Thesis Chapter 2 - Analysis and Evaluate the Effectiveness of a First Time Managers Programme in a Health Service Executive (Ireland)

Analysis and Evaluate the effectiveness of a First Time Managers Programme in a Health Service Executive (Ireland)

Chapter Two. Literature Review

 

2.1 Management and the Manager

The vast collection of printed books and scholastic journals in the field of management present a wide variety of sources. There are various segments of management that were studied and continuously attract researchers to delve into more researching and probing. From general management to international management up to the specifics namely human resources management (HRM), strategic management, operations management, financial management, marketing management, information technology management and healthcare management, it dynamically affect and serve as a contributory factor in the further development of the current trends that eventually improve the science of management as whole. Today, there are other management fields such as change management, career management, project management, knowledge management, risk management and the like that are considered significant and served as sub-fields and by-products of the general concept of a successful and inclusive management.

Managers and management have been studied extensively from several perspectives. Other stream of research has focused on the behaviour of managers and their role in organisations. Specifically, previous and early academic researches involved Mintzberg (1973) who examined the implementation of the managerial function or how managers perform their tasks and responsibilities. Further, other studies by Harbison & Myers (1959) have looked at managers as an interest group, class, or elite, and at least one classic inquiry) and treated managers as an economic resource.  A great deal of the work on managers and management has examined these perspectives across societies and cultures are presented in the studies of Massie and Luytjes in 1972 and Negandhi and Prasad in 1971.  Other literatures include the topics of employment practice (Martin & Kassalow, 1980; Smith, 1981; Windmuller & Gladstone, 1984) and managers as employees or worker (Roomkin, 1989).  Nearly all have focused on the non-managerial labour force or on managerial unionism. Roney (2004) provides an academic treatise of the main research literature in comparative and international management. Adler (1991) offers important lessons in consciousness-raising for students and managers alike. Sims, (2002) cover important topics like selection, training, compensation, and labour relations implications for firms operating internationally. Managerial values in different countries are the topic researches of Ralston et al., (1992), Bigoness & Blakely (1996) and Mathur, Neelankavil & Zhang (2000). They tackled the emerging management in selected countries of the West and East economies.

Currently, researches in management focus on the specific areas such as strategic and change managements. The reason behind this is to update the people in the all management environment and go along with the challenges of the global business environment. Strategic management, for example can be defined as the art and science of formulating, implementing and evaluating cross-functional decisions that enables any organisation to attain its objectives (Liou, 2000). Strategic management guides an organisation relative to challenges and opportunities appearing in the contingent environment (Pearce & Robinson, 2000; David, 2001; Drejer, 2002; and Thompson & Strickland, 2003). This is a systematic, comprehensive and encompassing process that is device to combat the inevitable challenges of global competition. Managers allocate a significant proportion of their abilities to go with the current trends affecting the organisation in which they work and affiliate themselves. Meanwhile, change management (or innovation management) is the formulation and assimilation of change in a methodical process (Burnes, 1996; Collins, 1996; Moran & Brightman, 2001; Matveev, 2002; and Butcher & Clarke, 2003). The major objective of change management is the introduction of innovative means and systems in the work organisation.  Organisations must normally undergo change in order to evolve to a higher level of for instance, stability, management or production. Appointing a new head officer, for example, can greatly enhance his subordinates based on his management principles and personality. Same as strategic management, managers today consider change as an indicator of the expected functions, productivity and future performances in the organisation.  

In healthcare organisations, Loo, (1997) justified the value and importance of implementing management practices.  In his study, he implemented two complementary research techniques: case study of one municipal hospital and Round 1 of a Delphi study in order to focus on management training and development of the Canadian healthcare sector, which is facing dramatic changes. Basically, Loo, (1997) focuses on effective management, which is a vital factor which influences the organisation and management training and development, which in turn helps to ensure the quality of health services being offered.  This literature is important because it can give the researcher important background information about the subject matter based on an actual scenario or case study.

