Transparency for Effective Management and Leadership in Healthcare Organizations - Term Paper Example

Table of Contents 1.0.Introduction 0 2.0.Transparency for the effective management and leadership of health care organizations 1 2.1.Transparency and good governance 2 2.2.Transparency and strategic decision making 3 2.3.Transparency and effective leadership 4 2.4.Transparency and organisational culture 5 2.5.Importance of transparency to community engagement 6 2.6.Transparency and organisational performance and reputation 7 2.7.Transparency align objectives and strategies 8 2.8.Transparency collaborate ideas and thoughts 8 3.0.Constraints on healthcare leaders to transparency 9 3.1.Political Regime on Transparency 9 3.2.Community involvement 10 3.3.Organisational culture 10 4.0.Conclusion 11 5.0.References 12 1.0. Introduction Transparency in health care organisations has been common among commentators writing about health care. The interest has been due to the fact that management teams in health care organisations occupy positions of trust thus responsible for exercising power in pursuit of collective interest. Just like researches approaching health care organisations are myriad, so are its definitions. Contemporary researches connect the theory of patient-medic relationship in understanding transparency. To that regard, the concept is seen as a situation where efforts are made to ensure patients and other stakeholders are more concerned about hospitals’ safety, quality and financial performance and prices for the services offered (Lewin and Regine, 2000). On the other hand, Knowles (2002) argues that transparency in the health sector goes beyond safety and quality. At its core, she believes transparency should encompass organisational behaviour, values and its willingness and commitment to achieving greater visibility. Other evidence-based researches integrate transparency, effective management and leadership in understanding modern health care organisations (Ovretveit and Gustafson, 2003; Kaplan and Norton, 2006). These researches posit that transparency in light of effective management and leadership is when one is honest, open and accountable in conducting business. In as much, there seems to be lack of size-fits-all formula when it comes to defining transparency within the context of health care organisation. This is the reason why researches on importance of transparency for the effective management and leadership of health care organisations still create gaps. This research therefore builds on previous research to ascertain importance of transparency for the effective management and leadership of health care organizations. Also discussed will be the existing theoretical frameworks relating to transparency and the constraints to achieving transparency. 2.0. Transparency for the effective management and leadership of health care organizations The dynamics of modern health care organisations such as complex payment systems, professional discretion and information asymmetry make organisations vulnerable to abuse of power. This is why there has been proliferation of global initiatives to enhance transparency within health care organizations. Good example of this is the healthdirect Australia where the manager explains the availability of transparent, “healthcare triage, health advice and health information” (Australian Council on Healthcare Standards, 2008, p 26). The British Medical Journal cites that transparency in health care organisations has long history and traces back when operations in health centres were not patient centred (Bossidy et al., 2004). Underlying theories of transparency, effective management and leadership posit that good governance and community engagement are good indicators of transparency (The American College of Medical Quality, 2003 as cited in Bossidy et al., 2004). However, importance of transparency cuts across various sectors. 2.1. Transparency and good governance Good governance is an intertwined term---cutting across aspects such as ways of managing organisations to realise its objectives. Many health care organisations are geared towards good governance. In response to recent governance scandals, there has been introduction of principles that help understand what good governance should be within health care organisations. Recent publication from Victorian Auditor General’s Office (2009) cites issues such as performance, accountability, voice, fairness and direction. How do these principles augur with transparency? Rosendorff and Vreeland in their article Democracy and Data Dissemination: The Effect of Political Regime on Transparency shows that the relationship between transparency and good governance is seen when a leader aims at reducing malpractices like failure to pay healthcare professionals and consumer organisations in the management of an organisation (Mankins and Steele, 2005). It therefore means transparency is not only a substitute of good governance but a way in which organisation is governed ethically and in accordance with laid down structures. Does this therefore mean democracies are more transparent compared to aspirations of the leader or the health care organisation entrusted with? Research by Johnson (2006) answers this question arguing, ‘good governance reflects transparency and in so doing, the leader needs to do other things including transparent information access that ensures effectiveness.’ (p.28). Literature reviews on indicators that measure good governance tend to be concentrated on provision of accurate information about operations and information collection (Dunn et al., 2007; Garling, 2013). In article, Organizational transparency drives company performance, Berggren and Bernshteyn link transparency and good governance explaining that at first level of transparency organisations ought to reveal its goals, strategies and objectives to its patients and other employees (Johnson, 2006). 2.2. Transparency and strategic decision making Recent studies have shown that transparency helps strategic decision making since it creates high involvement in work place and this in turn develop positive attitudes and beliefs. Organisational effectiveness scholar, Edward Lawler and other colleague present four interlocking principles that help understand how transparency in health care organisations build strategic decision making (Weaver et al., 2010). These principles can be generalised as information, power, knowledge and rewards. The argument regarding these principles is that when leaders become transparent systems become effective thus there is collective reasoning towards a problem. In some cases, transparency has necessitated creations of forums for employees to develop and share thoughts and ideas on how best an organisation can be improved thus becoming effective. A good example of such organisation is the Society of Hospital Pharmacists of Australia (SHPA) where transparency has been achieved through harmonised channel of communication (Williams et al., 2010). There has been relatively little research that extends understanding of how executives make strategic decisions on matters affecting multiple stakeholders with myriad of interests and how group behaviours affect that process (Weaver et al., 2010; Marshall, 2009). What is available though is what Weaver et al. describe as, ‘transparency a recipe for strategic decision making’ (p.25). When leaders become transparent in their operations strategic decisions such as introducing new service becomes efficient because everyone feels the organisation is his/her own. Though Williams et al. (2010) call for qualitative research that explores the possibility of having transparency affect decisions that are confidential to an organisation, Salas et al. (2011) argue otherwise. According to their findings, “transparency and strategic decision making are two factors that work together in organisations” (p.38). Workers tend to follow leaders they believe in and this happens even if such leaders move to other organisations. The reason behind these behaviours is that decisions made always factor their interests. 2.3. Transparency and effective leadership Through reviewing of literatures on effective leadership, a leader who inspires his/her followers to work extra hard, dig deep and commit to the cause is the one who inculcate framework for transparent leadership that builds credibility. When these leaders practice transparency---a sort of “what you see is what you get” then code of respect is created thus effective leadership. Australian Commission on Safety and Quality in Health Care (2010) shows that there is strong link between transparency and effective leadership. The commission gives an example of GlaxoSmithKline (GSK) where transparency is enhanced through removal of brand name reminders in the Medicines Code of Conduct. The significance of transparency in this case is that organisations benefit from efficient process of decision making and tactical execution of roles which ultimately makes healthcare organisations more vibrant though the leader. How does transparency relate with effective leadership? The answer to this question is twofold; firstly, Stead et al. (2009) cite that, “effective leader is the one who is able to build trust and experience more finely tuned collaboration with his/her workers” (p. 89). When this happens transparency must have played a key role and then is when organisation as a whole and individual workers perceive the leader as a person of higher level of credibility. Secondly, transparency limits risks health care organisations can be exposed to. This is achieved when leaders are effective and can share processes, procedures and exchanges of feedbacks especially when performances of such organisations tend to slow down. Citing relevant case, the Chair of Transparency International, Huguette Labelle recently signed transparency agreement with AusAID and in his speech he argued, ‘One way of minimising risks is through being transparent as this will also foster effectiveness of such leaders’ (Transparency International, 2009, p. 5). 