Tag Archives: academia

Messaging as an Ongoing Process

Just after midnight on March 24, 1989, the Exxon Valdez ran aground in the Prince William Sound off of the Alaskan coast causing the 36th largest oil spill in history (Baker, n.d.; Fearn-Banks, 2011; Holusha, 1989; Moss, 2010). Though the initial ecological insult was severe, Exxon’s poor response to the emergency is noted as having the most significance (Baker, n.d.; Holusha, 1989). According to Fearn-Banks (2011), the initial public relations response was swift, but the public perception, especially with the obvious absence of CEO Lawrence G. Rawl from the public spotlight, was that the company did not view the incident with the importance that it deserved (Holusha, 1989). “The biggest mistake was that Exxon’s chairman … sent a succession of lower-ranking executives to Alaska to deal with the spill instead of going there himself and taking control of the situation in a forceful, highly visible way” (Holusha, 1989, para. 6). Rawl made comments about being technologically obsolete as a reason for not responding to the incident personally, and in a later television interview, Rawl explained that it was not the responsibility of the CEO to read specific response plans, then he went on to blame the media for the crisis (Baker, n.d.; Fearn-Banks, 2011).

According to Fearn-Banks (2011), Don Cornet, Exxon’s Alaska public relations coordinator, rushed to the scene and instituted a plan focused on the clean-up upon hearing of the incident; however, resources were scarce and the plan was slow to implement. Alaskan oil industry regulations held that the Alyeska Pipeline Service Company, an oil company consortium, was ultimately responsible for the initial response, which was soon taken over by Exxon. It was Alyeska’s involvement in the incident that introduced George Mason, an experienced crisis communications public relations expert for the company that represented Alyeska, into the spotlight. Mason worked with Cornet to streamline the media response and did much to limit the impact of Exxon’s poor media relations, even in light of Rawl’s disastrous commentary. Without the efforts of Mason, Cornet, and a few others, it appears that Exxon’s reputation would have suffered much more.

The primary issues identified in Exxon’s response to the Valdez incident, according to Baker (n.d.), are 1) a lack of resources and preparedness for a crisis of this magnitude, 2) failing to commit to prevention efforts in the future, and 3) the perceived indifference to the ecological shock.

According to Holusha (1989), Exxon’s response to the Alaskan spill was immediately identified as highlighting what not to do in responding to a crisis. Holusha compared Rawl’s messaging and response with that of the Ashland Oil spill and the Union Carbide incident in Bhopal, India, in which both CEOs responded immediately, availing themselves to the media to answer questions and respond to scrutiny.

The Exxon Valdez spill was significant, large, costly, and affected many industries and lifestyles in Alaska. Rawl’s response should have been immediate, and he should have taken responsibility to be apprised of all efforts being undertaken to rectify the situation. Legitimizing Rawl’s concerns of being a distraction to local efforts, he could have held frequent press conferences in the mainland United States, which would have limited the media’s need to send so many representatives directly to Alaska. This would have helped to show cooperation with the media as well as allow Rawl to address any concerns that the public might have. The messaging should have been that Exxon will do everything needed to return Alaska back to pre-spill status no matter the cost or manpower required.

Today, social media presents a unique opportunity for companies to address their public. Recently, Connecticut Light and Power utilized Facebook and Twitter, two popular social media programs, to provide real-time updates to their affected customers during a freak early snowstorm that put most of Connecticut without power for weeks (Singer, 2011; State of Connecticut, Department of Emergency Services and Public Protection, 2011). Though there are still concerns that Connecticut Light and Power were unprepared for such a crisis, without the deliberate effort to maintain communication with customers, the corporate image would have been much worse, as Exxon experienced.

It is a common precept in crisis communications that crises will occur and hopes can only be made to minimize their effect (Fearn-Banks, 2011). While preparing for such a crisis, a focus on communication and messaging should be paramount. The more the public trusts that the company will respond to the emergency effectively, the more apt they will be to acknowledge the difficulties involved in such a response. Messaging should be open, honest, and realistic. Every effort to use a multitude of media (e.g. radio, television, print, internet, telephone, et al.) to maintain a sense of transparency should be used to promote messages that accept responsibility and sets realistic goals. These communications, however, should not be unidirectional. A conversation needs to take place where the public can have their concerns and curiosity addressed in a fair and open environment.

By addressing the concerns of all stakeholders in a timely, open manner, corporate images will fare much better even in light of the worst crisis imaginable.


Baker, M. (n.d.). Companies in crisis – What not to do when it all goes wrong: Exxon Mobil and the Exxon Valdez. Retrieved from http://www.mallenbaker.net/csr/crisis03.html

Coombs, W. T. (2012). Ongoing crisis communication: Planning managing, and responding (3rd ed.). Thousand Oaks, CA: Sage.

Fearn-Banks, K. (2011). “Textbook” crises. Crisis communications: a casebook approach (4th ed; pp. 90-109). New York, NY: Routledge.

