Running Head : REFLECTION PAPER

HOSPITAL ORGANIZATION AND MANAGEMENT

KRISTINA ASTUTI WINARTO
Batch 2
UPH – PKU

MASTER OF HOSPITAL MANAGEMENT

Prof. Richins
March, 2016
ORGANIZATIONAL THEORY
Organization theory is a theory that studies the performance of an organization. It discusses
how an organization carrying out the functions and actualize the vision and mission of the
organization. In addition, learn how an organization influences and is influenced by the people in the
organization and the work environment. In the discussion on organization theory includes the classical
organization theory, organizational theory neoclassical and modern organization theory. In this case I
will only discuss modern organization theory.

Modern theory is characterized by the rise of contingency movement pioneered by Herbert

Simon, who stated that the theory of the organization needs to exceed the principles shallow and too
simplified for an assessment of the conditions under which can be applied the principle of competing.
Then Katz and Robert Kahn in his book "The social psychology of organization" introducing an
organizational perspective as an open system. The book describes the advantages of open systems
perspective to examine the important relationship of an organization with its environment, and the
need for organizations to adapt to the changing environment if the organization wants to survive.
Modern theories which sometimes - sometimes referred to as an analysis system in the organization
is the third major stream in the organization and management theory. Modern theories see that all
elements of the organization as a whole an interdependence, in which argued that the organization is
not a closed system that is associated with a stable environment, but the organization is an open
system.

LEADERSHIP
Sarros and Butchatsky (1996), "leadership is defined as the purposeful behavior of Influencing
others to Contribute to a commonly the agreed goal for the benefit of the individual as well as the
organization or the common good". While according to Anderson (1988), "leadership means using
power to influence the thoughts and actions of others in such a way that Achieve high performance".

Based on the definitions above, the leadership has several implications among others:

First: leadership means involving people or other parties, namely the employees or subordinates
(followers). Employees or subordinates should have a willingness to receive direction from the leader.
However, in the absence of employees or subordinates, leadership will not be there as well.

Second: an effective leader is someone with his power (his or herpower) was able to inspire followers
to achieve satisfactory performance. According to French and Raven (1968), the power possessed by
leaders may come from:

• Reward power, which is based on the perception of subordinates that the leader has the ability and
resources to reward subordinates who follow the directives leaders.

• Coercive power, which is based on the perception of subordinates that the leader has the ability to
provide penalties for subordinates who do not follow the directives leaders

• Legitimate power, which is based on the perception of subordinates that the leader has the right to
use its influence and authority.
• Referent power, which is based on the identification (recognition) subordinate to the figure of the
leader. Leaders can use its influence because of his personal characteristics, his reputation or
charisma.

• Expert power, which is based on the perception of subordinates that the leader is a person of who
has the competence and have expertise in the field.

Third: the leadership must have the honesty to ourselves (integrity), attitude responsible sincere
(compassion), knowledge (cognizance), the courage to act in accordance with the faith (commitment),
confidence in yourself and others (confidence) and the ability to convince people other
(communication) in building the organization.

Leadership is an important function of management which helps to maximize efficiency and to

achieve organizational goals. The following points justify the importance of leadership in a concern :

 Initiates action

 Motivation

 Providing guidance

 Creating confidence

 Building morale

 Builds work environment

 Co-ordination

LEADERSHIP MODELS AND THEORIES

The following will discuss about the development of thinking experts in the management of the
leadership models and theories that exist in the literature.

