UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Management of laboratories : examining symbolic and substantive outcomes Pickard, Lynette Elizabeth 1982

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1982_A1 P53.pdf [ 7.29MB ]
Metadata
JSON: 831-1.0076971.json
JSON-LD: 831-1.0076971-ld.json
RDF/XML (Pretty): 831-1.0076971-rdf.xml
RDF/JSON: 831-1.0076971-rdf.json
Turtle: 831-1.0076971-turtle.txt
N-Triples: 831-1.0076971-rdf-ntriples.txt
Original Record: 831-1.0076971-source.json
Full Text
831-1.0076971-fulltext.txt
Citation
831-1.0076971.ris

Full Text

MANAGEMENT OF LABORATORIES: EXAMINING SYMBOLIC AND SUBSTANTIVE OUTCOMES by LYNETTE ELIZABETH PICKARD National Diploma i n Occupational Therapy, Pretoria College of Occupational Therapy, South A f r i c a , 1967 B.Sc. (Occupational Therapy), University of Western Ontario, 1975 M.A. (Adult Education) University of B r i t i s h Columbia, 1979 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE STUDIES (Interdisciplinary  Studies)  We accept this thesis as conforming to the required standard  THE UNIVERSITY OF BRITISH COLUMBIA September 1982 Lynette Elizabeth Pickard, 1982  In p r e s e n t i n g  t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of  requirements f o r an advanced degree at the  the  University  o f B r i t i s h Columbia, I agree t h a t the L i b r a r y s h a l l make it  f r e e l y a v a i l a b l e f o r reference  and  study.  I further  agree t h a t p e r m i s s i o n f o r e x t e n s i v e copying of t h i s t h e s i s f o r s c h o l a r l y purposes may  be granted by  department or by h i s or her  the head of  representatives.  my  It is  understood t h a t copying or p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l gain  s h a l l not be allowed without my  permission.  Department o f The U n i v e r s i t y o f B r i t i s h 1956 Main Mall Vancouver, Canada V6T 1Y3 Date  DE-6  (3/81)  Columbia  written  ABSTRACT Pfeffer  (1981)  contends  that  the role  of  the manager  i s chiefly  symbolic. The purpose of t h i s study was to investigate h i s claims  that the  manager's e f f e c t i s primarily on symbolic outcomes and less on substantive outcomes;  that  external  power  holders  have  a  small  effect  on  symbolic  outcomes; and that substantive and symbolic aspects of organizational a c t i v i t y are loosely l i n k e d . Two  hospital  laboratories  dimensions) were chosen  i n Western  Canada  (similar  f o r i n c l u s i o n i n the study.  Through  observation,  obtained  information  interviewing and examination of records,  the researcher  along  many  on relationships between the actions of managers and other power holders and substantive  and symbolic outcomes.  Pfeffer's theory  c l a s s i f i c a t i o n system f o r categorizing f i n d i n g s . approach, the researcher  was used  to form the  In addition to a deductive  attempted to discover patterns  from the data. Steps  were taken to check p o t e n t i a l sources of i n v a l i d i t y . Study findings indicated that external power holders have a small e f f e c t on symbolic outcomes.  P f e f f e r ' s claim that management has a greater impact on  b e l i e f s , attitudes and feelings than on tangible outcomes was not supported. Reasons  f o r this  contingent  may be that  on managerial  managerial  motivation,  e f f e c t on symbolic  type  of symbolic  outcomes i s  action,  l e v e l of  management, type of organization and time i n the organizational l i f e c y c l e . There was l i t t l e evidence to support Pfeffer's claim that substantive and symbolic  aspects  explanation  of organizational  of t h i s  appears  with  activity  to be that  the type  are imperfectly  linked.  The  factors a f f e c t i n g the strength of  coupling  differ  of symbolic  action  employed  existence  (or absence) of e f f o r t s to make the use of power  and with the  unobtrusive.  Concepts  which  emerged  from  data  captured  ideas  not  contained  Pfeffer's writings.  For example, managers and e x t e r n a l power h o l d e r s  an  unintentional  intentional  proximity  and  to/distance  e x t e r n a l power h o l d e r s Increased between impact  on  beliefs  influences  and the  attitudes; extent  have and  t o which  a f f e c t symbolic outcomes. of  and s u b s t a n t i v e  substantive  researchers.  the o r g a n i z a t i o n  understanding  symbolic on  from  influence  may  in  versus  the  variables  affecting  the  relationship  outcomes and the magnitude o f the  symbolic  outcomes,  may  be  utilized  manager's by  future  iv TABLE OF CONTENTS  ABSTRACT  .  i i  LIST OF TABLES LIST OF FIGURES ACKNOWLEDGEMENTS  vi vii viii  Chapter I.  SCOPE OF STUDY AND LITERATURE REVIEW Background of Problem Statement of Problem D e f i n i t i o n of Terms Literature Review Statements and Alternate Statements Summary  II.  METHOD Research Setting S i m i l a r i t i e s and Differences Between Research Settings. . . Importance of Differences i n Settings i n Terms of Investigating P f e f f e r ' s Statements Investigation of Research Statements: A General Outline. . . P i l o t Study Sampling Measuring Instruments Data Analysis V a l i d i t y of Findings  1 1 4 4 6 18 23 25 27 32 35 37 40 40 44 48 48  V  III.  ANALYSIS OF FINDINGS  52  Introduction Statement 1 Statement 2 Statement 3 Statement 3a Statement 4 Statement 4a Summary of Findings IV.  CONCLUSIONS  52 52 70 84 87 89 95 98 '  The Manager's Impact on Substantive Outcomes The Manager's Impact on Symbolic Outcomes The Influences of External Power Holders on Symbolic Outcomes The Linkage Between Symbolic and Substantive Outcomes. . . Significance of Findings Future Research. REFERENCES APPENDIX A APPENDIX B  100 100 102 108 109 116 118 123  vi LIST OF TABLES  I.  II.  III.  IV.  V.  VI.  VII.  S i m i l a r i t i e s and Differences Between Two Pathology Laboratories  33  Substantive Outcomes of Laboratories and Powerful Forces and Individuals Influencing Laboratory Operation  45  Interviews, Observations and Document Analysis Associated with Each Statement  47  Findings Related to Statement 1 i n Terms of Substantive Outcomes  54  Manager's Influence on Tangible Outcomes and B e l i e f s Related to Those Outcomes  72  Influence of External Powers on Beliefs of Laboratory Personnel  88  Relationships Between Tangible Aspects of Outcome and Beliefs About Outcome  9  0  VIII. Factors Influencing Strength of Coupling Between Substantive and Symbolic Outcomes With Various Types of Symbolic Action. . 115  vii LIST OF FIGURES  1.  2.  3. 4.  The Relationship Between Substantive and Symbolic Outcomes and Management Versus External Control  3  Conditions Producing Making  8  the Use of Power i n Organizational Decision  Sources of S t r u c t u r a l l y Determined Power and Strategies to Enhance That Power  12  Environmental and Hospital Forces Influencing Laboratory A c t i v i t i e s and Outcomes.  5.  Projected Relationships Between Variables  6.  P f e f f e r ' s Claims and Study Findings Regarding These Statements  28 41  101  7.  Factors Influencing Substantive Outcomes  103  8.  Substantive Versus Symbolic Impact By Level of Management. . . .  107  9.  External Powers Affecting Hospital Laboratories Categorized According to Intentionality of Influence and Proximity to Laboratories 10. Linkage Between Substantive and Symbolic Outcomes With and Without Managerial Legitimations  110 111  viii  ACKNOWLEDGEMENTS  Many people a s s i s t e d w i t h t h i s study and I wish t o thank them  all.  The d i r e c t o r , manager and s t a f f o f two l a b o r a t o r i e s i n Western Canada were p a r t i c i p a n t s i n the study.  T h e i r w i l l i n g n e s s t o be i n t e r v i e w e d  and t o have me spend time i n t h e i r l a b o r a t o r i e s , made the study p o s s i b l e .  Dr. Anne C r i c h t o n ' s knowledge o f the h e a l t h system was extremely h e l p f u l i n terms o f s e l e c t i o n o f study s i t e and i n t e r p r e t a t i o n of certain findings. was  Dr. P e t e r F r o s t ' s e x p e r t i s e i n q u a l i t a t i v e methodology  i n v a l u a b l e i n the study.  H i s i n t e r e s t , enthusiasm,  humour h e l p e d make t h e endeavour  enjoyable.  s e n s i t i v i t y and  Dr. Vance M i t c h e l l  guided  me through the v a r i o u s stages o f t h e s i s w r i t i n g w i t h warmth and unders t a n d i n g and always had time t o t a l k t o me.  S i d Jongbloed was l o v i n g and s u p p o r t i v e and amazingly a c c e p t i n g of time devoted t o t h i s t a s k .  1  CHAPTER I SCOPE OF STUDY AND LITERATURE REVIEW Background of Problem Causes  of organizational  conceptualized view  very  v a r i a t i o n i n function,  differently  v a r i a t i o n as caused  by various  organizational  largely by organizational  makers and the dominant e l i t e ) .  According  process  theorists.  members  to others,  and form are Some  (e.g. decision  forces  outside the  organization generate v a r i a t i o n . Organizational  variation  organizational members — Simon, 1958). The  has  to leaders  historically  been  attributed  to  i n p a r t i c u l a r (Gouldner, 1959; March &  And this remains the dominant view (e.g. Katz & Kahn, 1978).  manager's perceptions  of changes i n the environment lead to decisions to  adjust organizational structure and processes to this altered environment. i.  Theorists organizational  who  emphasize  the  v a r i a t i o n include  importance  population  of  ecologists  external Hannan  forces  in  and Freeman  (1977) and A l d r i c h (1979), who view the nature and d i s t r i b u t i o n of resources in  the organization's  change.  Given  environment as the c e n t r a l factor i n organizational  available  combinations of organizations. it  effectively  Theorists  who  managerial disturbances.  acquires  resources,  to  Population  environment  selects  optimal  A population of organizations survives because  resources  i n competition  a t t r i b u t e organizational  ability  the  buffer  the  with  other  organizations.  v a r i a t i o n to the manager organization  from  emphasize  environmental  ecologists, on the other hand, stress the numerous  2 internal  and external  pressures  towards i n e r t i a  (such  barriers to market entry, and sunk costs represented which constrain adaptation  options  In P f e f f e r and Salancik's forces  in  by plant and equipment)  (1978) resource dependence model, both external as important sources of organizational  Organization-environment coupling i n this model i s seen as loose,  contrast  strong.  and f i s c a l  (Hannan S Freeman, 1977).  and people are conceptualized  variation.  as legal  with  the population  The way  environment  i n which  affects  ecology  powerful  organizational  environment may also  model  i n which  organizational  actions.  a f f e c t organizational  i t i s viewed as  members  interpret the  But unnoticed outcomes —  parts  of the  an i n d i c a t i o n that  people are not i n complete control of organizational outcomes. Approaches observable,  to  organizational  theory  have  traditionally  measureable behaviours and f a c t s . Recently,  emphasized  however, a cognitive  perspective on organizations has emerged which, i n contrast to the t r a d i t i o n a l approach, assumes that r e a l i t y i s largely s o c i a l l y constructed  and emphasizes  the importance of language and symbols. Pfeffer cognitive  approaches and attempts  constraints  on  organization. task  of  activities  to resolve  and  the  the dualism  influence  of  between  external  individuals  i n the  He views organizations as systems of patterned a c t i v i t y and the  management  Substantive various  (1981) has a r t i c u l a t e d a model which combines t r a d i t i o n a l and  as  explaining  organizational  subunits  actions  can be predicted  and like  rationalizing the  these  allocation  from power-dependence  of  depends,  i s likely  to have  a  budgets  relationships.  subunit which copes with c r i t i c a l problems or supplies resources organization  activities.  l o t of power  to A  on which the  and thus  to be  allocated large sums of money i n comparison with less powerful subunits. Managers i n this model have a limited impact on tangible organizational outcomes;  their  effect  i s chiefly  on  symbolic  outcomes.  The manager  3  rationalizes outside  and  legitimates organizational a c t i v i t i e s to members and  organizational  boundaries,  thereby  ensuring  the  people  participation  and  commitment of members and support from the environment. P f e f f e r has drawn heavily on the writings of Edelman (1977) which state that every instance of p o l i c y formulation  involves both a symbolic e f f e c t and  a r a t i o n a l r e f l e c t i o n of i n t e r e s t i n resources. example,  confer  tangible  benefits  and  also  A manpower program may,  symbolize  that  action  is  for being  taken regarding unemployment. Edelman stresses the importance of examining some groups get  the  tangible things  they want from an organization and what  those actions mean to the rest of the people i n the organization. Lindblom  (1976) also distinguish between b e l i e f s and  note that p o l i c y change tends to be  how  incremental  Dahl  tangible outcomes.  and They  i n nature. Those with power  are often biased against reform and maintain a set of b e l i e f s and values which operate to t h e i r benefit and against major change (Bachrach and Baratz, 1970). Figure  1 shows relationships (proposed by P f e f f e r ) between symbolic  substantive action and control by management and the environment. FIGURE 1 THE RELATIONSHIP BETWEEN SUBSTANTIVE AND SYMBOLIC OUTCOMES AND MANAGEMENT VERSUS EXTERNAL CONTROL Substantive outcomes (allocations or decisions with physical referents)  Symbolic outcomes (attitudes, sentiments, values, perceptions)  External control based on power, dependence  Large e f f e c t predicted by resource dependence, natural selection, and operant conditioning approaches.  Small e f f e c t  Management control derived from language and symbolic action  Small effeet.because of environmental constraints and s o c i a l system size and complexity  Large e f f e c t predicted by theories of attitude formation change and the s o c i a l construction of r e a l i t y  SOURCE: P f e f f e r (1981).  and  4  The  organization of this d i s s e r t a t i o n i s as follows:  Chapter I, terms used i n the d i s s e r t a t i o n are defined, this  area  are  outlined.  described,  Statements  and  Pfeffer's  (about the  ideas  e f f e c t s of  In the remainder of empirical studies i n  regarding  managers and  management external  are  powers)  which are to be investigated are i d e n t i f i e d . Chapter methods  of  II  outlines  data  design  c o l l e c t i o n and  v a l i d i t y of findings. Conclusions,  the  Findings  of  analysis of the  the  study,  and  the  steps  study are  research  taken  to  described  setting,  increase  the  i n Chapter I I I .  implications for future research and the significance of findings  are presented i n Chapter IV. Statement of the Problem P f e f f e r proposes two actions  which  have  levels of analysis; one  observable  outcomes;  the  concerned with predicting  other  with  organizational a c t i v i t i e s are legitimated and perceived. loosely  linked.  His  claims  have not been investigated. The  study i s to investigate organizations manner which allows the actions, perceptions inquiry.  The  researcher  and outcomes.  empirically and  predicting two  how  l e v e l s are  purpose of this  to describe  them i n a  to examine P f e f f e r ' s central ideas  about  These claims provide the framework for the  Concepts (not addressed by Pfeffer) which emerge inductively w i l l be  used to suggest amendments to his ideas.  D e f i n i t i o n of Terms Power  " i s the  achieving refers  to  c a p a b i l i t y of  one  social  actor  to  overcome  a desired objective" (Pfeffer, 1981a, p. 2 ) . a  " s t r u c t u r a l phenomenon, created  departmentation  that  characterize  investigated" (Pfeffer, 1981a). exercise of power.  the  by  the  specific  resistance  in  In P f e f f e r ' s terms i t d i v i s i o n of  labour  organization  or  being  Certain i n d i v i d u a l c h a r a c t e r i s t i c s a f f e c t the  5  Manager i n this study refers to people at senior organizational l e v e l s . operational d e f i n i t i o n w i l l depend on the organization Pfeffer  (1977), empirical studies on  line supervisors.  studied.  According  leadership have mostly dealt with  If the leader has any  The  impact, i t i s l i k e l y to be at  to  first higher  organizational levels where there i s greater discretion i n decision making. Substantive  organizational  actions  referents"  are  "allocations  ( P f e f f e r , 1981).  or  decisions  objective,  physical  Operational  substantive  organizational actions w i l l depend on the organization  Substantive  outcomes "refer to tangible, measureable results such as  a l l o c a t i o n s , c a p i t a l or budget a l l o c a t i o n s " ( P f e f f e r , 1981). the research organization w i l l dictate how Symbolic outcomes are "assessed by  definition  of  studied.  The  substantive outcomes are  sentiments of a f f e c t , by  with  salary  nature  of  defined.  satisfaction,  values and by b e l i e f s " (Pfeffer, 1981). The nature of the organization  by  studied  w i l l determine the operational d e f i n i t i o n of symbolic outcomes. Tight coupling occurs when two  separate systems have many variables i n common  or when the common variables are more c l o s e l y linked than are other variables that influence the system.  For example, i f the goal of an organization is to  teach people to drive cars and the  the organization has  tangible outcomes (e.g. number of people who  about the number of people who  learn to drive are  the power to do this, then learn to drive) and likely  beliefs  to correspond  very  closely. Loose coupling  "occurs either when two  separate systems have few variables i n  common or when the common variables are weak compared to the other that influence the system" (Weick, 1979,  p.  111).  For example, i f an agency  bears symbolic r e s p o n s i b i l i t y for dealing with poverty but has get people jobs,  variables  then tangible organizational achievements and  l i t t l e power to the manager's  statements about these accomplishments are l i k e l y to correspond very  little.  6  Conditions  of power and  dependence.  Conditions  s c a r c i t y , interdependence, heterogeneous goals The  importance of the resource  power  is  used.  Power  for  and  beliefs  be  used  only  when  the  perceived as c r i t i c a l and when power and control are  cope  with  critical  use  of  power  are  about technology.  and the d i s t r i b u t i o n of power determine whether  will  Power i s determined by  the  a  problems  subunit's as  well  resource/decision  dispersed.  s t r u c t u r a l position and  as  by  is  personal  ability  to  c h a r a c t e r i s t i c s that  f a c i l i t a t e using power resources. Literature Review Theories constraints ecologists activity,  regarding on  the  relative  organizational  maintain  that  influence  activities  numerous  vary  of  leaders  greatly.  