organizational trust, decision making communication, and collaboration in hospital managers: a...

Organizational Trust, Decision MakingCommunication, and Collaboration

in Hospital Managers: A Quasi-FieldExperiment

Christopher J. Evans, DHA, FACHE, CMPE

Health Capital Advisors, Inc.

www.christopherevans.org

Executive SummaryThis study examined issues of organizational trust and decision-making, communication, and collaboration between senior leadership and middle management members in a large tertiary care hospital. Ninety-six middle managers were pre-tested with an electronic web-based survey instrument measuring their level of trust in the senior leadership group, and the nature of decision-making, leadership communication, and collaboration with senior leadership. An intervention in the form of a series of leadership development seminars was then provided to a mixed group of middle and senior managers, and the study group was post-tested with the same instrument.

All measures (trust; decentralization of decision making processes; openness, fullness, and fairness of communications; and level of collaborative activities) were highly positively correlated with each other (p<.0001) for both pre- and post-intervention data.

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Organizational Trust, Decision Making, Communication, and Collaboration in Hospital Managers

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Executive Summary, cont.The mean change in trust scores was significantly increased by the intervention (p=0.02). The intervention had no effect on communication scores or decentralization of decision making processes scores (p>0.1). The mean change (increase) in collaborative activities scores was borderline/marginally significant (p=0.061).

There was no difference in scores between the sexes for trust (p=0.25) or openness, fullness, and fairness of communication (p=0.12). Males tended to have higher posttest scores than females in decentralization of decision making (p=0.02).

The difference in collaboration scores between the sexes was borderline/marginally significant (p=0.061) with males tending to have higher scores than females. None of the measures was related to level of education, occupation, or years of experience (p>.1).

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Notes about this studyThis presentation is a brief synopsis of the research project. These first few slides provide the overall study findings. You may scroll through the rest of the slides for greater detail on the research project.

The key takeaways of this study are as follows:

All measures (trust; decentralization of decision making processes; openness, fullness, and fairness of communications; and level of collaborative activities) were highly positively correlated with each other. This suggests that employees believed conceptually that these elements relate to one another in a human resources context.

Employees viewed that each of these elements were important for effective employee-organization relationships, particularly related to leadership and organization culture.

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Notes about this studyKey takeaways, continued:

The level of trust between mid-level managers and senior management can be improved by exposure to and discussion of leadership concepts. Creating and increasing trust may be universally seen as valuable within organizations since trust is critical to effective human relationships.

Providing leadership training had no effect on communication scores or decentralization of decision making processes scores. This is not surprising since improved communications or delegation of decision making might be seen as the result of behavior change, which occurs gradually and generally not as a result of simple educational interventions.

Sustained behavior changes tend to be the result of ongoing, focused behavioral interventions (action learning, coaching, personal development plans).

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Notes about this studyKey takeaways, continued:

The mean change (increase) in collaborative activities scores was borderline/marginally significant, and the comments above on sustained behavior change appear applicable here as well.

Gender did not appear to be a factor in any of the elements measured, neither did level of education, occupation, nor years of experience .

For those of you reading further, a reminder: a p-value is an indication of statistical significance. Values below 0.05 indicate that the finding has less than a 5% chance of occurring by random chance and, therefore, we say that the finding is statistically significant. Values between 0.10 and 0.05 are considered marginally significant.

P.S. Thanks also to Greg Russell for assistance in data analysis

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Quantitative Exploratory Study

To consider issues of leadership and organizational alignment by examining:

Trust between organizational leadership units

Where decision making occurs

Senior leadership communication with mid-level leadership

If senior leadership fosters collaboration within and across boundaries

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Definitions

Central Administration: The senior leadership team of the organization consisting of the CEO, Chief Operating Officer, Chief Financial Officer, Chief Medical Officer, and the other Vice Presidents who supervise the departments of the organization.


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Collaboration: behavior that attempts to satisfy completely the needs of the parties that are in conflict with one another (Mishra, 1996).

Communication: The process by which information and feelings are shared by people through an exchange of verbal and nonverbal messages (Institute for International Medical Education, 2003).