Apparently, Mc Connell, (2007) valued the role played by the Care Supervisor. Mc Connell, (2007) shows how hands-on, practical application of classical and contemporary management principles contributes in health care setting. Mc Connell, (2007) also presents different strategies, techniques and tools in order to establish and reinforce management skills in order to meet the current challenges and risks to be faced by health care supervisors and managers. It also presents the current setting of the healthcare environment, which includes the changing roles of managers in an ever changing environment, as well as the difference of the healthcare industry with other industries. Mc Connell, (2007) argued that different actions and strategies are necessary in order to become a successful manager or supervisor. 

 Actually managers are also prone to problems.  Pearce (1999) studied the problems being faced by first-time managers. Pearce (1999) hypothesis tests that new manager’s experience a set of problems which happen with greater frequency for them than for more experienced managers. In addition, Pearce (1999) also examines and analyses the connections between the problems of individual managers and the demographic characteristics. Basically, he categorises problems into three areas: (1) new manager’s expectations, (2) relationships with subordinates and (3) relationships with their managers. The most meaningful discovery of the study is the vital lack of connection between the personal qualities of the manager’s and their most frequently encountered problems. In addition, Pearce (1999) also showed that the new manager’s relationship with their managers’ are connected to the three important demographic factors. On the other hand, few correlations were found between the characteristics of the surveyed new managers as well as individual programme frequencies. Actually, the study of Pearce (1999) was limited to the demographic variables, which include gender, age, level of formal education and their tenure with the organisation.

Management as a science and the role of managers continue to develop as changes in the global marketplace occur. It is a dynamic area of study that will continuously dedicate an enormous proportion of time for further researches and discoveries to develop, alter, and achieve optimal performance in management. Further, it is expected that there will still be new and on-going management studies and probes as managers maintain their prescribed functions and responsibilities in relation to the principles of management.

2.2 Managing the Healthcare Institution

Management is necessary to make labour and capital productive and requires converting economic principles into rules of behaviour that can be clearly communicated to employees, bosses, clients, and other partners. Management is not simple. In management it is people, not things,  that have to be managed, and because decisions must be made under uncertainty, based on expectations, without ever really knowing the entire facts one would like to have, it makes it all the more complicated.

Berk & Berk, (1991) prepares a manuscript designed for first-time managers’. Berk & Berk, (1991) offers different answers the day-to-day question about how managers can cope within their organisations, regardless if its size. Berk & Berk, (1991) also focuses on the process of understanding networks in all of its aspects, which include mentoring, coaching, ethics and establishing of connections and relationships inside the working environment. Basically, Berk & Berk, (1991)  are helping managers to focus on the essence of being good managers, which is to understand one’s responsibility, knowing the way of doing it, recruiting and cultivating the right people and helping these people to know and realise their full potential and skills.  

Apparently, Brown, (1992) with his book entitled ‘Health care management: Strategy, structure and process’ provides information based on the insights of management experts in healthcare settings, regarding the different issues such as diversification, mergers and acquisitions, vertical integration as well as total quality management, and how all of these factors are suitable in the entire organisational structure. It also focuses on the different issues and procedures related with managing the healthcare industry. Brown, (1992) helps to offer methods which can be used in the process of planning for future growth and maintaining good relationships between the organisation and its stakeholders.

In addition to this, Celik, Abma, Widdershoven, van Wijmen, and Klinge, (2008), shows some contribution about handling diversity in health care.  Basically,  Celik, Abma, Widdershoven, van Wijmen, and Klinge, (2008) focuses on an investigation of the degree of different healthcare practices, at the same time, focusing on the different opportunities and threats or risks which can be encountered during the implementation of diverse practices in the healthcare system. It also discusses the different factors that might influence the effectiveness of management procedures in the healthcare environment due to the issues of diversity, particularly due to the impact of globalisation. This is important because diversity is considered an important issue in management and leadership in a healthcare setting. This is because it can affect the overall policy and agenda creation and implementation in the organisation.

In the organisation paradigm, systemic empowerment, reciprocity, and representation are the factors that should be addressed. In the case before us, the whole healthcare organisation recognised that its approach of arrogance—its approach of knowing what is best in healthcare and serving the community—was its downfall in its attempts at successful healthcare management (Williams, 2002).