 The great man theory

o “leader is born not made”. The essence of this theory, stating that a leader because
of the emergence of heredity that genes descendants. The influence of biological
inheritance is received from parents.
 Trait model of leadership
o The trait model of leadership is based on the characteristics of many leaders - both
successful and unsuccessful - and is used to predict leadership effectiveness. The
resulting lists of traits are then compared to those of potential leaders to assess their
likelihood of success or failure. The trait theory gives constructive information about
leadership. It can be applied by people at all levels in all types of organizations.
Managers can utilize the information from the theory to evaluate their position in the
organization and to assess how their position can be made stronger in the
organization. They can get an in-depth understanding of their identity and the way
they will affect others in the organization. This theory makes the manager aware of
 their strengths and weaknesses and thus they get an understanding of how they can
develop their leadership qualities.
 Skills Theory
o Leadership may be something of an art; it still requires the application of special skills
and techniques. Even if there are certain inborn qualities that make one a good leader,
these natural talents need encouragement and development.
 Style Theory
o In general, the style of leadership can be classified into types, namely:
a. Authoritarian Type
The type of leadership that is centered on the job regardless of the interests of
members of the group altogether. The decision always rests with the leader, the group
members tended to be used as a tool of interest groups mengekploitir alone, so this
type have absolute power.
b. Type Laizess Faire
Type Laizess this faire provides too broad freedom for members of the group, so the
group as if it did not have a leader and group members tend to exhibit aggressive
behavior are high.
c. Democratic Type
A democratic type of leadership that was equally concerned with the achievement of
optimal group, perhaps by following a whole include the participation of members, all
the power and capabilities of shared responsibility. That is why the main characteristic
of this leadership style is the distribution of authority and responsibility of leaders in
the number of members, without prejudice to the participation and responsibility of
the group as a whole.
 Situational Leadership
o This model emphasizes that leadership effectiveness depends on the selection of a
person's leadership style appropriate to a particular situation and the level of maturity
of subordinates. Leadership dimensions that are used in this model is the behavior of
leaders associated with the task of leadership and superior-subordinate relationship.
A person's leadership effectiveness is determined by the ability to "read" the situation
at hand and adjust his leadership style to fit and able to meet the demands of the
situation. The adjustment referred leadership style is the ability to determine the
specific leadership traits and behaviors because of the demands of a particular
situation. However, this model is still considered inadequate since this model can not
predict leadership skills (leadership skills) which are more effective in certain
situations.
 Contingency theory
 Transactional Leadership
o Transactional leadership involves motivating and directing followers primarily
through appealing to their own self-interest. The power of transactional leaders
comes from their formal authority and responsibility in the organization. The main
goal of the follower is to obey the instructions of the leader. The style can also be
mentioned as a ‘telling style’. The leader believes in motivating through a system of
rewards and punishment. If a subordinate does what is desired, a reward will follow,
and if he does not go as per the wishes of the leader, a punishment will follow.
  Transformational Leadership
o In the process, the model is relatively new in leadership studies referred to as a model
of transformational leadership. This model is considered as the best model in
explaining the characteristics of a leader. The concept of transformational leadership
is to integrate the ideas developed in the approach to the character, style and
contingency. The four component (4 I’s) of transformational leadership are : idealized
infuence, inspirational motivation, intellectual stimulation, and individual
consideration.
 Leader-Member exchange (LMX) theory
o LMX is a theory that focuses on the interaction between leaders and followers. The
relationship between leaders and followers follows 2 stages : role taking (When a new
member joins the organization, the leader assesses the talent and abilities of the
member and offers them opportunities to demonstrate their capabilities) and role
making (An informal and unstructured negotiation on work-related factors takes place
between the leader and the member. A member who is similar to the leader is more
likely to succeed. A betrayal by the member at this stage may result in him being
relegated to the out-group). LMX explains how leaders and subordinates to develop a
relationship of mutual influence on each other and negotiate a subordinate role in an
organization. LMX not only look at the attitudes and behavior of leaders and followers
but the emphasis on the quality of relationships that are formed. LMX theory formerly
called Vertical Dyad Linkage theory because it focused on a reciprocal process that
occurs in the dyad (two pieces that form the unity that interact) and refers to the
relationship between a leader and a subordinate course.

LEADER VS MANAGER

Although leadership (leadership) is often equated with the management (management), two
concepts are different. The main difference between leaders and managers is that leaders have people
follow them while managers have people who work for them. Management normally focuses on work
and task. These activities fit within the subjects of resource : human, money, time, equipment, and
anything else that involves achieving that task. While leadership focuses on the process of achieving
tasks, keep the team motivated and empowered to achieve that task. It is about leading by example,
inspiring, empowerment, and creating the most conducive environtment for team success.

A successful business owner needs to be both a strong leader and manager to get their team
on board to follow them towards their vision of success. Leadership is about getting people to
understand and believe in your vision and to work with you to achieve your goals while managing is
more about administering and making sure the day-to-day things are happening as they should.

There are the differences between manager and leader :

Subject Manager Leader

Make up of role Stability Change
Decision making Makes Facilitates
Approach Plans detail around constraints Sets and leads direction
Vision Short term (today) Long term (horizon)
Control Formal influence Personal charm
Appeals to The head The heart
Culture Endorse Shape
Action Reactive Proactive
Risk Minimizes Takes
Rules Makes Breaks
Direction Existing direction / keep status New direction / challenge norm
quo
Values Results Achievements
Concern Doing the thing right Doing the right thing
Focus Managing work Leading people
Human resource Subordinates Followers
MANAGEMENT PROCESS

Management process is a series of planning activities and monitoring the performance of a

process, especially the business process. Management process to apply the knowledge, skills, tools,
techniques and systems to define, visualize, measure, control, report and improve processes with the
goal to increase profits or earnings.

PDCA (plan-do-check-act) is cycle management method used in business for the control and improve
the processes and products continuously.