2.4. Transparency and organisational culture Organisational culture has been interpreted differently. For instance, Kaplan and Norton (2006) define it to be code of conducts, beliefs and aspirations within a given organisation. It is generally accepted that culture of an organisation has big influence on the general performance of organisations. Irrespective of the organisation in question, none is able to develop transparency without first ensuring that fundamental conditions of operations are set. These fundamentals are what constitute culture. These cultures can therefore be maintained if transparency exists. It therefore goes without saying that transparency and organisational culture are related but the latter is dependent on the former. Organizational Culture Theories are more concerned with the specific values inherent in organisation and how effective these values can be harnessed for better performance of these organisations (Victorian Department of Health, 2009; Oriol, 2006). This is where transparency comes in. The point is, when leaders are open in their operations, traits of organizational culture are maintained. A good example where transparency has enhanced organisational culture is the pay-for-performance (P4P) programs and Defence Joint Health Command (JHC) which rewards clinical providers with incentive payments based on one or more measures of quality of care. Zeltser et al. (2010) in argue that, “JHC particular provides transparent health care and, from the health perspective, ensures the preparedness of Australian Defence Force” (pp. 13-23). 2.5. Importance of transparency to community engagement Community involvement can mean something different to each organisation and stakeholders depending on what such organisation view as community. Commonly used parameters to test what a community is made of include; professional health workers within healthcare organisation (Salas et al, 2011), patients, consumers and stakeholders associated with the healthcare (Victorian Department of Health, 2009), academic communities, non-governmental organisations and service providers engaged with the health centre (Australian Commission on Safety and Quality in Health Care, 2010). Irrespective of whatever is considered to be community, building good rapport with people around helps organisations achieve their intended goals. Such engagement covers aspects such as consultations on emerging issues, professional and financial help among others. These kinds of community engagements are only possible if such community see transparency in the way a leader manages organisations they are associated with. Queensland Department of Communities reports that community participations help in the smooth running of organisation especially in early stages of planning (Johnson, 2006). In a different research, Independent Commission Against Corruption (ICAC) reports that transparency helps improve ways in which community perceive operations organisations around them (Centre of Research Excellence in Patient Safety, 2011). The report adds that community is always very sceptical on how organisations are run in as much as there is openness. Therefore transparent leaders help provide accurate information to community, leading to less local opposition. 2.6. Transparency and organisational performance and reputation The level of transparency in an organisation optimises the operation efficiency within workers and for the general benefit of that organisation. The question that forms basis of many researches is the level of transparency and frictionless execution of activities that brings about performance and reputation. First, studies such as Lewin and Regine (2000) recognise that performance and transparency are interrelated factors that one brings the other in any organisations. Secondly, Bossidy et al. (2002) separate different levels of transparency and works with strategy transparency as the only indicator of performance and reputation. In so doing, they posit that strategic transparency is the key driver of institutional or organisational financial performance. They break down strategy into definitive components upon which every worker can act on so as to build reputation of the organisation. In separate researches, Leonard et al. (2009) Kaplan and Norton (2006) link transparency to worker motivation, performance and reputation. Giving examples of organisation such as Medicare Australia, they average that annually, organisations lose close to thirty per cent of social and financial values because leaders who are not transparent in organisations demotivate workers. These practices in turn have adverse effects on the performance and reputation of such organisations. 2.7. Transparency align objectives and strategies Objectives and strategies act like building blocks of every organisation. Current research conducted by Morison and Robinson helps understand how transparency helps align objectives and strategies organisations have (Knowles, 2002). Health care organisations unlike others have sensitive objectives that if not aligned lives of people are at stake. Morison and Robinson believe that leaders who renege on their promises or fail to share with other workers relevant organisational information reap negative follower behaviours which in turn impede the organisation from achieving their short and long term objectives. Examples of negative behaviours that can be reaped include higher turnover of workers, absenteeism, and increase in other deviant behaviours. On the other hand, they note that transparent leaders engaging workers in decision making process help captivate participation of his/her workers thus re-evaluation of objectives and strategies. Transparency and objectives of organisations have been linked with creativity and innovation. The point is, leaders’ transparency allow workers to express their abilities without fear of intimidation. In so doing, creativity will lead to creation of a new or useful solution or service provision. Knowles, (2002) notes that when transparency is not apparent in healthcare services workers feel they are in a culture that stunt creativity. He further cites that such leaders try to cut down on the amount of ideas suggested