zeine et al. considerate leadership in medical and higher education 2014

Organizational CulturesAn International Journal

OntheOrgAnIzAtIOn.COm

VOLUME 15 ISSUE 1

__________________________________________________________________________

Considerate Leadership as a Measure of Effectiveness in Medical and Higher EducationAnalysis of Supervisory/Managerial Leadership

RANA ZEINE, CHERYL BOGLARSKY, EDWARD DALY, PATRICK BLESSINGER, MARY KURBAN, AND ALWYN GILKES

ORGANIZATIONAL CULTURES: AN INTERNATIONAL JOURNAL www.ontheorganization.com

First published in 2014 in Champaign, Illinois, USA by Common Ground Publishing LLC www.commongroundpublishing.com

ISSN: 2327-8013

© 2014 (individual papers), the author(s) © 2014 (selection and editorial matter) Common Ground

All rights reserved. Apart from fair dealing for the purposes of study, research, criticism or review as permitted under the applicable copyright legislation, no part of this work may be reproduced by any process without written permission from the publisher. For permissions and other inquiries, please contact [email protected].

Organizational Cultures: An International Journal is peer-reviewed, supported by rigorous processes of criterion- referenced article ranking and qualitative commentary, ensuring that only intellectual work of the greatest substance and highest significance is published.

Organizational Cultures: An International Journal Volume 15, Issue 1, 2014, www.ontheorganization.com, ISSN 2327-8013

© Common Ground, Rana Zeine, Cheryl Boglarsky, Edward Daly, Patrick Blessinger, Mary Kurban, Alwyn Gilkes. All Rights Reserved. Permissions: [email protected]

Considerate Leadership as a Measure of

Effectiveness in Medical and Higher Education:

Analysis of Supervisory/Managerial Leadership

Rana Zeine, Saint James School of Medicine, USA

Cheryl Boglarsky, Human Synergistics International, USA

Edward Daly, Community College of Rhode Island, USA Patrick Blessinger, International Higher Education Teaching and Learning Association, USA

Mary Kurban, Christ the King Catholic School, USA

Alwyn Gilkes, Bronx Community College, USA

Abstract: Supervisory/Managerial Leadership characterizes many academic relationships within higher education

institutions. Students and trainees in many fields, including healthcare and graduate studies, often experience humiliation

and workplace aggression resulting from belittlement, bullying and abusive supervision which reflect defensive

organizational cultures. We and others have previously shown that higher education institutions, including medical

teaching centers, have detrimentally high levels of Aggressive/Defensive and Passive/Defensive cultural styles as

measured by the Human Synergistics International Organizational Culture Inventory® (OCI® & OCI-Ideal®) Surveys.

Central to effective undergraduate, graduate and post-graduate training are supervisory/managerial leadership practices

which are negatively impacted by the current higher education operating cultures. In this paper, we analyze

Consideration, one measure of supervisory/managerial leadership that assumes empathy in supportive/participative

leadership communications. Faculty and administrators at public and private higher education institutions were surveyed

using the Human Synergistics International Organizational Effectiveness Inventory® (OEI®). Results revealed

Consideration scores undesirably below both the Historical Average and the Constructive Benchmark in for-profit and

not-for-profit higher education institutions. To improve the effectiveness of higher education institutions we recommend

changing the dynamics of internal professional interactions by promoting the (a) adoption of Constructive organizational

culture norms, (b) application of Individualized Consideration and Positive Affect Transferal behaviors from

transformational leadership theory, and (c) institutionalization of path-goal theory-based Considerate Leadership

supervision.

Keywords: Consideration, Supervisory Managerial Leadership, Organizational Effectiveness, Organizational Culture,

Higher Education, Medical Education

Introduction

iven that the purpose of higher education institutions is to facilitate the transfer of

expertise from those who have it to those who seek to acquire it, most relationships

between higher education professionals and their followers are structured to support

teaching, learning, training, and mentoring activities. The effectiveness of these professional

interactions can be analyzed by applying the broader standards of supervisory/managerial leadership practices (Szumal 2001). Some notable examples of supervisory/managerial settings

that manifest during the course of higher education are (a) the supervision of graduate students

by mentoring professors, (b) the training of nurses by nursing supervisors, and (c) the

management of medical teams by attending physicians. Educators in such settings operate as

supervisory/managerial leaders who are often faced with the challenges of attaining multiple

goals concurrently, for example, the transferal of competencies in six integrated healthcare

domains including medical knowledge, patient care, research- or evidence-based medicine,

systems-based practice, professionalism, and communication skills (Crain, Alston et al. 2005)

G

ORGANIZATIONAL CULTURES: AN INTERNATIONAL JOURNAL

Consideration as an Effectiveness Measure of Supervisory/Managerial

Leadership

One measurable characteristic of supervisory/managerial leadership is the degree of

Consideration that is afforded by the supervisor and perceived by the subordinate. The traditional

Consideration dimension refers to a people-oriented style of leadership that is both supportive

and participative, and in which supervisory interactions create a positive psychological

environment that supports goal attainment (Mulki and Jaramillo 2011; Ohio State Michigan

studies reviewed in Yukl 2012). Individualized Consideration, which is a component of Transformational Leadership theory, also focuses on understanding the needs of followers

(supportive leadership) with a view to empowering them (developmental leadership) towards

attaining higher levels of potential (Bass, Avolio et al. 1996; Avolio and Bass 1999; Rafferty and

Griffin 2006). To recognize and elevate follower needs, Individually Considerate leaders show

empathy and concern for the individual needs of their followers (Bass, Avolio et al. 1996).