The first recognition was that the experts’ model did not lend itself very well to issues of empowerment for the employees or the community. Therefore, whatever new strategy was developed, it had to embrace empowerment of all in decision making, organisational and performance structure, service delivery modelling, and people behaviour if the model was to meet the communal needs of the client base to be served (Williams, 2002).

Second, the business model would need to embrace the thought issue of collaboration and the behavioural issues embedded in reciprocity—the give and take.

Last, medical care and management needed to be a representation of all affected by the healthcare. This would mean that an experts approach might not be as successful as a case conference approach which would involve physicians, mental health professionals (clinical and organisational psychologists, specialty and organisational psychiatrists), social workers, church leaders, family members, and family support system members. Although the process might seem unwieldy, the reality was that differing ways of knowing and differing world views would expand the options and capacities needed to craft strategies that fostered harmony, bonding, trusting, and honouring of the client and the healthcare system (Williams, 2002).

 

2.3 Managing Healthcare Quality

The current preoccupation with quality assurance is symptomatic of a far wider concern with modern management methods and contemporary management speaks and their application to the health care field (Blumenthal, 1996). This has, in part, been driven by the relatively new competitive and contractual climate in health care delivery and in part by the need to provide effective and efficient services and programmes.  

One of the factors that influence healthcare providers to implement quality management is the emergence and growth of accrediting bodies in healthcare (Blumenthal, 1996).  In response of healthcare management to the public concern about quality of care provided in managed care organisation and to the assumption that the government and national health authorities might soon develop another institution that would monitor healthcare providers, different nations have developed accrediting agencies.  These agencies are responsible for inspecting a certain healthcare providers to determine if such provider executes quality management. Realising that the assessment of accrediting agencies is important for the organisation, many healthcare providers adhere to the needs of imposing quality management in healthcare.

Healthcare Quality - Another factor that influences healthcare providers to implement quality management is the emergence and growth of accrediting bodies in healthcare (Blumenthal, 1996).  In response of healthcare management to the public concern about quality of care provided in managed care organisation and to the assumption that the government and national health authorities might soon develop another institution that would monitor healthcare providers, different nations have developed accrediting agencies (Blumenthal, 1996).  These agencies are responsible for inspecting a certain healthcare providers to determine if such provider executes quality management. Realising that the assessment of accrediting agencies is important for the organisation, many healthcare providers adhere to the needs of imposing quality management in healthcare.

Ensuring Quality Service - According to Bethke et al (1994), implementing a quality management system has become the preferred approach for improving quality and productivity in different organisations including the healthcare organisations. The concept of quality management, which has been adopted by different healthcare organisations, is a participative system empowering all employees to take responsibility for improving quality within the organisation (Bethke et al, 1994). Instead of using traditional bureaucratic rule enforcement, quality management calls for a change in the corporate culture, where the new work climate has the following characteristics: an open, problem-solving atmosphere; participatory design making; trust among all employees (healthcare workers, managers); A sense of responsibility for goal achievement and problems solving; and, self-motivation and self-control by all healthcare workers and providers (Bethke et al, 1994). The quality management approach involves more than simply meeting traditional rejection rate standards. The end result of quality management within healthcare system is the efficient and effective use of all organisational processes in providing consistent quality to make the patients and consumers satisfied.

Gaining Competitive Advantage - Winning s strategies such as the utilisation of quality management approach are grounded in sustainable competitive advantage.  It is said that a healthcare organisation has competitive advantage whenever it has an edge over its competitors in attracting customers and defending against competitive forces. Competitive advantage is derived from external factors or positional advantage and internal factors or resources and assets used. The latter is the effect of the competencies of the firm (Barney, 1991).

Thus, a definition of competitive advantage might be: competitive advantage is a measure of the ability of the company to deliver value to the customer or patients divided with the resources used relative to the competitors.  This measure of competitive advantage is not an operational measure and should not be taken as such. However, it does focus attention on two different issues that must be seen in connection in quality management: the position enjoyed by the healthcare organisation and the internal competencies of the firm, which together form the basis for judging the competitive advantage of the firm. Evidently, both measures must be taken relative to the competitors of the company (Porter, 1985).