external  forces  and  external  While  population  constrain  managerial  the dominant view remains that leaders have considerable  impact on  organizational a c t i v i t i e s and outcomes. Empirical  studies  i n this  sought to determine variance manager.  area  and  O'Connor (1972) and  They concluded that the manager has that managerial  Three studies  have  in organizational outcomes attributable, to  Only 15 percent of variance i n outcomes was  in studies by Lieberson  and  have been scarce.  influence  little  the  attributable to managers  Salancik  and  P f e f f e r (1977).  e f f e c t on organizational outcomes  is drastically  limited by  organizational  and  environmental constraints. Weiner  and  above studies,  Mahoney used  (1981), noting  a multivariate analysis  independent variable sequentially. organizational  d e f i c i e n c i e s in the  measures  instead  of  thus avoiding  They examined s p e c i f i c a t t r i b u t i n g variance  performance to changes in year, industry and  designs  of  considering environmental in  the each and  organizational  company. Stewardship (the same  measure of leadership used by Lieberson and O'Connor) was  found to account for  7 40 percent  of  the  variance  i n p r o f i t a b i l i t y and  stock prices over and  environmental, organizational or leadership strategies (defined  above  as observable  patterns of corporate action). Theories  and empirical studies have examined the influence of leaders  tangible, measurable outcomes. social  in nature  (Berger and  on  Organizational r e a l i t y i s , however, inherently Luckman, 1976).  Feelings  about decisions  and  actions can be affected quite independently of tangible actions and outcomes. Factors  such  perceptions  as  work  hours  promotions  have  physical  referents  but  about these factors are subject to s o c i a l influences.  Analysis of Management at Two According two  and  levels.  Levels  to Pfeffer (1981), the analysis of management should At  the  l e v e l of  tangible actions  and  occur at  outcomes, decisions  are  mostly the r e s u l t of power-dependence relationships and external constraints. At  the  symbolic  legitimate  level, p o l i t i c a l  language and  organizational decisions.  Each of  symbolic these  action  levels  are  used  to  i s described  in  some d e t a i l below. Substantive  level  Substantive  results i n P f e f f e r ' s model are determined by the d i s t r i b u t i o n  of power i n a s i t u a t i o n .  Conditions  for the use of power are interdependence,  scarcity and heterogeneous goals and b e l i e f s about technology. used only power and  when the  resource  or decision i s perceived  control are dispersed  ( i . e . not c e n t r a l i z e d ) .  Conditions  of  uncertainty, decision  producing  schematically  2.  What are sources  be  as important and when  the use of power i n organizational decision making are presented i n Figure  Power w i l l  sources of power i n an organization? power  for  coping  capacity,  process.  individuals resource  and  subunits  dependence and  Functionally determined are  substitutability,  ability  to a f f e c t  the  8  FIGURE 2 CONDITIONS PRODUCING THE USE OF POWER I N ORGANIZATIONAL DECISION MAKING  Interdependence  Heterogeneous goals  Scarity,  Heterogeneous b e l i e f s about technology  Conflict  Importance of resource/ decision D i s t r i b u t i o n o f power  Politics  SOURCE:  Pfeffer  (1981a)  9  The  amount  importance of arise  from  of  power  his/her  the  an  i n d i v i d u a l possesses  performance  division  of  i n the  labour  is  derived  organization.  (or task  from  the  Power differences  specialization).  When various  people perform d i f f e r e n t parts of the whole task i t i s almost inevitable that these tasks w i l l not be equally c r i t i c a l to task completion and organizational survival. t h i s way  Units responsible for most important tasks have the most power. power can be seen to be s t r u c t u r a l l y determined.  In  Power also derives  from people's a b i l i t i e s to perform their tasks and increase t h e i r power bases by convincing others of the necessity of their contributions. Power derives from the a b i l i t y to supply or withhold the  organization  defined  as  a  central  to  the  i s dependent.  critical  Ability  resource.  organization's  to  If the activities  cope with  uncertainty and  resources  on which  uncertainty being  i f the  dealt  subunit  can  be  with  is  coping  with  uncertainty i s non-substitutable, then that subunit w i l l have power. Being irreplaceable i s an additional source of power.. i s a dynamic concept; and centralization attempting  expertise  may  be  employed  by  subunits  and  individuals  also derive from influence over decision processes.  l a r g e l y determined  control  strategies such as use of s p e c i a l i z e d language and  to enhance their power within the organization.  Power may are  of  Irreplaceability  decision  by  the  premises  premises  are  powerful,  underlying as  are  decisions. those  who  Decisions Actors  control  who  which  alternatives are considered and information about a l t e r n a t i v e s . Consensus subunit.  and  technological  certainty can  Consensus f a c i l i t a t e s cohesion;  enhance  the  power  of  the  and the a b i l i t y of members to argue  that r e s u l t s are c e r t a i n , increases the l i k e l i h o o d of resource  a l l o c a t i o n to  such a subunit. One's  position  in  the  formal  and  informal  communication  networks  10  determines the power one w i l l have from information control. subunit  i n which the actor  i s located  The power of the  i s another determinant of i n d i v i d u a l  power. Political  strategies can enhance the power of an i n d i v i d u a l within the  constraints described  above.  Most strategies are aimed at making the use of  power less obtrusive, at legitimating the decision that i s to be made on the basis  of power  to organizational  members or at increasing  position advocated by a c e r t a i n actor.  support  of the  Strategies aimed at a t t a i n i n g one or  more of these goals are outlined below. In  decision  s i t u a t i o n s , decision  makers are confronted  among multiple alternatives and multiple argue f o r the v a l i d i t y  criteria.  with  choosing  I t i s not legitimate to  of a c e r t a i n actor on the basis of an actor's power.  Choices must be legitimated by s e l e c t i v e l y  emphasizing c r i t e r i a  that  favour  the p o s i t i o n which that actor advocates. Using an expert can allow the use of power to a f f e c t decisions i n a less v i s i b l e way.  Experts can also legitimate decisions reached.  agenda and thereby preventing place, i s a very unobtrusive Tactics formation  through  from a r i s i n g i n the f i r s t  way of exercising power.  which  and cooptation.  the decision issue  Controlling the  additional  power  C o a l i t i o n formation  i s mustered  are  involves mobilising support on  the part of those who agree with the organizational member involved. may b u i l d relationships with external power  within  the organization.  Less  coalition  Subunits  groups as a way of increasing powerful  organizational  a t t a i n t h e i r goals by forming a l l i a n c e s with others,  their  members can  p a r t i c u l a r l y those with  greater power. Cooptation actors  so that  i s concerned they  favour  with  t r y i n g to change the views  the interests of the subunit.  coopted to p a r t i c i p a t e i n decision making are confronted  of powerful  Those who are  with pressures  to  11  conform,  informational  social  commitment to the organization  influences  and  expectations  that  increase  (Pfeffer, 1981a).  In legitimating decision making processes and mobilising support for the subunit's  position  r i t u a l s and  on  important  issues,  symbols i s important.  the  use  of  language,  ceremonies,  P f e f f e r (1981) refers to these a c t i v i t i e s  as the symbolic l e v e l of management. To summarize, within s t r u c t u r a l constraints there are differences i n the a b i l i t i e s of i n d i v i d u a l s to advocate t h e i r s k i l l s i n dealing with problems, to shape the way  the s i t u a t i o n i s defined and i n willingness to use their s k i l l s  to impact the p o l i t i c a l process. s t r u c t u r a l p o s i t i o n and personal  Power i s thus determined by the  subunit's  a b i l i t y to cope with c r i t i c a l problems as well as by  c h a r a c t e r i s t i c s which  facilitate  using  power  1981a). These concepts are schematically represented  resources  i n Figure  (Pfeffer,  3.  Symbolic l e v e l It  is  resource  important  to  distinguish between decisions  a l l o c a t i o n and b e l i e f s about these decisions.  (1979) found, experimentally,  that job perceptions  like  promotions  O'Reilly and  and  Caldwell  and emotional reactions to  the job were more strongly influenced by s o c i a l information than by the nature of  the  task  itself.  s o c i a l l y anchored literature  Perceptions  (Adams, 1965;  (Salancik  environment.  The  equity have also been found to  Goodman & Friedman, 1971).  & P f e f f e r , 1978)  legitimacy of a decision and social  of pay  f o r decisions  environment has  dimensions of a decision an i n d i v i d u a l focuses weighted  and  i t also  provides  cues  task  indicates that perceptions  justification  social  The  about  how  a  on,  can  large how  others  be  design  about  the  stem from  the  influence  on  the  these dimensions  are  have  evaluated  the  decision on various dimensions. Those  exercising  power  within  organizations  employ  social  processes  FIGURE 3 SOURCES OF STRUCTURALLY DETERMINED POWER AND STRATEGIES TO ENHANCE THAT POWER  Structurally  P o l i t i c a l S t r a t e g i e s to Enhance S t r u c t u r a l l y Determined Power  Determined Power  Power d e r i v e s from d i v i s i o n of labour. I n d i v i d u a l s / u n i t s doing most important have most power. Sources o f s t r u c t u r a l l y determined  power a r e  making power less obtrusive e.g. c o n t r o l l i n g "the agenda  a b i l i t y to a f f e c t the decision process  irreplaceability  coping capacity  tasks  mustering additional power/support for the position of a n . a c t o r  legitimating d e c i s i o n s to be made on the b a s i s of power e.g. u s i n g e x p e r t s to l e g i t i m a t e the d e c i s i o n  e.g. c o - o p t a t i o n and c o a l i t i o n formation  use o f language ceremonies rituals symbols important  resource dependence  a b i l i t y t o cope with uncertainty  SOURCE:  Peters  (1978)  13  similar to those i d e n t i f i e d above to j u s t i f y decisions that have been made on the basis of power ( p f e f f e r , 1981a).  Weick (1979) notes that the task of the  manager i s largely management of myths, symbols and  images.  And  Pondy (1978)  views symbolic a c t i v i t y as a major component of the exercise of power. Managers label and define decisions and actions and also develop a s o c i a l consensus around ensuring  these labels and  commitment  participants and  that  is  the  organization  on  Legitimations the  part  support from the larger s o c i a l context.  obtaining external way  to  definitions.  support i s by presenting  consonant  with  existing  are  aimed  at  of  organizational  One  of the ways of  an organizational paradigm i n a  social  expectations,  as  well  as  by  i d e n t i f y i n g the organization with s o c i a l l y accepted i n d i v i d u a l s , instructions and methods of operation Pfeffer  (1981)  ( P f e f f e r , 1981).  illustrates  the  symbolic  role  of  management  in  a  description of a school i n a p a r t i c u l a r university i n which s a l a r i e s were low i n comparison with other schools interpreted as questionable school.  A  possessed  an  thought and  social  that  fewer e x t r i n s i c This  might  have  relationships. geographic area.  Low  of  the  environment  situation developed conducive  to  rewards because  The  a  real  leaders of  that  research  faculty members chose to remain i n this  been  s a l a r i e s could be  competence on the part of current  definition  intellectual  i n that organization.  the  and  the  school creative  organization  with  of  its intrinsically  rewarding  atmosphere.  conscious  misinterpretation  of  and  cause  lack  might  of  of  turnover  cause  have  effect  been  the  By managing a s o c i a l d e f i n i t i o n of the s i t u a t i o n , commitment  to the organization was  managed.  With this s i t u a t i o n a l d e f i n i t i o n  of those currently i n administrative positions was  the power  maintained.  Power (derived from strategies and resource-based considerations) i s used in  defining s o c i a l  realities  and  in justifying  activities  i n ways that  are  14  consistent with the p o s i t i o n of those i n power. s o c i a l influence and i s c r u c i a l i n developing  Language i s a key  j u s t i f i c a t i o n s and  tool of  rationaliza-  tions for a c t i v i t i e s . P o l i t i c a l language i s used to j u s t i f y organizational decisions, thereby making  the  regarding  exercise the  of  value  of  power more e f f e c t i v e and r a t i o n a l planning  outcomes, while obscuring  may  be  less used  overt. to  Ideologies  justify  decision  the use of power which underlies the decision making  process. Political reasons.  language and  F i r s t , preferences  be uncertain  symbolic action can be e f f e c t i v e for a number of of individuals or groups i n the organization  or undefined. March (1978) argues that preferences  action, but emerge as a consequence of action. Weick  (1979) i n his  then,  discover  decisions. or how  preferences  One  may  of  This point i s also made by  retrospective  through  what  they  not be able to i d e n t i f y how  do not guide  rationality. obtain  People  from  may,  organizational  much of a resource  one  desires  one w i l l react to the h i r i n g of a colleague, u n t i l these decisions have  been made and will  discussion  may  the outcomes are evident.  have d i f f i c u l t y  process  are  evaluated people  i n assessing  satisfactory.  when preferences are  unclear  about  If preferences  whether p o l i t i c a l  S a t i s f a c t i o n with are  formed  what  are unstable,  outcomes of a decision  decisions  before  the  they ' want,  people  i s far more  decision  they  may  easily  outcome. have  When  difficulty  discriminating symbolic language from substantive outcomes (Pfeffer, 1981a). Second,  informational  social  circumstances (Festinger, 1954). patterns also  influence  of an organization are unfamiliar to newcomers.  usually  a  physically  to  be  anxious  and  in  uncertain  The surroundings, a c t i v i t i e s and i n t e r a c t i o n  separate  entity,  s o c i a l i z a t i o n process (Dornbusch, 1955). likely  i s more powerful  uncertain  New  about  an  The  important  organization i s factor  in  the  entrants to the organization are what  is  required  of  them  and  15  consequently susceptible to believing s o c i a l s t o r i e s and p o l i t i c a l language. Third, even i f preferences enough to  satisfy  Hospitals  tend  are well  formed, p o l i t i c a l  some people i f evaluation  to  avoid  publishing  of  mortality  language may  the  decision i s d i f f i c u l t .  or  morbidity  figures  educational organizations the release of student achievement data. access  to  information  justify  the  release  of  i s supported  practice.  For  through the  development of  example, public school  achievement data w i l l  tend  to  officials  people may  find  i t difficult  outcomes which have may  attributes.  may  definition  also  stem  from  a  of  claim that  those  which  acceptable  who  they should of  what  believe.  one  define  that  to i d e n t i f y  for others  what  Even i n the absence of p r o f e s s i o n a l i z a t i o n , assessment  receives  organizational  for  maintains  Those designated  experts  teach  about the value of outcomes  professionalism  become the  the  organizational  c l i e n t s are not q u a l i f i e d to evaluate decisions. decision c r i t e r i a  myths which  are broadly trained.  to evaluate  Uncertainty  and  Restricted  d i r e c t instructors to  proficiency on t e s t s , rather than produce c i t i z e n s who Fourth,  be  many be  decisions.  hindered Finally,  by if  the  multi-attribute  people  are  nature  unable  to  of  assess  organizational outcomes or specify exactly what they want, a symbolic response may  be  a l l that  they desire  (e.g. some reassurance that their concerns are  being taken seriously) (Pfeffer, 1981a). A l l these factors combined indicate that p o l i t i c a l language may  have r e a l  consequences i n terms of quieting opposition, mobilizing support, d i v e r t i n g or satisfying  demands.  The  effects  participatory  decision  making.  symbolic,  increase  commitment  can  of  symbolic  Involvement  in  to decisions  d i s s a t i s f i e d with the organization may  action decision  reached.  are  evident  making,  in  even i f  Groups which  be placated by symbolic actions.  are For  example, the existence of an administrative structure to deal with complaints may  quiet students.  Political  language and  symbolic actions may  be  used i n  16  implementing change.  For example, since one measure of the importance of a  goal i s the time spent on i t , the symbolic time  on an a c t i v i t y  administrative action of spending  that i s defined to be important,  conveys to others the  importance of the focus of that time (Peters, 1978). Four process.  types  of symbolic  action are important  These are ceremonies, settings,  i n the meaning creation  language and the use of symbols.  Examples are given below. Ceremonies.  Replacing  someone i n an executive  position  provides  an  opportunity to manage meaning creation and could indicate intention to change organizational operations.  I t may involve r i t u a l s to emphasize the importance  of the position. Meetings may be ceremonial interests  in character and provide reassurance  of a p a r t i c u l a r group are being seriously considered.  meeting of stockholders i s a ceremony and creates an i l l u s i o n Stockholders review  have the opportunity  financial  reports.  to ask questions, vote  The symbolic  value  that the  The annual of c o n t r o l .  for directors and  of the meeting  lies  in  reassurance of the owners of the corporation that they have an important  its role  in the corporation. Symbols. process. may  Organizational  restructuring  I t may provide symbolic  change  the  symbolic  organizational operation.  reassurance  meanings  given  can be  seen  as a  symbolic  that action i s being taken and to  various  aspects  of the  The creation of new subunits, f o r example, allows  new aspects of the organization to be emphasized. Settings.  The e f f e c t of ceremonies, language and symbols depends on the  physical setting i n which these a c t i v i t i e s take place. The size, location and physical space i n which p o l i t i c a l a c t i v i t y occurs influences meanings given to that  activity.  Settings influence how organizational members perceive the  17 organization  and  their  role  in i t .  Location and  amount of o f f i c e  space  provide an index of h i e r a r c h i c a l p o s i t i o n . Language.  