Another component of Transformational Leadership theory is Charisma, which is a factor that

provides followers with an energizing sense of purpose and enhances their identification with the

leader and the leader’s vision (Avolio and Bass 1999; Judge and Bono 2000). Studies have

demonstrated that leader charisma is positively associated with followers’ positive affect, and

negatively associated with followers’ negative affect (Erez, Misangyi et al. 2008).

The Considerate leader is further informed by the Path-Goal theory of supervision, which

focuses on how formally appointed superiors can affect the motivation and performance of their subordinates by ensuring that they “experience intrinsic satisfaction” as a result of attaining work

goals (House 1996).

Unfortunately, the majority of higher education professionals have never had opportunities

to reflect on either Bass’s Transformational Leadership theory, or House’s Path-Goal theory. In

addition, supervisors, subordinates and students may be resigned to a culture of bullying as a

result of having been exposed to bullying in their past, or of feeling powerless to change

prevailing institutional culture and policies. Studies indicate that bullying is a learned behavior

that could be perpetuated by overly competitive work environments and organizational reward

systems that encourage overly aggressive behaviors (Lewis 2006). This lack of sensitivity,

combined with a lack of awareness of the importance of Consideration, Individualized

Consideration, and Considerate Leadership approaches to achieving the goals of education, has led to a culture of tolerance towards chronic incivility behaviors in higher education institutions.

Incivility Problems in Higher Education

Sadly, the void created by the paucity of supervisory/managerial Consideration can foster the

emergence of a spectrum of hostile behaviors classified as incivility, humiliation, intimidation,

mistreatment, academic harassment, bullying, abuse and workplace aggression or violence

(Morse 2010; Hershcovis 2011). In schools, bullies target anyone who has a trait that is different

from theirs. Abusive supervision interferes with goal attainment by (a) negatively influencing the

followers’ perceptions of interactional justice, (b) significantly diminishing their beliefs that they

are engaged in meaningful work, and (c) considerably weakening their levels of organizational-

based self-esteem (Rafferty and Restubog 2011). Indeed, students’ emotional responses to experiences of either distributive, procedural or interactional injustice include feelings of anger,

frustration, powerlessness, stress, embarrassment, disgust and a sense of having been cheated

(Horan, Chory et al. 2010).

Workplace bullying has been shown to be more prevalent in stressful working environments

especially those that are characterized by intense interpersonal friction and destructive leadership

styles (Hauge, Skogstad et al. 2007). Workplace bullying involves negative social acts and

practices that are repeatedly and regularly directed at a target individual who may feel badgered,

2

ZEINE ET AL.: CONSIDERATE LEADERSHIP AS A MEASURE OF EFFECTIVENESS IN EDUCATION

insulted, humiliated, offended, intimidated, harassed, or socially excluded, and who perceives

having no recourse to retaliate (Hauge, Skogstad et al. 2007). Examples of nursing faculty

behaviors that have been perceived by nursing students as bullying include the deliberate

provision of punitive assignments or bad grades, and the setting of unmanageable workloads or

unrealistic deadlines (Cooper, Walker et al. 2011).

Many graduate students find that they are highly vulnerable to those who would use their

position or power to intimidate or harass them (Morse 2010). Examples of issues that are brought

to the attention of the Ombudsman by graduate students include (a) concerns that an adviser is

delaying their student’s degree progress in order to retain a cheap source of labor, (b) situations

in which a faculty member is taking advantage of a student research assistant who fears losing their visa status, or (c) one trainee is being given credit for another student’s work (Morse 2010).

Medical Students Experience Workplace Aggression

The use of aversive methods in medical education has left a "transgenerational legacy" of

mistreatment perpetuated by misguided efforts to achieve reinforcement of learning (Baldwin,

Daugherty et al. 1991; Kassebaum and Cutler 1998). Educators have used public belittlement,

intimidation and bullying of medical students and postgraduate trainees as tools to ‘teach through

humiliation’ (Spencer and Lennard 2005). Despite the knowledge that humiliation undermines

students’ self-esteem and is an unnecessary and preventable cause of harm (Rosenberg and Silver

1984), the view that learners somehow ‘benefit’ from being humiliated by their instructors

continues to be a subject of discussion in the medical education literature (Cookson 2006). Surveys of medical students and postgraduate trainees reveal that the perpetrators of adverse

experiences commonly include faculty members, senior doctors and nurses who do not refrain

from yelling, shouting, swearing, hitting, pushing, threatening, punishing, demeaning or

degrading acts. In one medical school in Chile, medical students reported that workplace

aggression negatively impacted their physical and mental health, social and family life, quality of

work, image of physicians and level of attraction to the medical profession (Maida, Vásquez et

al. 2003). In a nationwide study of four medical schools in New Zealand, medical students

affected by episodes of humiliation or degradation reported consequently avoiding the

department or individual perpetrator(s) (67%), seeking help or support from others (49%),

turning away from subspecialties that tolerate abusive behaviors (34%), becoming increasingly

withdrawn or isolated (26%), considering quitting medicine (16%) and taking time off from

medical school (5%) (Wilkinson, Gill et al. 2006). In a longitudinal study of sixteen medical schools in the United States, medical students who reported having been harassed or belittled

differed significantly by subspecialty (Table 1), and were significantly more likely to suffer from

stress, depression, binge drinking, suicidal ideation, suicide attempts and feelings that their

faculty did not care about them (Frank, Carrera et al. 2006).