Any organisation is interested in competitive advantage; actually it may be said to be the very purpose of quality management, especially if the advantage proves to be sustainable. Barney, (1991) defines this as, “…companies have sustainable competitive advantage when they consistently produce service systems with attributes which correspond to the key buying criteria for the majority of customers in their targeted market…” Thus, if a company has sustainable competitive advantage, customers will prefer its product offerings to those of the competition; that is, external and internal productivity will be greater than that of other firms in the targeted market.

Having effective management system - Lastly, it is said that healthcare organisations tries to utilise a quality management healthcare system because they want to initiate an effective management system which will be helpful in adhering to quality assurance.  The implementation of the concept of quality assurance enables the health care system determine the focus of work, directions and content of healthcare activities and the cost effectiveness priorities of the person involved.  The need of the healthcare system may be determined in a variety of ways but typically through the judicious use of focus groups using rapid appraisal techniques or through standard questionnaires as assessment instruments. QA can be built into the needs assessment strategy by developing post-intervention methods that rely on, for example, critical incident techniques. This allows members of the community to assess explicitly whether a health care programme has met and satisfied the identified need. This application of QA to the process of an interventions life has to have standards in order to measure the quality. These standards, which should be quantifiable, need to provide a precise indication of consistency. They should initially be based on best existing practice with the cooperation of practitioners, and have a temporal dimension which allows them to improve over time. Standards can be sub-divided into criteria and indicators, depending on how precise the QA process is to be.

2.4 Training and Development

In order to effectively implement changes, organisation administrators need to have systematic procedures to get these done. According to Hornsby & Kuratko (2005), training and development activities can help companies acquire a staff with the right combination of skills and motivations which an organisation needs to be competitive. They further explained that this process includes three different types of activities namely: orienting the new employees; helping employees acquire new skills and helping the employees strengthen existing skills.

Goad, (2010) in his paper presents the different risks and threats related to facilitating learning in an organisation and towards the employees of different working environments. This is important because Goad, (2010) focuses on analysing the changes in the working environment, due to a highly diverse workforce, particularly the differences in terms of age and culture, which can affect their learning process. In addition, it also presents the different available technology and innovations which can be used in order to facilitate learning and training in the working environment. It also presents different techniques, procedures and strategies to be implemented in order to ensure successful training and development.

 On the other hand, Phillips, (2003) examines return on investment which is critical for any training programme to survive. Where an individual is involved it needs assessment to see if there is a performance improvement. Also any assessment should look at the instructional design, delivery and evaluation of the programme. Phillips, (2003) with its step by step approach and its use case studies is of value and interest from management teams and clients wishing to enhance their skills on converting data to monetary values.

An integral part of paper of Phillips, (2003) is the consulting process used which involves continuously evaluating success and measuring ROI for training programmes. It demonstrates how to capture both qualitative and quantitative data and how this information is evaluated.

Basically, there are many trends in training which companies employ today. Goldstein & Gilliam (2000) have suggested that training has to adapt to four major trends: (1) changes in the demographic characteristics of the workforce; (2) increased technology; (3) shifts from manufacturing to service-oriented jobs; and (4) the increased influence of international markets. Managers today invest in training their staff in order to be updated with the latest developments in whatever sector they are in. All the trends that exist nowadays are relevant in the overall performance of managerial roles of the manager especially in global business environment. Included in training and development is the aspect of discipline which is becoming more troublesome in the recent years because managers consider it a trial to enforce while the employees consider it unfair and inconsistent in application (Hornsby & Kuratko, 2005). Some disciplinary procedures can result to high turnover, loss of morale, lower performance levels, legal problems and loss of employee respect for managers. Companies have many alternatives in ensuring that a degree of discipline is instilled in the office either by someone whose performance is not up to standards or by someone who exhibited inappropriate behaviour. Thus, the manager is in-charge not only to the development of the organisation but to the totality of his/her workforce as well.

