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The word count distribution must include at least 350 words in response to each question. 1400 words total and 3 scholarly sources total. References for this case should be current online sources. RESEARCH: You need to cite at least three Scholarly Journal articles in addition to citing the course textbook Burns, L. R., Bradley, E. H., & Weiner, B. J. (2011). Shortell and Kaluzny’s Health Care Management: Organizational Design and Behavior (6th ed.).RESEARCH: You need to cite at least three Scholarly Journal articles in addition to citing the course textbook. At least (2) of your citations must be from scholarly journal articles with references and must use citations from the downloaded book, Burns, L. R., Bradley, E. H., & Weiner, B. J. (2011). Shortell and Kaluzny’s Health Care Management: Organizational Design and Behavior (6th ed.). Wikipedia, Wiki Answers, About.com, Ask.com, Yahoo Answers, eHow, Personal blogs, and other sources of that ilk are not credible for academic work. Quoting such sources as credible is strictly forbidden.Finding Articles in EBSCO (Library Help)Here are 2 links that should help you in finding articles in the library:Ebsco-finding articlesEbsco-in a minuteOUTLINE FOR THIS CASE: READ THE CASE STUDY ON PAGE 276 CALLED MOVING BEYOND DATA ACCESS TO QUALITY IMPROVEMENT ACTION. ANSWER THE FOLLOWING QUESTIONS.1. In a narrative format, discuss the key facts and critical issues presented in the case.2. Given this situation, what are the apparent barriers to using incident reporting systems for QI? How can these barriers be overcome? 3. What steps would you propose to engage both clinicians and QI staff in enhanced QI activities?4. As a leader in health care, how would you handle the problem and implement changes?
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Chapter 7
Power, Politics, and Conflict
Management
S
Timothy Hoff and Kevin W.ARockmann
CHAPTER OUTLINE
U
N
D
E
R
S

