Whose Side Are You On? Interdependence and its Consequences in Management of Healthcare Delivery

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Healthcare employees who are committed to the organization and go the extra mile are especially needed today. An empirical study of visiting nurse agency employees showed that a sense of being "in the same boat" with management, or perceiving outcome interdependence, contributed to positive behaviors. Supervisors were generally more inclined than were their subordinates to perceive this interdependence, to be committed, and to exhibit good citizenship behavior. Unexpectedly, physical therapists who worked as hourly part-time contractors reported even stronger feelings of being in the same boat with management and being more committed than the supervisors. Such a sense of partnership could have been a result of the therapists' long-term relationship with the agency over an indefinite time. They might have also felt that they worked voluntarily and autonomously, rather than under close supervision. These findings point to various management actions that can engender a feeling of interdependence, pride in the organization, and fairness of treatment. One step is to involve employees in joint goal setting, organized around "our problems," not just the person's own concerns. Authentic downward communication and the sharing of operating results can convey to employees the major issues that challenge the organization. Such information makes it possible for employees to provide vital input, if not actually take on more decisions themselves. Executives can expect less commitment and less inclination from employees to go above and beyond what is expected if they fail to acknowledge good performance and if they accentuate differences between the most-senior leaders and lower-level employees.