Whether organizational outcomes are successful or not depends  largely on d e f i n i t i o n s and  classifications.  Shared language i s one  ways i n which shared b e l i e f s , paradigms and cultures are created.  of  the  Language i s  used to legitimate and develop support for decisions that are reached  on the  basis of power. Questionnaires assess i n d i v i d u a l preferences while at the same creating those  preferences.  symbolic  Asking  assurance  of  employees  changes  i n the  their  opinions  future and  provides  that  their  them  with  opinions  are  important. Pfeffer regarding  (1981a) and  the nature  Culbert and  McDonough  of legitimations.  study to examine the nature  (1980) have d i f f e r e n t  ideas  While i t i s not the intent of  of legitimations,  this  these are discussed with  the  view to a s s i s t i n g the researcher i d e n t i f y legitimations. Pfeffer states feeling  (1981) refers  that people of  to  the  literature  on  attribution  theory  which  seek explanations which are both accurate and provide a  control  constrained  to  be  over  events.  legitimate  He  hypothesizes  in  that  that explanations  context,  with  a  will  preference  be for  explanations which provide a f e e l i n g of control over events. Culbert orientation  and  McDonough  (1980)  that spontaneously  serve the unique way  state  spins out  that  "people  proceed  interpretations  and  with  a  job  meanings that  they need r e a l i t y constructed i n order to be a success."  They argue that managers w i l l attempt to show organizational participants that (i)  their  (the  organization, way  managers')  mission  is  essential  to  the  health  of  the  ( i i ) the role they have defined f o r themselves i s an e f f e c t i v e  of contributing to the mission,  and  (iii)  their  accomplishments of organizational mission are linked.  daily  actions and  the  18  Statements and Alternate Statements Pfeffer  (1981a)  claims  that  substantive  actions  determined by the d i s t r i b u t i o n of power i n a s i t u a t i o n . decisions beliefs  that  about  have been made on these  decisions.  the Four  basis of  of  his  outcomes  are  The manager j u s t i f i e s  power,  key  and  thereby  statements  influencing  regarding  the  effects of the manager and power-dependence relationships are presented below, along with some alternate ideas. Statement 1 (SI). The manager has l i t t l e , although some discretionary impact on instrumental a c t i o n . There  i s , according  to  Pfeffer, a  tendency  outcomes to factors inside the organization.  (departments, unions,  a t t r i b u t e actions  and  He asserts that understanding of  the organizational s o c i a l context i s c r i t i c a l . manager i s embedded  to  The s o c i a l system i n which the  the  government, etc.)  constrains  managerial behaviour. The manager accounts for very l i t t l e variation i n organizational outcomes compared to external factors ( P f e f f e r , 1977). contingencies,  facilitate  and a l t e r the context  the  The manager i s able to react to  adjustment of the organization  of the organization to some extent  i n i t s context  (Pfeffer & Salancik,  1978). Many  factors  a f f e c t i n g organizational  leader's control; and resources. the  are  not  under  leaders t y p i c a l l y have u n i l a t e r a l control over very  Leaders' positions vary  organization.  performance  Also,  i n terms of the strength  organizations  have  fairly  the few-  and position of  enduring  strengths  and  weaknesses ( P f e f f e r , 1977). Pfeffer small.  contends  that  the  manager's  impact  on  tangible  outcomes i s  Where, then, does he see the manager as having some influence?  Statement 2 (S2). symbolic outcomes.  Management's action operates ( P f e f f e r , 1981, p. 6)  l a r g e l y on  expressive  or  19  Social  reality  construction. shared  One  is  By  labelling,  outcome  defining  of  the  activity and  process  is  the  explaining  the manager makes these events meaningful and  consensus around them. settings,  an  important administrative  paradigms.  activities,  partly  decisions  Through the use  that  are  of  social  development  of  organizational  develops a  social  of language, ceremonies, symbols and  largely outcomes  of  power  and  influence  are  rationalized. The  purpose  activities continued obtaining  is  of  to  the  r a t i o n a l i z a t i o n and  ensure  support  from  the  legitimation of organizational  organizational environment  commitment to the organization by organizational members. external  support  for  an  organization  is  to  and  A way  make the  of  goals  and  outcomes of the organization appear valuable to the larger s o c i a l system. Pfeffer outcomes.  argues  that  the  manager  has  little  effect  on  substantive  Influencing symbolic outcomes i s the domain of the manager.  then, are his views regarding  What,  the effects of power and dependence on symbolic  outcomes? Statement 3 (S3). Conditions of power and dependence have a small e f f e c t on symbolic outcomes (such as attitudes, values, perceptions). Pfeffer  provides  little  rationale  that conditions of power and (Pfeffer,  1981b).  for this  hypothesis,  but  does state  dependence are decoupled from symbolic outcomes  Although  variables  related  to  a  effects might be  particular highly  set  of  power-dependence relationships and  their  related  to  b e l i e f s about these conditions and  their e f f e c t s , close relationships between  power conditions and b e l i e f s would not be the norm. Knowledge of which units provide c r i t i c a l resources, are irreplaceable or able to a f f e c t decision processes could would be influenced and  i n what way.  unit of a h o s p i t a l provides  not be used to predict whose b e l i e f s  For example, knowing that the emergency  an essential service, does not provide  one  with  20  information regarding whom the manager of the emergency u n i t w i l l attempt to influence nor the nature of t h i s influence. that the knowledge of the d i s t r i b u t i o n substantive  outcomes,  outcomes; people do.  as  Pfeffer  (Similarly, i t could be argued  of power i s i n s u f f i c i e n t to predict  claims i t i s . ) Conditions do  not  affect  The d i s t r i b u t i o n of power allows those with power to  a f f e c t substantive and symbolic outcomes.  The strategies employed by people  are c r i t i c a l i n each case. Alternate Statement 3 (S3a). Conditions of power and dependence have a p o t e n t i a l l y powerful e f f e c t on symbolic outcomes i n that they allow those with power to influence symbolic outcomes. When and how this occurs depends on the motivations of those with power. Pfeffer by  the  (1981a) views power as both s t r u c t u r a l l y determined and affected  strategies  undertaken  by  organizational  power. Many of these strategies are concerned attitudes of others.  members to  increase  their  with influencing b e l i e f s  and  What comes to be seen as uncertainty or as a c r i t i c i a l  resource i s largely a matter of s o c i a l definition'.  For example, because i t i s  seldom possible to determine s c a r c i t y objectively, the group or person owning the resource can increase their power and the value of the resource by talking and behaving as i f the resource were scarce. Those with powers may a f f e c t decision premises; they may control both the alternatives considered and information about a l t e r n a t i v e s . a f f e c t the b e l i e f s of others.  In so doing they  By s e l e c t i v e l y stressing c e r t a i n c r i t e r i a for  evaluating alternatives, the perceptions and b e l i e f s of those exposed to this information are influenced. are  subjected to  People co-opted to support a p a r t i c u l a r position  informational s o c i a l  attitudes and perceptions.  influence which often changes  The motivations of those with power w i l l  their  determine  the nature of b e l i e f s which they influence. It  is  not  contended  that  a l l power-dependence  relationships  are  21  associated  with  a f f e c t i n g attitudes  and  beliefs.  Rather,  power  conditions  create an environment which allows certain individuals to influence b e l i e f s of others. Thus, conditions  of power and  attempts to influence symbolic outcomes  w i l l be c l o s e l y linked more often than hypothesized by P f e f f e r . Pfeffer influence  (1981) argues  the  distribution  beliefs of  that  and  language  attitudes  power determines  symbolic and instrumental  and  of  symbolic  action  organizational  substantive  results.  are  used  to  participants. How,  The  then, are  the  aspects of organizational a c t i v i t y linked? According  to P f e f f e r (1981) they are imperfectly related. Statement 4 (S4). The symbolic and instrumental aspects of organizational a c t i v i t y are c l e a r l y linked; but i t i s clear that the coupling between them i s loose. Decisions  may  well  precede  the  formation  of  explanations,  just  behaviour often precedes the development of an attitude consistent with behaviour.  The explanation  for a decision and  the decision i t s e l f may  as that  be very  loosely linked. If inconsistencies between the content of the explanations the  content of  organizational (Pfeffer,  the  decision  activities  1981a).  Thus  are  may  made more v i s i b l e ,  invest  when  more  external  energy  demands  attitudes w i l l l i k e l y correspond very l i t t l e . greater  and  then those legitimating in  are  explaining absent,  decisions  outcomes  But external forces may  and  prompt  e f f o r t into legitimating organizational a c t i v i t i e s and perceptions  of  these a c t i v i t i e s ( P f e f f e r , 1981). The only factor i d e n t i f i e d by P f e f f e r (1981a) as influencing the of  coupling  between  symbolic  absence of external demands. between  substantive  and  and He  symbolic  substantive  views the amount and outcomes  Three factors which possibly influence how outcomes are linked are described  outcomes  as  an  is  the  conditions  important  presence  or  of  linkage  research  issue.  strongly symbolic and  i n Alternative Statement 4.  strength  instrumental  22  Alternate Statement 4 (S4a). The symbolic and instrumental aspects of organizational a c t i v i t i e s are linked. How strongly or loosely they are linked w i l l be influenced by (a) managerial motives for redefining the s i t u a t i o n , (b) c h a r a c t e r i s t i c s of the outcomes, and (c) c h a r a c t e r i s t i c s of recipients of outcomes. (a)  Managerial motives for redefining the s i t u a t i o n Incongruities between the goals of an organization and i t s actual power  may prompt  emphasis  substantive  outcomes.  on symbolic A welfare  outcomes  which  are loosely  coupled  with  agency, for example, has no legal power to  get people jobs, yet bears the major public symbolic r e s p o n s i b i l i t y for coping with poverty  (Edelman, 1977).  these  i s likely  goals  Congruence between goals  to be  associated  with  and power to achieve  tighter  coupling  between  substantive and symbolic goals. In an organization purpose,  the difference  whose achievements are at odds with i t s ostensible between  seeing themselves as vulnerable.  aims  and outcomes  may r e s u l t i n managers  For example, public d i s a f f e c t i o n with huge  p r o f i t s of o i l companies may lead to o i l companies emphasizing the importance of spending money on research and exploration (Frost, 1981). In an organization likely  to be motivated  substantive  with a controversial objective,  to explain the s i t u a t i o n i n ways which d i f f e r  outcomes. Coupling  l i k e l y to be loose.  those i n power are  between substantive  With an uncontroversial  from  and symbolic outcomes i s  objective, t i g h t e r coupling i s  more l i k e l y . When there i s a need to focus attention on a symptom, thereby d i v e r t i n g attention  from  the root cause  (e.g.,  i n e f f i c i e n c y ) substantive  and symbolic  outcomes are l i k e l y to be loosely linked, (b)  C h a r a c t e r i s t i c s of outcomes When organizational outcomes are not d i r e c t l y observable by people i n or  outside  the organization  there i s greater p o t e n t i a l for people with power to  23 redefine outcomes and hence a greater substantive and symbolic all  organizational  outcomes.  likelihood  of loose  coupling  When outcomes are c l e a r l y  p a r t i c i p a n t s , there  is a  greater  between  observable  likelihood  of  to  tight  coupling. (c)  C h a r a c t e r i s t i c s of recipients of outcomes When  preferences  undefined/ambiguous, definition  of  the  of this  people allows  situation  substantive and symbolic  in those  more  (or  outside)  the  organization  defining the situation  readily  acceptable.  to make their  Coupling  outcomes i s l i k e l y to be loose.  are  between  When preferences are  unambiguous, this w i l l be less easy. In situations where groups i n contact with the organization are unable to define the value of an outcome, have undefined action  only,  loose  coupling  between  preferences  substantive  and  or desire  symbolic  symbolic  outcomes i s  likely. Symbols and perceptions which are i n s t i t u t i o n a l i z e d become the basis on which decisions are made. This i s tight coupling. Summary This influence  chapter of  activities.  reviewed  the  empirical  manager  and  studies  external  overview  was  organizations. distribution  theories  constraints  The dominant view i s that managers exert  over organizational outcomes; and observable An  and  presented He  of  states  power  of that  in a  Pfeffer's substantive  situation.  on  on  the  relative  organizational  considerable control  a c t i v i t i e s have been emphasized. theory  regarding  management i n  outcomes are determined A  combination  of  five  by the factors  determines whether p o l i t i c a l a c t i v i t y w i l l be the method by which choices are made.  Power i s determined by the subunit's  structural p o s i t i o n as well as by  personal c h a r a c t e r i s t i c s which f a c i l i t a t e using power  resources.  24  The task of management i s to provide explanations and legitimations for organizational  activities.  e f f e c t i v e because those  The  symbolic  i n contact with  actions  of  management  the organization may  have  can  undefined  preferences, organizations may avoid assessment, individuals or groups may unable  to evaluate  the value of outcomes  nothing more than symbolic Symbolic satisfying  action  demands.  can The  be  be  they are receiving and may desire  outcomes. have general  consequences forms  of  for  mobilizing  symbolic  action  support  and  are language,  ceremonies, the use of symbols, and settings. The objectives of the study were stated as investigating empirically, researcher outcomes  with  the intent of looking for evidence  to assess  and  i s less  whether on  the manager's e f f e c t  substantive  outcomes;  coupled.  and  substantive  aspects  of  which would allow the  i s primarily on  whether  power i n an organization has a small e f f e c t on symbolic symbolic  organizations  symbolic  the d i s t r i b u t i o n  of  outcomes; and whether  organizational a c t i v i t y  are loosely  25  CHAPTER II METHOD This chapter outlines the study design, methods of data c o l l e c t i o n , data analysis and steps taken to increase the v a l i d i t y of findings.  Differences  between two research s i t e s are analyzed i n terms of their potential impact on the investigation of Pfeffer's  statements.  The  steps involved i n  examining  each statement are presented and sampling procedures and measuring instruments are  described.  The  chapter  concludes  with  a discussion of  data  analysis  procedures. This  study  focused  on  gaining  relationships and managerial  understanding  of  the  impact  actions on tangible outcomes and  of  power  beliefs.  The  meaning people give to events and the manager's a b i l i t y to influence b e l i e f s and  meanings were important  lend themselves How  aspects of the study.  to experimental or even less  Study questions did not  rigorous quantitative  designs.  the words and actions of the manager and others with power are related to  symbolic and substantive outcomes can best be understood within a n a t u r a l i s t i c design, which prescribes the gathering of data on a large number of aspects of the organization i n an attempt whole.  Key  statements  to understand phenomena and the s i t u a t i o n as a  i n Pfeffer's  data c o l l e c t i o n and analysis.  (1981) theory were used as a scheme for  Data were descriptive and content analysis  was  used to examine patterns which emerged. Why and  did the researcher choose the above design, method of data c o l l e c t i o n  analysis?  As  mentioned  earlier,  there  has  been  little  empirical  26 investigation The  three  into  the  influence of the manager on organizational outcomes.  studies conducted  i n this  area  have  examined  existing  data  on  organizational outcomes over a period of time and determined  how much variance  could  social  be  attributed  managerial  influence nor  An examination the  to  impact  of  represents  a  techniques,  the  manager.  None examined  the  nature  involved a closeness to the phenomena under  of  study.  of Pfeffer's theory of managerial action, with i t s emphasis on the new  manager's area  of  actions  on  beliefs,  investigation.  non-traditional i n  The  attitudes and  application  organizational behaviour,  of are  feelings, descriptive  expected  to  provide the basis f o r i n i t i a l study of Pfeffer's ideas. Understanding  the  texture and  the kinds  of relationships which  between symbolic and substantive outcomes, should precede s t a t i s t i c a l of hypotheses. quantities  of  I t was data  on  considered premature at this relationships  between  testing  point to gather  selected  variables.  exist  large Future  studies might well do t h i s . Interviews, systematic observation, and examination to study  the same phenomenon. Interviews  form of communication. to focus on s p e c i f i c  c a p i t a l i z e on  of records were used language, a  powerful  Structured, open-ended questions allow the interviewer issues and interviewees freedom to express thoughts  and  feelings about those issues. Changes i n the interviewer are a p o t e n t i a l source of i n v a l i d i t y (Bouchard, 1976). Systematic observation focuses on behaviour utilizes  categories  from  theory  as  organizational members to the presence observed.  units  for  rather than verbal cues and observation.  of the manager, may,  Reactions  of  f o r example, be  Sources of i n v a l i d i t y include s i m p l i f i c a t i o n of the problem by the  observer, enhancing  some factors while ignoring others and hesitancy to give  extreme ratings (Weick, forthcoming). that they are not contaminated  The  advantage of examining records i s  by r e a c t i v i t y .  27  Research Setting Power i s c e n t r a l to Pfeffer's theory. the  research  actors  setting for a short period  affect  operation  The a b i l i t y of the researcher  of  which power  outcomes, in  that  depends  (in  of time) to detect which powerful largely  organization.  