The Uses of Power in Organizations

Key Power Relationships in Health Care Organizations

The Political Nature of Power

S
The Abuse of Power in Health Care Organizations

Power as a Key Source of Conflict

R
.
Types of Conflict
Common Mistakes in Thinking about Confl
, ict

Key Conflict Management Strategies

Conclusion

G
A
LEARNING OBJECTIVES
After completing this chapter, the readerR
should be able to:
Rwithin health care organizations
1.
Recognize what power is and how it is used
2.
Describe and compare the major sources ofYpower within health care organizations
3.
Recognize the differences between managerial and professional sources of power within health care organizations
4.
Summarize the interrelationship between power
2 and politics within organizational settings
5.
Describe the demographic and contextual factors
0 that affect how power is distributed within health care organizations
6.
Classify the various conditions that give rise to power abuses in health care organizations
7.
Compare the different roles played by trust, fairness, and transparency in preventing power abuse in health care
0
organizations
8.
Distinguish between the different types of T
conflict and how they might be present in various health care
organizations
S
9
Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
CHAPTER 7 • Power, Politics, and Conflict Management
9.
Understand how emotions affect individuals attempting to manage conflict
10.
Describe the various mistakes relating to how individuals think about negotiation and how they think about
relationships
11.
Identify the difference between interests and positions and describe why understanding that difference is critical in
negotiation
12.
Compare the benefits of compromise, competition, and collaboration as three distinct strategies for negotiation
13.
Describe the tactics to find a better solution, the tactics to acquire information, and the tactics to influence others
KEY TERMS
Anchoring Bias
BATNA
Coalitions
Coercion
Cognitively active
Collaborating
Competing
S
A
U
N
D
E
R
S
Compromising
Confirming Evidence Bias
Culturally Derived Power
Emotional Contagion
Fractioning
Functional Fixedness
Network Centrality
Nonspecific Compensation
Organizational Politics
Power
Power Abuse
Power Stratification
Reciprocity
Relationship Conflict
S
R
.
,
Inert Knowledge Problem
Self-Fulfilling Prophecy
Structurally Derived Power
Study of Conflict Management
Task Conflict
Threat Rigidity Effect
Value in Negotiation
Winner’s Curse
G
Logrolling
A
R
R and Power: Influencing and Negotiating
IN PRACTICE: Pay-for-Performance
the Murky Measurement Waters of Value-Based
Purchasing
Y
Knowledge-Based Sources of Power
The concept of “value-based purchasing” (VBP) has gained traction as a potential means to better link health care
outcomes to payment. Numerous national demonstration projects are underway, and the concept’s flagship philosophy,
2 the majority of physician practices and many hospitals across the
“pay-for-performance” (P4P), has been integrated into
United States. VBP rests on a fundamental principle—that
0 practitioners and institutions that produce the best outcomes,
from both an efficiency perspective and a quality-of-care perspective, should be rewarded financially, while those who
9
underperform should be subject to earning less. This approach is innovative because traditionally everyone in health care
0
gets paid the same, regardless of their performance excellence,
for the services they provide.
T
S
Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
189
190
PART 2 • Micro Perspectives
IN PRACTICE: Pay-for-Performance and Power: Influencing and Negotiating
the Murky Measurement Waters of Value-Based Purchasing (Continued)
However, the VBP approach unleashes the potential for many power dynamics within the health care setting, and for
conflict among different stakeholders. For example, the issues of how to measure cost-effectiveness and quality become front
and center to making VBP work. Because there can be substantial disagreement as to the “right” ways to measure these
outcomes, the use of power can become an integral component of making decisions in this regard. When one stakeholder
uses their power to try to influence the kinds of measures used, conflict may erupt. This conflict can undermine the success
of pay-for-performance programs by promoting an adversarial relationship among the parties involved. Insurance companies,
S
employers, and government—all of whom pay for health care services—may seek to exhibit greater influence over the
measurement debate because of the dependence A
by providers such as physicians and hospitals on that payment for their
economic survival. This may cause consternation and
U resistance among providers such as physicians and hospitals, especially
if they have differing opinions on the measurement issue.
N
On the other hand, physicians may use their own advantages of control over clinical knowledge and the public’s trust
D which measurements will form the basis for paying on the basis
in them to counteract the influence of payers in deciding
of quality and value. Hospitals, because they possess the infrastructure that everyone in the system relies upon to deliver
E
complex care, can exert their own influence to shape measures in a way favorable to their interests and constituencies.
R the measurement debate, simply because they do not have a source of
Moreover, patients may have little ability to influence
power upon which to draw in getting the other stakeholders
to comply with their preferences. In fact, these overall power
S
dynamics have been seen in the current value-based purchasing movement, where many major decisions around how to
measure become drawn-out exercises in power use and influence tactics.
S way to measure outcomes in a pay-for-performance incentive program
The conflict that arises around identifying the best