Cifalino, (2009) presents an exploratory study of the evaluation of training programmes based on a theoretical framework, which review both the training literature and some strategic performance measurement literature. It helps to analysis whether operational approach, which was suggested by many training literature and the strategic approach, which is suggested by strategic performance measurement, are considered as actionable and feasible to measure the performance of training programmes and what happens between these two approaches. In addition, Cifalino, (2009) helps the researcher to focus more on the cost or financial aspect of the programmes which are related with the training and other aspects of human resources in a healthcare setting. 

Moreover, Coulson-Thomas, (2010) shows how currently the entire healthcare industry is facing risks, threats and challenges which affect the entire process of managing its workforce. With this in mind, it is important to focus on these factors and issues in order to implement and apply strategies that will meet the demands of healthcare organisations. Coulson-Thomas, (2010) focuses on the use of a new generation of learning and support tools in order that they make a vital contribution in tackling issues and problems related to the healthcare environment. Coulson-Thomas, (2010) presents information related to the education and training needs and demands in the healthcare environment.       

 

2.5 Leadership: the Manager’s Armour

As implied in the previous definitions of a manager, a manager is a LEADER. Leadership comprises the aptitude and ability to inspire and influence the thinking, attitudes, and behaviour of other people (Adler, 1991; Bass, 1985; Bass and Stogdill, 1989; and Bennis & Nanus, 1985). Leadership is a process of social influence in which one person is able to enlist the aid and support of other individuals in the achievement of a common task (Chemers, 1997). The major points of this definition are that leadership is a group activity, is based on social influence, and revolves around a common task. Although this specification seems relatively simple, the reality of leadership is very complex. The leadership styles sometimes can make an organisational change be successful or be a total failure.

Domeyer, (1999) offers leadership tips for first-time managers.  Domeyer, (1999) focuses on the different steps which first-time managers can take in order to hone their supervisory skills, establish credibility and win the support from his or her staff.  Domeyer, (1999) also focuses on the importance and significance of communicating in a clear manner, setting good example and encouraging feedback to staff.  Basically, Domeyer, (1999) recommended actions which first-time managers can do and apply to their jobs to carry out their responsibilities in a successful manner.

In the paper of Eni, (1989), he described the Critical Success Factor (CSF) as used in different healthcare organisations. Eni, (1989) discusses the use of the CSF approach in order to manage different aspects of the healthcare industry such as management of health services. Eni, (1989) explain how senior healthcare executives can use it in order to improve its management process. This is because it can help to define and direct the planning needs of the entire organisation. In addition, it can also help managers to achieve the overall goals of the organisation based on its mission, which consequently results to the maintenance of competitive advantage.   

Apparenlty, Hellstrom, Lifvergren, & Quist, (2010) studies what will happen when new management ideas with manufacturing origin are implemented in healthcare organisations. Hellstrom, Lifvergren, & Quist, (2010) focuses on process management particularly the aspect of the healthcare environment by considering the different methodologies and approaches used in the process management in the entire organisation. It also tackles the different issues and factors which can influence or hinder its application in a healthcare setting. Hellstrom, Lifvergren, & Quist, (2010) also recommends different actions and strategies to be implemented in order to ensure success in the healthcare setting.  Compared to the study of Jasper, & Jumaa, (2005), Jasper & Jumaa, (2005) integrates different theories and practices which are connected to the reality of healthcare leadership in the contemporary world. It address the issues related to the strategies for leadership, at the same time analyse the leadership skills that are needed in order to implement and maintain developments in the healthcare environment. According to Jasper & Jumaa, (2005), leadership in a healthcare setting is very important, particularly because it is considered a very complicated environment to work in. It is also important to focus on the different aspects which are connected on how to lead people in the industry, because this is one of the primary tasks to be done by first-time managers in this environment. 

Finally, Levine, & Zhu, (1999) focus on the importance of training in the overall management and implementation of medical or health services in the hospital or healthcare setting. Levine, & Zhu, (1999) study was implemented in a complicated setting. Levine, & Zhu, (1999) focuses on process management; it also looks at other aspects of the healthcare environment, by pertaining on different methodologies and approaches which can be used in the process management of the entire organisation. It also tackles the different issues and factors which can influence or hinder its application in a healthcare setting. 