Holusha, J. (1989, April 21). Exxon’s public-relations problem. New York Times. Retrieved from http://www.nytimes.com/1989/04/21/business/exxon-s-public-relations-problem.html

Moss, L. (2010, July 16). The 13 largest oil spills in history. Mother Nature Network. Retrieved from http://www.mnn.com/earth-matters/wilderness-resources/stories/the-13-largest-oil-spills-in-history

Singer, S. (2011, November 4). CT utility takes heat over winter storm response. News 8 WTNH. Retrieved from http://www.wtnh.com/dpp/weather/winter_weather/ct-utility-takes-heat-over-winter-storm-response-

State of Connecticut, Department of Emergency Services and Public Protection. (2011, November 8). Winter storm October 29, 2011 (Situation Report #49). Retrieved from http://advocacy.ccm-ct.org/Resources.ashx?id=802e4723-2e4a-4a61-896e-f51eafbbd4c0

The Importance of Planning

To borrow from the motto of the Boy Scouts of America (2011), “Be prepared!” There is no possible way to fully predict with perfect accuracy when and where a crisis will develop. However, with some foresight, the adoption of a comprehensive crisis communication plan will allow an immediate response to any emergency, disaster, or other crisis that might arise. Gray (2008) discusses how JetBlue might have benefited from such a plan. JetBlue, if they had focused on developing a crisis communication plan, might have uncovered the not unlikely possibility of a major storm grounding many of its passengers. In this case, JetBlue would have been in a more proactive position to mitigate the effects such a storm might produce on passengers and their east coast operations. According to Fearn-Banks (2011), the impending storm prediction would have been a warning sign, or prodrome, that JetBlue could have responded to in order to prevent the crisis. Had JetBlue contacted the passengers prior to their arrival at the airports, they might have been able to secure better and more comfortable accommodations than the airports had to offer. Additionally, the company would have presented themselves proactively instead of taking the defensive posture noted by Gray.

In December 1984, Union Carbide, a pesticide production company, was the subject of the worst industrial accident in history. At their plant in Bhopal, India, an employee purposefully allowed water into large tanks of a chemical called methyl isocyanate (MICN) which caused a chemical reaction (according to Union Carbide management), bursting the tanks and releasing MICN gas into the environment killing more than 3,000 people (some estimates exceed 25,000 dead) and injuring 100 times that amount (Venkatasubramanian, 2011). According to Muller (2001), MICN was stored in large above ground tanks, a water valve was connected to the tanks, and employees had largely unrestricted access to these tanks and valves. When liquid MICN and water are mixed, MICN rapidly expands to a gaseous state and can quickly overwhelm holding tanks. Had Union Carbide conducted an investigation of potential crises while constructing a crisis communication plan, these circumstances might have been uncovered and considered prior to the accident, allowing company officials the opportunity to mitigate the potentially deadly situation and avoid the catastrophe in 1984. Additionally, had this crisis occurred regardless of mitigation, the company would have been poised to provide helpful instructions and recommendations to public safety officials and the public to minimize the loss of life. Union Carbide was eventually sued for billions of dollars, which it has never paid.

Another incident that might have benefited from a crisis communication plan is the Massey Energy Upper Big Branch mine explosion that occurred in West Virginia on April 5, 2010. Venkatasubramanian (2011) describes this explosion as the worst mining accident in four decades, killing 29 people. Like the Union Carbide example above, Massey Energy initially tried passing the blame to employees and single system failures, but eventually the company closed its Kentucky Freedom Energy Mine #1, and the CEO, Don Blankenship, stepped down. This after being confronted with the over 600 safety violations in 2009 and 2010. Again, the implementation of a crisis communication plan would have focused on potential accidents and allowed a window for mitigation and prevention. Upon completion of the effort, when the accident occurred, there would have been clear directives on how to proceed, which might have helped to save the company’s reputation; although, in this case, that is unclear.

Only when a company’s management realizes that safety is important and that crises do occur can they set forth means of mitigating their risk. One important way to mitigate risk is to consider that no matter the attempts at prevention, errors and failures can always occur and it is best to be prepared for the worst-case scenarios in hopes that they never do occur. By being prepared for the worst case scenarios, mainly by having drafted crisis communication plans along with incident action plans, the company representative has focus and direction on how to proceed with response efforts both publicly and internally. The benefits are appearing with a unified message of adequately responding and recovering from the crisis, and bringing a sense of strength and direction to that effort that the public, employees, and shareholders alike can appreciate and find faith. It is always best to be prepared.


Boy Scouts of America. (2011, March). Overview of Boy Scouts of America. Retrieved from http://www.scouting.org/About/FactSheets/OverviewofBSA.aspx

Fearn-Banks, K. (2011). Crisis communications: a casebook approach (4th ed.). New York, NY: Routledge.