is often managed through a political process in which different stakeholders attempt to use their power in shaping how the
R
debate is conducted. For example, health care payers may push for the establishment of public reporting of clinical outcomes
. to get consumers on their side and to put physicians and hospitals
through devices like “report cards,” in part as a means
on the defensive. The use of tactics like report cards
, may be promoted overtly as a rational means to achieve performance
transparency. However, these tactics may also be used covertly to exert and enhance the payers’ control over how “value”
and “quality” should be defined and measured in the eyes of the general public. Alternatively, health care providers may put
forth a message of “we know best because we deliver
G the care” to patients and advocacy groups to try to convince them
that they should be allowed to exert greater influence over which measures are used.
A
This is where conflict management and, more specifically, the process of negotiation can play a role in moving the
Rtreating the discussion around measurement within a VBP approach
use of power and politics to a productive end. By
as one in which multiple stakeholders can simultaneously
“win,” there is a higher probability that the outcome will have
R
something favorable in it for everyone (including patients) and, as a result, will be more easily accepted by all the relevant
Yaround how to measure “cost effectiveness” or “quality” that consider
parties in the negotiation. In this way, negotiations
multiple viewpoints, provide voice to a diverse group of stakeholders for input, and seek to achieve a level of acceptance
and satisfaction among all constituencies are likely to create a more favorable climate for implementing pay-for-performance
2
programs, and to enhance the chances for their long-term
success. The use of power and politics goes hand in hand with
the use of negotiation, simply because power and
politics
create the potential for conflict among stakeholders, and this
0
conflict is best managed through a more rational approach that seeks to find the most optimum outcome that can be
9
accepted by all.
0
T
S
Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
CHAPTER 7 • Power, Politics, and Conflict Management
CHAPTER PURPOSE
As the first In Practice example illustrates, perhaps nothing
is as potent a force in organizational life as power. Power is
the ability to exert influence or control over others. It dictates
a significant degree of what goes on in organizations, from
decision making to performance outcomes. Power involves
two key dynamics—influence and dependence—and when
these dynamics are present in large quantities, power may
be wielded by individuals, groups, and organizations inSways
that allow them to achieve their preferred vision and goals.
A
The purpose of this chapter is to provide students with
U to
a clearer understanding of what power is, how and where
look for it, and how it plays out in health care organizations.
N
In addition, emphasis is placed on how power relates to the
D as
political aspects of organizational action in settings such
hospitals and physician practices, and the conditions
Eand
circumstances that give rise to power abuse are featured as
important factors for managers to keep in mind at all R
times.
A key focus in the second half of the chapter is on the role
S of
conflict management in managing the role of both power and
politics. A practical guide is offered for how to use the process
of negotiation to achieve mutually satisfactory outcomes among
S
organizational stakeholders.
R
Power and politics can be implemented in dysfunctional,
.
self-interested ways by a variety of organizational stakeholders.
This chapter touches upon this issue. But it also stresses
, the
important and necessary functions played by power and politics
in getting organizations and workers to perform effectively. In
either case, the use of power and politics heightens theGlevel
of conflict that may occur in organizations, and such conflict
A
is best managed, this chapter argues, through a more strategic
R
perspective that focuses on an ethical, rational, and resultsoriented process of conflict management and negotiation.
R
THE USES OF POWER
IN ORGANIZATIONS
Power can be used for different purposes within organizational
settings. Perhaps the most ubiquitous use of power in
organizations involves determining the key choices made
at an organizational level to guide overall company strategy
(Finkelstein, 1992). The types of choices in this regard most
amenable to the use of power include those that involve
higher levels of uncertainty and innovativeness (Mintzberg,
Raisinghani, and Theoret, 1976). The use of power by chief
executive officers, boards of directors, and other top leadership
to guide the direction in which the organization moves, how
it chooses to compete, which products or services to offer,
and the type of business model employed for pursuing profit
has existed as long as the concept of the corporation. Leaders
can and do use power effectively to make strategic decisions
in efficient ways.
Power may also be used to influence the actions of others,
be they workers, professionals, other organizations, or the
customers that use the organization’s products. In this
way, power is thought of as a highly coercive mechanism
alongside other influence-wielding tactics such as trust,
cooptation, and conformity (Hart and Saunders, 1997).
Power in this regard is simply another in a toolbox of tactics
individuals in organizations employ to get other people to
behave in desired ways. While it is worth noting that the use
of power in this regard may be no more effective than other
“softer” tactics such as gaining people’s trust to believe
that what is being asked of them is the correct thing to
