goal was to make conclusions about the three proposed theories, this type of analysis should work best for and will provide the accurate analysis needed.

Results Focused interviews were conducted with Terry O'Grady, Director of the Community and Physician Relations Department (CPRD); Deb Zwahlen, Pediatric Telecenter Coordinator; and Ellen Corman, Community Outreach Manager. Once that information was collected and compared to archival records, documents and personal observations using the pattern-matching technique, five patterns resulted. These five patterns were: 1) The leadership style of the director is mostly participative with definite instances of authoritative, 2) The main role of each area is "relationships" whether this be with the community, physicians or dominant coalition, 3) The director of the CPRD is a member of the hospital's dominant coalition, 4) The director's background as a nurse impacts her management style, and 5) Each sub-area of the department has a different idea of how they will be affected by the changes in the healthcare industry.

Result 1 - Leadership Style O'Grady has worked within the Stanford hospital system for the past 20 years in a variety of managerial roles. As the current director of the CPRD, she hopes her staff sees her as "collaborative" and that she tries to present things in a "palatable" way to make things OK with everyone. O'Grady said, "Teamwork is very, very important to me in how I manage." She said she tries very hard to be a good listener and tries to be as available as possible when staff need her and helps them problem solve as necessary. O'Grady also said she gives as much authority as possible to her managers, but she will stay more involved if she feels she has more of a history in the situation or that her relationships with others will help in a particular situation. The two managers seem to corroborate much of what O'Grady said she tries to do.

Zwahlen, who has known O'Grady since 1982, said they have built a "foundation of trust" that helps them have a positive working relationship. Zwahlen gets a "huge amount of support" from O'Grady in regular meetings, "spur of the moment" meetings when extra input is needed, and the time O'Grady gives to plan out future projects and just "touch base" on current ones.

Zwahlen also said O'Grady is a great listener and "really cares what I am doing." Zwahlen also mentioned O'Grady's creative energy and encouragement as two more positive characteristics to her management style.

Corman also said O'Grady is a good listener and appreciates the consistent "open door policy" that allows her to talk with O'Grady as needed even during the busiest of times. Corman said it is easy to talk with O'Grady and also mentioned the director's ability at providing praise and not constant criticism of her staff. Corman also said O'Grady is good at bringing information from meetings with senior managers to her staff to keep them informed. She added that 0'Grady has "enthusiasm for the job and hospital and tries to make everyone else feel the same way."

Overall, Corman felt O'Grady "believes in what I do and is there for me."

The overall comments on O'Grady's leadership style parlay directly into the goals she strives for as a leader. However, Corman and Zwahlen both said O'Grady needs to give more authority to them. Zwahlen said she has about "70% of the authorirj" over her area that she should have which she attributes to O'Grady's fear of burdening her staff and her innate nature as a perfectionist who is used to doing things herself. Zwahlen said O'Grady "doesn't punt more to me" but that they have discussed this and more responsibility is being relinquished to Zwahlen after each of these talks. Zwahlen feels that because of her long time relationship with O'Grady, they are able to discuss differences and that O'Grady really listens to her input.

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