3


Table 1: Percentages of medical students, surveyed at 16 US medical schools, who experienced

belittlement and harassment from residents or clinical professors

Subspecialty Residents Clinical Professors

Belittlement Harassment Belittlement Harassment

Psychiatry 77 % 38 % 66 % 21 % Family medicine 75 % 32 % 69 % 30 %

General Internal medicine 72 % 28 % 65 % 25 %

Emergency medicine 71 % 30 % 64 % 22 %

Surgery 70 % 28 % 60 % 24 %

Pediatrics 73 % 22 % 67 % 20 %

Public health, preventive

medicine, urology, undecided, other

69 % 27 % 62 % 22%

Anesthesiology, Pathology or

Radiology

70 % 27 % 60 % 16 %

Obstetrics & Gynecology 71 % 24 % 58 % 16 %

Total 71 % 27 % 63 % 21 % Data are adapted from “Experiences of belittlement and harassment and their correlates among

medical students in the United States: longitudinal survey,” by Frank, E. et al., 2006, BMJ, 333(7570)

In a cross-sectional survey of six medical schools in Japan, 68% of respondents reported

encountering some type of medical student abuse, however, only 8% of those affected had

formally reported the adverse incidents to authorities (Nagata-Kobayashi, Sekimoto et al. 2006).

The majority of medical students had doubts that reported problems would be dealt with fairly,

and they consciously refrained from asserting their rights for fear of retribution and/or conflict

escalation that could jeopardize their academic standing or interfere with the attainment of their

career goals (Nagata-Kobayashi, Sekimoto et al. 2006). A cross-sectional survey of six medical

colleges in Pakistan revealed that among the 52% of students who had faced bullying or

harassment, the frequencies of adverse experiences were less than once a month in 25%, once a

month in 16%, and once a week in 11% of the cases (Ahmer, Yousafzai et al. 2008). In addition

to experiencing verbal abuse (57%), physical abuse (5%) and written abuse (2.5%), medical students in Pakistan encountered behavioral gestures that they perceived as representing bullying

or harassment (26%), and a proportion felt that they had been either deliberately ignored (16%)

or excluded (11%) (Ahmer, Yousafzai et al. 2008). Another study documented the prevalence of

unfair practices by residents, colleagues and seniors who took credit for work done by medical

students (Shoukat, Anis et al. 2010).

Organizational Cultures with Defensive Styles and Workplace Bullying

Research instruments have been developed to explore organizational culture models qualitatively

and quantitatively (Jung, Scott et al. 2009). Organizations with Aggressive/Defensive cultures are

volatile because they value coercion, confrontation, criticism, and overconfidence, and their

members suffer from disempowerment, cynicism, disrespect and reliance on security-preserving

mechanisms such as the punishment and blaming of others (Cooke and Rousseau 1988). Organizations with Passive/Defensive cultures are vulnerable because conflicts tend to remain

unresolved as members lose their motivation, remain noncommittal and resort to self-protecting

mechanisms such as accommodation, avoidance, withdrawal and quitting (Szumal 2003). By

contrast, Constructive cultural styles support sustainability as organizational members thrive

through creativity, flexibility, consultation, communication, sharing of knowledge and insight,

reason, coordination, cooperation and behaviors that enhance self and develop others (Cooke and

Szumal 2000). To analyze the organizational culture in higher education, faculty, administrative

directors, department chairs and deans at institutions worldwide were surveyed using the Human

4


Synergistics International Organizational Culture Inventory® (OCI®) and OCI-Ideal® surveys

(Zeine, Boglarsky et al. 2011). The Ideal cultural profile scored above the 95th percentile for

Constructive styles, promoting Achievement (98%), Self-Actualization (98%), Affiliation (92%)

and Humanistic-Encouraging (98%) norms (Zeine, Boglarsky et al. 2011). By contrast, Current

operating cultures manifested excessively high levels of Aggressive/Defensive styles, evidenced

by Oppositional (67%), Power (50%), Competitive (63%) and Perfectionistic (52%) behavioral

norms; and similarly high scores for Passive/Defensive styles, evidenced by Approval (55%),

Conventional (54%), Dependence (55%) and Avoidance (59%) normative expectations (Zeine,

Boglarsky et al. 2011). Indeed, Constructive styles were below the 29th percentile on the 2000-

2001 OCI® profile for the Ohio State University Medical Center, whereas Avoidance (91%) and Oppositional styles were concurrently predominant (Sanfilippo, Bendapudi et al. 2008).

All types of workplace aggression, including bullying, social undermining, abusive

supervision, incivility, emotional abuse, interpersonal conflict and violence, are mediated

through blame attribution, affect and forms of injustice (Hershcovis 2011). It is believed that “the

norms and values within an organization, as well as the type and quality of the organizational

communication patterns, may constitute some of the essence of the bullying problem”

(Matthiesen and Einarsen 2010). Moderators of workplace aggression include perceived intent,

perceived intensity, frequency, perceived invisibility (covert versus overt), and formal power

dynamic in the perpetrator-victim relationship (Hershcovis 2011).