Gray, S. (2008). Without crisis plan, your reputation could be at risk. Las Vegas Business Press, 25(8), 22. Retrieved from http://www.ebscohost.com/academic/regional-business-news

Muller, R. (2001). A significant toxic event: The Union Carbide pesticide plant disaster in Bhopal, India, 1984. Rural and Remote Environmental Health, 1(10). Retrieved from http://www.tropmed.org/rreh/vol1_10.htm

Venkatasubramanian, V. (2011). Systemic failures: Challenges and opportunities in risk management in complex systems. AIChE Journal, 57(1), 2-9. doi:10.1002/aic.12495

Defining Crisis

A crisis is any problem that has a significant impact. Most simply, a crisis is a decision-point of change, for better or worse. For example, a new father seeing his child for the first time might have a crisis of faith. A beautiful and healthy child may trigger thoughts of awe and trigger a divine revelation; whereas, a seriously ill child may bring feelings of doubt and religious contempt. In the field of crisis management, Coombs (2012) defines crisis as “the perception of an unpredictable event that threatens important expectancies of stakeholders and can seriously impact an organization’s performance and generate negative outcomes” (p. 2). In this definition, Coombs suggests that crises are both negative and unpredictable events that effect others. While I agree with the scope of the definition, as I stated above, crises do not necessarily have to be negative events, and frequently, they can be predicted. Predictable negative crises are usually caused by negligent management, such as economic crises (Berg & Pattillo, 1998; Compagnon, 2011; Feldstein, 2010; Roubini, 2010).

A crisis usually develops from a less significant issue and, if understood and contemplated, can be mitigated early (Coombs, 2012). A crisis stemming from an issue finds a causal relationship with risk. Risk can be categorized by human, systematic, and process or random (Youndt, Snell, Dean, & Lepak, 1996). Human and systematic risk can be mitigated easily; however, process risk is inherent and requires substantial process change to minimize.

The British Petroleum Deepwater Horizon event, which occurred on April 20, 2010, was said to have been fraught with risk of all three types. A New York Times article by Barstow, Rohde, and Saul (2010) describes the event and attempts to elucidate what went wrong. Initially, according to the article, there was a blowout of the Macondo Prospect well, a risk that is inherent to drilling, especially in deep water. Next, every single “formidable and redundant defenses against even the worst blowout” (para. 10) failed. This was certainly a failure of process errors (geological “bursts” causing the well blowout), systematic errors (“One emergency system alone was controlled by 30 buttons” [para. 18]), and human errors (“members of the crew hesitated and did not take the decisive steps needed. Communications fell apart, warning signs were missed and crew members in critical areas failed to coordinate a response” [para. 15]).

On a micro-organizational level (the rig), these failures are evident and allowed risk to develop into an issue, which developed into a crisis. On a macro-organizational level, however, the response seemed to be swift, but the focal response to the incident and the public relations response appeared very disjointed, which was compounded by both the media and the federal government, that is, until the U.S. Coast Guard took control. It was apparent very early that both British Petroleum and the federal government were concerned with reputation over response and recovery from the focal incident. This translated to poor support for both by the public. I believe the U.S. Coast Guard is the only managing entity involved in the response to have managed to maintain dignity throughout the effort.

Crisis management is promoted as a multifaceted approach to mitigate, alleviate, respond to, and recover from crises of different types and scope. Although there are many aspects to organizations that require attention during these efforts, it needs to be understood that some have higher priorities than others, and reputation is a culmination of all of these.


Barstow, D., Rohde, D., & Saul, S. (2010, December 25). Deepwater Horizon’s final hours. New York Times. Retrieved from http://www.nytimes.com/2010/12/26/us/26spill.html

Berg, A. & Pattillo, C. (1998). Are currency crises predictable: a test (Working paper #98/154). International Monetary Fund. Retrieved from http://books.google.com/

Compagnon, D. (2011). A predictable tragedy: Robert Mugabe and the collapse of Zimbabwe. Philadelphia, PA: University of Pennsylvania Press.

Coombs, W. T. (2012). Ongoing crisis communications: planning, managing, and responding (3rd ed.). Thousand Oaks, CA: Sage.

Feldstein, M. (2010, June 14). A predictable crisis: Europe’s single currency was bound to break down. The Weekly Standard, 15(37), 1-3. Retrieved from http://www.weeklystandard.com/articles/predictable-crisis

Roubini, N. (2010, May 17). All crises are predictable: Contrary to beliefs, history shows there’s nothing new in debt or inflation. Gulf News. Retrieved from http://gulfnews.com/business/features/all-crises-are-predictable-1.627708

Youndt, M. A., Snell, S. A., Dean, J. W., & Lepak, D. P. (1996). Human resources management, manufacturing strategy, and firm performance. The Academy of Management Journal, 39(4), 836-866. doi:10.2307/256714

Human Resources & Challenges in Health Care

The function of human resources is not without its challenges and difficulties. No matter the industry or organization, acquiring and managing a pool of employees can be overwhelming (Thompson, 2012). Human resources managers in health care organizations seem to face more challenges than most. From nursing and physician shortages to attracting innovative and contemporary researchers, health care organizations seem to search within thinning pools of prospective employees, yet still demand the best and brightest (Keenan, 2003; Lewis, 2010; Thompson, 2012).

One of the most challenging issues to health care over the last few decades has been a significant nationwide nursing shortage (Keenan, 2003; Lewis, 2010). Thompson (2012) outlines both a declining skilled workforce and an increasing population contributing to the problem. Both Keenan (2003) and Lewis (2010) cite the aging babyboomer population adding to the increased need for nurses through 2020 and beyond. Novel human resources strategies can result in an augmented workforce designed to meet the continually growing impact these forces have on health care organizations, specifically those with emergency departments.