on  Two  the  prominence  pathology  of  the  laboratories  in  teaching hospitals i n Western Canada were chosen as research settings for t h i s study. Power relationships constitute an important part of the functioning of these u n i t s . Is i t l i k e l y that the health care setting influenced answers obtained study questions?  Power relationships i n health care settings are affected by  the issue of professionalism. basis  may,  to  for example, not  Pathologists remunerated on a fee for service view themselves as  such  contextual  hospital employees.  contended,  however,  that  questions.  Whether  the  substantive  outcomes; and whether b e l i e f s are loosely or t i g h t l y linked with  manager  has  a  issues  do  greater  not  effect  impinge on  on  It i s study  symbolic  than  tangible outcomes are not l i k e l y to be greatly affected by the s e t t i n g . The a  laboratory i s a component of the h o s p i t a l , which i n turn, i s part of  larger environment.  environment  which  Factors  impinge  Western Canada are portrayed are  the  on  from within  the  laboratories  i n Figure  Regional Hospital D i s t r i c t ,  4.  the  h o s p i t a l and in  i n the  teaching  Forces i n the  hospitals  on  Hospital  Technologists,  the  technical  clerical  and  Accreditation,  Royal College staff.  of  the  P r o v i n c i a l Ministry of Health,  Canadian  Physicians  Forces within  and the  laboratory functioning are the type of hospital and  in  larger environment  u n i v e r s i t y i n that area providing t r a i n i n g for medical students, Council  larger  Society  the  the Canadian  of  Laboratory  Surgeons and  unions for  hospital which hospital  The impact of each of these factors i s b r i e f l y outlined below.  influence  administrators.  28  FIGURE 4 ENVIRONMENTAL AND HOSPITAL FORCES INFLUENCING LABORATORY ACTIVITIES AND OUTCOMES  Royal C o l l e g e o f Physicians & Surgeons Regional District  Hospital  Provincial Ministry of H e a l t h  Canadian C o u n c i l on H o s p i t a l Accreditation  ity  Canadian Society of Laboratory Technologists  Provincial Medical Association  Unions f o r technical & clerical staff  HOSPITAL  Type o f Hospital  Hospital Administrators  LABORATORY  29  Larger Environment M i n i s t r y o f Health Total  operating  costs  of  hospitals  (Provincial Ministry o f Health).  are funded  The amount a l l o c a t e d  by  Hospital  Programs  to any one h o s p i t a l f o r  a p a r t i c u l a r year i s the outcome o f b a r g a i n i n g between h o s p i t a l a d m i n i s t r a t o r s and the  Ministry  o f Health  hospital  informally  officials.  administrator  and  the amount a l l o c a t e d  The M i n i s t r y equipment  and  Each can  department attempt  head  to  submits  influence  a budget to formally  and  t o h i s / h e r department.  of H e a l t h p r o v i d e s 75 p e r c e n t o f the f u n d i n g f o r d i a g n o s t i c  33.33  percent  of  the  funds  f o r non-diagnostic  equipment.  Department heads submit  r e q u e s t s f o r equipment to h o s p i t a l a d m i n i s t r a t o r s who,  in  of h o s p i t a l  priorities  to the M i n i s t r y  District.  Officials  i n these  the  t u r n , submit Regional  equipment  a list  Hospital  requests  from  many  hospitals  and  then  o f Health and  organizations  make  decisions  review  regarding  allocations.  Regional H o s p i t a l D i s t r i c t The  Regional  Hospital D i s t r i c t  pays 25 p e r c e n t o f the c o s t o f d i a g n o s t i c  equipment and 66.66 p e r c e n t o f the c o s t o f equipment operating  tables.  The a l l o c a t i o n  Regional H o s p i t a l D i s t r i c t of  funds  process  such  as w h e e l c h a i r s and  was d e s c r i b e d above.  Decisions of  o f f i c i a l s are c o n s t r a i n e d i n t h a t t h e i r  allocation  r e q u i r e s the a p p r o v a l o f the M i n i s t r y o f H e a l t h .  University The another  university force  hospitals. The  teaching  affecting  Medical  university  offering  a  medical  teaching  students  training  hospitals  gain p r a c t i c a l  and  f o r medical  students  and  i n that  laboratories  experience  has an a f f i l i a t i o n agreement with  programs  program  those  i n hospital hospitals  residents.  The  area i s in  these  settings. conducting agreement  30  stipulates that where a teaching and/or  d i v i s i o n , the chairman  program i s offered by a hospital department of the d i v i s i o n i s to be appointed  and/or  reappointed by a formal agreement between the h o s p i t a l and u n i v e r s i t y . In addition  to t h i s ,  hospitals  are to hold  medicine,  with  budget  chairmen of the c l i n i c a l departments a t teaching  full  time  some component  academic appointments  of t h e i r s a l a r i e s coming from  of the u n i v e r s i t y . And whenever  appointed  to departments  i n the f a c u l t y of  involved  new  members  i n teaching,  department involved i s to be consulted  the academic  of s t a f f  are to be  the head of the university  ( A f f i l i a t i o n Document Between Hospital  A and the university, 1980; A f f i l i a t i o n Document Between Hospital B and the university, 1977).  Unions Technologists  belong  to  employees to a national union. and  the P r o v i n c i a l  Health  a  provincial  union  and  clerical  hospital  The c o l l e c t i v e agreement between each union  Labour  Relations  Association  sets  forth the  conditions of employment r e l a t i n g to remuneration, hours o i work, benefits and general working conditions. The Canadian Council on Hospital Accreditation The  Canadian Council on Hospital Accreditation i s authorized  accreditation programs i n Canadian h o s p i t a l s . voluntary;  however,  accreditation.  hospitals  The Council  cannot  to conduct  P a r t i c i p a t i o n i n the program i s  operate  teaching  programs  without  conducts accreditation programs and establishes  standards for h o s p i t a l operation. A h o s p i t a l may be accredited for a period of one,  two or three years.  A one year c e r t i f i c a t e of accreditation w i l l  likely  be issued i f major changes are required. Standards have been i d e n t i f i e d f o r laboratory medicine i n the areas of organization  and s t a f f i n g ,  facilities,  channels  of communication,  quality  31 control  systems,  service  and  tissue  clinical  examination,  reports  necropsy  (Canadian  Council  service, of  blood  Hospital  transfusion  Accreditation,  1977). The P r o v i n c i a l Medical Assocatiotion An Accreditation committee of the p r o v i n c i a l medical association examines laboratory  operations  every two  years.  Much emphasis  i s placed  on  quality  control. The Royal College of Physicians The  Royal College  of  resident training program.  and Surgeons  Physicians  and  Surgeons accredits  the  pathology  be  limited i f  Resident training in a hospital may  the training program i s assessed as inadequate along c e r t a i n dimensions. The Canadian Society of Laboratory The  Canadian  Society  Technologists  of  Laboratory  Technologists  accredits  the  technologist t r a i n i n g program and defines what students are to be taught. Hospital Forces P o l i c i e s and considerable  decisions  of  two  groups of people in the  hospital have a  impact on laboratory actions and outcomes.  Type of Hospital Provision convenient  of  to  the  reliable  physician  economical, are central goals (in p a r t i c u l a r , i t s teaching presence  of  and  residents  and  accurate and  test  patient  and  of laboratory status) medical  quantitative  response  to  contributes students  uncertainty.  experience increased amounts of uncertainty  in  which  are,  operation.  increased volume of laboratory tests ordered. a  results  in  The  ways in  hospital  are  addition,  type of hospital  to demand for a  that  tests.  results  The in  an  Laboratory tests can be seen as  Those i n t r a i n i n g are  likely  (Martz and Ptakowski, 1978).  to  32  Hospital  Administrators  The h o s p i t a l administrator's capital  and  operational  funds  r e s p o n s i b i l i t i e s include the a l l o c a t i o n of to  departments.  Laboratory  influenced by the degree to which the administrator lines of communication he/she establishes and the d i r e c t o r of the  how  operation  is  c e n t r a l i z e s control, the  he/she regards the role of  laboratory.  S i m i l a r i t i e s and Differences Between Research Settings In order to draw inferences from patterns that emerged, data were needed on a minimum of two managers i n each of two findings could settings,  similarity  desirable. being  not be  settings.  attributed to i n i t i a l differences between managers or of  managers and  settings along certain dimensions  The unit of analysis i n t h i s study was  the  focal individual.  laboratory).  So that differences i n  Managerial  The  and  the i n d i v i d u a l ; the manager  content of analysis was  subunit  factors  was  were  the  hence  subunit  considered  (the more  important than organizational c h a r a c t e r i s t i c s such as age and s i z e . Two  laboratories  study.  They  are  i n Western Canada were chosen similar  along  many  dimensions  for i n c l u s i o n i n this but  differ  on  some.  S i m i l a r i t i e s and differences are l i s t e d i n Table I. The  administrative  Division heads are such as research  structure  responsible  and  teaching  to the and  such as equipment and supplies. The  laboratory  director  of  the  two  laboratories  is  d i r e c t o r for professional  similar. activities  to the manager for administrative concerns  (See Appendix B) and  d i v i s i o n heads i n  Hospital  A  have  joint  appointments with the u n i v e r s i t y . The director spends less than 50 per cent of his  time at  there.  The  associated greatly  the  hospital; d i v i s i o n heads spend 90 per  laboratory with  the  i n terms of  and  d i v i s i o n heads at  university. the  amount of  However, the  Hospital  cent of B are  laboratories  time d i r e c t o r s  spend  on  t h e i r time  less c l o s e l y do  not  differ  administrative  33  TABLE I SIMILARITIES AND DIFFERENCES BETWEEN TWO PATHOLOGY LABORATORIES  Variable  Laboratory A  Laboratory  S i z e (no. of employees i n laboratory  240  150  P e r i o d of time l a b has been in existence Type of  hospital  30+  years  30+  Teaching  B  years  Teaching  T e c h n i c a l system of l a b o r a t o r i e s  Work p r o c e d u r e s s t a n d a r d i z e d s i m i l a r across l a b o r a t o r i e s .  Power  Power i n d i v i d u a l s or u n i t s i n and o u t s i d e the o r g a n i z a t i o n are s i m i l a r a c r o s s l a b o r a t o r i e s , w i t h one exception. |  Environment  grouping  Recent h i s t o r y of u n i t  Pay of staff  and  professional  I  Very s i m i l a r a c r o s s Divisions dispersed  Power of d i v i s i o n s differed. Role of| manager to a l l o cate resources a c c o r d i n g to need Salaried staff  laboratories. Divisions located on 3 f l o o r s , d i r e c t l y above one another. A relatively stable unit. No major changes or upheavals i n the l a s t years. Pay based on a percentage of fees f o r s e r v i c e .  Length of time manager has been i n that p o s i t i o n Background Manager Sex  Statement 1 Statement 3  The h o s p i t a l and e x t e r n a l e n v i r o n ments are s i m i l a r a c r o s s l a b o r a t o r i e s .  Admin, s t r u c t u r e of u n i t Unit  Difference affects i n vestigation of statement  of  of Manager  Computer s c i e n c e and systems analysis. Male  T e c h n i c a l : has worked i n l a b o r a t o r y f o r 20 y e a r s . Female  Statement  1  34 concerns,  since  the  director  at  Hospital  B  spends  most  of  his  time  on  pathology related tasks. The  background  of  the  laboratory manager i n Hospital A i s i n computer  science and systems analysis. way  H i s t o r i c a l l y this laboratory operated in such a  that d i v i s i o n s which made the  greatest demands were allocated the most  resources. The present manager has been responsible for r a t i o n a l i z i n g allocation.  He has considerable  power i n that the director r e l i e s on him for  information about d i v i s i o n needs and bases decisions on this The  resource  information.  laboratory manager i n Hospital B has a technical background.  She  has  worked i n the laboratory for 20 years and been the manager for the l a s t seven years.  The  operation  of this  laboratory has  been r e l a t i v e l y stable over the  l a s t 10 years. The  director  of  the  laboratory  at  Hospital  A  is  also  head  of  the  department of pathology at the u n i v e r s i t y . His sources of power are several. As  head  division  of  pathology  heads  in  he  has  considerable  laboratories  in  appointments require his approval. specialties this  way.  in microbiology, He  i s well  minister at one time.  control over  a l l teaching He  exerts  i n the  field  appointment  hospitals,  in  control over the way  haematology, e t c . develop  respected  the  and  his  of  that a l l i n which  in each hospital i n brother  was  a deputy  Thus, what constitutes an external power for Hospital B  i s both an external and i n t e r n a l power for Hospital A. Professional s t a f f (the d i r e c t o r and d i v i s i o n salaried members of s t a f f .  heads) a t Hospital A are  Hospital o f f i c i a l s have established rates of  pay  for assistant pathologists, associate pathologists and pathologists. Part of a d i v i s i o n head's salary may  come from the university; the amount depending on  the degree of his/her involvement there. At  Hospital  B,  hospital  administrators  laboratory professional s t a f f ) the  assess  and  volume of work done by  the  measure  (with  laboratory i n  35 terms of fees for service. The  t o t a l fee for service i s based on a percentage  of fees l a i d out by the P r o v i n c i a l Medical Association schedule of fees.  The  percentage of fees i s adjusted p e r i o d i c a l l y to insure that t o t a l fees i n a 12 month period do not exceed a certain amount.  The t o t a l figure i s comprised of  the fees paid by the hospital to the professional s t a f f and the amount paid by the  regional member hospital laboratories• which use  Hospital B's  laboratory  services (Agreement Between Hospital B and Laboratory Director and  Associates,  1981). The  laboratory  this study.  d i r e c t o r and  manager i n each hospital are  the  focus  of  The term "management" applies to these i n d i v i d u a l s . Importance of Differences i n Settings i n Terms of Investigating Pfeffer's Statements  S1  asserts  Investigation  that the manager has  of  this  statement  a small impact on instrumental  included  outcomes.  examining  the  e f f e c t of  action. external  powers on  instrumental  potential  of  outcomes.  The pay of pathologists i n Hospital B i s based, i n part, on number  affecting  the  Method of payment i s a variable with  manager's  ability  to  influence  the  substantive  i  of tests performed, which may  serve  as a motivator for creating  conditions  which promote increased u t i l i z a t i o n (e.g. allowing the laboratory to be operational 24 hours a day).  fully  Pathologists i n Hospital A are on s a l a r i e s and  unlikely to be s i m i l a r l y motivated. The  head of the department of pathology at the u n i v e r s i t y serves  external  power for Hospital B and  director  i n Hospital  A.  as both an external power and  Ambiguity  about whether  pathology had influenced outcomes was According  to  symbolic outcomes. size can  influence  S2,  management's  amount of  director  an  laboratory or  head  of  with  and  on  expected. action  Which variables are the  the  as  time  operates  largely  l i k e l y to a f f e c t such action? the manager i s required  Unit  to spend  on  36 supervision  and  hence time l e f t for other tasks.  responsible  for  supervision  but  supervision.  direct  supervision.  standardization  None of these managers i s  Division  of  work  heads  reduces  do  the  Unit size i s thus unlikely to influence  some need  the  technical  for  direct  effect the manager  has on symbolic outcomes. Laboratories A and  B differ  in terms of unit grouping.  When d i v i s i o n s  are dispersed, as in Laboratory A, r i v a l r i e s often develop making i t d i f f i c u l t for  the  manager  investigating symbolic  to  create  S2,  consensus  involved  outcomes,  not  about  examination  the  existence  organizational  of of  the  impact  consensus.  activities. of  the  But  manager  Differences  in  on unit  grouping were not expected to hinder examination of this statement. One  manager has  background. greater  The  a  background  i n management and  former i s very aware of  motivation  than  manager i s male and  the  the  latter  to  other, female.  the  political  influence  other  variables symbolic  a  technical  and  may  have  outcomes.  One  Pfeffer maintains, however, that  the  manager's actions w i l l have their largest effect on symbolic outcomes in spite of such i n d i v i d u a l S3  focuses  differences.  on  symbolic outcomes.  the  effects  of  influenced S4  that  symbolic  organizational  a c t i v i t y are  the  strength  of  redefinition,  the  recipients and  Possible  outcomes i n this laboratory  claims  the  power  and  dependence  on  likely  linkage  of outcomes. of  to be  will  ambiguity regarding which role  was  outcomes  characteristics  characteristics  anticipated.  and  the  depend  on  of outcomes and  Since c h a r a c t e r i s t i c s of recipients  of  instrumental  closely linked.  outcomes  laboratories, investigation of S4 and S4a was i n Table I.  of  As outlined above, the head of the department of pathology  plays a dual role i n Laboratory A. had  conditions  the  very  S4a,  motives  for  characteristics  outcomes (e.g. are  o1  According to  managerial on  aspect  of  equipment)  similar  in  not affected by variables  both listed  37 In  summary, differences  investigation  of  statements  professional personnel could laboratory  between in  laboratories were  certain  ways.  expected  Method  of  to a f f e c t payment  influence examination of S1 ; and the fact  relationships with  the head  of pathology  differ,  of that  might a f f e c t  investigation of S1 and S3. Investigation of Research Statements: A General Outline Research statements were not investigated interview with the manager focused  separately.  For example, the  on issues related to several statements.  The section below presents a general picture of what was involved i n examining each statement. SI:  The manager has l i t t l e e f f e c t on substantive outcomes. Exploring  and  this  statement involved  several steps  which are l i s t e d  below  elaborated. (i) (ii)  i d e n t i f y i n g substantive determining substantive  whether outcomes  outcomes. the  and how  manager's large  this  actions  directly  affect  impact i s i n relation  to  other factors influencing outcomes. (i) many  Because managerial impact on various substantive outcomes may d i f f e r , as substantive  (retrospectively)  outcomes the  as  causation  possible of  substantive outcomes can be problematic.  