Micromanagement, or demanding oversight, is an inherently faulty strategy as it is generally deemed as too invasive by staff and is counterproductive . Increasing both the amount and types of involvement in work activities can also lead to improved confidence that the output will be sound. It was additionally theorized by this author based on observation that managerial confidence could additionally result when workers regularly communicate work status and share deliverable output with management prior to deadlines. Regular communication of work status refers to proactive discussions concerning status, risks, or issues pertaining to the current set of work. When work is provided for review with little to no time allowed for manager input and possible rework , the level of managerial confidence in the work is not maximized. It was asserted at the start of this study that when managers are intimately involved with the work performed in their area, confidence in performance results. The concept of self-efficacy within the management literature is well documented in relation to its association with confidence in performance or output. Gist and Mitchell define self-efficacy as “a person’s estimate of his or her capacity to orchestrate performance on a specific task” . They found that improvements to self-efficacy led to increases in performance . The use of this measure was to assess how confident administrators were in various aspects of program delivery that coincided with their ability to act on any identified areas of deficiency. It was felt that measuring aspects of confidence in the program, which could not be directly remedied,best vertical garden system would not serve the purpose of attempting to use the survey itself as an enabling tool for all levels of management.
Measuring confidence in the model is assessed on the basis of three variables: quality of the work output, quality of the vision about the implementation plan, and quality of the external vendor consultants utilized. As there was an extensive use of external consultants within the program, as is typically the case in large-dollar projects, understanding the quality of their work product on an ongoing basis was vital to ultimate program success. As vendor consultants were paid on a time and materials basis, the quality of their work output could slip without being tied to financial compensation, with the exception of future compensation in the case of contract termination. Understanding their work output could prevent any cascading catastrophes, including the costs involved with recruitment and retention of new consultants or of full-time personnel. The receivership program used a vast amount of consultants, with the project management office noting that it had more project managers under contract than any other U.S. government agency—with the single exception of NASA. Managerial involvement in the work was the other assessment measure of the management assessment model and survey. This measure relied on two aspects to gauge the level of managerial involvement: intensity of involvement in the work at hand and quality of the manager’s attempts to be involved with subordinate staff. The assumption underlying this part of the model was that the more involved managers become with the work at hand, the more visible their presence becomes, and therefore worker performance would improve. The theoretical basis for this was derived from auditing theory, which holds that results-based management is most effective when evaluation techniques are applied frequently . To assess a manager’s level of involvement in his or her area in the program, survey questions queried various perceptions.
Questions were designed to understand information flow as well as the types and frequencies of communications that made clear to managers which work should be performed in order to enable successful outcomes. An important assumption underlying this survey was that administrators were competent enough to perform their duties and further were enabled to take action in any area they felt deficient as a result of the survey results.Surveys were administered quarterly beginning in fall 2009 to both prison-level and headquarters-level managerial staff. The data were submitted anonymously and, after aggregation of results was performed each quarter, a review of the results was undertaken to elucidate general areas of program deficiency as reported by the management within the receivership or involved with implementing receivership programs. Once areas of deficiency were identified, intervention programs were constructed and rapidly deployed to management staff at both levels. The managerial behavioral assessment model as expressed in Figure 4 shows five scale items that were the target areas for improvement when survey results showed groupings of negative responses. The survey was scored on a 5-point Likert scale with responses ranging from “strongly disagree” to “strongly agree,” with neutral in the middle. After baseline assessments were performed, it was found that perceptions were low in all predefined areas: output of work quality, quality of the applied program vision, quality of the what was expected of or required from consultant partners, the level of involvement managers had to their accountable work, and finally the quality of the interaction they had with the workers they had performing the work. As a result, interventions were developed to improve on all five measured areas.
In the early 1950s, a tool now commonly referred to in the management literature as the Ohio questionnaire was developed to assess administrative behavior . This style of assessment was further developed , and measured three distinct dimensions: change-centered, task- or production-structure centered, and employee-relations-centered managerial behavior. These three foundational dimensions are developed into profiles of management . Numerous other assessment tools have been developed to track and understand managerial behavior along these dimensional lines . These readily observable and measurable criteria have certain central themes as their theoretical bases. For the change-centered dimension, the assessed behavior focuses on major innovative improvements and adaptation to external changes. When evaluating administrators around task- or production-centered behavior, the primary objectives review high efficiency in the use of resources and personnel, and high reliability of operations, products, and services. The primary objectives of relation’s behavior analysis seek to assess and guide a strong commitment to the unit and its mission. Additionally, a high level of mutual trust and cooperation among members develops. None of these tools can explain and motivate the managers to improve upon their program performance. Multiple surveys would have had to have been employed and tailored to understand administrative behavior within this context. For example, the Conger-Kanungo scale seeks to understand the nature of charismatic leadership in a change context. By itself, it would be insufficient to understand how managers perceive the nature of work performed or to be performed under a transformational program structure; therefore, it would have to be either altered or combined with other proven valid assessment tools, which would make the measurement process overly onerous. Many theories and approaches for studying administrative behavior within organizations have been developed and advanced over the past half century. Overarching themes have asserted the rational limitations of management behavior, blaming either the individual actor or the organization for the inability to adapt to the parameters of the situation . In other literature,vertical farming equipment frameworks have appeared supporting a more micro approach to the dissection of administrative behavior by focusing on the roles and interactions between rational actors within the confines of the organization.
