In Support of Evidence-Based Healthcare Management: an ...

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In Support of Evidence-Based Healthcare Management_________________________________________________________________________________________behaviours, or on the amount of time devoted to particular activities, and not to the identification andquality of specific behaviours associated with either effective or ineffective management andleadership (Shipper, 1991; Yukl, 1994; Shipper & White, 1999). Furthermore, O’Driscoll et al (1991)found that the frequency of activities performed by managers is unrelated to the way subordinates ratemanagerial competence. For the purpose of this study it should be noted also that Shipper et al (1998)drew attention to the fact that not much management research conducted to date has been focused onleadership skills (or behavioural competencies), and little has been done to examine leaders (andmanagers) in health care settings. In contrast the present study focuses primarily on identifying thosespecific managerial behaviours and competencies exhibited within the healthcare sector that areperceived to be examples of effective and ineffective management. In part it complements the studiesof Flanagan (1990) and Alimo-Metcalfe (1998) who have also researched managerial/leadershipeffectiveness within the NHS. However, whereas the work of these researchers focusedpredominantly upon top and senior managers, the study reported here was concerned mainly withmiddle, junior and front line managers, as already mentioned.Basing their arguments on the work of writers such as Thornton (1980), Foti (1990), Shipper (1991),Bass and Yammarino (1991), Atwater and Yammarino (1992), and Tsui and Ashford (1994), it hasbeen suggested by Van Der Velde et al (1999) that the ways in which managers are perceived andevaluated by others are important determinants of managerial success. However, subordinates, peers,superiors and self-perceptions often differ in their judgement of behaviours and perceptionsconstituting managerial effectiveness. This conclusion is supported by Shipper (2000) whorecommends that managerial effectiveness should be examined from the perspective of both superiorsand subordinates. It so happens a multiple perspective was adopted for the present study.MethodThe research programme comprised three stages, as follows:Stage 1In this first phase of job analysis, statements of specific behaviours and behavioural dimensionscharacterising effective and ineffective management were generated using the well established CriticalIncident Technique (CIT), as originated by Flanagan (1954) and applied by Latham et al (1975) in theUSA and by Hamlin (1988) and Hamlin & Reidy (1997) in the UK. The definitions relating to theterms ‘incident’ and ‘critical incident’ used to research effective and ineffective managementperformance, within the context of the present study, were those originally established by Flanagan asfollows:• Incident any observable human activity that is sufficiently complete in itself to permitinferences and predictions to be made about the person performing the act.• Critical Incident where the purpose and intent of the incident is seen to be clear and itsconsequences sufficiently definite to leave little doubt concerning its effects.Effective management performance was defined as “behaviour which one would wish all managers toadopt if and when faced with similar circumstances”. Ineffective management performance wasdefined as “behaviour which, if it occurred repeatedly or even once in certain circumstances mightcause one to begin to question or doubt the managerial ability of the particular manager observed inthat instance”.Stage 1 involved interviewing 45 managers across 4 levels of the management hierarchy excluding thesenior executives, plus 12 non-managers, in order to obtain examples of ‘effective’ and ‘ineffective’management performance applying within the organisation.8 Management Research Centre 2001
In Support of Evidence-Based Healthcare Management_________________________________________________________________________________________Each person was asked to describe five examples of ‘effective’ and ‘ineffective’ managerial behaviourwhich they had personally observed within the preceding six months, and which in hindsight, couldbe regarded as ‘critical incidents’.Managers interviewed were not allowed to volunteer critical incidents (CIs) based on their ownmanagerial practice, but only those they had observed in the management practice of other managers.In total 405 critical incidents were collected.Stage 2This phase concerned the creation and administration of a Behavioural Item Questionnaire (BIQ)based on the Stage 1 findings. The process comprised, in the first instance, a detailed sorting of theCIs which revealed degrees of overlap, duplication and similarity of meaning. Only those that werefound to be the same as or similar in meaning to at least two other CIs gathered from different parts ofthe organisation were used. Twenty eight CIs were considered unusable for a variety of reasons suchas lack of detail, suitability and/or ‘critical’ element or being ‘single’ incidents. Ultimately 377 CIswere used to create the BIQ. Of these 161 were ‘positive’ examples of effective management and 216were ‘negative’ examples of ineffective management. In developing the BIQ the CIs were examinedfor sameness or similarity of meaning and thereby grouped to create a set of discrete ‘positive’ and‘negative’ behavioural items. Each behavioural item comprised a minimum of three and up to amaximum of nine CIs with one being selected in most cases as a representative ‘verbatim’ statementof that particular critical behaviour. In some instances, composite behavioural items were constructedfrom certain clusters of CIs. The BIQ so created comprised 55 discrete behavioural items to whichwere attached a 5-point Likert rating scale. Following a pilot exercise administering the BIQ theinstrument was reduced to 52 items with an equal balance of ‘effective’(positive) and ‘ineffective’(negative) behavioural statements (items).Stage 3This final stage involved establishing job dimensions and identifying criteria of managerialeffectiveness through a process of reducing, classifying, and grouping the effective and ineffectivebehavioural items into behavioural categories. To avoid the possibility of subjective judgements ofthe researchers/job analysts creeping into and contaminating the research findings, it was decided touse a statistical method for exploring the relationships between the 52 behavioural items and formaking sense of the large number of correlations between these variables. As in previous studiesSPSS factor analysis was chosen for this purpose, and, the particular method considered mostappropriate to secure a maximum number of extracted factors was ‘alpha factoring with varimaxrotation’. The BIQ was administered to three sets of people within the NHS trust hospital as follows:• Managers and non-managers who were asked to use the BIQ to rate their immediate line manager(Bottom up rating).• Managers who were asked to rate themselves against the BIQ (Self rating).• Managers, who were asked to rate a number of managers reporting directly to them, includingthose they considered on balance their ‘most’ and ‘least’ effective managers respectively (Topdown rating).A total of 44 ‘bottom up’, 64 ‘self rated’ and 31 ‘top down’ BIQs were obtained and subjected tofactor analysis. The 26 positive items and 26 negative items comprising the BIQ were separately‘alpha’ factor analysed for each ‘bottom up’, ‘self rated’ and ‘top down’ data set. This yieldedstatistically stable factorial solutions for all data sets except for the ‘top down’ negative items.However, by applying the ‘principal components’ method of factor analysis stable solutions wereobtained for both positive and negative items of this data set. Following the factoring process, thefactors so extracted were explored for meaning and given descriptive labels that described in essencethe nature and classification of the respective behavioural items loaded onto each factor. Asdiscussed later, the resultant factorial solutions derived from each data set were very similar, thereby9 Management Research Centre 2001
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