Energy management: a reemerging concern for the department manager.

The cost of energy in the average health care institution, at one time rarely more than I percent of the total budget, has amounted to 3 percent to 5 percent or more of the budget since the mid-1970s. As society gradually adjusted to these higher energy costs, the urgency for energy conservation faded, and true energy management, briefly a high priority, fell by the wayside. It is now evident that higher energy costs are here to stay, and energy supplies are becoming more limited, in some areas alarmingly so, at the same time other financial concerns are making themselves felt. Therefore, energy management is resurfacing as an active management concern. Much of energy management at the department level is a matter of awareness and attitude, and an energy-conscious manager can influence the staff toward energy consciousness.

The manager and equipment decisions: is that in the capital budget?

Although any decision to purchase a piece of capital equipment involves a number of the organization's functions, the department manager has some significant responsibilities in the selection and acquisition of capital equipment. Except for unavoidable replacement of essential equipment that fails unexpectedly, capital purchases must ordinarily be planned in advance through the annual budgeting process. The department manager is ordinarily the organization's primary source of information in major capital expenditure projects; therefore, it is essential that the manager follow a logical process for identifying and evaluating alternative equipment choices and perform a consistent economic analysis of the alternatives.

Health care cost containment: a contradiction in terms?

For about three decades health care costs have been growing at a seemingly uncontrollable rate. Health care costs have in some years grown at two to three or more times the rate of so-called "normal" inflation. The causes of this cost inflation are many and varied, although a number of the industry's participants tend to blame each other for much of the problem. The primary reaction to escalating costs has been regulatory pressure brought to bear on providers with the intent of forcing the health care system to function on reduced or controlled financial resources. Health care cost containment promises to be a major concern for the foreseeable future, and the individual department manager will continue to be called upon to exercise cost-conscious management at the hands-on working level where so many resource, are applied.

Control of overtime: a department manager's never-ending task.

Overtime is an organizational necessity that is misused or abused as often as it is applied appropriately. As an element of labor cost it is sometimes seen as an extra expense to be avoided by all means, yet there are times when overtime is the best response to a particular need. The determination and payment of overtime are dictated by provisions of the Fair Labor Standards Act (FLSA), the federal wage and hour legislation that governs a number of aspects of employment. Overtime is often taken for granted, and it can readily go out of control. It is the task of the department manager to maintain control of overtime, adhering to a budget and taking active steps to ensure that only essential overtime is approved and worked.

The anatomy of a decision.

There is a decision-making pattern that applies in all situations large or small, though in small decisions the steps are not especially evident. The steps are: gathering information, analyzing information and creating alternatives, selecting and implementing an alternative, and follow up on implementation. The amount of effort applied in any decision situation should be consistent with the potential consequences of the decision. Essentially all decisions are subject to certain limitations described as constraints, forces, or circumstances that limit one's range of choices. Follow-up on implementation is the phase of decision making most often neglected, yet it is frequently the phase that determines success or failure. Risk and uncertainty are always present in a decision situation, and the application of human judgment is always necessary.

The changing face of health care management.

In health care as elsewhere, the only constant is change. Change has been especially rapid in health care, forcing dramatic changes in the way health care managers work. Management style in health care may or may not be different from that in other industries; its determinants are related primarily to certain universal characteristics that may be present in many businesses but have one dimension in common: immediacy of the customer (that is, hands-on, face-to-face service). Health care management has had to change considerably in the past 30 years and will be required to change further still in the years to come. In changing with the industry, the role of the health care manager will include enhanced span of control and increased authority and responsibility, and thus greater accountability. Given the changing nature of the environment, the most valuable characteristics of tomorrow's health care manager will be flexibility and adaptability.

Speak up: the manager's guide to oral presentations.

Public speaking is a skill that can prove to be of considerable value to health care managers, yet a great many managers have not been trained as speakers and thus tend to avoid speaking situations or approach them with fear and doubt. However, any working manager can become an effective speaker through conscious effort to do so. The keys to developing one's ability to deliver effective oral presentations are preparation and practice. Preparation includes knowing one's subject and one's audience, appropriately organizing the material, learning how to present information according to what one wishes to convey or accomplish, learning how to use visual aids, and working to improve one's manner of using language in a public setting. Beyond following the guidelines for appropriate preparation and delivery, success and a degree of comfort with public speaking comes with practice, practice, practice.

