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Almost 100 years ago, Frederick Taylor argued that most jobs could be done more efficiently if they were analyzed thoroughly (Lee, 1980; Locke, 1982). Given a well-designed task and enough incentive to get the work done, workers will be more productive. For example, Taylor promoted the concept of paying people by the piece instead of by the hour. In health care, the equivalent of what Taylor recommended would be paying by the number of patients bathed or visited at home rather than by the number of hours worked. This creates an incentive to get 3663_Chapter 2_0017-0026.indd 17 663_Chapter 2_0017-0026.indd 17 9/15/2014 4:37:02 PM /15/2014 4:37:02 PM Process Cyan rocess CyanProcess Magenta rocess MagentaProcess Yellow rocess YellowProcess Black rocess Black 18 unit 1 ■ Professional Considerations the most work done in the least amount of time. Taylorism stresses that there is a best way to do a job, which is usually the fastest way to do the job as well (Dantley, 2005). Work is analyzed to improve efficiency. In health care, for example, there has been much discussion about the time and effort it takes to bring a disabled patient to physical therapy versus sending the therapist to the patient’s home or inpatient unit. Reducing staff or increasing the productivity of existing employees to save money is also based on this kind of thinking. Nurse managers who use the principles of scientific management will pay particular attention to the types of assessments and treatments done on the unit, the equipment needed to do them efficiently, and the strategies that would facilitate more efficient accomplishment of these tasks. Typically, these nurse managers keep careful records of the amount of work accomplished and reward those who accomplish the most. Human Relations–Based Management McGregor’s theories X and Y provide a good contrast between scientific management and human relations–based management. Like Taylorism, Theory X reflects a common attitude among managers that most people do not want to work very hard and that the manager’s job is to make sure that they do work hard (McGregor, 1960). To accomplish this, according to Theory X, a manager needs to employ strict rules, constant supervision, and the threat of punishment (reprimands, withheld raises, and threats of job loss) to create industrious, conscientious workers. Theory Y, which McGregor preferred, is the opposite viewpoint. Theory Y managers believe that the work itself can be motivating and that people will work hard if their managers provide a supportive environment. A Theory Y manager emphasizes guidance rather than control, development rather than close supervision, and reward rather than punishment (Fig. 2.1). A Theory Y nurse manager is concerned with keeping employee morale as high as possible, assuming that satisfied, motivated employees will do the best work. Employees’ attitudes, opinions, hopes, and fears are important to this type of nurse manager. Considerable effort is expended to work out conflicts and promote mutual understanding to provide an environment in which people can do their best work. Servant Leadership The emphasis on people and interpersonal relationships is taken one step further by Greenleaf (2004), who wrote an essay in 1970 that began the servant leadership movement. Like transformational and caring leadership, servant leadership has a special appeal to nurses and other health-care table 2-1 Differences Between Leadership and Management Leadership Management Based on influence and shared meaning Based on authority An informal role A formally designated role An achieved position As assigned position Part of every nurse’s responsibility Usually responsible for budgets, appraising, hiring, and firing people Requires initiative and independent thinking Improved by the use of effective leadership skills THEORY X Work is something to be avoided People want to do as little as possible Use control-supervision-punishment THEORY Y The work itself can be motivating People really want to do their job well Use guidance-development-reward Figure 2.1 Theory X versus Theory Y. 3663_Chapter 2_0017-0026.indd 18
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