do (McEvily, Perrone, and Zaheer, 2003), nonetheless, it is
often viewed as a quick, reliable form of control that can be
employed across a diverse array of organizational situations
(Pfeffer, 1981).
Y
IN PRACTICE: The Quality Improvement
Department,
2
Accreditation, and Power
0
Organizations in the health care industry gain a great deal of their legitimacy from accreditation. Many different types
9
of accrediting processes exist, from the Joint Commission
for hospitals and other health providers, to the National
Committee for Quality Assurance (NCQA) for insurance
plans,
and to more specialized accreditation for niche providers
0
like laboratories and radiology facilities.
T
S
Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
191
192
PART 2 • Micro Perspectives
IN PRACTICE: The Quality Improvement Department,
Accreditation, and Power (Continued)
Nothing shifts the power structure more in a health care organization, at least temporarily, than the process of gearing up for
one of these many accreditations. Much of the time, the power shift moves favorably in the direction of quality improvement
(QI) staff and units within the organization. These staff and units are often the nerve centers of data collection, analysis,
and reporting for the kinds of things accrediting organizations request and verify when they visit. Thus, accreditation
offers them an opportunity to gain greater control over scarce resources, influence strategic decision making, shape
organizational culture, and change the manner in which the organization’s workforce does their jobs.
S
For example, there may be a particular area or work output of the organization where quality measures lag and a problem
A
regarding quality is thought to exist. While a QI department
may be involved over time in addressing the issue, if the issue
impacts accreditation, greater resources may be made
U available to QI staff, and greater freedom provided to them by top
management, to try to correct the issue in a timely manner. The resources given to QI may be taken away from some other
N
part of the organization, lessening the influence of other stakeholders in the process.
D
The QI function may be emboldened by the organization
to reshape how work is performed in the particular area, how
workers do and think about their jobs, what performance
data should be collected, and how that data must be evaluated.
E
In this way, QI staff come to be relied upon by top management and the organization as a whole to help ensure that not
Rthat the all-important external accreditation is not jeopardized in any
only are quality problems identified and fixed, but
substantive way. This may also represent an opportunity
S for the QI function to solidify its influence within the organization,
acquire greater resources for itself, and gain greater control over others competing for the same resources. Thus, even
a short-term shift in power and influence within an organization can have long-term consequences.
S
R
. of all
Power can control, allocate, and redistribute resources
types within organizations (Pfeffer and Salancik, 1978).
, These
resources include human capital such as clinical staff, financial
resources such as budget allocations to hospital departments,
and knowledge resources like innovations that G
enable a
production process to be done better. For example, power can
A
be used to decide which part of a health care system should
have a fully integrated electronic medical record toRuse first
in its everyday work. By being the first to use such a system,
R
favorable benefits may accrue to that part of the system earlier
Y control
and in greater quantity than later adopters. Resource
and allocation is perhaps the most widely used application of
power within organizations. As the sociologist Charles Perrow
asserts, this use of power deals with “the size of2the pie”
within organizations and how it is sliced—i.e., who0
wins and
who loses in getting more of something that they want, while
9 thing
at the same time preventing others from doing the same
(Perrow, 1989).
0
Power may also be wielded for purposes of shaping
T or
transforming organizational or work cultures in ways top
S
management desires, or to move the organization toward
being more competitive and effective in the marketplace. For
example, leaders of both General Electric and IBM used their
positions and authority, along with that of their top managers,
to help transform these companies during the 1980s and
1990s into global, innovative firms (Gerstner, 2002; Slater,
1999). They did this in large part through a focus on shifting
the meaning systems among employees within each of the
organizations toward beliefs and values that could support
a new way of doing business, one that would enable the
companies to meet the challenges of a changing marketplace.
However, using power to change organizational culture carries
risks, because culture is difficult to change (Martin, 1992).
What Is Power, and Where Does
It Come From?
Power has been defined in a variety of different ways. However,
common to all definitions is the notion of one stakeholder’s
ability to exert influence over others in ways that, among other
things, influence them to do things they normally would not
Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
CHAPTER 7 • Power, Politics, and Conflict Management
do (Pfeffer, 1981). In short, power is defined by the control
one group has over another’s behavior (Hickson et al., 1971).
Central to this definition of power is the idea of influence—
i.e., that an individual, group, subunit, or organization has
both the ability and opportunity to control how another acts
either directly or indirectly (Dahl, 1957). In this way, power
by definition involves coercion. Coercion is the use of subtle
influence dynamics to achieve desired goals, which means that
all power …
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