Employment references: walking scared between the minefield of defamation and the specter of negligent hiring.

In present day reference checking, many of the same organizations that seek as much information as possible about people they wish to hire resist giving out more than a bare minimum of information to other organizations. The strongest force driving this minimal reference information release is fear of legal action taken because of something said about an individual (defamation, supposedly). Many employers appear so frightened of being sued for libel or slander that they share nothing of substance, usually not realizing that in trying to protect themselves against defamation charges they are increasing their legal risk associated with negligent hiring charges. However, truthful reference information can be provided with minimal risk if it is provided in good faith, given only to someone who has a legitimate need to know, is related strictly to job in character, and is not communicated maliciously. Also, reference always must be answered completely objectively with information verifiable in the individual's personnel file.

The manager and the merger: adaptation and survival in the blended organization.

Recent decades have seen health care changing from a cottage industry of scattered providers to an industry of larger organizations and multi-organizational systems. Various organizational combinations continue to occur, especially in the form of mergers and the creation and expansion of systems. In the midst of this ongoing dramatic change the role of the individual manager remains essentially unchanged in concept, but the arena in which it is applied is rapidly changing. Areas of responsibility are becoming broader, staffs are becoming larger for individual managers, and many of the older "principles" of management are being tested and strained. Today's health care manager is learning that survival and success more than ever depend on flexibility and adaptability.

A working manager's guide to effective and legal employee selection interviewing.

Employment interviewing as we know it today is an essential process but one fraught with potential traps and legal pitfalls. Overall, it is a far-from-perfect means of selecting employees, but it the best such means available. Effective interviewing requires thorough preparation, including knowledge of how to seek out the most helpful kinds of information available, complete information about the position as it currently exists, and detailed knowledge of what kinds of questions can or cannot be asked legally. Effective interviewing also depends on the development of one's ability to seek out intangible and factual information and use all that is learned, recognizing that the well-cultivated "gut-feel" is fully as important as "facts" in evaluating an employment applicant.

From idea to print: writing for a professional journal.

Those who have occasionally thought about writing for a professional journal should be encouraged by the fact that most journal writers are just like journal readers--practitioners and educators with something of value to share with others. There are career-enhancing advantages to journal writing, and there can be a significant amount of personal satisfaction as well. Succeeding at writing and placing a journal article requires: selecting an appropriate topic; knowing the publication and its audience and framing the article in the style they require; working with the journal editor to create an acceptable manuscript, which includes responding positively to the editor's criticisms and suggestions; and observing all submission requirements and deadlines. One who follows this entire process to its positive conclusion will find that journal writing can be an exacting, demanding, frustrating--and immensely satisfying--professional activity.

Staff turnover: occasional friend, frequent foe, and continuing frustration.

Turnover appears to be a relatively simple concept. However, considerable confusion results when discussing turnover because of differences in how it is defined--what is counted, how it is counted, and how the rate of turnover is expressed. Turnover is also costly, although not enough attention is paid to turnover's cost because so much of it is indirect and thus not readily visible. There are a variety of causes of turnover, some which can be corrected and some which cannot be avoided. Reducing or otherwise controlling turnover requires continuing management attention to its causes and constant recognition of what can and should be controlled and what cannot be controlled. Ongoing attention to turnover is an essential part of the department manager's role.

Balancing inside and outside: preparing for tomorrow while fulfilling today's responsibilities.

Many managers experience a common organizational contradiction in terms of how their attention is focused. One may be primarily internally focused (primarily attentive to people and activities within the department or organization), meaning that it is the job at hand that commands the most attention. Or one may be externally focused (primarily attentive to people and activities outside of the department or organization), meaning that it is the sources of reward and opportunity that command the most attention. Over the long run, the internally focused individual tends to develop more strongly as a manager but the externally focused individual, by virtue of greater visibility, tends to attract more career advancement opportunity. For lasting growth and advancement, the manager requires both solid experience and opportunity; the individual can be neither slave to the daily task nor absentee manager. Rather, a sensible approach to career advancement requires a healthy balance of internal and external focus.

Mixed motivations: the leadership contradiction.

