Medical Errors Report #8

A Four-Year Solution Implementation Study

 A Disconnection Between Middle and Upper Management Retards Quality Improvement

There is a disconnection between hospital upper and middle management. The frontline workers are receiving conflicting messages from both systems. Upper management has policies to be implemented by middle managers. But the upper management is never aware of what the middle managers are telling the frontline workers. Presently, there is no effective way to measure the disconnection between the message from upper management and the behavior of middle management. When such conflicts are experienced, the frontline workers naturally stop responding. The basic fundamentals of human behavior dictate that, people do not believe in what is being said to them as much as they react to attitudinal behavior. Regardless of what hospital upper management tells employees, workers react more to the behavior of the middle managers which directly impacts their work. There is a major problem in health-care administrations and businesses still using hierarchical power structure. Some hospital establishments are already seeing this problem and are replacing the hierarchy of communication with parallel communication between the administration and employees through the shared accountability concept. Some hospital administrators are setting up townhall meetings or breakfast chats with employees to hear their concerns. Other administrative officials conduct similar meetings for show, that results in no change in administrative policies. Not responding to employees concerns can be more damaging to the credibility of an administration. If you know you are not willing to modify the system, do not ask employees for their opinions. Parallel communication of employees directly with hospital executives allows employees to relate concerns directly to administration without asking permission from their supervisor.

 Many times managers will say, “I’ve tried everything; nothing seems to fix this problem because workers are not responding.” But the same managers are unaware of the less than professional way they have treated their workers by sending the wrong messages. It is important to bridge the gap between the middle management and that of the upper management messages sent to frontline workers. Disconnection of messages between the upper management and that of the middle management remains a persistent source of employee disenchantment. Disgruntled workers are not motivated to fix systemic failures. According to one physician who preferred his name not be used said,  “Quality improvement is more attainable in hospitals where the administration is more connected to employees working on the frontline compared to those hospitals where the hospital executives have insulated themselves from employees.”

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