Leadership is an important aspect of management. As stated by a few authors (e.g. Cohen & Brand, 1993 and Hyde, 1992), management requires full leader participation and involvement instead of designating individual groups who will shoulder all the responsibilities. The involvement of leaders serves a number of purposes. For instance, this helps in preventing the resistance of employees to changes brought about by the implementation of quality systems. The enthusiasm and determination of the leaders to make the project work can positively influence other company staff. Furthermore, this also helps in creating a sense of commitment and loyalty (Hill, 1991).

In leading, there are several leadership styles that are utilised by the manager. Leadership style is the pattern of behaviour used by a leader in attempting to influence group members and make decision regarding the mission, strategy, and operations of group activities (Scholl, 2000). The presence of leadership in management is also one effective factor in addressing technical and non-technical issues. It is important however that the appropriate leadership style is used. The following discussion is the styles in leadership that managers implement in the organisation.

Transactional and Transformational Leadership. In transformational leadership, strong personal identification of the leader is involved. Furthermore, the relationship in this leadership style is more than the fulfilment of self-interest or provision of rewards (Hater & Bass, 1988).

Transactional leadership, the counterpart of the transformational style, is more on controlling people and giving out orders. This style has two main categories. One is called the management-by-exception where leaders tend to make use of their authority to reward or penalise people under them. Managers or leaders who use this category of transactional leadership tend to focus on asserting power, pointing out errors and disciplining subordinates with poor performance (Bass, 1985). Contingent reward leadership is the other category of this leadership style. In this style, the focus is on the communication of work standards and the provision of rewards if these standards are followed. Leaders applying this style ensure that the subordinates know what is expected of them and the consequences should they fail to meet these expectations. Naturally, rewards are given for good performance while punishments are given for poor performance (Avolio, 1999).

From this brief description, it becomes clear that transformational leadership is the most effective for all types of managers. Unlike transactional leaders, transformational managers value the interests of their employees as well as matters that will benefit the entire group. They tend to create realistic visions and encourage others to support them (Yammarino & Bass, 1990). Clearly, there is a direct interaction and open communication between the leaders and the followers in transformational leadership. Such leadership style is useful for implementing quality management systems, particularly in task delegation, training and project monitoring.

Other Types of Leadership Styles. The ever-changing trends in the business communities worldwide permit every organisation to use the most suited leadership styles. There are other types of leadership styles that can be utilised by the manager; however such styles are dependent to the strategic implementations of the organisation’s mission and vision. Among these styles are: aristocratic (monarchy), autocratic/paternalistic (dictatorial), democratic or participative, laissez-faire, and/or combination of both. But then again, the leadership style that a manager applies is defined by the nature and operations of the organisation he/she belong.

For instance, the role of manager in healthcare institution in connection to leadership include implementing policies, communicating policy to staff, and assisting healthcare practitioners in giving healthcare services. It is similarly focused into the leadership functions in the society’s city and county managers. However, with the dynamic changes of the society, there are also considered alterations in the traditional roles of the public management manager. Among these are leadership change, crisis-external and internal, and planned changes (Luthy, 1993). Again, the fact that there are new patterns and approaches continuously emerging in management science, every managerial function is subject for further development for immediate satisfactory effect. Research coupled with experience convinced managers for worthy considerations and trials.

References:

Adams, I., Darko, D., & Accorsi, S., (2004) Improving Efficiency, Assessing Efficiency in Service Delivery, Bulletin of Health Information 1 (1) [Online] Available at: http://www.ghanahealthservice.org/includes/upload/publications/Assessing%20efficiency%20in%20service%20delivery.pdf [Accessed 13 July, 2010]

Adler, N.J. (1991) International Dimensions of Organisational Behaviour. Boston, MA: Kent.

Avolio, B.J., Howell, J.M., & Sosik, J.J. (1999) A funny thing happened on the way to the bottom line: Humor as a moderator of leadership style effects. Academy of Management Journal, 42 (2): 219-227.

Barney, J.B. (1991) Firm Resources and Sustained Competitive Advantage. Journal of Management, 17: 12–26.

Bass, B.M. & Stogdill, R.M. (1989) The Handbook of Leadership. New York: The Free Press.