In a survey conducted in Belgium on the quality of working life among employees within

the textile industry and financial services, job insecurity was found to be associated with reports of workplace bullying by both targets and perpetrators, and the relationship between job

insecurity and workplace bullying was stronger under conditions of high perceived employability

(De Cuyper, Baillien et al. 2009). Furthermore, evidence has indicated that targets’ reporting of

bullying are positively correlated with job demands, and inversely correlated with job resources

over time (Baillien, Rodriguez-Munoz et al. 2011).

In the healthcare industry there is a history of tolerance and indifference to intimidating, and

disruptive behaviors because unprofessional practices are believed to be excusable when dealing

with ‘high stakes’ situations, coping with fear of litigation, and ‘surviving’ within embedded

hierarchies (Beck, Hackett et al. 1997; Joint Commission 2008).

It is important to note that both victims and non-victims of bullying experience a poor

interpersonal work environment where bullying occurs (Skogstad, Torsheim et al. 2011). Within

departments of Norwegian organizations from financial institutions, fish farming, healthcare sector, governmental and municipal agencies, media, offshore industries, research, higher

education institutions, passenger transport and manufacturing companies, bullying observed by

respondents, between January 2000 and January 2006, strongly correlated, at the within-group

level, with social climate (organizational culture), leadership behavior (supervisory support,

empowering leadership, fair leadership) and role conflict (Skogstad, Torsheim et al. 2011).

An ecological model of workplace bullying has been described consisting of four

interrelated systems: the microsystem containing the bully and the target, the mesosystem

including the workgroup and its supervisor/manager, the exosystem provided by the

organization, and the macrosystem formed by the society (Johnson 2011). Antecedent factors

flow from the outer macrosystem through the inner exo- and meso- systems creating conditions

conducive of bullying within the microsystem (Johnson 2011). In this paper, we compared perceptions of Consideration among higher education institutions to corporate benchmarks.

5


Methods

Participants in this study were 52 higher education administrators and teaching faculty who

individually completed the Human Synergistics Organizational Effectiveness Inventory survey

(OEI®, web-based version, http://www.humansynergistics.com/) (Cooke 1997). Respondents

were affiliated with institutions located in at least 16 countries in North America, Europe, India,

Australia, Latin America, Africa and the Middle East (Human-Synergistics 2012). The OEI®

evaluates 43 effectiveness measures consisting of two factors relevant to mission articulation and

customer-service-focus; 29 components of systems, structures, human resources,

communications and supervisory leadership, considered to be ‘causal factors’; and 12

performance outcomes (Cooke and Szumal 2000; Szumal 2001).

Demographic data and score results for one measure of supervisory/managerial leadership,

Consideration, are presented and analyzed in this paper (Figure 1). Consideration is a relational

leadership skill which pertains to the extent of supportiveness and consideration that supervisors/managers exhibit towards their subordinates.

The mean scores and standard errors were computed and plotted for total respondents (n=52)

and for eight subgroups of faculty (n=25), administrators (n=20), female (n=25), male (n=26),

for-profit-public (n=4), for-profit-private (n=10), not-for-profit-public (n=30) and not-for-profit-

private (n=8) institutions (Figure 1). OEI® results were compared to the Historical Average (50th

percentile), which is the median of the OEI® responses of members from 1084 organizational

units, and to Constructive Benchmarks, which are based on the median of OEI® results for 172

organizational units with predominantly Constructive operating cultures (Human-Synergistics

2012). The Constructive Benchmark score was greater than the Historical Average score, and any

results for Consideration falling below the value for the Historical Average were considered

undesirable. One-way ANOVA was used to assess the statistical significance of inter-subgroup differences.

Results

Demographics of Respondents

Participants were affiliated with higher education institutions in the United States (n=23), India

(n=4), United Kingdom (n=3), France (n=2), Australia (n=2), Canada, Wales, Spain, Denmark,

Greece, Macedonia, New Zealand, Ethiopia, Egypt, Jordan, Costa Rica and undetermined

countries. Institutional levels were 56% Doctorate-granting universities, 19% Master’s

colleges/universities, 13% Bachelor’s colleges, 6% Associate’s colleges, 2% Special Focus and

4% undetermined. The age distribution of the participants was widely spread with 56% falling in

the 40-59 years age bracket, 21% being older than 60 years, and 17% being younger than 39

years of age. The professional roles of respondents were faculty/professor (48%), director (19%), associate dean (6%), chair (4%), dean (4%), provost/dean academic affairs (4%), president (2%)

and undetermined (13%). 15% had spent more than 15 years at their current institutions, while

6% had spent 10 to15 years, 19% had spent 6 to10 years, 23% had remained for 4 to 6 years,

19% had spent 2 to 4 years, and 6% had been affiliated for 1 to 2 years, while 6% had spent 6

months and 4% less than 6 months. There were equivalent numbers of men and women

participants (1:1 male to female ratio).

Consideration Levels are Undesirable in Higher Education Institutions

Scores for Consideration were below the Historical Average (50th percentile, 4.03) and the

Constructive Benchmark (4.36) for total respondents (mean 3.69 ± 0.17 SE), and for faculty

(mean 3.76 ± 0.24 SE) , administrators (mean 3.80 ± 0.28 SE), male (mean 3.62 ± 0.24 SE) and

6


female (mean 3.80 ± 0.25 SE) subgroups as shown in Figure 1. Minimally higher scores were

obtained for the administrators as compared to the faculty subgroups; and a trend for higher

scores was noted in the female as compared to the male subgroups (p-value = 0.598 female vs.

male). However, statistical significance was not reached for any of the inter-subgroup differences

(using one-way ANOVA).