were  factors  examined. that  Determining  influenced  existent  Archival data were thus used where  possible; for example, d i v i s i o n heads' written requests  for equipment.  ( i i ) Determining the extent to which the manager d i r e c t l y affects substantive outcomes included: (a)  interviewing the manager regarding his/her impact on substantive  (cognizant  of the fact  his/her a c t i o n s ) .  that  a manager would  likely  outcomes  attribute outcomes to  38  (b)  i d e n t i f y i n g conditions of power and dependence at the organizational and  subunit  levels; i d e n t i f y i n g which of these could have influenced  outcomes;  interviewing  people  and  examining relevant  substantive  documents i n order  assess the magnitude of the impact of the external power versus that of  to the  manager on substantive outcomes. S2.  Management's action operates largely with and on symbolic outcomes. Examining this statement involved the following:  (i)  interviewing the director, associate d i r e c t o r and as wide a range of their actions as possible.  ( i i ) observing regarding  manager and  and conducting interviews with organizational participants the meanings they ascribed to managerial behaviour.  Each of the above steps i s examined i n some d e t a i l below, (i) actions.  observing  Managerial  P f e f f e r (1981a) states that managerial control derives from symbolic  action.  Symbolic action refers to actions/ utterances  meaning d i f f e r s  from  the  obvious  or  literal  i n which the  meaning.  An  intended  act may  be  both  symbolic and substantive i n nature. The asking  overt  him/her about intended  recognized  Meaning  manager  was  determined  meanings of actions and  words.  uses  (in part) Since  that this would not always y i e l d v a l i d information,  were i n d i r e c t . (ii)  meaning of a manager's actions  it  to  language,  managerial symbols,  actions.  rituals  and  was  some questions  Descriptive and contrast questions were used (Spradley, assigned  by  1980).  According  to  Pfeffer,  the  ceremonies  to  achieve  the  following goals: (a) to give organizational actions and events meaning, (b) to legitimate  decisions  mobilize support, and The contrast  were resolved  through  the  use  of  power,  (c)  to  (d) to quieten the d i s s a t i s f i e d .  meaning assigned  to managerial actions  questions,  as  contrasts may (iii)  that  such  "Do  you  see  any  was  ascertained  differences  ...?"  by  asking Sets  of  reveal kinds of differences that reveal symbolic meaning.  Is management's e f f e c t primarily with  respect  to symbolic outcomes?  39 Whether the manager's e f f e c t i s primarily on symbolic outcomes can be answered only i n conjunction  with the issue of the extent of the manager's e f f e c t on  substantive outcomes (S1). 53. Conditions of power and dependence have a small outcomes (such as attitudes, values and perceptions).  e f f e c t on symbolic  S3a. Conditions of power and dependence have a p o t e n t i a l l y powerful e f f e c t on symbolic outcomes i n that they allow those" with power to influence symbolic outcomes a t the organizational, subunit and i n d i v i d u a l l e v e l s . When and how t h i s occurs depends on the motivations of those with power. Examining  these  statements  included  conditions of power and dependence. resource  s c a r c i t y , interdependence,  resources  and dispersion of power.  (ii)  i d e n t i f y i n g the extent  affected actors, symbolic  symbolic managers  disagreement  This  which  might  conditions  involved  and organizational  outcomes  (i)  identifying  This involved i d e n t i f y i n g conditions of  to which  outcomes.  the following:  regarding  of power  talking  goals,  important  and dependence  to powerful  external  participants and i d e n t i f y i n g types of  benefit  powerful  external  actors  or  organizations. (iii)  the extent  to which powerful individuals succeeded i n influencing the  b e l i e f s of organizational members was ascertained by t a l k i n g to these members. 54. The symbolic and instrumental aspects of organizational a c t i v i t y are c l e a r l y linked; but a t the same time i t i s l i k e l y that the coupling between them i s loose. S4a. The symbolic and instrumental aspects of organizational a c t i v i t i e s are linked. How strongly or loosely they are linked w i l l be influenced by (a) managerial motives f o r redefining the s i t u a t i o n , (b) c h a r a c t e r i s t i c s of outcomes, and (c) c h a r a c t e r i s t i c s of recipients of outcomes. Substantive loosely selected  coupled  and symbolic have  aspects  few variables  and variables  i n that  of organizational a c t i v i t y i n common. A substantive  outcome  interviewing and examination of records.  identified  .through  which are  outcome was observation,  B e l i e f s and feelings related to that  outcome were i d e n t i f i e d and the degree of s i m i l a r i t y / o v e r l a p between variables of substantive and symbolic outcomes was assessed.  40 This  process  was  repeated  with  a  number  of  substantive  Patterns of r e l a t i o n s h i p s between pairs of substantive and  symbolic  outcomes. outcomes  were examined i n order to determine whether loose coupling i s more l i k e l y when one or more of the following conditions i s present: incongruities e x i s t between organizational goals and power. organizational achievements are at odds with i t s purpose the organization has a controversial objective, organizational outcomes are not d i r e c t l y observable. preferences of people (in or outside the organization) are undefined/ambiguous. Projected relationships between variables i n a l l statements  are presented  diagramatically i n Figure 5. P i l o t Study A p i l o t study was conducted i n the laboratory of a teaching hospital; the purpose of which was  to determine and correct any f a i l i n g s discovered i n study  design and methods.  Some of the standardized open-ended interview questions  initially  included i n the interview schedule  were found  to be inappropriate  and were a l t e r e d . Sampling The investigator spent 25 days (between February  1 and March 12, 1982) i n  Laboratory A and 18 days (between March 15 and A p r i l 15, B.  Size explains the discrepancy  i n time spent  1982)  i n Laboratory  i n each; Laboratory  A  has  considerably (240 vs 150) more s t a f f than Laboratory B and a greater number of interviews was  required there. The researcher did not enter both laboratories  with the same assumptions and expectations.  From her experience i n Laboratory  A, she had some sense of the strengths and shortcomings of Pfeffer's ideas and then explored  these  i n greater depth i n Laboratory  B.  Since the nature  of.  41  FIGURE  5  PROJECTED RELATIONSHIPS BETWEEN VARIABLES  Powerful i n d i v i d u a l s i n or o u t s i d e h o s p i t a l  A c t i o n s of management  I x  SI S2 A c t i o n s o f management have l i t t l e e f f e c t on s u b s t a n t i v e outcomes  S3a S3 C o n d i t i o n s of power and dependence do not a f f e c t symbolic outcomes  x X X  Symbolic Outcomes (Attitudes Feelings Beliefs) x X  S4 Loose coupling e.g. Important factors i n promotions, acquiring capital equipment e t c . and b e l i e f s about these factors correspond very l i t t l e  .—>-  —xx  xx  xx—y  \  x/  \  X X  X  \ \  X  S4a S t r e n g t h o f c o u p l i n g depends on the m o t i v a t i o n s of manager, c h a r a c t e r i s t i c s of \ outcomes and j c h a r a c t e r i s t i c s of r e c i p i e n t s of outcomes  f  Substantive a c t i o n s and outcomes ^ (laboratory tests acquiring c a p i t a l equipment, h i r i n g f i r i n g , promotions, budget a l l o c a t i o n s )  actions  a f f e c t outcomes  actions  do not a f f e c t outcomes  l i n k a g e ( r e l a t i o n s h i p ) between symbolic and s u b s t a n t i v e outcomes  42 t h i s research i s both inductive and deductive, this process i s appropriate and desirable. A l l those interviewed were informed that the intent of the study was to i d e n t i f y the extent to which laboratory a c t i v i t i e s are influenced by people i n the laboratory and to what extent by people i n other parts of the hospital or outside the h o s p i t a l . Several consecutive days were spent i n each of the f i v e d i v i s i o n s i n each laboratory.  In an attempt  to reduce  obtrusiveness, the investigator  spent  5-10 hours observing d i v i s i o n a c t i v i t i e s and interacting with d i v i s i o n members before conducting interviews. After i n d i v i d u a l s had discerned the purpose of her study and had  talked to her, they appeared  to f e e l comfortable with her  presence and continued with work routines and i n t e r a c t i o n s . F i e l d notes were taken at coffee breaks, lunch times and other i n t e r v a l s during  the day.  Each interview lasted  assented to be tape recorded. who  40-90 minutes.  Many interviewees  Notes were taken during the interviews of those  did not, and expanded immediately following the interview. Time sampling  of tapes was performed to assess the consistency of investigator behaviour i n interviews, over time. The  investigator noted that people i n positions of power were far more  open when the tape recorder was switched o f f than when i t was on. the decision power  (e.g.  not to attempt laboratory  This led to  to tape interviews with those i n positions of  managers  and  hospital  administrators).  Study  participants at lower levels i n the organization may also have been reluctant to be completely honest while being taped. these  individuals  posed  less  risk  of  But since the question asked of  exposure,  i t was  thought  that  the  hesitancy they might experience would be minimal. Sources of information were interviews, observations and documents. source i s described below.  Each  43  Interviews Interviews organization.  were  conducted  with  the  following  people  in  each  (Questions asked are l i s t e d i n the Appendix).  (i)  the laboratory director and manager.  (ii)  the a s s i s t a n t director and assistant manager i n Laboratory A (positions which do not e x i s t i n Laboratory B).  (iii)  d i v i s i o n heads (5 i n Laboratory A; 4 i n Laboratory B).  (iv)  a s t r a t i f i e d sample of medical s t a f f (10 percent selected randomly from each d i v i s i o n , i . e . 4 individuals i n Laboratory A and 1 i n Laboratory B) .  (v)  head technologists (9 i n Laboratory A, 5 i n Laboratory B).  (vi)  a s t r a t i f i e d sample of technologists (25 percent selected randomly from each d i v i s i o n ; i . e . 15 i n Hospital A and 8 i n Hospital B).  (vii)  the hospital administrator responsible f o r resource a l l o c a t i o n .  ( v i i i ) person responsible for labour r e l a t i o n s . (ix)  the head of the department of pathology at the u n i v e r s i t y . Research reports have documented the influence of physician demand on the  number of tests performed  (Freeborn, Baer,  et a l , 1972).  Interviewing of  physicians i n r e l a t i o n to this issue was thus considered redundant.  Observations Observations were conducted of the following: (i)  the general a c t i v i t y i n each of the d i v i s i o n s of both laboratories.  (ii)  the actions, language, dress, o f f i c e furniture and o f f i c e layout of the laboratory d i r e c t and manager.  Documents Agreements between technical and c l e r i c a l employees and t h e i r respective unions were studied.  Reports of research on laboratory costs and u t i l i z a t i o n  conducted by the d i r e c t o r and others i n Laboratory A were examined.  Documents  44 (written  by  division  heads  and  laboratory  managers)  requesting  capital  equipment and a d d i t i o n a l s t a f f were reviewed, as were annual reports of  the  department of pathology at the u n i v e r s i t y . Measuring Instruments Observations of  managers  and  and  outcomes.  questions  other  focused  powerful  Substantive  on relationships between the actions  i n d i v i d u a l s and  outcomes  and  substantive  powerful  and  symbolic  individuals (identified  in  conjunction with the managers of laboratories and others knowledgeable i n this field)  are  itemized  i n Table  II.  Powerful i n d i v i d u a l s are  those  with some  control over resources or decisions of importance to laboratory operation. The the  study  was  laboratory.  personnel were  Tangible  could  not  limited  have  examined,  to  examination  outcomes outside  affected since  (e.g.,  this  of the  hiring  would  substantive  outcomes within  laboratory which laboratory of  have  the  d i r e c t o r of  required  nursing)  investigation  of  numerous a d d i t i o n a l influences. This which  section  could  attitudes  be  were  outlines specified  unknown  those in  prior  observations  advance. to  entry  and  Factors in  the  formulation of a l l questions and observations was  interview such  as  questions  beliefs  organizations.  and  Advanced  thus not f e a s i b l e .  Interviews The  existence of some unknown factors such as the nature of b e l i e f s and  feelings about managerial actions, necessitated the use of two conducting  open-ended  constructed  in  interview.  This  interviews.  advance,  phrased  Standardized precisely  approach i s intended  as  open-ended they  to minimize  were  approaches to questions asked  interviewer  were  in  the  effects  and  enhances the c r e d i b i l i t y of data c o l l e c t e d . An interview guide of issues to be explored  during  the interview was  prepared.  The  guide kept the i n t e r a c t i o n  45  TABLE I I SUBSTANTIVE OUTCOMES OF LABORATORIES AND POWERFUL FORCES AND INDIVIDUALS INFLUENCING LABORATORY OPERATION  S u b s t a n t i v e Outcomes  Funding f o r equipment O p e r a t i n g budget L a b o r a t o r y c o s t s and u t i l i z a t i o n Research Teaching Quality Control Accreditation H i r i n g of p r o f e s s i o n a l personnel Promotion o f p r o f e s s i o n a l p e r s o n n e l F i r i n g of p r o f e s s i o n a l personnel Payment o f p r o f e s s i o n a l p e r s o n n e l H i r i n g o f t e c h n i c a l and c l e r i c a l p e r s o n n e l Promotion of t e c h n i c a l and c l e r i c a l p e r s o n n e l F i r i n g o f t e c h n i c a l and c l e r i c a l p e r s o n n e l  P o w e r f u l I n d i v i d u a l s and F o r c e s  Physicians ordering laboratory tests Hospital administrators M i n i s t r y of Health o f f i c i a l s Head o f department o f p a t h o l o g y a t u n i v e r s i t y Canadian C o u n c i l on H o s p i t a l A c c r e d i t a t i o n Canadian S o c i e t y o f L a b o r a t o r y T e c h n o l o g i s t s R o y a l C o l l e g e o f P h y s i c i a n s and Surgeons Unions f o r t e c h n i c a l and c l e r i c a l s t a f f P r o v i n c i a l Medical Association  46 i  focused,  but  allowed  f o r the  emergence  of  individual  perspectives and  experiences (Patton, 1980). Standardized open-ended interview questions asked of selected individuals in each setting are itemized i n the Appendix. person  may  pertain  Questions asked of a p a r t i c u l a r  to several statements.  interviewed and statements  Table  III l i s t s  to which interview questions  relate.  the  people  Interviews  which were long were staggered over a period of two or three days.  Observation Observation was used primarily i n investigating Statement 2 and focused on ways i n which the behaviour of the manager operated on b e l i e f s , and attitudes. directors  The dress, speech, actions, o f f i c e layout and o f f i c e design of  and managers convey  e x p l i c i t l y planned convey f r i e n d l i n e s s will  have this  feelings  to do so.  nonverbal  even when not  Open desk placement i s , f o r example, l i k e l y to  (Morrow & McElroy,  effect.  messages to others  1981); but one cannot  assume that i t  The only way of finding out what particular actions  mean to people i s to ask them. The researcher noted which people have the most contact with the director and  manager.  Subtle comments on the behaviour  were made to these people i n an attempt  of the d i r e c t o r and manager  to discover what the actions of those  in charge of the laboratory meant to them. According to P f e f f e r (1981a), the manager uses language, and  symbols, r i t u a l s  ceremonies to legitimate decisions made on the basis of power, to give  meaning to organizational a c t i v i t i e s , dissatisfied. advance.  Observations  to mobilize support and to quieten the  to be made could not be p r e c i s e l y  The researcher was heedful of managerial  attempts  specified i n  to legitimate,  mobilize support, e t c . However, since managers and directors spent l i t t l e in  the laboratory, the research was afforded l i t t l e  t h e i r interactions with laboratory personnel.  time  opportunity to observe  47  TABLE I I I INTERVIEWS, OBSERVATIONS AND DOCUMENT ANALYSIS ASSOCIATED WITH EACH STATEMENT  SI involved  I n t e r v i e w i n g the director  S2 involved  S3 involved  S4 involved  /  I n t e r v i e w i n g the manager  /  /  /  /  Interviewing medical s t a f f  /  /  /  /  Interviewing heads  /  /  /  /  I n t e r v i e w i n g head technologists  /  /  /  /  Interviewing technologists  /  /  /  /  Interviewing h o s p i t a l administrators  /  /  division  I n t e r v i e w i n g head o f pathology at the university  /  Observing.manager s actions  /  Observing d i r e c t o r ' s actions  /  Observing a c t i v i t y in laboratory  /  Document a n a l y s i s  /  1  /  48  Data Analysis Since  the study  substantive outlined  and  by  classification observations,  was  concerned with  symbolic  outcomes  i n v e s t i g a t i n g relationships between  and  Pfeffer,  his  theory  system  for  categorization  interviews  and  had  managerial an  documents  important of  item  against  which  the  external control  role  observations.  were  reviewed  according to their relevance to various statements. statements. Each observation  versus  in  forming  Field  and  notes  data  statement  was  checked;  implications of each aspect of theory were looked f o r . the implications against which each statement was  on  labelled  Data were organized into  or response to an interview question  research  the  became an  i.e.  multiple  A record was  checked and  kept of  the number of  'positive' items compared with the number of 'negative' instances. Data analysis also included developing multiple images of what data could mean.  For example P f e f f e r states that substantive and  loosely  linked.  Indications  that,  b e l i e f s about a l l o c a t i o n correspond  for  example,  symbolic  equipment  outcomes are  allocation  very l i t t l e were looked f o r .  and  Evidence was  also sought that strength of linkage between equipment a l l o c a t i o n and  beliefs  about a l l o c a t i o n were influenced by managerial motivations, c h a r a c t e r i s t i c s of outcomes,  and  preferences  of  individuals.  In  addition  to  this  deductive  approach, the researcher attempted to discover categories from the data. example, type of symbolic  For  outcome emerged as a category of factors influencing  the strength of coupling between substantive and symbolic outcomes V a l i d i t y of Findings The  purpose of this study  about the symbolic consists meaning.  