This approach, known leader-member-exchange theory , is another approach that focuses on interactions between workers and staff. The next chapter will describe the effects of the implementation of the chronic care model, a part of the receivership’s health care reform program. The data presented in the following chapter depict organizational performance based on the efforts of program development and attention to the improvement of management behavior as explained in the present chapter.The essence of the previous three chapters’ information translates directly to the overarching theme of this study’s contribution to the literature: a framework for implementing a not-for-profit health program within a public sector organization. The evaluation and understanding of program implementation calls for, “careful, retrospective assessment of the merit, worth, and value of administration, output, and outcome of government interventions, which is intended to play a role in future, practical action situations” . The findings presented within this chapter detail the program implementation’s outcomes in relation to the study’s goal of improving health care outcomes. At the outset of program implementation, clinical administrators from all primary care disciplines were tasked by the Receiver to improve the outcomes of health care treatment. The Chronic Care Model as designed by Edward Wagner , was thus adopted and then adapted to fit the correctional environment. The goal of the program was to reduce unnecessary health care delivery by treating the inmate-patient in an improved and comprehensive manner—as opposed to the status quo model for care delivery. As such, reductions in emergency room visits and specialist physician visits were established by the program administrators as key performance indicators. Additionally, it was felt that the management of the inpatient admission and length of stay process could be effectively impacted by this model without reducing clinical efficacy in treatments. As a result, length of stay and the number of admissions to inpatient facilities were viewed as outcomes of significance. To determine overall program performance, the data must reveal whether inmate-patients in the CCM pilot sites used less specialist care, less emergency department care, were hospitalized less, and, when hospitalized, had a shorter length of stay than those not receiving their medical care under the CCM model. The rest of this chapter will discuss the data from the chronic care model program implementation in support of the research question: Were healthcare outcomes improved as a result of program implementation? Information will first be presented about the prisons that were selected for pilot-phase implementation and the factors underlying those decisions. To provide knowledge of the cohorts reviewed, descriptive statistics will be then presented, followed by statistical analysis of program output.Six pilot prisons sites were chosen by the implementation team to pilot test the chronic care model developed for the correctional environment . A primary consideration for selection of the first six sites was that each site did not differ from the other sites in terms of geographic and physical characteristics because such variance affects a prison’s proximity to outside health delivery facilities . Physical characteristics primarily referred to the layout of the institution relative to the operational requirements for health care delivery under the model. Space allocated to the housing of medical records or treatment rooms was the primary concern. This approach was taken to address the statewide variability in prisons in hopes of maximizing generalizability of results. The benefit to generalizable results was ease in the development of a model that could be spread to all 33 prisons. Staffing levels were also taken into consideration, as prison sites that had many vacant clinical positions were not considered sustainable for the model’s long-term implementation and therefore were not suitable as ongoing reference points for best-practice identification after implementation. The six pilot facilities were expected to collect and report performance measures; however, most data remained in paper charts and ad hoc spreadsheets. Data collection for this study was limited to a partially completed registry database, weak administrative systems, and information from paper charts from all six institutions, as well as control data from inmate-prisoners at prisons not utilizing CCM. The improvement of health care outcomes was pivotal in assessing effectiveness of the model as it was implemented in this setting. During the early stages of the implementation , the program’s success was dictated solely by improving health care delivery as mandated by the receiver’s mission. Research Design In order to assess the possible association between the CCM program and diabetes symptom aggravations resulting in the need for treatment, a population-based, 1:2 retrospective-matched cohort study was undertaken in the second phase of the program’s implementation. During the first phase, asthma was the disease condition of focus while the program was developed and its fit with the environment understood, all while utilizing the breakthrough collaborative approach discussed in an earlier chapter. For Phase 2, diabetes was the focus, and during this phase live-data-collection and aggregation methods were substantially improved over Phase 1’s construction efforts. The matched cohort retrospective methodology was chosen in order to understand whether the CCM program had an impact on the subsequent need for care for the chronic care condition.