Mean scores for private not-for-profit (mean 3.71 ± 0.34 SE), public not-for-profit (mean

3.60 ± 0.24 SE) and private for-profit (mean 3.77 ± 0.36 SE) subgroups also fell below the

Historical Average, with the public not-for-profits (n=30) scoring lowest (Figure 1). By contrast,

the mean score for the small (n=4) public for-profit subgroup (mean 4.08 ± 0.92 SE) reached the

Historical Average and showed wide variation the rose above the Constructive Benchmark (Figure 1). The differences between the public for-profit and the other three institutional type

subgroups did not reach statistical significance (p-value = 0.914 public for-profits vs. public not-

for-profits).

Figure 1: Consideration measure of supervisory/managerial leadership in higher education institutions. OEI®

Consideration Mean score ± standard error (SE) for total respondents, and for female, male, faculty, administrators,

public for-profit, private for-profit, public not-for-profit and private not-for-profit subgroups compared to the Historical

Average and the Constructive Benchmark. Except for the small public for-profits subgroup, the mean scores fall below

both the 50th percentile and the Constructive Benchmark for Consideration.

Discussion

In this study, pooled scores on the Consideration dimension of leadership, obtained from faculty

and administrators, revealed a definite vulnerability of higher education institutions to tolerate

supervisory/managerial practices that are not sufficiently people-oriented. Perceptions of

Consideration were undesirably low in for-profit and not-for-profit institutions, and lowest in the

male subgroup, pointing to the prevalence of inadequate levels of developmental leadership and

supportive leadership styles in higher education institutions (Figure 1) (Rafferty and Griffin 2006).

Our findings of inadequate Consideration levels are symptomatic of systemic incivility

problems that are compromising the effectiveness of higher education (Figure 1). When medical

7


students, as subordinates, describe being subjected to hurtful experiences by their superiors, they

are highlighting the poor quality of that supervisory/managerial relationship. Subgroup analysis

revealed notable agreement among faculty vs. administrators, males vs. females, private vs.

public and for-profit vs. not-for-profit organizations in Consideration scores (Figure 1). Our

findings of low Consideration levels are consistent with our results showing undesirably high

levels of Job Insecurity in Higher Education institutions (data not shown, manuscript in

preparation), since Job Insecurity is negatively correlated with developmental leadership

(Individualized Consideration) and is an antecedent factor for supervisory abuse (Rafferty and

Griffin 2006). Furthermore, our findings are also consistent with our results revealing

undesirably low levels of Customer Service Focus in higher education institutions (Zeine, Palatnick et al. 2014).

Understanding Resistance to Change

While adapting to change, it is natural to transition through psychological phases beginning with

Denial and progressing through periods of Resistance and Exploration before attaining

Commitment (Jaffe and Scott 2010). Change occurs when something either “starts or stops, or

when something that used to happen in one way starts happening in another” (Bridges 1986).

Resistance to change develops because of the difficulty people have with “letting go of who they

were and where they have been” which can be experienced as a disengagement from their old

identity (Bridges, 1986, p.25). Overcoming this “Ending Phase” leads into a "Neutral Zone"

where reorientation and reintegration occur, sparking a phase of “New Beginnings” where people come to the realization that they have to make changes (Bridges, 1986).

Reasons for resisting proposed changes to policies, procedures, roles or responsibilities

include human nature, fears and imagined threats (Caruth, Middlebrook et al. 1985). Once

employees become accustomed to a situation, even if it is uncomfortable and undesirable, they

tend to strongly resist any suggestions for changing it (Caruth, Middlebrook et al. 1985). Even

when a proposed change is likely to be beneficial for an individual’s circumstances, resistance

mounts due to “fear of the unknown, fear of reduced job security, fear of suffering economic

loss, fear of reduced job status, or fear of change in work group relationships” (Caruth,

Middlebrook et al. 1985).

Creating Readiness for Change

To reduce delays and minimize losses in productivity, change managers endeavor to assist in overcoming Denial and Resistance by communicating the importance and details of the proposed

change, and by listening sympathetically, acknowledging, and supporting people in experiencing

their difficult feelings (Jaffe and Scott 2010). In the Exploration stage, the change has been

accepted and change managers can assist in focusing energies, discovering possibilities, choosing

options and seeking ways to make the change successful (Jaffe and Scott 2010). Once people

have mastered the new ways, gained confidence in their new skills and learned to succeed within

their new realities, they are in Commitment, and begin to focus their attention externally on the

needs of their team and organization (Jaffe and Scott 2010).

Creating readiness for change requires the delivery of a persuasive change message designed

to influence five key beliefs that organizational members hold about the change (Armenakis and

Harris 2009). Discrepancy is the belief that change is needed in order to move the organization from its current state towards a perceived ideal, appropriateness is the belief that the proposed

change is the right one for the circumstances, efficacy reflects their level of confidence in the

feasibility of the change, principal support is the perception that there is commitment to the long-

term success of the change at the leadership levels of the organization, and personal valence is

the conviction that the change will be beneficial (Armenakis and Harris 2009).