One novel strategy includes consideration of other highly-skilled clinicians that do not traditionally work in hospitals. As Oglesby (2007) considers the possibility, paramedics are, by far, one of the best examples. By introducing paramedics into the emergency department, a hospital can redistribute the nurses to clinical areas more suited towards their training, decrease the patient-to-nurse ratios (thereby increasing patient safety and maximizing outcomes), and tap into a new pool of prospective employees that are well-suited to rise to the stressful demands of the emergency department (Keenan, 2003; Swain, Hoyle, & Long, 2010). Additionally, organizations employing paramedics can augment both their emergency department operations and home health care operations by sending paramedics to certain patients to mitigate their complaints and minimize the number of inappropriate patient transports to the emergency department (Swain, Hoyle, & Long, 2010). This alone would decrease emergency department overcrowding and maximize revenue and efficiency in the delivery of care. Additionally, turn-over rates should be significantly lower with a more productive work environment where stress is managed, outcomes are met, and patients are care for more effectively.

In conclusion, intelligent and novel planning of the workforce can, itself, lead to increases in recruitment and retention; however, efforts still need to focus on each individually in order to attract, maintain, and develop a first-class workforce (Thompson, 2012).


Keenan, P. (2003). The nursing workforce shortage: causes, consequences, proposed solutions (Issue brief #619). The Commonwealth Fund. Retrieved from http://mobile.commonwealthfund.org/

Lewis, L. (2010). Oregon takes the lead in addressing the nursing shortage: A collaborative effort to recruit and educate nurses. American Journal of Nursing, 110(3), 51-54. doi:10.1097/01.NAJ.0000368955.26377.e1

Oglesby, R. (2007). Recruitment and retention benefits of EMT—Paramedic utilization during ED nursing shortages. Journal of Emergency Nursing, 33(1), 21-25. doi:10.1016/j.jen.2006.10.009

Swain, A. H., Hoyle, S. R., & Long, A. W. (2010). The changing face of prehospital care in New Zealand: the role of extended care paramedics. Journal of the New Zealand Medical Association, 123(1309), 11-14. Retrieved from http://journal.nzma.org.nz/

Thompson, J. M. (2012). The strategic management of human resources. In S. B. Buckbinder & N. H. Shanks, Introduction to Healthcare Management (Custom ed.; pp. 81-118). Sudbury, MA: Jones & Bartlett.

Prior Proper Planning …

… Prevents Poor Performance

I am in the midst of planning an ad hoc merger of a number of local emergency medical service agencies into a single regional provider to reduce overall costs while maximizing revenue, improve training and the delivery of care, and to streamline the operational processes that support our providers in the field. Unfortunately, I have found that there are many obstacles that need to be dealt with at every step before moving on to the next. My research has certainly opened my eyes to developing a useful approach to these problems.

Planning “[provides] the appropriate focus and direction for … organizations” (Zuckerman, 2006, p. 3). Without planning, organizations risk stagnation and obsolescence. For any organization to succeed (and continue to do so), the strategy needs to focus both on the contemporary traditional needs as well as those anticipated in the future, but this focus needs to be comprehensive. Bartling (1997) writes of 25 different pitfalls any health care organization might face when considering strategic planning. These 25 pitfalls are just some of the issues I hope to avoid.

One of the largest difficulties in planning for emergency medical systems, however, is the sense of ‘fiefdom’, or an assertion of organizational ownership — in a truly feudal sense. A fiefdom is a literal power trip. In this area, there are 10 towns with an average of two ambulances each, and each department’s administration will fight tooth and nail to keep the organization from outgrowing them. What is interesting about the area is that many of the members of one department work for at least two of the other departments, also. This is because the pay is so meager they have to work as many hours as possible, and there is no chance of working more than 32 hours at any one service in any given week. The pay is low as is the quality of care. This needs to change, but how do I create an amalgumated organization from the bits and pieces that I have to work with? Add to that my lack of formal authority in this process. My vision is to reduce the number of ambulances by staffing eight ambulances at all times and tactically positioning them around the region. This alone would create 48 well-paid jobs, using the same 40 people who currently job share across organizational lines.

In reviewing the available resources, I have learned that there is no particular process or flow-chart pathway to effective planning (Bartling, 1997; Begun & Kaissi, 2005; Zuckerman, 2006). Critical forward thinking is needed, instead. Some of the particular issues that Bartling (1997) discusses and I foresee might be particular to my planning process are: inadequate planning, short-sightedness, underestimating the complexity of the process, post-merger angst, analysis paralysis, and lack of evaluative criteria, to name a few. Politics plays a large role in many of these issues I mention.

Inadequate planning, short-sightedness, and a lack of evaluative criteria are closely related. I see in the present that the system does not work as well as it should (short-sightedness), and I want to develop a plan that can be implemented immediately (probably suffering inadequate planning). This would leave me with a fragmented system devoid of vision and, therefore, crippled from improving (lacking that evaluative criteria). These are pitfalls that I need to avoid. These issues would give rise to the others dooming my effort to failure and, possibly, leaving the system in even worse shape than it began.

Perhaps, my only chance of fulfilling this process is to first perform a limited situational assessment by identifying the mission, vision, and values of all of the stakeholders and show how a streamlined process can better fulfill their visions (Casciani, 2012). By gaining stakeholder support, I might better leverage my idea against those who fear change.