Individuals who seek leadership positions are driven by a mixture of motivating forces that involve the pursuit of largely psychological needs that are often far more self-serving than altruistic. Because of personal drives involved, we have reason to conclude at times that the leaders we do get are not the best, because the truly best are not strongly driven to seek leadership. Also, supervisors and other managers frequently make the mistake of judging employees' drives and motivations differently from their own. However, followers follow for the same essential reason that leaders lead: to attain need satisfaction. There are various patterns or styles of leadership, and it is possible to readily identify a particular leader's style and to learn something about the needs that drive the leader simply by observing that person's behavior. Ultimately the leaders who are most successful are those who are able to make the organization's goals their own and to be genuinely driven to attain those goals.

Fattened and flattened: the expansion and contraction of the modern organization.

In a changing world, organizations must change as surely as individuals must change. Recent years have been seen an increase in organizational "flattening", the tendency to shrink the organizational structure through the removal of layers in the hierarchy. Today flattening is especially prevalent in health care, particularly in hospitals, as the industry adjusts to various external pressures through mergers, acquisitions, and sometimes closures. While organizational growth, or "fattening", is usually slow, occurring sometimes imperceptibly over long periods of time, flattening is usually abrupt and therefore painful. Especially affected are first-line supervisors and middle managers. The supervisor's main defense against obsolescence in this new environment is to become as multifaceted as possible, recognizing that one's future security lies not in constancy and specialization but rather in flexibility and adaptability.

Learn what motivates your employees: look to yourself.

Supervisors and managers tend to behave as though they are responsive to somewhat different motivating forces than their employees. However, employees at all levels are basically similar in terms of what they want to obtain from work. While drives vary in intensity from person to person, the basic motivating forces remain the same. Essentially it is not possible to "motivate" another as such; it is possible only to create the conditions under which another can become self-motivated. The supervisor must appreciate the key principles of motivation, including the relationship between repetition and reinforcement and the importance of timely feedback. Also, the supervisor must learn what his or her legitimate role is concerning the fulfillment of employee needs. Successful supervisors will be those who are sensitive to their own needs and desires, credit their employees with the same or similar needs and desires, and treat employees in the manner in which they would like to be treated by higher management.

Employee involvement: motivation or manipulation?

Employee involvement is subject to a great deal of verbal tribute; there is hardly a manager at work today who will not praise the value of employee input. However, many employee involvement efforts leave employees feeling more manipulated than motivated. This occurs because supervisors and managers, while expecting employees to change the way they work, are themselves either unwilling to change or remain unconscious of the need to change. The result is that, although employee input is regularly solicited in a number of forms, it is often discounted, ignored, or altered to fit the manager's preconceptions. Often the employee is left feeling manipulated. Since the opportunity for involvement can be a strong motivator, it becomes the manager's task to learn how to provide involvement opportunity in manipulative fashion. This can be accomplished by providing involvement opportunity accompanied by clear outcome expectations and allowing employees the freedom to pursue those outcomes in their own way.

Formula management: in search of magic solutions.

Formula management is the unjustified reliance on a set of rules or prescribed behaviors--a management formula, fad, or "flavor-of-the-month"--as the answer to an organization's needs. It is the manifestation of a tendency to believe that the essence of management can be proceduralized, that the art of management can be replaced with an expanding science of management. This tendency has been repeatedly demonstrated in the application of concepts such as management by objectives (MBO) and the variants of total quality management (TQM). All of management's "formulas" have their place; however, none of them provide all of management's needed answers. To view any of the specifically delineated "kinds of management"--all of which are highly susceptible to misapplication and resistance to change both blatant and subtle--as a cure-all is fully as inappropriate as denying their value out of hand. Formula or not, organizational results will continue to depend on the practice of the art, as well as the science, of management.

Effective employee counseling for the first-line supervisor.

Counseling is an important supervisory skill applied for a number of purposes. Although the need for counseling is as constant as any need facing the supervisor, a number of commonly encountered barriers often prevent effective counseling. In most instances counseling is a necessary step preceding disciplinary action, and it is always an important step in improving employee performance. Although the supervisor may not come to the job with expertise in counseling, counseling can nevertheless be learned through practice and the conscientious application of a few simple guidelines.