8


To transform organizational culture and performance, the Ohio State University Medical

Center (1) selected a small leadership team consisting of appointees from academic, clinical and

administrative units, (2) assessed challenges and opportunities by evaluating organizational

culture using the Human Synergistics Organizational Culture Inventory, OCI®

Survey, (Cooke

and Lafferty 1987; Szumal 2003), and soliciting formal and informal input on organizational

structure, function, and performance, (3) set expectations for a high degree of collaboration

within and among units, and clearly communicated a shared vision, (4) aligned medical school,

practice plans, and hospital functional units; education, research, clinical and support service

missions, (5) engaged faculty, staff and external constituents in driving that change, (6)

developed leadership skills through retreats and educational programs, implemented “360” leadership scorecards and mentoring, and (7) defined strategies and established criteria for

tracking outcomes measures (Sanfilippo, Bendapudi et al. 2008). As compared to their

organizational culture profile in 2000-2001, the Ohio State University Medical Center’s 2005-

2006 OCI® profile revealed a rise in Constructive styles to the 62nd percentile, and a drop in the

Passive/Defensive Avoidance style from the 91st to the 61st percentile, concomitant with an 8%

increase in student satisfaction rates (Sanfilippo, Bendapudi et al. 2008).

Recommendations

To raise the levels of Consideration in Higher Education Institutions, we recommend the

following practices:

I. Monitor employee well-being, job satisfaction and student satisfaction regularly

and address the feedback systemically. Feedback Surveys can be designed to

monitor program-specific concerns. Levels of stress, fatigue, emotional exhaustion,

depersonalization, depression and quality of life can be evaluated using The

Medical Student Wellbeing Index (MSWBI) which was developed by researchers at

the Mayo Clinic College of Medicine (Dyrbye, Szydlo et al. 2010). Higher

Education institutions can choose to address such concerns systemically, for

example, the ombudsman at the University of Minnesota is using a systems

approach and data collected in a survey of more than 10,000 graduate students to

implement a campus-wide change initiative aimed at establishing a shared vision

for a positive academic and work environment that would be free from offensive,

hostile and intimidating or toxic behavior (Morse 2010). II. Improve Professional Standards. As part of the Standards Improvement Initiative,

The Joint Commission introduced requirements for all accreditation programs in the

United States to ensure that (a) healthcare organizations define disruptive and

inappropriate behaviors in their code of conduct, (b) healthcare leaders create and

implement a process for effective management of disruptive and inappropriate

behaviors, and (c) healthcare educators/managers evaluate and monitor medical

staff professionalism and interpersonal skills as competencies to be addressed in the

credentialing process (Joint Commission 2008).

III. Introduce Active Learning. Academic achievement has been positively correlated

with deep understanding and with strategic approaches to learning that are

motivated by assessment, and negatively correlated with surface (memorization)learning approaches (Reid, Duvall et al. 2007). The adoption of student-centered

and competency-based reforms to medical education continues to positively impact

medical student satisfaction and team-building skills (Mennin, Gordan et al. 2003;

Kyong-Jee and Changwon 2010). A study conducted in four medical schools in

Turkey demonstrated that students who experienced a learner-centered curriculum

exhibited improved metacognitive awareness and self-regulated learning skills

9


(Turan, Demirel et al. 2009). One study from the US described the transformation

over ten years of an evidence-based medicine curriculum from a teacher-centered

approach to a learner-centered, and patient centric approach (Aiyer and Dorsch

2008).

IV. Raise awareness about the benefits of Considerate Leadership in education. To raise

more considerate educators, we call for the development of training programs in

leadership skills for educators, students, and all those who are assigned to

supervisory roles in higher education institutions. The ‘transferal of positive affect’

component of Charisma, and expressions of enthusiasm, humor and empathy, have

been shown to enhance the effectiveness of interprofessional education (Lindqvistand Reeves 2007; Erez, Misangyi et al. 2008). Supervisors need to become familiar

with the types of statements that followers use to describe leaders who exhibit

individualized consideration (Boyette 2006).

V. Adopt Constructive Cultural Styles throughout the Higher Education

Institution. Design and implement a systematic change initiative to replace

Defensive styles with Constructive styles at all academic and administrative levels

(Sanfilippo, Bendapudi et al. 2008; Zeine, Boglarsky et al. 2011).

Conclusion

The defensive organizational cultures prevailing in higher education institutions are

compromising organizational effectiveness as measured by supervisory/managerial leadership. There is a need for improving the levels of Consideration encompassing developmental and

supportive leadership styles in higher education institutions. Changes in organizational culture,

policies and standards are needed to reverse long-ingrained behavioral norms and to improve the

effectiveness of graduate, medical and professional higher education.

10


REFERENCES

Ahmer, S., A. W. Yousafzai, et al. (2008). "Bullying of Medical Students in Pakistan: A Cross-

Sectional Questionnaire Survey." PLoS ONE 3(12): 1-4.

Aiyer, M. K. and J. L. Dorsch (2008). "The transformation of an EBM curriculum: a 10-year

experience." Medical Teacher 30(4): 377-383.

Armenakis, A. A. and S. G. Harris (2009). "Reflections: our Journey in Organizational Change

Research and Practice." Journal of Change Management 9(2): 127-142.

Avolio, B. J. and B. M. Bass (1999). "Re-examining the components of transformational and

transactional leadership using the Multifactor Leadership Questionnaire." Journal of Occupational & Organizational Psychology 72(4): 441-462.

