Classical Management Theories in Healthcare Compare and Contrast

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CLASSICAL MANAGEMENT THEORIES The classical perspective emerged during the nineteenth and twentieth centuries, and emphasized a rational, scientific approach to the study of management. The factory system of the 1800’s faced challenges such as tooling plants, organizing managerial structure, training non-English speaking employees (immigrants), scheduling, and resolving strikes. These new problems and the development of large complex organizations demanded a new perspective on coordination and control.

The classical perspective contained three subfields, each with a slightly different emphasis – scientific management, bureaucratic organizations and administrative principles. A. SCIENTIFIC MANAGEMENT Scientific management was developed by Frederick Winslow Taylor (1856 – 1915) at the end of the nineteenth century to improve labor productivity by scientifically analyzing and establishing optimal workflow processes. Taylor believed that in the same way that there is a best machine for each job, so there is a best working method by which people should undertake their jobs.

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He considered that all work processes could be analyzed into discrete tasks and that by scientific method it was possible to find the “One Best Way” to perform each task. Each job was broken down into component parts, each part timed and the parts rearranged into the most efficient method of working. Taylor was a believer in the rational–economic needs concept of motivation. He believed that if management acted on his ideas, work would become more satisfying and profitable for all concerned. Workers would be motivated by obtaining the highest possible wages through working in the most efficient and productive way.

Taylor was concerned with finding more efficient methods and procedures for co-ordination and control of work. He set out a number of principles to guide management. These four principles of scientific management process are; 1. Replace rule of thumb work methods based on a scientific study of the tasks. 2. Select, train, teach, and develop the most suitable person for each job, again scientifically, rather than passively leaving them to train themselves.

3. Managers must provide detailed instructions and supervision to each worker to ensure the job is done in a scientific way. . Divide work between managers and workers. The managers apply scientific management principles to planning and supervising the work, and the workers carry out the tasks. According to Braverman (1974), “scientific management starts from the capitalist point of view and method of production, and the adaptation of labor to the needs of capital. Taylor’s work was more concerned with the organization of labor than with the development of technology”. A distinctive feature of Taylor’s thought was the concept of management control.

Braverman suggests Taylor’s conclusion was that workers should be controlled not only by the giving of orders and maintenance of discipline, but also by removing from them any decisions about the manner in which their work was to be carried out. By division of labor, and by dictating precise stages and methods for every aspect of work performance, management could gain control of the actual process of work. The rationalization of production processes and division of labor tends to result in the de-skilling of work and this may be a main strategy of the employer.

Cloke and Goldsmith (2002), also suggest that Taylor was the leading promoter of the idea that managers should design and control the work process scientifically in order to guarantee maximum efficiency. He believed in multiple layers of management to supervise the work process and in rigid, detailed control of the workforce. Other contributors to scientific management are: Henri Gantt who developed the ‘Gantt Chart’, a bar graph that measured planned and completed work. Frank B. and Lillian M.

Gilbreath pioneered ‘Time and Motion Study’, which stressed efficiency and the best way to do a job. Also, Lillian pioneered the field of industrial psychology and made substantial contributions to human resource management. Scientific management is important today, specifically the idea of arranging work based on careful analysis of tasks for maximum productivity. It is used in developing standards for jobs, selecting workers with appropriate abilities, training workers, supporting workers, eliminating interruptions, and providing wage incentives. B. BUREAUCRATIC ORGANIZATIONS

In the late 1800’s, Max Weber (1864 – 1920), a German sociologist, disliked that many European organizations were managed on a “personal” family – like basis and that employees were loyal to individual supervisors rather than to the organizations. He believed that organizations should be managed impersonally and that a formal organizational structure, where specific roles were followed, was important. In other words, he didn’t think that authority should be based on a person’s personality. He thought authority should be something that was part of a person’s job and passed from individual to individual as one person left and another took over.

This nonpersonal, objective form of organization was called a “Bureaucracy”. Through analysis of organizations Weber identified three basic types of legitimate authority. 1. Traditional authority – it derives its authority from tradition and custom since ancient times. This kind of patrimonial authority receives ready obedience because of a peculiar faith in traditional status and personal loyalty to the dominant person. The administrative apparatus in this kind of authority would consist of the personal relations, servants and relatives. 2.

Charismatic authority – charisma literally means gift of grace, the power exercised, by a leader. The acceptance of authority arises from loyalty to, and confidence in, the personal qualities of the ruler. 3. Rational – Legal authority – it is based on the belief in the rightness of the law. People obey the laws because they believe that these are enacted by a proper objective procedure. The typical administrative apparatus corresponding to this kind of domination is bureaucracy. The rules delineate in a rational way the hierarchy, the rights and duties of every osition and the methods of promotion, recruitment and other conditions of service. In a bureaucracy, managers do not depend on personality for successfully giving orders, but rather on a legal power invested in their managerial positions. According to Blau (1966), Weber did not actually define bureaucracy, but did attempt to identify the main characteristics of this type of organization. He emphasized the importance of administration based on expertise (rules of experts) and administration based on discipline (rules of officials).