Bartling, A. (1997). 25 pitfalls of strategic planning. Healthcare Executive, 12(5), 20–23.

Begun, J. & Kaissi, A. (2005). An exploratory study of healthcare strategic planning in two metropolitan areas. Journal of Healthcare Management, 50(4), 264–274.

Casciani, S. J. (2012). Strategic planning. In S. B. Buckbinder & N. H. Shanks (Eds.), Introduction to healthcare management (Custom ed.; pp. 3-23). Sudbury, MA: Jones & Bartlett.

Zuckerman, A. (2006). Advancing the state of the art in healthcare strategic planning. Frontiers of Health Services Management, 23(2), 3–15.

Leadership: Determining the Best Approach

 The true value of leadership is empowerment, or the ability to promote those traits through the chain of command for subordinates to use to effectively make decisions that are in the spirit of the vision of the leader (Buchbinder, Shanks, & McConnell, 2012; Kirkpatrick & Locke, 1991; Wieck, Prydun, & Walsh, 2002). When leaders make decisions, the focus is not on the myopic view of the here and now but reflects the nature of ethics and vision promoting the endeavor (Kirkpatrick & Locke, 1991).

Buchbinder, Shanks, and McConnell (2012), discuss various strategies and attitudes employed to both lead and manage the health care workforce. Though each of the styles presented are effectively used in certain scenarios, many managers and ineffective leaders misuse these styles due to misplaced attitudes, trust, and motives. These styles are authoritarian, bureaucratic, participative, theory Z, laissez-faire, and situational. The authoritarian and bureaucratic styles are closely related as dictatorial and at risk for involving micromanagement; however, authoritarians tend to be motivated by their responsibilities, whereas bureaucrats tend to disregard their responsibilities. The participative and theory Z styles are more democratic and egalitarian describing the usefulness of a majority opinion or consensus before moving forward. Though these styles could result in indecision, they are best implemented when a leader has ultimate decision-making capabilities and relies on his or her subordinates for input. Laissez-faire leadership is typically characterized as the hands off approach. Laissez-faire leadership, when used correctly, relies on the specialized training or focused scope of the work of the subordinates and lends guidance only when necessary. Laissez-faire leadership, however, can provide refuge for a lazy manager. Situational leadership is the use of all or some of the styles described above depending on the specific circumstances of a given situation. For instance, providing guidance to a new employee might benefit from an authoritarian approach; however, deciding on the best approach to implementing a new process might benefit from a participative style of leadership.

In the emergency medical services, a move has been made over the last decade to separate from the authoritarian leadership of the fire service. In my opinion (due to the gross lack of research within both the fire and emergency medical services), the attitudes of the fire service leadership do not correspond well with the manner in which paramedics wish to be led. As paramedics are formally educated and expected to perform as skilled clinicians in the field, they tend to operate independently and view their supervisors more as a resource tool than as tactical or clinical decision-makers. Combination departments, or those that operate both fire and emergency medical services, would do well with developing situational leadership skills to guide both operations (Mujtaba & Sungkhawan, 2009). Though paramedics may utilize an authoritarian style of leadership during an emergency call (and, do well to follow such styles in these environments), during normal day-to-day operations, paramedics respond much better towards a laissez-faire, or indirect, style of leadership that allows for independent critical thinking (Buchbinder, Shanks, & McConnell, 2012; Freshman & Rubino, 2002). For example, during a call, I expect that when I direct my crew to perform a certain task that it is completed immediately; however, between calls when I might say that in a particular scenario a certain intervention is necessary, I expect some discussion to aid in the learning of my crews and to help develop and hone their critical thinking skills.

True leadership has its own rewards, primarily, empowering those who follow to synthesize the traits of their leaders and evolve into leaders, themselves. This, in addition to watching your own visions take root and flourish.


Buchbinder, S. B., Shanks, N. H., & McConnell, C. R. (2012). Introduction to healthcare management (Laureate Education, Inc., Custom ed.). Sudbury, MA: Jones and Bartlett.

Freshman, B. & Rubino, L. (2002). Emotional intelligence: a core competency for health care administrators. Health Care Manager, 20(4), 1-9. Retrieved from http://ezp.waldenulibrary.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=12083173&site=ehost-live&scope=site

Kirkpatrick, S. A. & Locke, E. A. (1991). Leadership: Do traits matter? Academy of Management Executive, 5(2), 48-60. doi:10.5465/AME.1991.4274679

Mujtaba, B. G. & Sungkhawan, J. (2009). Situational leadership and diversity management coaching skills. Journal of Diversity Management, 4(1), 1-55. Retrieved from http://journals.cluteonline.com/

Wieck, K. L., Prydun, M., & Walsh, T. (2002). What the emerging workforce wants in its leaders. Journal of Nursing Scholarship, 34(3), 283-288. doi:10.1111/j.1547-5069.2002.00283.x

Profile of a Health Care Manager

According to Buchbinder and Thompson (2010), formal training in hospital administration did not exist until 1934 when Michael M. Davis, along with the University of Chicago, developed the first Health Administration program, combining both business and social education to meet the dynamic and unique needs of health care. In today’s economy of almost 10% unemployment nationwide, the health care field continues to grow, even in the face of uncertain regulation and remuneration (Fiscella, 2011; Sanburn, 2011; Scangos, 2009). However, as the economy continues to stagnate, health care providers still require to paid for their services. This is where the health care manager comes in.