by followers. These in turn affect objectives and strategies such organisations tend to have. 2.8. Transparency collaborate ideas and thoughts Just like how transparency helps align objectives and strategies, if well practiced, transparent leadership inculcate collaborative ideas and thoughts. Collaboration of ideas and thoughts are important factors that ensure delivery of services to patient are safe and chances of harm and errors are equally reduced. There have been cases where post-operative measures were not taken and patients were to be booked for another operation. These are issue that are brought about by lack of collaborative ideas and thoughts. Recent researches show that adverse patient outcomes are generated by poor communication---ideas and thoughts not well collaborated (Victorian Department of Health, 2009). While this looks like analysis of collaboration of ideas and thoughts, transparency plays significant role. During the period of 2005 and 2006 it was attributed that poor direction and inconsistent leaders led to over 20 per cent cases of patient mistreatments in Queensland (Victorian Department of Health). Therefore lack of transparency kills decision making which in turn affect how ideas and thoughts should be collaborated for the benefit of workers, organisation and patients. 3.0. Constraints on healthcare leaders to transparency In their capacities as health care leaders, they may be willing to be transparent in their operations and approach to strategic management of the organisation. However, there are various factors---internal and external affecting willingness or ability to be transparent. 3.1. Political Regime on Transparency The first constraint to transparency is what Rosendorff and Vreeland define as political regime (Mankins and Steele, 2005). Political regime within this context is the government in office and such have policies and operational frameworks that must be adhered to by health care organisations. Turning on the effect of political regime and transparency, the incumbent regime have influence on the kind of data, information and reporting an organisation should make. For instance, to prevent its bad image, the regime can prevent the organisation from reporting rates of inflation, unemployment as well as economic growths. Rosendorff and Vreeland conclude by presenting how regimes affect data reporting by central banks which in turn affects the operations and transparencies of healthcare services. 3.2. Community involvement For healthcare organisations, there has been underlying tension between easing regulatory path for medical practitioners to perform and ensuring that there is an open transparent opportunity for the community to have its say on how these organisations are managed. From a review of major health care organisations in Europe and North America, Salas et al. (2011) conclude that, ‘…before any decision is made, significant population must be engaged and real choices have to be made. This sometimes affects transparency because of the fear of consequences’ (p.45). These findings are consistent with that of State and Territory Planning Agency Survey where councils in NSW and South Australia realised that most hospitals are affected by community influence in decisions made. This in turn affects transparency as these hospitals feel there is information that should not be shared with the community (Centre of Research Excellence in Patient Safety, 2011). 3.3. Organisational culture There are two key organisational cultures that affect willingness of a leader to be transparent. First is access to decision-making processes. Meeting of public bodies where serious, discretionary and contentious decisions are made only become transparent if the culture of the organisation allows matters of these meeting to be open for scrutiny. However, if leaders are not allowed by organisational cultures to reveal or share such information then tendency to become transparent is affected. Another culture that affects transparency is the public provision of information on performance. One of the vital aspects of running health care organisations which in turn facilitates transparency and accountability in decision making is the provision of information to workers, patients and the community. However, when organisation operates in an environment where this is not allowed then leaders are left with no choice but lack transparency in their dealings. 4.0. Conclusion What has been considered so far concerning transparency has focussed on organisational design and how a leader ought to manage health care centres. Yet these avenues of research fail to capture how change develops in an organisation and even the micro organisational social processes that can influence policy implementations. Eliciting researches of transparency in health care organisations is able to act as a tool that gains insight into how to nurture and develop organisational cultures favourable to transparency. In as much, this research finds that transparency alone is not a good recipe for good leadership and effective management of health care organisations. Instead, it also requires an understanding of how people construct the meaning of transparency. The conceptual methods presented in this research only provide a way of understanding transparency within health care organisation and such can be interpreted differently. 5.0. 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