Bass, B.M. (1985) Leadership and Performance beyond Expectations. New York: The Free Press.

Bennis, W. & Nanus, B. (1985) Leaders. New York: Harper and Row.

Berk, J. & Berk, S. (1991) ‘Managing effectively: A handbook for first-time managers’. New York: Sterling Publishing.

Bethke, L.A., Clinton, R.J. and Williamson, S. (1994) Implementing Total Quality Management: The Role of Human Resource Management. SAM Advanced Management Journal, 59 (2).

Bigoness, W.J. & Blakely, G.L. (1996) A Cross-National Study of Managerial Values. Journal of International Business Studies, 27(4), 739-752.

Blumenthal, D. (1996) Part 1: Quality of care – What is it? New England Journal of Medicine 335, 891-894.

Brown, M. (1992) ‘Health care management: Strategy, structure and process’. Jones & Bartlett Learning.

Burnes, B. (1996) Managing change: A strategic approach to organisational dynamics. 2nd ed. London: Division.

Butcher, D. & Clarke, M. (2003) Redefining Managerial Work: Smart Politics. Management Decision, 41 (5), 477-487.

CDCP, (2003) Roundtable on Hospital Communications in a Mass Casualty Radiological Event, Centers for Disease Control and Prevention [Online] Available at: http://www.bt.cdc.gov/radiation/pdf/hospitalroundtablereport.pdf [Accessed 13 July 2010].

Celik, H., Abma, T., Widdershoven, G., van Wijmen, F. C. B., & Klinge, I. (2008) ‘Implementation of diversity in health care practices: Barriers and opportunities’. Patient Education and Counselling. 71(1), 65-71.

Chemers, M.M. (1997) An Integrative Theory of Leadership. London: Lawrence Erlbaum Associates.

Cifalino, A. (2009) ‘Training programs and performance measurement: Evidence from healthcare organisation’ Journal of Human Resources Costing & Accounting. 13(4), 294-315.

Cohen, S. & Brand, R. (1993) Total Quality Management in Government. San Francisco: Jossey-Bass, Inc.

Collins, D. (1996) New paradigms for change? Theories of organisation and the organisation of theories. Journal of Organisational Change Management, 9(4), 9-23.

Coulson-Thomas, C. (2010) ‘Transforming productivity and performance in healthcare and other public services: How training and development could make a strategic contribution’. 42(5), 251-259.

David, F.R. (2001) Strategic Management: Concepts and Cases. 8^th ed. Upper Saddle River, NJ: Prentice Hall, Inc.

Domeyer, D. (1999) ‘Leadership tips for first-time managers’ Women in Business. Vol. 51, no. 2, p. 42.

Drejer, A. (2002)  Strategic Management and Core Competencies: Theory and Application. Westport, CT: Quorum Books.

Eni, G. (1989) ‘The concepts of critical success factors (CSFs) as a planning tool for healthcare managers’ Healthcare Management Forum. 2(2), 12-17.

Goad, T. (2010) ‘The first-time trainer: A step-by step quick guide for managers, supervisors, and new training professionals’. AMACOM Div American Mgmt. Association

Goldstein, I.L. & Gilliam, P. (2000) Training system issues in the year 2000. American Psychologist 45.2: 134-143.

Harbison, F. & Myers, C.A. (1959) Management in the industrial world: An international analysis. New York: McGraw-Hill Book Company, Inc. Hater, J.J. & Bass, B.M. (1988) Superior's Evaluations and Subordinate's Perceptions of Transformational and Transactional Leadership. Journal of Applied Psychology, 73(1), 695-702.

Hellstrom, A., Lifvergren, S & Quist, J. (2010) ‘Process management in healthcare: Investigating why it’s easier said than done’. Journal of Manufacturing Technology Management. 21((4), 499-511.

Hill, S. (1991) Why Quality Circles failed but Total Quality management might succeed. British Journal of Industrial Relations, 29(4), 541-568.

Hornsby, J.S. & Kuratko, D.F. (2005) Frontline HR: A Handbook for the Emerging Manager. Crawfordsville, IN: Thomson.