was  to investigate some of P f e f f e r ' s claims  role of management. P f e f f e r states that the manager's role  largely of legitimating, explaining and  creating shared  systems of  I t i s c r u c i a l for v a l i d i t y to try and picture the empirical world as  49 quantify managerial e f f o r t s  to influence b e l i e f s and  attitudes  (as well  as  resultant b e l i e f s ) , an attempt was made to understand both what the manager's words meant to organizational members and the manager's intentions.  Meanings  of words, actions and events are best understood by asking people what these things  mean  to  them  feelings i n t h e i r own  and  by  allowing them  words.  to express  their  thoughts  Use of open-ended questions f a c i l i t a t e d  and such  responses. The  following  steps  were  taken  to  check  other  potential  sources  of  i n v a l i d i t y , thereby increasing confidence i n the analysis of findings. (i)  The researcher attempted division them.  and But  interacting such  "insider" and was,  action  to reduce r e a c t i v i t y by spending time i n each with may  division result  in  members the  before  interviewing  researcher  becoming  losing research questions as a point of reference.  however, never i n a p a r t i c u l a r  section of a d i v i s i o n  an She  for longer  than three days, which c u r t a i l e d the development of "insider" status. (ii)  The  researcher  Evidence  searched  for  supporting Pfeffer's  rival  explanations  claims was  sought,  of  relationships.  as was  r i v a l explanations (formulated as alternate statements).  support for Explanations  for relationships which emerged from the data, were also sought. ( i i i ) If those interviewed and observed t r y to maintain appearances, data w i l l be i n v a l i d  (Van Maanen, 1978). In t o t a l , 61 people were interviewed and  many observed. maintained  It i s unlikely  that p r e c i s e l y the same appearance  by a l l these people.  If people express their b e l i e f s  feelings honestly, the data can be considered v a l i d because of the study i s to i d e n t i f y these views and (iv)  Feedback from  study participants picture,  is a  was and  the intent  emotions.  regarding whether the researcher i s  getting  the  stringent  test  of  validity  1978).  With people with whom she interacted frequently,  (Van  Maanen,  (the manager,  50  head  technologists  whether her  and  some  understanding  technologists)  of what they  corresponded with what they had  had  intended  the  said  researcher about various  to convey.  checked issues  But t h i s was  not  done with a l l study p a r t i c i p a n t s . (v)  The  consistency  collection  was  technologists'  of information derived from d i f f e r e n t methods of cross  checked.  statements  Observational  about  union  data,  for  data  example,  head  regulations were compared  with  written statements i n union agreements. (vi)  A  large proportion  of  the  interviews  verbal  information  were  taped,  would  be  which  reduced  the  misinterpreted  or  likelihood  that  forgotten.  Notes were taken during interviews which were not taped, to  reduce the p o s s i b i l i t y of loss of information or inaccurate  information  recall. ( v i i ) Time sampling of tapes change  significantly  conducted were taped. consistency  of  indicated that investigator behaviour did over  time.  Two  interviewer  The  of  the  61  interviews  i n d i v i d u a l s , working independently, behaviour  placed into f i v e groups according been conducted.  Seventeen  across  interviews.  assessed  Tapes were  to the order i n which interviews  f i r s t evaluator randomly selected one  not  had  tape out of  each group for assessment by both evaluators. The r a t i o of leading to non-leading questions was across interviews.  The interviewer was  found constant (9:100)  assessed as being  facilitative.  Use of open-ended questions and an interview guide sometimes resulted i n rambling According  responses. to Van  Maanen (1981a), the e s s e n t i a l test of v a l i d i t y i s the  use findings have for those who  enter similar organizations at a l a t e r time.  The o r i g i n a l concepts are then changed, discarded or validated on the basis of  51  their  ability  to capture  the experiences  of another  researcher.  He  adds,  however, that In the f i n a l analysis, a l l organization studies rely on the i n s i g h t and judgement of the investigator because there are no forms of v e r i f i c a t i o n that transcend the assumptions b u i l t into the technique and theory followed by the investigator (Van Maanen, 1981, p. 17).  52  CHAPTER III  ANALYSIS OF FINDINGS  Introduction  This chapter describes posed, but  also  findings of the study.  examines relationships not  It emphasizes  formally  posited  questions  i n the  study.  Findings related to the following three issues are presented: 1.  the r e l a t i o n s h i p symbolic outcomes  between  managerial  2.  the r e l a t i o n s h i p between external control and symbolic outcomes  3.  the r e l a t i o n s h i p between organizational a c t i v i t y  substantive  action  and  and  substantive  symbolic  aspects  and  of  Some of the data are relevant to more than one statement and are, accordingly, not repeated i n toto. Statement 1 Statement 1 asserts that the manager has a limited impact on outcomes. laboratory  This  statement  managers on  promotions) i n r e l a t i o n and  unions).  The  examines  the  magnitude  of  the  substantive  impact  of  four  tangible outcomes (such as equipment a l l o c a t i o n s and to external forces  (such as  purpose of this research was  hospital  administrators  to i d e n t i f y extremes i n terms  of managerial impact on tangible outcomes, i . e . , whether he/she i s constrained on most tangible outcomes or has a large impact on most of these outcomes. was  thus  decided  that  the  statement  will  be  supported  i f the  It  manager's  influence i s found to be external factors on more than 50 percent of tangible  53  outcomes.  (Managerial impact on 16 tangible outcomes was examined).  Findings that indicate that the manager has a powerful influence on more than 50 percent of substantive outcomes w i l l not support this statement. the manager and external forces each have a powerful e f f e c t on  If  approximately  50 percent of substantive outcomes, findings w i l l be considered inconclusive. People  and  organizations a f f e c t i n g  below, as are b e l i e f s and the  extent  to which  each  tangible outcome are described  attitudes about that outcome. Table IV summarizes  findings  related  to each  substantive outcome  support  Statement 1.  Funding f o r C a p i t a l Equipment The minimal  expectation impact  on  c a p i t a l equipment. paid  is  the  that  laboratory directors  amount of money allocated  the  Regional  Hospital D i s t r i c t  Ministry  of  Health.  For  and  non-diagnostic  75  division  their  percent  equipment,  D i s t r i c t pays 66.66 percent of the cost and  The  to  managers  will  have  departments for  Twenty f i v e percent of the cost of diagnostic equipment i s  by  percent.  and  by  the  the  Provincial  Regional Hospital  the Ministry of  Health, 33.33  Laboratory equipment i s c h i e f l y diagnostic. laboratory d i r e c t o r heads  and  submit  and  this  manager list  to  prioritize hospital  requests  from  their  administrators, who  (in  consultation with committees) p r i o r i t i z e equipment requests from a l l hospital departments.  The  District  the  and  list  of p r i o r i t i e s  Provincial  i s submitted  Ministry  of  to the Regional Hospital  Health.  organizations review requests from numerous h o s p i t a l s . District  Act stipulates  that the  Regional  Officials  in  The Regional Hospital  Hospital D i s t r i c t  may  not incur  c a p i t a l expenditures without the approval of the Ministry of Health. other hand, the Ministry of Health may approval of the Hospital D i s t r i c t .  these  fund equipment purchases  On the  without  the  TABLE IV FINDINGS RELATED TO STATEMENT 1 IN TERMS OF SUBSTANTIVE OUTCOMES  No support for Statement 1  Support for Statement 1 Amount of Support Large  Substantive Outcome Capital equipment funding  Hospital B Hospital A Ministry of Health a hospital administrators are powerful forces  Operating budget (supplies)  Large  Ministry of Health, hospital administrators & economic conditions are powerful forces  Operating budget  Large  Ministry of Health & hospital administrators are powerful forces  Laboratory costs  Large  Demand for tests by physicians & costs of factors of production are powerful forces  Hiring professional personnel  Large  A f f i l i a t i o n documents between hospitals & university Creation of research position  (personnel)  Promoting professional personnel  Inconclusive  Firing professional personnel  Large  Payment of professional personnel  Since external power i s also director, assessment difficult Professionalism and head of pathology at university are constraints  Inconclusive  Hiring technical & c l e r i c a l personnel  Large  Unions exert a powerful influence  Promoting technical personnel  Large  Unions exert a powerful influence  Firing technical personnel  Large  Research  Large  Head of pathology (unlv.) service demands & -fiscal restraint are powerful forces  Teaching  Large  Canadian Society of Laboratory Technologists head of pathology at unlv. & Royal College bf Physicians & Surgeons powerful forces  Quality Control Accreditation  Large amount of support: No support: Inconclusive findings:  Inconclusive Large  Unions exert a powerful influence Pulmonary research determined by head of pathology  Pathologists' choice of work setting & fee for service has large effect i n Hospital B  Whether external demands or manager has largest effect, d i f f i c u l t to determine Canadian Council on Hospital Accreditation i s a powerful force  External power holders have greater impact on tangible outcome than manager. Manager's power to influence tangible outcome i s constrained very l i t t l e by external power holders. In 50% of instances manager has considerable power to influence tangible outcome; in other 50% external power holders have a greater impact on tangible outcomes than manager.  55  Equipment funds allocated to the laboratory are determined i n large part by  the  Ministry  administrators prioritize strongly  of  Health,  the  (external powers).  equipment requests. motivated  subordinates) legitimate  Regional  to  to  The  other  greater  to  these  and  hospital  manager have power  d i r e c t o r i n Hospital A  power  resources  expenditures  District  d i r e c t o r and  manager and  influence  allocate  laboratory  The  Hospital  holders  to  the  (as  individuals.  are  opposed  laboratory  considerably  counterparts hospital  in  less  Hospital  administrators  energy A.  They  efforts.  A  state  and  that  Ministry  the  "we  to  Maintenance  some  "The  of  beliefs  Hospital  Health  A  than claim  officials  a l l o c a t i o n s have  do  their  they  lobby  regarding  concurrence  resulted with  evidence they bring me  need f o r more equipment and  from  that  of  They  h i g h l i g h t programs that are written up  h o s p i t a l administrator's  evident i n the following: of  influencing  Management i n  importance of their requests; paper".  to  to  and  adequate services i s the goal of the manager and d i r e c t o r at Hospital B. devote  to  the on  lobbying  statement  sometimes convinces  was me  I a l l o c a t e more money".  Managers i n  to  and  Hospital B do not engage i n lobbying. Division clubs  heads  sometimes apply  for equipment funding.  external  If they obtain  organizations  25 percent  of the  p a r t i c u l a r piece of equipment from such an organization, they may balance from the p r o v i n c i a l government.  service  cost of a request  the  Requests to the p r o v i n c i a l government  are channeled through laboratory management and h o s p i t a l administrators. It  i s noteworthy  administrators  and  that objectives of  the  laboratory management d i f f e r  Ministry of  Health,  considerably.  An  hospital important  goal of Ministry of Health o f f i c i a l s i s the a l l o c a t i o n of funds to health care f a c i l i t i e s across the province i n ways they consider w i l l help t h e i r party to be  re-elected.  with  the  The  Ministry  objectives of h o s p i t a l administrators include compliance of  Health  mandate  to  exercise  fiscal  restraint  and  56  allocation  of resources  powerful groups.  within  the  Management at  hospital i n ways which s a t i s f y the most  Hospital A wishes to achieve i n t e r n a t i o n a l  recognition for research, which requires up-to-date equipment and an adequate personnel  budget.  An  important  objective  of  the  laboratory  director  at  Hospital B i s p r o f i t maximization. Overall,  findings  related  to  funding  for  capital  equipment  support  Statement 1, i n that the power of laboratory management to obtain this  funding  i s constrained by the Ministry of Health and hospital administrators.  Operating Budget  (Supplies)  Statement 1 leads  to the  expectation  that the  laboratory  director  and  manager w i l l have l i t t l e impact on the size of the supply budget allocated to the laboratory. Health  The supply budget allocated to a hospital by the Ministry of  i s based on  the  budget for the  previous  year with an  increment for  i n f l a t i o n (12 percent i n 1981). Administrators  allocate  supply  budgets  to  the  laboratory.  Decisions  regarding a l l o c a t i o n s to the d i v i s i o n s are made by the laboratory manager and director. obtain. obtain  Money f o r  supplies  Managers report a l l the  that,  laboratory  supplies  there  supplies.  Laboratory managers are  officials  and  been  pressure  hospital  traditionally,  for the  restraint,  Health  has  has,  most part,  not  been  difficult  to  they have been able  to  they have requested. on  managers  constrained  administrators.  to  But  reduce  by decisions These  with the  fiscal  cost  of  of Ministry of  findings  support  Statement 1. Operating Budget (Personnel) Evidence that management i s constrained personnel budget w i l l support Statement 1.  i n i t s a b i l i t y to influence the  The personnel budget allocated to  each department i s larger by a c e r t a i n percentage than that of the  previous  57  year  and  as  staffing. Ministry  a  is sufficient  Management of  positions. as  such  Health  at  officials  A  the  lobbies  regarding  previous  hospital  additional  these lobbying  constraint by allowing laboratory but  efforts. Fiscal  level  programs  and  of and  staff  additional s t a f f i n g  r e s t r a i n t has  resulted i n a  Laboratory management has found ways around this  laboratory personnel to work overtime. In addition, i f  budget i s over-expended, the  to pick up  year's  administrators  They.think that sometimes they have obtained  r e s u l t of  option  maintain  Hospital  h i r i n g freeze at Hospital A.  the  to  the  tab.  Ministry of  Health  has  had  no  Laboratory managers have limited power i n  r e l a t i o n to the personnel budget; finding which, supports Statement 1. At Hospital B, requests  for additional positions have to be j u s t i f i e d by  the Hospital Position Committee. these  positions  requests.  and  There i s competition  department  heads  present  among departments for  data  justifying  position  Should the laboratory be allocated some, or a l l , of the positions  requested, laboratory management has  the power to decide how  these are to be  d i s t r i b u t e d . This indicates limited power and supports Statement 1. Overall, findings related to the personnel budget support Statement 1, in  that  hospital  the  manager's power i s constrained  by  the  Ministry of  Health  and  administrators.  Laboratory Costs and U t i l i z a t i o n Factors external to the laboratory are expected to have a great impact on laboratory  costs  and  utilization.  It  is  anticipated  that  the  power  of  laboratory d i r e c t o r at Hospital A i n i t i a t e d a s e r i e s of studies  on  laboratory management i s limited (Statement 1). The  laboratory costs and u t i l i z a t i o n . costs  were found  (qualified  and  to be  trainee)  The  two most s i g n i f i c a n t factors a f f e c t i n g  (i) demand for tests per  occupied  bed.  and  number of  Medical  staffing  test  orderers  and  training  58  p o l i c i e s are c r u c i a l issues here. the  laboratory.  According  to  Demand i s l a r g e l y outside  study  t o t a l l y reactive to work sent to i t . and  little  findings,  "The  the control of  laboratory  is  almost  It has l e g a l l y mandated tests to perform  d i s c r e t i o n i n refusing  to perform  tests ordered  by  physicians"  (Study at Hospital A, 1981). Although formal studies of laboratory costs and u t i l i z a t i o n have not been conducted little  at  Hospital  B,  i t i s likely  from those at Hospital A.  other parts of Canada and et  a l , 1972;  P h i l i p and  heads at Hospital provides  B are  some incentive  Studies  the U.S. Hai, on  that causative on  factors would  laboratory  costs  reach s i m i l a r conclusions  1979).  The  a modified  to increase  laboratory  fee  differ  conducted i n  (Freeborn,  d i r e c t o r and  Baer  division  for service salary scheme which  demand. Substantive  evidence that  this  occurs i s not r e a d i l y a v a i l a b l e . (ii)  Examination of the cost of factors of production  reveals that costs of labour not  been  compensated  for  complexity of t e s t i n g .  and  by  materials have increased  increases  Technology can  in  productivity  i n these studies and  that this  has  or  reduction  in  reduce the cost of performing tests;  but an increase i n a v a i l a b i l i t y stimulates c l i n i c a l demand and the net e f f e c t i s increased t o t a l costs.  The a b i l i t y to match wage settlements  (of technical  and c l e r i c a l personnel) with increases i n productivity i s not under management control since these personnel are Findings  on  laboratory  costs  factors influencing costs are  unionized. provide  support for Statement  c h i e f l y external  1,  i n that  forces. Management's limited  power l i e s i n the a b i l i t y to select productivity increasing equipment. Hiring of Professional Personnel Statement 1 leads one to expect the laboratory d i r e c t o r to be by  external  factors  and  to  possess  limited power  only  in  the  constrained hiring  of  59  professional personnel.  The  head of pathology  at one of the u n i v e r s i t i e s i n  the province has considerable input into the h i r i n g of professional s t a f f i n teaching  hospitals  in  the  province.  university and hospitals A and  Affiliation  documents  between  the  B state that "Where a h o s p i t a l department or  d i v i s i o n conducts a teaching program, the chairman of the department and/or director of d i v i s i o n at the h o s p i t a l s h a l l be appointed and/or re-appointed  by  formal j o i n t agreement between the hospital and the university"; and this i s , indeed,  what occurs.  