A good health care manager is expected to make decisions that benefit both the organization and the client. Although health care is a business, one might say that it is expected to be the most ethical of all businesses as people’s lives are dependent upon its efficacy and continuity. As such, health care managers are expected, according to Buchbinder and Thompson (2010), to have a high ethical standard along with a requisite savvy business sense. Health care managers are also expected to have refined interpersonal skills, leadership, and integrity. Katz (as cited in Buchbinder & Thompson, 2010) defines the characteristics of an effective manager as possessing critical thinking and complex problem solving skills, expertise in their field, and the ability to effectively communicate with others.

Health care managers can work in a variety of settings and operate under many titles; however, these settings can be defined by two descriptors: direct care and nondirect care. Direct care settings, as described by Buchbinder and Thompson (2010), are those settings in which services are provided directly to the patient. Managers within direct care settings should be customer-focused with great interpersonal skills and dedication. These managers should also be excellent problem solvers, as direct consumers tend to require more expedient solutions than ubiquitous deadlines permit. A person may be better suited for this role if he or she enjoys dealing with the general public and solving complex problems with limited information. Nondirect care settings, on the other hand, can be described as health care support organizations as they might provide supplies, logistics, and expertise to those in direct care settings. Managers within nondirect care settings need to be more business savvy as they will typically interact with clients and associates on that level than, per se, a patient-provider level. Nondirect care managers must also be skilled in marketing and finance. Those with an affinity to these roles might possess more professional or technical skills, focusing more on business than personal relationships.

Both direct and nondirect care settings are important to the delivery of health care, today. Buchbinder and Thompson (2011) describe each as well-paying with opportunity, commensurate with education and experience, to advance within the field of health care management. Health care is both growing and changing, and it is a promising occupational arena.


Buchbinder, S. B. & Thompson, J. M. (2010). Career opportunities in health care management: Perspectives in the field. Sudbury, MA: Jones and Bartlett.

Fiscella, K. (2011). Health care reform and equity: promise, pitfalls, and prescriptions. Annals of Family Medicine, 9(1), 78–84. doi:10.1370/afm.1213

Sanburn, J. (2011, August 18). Health care industry growth beginning to slow. Time Moneyland. Retrieved from http://moneyland.time.com/2011/08/18/health-care-industry-growth-beginning-to-slow/

Scangos, G. A. (2009). Proceeding in a receding economy. Nature Biotechnology, 27(5), 424-425. doi:10.1038/nbt0509-424

Self-Assessment: Finding My Niche

 Combining the business-sense with the altruistic nature of health care, a health care manager is truly unique in focus. Some of the virtues and qualities a health care manager must posses for a long and rewarding career include a high sense integrity and of one’s self, emotional intelligence, the ability to think critically and globally, and must be equitable and just to both colleagues and clients, customers, and patients (Buchbinder, Shanks, & McConnell, 2012; Buchbinder & Thompson, 2010a).

A qualitative self-administered inventory instrument, presented by Buchbinder and Thompson (2010b), provides some insight into the qualities and virtues useful and, perhaps at times, necessary to pursue a management career in health care. The instrument, designed in Likert fashion, presents quality statements with which the subject is to agree or disagree, whether strongly or not (Likert, 1932). Although this instrument is based on the authors’ opinion, albeit expert, and there is no scoring mechanism recommended aside from high is better than low, I performed the inventory as a self-assessment to help identify some of my strengths and weaknesses (Buchbinder & Thompson, 2010a). The scoring was performed by assigning values to the the statements: 5 for strongly agree, 4 for agree, 2 for disagree, and 1 for strongly disagree, and dividing the sum of the answers scored by the median neutral value of 3 (Garland, 1991; Likert, 1932).

My score using the instrument was 153 out of 180 (85.00%). According to Buchbinder and Thompson (2010a), I possess more skills than not for a management career in health care. The lack of import placed on time management and project management seem to be two of my weaknesses, according to the instrument; although without further scrutiny, it is hard to tell if these particular items may actually suggest otherwise (Buchbinder & Thompson, 2010b; Clason & Dormody, 1994). The instrument helped to identify my critical thinking skills and my communication skills as strengths that would be useful in a health care management career (Buchbinder & Thompson, 2010b). It also showed that I have a strong ethical focus on integrity and equity.

Qualitative self-assessment instruments, such as the one developed by Buchbinder and Thompson (2010b), allow the subject insight as to the appropriateness of something like a career choice or lifestyle. Being honest with one’s self in using these self-assessment tools will also help to inform the subject of characteristics in need of cultivation.


Buchbinder, S. B., Shanks, N. H., & McConnell, C. R. (2012). Introduction to healthcare management (Laureate Education, Inc., Custom ed.). Sudbury, MA: Jones and Bartlett.

Buchbinder, S. B. & Thompson, J. M. (2010a). Career opportunities in health care management: Perspectives in the field. Sudbury, MA: Jones and Bartlett.

Buchbinder, S. B. & Thompson, J. M. (2010b). Healthcare management talent quotient quiz. Career opportunities in health care management: Perspectives in the field (pp. 5-7). Sudbury, MA: Jones and Bartlett.