Hyde, A. (1992) The Proverbs of Total Quality Management: Recharting the Path to Quality Improvement in the Public Sector. Public Productivity and Management Review, 16(1), 25-37.

Jasper, M. & Jumaa, M. (2005) Effective Healthcare Leadership. Wiley-Blackwell.

Levine, R. & Zhu, K. (1999) Preventive practicum in healthcare organisation: The Meharry model. American Journal of Preventative Medicine. 17(1), 91-96.

Liou, K.T. (2000) Applying Strategic Management to Economic Development: Benefits and Challenges. International Journal of Public Administration, 23 (9), 1621+.

Loo, R. (1997) ‘The future of management training in Canadian healthcare organisations’ Journal of Management Development. 16(9), 680-689.

Luthy, J.F (1993 April) Transition Management: A Redefined Role for Public Managers. Public Management, 75(4), 2+.

Martin, B. & Kassalow, E.M. (1980) Labor relations in advanced industrial societies: Issues and problems. Washington, D.C.: Carnegie Endowment for International Peace.

Massie, J., & Luytjes, J. (1972) Management in an international contest. New York: Harper & Row.

Mathur, A., Neelankavil, J.P., & Zhang,Y. (2000)  Determinants of Managerial Performance: A Cross-Cultural Comparison of the Perceptions of Middle-Level Managers in Four Countries. Journal of International Business Studies, 31(1), 121.

Matveev, A.V. (2002) The Advantages Of Employing Quantitative And Qualitative Methods In Intercultural Research: Practical Implications From The Study Of The Perceptions Of Intercultural Communication Competence By American And Russian Managers. New York: Russian Communication Association.

Mc Connell, C. (2007) ‘The Effective Health Care Supervisor’. Jones and Bartlett Learning.

Mintzberg, H. (1973) The nature of managerial work. New York: Harper & Row.

Moran, J.W. & Brightman, B.K. (2001) Leading organisational change. Career Development International, 6(2), 111-118.

Negandhi, A.R. & Prasad, S.B. (1971) Comparative Management. New York: Appleton-Century-Crofts.

Pearce, II, J. A. (1999) ‘Problems facing first-time managers’ Human Resource Management. 21(1), 4-6.

Pearce, J.A. & Robinson, R.B. (2000) Strategic Management: Formulation, Implementation and Control. Boston: Irwin/McGraw Hill.

Phillips, J. J. (2003) Return on Investment. Butterworth- Heinemann

Porter, M.E. (1985) Competitive Advantage. New York: The Free Press.

Ralston, D., Gustafson, D.J., Cheung, F.M. & Terpstra, R.H. (1992) Eastern values: A comparison of U.S., Hong Kong and PRC managers. Journal of Applied Psychology, 77: 664-71.

Roney, C.W. (2004) Strategic Management Methodology: Generally Accepted Principles for Practitioners. Westport, CT: Praeger.

Roomkin, M.J. (ed.). (1989) Managers as Employees: An International Comparison of the Changing Character of Managerial Employment. New York: Oxford University Press.

Scholl, W.R. (2000) Application of transtheoretical model. Changing leadership style. Retrieved January 20, 2011, from University of Rhode Island Website.

Sims, R.R. (2002). Organisational Success through Effective Human Resources Management. Westport, CT: Quorum Books.

Smith, E.O. (1981) Trade unions in the developed economies. New York: St. Martin's Press.

Thompson, A.A. & Strickland, A.J. (2003) Strategic Management: Concepts and Cases 13^th ed. New York: McGraw Hill.

Walford, V., & Grant, K., (1998) Health Sector Reform, Improving Hospital Efficiency [Online] Available at: http://www.dfidhealthrc.org/publications/Toolkits/HospEff.PDF [Accessed 13 July 2010]

Williams, L.C. (2002) Creating the Congruent Workplace: Challenges for People and Their Organisations. Quorum Books.

Windmuller, J.P. & Gladstone, A. (1984) Employers associations and industrial relations: A comparative study. Oxford, England: Clarendon Press.

Yammarino, F.J. & Bass, B.M. (1990) Transformational leadership and multiple levels of analysis. Human Relations, 43(10), 975-995.