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Fairness: the presence of a conscious effort not to mislead another (Zand, 1981).

Fullness: Completeness of the information transmitted to another. There is a lack of effort to omit useful information in communications (Zand, 1981).


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Openness: freely sharing ideas and information across a broad spectrum of organizational topics and issues (Mishra, 1996).

Middle Managers: Supervisory individuals at the department director or department manager level.


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Organizational Trust: an individual’s belief, or common belief among a group of individuals that another individual or group (a) makes good faith efforts to behave in accordance with any commitments, both implicit and explicit, (b) is honest in whatever negotiations precede such commitments, and (c) does not take excessive advantage of another even when the opportunity is available (Cummings & Bromily, 1996).


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Study Rationale

Trust within organizations is seen as a critical component to effective organizational cultures

Corroborate findings of other studiesBlevins, 2001

Cummings & Bromily Organizational Trust Inventory (OTI), 1996

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Research Question 1

Is the level of organizational trust positively associated with leadership development education?

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Research Question 2

Is the level of organizational trust positively associated with the levels of decentralization found in decision-making processes?

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Research Question 3

Is the level of organizational trust positively associated with openness, fullness, and fairness of communication?

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Research Question 4

Is the level of organizational trust positively associated with the level of collaborative activities?

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Research Methods

Study population - Mid-level managers at one hospital in North Carolina (N=96)

Survey instrument - Web-based/self report

Sign-in (Q. 1-2)

Cummings-Bromily OTI (Q. 3 - 14)

Open, full & fair communication (Q. 15-18)

Centralization of decision making (Q. 19 - 21)

Collaboration (Q. 22 - 24)

Demographic information (Q. 25 - 29)

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Validity and Reliability

Construct validity and reliability were assumed

OTI scale previously validated

Some limitations exist with questions not formally validated

Subscales for communication, decision making, and collaboration were used effectively by Blevins, 2001

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Research Methods, cont.

InterventionSix leadership development educational sessions over 9 months (4-8 hours each)

Generally in groups of 25 persons

Topics included Change Leadership, Healthcare Finance, Managing the Job, Coaching and Developing Employees, Empowerment and Delegation, and Establishing Strategic Direction

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Research Methods

Survey administrationCover emails from organization CEO

Web-based survey software used for pre- and post-tests

Follow-up faxes and emails to ensure 100% participation by persons in position

Some staff turnover resulted in less than 100% pre- and post-test data

Data extracted into SAS® database

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Descriptive Findings

RespondentsPre (n=96), Post (n=90), Both (n = 77)

Male: 25 (29.4%), Female: 60 (70.6%)

Education levelHigh School 3 (3.5%)

Some college: 7 (8.2%)

Certificate: 5 (5.9%)

Bachelors 43 (50.6%)

Masters and Doctoral 27 (31.8%)

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RespondentsYears experience in supervision

< 6 years: (18%)

6-10 years: (16.9%)

11-20 years: (46.1%)

> 20 years (9%)

Years at the organization< 6 years: (38.2%)

6-10 years: (29.2%)

11-20 years: (22.5%)

> 20 years (10.1%)

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Descriptive Findings, cont.

Respondents

OccupationNurse: 32 (35.6%)

Therapist: 3 (3.3%)

Technologist: 4 (4.4%)

Pharmacist: 2 (2.2%)

Other licensed/certified professional: 25 (27.8%)

Other: 24 (26.7%)

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Hypothesis 1

The Organizational Trust Inventory (OTI) score is higher after providing leadership development education.

Findings

Mean trust level increased from OTI scale score 64.5 to 68.3

Paired t-test significant at =0.05

Hypothesis 1 accepted

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Hypothesis 2

The Organizational Trust Inventory (OTI) score and the measure of decentralization of decision-making are positively associated.

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Pearson Correlation Coefficient reports high correlation between trust and decentralization of decision-making (p<.0001). Hypothesis 2 accepted

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Hypothesis 3

The OTI score and the measure of open, full, and fair communication are positively associated.