Clason, D. L. & Dormody, T. J. (1994). Analyzing data measured by individual Likert-type items. Journal of Agricultural Education, 35(4), 31-35. doi:10.5032/jae.1994.04031

Garland, R. (1991). The mid-point on a rating scale: Is it desirable? Marketing Bulletin, 2, 66-70. Retrieved from http://marketing-bulletin.massey.ac.nz/V2/MB_V2_N3_Garland.pdf

Likert, R. (1932). A technique for the measurement of attitudes. Archives of Psychology, 22(140), 1–55.


Challenges in Developing  Standards

The U.S. health care industry is contemplating the implementation of pay-for-performance reimbursement schemes in order to increase quality and safety in the delivery of health care. Pay-for-performance is a business model that combines reduced compensation for those who fail to meet standards and bonus payments for those that meet or exceed the stated expectations, but the results of such programs, thus far, is mixed (Baker, 2003; Campbell, Reeves, Kontopantelis, Sibbald, & Roland, 2009; Lee & Ferris, 2009; Young et al., 2005). The introduction of pay-for-performance models is primarily to provide relief from other, more extreme, reimbursement models, such as fee-for-service (which rewards overuse) and capitation (which rewards underuse), and with rising health care costs, a diminishing economy, and the increasing number of Americans lacking adequate health insurance, its introduction to the U.S. health care system could not be more timelier (Lee & Ferris, 2009).

The impetus of contemporary pay-for-performance schemes is derived from a report from the Institute of Medicine (2001). This report argued that current reimbursement schemes fail to reward quality in health care and may possibly create a barrier to innovation (Baker, 2003; Young et al., 2005). There are many international supporters of health care pay-for-performance, especially in England where the National Health Service employs pay-for-performance to keep costs under control while attempting to provide for quality and safety in the delivery of primary health care (Baker, 2003; Campbell et al., 2009; Young et al., 2005). However, the adoption of pay-for-performance seems to face many challenges.

One challenge to pay-for-performance implementation concerns the effectiveness in the overall continuity of care. Campbell et al. (2009) conducted an analysis of the effect of pay-for-performance in England and found that, although implementation of pay-for-performance in 2004 resulted in short-term gains in the quality of care, the improvements receded to pre-2004 levels. Beyond the pay-for-performance standards, though, the quality of care in areas not associated with incentives declined. Cameron (2011) reports on a recent study of the effectiveness of pay-for-performance on hypertension – the study shows no improvement in any measure including the incidence of stroke, heart attack, renal failure, heart failure, or combined mortality among the group (Lee & Ferris, 2009). McDonald and Roland (2009) describe these effects on other aspects of care as unintended consequences detrimental to health care quality and safety as a whole.

Another significant challenge to pay-for-performance implementation is ensuring that certain patient populations continue to be able to access appropriate care (McDonald & Roland, 2009). Under some pay-for-performance schemes, practices with a sicker patient demographic (i.e. geriatrics, oncology, neonatology, etc.) will suffer economically despite providing a higher level of care than their counterparts in family medicine or other more generalized practices. Specific concerns address a physicians ability to choose not to treat patients due to their non-compliance with medical orders (McDonald & Roland, 2009). Equity and access cannot suffer under a just reimbursement model, just as physicians with a sicker demographic should not suffer.

Identifying a reliable standard of measure in health care quality proves difficult. Earlier methods, such as those developed by Campbell, Braspenning, Hutchinson, and Marshall (2002), initially appeared sound, but ineffective methods and unintended consequences were soon identified (Cameron, 2011; Lee & Ferris, 2009; McDonald & Roland, 2009). More recent work by Steyerberg et al. (2010) shows that new approaches are on the horizon and that pay-for-performance may still remain a viable scheme, providing the measures and standards are, in fact, legitimate and accurately identify improved quality without detracting from other aspects of heath care. Steyerberg et al. identifies novel approaches to prediction models that may help to standardize measures in pay-for-performance schemes to be more realistic and reliable without causing many of the unintended consequences of earlier plans.

As we become more technologically advanced and find ways, albeit expensive, to cure and treat diseases that until now were intractable, we must address the ethics surrounding the provision of this care as a system of management. By combining the whole of health care into the ethics discussion, we opt to leave no one wanting for care, but we now have to address the problem of paying for the expensive care that we have all but demanded. Pay-for-performance, though not perfect, shows much promise in keeping health care costs manageable. However, we must strive to identify those patients and practitioners that lose out under this system of reimbursement and strive to identify just and ethical means of repairing the scheme. Though, we should first answer the question: is health care a right or a privilege?


