Four Hypotheses For Why Health Care Managers Don’t Get Engagement

I devote much of my time as a health care researcher and management consultant to creating and delivering persuasive communications. I’m trying to convince health care managers to take engagement seriously. My objectives are (1) to enlist their participation in management research to explore new knowledge or (2) to see a consulting service based on existing knowledge. They are often a tough audience. Here are four hypotheses for why making the case for work engagement is so tough.

Why don’t health care managers get Engagement?

Hypothesis One: Line Control. Perhaps health care managers truly believe that they can exert sufficient control over employees’ behavior through the legitimate power that comes with their management position. They are the bosses, and as such, they have the authority to direct employees’ to act in ways that further the hospitals’ missions for patient care.

Hypothesis Two: Engagement is Irrelevant. Regardless of whether managers believe that employees will follow every directive with thoroughness and understanding (re Hypothesis One), managers may believe that performance is unrelated to however burned out or engaged employees may be. Managers may believe that these psychological states influence employees’ happiness, but not the nitty-gritty of their work performance. Investing in engagement has no payoff from this perspective.

Hypothesis Three: Engagement is Impossible. Even if managers believe in the importance of engagement for performance, they see engagement as a static quality of a person. Some employees arrive with an engagement potential; others don’t. After the selection process is complete, managers simply have to live with what they’ve got. They believe organizational psychologists lack conclusive knowledge on bringing about engagement where it does not already exist.

Hypothesis Four: The Powerless Manager. Even if managers believe in the possibility of influencing employees’ level of work engagement, they feel powerless to act. Their authority and resources as a manager limit their options so severely that they would be unable to take the action necessary to influence employees’ engagement. Managers believe they lack the financial support, people, or executive mandate to change what really matters within their workplaces.

My experience convinces me Hypothesis Four is the dominant view. My conclusion is discouraging in that it suggests that a large majority of people managing our health care systems can’t address the big issues of the day. The powerless position discourages managers to participate in intervention studies that make demands on resources and on their management credibility. Instead they limit the research activities within their domains to surveys that reinforce existing knowledge without prompting change. The powerless position encourages managers to choose programs on the basis of low cost or minimal disruption rather than effectiveness.

Health care managers are idealistic people facing major challenges with limited resources of time, money, and support staff. Although they face real limits, they are not truly powerless. The quality of health care and their employees’ fulfillment rests to some degree on managers stretching those limits to discover and apply new knowledge to further work engagement.

In light of this reflection on the state of health care management, my priority is helping managers discover the creativity and confidence necessary to pursue meaningful change.

1 Comment

  1. While all of your hypotheses are correct # 4 I agree is closer to the truth but it does not drill down far enough.

    After my 16 years as a nurse manager and for the last 14 years of working directly with Nurse and Health care Managers and their staff across this country the real issues have for the most part not been named.

    In attempting to help managers address their issues I’ve just written and published a book for Clinical Nurse Managers that reflects my experience of what I have seen, heard and coached them about regarding their role and responsibilities. Although the book targets Clinical Nurse Managers it is applicable to middle management in many organizations both inside and external to health care. It is brief, to the point and offers strategies that I have been told are relevant. I am currently in the process of writing a textbook with the same themes but offering greater depth. My book is:

    Fry, B. (2010). Fast Facts for Clinical Nurse Managers: Managing a Changing Workplace in a Nutshell. New York: Springer.

    A few years ago I gave you a copy of my Masters thesis which I now realize represented only the tip of the NM/staff engagement iceberg. Two years ago I was the closing keynote at the Canadian Nurses Association’s 100th birthday celebration during which I touched on the underbelly of the nursing culture that must change…tough words that tapped into the roots of powerlessness. The audience response was overwhelming and told me that I struck a raw nerve still deeply buried within the nursing and health care culture and in desperate need of healing.

    Yes today’s HCM’s are a tough audience who are diamonds in the rough. The challenge is how best to help this vitally important group of leaders who have the real power to improve quality of work life and quality of care. I believe that the situation is fixable and the key lies in creating new new way of being. Barb

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