Baillien, E., A. Rodriguez-Munoz, et al. (2011). "Do demands and resources affect target's and

perpetrators' reports of workplace bullying? A two-wave cross-lagged study." Work &

Stress 25(2): 128-146.

Baldwin, D. C., Jr., S. R. Daugherty, et al. (1991). "Student perceptions of mistreatment and

harassment during medical school. A survey of ten United States schools." West J Med

155(2): 140-145.

Bass, B. M., B. J. Avolio, et al. (1996). "The Transformational and Transactional Leadership of

Men and Women." Applied Psychology: An International Review 45(1): 5-34.

Beck, D. L., M. B. Hackett, et al. (1997). "Perceived level and sources of stress in university

professional schools." Journal of Nursing Education 36(4): 180-186. Boyette, J. H. (2006) "Transformational Leadership: The highly effective leader/follower

relationship " The Science of Leadership, 1-9.

Bridges, W. (1986). "Managing Organizational Transitions." Organizational Dynamics 15(1): 24-

33.

Caruth, D., B. Middlebrook, et al. (1985). "Overcoming Resistance to Change." SAM Advanced

Management Journal 50(3): 23.

Cooke, R. A. (1997). Organizational Effectiveness Inventory®. Plymouth, MI, Human

Synergistics.

Cooke, R. A. and J. C. Lafferty (1987). Organizational Culture Inventory®. Plymouth, MI,

Human Synergistics.

Cooke, R. A. and D. Rousseau (1988). "Behavioral Norms and Expectations: A quantitative

approach to the assessment of organizational culture." Group & Organization Studies (1986-1998) 13(3): 245.

Cooke, R. A. and J. L. Szumal (2000). Using the Organizational Culture Inventory to understand

the operating cultures of organizations. Handbook of Organizational Culture and

Climate. N. M. Ashkanasy, C. P. M. Wilderom and M. F. Peterson. Thousand Oaks,

CA, Sage Publications: 147-162.

Cookson, J. (2006). "Dealing with the effect of stress and adverse circumstances on examination

results in medical students." Medical Teacher 28(2): 101-102.

Cooper, J. R. M., J. Walker, et al. (2011). "Students’ perceptions of bullying behaviours by

nursing faculty." Issues in Educational Research 21(1): 1-21.

Crain, B. J., S. R. Alston, et al. (2005). "Accreditation council for graduate medical education

(ACGME) competencies in neuropathology training." J Neuropathol Exp Neurol 64(4): 273-279.

De Cuyper, N., E. Baillien, et al. (2009). "Job insecurity, perceived employability and targets'

and perpetrators' experiences of workplace bullying." Work & Stress 23(3): 206-224.

Dyrbye, L. N., D. W. Szydlo, et al. (2010). "Development and preliminary psychometric

properties of a well-being index for medical students." BMC Med Educ 10: 8.

11


Erez, A., V. F. Misangyi, et al. (2008). "Stirring the Hearts of Followers: Charismatic Leadership

as the Transferal of Affect." Journal of Applied Psychology 93(3): 602-615.

Frank, E., J. S. Carrera, et al. (2006). "Experiences of belittlement and harassment and their

correlates among medical students in the United States: longitudinal survey." BMJ

333(7570): 682.

Hauge, L. J., A. Skogstad, et al. (2007). "Relationships between stressful work environments and

bullying: Results of a large representative study." Work & Stress 21(3): 220-242.

Hershcovis, M. S. (2011). "'Incivility, social undermining, bullying...oh my!': A call to reconcile

constructs within workplace aggression research." Journal of Organizational Behavior

32(3): 499-519. Horan, S. M., R. M. Chory, et al. (2010). "Understanding Students' Classroom Justice

Experiences and Responses." Communication Education 59(4): 453-474.

House, R. J. (1996). Path-goal theory of leadership: Lessons, legacy, and a reformulated theory.

Leadership Quarterly, Elsevier Science Publishing Company, Inc. 7: 323.

Human-Synergistics (2012). OEI Report, HETL-Keller OEI Higher Ed Research Project. USA,

Human Synergistics, Inc.: 16-150.

Jaffe, D. T. and C. D. Scott (2010) "Mastering the Change Curve Facilitator Guide Facilitator

Guide - Theoretical Background." 11-26.

Johnson, S. L. (2011). "An Ecological Model of Workplace Bullying: A Guide for Intervention

and Research." Nurs Forum 46(2): 55-63.

Joint Commission (2008) "Behaviors that Undermine a Culture of Safety." 40:1-3. Judge, T. A. and J. E. Bono (2000). "Five-Factor Model of Personality and Transformational

Leadership." Journal of Applied Psychology 85(5): 751-765.

Jung, T., T. Scott, et al. (2009). "Instruments for Exploring Organizational Culture: A Review of

the Literature." Public Administration Review 69(6): 1087-1096.

Kassebaum, D. G. and E. R. Cutler (1998). "On the culture of student abuse in medical school."

Acad Med 73(11): 1149-1158.

Kyong-Jee, K. and K. Changwon (2010). "Reform of medical education in Korea." Medical

Teacher 32(2): 113-117.

Lewis, M. A. (2006). "Nurse bullying: organizational considerations in the maintenance and

perpetration of health care bullying cultures." Journal of Nursing Management 14: 52-

58.