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Pearson Correlation Coefficient reports high correlation between trust and open, full, and fair communication (p<.0001)


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Hypothesis 4

The OTI score and the measure of collaboration are positively associated.

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Pearson Correlation Coefficient reports high correlation between trust and collaboration (p<.0001)


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Hypothesis 1 - Findings cont.

An organizational intervention aimed at leadership development should increase trust levels between senior leadership and mid-level management.

Positive development of organizational cultures, evidenced, in part, by a reduction of risk & vulnerability, can be effected through education.

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Hypotheses 2-4 - Findings cont.All outcome measures (trust; decentralization of decision making processes; openness, fullness, and fairness of communications; and level of collaborative activities) were highly correlated with each other (p<.0001)

People who felt senior leadership was trustworthy also felt that senior leadership had fair, open & complete communications and supported collaboration and decentralized decision making

The inverse is also true

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Hypotheses 2-4 - Findings cont.Communication

To test the significance of the average change in communication, a paired t-test was used. The mean change is not significantly different from zero (p=0.21) indicating that the intervention had no significant effect on communication scores.

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Hypotheses 2-4 - Findings cont.Decentralization of decision making processes

To test the significance of the average change in decentralization of decision making processes, again, a paired t-test was used. The mean change is not significantly different from zero (p=0.47) indicating that the intervention had no significant effect on decentralization of decision making processes scores.

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Hypotheses 2-4 - Findings cont.Collaborative activities

To test the significance of the average change in collaborative activities, a paired t-test was used. The mean change is borderline/marginally significant (p=0.061) indicating that the intervention may have had an effect on collaborative activities scores.

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Hypotheses 2-4 - Findings cont.If an intervention was designed to improve one of these elements of effective organizational culture (trust; decentralization of decision making processes; openness, fullness, and fairness of communications; and level of collaborative

activities) an increase should typically be seen in other elements as well

It is possible that there was not enough change in elements to observe this increase in this study

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Other Findings

There was no difference in scores between the sexes for trust (p=0.25) or openness, fullness, and fairness of communication (p=0.12)

There was a difference in how males and females reported the change in decentralization of decision making (p=0.02), with males tending to have higher scores than females

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Other Findings

The difference in collaboration scores between the sexes was borderline/marginally significant (p=0.061) with males tending to have higher scores than females

None of the outcome measures was related to level of education, occupation years of experience, all (p>.10)

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Discussion

Discussion - Quasi-field research

A melding of the rigor of the laboratory with actual behavior in practice

Pre- and post-test designed to evaluate change in behavior and perceptions

Recognized format for applied research

Results are probably generalizable to the U.S.

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Discussion - Leadership development

Educational exposure curriculums can have a positive affect on employee perceptions and behaviors

Most sources suggest that sustained improvements come from deeper-seated behavior changes

Behavior changes derive from developing new patterns over time (adopting new habits)

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Discussion - Trust and culture

Trust, as a lubricant to social interactions, reduces anxiety and promotes effective interpersonal and interorganizational communication

Explicit efforts to improve trust among and within work groups should have strong collateral cultural benefits to the organization

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Discussion - Culture and relationships

Effective organizational cultures may be seen as passing through stages whereby stability in role relationships and risk & vulnerability give way to developing boundary spanning relationships within the organization

Solidifying this platform of relationships across the organization is an effective step in building strong cultures

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A gentle plugDr. Christopher J. Evans has over 25 years of business experience in business operations and financial management. He works primarily in organization dynamics, assisting executives to develop personal potential. His clients range from major academic medical centers and Fortune 100 companies to small businesses.

Chris contributes to the field through original research, as the author of several textbooks and articles on business operations and finance, teaching in graduate programs in business and health administration, and by serving as technical faculty to numerous professional organizations.

You may call Chris at (336) 918-8415 to discuss how to address your organizational challenges or work with your key executives and departments to help them become their best.

Christopher J. Evans, DHA, FACHE, CMPEHealth Capital Advisors, Inc.204 Lakeway DriveLewisville, NC 27023

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