Baker, G. (2003). Pay for performance incentive programs in healthcare: market dynamics and business process. Retrieved from http://www.leapfroggroup.org/media/file/Leapfrog-Pay_for_Performance_Briefing.pdf

Cameron, D. (2011, January 27). Pay-for-Performance does not improve patient health. Harvard Medical School News. Retrieved from http://hms.harvard.edu/public/news/2011/ 012611_serumaga_soumerai/index.html

Campbell, S. M., Braspenning, J., Hutchinson, A., & Marshall, M. (2002). Research methods used in developing and applying quality indicators in primary care. Quality and Safety in Health Care, 11(4), 358–364. doi:10.1136/qhc.11.4.358

Campbell, S. M., Reeves, D., Kontopantelis, E., Sibbald, B., & Roland, M. (2009). Effects of pay for performance on the quality of primary care in England. New England Journal of Medicine, 361(4), 368-378. doi:10.1056/NEJMsa0807651

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Retrieved from http://www.iom.edu/reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx

Lee, T. H. & Ferris, T. G. (2009). Pay for performance: a work in progress. Circulation, 119(23), 2965-2966. doi:10.1161/CIRCULATIONAHA.109.869958

McDonald, R. & Roland, M. (2009). Pay for performance in primary care in England and California: comparison of unintended consequences. Annals of Family Medicine, 7(2), 121–127. doi:10.1370/afm.946

Steyerberg, E. W., Vickers, A. J., Cook, N. R., Gerds, T., Gonen, M., Obuchowski, N., … Kattane, M. W. (2010). Assessing the performance of prediction models: A framework for traditional and novel measures. Epidemiology, 21(1), 128–138. doi:10.1097/EDE.0b013e3181c30fb2

Young, G. J., White, B., Burgess, J. F., Berlowitz, D., Meterko, M., Guldin, M. R., & Bokhour, B. G. (2005). Conceptual issues in the design and implementation of pay-for-quality programs. American Journal of Medical Quality, 20(3), 144-50. doi:10.1177/1062860605275222

Electronic medical records:

The Push and the Pull

Increasing safety and efficiency in medicine can only lead to an increase in health care quality, right? Some might not agree, especially when it comes to the implementation of electronic medical records (EMRs). There is a federal effort to ensure all medical records are in digital format by 2014, and supporters of EMR technology laud their effectiveness at minimizing medical errors, keeping records safe, facilitating information portability, and increasing cost-efficiency overall (The HWN Team, 2009; Preidt, 2009). Unfortunately, many are skeptical of the cost, security, and utility of such systems (Brown, 2008; The HWN Team, 2009; Preidt, 2009; Terry, 2009). These concerns (and others) are dramatically slowing the pace of EMR adoption, especially in smaller private practices where cost is a significant issue (Ford, Menachemi, Peterson, & Huerta, 2009).

Does EMR adoption actually increase safety? As Edmund, Ramaiah, and Gulla (2009) point out, a working computer terminal is required in order to read the EMR. If the computer system fails, there is no longer access to the medical record. This could be detrimental in a number of cases, especially when considering emergency medicine. Edmund, Ramaiah, and Gulla also describe how difficult it can be to maintain such a system. With this in mind, it is plain that as the system ages there will be more frequent outages and, therefore, more opportunity for untoward effects. Further, recent research shows how EMRs enforce pay-for-performance schemes that many U.S. physicians resent. McDonald and Roland (2009) demonstrate that physicians in California would rather disenroll patients who are noncompliant when reimbursed under pay-for-performance models enforced by the EMR software. Declining to treat patients who express their personal responsibility and choice in their own medical treatment cannot improve the effectiveness of safety in the care that they receive.

There needs to be a middle ground. Baldwin (2009) offers some great real world examples of how some hospitals and practices use hybrid systems to ensure effectiveness and quality while enjoying the benefits of digital records. According to Baldwin, there are many concerns to account for when considering a move from an all paper charting system to an all digital system. Many times, these concerns cannot be allayed and concessions between the two systems must be made. Brown (2008) suggests providing a solid education to the front-line staff regarding EMR implementation, and hence, obtaining their ‘buy in’ to the process to create a smoother transition to implementation. However, this does not address the safety concerns. Baldwin’s advice to analyze which processes should be computerized allows a solid business approach to EMR implementation, allowing some processes to remain paper-based if it makes sense to do so.


Baldwin, G. (2009). Straddling two worlds. Health Data Management, 17(8), 17-22.

Brown, H. (2008, April). View from the frontline: Does IT make patient care worse? He@lth Information on the Internet, 62(1), 9.

Edmund, L. C. S., Ramaiah, C. K., & Gulla, S. P. (2009, November). Electronic medical records management systems: an overview. Journal of Library & Information Technology, 29(6), 3-12.

Ford, E. W., Menachemi, N., Peterson, L. T., & Huerta, T. R. (2009). Resistance is futile: But it is slowing the pace of EHR adoption nonetheless. Journal of the American Medical Informatics Association, 16, 274-281. doi:10.1197/jamia.M3042

The HWN Team. (2009, March). Electronic medical records: the pros and cons. Health Worldnet. Retrieved from http://healthworldnet.com/HeadsOrTails/electronic-medical-records-the-pros-and-cons/?C=6238

McDonald, R. & Roland, M. (2009, March). Pay for performance in primary care in England and California: Comparison of unintended consequences. Annals of Family Medicine, 7(2), 121-127. doi:10.1370/afm.946

Preidt, R. (2009, December 16). Pros and cons of electronic medical records weighed. Business Week. Retrieved from http://www.businessweek.com/lifestyle/content/healthday/634091.html

Terry, N. P. (2009). Personal health records: Directing more costs and risks to consumers? Drexel Law Review, 1(2), 216-260.