Lindqvist, S. M. and S. Reeves (2007). "Facilitators' perceptions of delivering interprofessional education: a qualitative study." Medical Teacher 29(4): 403-405.

Maida, A. M., A. Vásquez, et al. (2003). "A report on student abuse during medical training."

Medical Teacher 25(5): 497.

Matthiesen, S. B. and S. Einarsen (2010). "Bullying in the workplace: Definition, Prevalence,

Antecedants and Consequences." International Journal of Organization Theory &

Behavior 13(2): 202-248.

Mennin, S., P. Gordan, et al. (2003). "Position Paper on Problem-Based Learning." Education for

Health: Change in Learning & Practice (Taylor & Francis Ltd) 16(1): 98.

Morse, J. (2010). "Tackling Systemic Incivility Problems: The Ombudsman as Change Agent."

Journal of the International Ombudsman Association 3(2): 34-38.

Mulki, J. P. and F. Jaramillo (2011). "Workplace isolation: salespeople and supervisors in USA." International Journal of Human Resource Management 22(4): 902-923.

Nagata-Kobayashi, S., M. Sekimoto, et al. (2006). "Medical Student Abuse During Clinical

Clerkships in Japan." JGIM: Journal of General Internal Medicine 21(3): 212-218.

Rafferty, A. E. and M. A. Griffin (2006). "Refining individualized consideration: Distinguishing

developmental leadership and supportive leadership." Journal of Occupational &

Organizational Psychology 79(1): 37-61.

12


Rafferty, A. E. and S. L. D. Restubog (2011). "The Influence of Abusive Supervisors on

Followers' Organizational Citizenship Behaviours: The Hidden Costs of Abusive

Supervision." British Journal of Management 22(2): 270-285.

Reid, W. A., E. Duvall, et al. (2007). "Relationship between assessment results and approaches to

learning and studying in Year Two medical students." Med Educ 41(8): 754-762.

Rosenberg, D. A. and H. K. Silver (1984). "Medical student abuse. An unnecessary and

preventable cause of stress." JAMA 251(6): 739-742.

Sanfilippo, F., N. Bendapudi, et al. (2008). "Strong leadership and teamwork drive culture and

performance change: Ohio State University Medical Center 2000-2006." Academic

Medicine 83(9): 845-854. Shoukat, S., M. Anis, et al. (2010). "Prevalence of Mistreatment or Belittlement among Medical

Students -- A Cross Sectional Survey at a Private Medical School in Karachi, Pakistan."

PLoS ONE 5(10): 1-6.

Skogstad, A., T. Torsheim, et al. (2011). "Testing the Work Environment Hypothesis of Bullying

on a Group Level of Analysis: Psychosocial Factors as Precursors of Observed

Workplace Bullying." Applied Psychology: An International Review 60(3): 475-495.

Spencer, J. and T. Lennard (2005). Time for gun control? Med Educ, Wiley-Blackwell. 39: 868-

869.

Szumal, J. L. (2001) "Reliability and Validity of the OEI." Reliability and Validity Report, 1-21.

Szumal, J. L. (2003). Organizational culture inventory: OCI, interpretation & development guide.

Plymouth, MI, Human Synergistics International. Turan, S., Ö. Demirel, et al. (2009). "Metacognitive awareness and self-regulated learning skills

of medical students in different medical curricula." Medical Teacher 31(10): 477-483.

Wilkinson, T. J., D. J. Gill, et al. (2006). "The impact on students of adverse experiences during

medical school." Medical Teacher 28(2): 129-135.

Yukl, G. (2012). Leadership in Organizations, Prentice Hall.

Zeine, R., C. Boglarsky, et al. (2011). Organizational Culture in Higher Education. The Strategic

Management of Higher Education Institutions: Serving Students as Customers for

Institutional Growth. H. H. Kazeroony. New York, NY, USA, Business Expert Press,

LLC; Webinar http://www.slideshare.net/rzeine/webinar-changing-organizational-

culture-in-higher-education: 19-38.

Zeine, R., F. Palatnick, et al. (2014). Customer Service Focus and Mission Articulation as

Measures of Organizational Effectiveness in Higher Education Institutions: Driving Student Success. Accepted for publication in Management Education: An International

Journal, vol. 13, 2014 (in press).

ABOUT THE AUTHORS

Dr. Rana Zeine: Associate Professor, Basic Medical Sciences, Bonaire, Saint James School of

Medicine, HRDS, Park Ridge, IL, USA

Dr. Cheryl Boglarsky: Human Synergistics International, Plymouth, Michigan, USA

Dr. Edward Daly: Community College of Rhode Island, Warwick, Rhode Island, USA

Dr. Patrick Blessinger: International Higher Education Teaching and Learning Association,

New York, USA

Dr. Mary Kurban: Christ the King Catholic School, Los Angeles, California, USA

Dr. Alwyn Gilkes: Bronx Community College, New York, USA

13

Organizational Cultures: An International Journal is one of four thematically focused journals in the collection of journals that support The Organization knowledge community—its journals, book series, conference and online community.

The journal explores success factors in the management of organizational culture in responsive, productive and respected organizations.

As well as papers of a traditional scholarly type, this journal invites case studies that take the form of presentations of management practice—including documentation of organizational practices and exegeses analyzing the effects of those practices.

Organizational Cultures: An International Journal is a peer-reviewed scholarly journal.

ISSN 2327-8013