1. The tasks of the organization are allocated as official duties among the various positions. . There is an implied clear-cut division of labor and a high level of specialization. 3. A hierarchical authority applies to the organization of offices and positions. 4. Uniformity of decisions and actions is achieved through formally established systems of rules and regulations. Together with a structure of authority, this enables the coordination of various activities within the organization. 5. An impersonal orientation is expected from officials in their dealings with clients and other officials. This is designed to result in rational judgments by officials in the performance of their duties. . Employment by the organization is based on technical qualifications and constitutes a lifelong career for the officials. The four main features of bureaucracy are summarized by Stewart (1999), as specializations, hierarchy of authority, system of rules and impersonality. 1. Specialization applies more to the job than to the person undertaking the job. This makes for continuity because the job usually continues if the present job-holder leaves. 2. Hierarchy of authority makes for a sharp distinction between administrators and the administered or between management and workers.

Within the management ranks there are clearly defined levels of authority. This detailed and precise stratification is particularly marked in the armed forces and in the civil service. 3. System of rules aims to provide for an efficient and impersonal operation. The system of rules is generally stable, although some rules may be changed or modified with time. Knowledge of the rules is a requisite of holding a job in a bureaucracy. 4. Impersonality means that allocation of privileges and the exercise of authority should not be arbitrary, but in accordance with the laid-down system of rules.

In more highly developed bureaucracies there tend to be carefully defined procedures for appealing against certain types of decisions. Stewart sees the characteristic of impersonality as the feature of bureaucracy which most distinguishes it from other types of organizations. A bureaucracy should not only be impersonal but be seen to be impersonal. Bureaucracy is founded on a formal, clearly defined and hierarchical structure. However, with rapid changes in the external environment, de-layering of organizations, empowerment and greater attention to meeting the needs of customers, there is an increasing need to organize for flexibility.

Stewart (1999), suggests that more organizations today contain mainly or a considerable number of professionals. Such organizations will still have bureaucratic features, although there is more reliance on professional discretion and self-regulation than on control through rules and regulations. However, despite new forms of organization which have emerged, many writers suggest that bureaucracy is still relevant today as a major form of organization structure. C. ADMINISTRATIVE PRINCIPLES Managers in the early 1900s had very few external resources to draw upon to guide and develop their management practice.

But thanks to early theorists like Henri Fayol managers began to get the tools they needed to lead and manage more effectively. Fayol, and others like him, are responsible for building the foundations of modern management theory. This theory focused on the total organization rather than the individual worker, delineating the management functions of planning, organizing, commanding, coordinating, and controlling. Henri Fayol (1841 – 1925), was a French mining engineer and the “Father of Modern Management”. He started the functional approach to management.

He believed that there was a single “administrative science” whose principles were applicable not only to business but also to government, religious, and other organizations. According to Fayol, “Knowledge of administration rather than technical knowledge is what is needed at higher levels of an organization”. In contrast to Taylor, Fayol concentrated on the senior management of an organization and concluded that there were six essential business activities in an organization. This gave recognition to management as a separate and distinct business activity. These areas were: a. Technical activities b. Commercial activities

Financial activities d. Security activities e. Accounting activities f. Managerial or Administrative activities According to Fayol, administration comprises the five primary functions of management: (a) planning, (b) organizing, (c) co-ordination, (d) commanding (directing) and (e) controlling. He perceived the administration from a manager’s point of view and confined his analysis to top managerial functions. His theory is often considered as the first complete theory of management. In his book, “General and Industrial Management” (1916), Fayol identified fourteen principles of management that include the following: . Division of labor – division of work and specialization produces more and better work with the same effort. 2. Authority and Responsibility – authority is the right to give orders and the power to exact obedience. A manger has official authority because of her position, as well as personal authority based on individual personality, intelligence, and experience. Authority creates responsibility. 3. Discipline – obedience and respect within an organization are absolutely essential. Good discipline requires managers to apply sanctions whenever violations become apparent. 4.

Unity of command – every employee should receive orders from only one superior. 5. Unity of direction – organizational activities must have one central authority and one plan of action. 6. Subordination of individual interests to the general interests – the interests of any one employee or group of employees is subordinate to the interests and goals of the organizations. 7. Remuneration – workers must be paid a fair wage for their services. This includes financial and non-financial compensation. 8. Centralization – it refers to the degree to which subordinates are involved in decision making.