Since  the  head of pathology  i s also the  laboratory  d i r e c t o r at Hospital A, assessment of the impact of an external power holder on h i r i n g i n t h i s organization i s d i f f i c u l t . The  head  of the department of pathology  noted  that though he  has  the  power to influence h i r i n g i n teaching hospitals, he exercises d i s c r e t i o n i n using  that power.  He  stated, "My  role i n influencing who  i s hired depends  largely on the a f f e c t of the i n s t i t u t i o n . If people there don't want to be at the forefront of technology,  c r e a t i v i t y and innovation, i t won't help matters  to i n s i s t on placing a top-notch in."  researcher there.  This r e f l e c t s the s i t u a t i o n at Hospital B.  That person wouldn't f i t The pathology  head has for  the most part, not a c t i v e l y intervened i n h i r i n g decisions there. the power to make this decision supports Statement 1. a p o s i t i o n (marginally attached i n pulmonary function. from the u n i v e r s i t y .  That he has  He d i d , however, create  to the laboratory) for a renowned researcher  Seventy f i v e percent of t h i s i n d i v i d u a l ' s salary comes  This finding supports Statement 1.  When asked about the  impact of the head of pathology  on his department, the laboratory d i r e c t o r at  Hospital B declared vehemently,  (head of pathology) controls other  teaching hospitals, but has absolutely no input here"; and then he asked, "Are you sure t h i s i s c o n f i d e n t i a l ? " In holders  summary,  objective  (affiliation  indicators of  documents  and  the  the  influence of  creation  of  a  external power  research  position)  60  support  Statement does  1; whereas the perception of  Hospital  B  evidence  than  Evidence  for the limited  do  not.  Objective  perceptions  indicators  of  in  influence,  the  laboratory director  this  and  case  are  provide  also  power of management i s large;  more  and  at  stronger numerous.  Statement  1 is  su£>ported.  Promotion of Professional Personnel The  expectation  related  to  Statement  1  regarding  promotion  of  professional personnel i s that such decisions are largely outside the purview of  laboratory management.  personnel  (with and  At  without  c r i t e r i a i . e . , publications.  Hospital A,  academic  promotions  appointments)  of  are  a l l professional  based  on  academic  One d i v i s i o n head noted, "I suspect that was  director's doing, even though he hasn't said so.  I don't  the  think i t ' s r i g h t .  People who  are hired f o r service, shouldn't be evaluated i n terms of academic  criteria."  It i s the dream of the head of pathology a t the university that  the  complex  of  teaching  laboratory research. to  introduce  hospitals  in  this  province  become  His position as laboratory director l i k e l y  academic  personnel i n Hospital A.  criteria  for performance  evaluation of  renowned  for  allowed  him  professional  Every year he recommends the promotion and/or tenure  of certain individuals to a promotion  and tenure committee at the u n i v e r s i t y .  Since the head of pathology i s also the laboratory d i r e c t o r , i t i s d i f f i c u l t to  assess the extent to which the head of pathology  responsible for introducing these promotion  (an external force) was  c r i t e r i a . However, t h i s could not  have occurred without the consent of the d i r e c t o r .  Findings suggest support  for Statement 1. At Hospital B, there i s no p o s s i b i l i t y f o r promotion personnel i n the laboratory.  among professional  Each remains i n the position i n which he/she was  appointed and expects t h i s to be the case when appointed. data regarding promotions i n this organization.  There are thus, no  61  In summary, data on promotion whether these  decisions  of professional personnel do not indicate  are made c h i e f l y  university or by the d i r e c t o r .  by the head of pathology  at the  Evidence related to Statement 1 i s therefore  inconclusive. F i r i n g of Professional Personnel It  i s anticipated  that  the director's Firing  to f i r e  professional  personnel i s limited  (Statement  academic appointments  cannot occur without consultation with the head of the  department of pathology.  1 ).  power  S i m i l a r l y , the head of the department of pathology  may not withdraw the academic appointment academic  and h o s p i t a l  laboratory d i r e c t o r .  of professional personnel with  appointments  of an i n d i v i d u a l who holds  without  prior  consultation  both  with the  The power of each of these individuals i s constrained by  the other. The fire  laboratory  professional  constrained explanation  manager i n Hospital A noted personnel  because  (with  and without  the i n d i v i d u a l s  went as follows,  concerned  that  management's  academic  appointments)  are professionals.  "It's a business of my expertise  Who am I to say, 'You as a professional are not sound?' here,  there's been one demotion, but I've never  looking  f o r another  job."  His  versus yours.  In my f i v e  years  You s i g n a l to them  not e n t i r e l y happy with t h e i r performance.  d i v i s i o n head that I mistrust.  is  seen anyone actually f i r e d .  The way you get people to leave, i s by not promoting them. that way that you're  power to  There's one  I give him no resources and I heard he's been Since  professionalism  serves  as an  external  constraint, t h i s f i n d i n g supports Statement 1. The accepting firing  laboratory  director i n Hospital B i s not ambitious.  He i s quite  of professional personnel who function more or less competently and  these people i s seldom, i f ever, contemplated.  The manager made this  62  remark about one his  boat and  position  of the d i v i s i o n heads, "Dr.  home than i n his  was  not  professional  secure.  staff  job,"  and  i s more interested in  added  However, should  member, i t i s l i k e l y  the  that  that  this didn't  director attempt he  would  be  mean h i s to  fire  confronted  a  with  similar constraints as those faced by the director Hospital A. In summary, findings i n both organizations  support Statement 1, i n that  the manager has no power to f i r e professional s t a f f . Method of Payment of Professional Personnel Professional personnel i n most h o s p i t a l laboratories are paid on a fee for service basis. modified  fee  would prefer  for service a full  fee  system.  In Hospital B the method of payment i s a Professional  for service  percent.  there, We'd  hospital  is  hat  in hand, and  just hand  against  i n our  this."  determined i n large part by h o s p i t a l The  action was  the  schedule. in  But  Hospital  B,  higher thoughts'."  the  laboratory We  wouldn't and  president  method  of  instrumental The  to free professional s t a f f to do research. the move thus,  people worrying about money.  the  get 8 of  the  payment  is  administrators.  method of payment i n Hospital A.  in Hospital A explained  As  for a 10 percent increase  head of pathology at the university was  salaries as  this hospital  much more f l e x i b i l i t y .  ask  fee  Thus,  personnel at  system of payment.  director phrased i t , " I t would give us have to go  i n Western Canada  "He  in establishing  motivation  The  for t h i s  laboratory manager  (head of pathology) doesn't want  He says, 'Here's what i s .  Now  get on and  think  Method of payment i n Hospital A has been determined by  an  external power. In  summary,  method  external power holders.  of  payment  of  personnel  Statement 1 i s supported.  is  largely  determined  by  63  Hiring of Technical and C l e r i c a l Personnel Technical s t a f f belong to a p r o v i n c i a l health worker's union.  Clerical  s t a f f are memebers of the Hospital Employees' Union, a national organization. Union agreements contain clauses (such as the length of time vacancies are to be posted) which l i m i t managerial require  the  employer  to  freedom i n h i r i n g .  provide  the  union  with  Union agreements also  descriptions  classifications.  Two head technologists claimed to have succeeded  job  around  descriptions  supported,  in  that  the  individuals manager's  they  wished  freedom  to h i r e .  in hiring  is  of  a l l job  i n writing  Statement limited  1 is  by  union  agreements.  Promotion of Technical and C l e r i c a l Personnel Union  agreements state  that performance,  qualifications  w i l l be determining factors i n the promotion of employees. clerical  workers  technologists  belong  admitted  individuals they wished applying  for  promotion  places to  much  having  written  to promote. avoids  emphasis  One  job  on  seniortity  The union to which  seniority.  descroptions  also stated,  assuming  and  Three to  f i t those  "If I know the person  responsibility,  I  stress  r e s p o n s i b i l i t y factor i n this position, and they usually back down. management i s c u r t a i l e d by the unions."  head  the  Effective  Statement 1 i s supported.  F i r i n g of Technical and C l e r i c a l Personnel Union agreements s t i p u l a t e that no-one may  be f i r e d without just  cause.  Alleged reasons for dismissal must be documented; and employees dismissed for any cause have the r i g h t to process a grievance. dismiss an employee i s r e s t r i c t e d supported.  by union  The power of the manager to  regulations; and  Statement 1 i s  64  Time Spent on Research Research conducted at these h o s p i t a l laboratories can be  categorized  as  follows: (i)  applied and basic medical s t a f f .  laboratory  research  conducted  by  d i v i s i o n heads  and  ( i i ) research engaged i n by the laboratory d i r e c t o r (and colleagues) at Hospital A, whose goal i s increased knowledge of factors a f f e c t i n g laboratory costs and u t i l i z a t i o n . The expectation on  research  will  related to Statement 1 i s that the amount of time spent be  determined  largely  by  external  factors.  Factors  influencing each type of research are outlined below. (i)  Research conducted by d i v i s i o n heads and medical s t a f f .  The  goal of the  head of pathology at the university i s that the network of in  teaching  hospitals  in  the  province  gain  through producing outstanding research. the  hiring  hospitals. pathology  at  and  promotion  The  laboratory  the  of  university.  international  He has  at  According  personnel  Hospital to  recognition  considerable  professional  director  laboratories  the  A  is  input in  D.  He was  instrumental  in this i n s t i t u t i o n . The  at Hospital C and  head of  of  There i s _  at  i n having professional s t a f f placed  head  manager at  Hospital A, "The head of pathology has picked key researchers; at Hospital A,  teaching  also  laboratory  into  Hospital  on s a l a r i e s  This frees these people to think higher thoughts."  pathology  identified  u n i v e r s i t y promotion and  tenure  decisions as the c r u c i a l factors determining the amount of research which occurs.  He  said that an individual's salary may  be  paid  completely  by  the hospital, completely by the university or by both i n s t i t u t i o n s .  He  considered  20  percent  or  that more  in of  arrangements the  where  individual's  the  university  salary,  contributed  university  promotion (which stress publications) would be applied.  criteria  for  65  Of that  the f i v e d i v i s i o n heads interviewed university  appointments  and  at Hospital A,  recognition  three  that  agreed  accompanied  publications were primary factors i n influencing the amount of  research  they d i d .  teaching  Two  and research, and  had  i n that order; and that research was  teaching  researcher  emphasized that t h e i r jobs consisted of service,  commitments allowed t h i s .  in  one  less  professional  consequently reduced time for Comparatively Hospital  B.  In  publications heads claim  little  1980  and  research  providing  profits. provides laboratory system  an  is  in  the  and  laboratory  at  i n Hospital B,  five.  The  17  Division  culture here i s  laboratory at Hospital A.  Professional  service are  to  incentive  on  to  director and  personnel  in  less value on research.  the  paid  The  priority  hospital a  in  modified  perform  as  ways  fee many  the  maximize  service  tests  in  They are committed  which  for  laboratory  as  their  system which  possible.  The  other professional personnel chose this payment  (or employment i n a h o s p i t a l with such a system), which almost  precludes a dedication which  conducted  division  most d i v i s i o n heads i n Hospital A i s publication of  research.  They  his  time for such endeavours.  Hospital B place considerably to  in  professional personnel in Hospital A produced  to have no  quality  avid  r e s t r a i n t at the hospital  person  a pulmonary researcher  of management and  i s an  research.  very d i f f e r e n t from that i n the  high  A d i v i s i o n head who  mentioned that a p o l i c y of f i s c a l  resulted  done only when service  asserts  that  to research.  the  amount of  This time  does not support Statement 1  spent  on  research  is  largely  influenced by external factors. Pharmaceutical companies i n i t i a t e research equipment and chemicals). the  research  (in the form of t r i a l s of  Such research forms a very small proportion  conducted at Hospital A,  and  a  large  proportion  of  of  that  66  conducted at Hospital B. The only research conducted i n the laboratory at Hospital B i s that done  by  an  i n t e r n a t i o n a l l y recognized  marginally attached  to the laboratory.  pulmonary  researcher,  His p o s i t i o n was  who  is  created by  the  head of the department of pathology at the university; and the university pays 75 percent of his salary. research.  Since  This i n d i v i d u a l ' s mandate i s to conduct  the mandate comes from an external organization,  this  finding supports Statement 1. ( i i ) The  research conducted by the head of the department of pathology at the  university/laboratory factors determining to this research  research which  laboratory  d i r e c t o r at  Hospital A  laboratory costs and  and  colleagues,  utilization.  i s c l o s e l y related to motivations  are  twofold  policies  (a)  and  to  have  actions  a  tool  against  The  examines  time devoted  for performing  with  the  which  to defend  of  hospital  demands  administrators and Ministry of Health o f f i c i a l s that costs be reduced (an external  motivation)  pathology/laboratory  and  (b)  of  which  is  desire  on  the  part  of  the  head, of  director to obtain i n t e r n a t i o n a l recognition through  publishing this research. The one  a  managerial  goals of one person and  one  of  which  (evident i n two roles is  external)  hampers  c l a s s i f i c a t i o n of the person l a r g e l y responsible for this research.  In summary, objective indicators of external influence on u n i v e r s i t y c r i t e r i a for promotion and Hospital B. administrators  Service can  be  and  teaching  classified  the appointment of a key  demands, f i s c a l as  perceived  research  are  researcher  to  r e s t r a i n t and external  perceived i n t e r n a l influence i s the fee for service system.  demands of  influences.  Overall, there i s  strong evidence that external power holders have much influence on and Statement 1 i s supported.  A  research  67  Teaching Teaching i n laboratories of teaching hospitals occurs at three i.e.,  with  residents.  medical  technology  students,  medical  students  and  levels,  pathology  The expectation related to Statement 1 i s that managerial  impact  on teaching i s limited. Factors influencing teaching at each l e v e l are outlined below: Technologists:  The academic training of medical technologists occurs at  a community college, a f t e r which they spend one year i n a teaching h o s p i t a l gaining  practical  experience.  The  Canadian  Society  Technologists defines what the students ought to be taught. examinations hospital  at the end of the one year time period.  teaching  program  every  2-3  years,  and  organizations.  of  student  technologists i s  Laboratory  personnel  largely  i n charge  of  Laboratory  They write CSLT  The CSLT accredits the the  Canadian  Association accredits the quality of personnel and t r a i n i n g Teaching  of  Medical  facilities.  influenced  by external  teaching have power to  schedule students and to choose teaching methods (Support f o r Statement 1). Medical Students:  Many of  the professional  teaching hospitals have j o i n t appointments do some teaching. teaching assignments  the  syllabus  i n laboratories i n  with the u n i v e r s i t y and expect to  Heads of pathology and microbiology departments allocate to people according to t h e i r areas of expertise.  The amount of time devoted by  staff  curriculum committee i s determined  teaching of pathology  by  to pathology  i n the  the  head  faculty of  the  (vs. other subjects) i s decided of  medicine.  department  The  pathology  of pathology.  The  to medical students i s influenced c h i e f l y by external  organizations and people (Support for Statement 1). Pathology residents:  The number of residents positions i n each teaching  h o s p i t a l i n the province i s .established by the p r o v i n c i a l Ministry of Health.  68  The  resident teaching program i s accredited by the Royal College of Physicians  and  Surgeons of Canada.  Accreditation  includes  assessment of space,  materials and the q u a l i f i c a t i o n s of pathologists.  I f pathologists have l i t t l e  teaching and research experience, the time residents are permitted that i n s t i t u t i o n i s limited. Residents'  to spend i n  results on fellowship exams are viewed  as an indicator of the q u a l i t y of the residency  t r a i n i n g program.  teaching  students,  of medical  residents  technologists  i s largely  determined  and medical by  case  external  As with  the t r a i n i n g of  organizations  (Support f o r  Statement 1). In summary, findings related to teaching to influence teaching i s l i m i t e d .  indicate that managerial power  Statement 1 i s supported.  Quality Control Quality order  control procedures  are  conducted  to ensure a degree of r e l i a b i l i t y  i n h o s p i t a l laboratories i n  of the information  generated  there.  Quality control i s a technical procedure, r e s p o n s i b i l i t y for which l i e s at the d i v i s i o n head l e v e l . It  i s expected  procedures  is  organizations  that  chiefly  the amount of time  determined  by  devoted  demands  of  to q u a l i t y external  control  people  or  and that the power of d i v i s i o n heads i s limited (Statement 1).  The p r o v i n c i a l medical association accreditation committee examines laboratory operations  approximately every two years, and considerable  on q u a l i t y c o n t r o l . contracted surveys.  Many  Accreditation depends, i n part, on the laboratory having  to p a r t i c i p a t e To some extent,  organizations. division  emphasis i s placed  regularly then,  i n Canadian  or U.S. q u a l i t y  q u a l i t y control i s influenced  control  by external  However, optimal q u a l i t y control i s a professional decision. heads  claimed  external organizations.  