 Plan
o Setting objectives and processes necessary to deliver results in accordance with the
expected outputs (target or destination). By forming the output expectations, the
completeness and accuracy of the specification is also a part of the targeted
improvement. If possible, start on a small scale to test possible effects.
 Do
o Implement the plan, explain the process, making the product. Collect data for charting
and analysis in the "rates" below and "ACT" steps.
 Check
o Learn the actual results (measured and collected in "DO" above) and compare with
the result as expected (target or goal of "PLAN") to ascertain the difference. Look for
the irregularities in the implementation of the plan and also look for suitability /
completeness of the plan as a tool for making decisions. Charting the data can make
 it easier to see trends from several PDCA cycle and to convert the collected data into
information. Information is what is needed to "ACT" in the next step.
 Action
o Request corrective actions on significant differences between actual results and
planned. Analyze the differences to determine their root causes. Determine where to
apply changes that will include improvement of the process or product. When we
passing through these four steps but the result does not satisfactory, the scope of
which PDCA is applied may be refined to plan and improve with more detail in the
next repetition of the cycle, or attention must be placed in a different stage of the
process.

PROCESS IMPROVEMENT FOR MANAGEMENT IN HOSPITAL ORGANIZATION

In a book titled Out of the Crisis, W. Edwards Deming argued "This is not a structural
reconstruction or revision of work ... American Management requires a new structure as a whole, from
the bottom to the top." Deming is concerned about the failure of American management plan for the
future and foresee problems yet to emerge. Deming thus concluded that the problem lies in the
quality of management problems.

According to Deming, there are 14 principles that should be taken to achieve a quality of
products / services. But, in this case, let me share five principles that I believe can make the biggest
difference in healthcare process improvements :

1. Quality improvement is the science of process management.

Deming’s quality control methods based on one simple concept. It’s centered on the fact that quality
improvement is really about process management. These quality improvement concepts and
techniques have been used to transform almost every major industry in the world with dramatic
results, including healthcare. If we focus on the processes of care one at a time, we can fundamentally
change the game and deal with the challenges facing healthcare. Now, this may seem like a tall order,
but Pareto’s principle tells us that there are probably 20% of those processes that will get us 80% of
the impact. So the challenge of every organization is to identify that 20%, roll up their sleeves, and
begin the important work of addressing those challenges.

2. If you cannot measure it…You cannot improve it.

Meaningful quality improvement must be data-driven. This is particularly true in healthcare. Someone
can not work in the healthcare if they do not have a good data base. Hospital Management
Information System, Clinical software, Web database, complete with realtime features of the bill, is
expected to be a breakthrough in information systems in the health sector, so that they can adessing
healthcare’s most critical needs.

3. Managed care means managing the processes of care, not managing physicians and nurses.

Managing care means managing the processes of care. It does not mean managing physicians and
nurses. One of the big mistakes made in the 90’s with the “managed care” movement was naively
thinking that managing care meant telling physicians and nurses what to do. The reality is that you
need to engage clinicians in the process because they understand the care delivery process and they
are best equipped to figure out how to improve the process of care over time. And for this reason, I
very strongly believe that these changes will, in fact, ultimately be very empowering for all clinicians
who try to get involved.

4. The right data in the right format at the right time in the right hands.

If clinicians are going to manage care, they definitely need data. They need the right data delivered in
the right format at the right time and in the right place. And the data has to be delivered into the right
hands—the clinicians involved in operating and improving any given process of care.

5. Engaging professionals clinicians in healthcare.

If quality improvement is going to work in healthcare, if we are going to realize value, it means we
have to engage clinicians (as mentioned in point no.3). To use Deming’s term, clinicians are
healthcare’s so-called “smart cogs.” They are the frontline workers who understand and own the
processes of care. But some physician are clinging to the past and are demoralized because they don’t
see a new future. And in that short phrase, this very excellent physician leader pretty much
encapsulated the problem and points us towards the solution. So, how do we reconcile this? I believe
we need to help clinicians figure out how to give up the past by helping them see a new future and
help them understand their role in creating and sustaining that new future. In fact, I believe one can
make a very strong case that the future will be very empowering for clinicians of all types if we can
successfully inform them, engage them, and inspire them. Applying these key Deming principles to
healthcare process improvement can help every healthcare organization show the workforce why
change is necessary, what they need to understand in order to participate in meaningful change, and
what success will ultimately look like.

In conclusion, there are some things which are expected from that process improvement are :

 The highest quality of patient care

 The delivery of reliable care
 The lowest cost of healthcare
 Uncompromising levels of patient safety
 High morale for both employees and patients
References

Anonim. 2010. PDCA. From: http://en.wikipedia.org/wiki/PDCA

Bass, B.M. and Avolio, B.J., 1994, Improving Organizational Effectiveness through Transformational
Leadership, Sage, Thousand Oaks.

Bass, B.M., 1960, Leadership, Psychology and Organizational Behavior, Harper and Brothers, New
York.

Dr. W. Edwards Deming. (n.d.). Retrieved February 25, 2016, from

http://www.skymark.com/resources/leaders/deming.asp

Fiedler, F.E., 1967, A Theory of Leadership Effectiveness, McGraw-Hill, New York.

Leadership versus Management: What is the difference? (n.d.). Retrieved February 25, 2016, from
http://www.educational-business-articles.com/leadership-versus-management.html

MSG Management Study Guide. (n.d.). Retrieved February 25, 2016, from
http://managementstudyguide.com/leadership_basics.htm