The objective is the best utilization of personnel. 9. Scalar chain – a chain of authority exists from highest organizational authority to the lowest ranks. 10. Order – the workplace facilities must be clean, tidy, and safe for employees. Everything should have its place. 11. Equity – managers should be kind and fair to their subordinates. 12. Stability of tenure of personnel – to attain maximum productivity of personnel, a stable work force is needed. Management should provide orderly personnel planning and ensure that replacements are available to fill vacancies. 13.

Initiative – employees who are allowed to originate and carry out plans will exert high levels of effort. 14. Esprit de corps – promoting team spirit will build harmony and unity within the organization. Fayol’s six primary functions of management, which go hand in hand with the Principles, are as follows: 1. Forecasting. 2. Planning. 3. Organizing. 4. Commanding. 5. Coordinating. 6. Controlling. According to Fayol, a manager requires the following qualities and skills: 1. Physical Qualities, 2. Mental qualities, 3. Moral qualities, 4. General education, 5. Special knowledge, and 6.

Work Experience Henri Fayol’s management principles and functions are still widely used even today for managing the organizations and have been a significant influence on modern management theory. They provide modern day managers with general guidelines on how a supervisor should organize her department and manage her staff. Fayol’s works has endured the test of time more than other early management theorists and remain relevant in today’s organization. Many of the principles are now considered to be common sense, but at the time they were revolutionary concepts for organizational management.

APPROACH OR PERSPECTIVE THAT WILL ENHANCE PERFORMANCE IN HOSPITAL In my opinion, among the three classical theories, Taylor’s scientific management if applied in my hospital, where I worked at will enhance its present level of performance. The hospital is a complex organization humming with activities aimed to achieve the patient care satisfaction. This organization is, though, entirely different from other organizations like computer industry, industry associated with production of clothing or cars, yet all the principles of management are applicable in the hospital environment.

Since hospitals are labor intensive organizations and oftentimes, involve a large number of professionals who are dealing with life and death situation, leadership is one of the areas which attach lot of significance in the hospital management. A time and motion study is a major part of scientific management (Taylorism). Time study was developed in the direction of establishing standard times, while motion study evolved into a technique for improving work methods.

The two techniques became integrated and refined into a widely accepted method applicable to the improvement and upgrading of work systems. It is applied today to industrial as well as service organizations, including banks, schools and hospitals. This time and motion study helps people identify waste and unnecessary variation in their work and it also helps them see how different roles fit together (or don’t fit together) in a system (or a non-system).

Time study is a direct and continuous observation of a task, using a timekeeping device (e. g. decimal minute stopwatch, computer-assisted electronic stopwatch, and videotape camera) to record the time taken to accomplish a task and it is often used when: * there are repetitive work cycles of short to long duration, * wide variety of dissimilar work is performed, or * process control elements constitute a part of the cycle. At its most basic level, time studies, involved breaking down each job into component parts, timing each part and rearranging the parts into the most efficient method of working. Hospital managers who want specific results often rely on scientific management theory to guide their operations.

Nurses are the primary hospital caregivers, and the efficient use of their time and energy is critical to the future of our country’s hospitals. These frontline caregivers represent a critical and costly resource; maximizing the efficiency and effectiveness of nurses is essential to the integrity of hospital function and the promotion of safe patient care. An understanding of how nurses spend their time will target opportunities for nursing care effectiveness through improvements in management, workforce, work processes, and organizational culture.

The use of time and motion study can quantify how nurses spend their time, in real-time and in real work contexts. It can be applied in three major activities of nursing practice namely: documentation, care coordination, and medication administration. Other advantages of time and motion study in hospital industry are same as that in any other industry. These include the following. 1. To improve the methods or procedures adopted in performance of various jobs. 2. Improving the lay out of the facility.

For example in a hospital it may include lay out for facilities such as overall hospital layout, lay out of beds in a ward, layout of support facilities such as kitchen and reception area. 3. To improve utilization of resources. For hospitals will include resources like hospital support staff, operating rooms, hospital equipments, and diagnostic equipments. 4. To reduce human effort by proper design of processes. In hospitals this can also include reducing the efforts patients need to make for different actions involved in their treatment as well as for their routine hospital treatment and care. 5. To develop suitable working conditions.

In hospitals this would include design to suit the requirements of hospital staff as well as the patients. Summing it up, we can say that Taylor’s “scientific management” principles are still applicable in our current organizational management practices to a great extent. As seen before, the application of Taylor’s principles might lead to advantages that are required or desired in the 21st century, as an increase in an organization’s efficiency and managerial control. Nevertheless, we must pay close attention to the potential dangers and risks that might come along with the utilization of the principles of Taylor’s scientific management.

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