to do more q u a l i t y  control  than  required  by  Opinions of laboratory s t a f f d i f f e r e d regarding the  69  magnitude of the impact of external  demands versus professional decisions on  the amount of q u a l i t y control performed. Complicating assessment of the external fact  that  the amount of q u a l i t y  control  nature of the tests being conducted.  vs. managerial influence  performed  depends  largely  For example, information  i s the on the  provided by  c e r t a i n tests w i l l be used to make c r u c i a l medical decisions; other tests give routine  information.  considered very  Quality  important.  control  of tests  i n the former  category i s  But i t i s not clear whether these  are c h i e f l y  mandated from inside or outside the laboratory. proportion  of q u a l i t y control procedures which are externally mandated and the  proportion  generated  require  factorial  a  Accurate determination of the  by professional design  (test  decisions  within  classification  the laboratory  by  factors  would  influencing  performance). In summary, both external demands and managerial decisions determine the amount and type of q u a l i t y control tests performed. affects q u a l i t y control i s not c l e a r .  Findings  The extent to which each  related  to Statement 1 are  inconclusive. Accreditation The  Canadian  Council  on Hospital  programs i n Canadian h o s p i t a l s . voluntary;  but  accreditation. years.  hospitals  Accrediation  conducts  accreditation  P a r t i c i p a t i o n i n the accreditation program i s  may  not  offer  teaching  programs  without  A h o s p i t a l may be accredited f o r a period of one, two or three  I f major changes are required, a one year c e r t i f i c a t e of accreditation  w i l l l i k e l y be issued. Standards have been established areas  of organization  quality  control  and s t a f f i n g ,  systems,  tissue  f o r laboratory facilities, examination,  medicine services i n the  channels of communication, necropsy  service,  blood  70  transfusion  service  and  Accreditation, 1977).  clinical  In 1981,  reports  two  (Canadian  Council  on  Hospital  sections of the d i v i s i o n of chemistry at  Hospital A were assessed as having inadequate space and given a l i m i t e d period of time i n which to make changes. is limited.  Statement 1 i s supported.  Conclusions of Findings to Statement 1 Statement outcomes.  Managerial power to influence accreditation  Related  1 asserts  Table IV  that  (p. 54)  the  manager has  limited impact  outcome. Data on  Statement 1.  3 outcomes are inconclusive.  on  tangible  summarizes findings related to this statement i n  terms of each substantive Findings  on  12  (out of  15)  outcomes support  Since  the manager's  influence on tangible outcomes i s constrained by external factors i n more than 50 percent of these outcomes, Statement 1 i s supported. Statement 2 Statement 2 asserts that management's action operates largely with and on symbolic outcomes and that the manager has less impact on instrumental action than on symbolic outcomes. This  statement  focuses  on  whether  the  behaviour  of  four  laboratory  managers has a greater influence on tangible outcomes (such as promotions and equipment allocations) or on attitudes and  b e l i e f s of people i n and  the organization  equitable an equipment a l l o c a t i o n  was).  (such as b e l i e f s about how  outside  The statement w i l l be supported i f findings indicate that the manager's  t o t a l impact on b e l i e f s (beliefs related to organizational outcomes as well as shared meanings) appear to be greater than his/her t o t a l influence on tangible outcomes.  If  the  manager's influence  larger than his/her e f f e c t on b e l i e f s , And  on  tangible  outcomes appears to  the statement w i l l  not be  supported.  i f data indicate that the manager affects tangible outcomes and  almost equally, findings w i l l be considered  inconclusive.  be  beliefs  71  Findings  related  to  the  manager's influence  on  beliefs,  attitudes  and  feelings are presented i n three sections. (i)  the manager's impact on each tangible outcome and b e l i e f s and attitudes related to that outcome.  (ii)  the manager's assessment of the magnitude of his/her impact on symbolic and substantive outcomes.  ( i i i ) the manager's outcomes). (i)  impact  on  shared  meanings  his/her  (unrelated  impact  to  on  tangible  Managerial Impact on Tangible Outcomes vs. Influence on B e l i e f s Related to Outcomes. This section focuses  beliefs  related  management's outcomes  to  on the manager's e f f e c t on each tangible outcome and  that  influence  will  themselves.  be  outcome. on  greater  Each  It  beliefs than  tangible  and  his/her  outcome  is  is  anticipated  attitudes influence  discussed  that,  overall,  regarding on  tangible  tangible  below;  and  outcomes  findings  are  summarized i n Table V. Funding f o r C a p i t a l Equipment The far  expectation  greater  than on  the  related to Statement 2 i s that the manager w i l l have a  impact on b e l i e f s of people about funding  for c a p i t a l equipment  magnitude of equipment funds allocated to the  department.  described under findings related to Statement 1, administrators allocate  equipment d o l l a r s to each h o s p i t a l department.  administrator,  "Those  exerting  the  most  pressure  a l l o c a t i o n s . It's the squeaky wheel p r i n c i p l e . " manager  attempt  formally  h o s p i t a l administrators  (with  The  documentation) and  i n Hospital A  According  receive  the  informally  to The  influence laboratory  following way,  "Human systems  around  written  paper  i n t e r e s t you.  A  program  up  on  one  laboratory d i r e c t o r and  to allocate greater sums to pathology.  contact.  to  largest  manager outlines his approach i n the personal  As  may  or  revolve may  not  If someone comes and highlights the good news, the chances are  72  TABLE V MANAGERS' INFLUENCE CM TANGIBLE OUTCOMES AND BELIEFS RELATED TO THOSE OUTCOMES  Substantive outcome  Managers influence tangible outcomes through:  Statement 2 supported  Manager affected beliefs Hospital A  Hospital B  Capital equipment funds  limited formal power & influencing beliefs  Yes  No  No (effect on tangible outcomes greater than on beliefs)  Operating budget (supplies)  power greater than discretionary  Yes  No  No (effect on tangible outcomes greater than on beliefs)  Operating budget (personnel)  limited formal power & influencing beliefs  Yes  No  No (effect on tangible outcomes greater than on beliefs)  Laboratory costs  limited formal power  No  No  Hiring professional personnel  limited formal power  No  No  Promoting professional personnel  limited formal power  No  No  No  F i r i n g professional personnel  limited formal power  No  No  No  Payment of professional personnel  limited formal power  No  No  No  Hiring technical & c l e r i c a l personnel  limited formal power  No  No  No  Promoting technical & clerical personnel  limited formal power & influencing beliefs  Yes  No  No (effect on tangible outcomes greater than on beliefs)  F i r i n g technical & c l e r i c a l personnel  limited formal power  No  No  No  Research  limited formal power  No  No  No  Teaching  limited formal power  No  No  No  Quality Control  limited formal power  No  No  No  Accreditation  limited formal power  No  No  No  No No  73  y o u ' l l be influenced. once.  Most of my  People comment on my  influence i s personal.  three-piece  suit.  And  I don't go just  It's part of the  strategy  of  influence." The d i r e c t o r and manager each claim to have affected b e l i e f s of hospital administrators  and  Ministry  equipment.  the  manager phrased  As  equipment.  Health  officials  regarding  i t , "From time to  their  time we  need  get  for  capital  Occasionally I think i t ' s the r e s u l t of our lobbying e f f o r t s . "  Administrators hospital  of  concur  administrator  manager) lobby me. sometimes  that  stated,  me  of  have,  indeed,  "  They bring me  convince  they  the  (the information need  or  been  influenced.  laboratory  One  director  and  about the work load, etc.,  and  advisability  of  purchasing  new  equipment." Do  the  regarding  manager and  director influence b e l i e f s  equipment allocations?  equipment requests  The  laboratory  manager outlined how  from the d i v i s i o n s , "We  we want to b u i l d up.  of  they  Divisions don't a l l get the same amount each year.  them i t i s equitable."  manager's  legitimations  changed.  One  There was,  were  effective.  however, l i t t l e Most  expressed his feelings this way,  d i v i s i o n heads.  prioritize  a l l o c a t e equipment to those areas  times some d i v i s i o n heads f e e l the a l l o c a t i o n i s not equitable. tell  personnel  But I go and  evidence  division  heads  that  no  the  felt  short  "There i s competition  among  Those that make the most noise get the most equipment."  The manager stated that the d i v i s i o n which produced l i t t l e research, given  At  resources.  His  legitimations to the d i v i s i o n head concerned (that  d i v i s i o n s have to take turns i n receiving a large share of the pie) did placate this i n d i v i d u a l .  was  not  (Statement 2 not supported).  Findings related to Hospital A are summarized i n Table V. Managers have limited formal power to a f f e c t equipment funds. They also influence b e l i e f s of hospital  administrators  and  Ministry  of  Health  officials.  Whether  these  74  efforts  have a greater  e f f e c t funds or b e l i e f s about funds i s d i f f i c u l t  to  assess. Management i n Hospital hence l i t t l e is  little  motivation  B has  limited power to  to make their  use  of  a l l o c a t e equipment  power unobtrusive;  and  there  evidence that they influenced b e l i e f s of d i v i s i o n heads i n r e l a t i o n  to equipment a l l o c a t i o n .  Findings  related to Hospital B therefore  indicate  that management's e f f e c t on equipment funds (though limited) i s greater their  and  e f f e c t on  beliefs  related  to  these  funds.  This  does  not  than  support  Statement 2. In summary, managers i n both organizations have some formal power (though limited)  to  a f f e c t equipment  funds.  influence b e l i e f s of d i v i s i o n heads.  In  neither  In Hospital A there  managers influenced b e l i e f s of administrators and  that this was  outcomes).  did managers  i s evidence  and Ministry of Health  that  officials  often associated with obtaining a d d i t i o n a l funds (tangible  Overall, therefore, management's e f f e c t on b e l i e f s about equipment  funds i s not greater Statement  organization  2  is  not  than their influence on equipment funds themselves; supported.  The  influence  of  external  power  and  holders  (hospital administrators and Ministry of Health o f f i c i a l s ) on equipment funds, i s , nevertheless,  greater than the influence of management on this outcome.  Operating Budget  (Supplies)  The and  expectation  manager w i l l  related to Statement 2 i s that the  have a  larger influence  on  the  laboratory director  beliefs  of  people  in  and  outside the laboratory about the supply budget than the budget i t s e l f . U n t i l recently both laboratories have had supplies  they  required.  influence b e l i e f s  The  managers  about supplies  and  at  the  power to obtain  Hospital  B  make no  consequently have a greater  supplies than b e l i e f s about supplies (Statement 2 not supported).  a l l the  attempt  to  impact  on  75  With f i s c a l r e s t r a i n t at the p r o v i n c i a l government l e v e l , there has been some pressure at Hospital A to be dollars.  accountable  for u t i l i z a t i o n  of supplies  According to the manager there, "Many suppliers attempt  into using their products.  They imply,  machine won't work as well or we  'If you don't use our reagents,  won't be able to service you.'  them, 'To h e l l with your i n s e c u r i t i e s . court!' which has now  to lock us  If you threaten me,  I'll  the  I say to take you to  got them insecure and they're backing o f f and beginning  to bring prices down."  The manager's statements affected both b e l i e f s related  to supplies; and Statement 2 i s not supported.  Operating Budget (Personnel) Statement  2  leads  one  to expect  influence on  beliefs  related to the personnel budget w i l l be greater than on that budget  itself.  As  limited  described under findings  power i n r e l a t i o n  related  that managerial  to Statement 1, management has  to the personnel budget.  Managers screen  d i v i s i o n heads for additional staff on new programs.  requests  from  Managerial legitimations  regarding funding of p a r t i c u l a r programs and not others are not successful i n convincing d i v i s i o n heads or technologists. Managerial explanations regarding such decisions, eg: "Chemistry has the greatest need f o r these two positions", are met with remarks such as that of one head technologist, "The d i v i s i o n head of chemistry i s much more e f f e c t i v e That's why  at lobbying than other d i v i s i o n heads.  that d i v i s i o n i s so much better o f f than others.  We have a short  s t a f f i n g problem i n our d i v i s i o n that has been chronic as long as I have been here." The  laboratory d i r e c t o r  committees influence (which  with these  Ministry officials  and of  to  manager at Hospital A Health  officials  supply  funding  generally require additional  staff).  which  for new The  choose  or  to  allows expanded  manager  s i t on them  to  programs  explained  their  76  approach funding and  thus,  "We  don't  for a program.'  formally  apply  their processes and  for  go We  to  the  Minister  funding and  some time l a t e r ,  committees where we  can  attempt  saying,  'Look, we  cons.'"  The manager claimed  have a  proposal  coming  r e s u l t of  say,  'We  want  They go  when we  through  happen to  to influence people, we forward.  Here  are  the  be  lobby,  pros  and  that they have influenced the b e l i e f s of Ministry  of Health o f f i c i a l s and said, "Occasionally the  and  from administration.  priorities;  on  is  Health  go through the normal channels i n the h o s p i t a l ,  that  sitting  program  of  our  efforts."  (we  think) the approval  Managerial  of a  e f f o r t s influence  new both  b e l i e f s related to the personnel budget and the budget i t s e l f . According  to  approaches the task He  elaborated  an  administrator  of obtaining  as follows,  The d i r e c t o r says,  'Oh,  "The  in  Hospital  additional s t a f f  manager says,  okay'. They present  'That's rubbish!  'We  B,  laboratory  management  i n an incompetent manner. need another s t a f f member'.  this to a member of the position  board who  says,  Your volume i s down 50  year'. And  they go away with egg on t h e i r faces."  percent  from  last  There i s no evidence, then,  that their a b i l i t y to influence b e l i e f s of position board members results i n obtaining a d d i t i o n a l p o s i t i o n s . In summary, managers have some (though limited) power to influence personnel budget. the budget.  the  Managers i n Hospital B do not influence b e l i e f s related to  Their e f f e c t on the budget i s , therefore, greater than on b e l i e f s  o about the budget.  Through lobbying,  b e l i e f s about the budget and  managers i n Hospital A  the budget i t s e l f .  influence both  Overall, management's e f f e c t  on b e l i e f s about the budget i s smaller than on the budget i t s e l f .  Statement 2  i s not supported. Laboratory Costs Findings  i n d i c a t i n g that management's influence  on  laboratory  costs i s  77  less  powerful  than  on  beliefs  about  cost w i l l  provide  evidence to  support  Statement 2. Until  very  laboratory hospital  recently  operation.  from  Administrators  was  at  Hospital of  the  assert that resources  maintain  The  that  little  cost reduction  that  reduce expenditures.  costs.  But  administrators  substantially  results,  there  has  A  and  their  One  reduce  costs  of  goal  of  important philosophy  manager  differs  and  director.  are limited and that the laboratory must manager, r e f e r r i n g  managers  have  Their research reports have been presented  and to h o s p i t a l administrators.  to  become an  laboratory  d i r e c t o r and laboratory  incentive  to  their  minimal power  research  to  control  to the Ministry of  Health  administrator expressed his view of these  research results as follows, "You've seen the papers the d i r e c t o r and wrote.  They  demands.  don't  think  they're  That's t h e i r philosophy.  managing We,  the  'We  can'.  give you a fixed amount of resources  Laboratory  control research  demand  or  tests.'"  respond  to  d i f f e r e n t point of view.  We  and you manage them as best  you  management doesn't go along with that. limit  They  as representatives of the people and  the S o c i a l Credit Government, have a completely say,  system.  others  I t appears,  They say,  therefore,  that  'We  can't  managerial  reports and accompanying e f f o r t s to legitimate laboratory costs have  not influenced the b e l i e f s of h o s p i t a l administrators. Unlike  laboratory managers at Hospital A,  under pressure to reduce laboratory costs.  those at Hospital B are  There i s no motivation,  not  therefore,  to convince administrators of their a b i l i t y to reduce costs. In summary, managers have limited about costs.  power to influence costs and  beliefs  There i s thus, l i t t l e evidence to support Statement 2.  Promotion of Technical and C l e r i c a l Personnel Statement  2  leads  one  to  anticipate that  management w i l l  have  less  78  influence  on promotions of technical and  c l e r i c a l personnel than on b e l i e f s  about these promotions. As outlined under findings related to Statement 1, managerial freedom i n h i r i n g i s limited by union agreements. descriptions explained  around  the  t h e i r actions  skills.  person  they wished  i n terms of  to h i r e , hired  requiring  They succeeded i n convincing  their a c t i o s .  Several head technologists  an  wrote job  this person  and  employee with p a r t i c u l a r  most technologists  of the v a l i d i t y of  They effected b e l i e f s and the promotion i t s e l f .  Findings  thus,  do not support Statement 2.  Accreditation. Findings  i n d i c a t i n g that  management's e f f e c t on  accreditation  i s less  powerful than on b e l i e f s about accreditation w i l l support Statement 2. The aspects  decision of  by  the  laboratory  Canadian  function  Council  are  on  Hospital  inadequate  provides  laboratory management to pressure hospital administrators have attempted to introduce  earlier.  have u t i l i z e d such opportunities Management's  influence  on  relation  to  personnel; h i r i n g or  accreditation  laboratory  promoting,  firing  of  opportunity  for changes they  that for may  claim to  for influencing b e l i e f s .  evidence that  hiring,  an  Managers i n both organizations  decisions  powerful than on b e l i e f s related to accreditation. There i s l i t t l e  Accreditation  firing  technical  is  minimal;  Statement 2 i s supported.  managers influence or  and  less  payment  clerical  of  beliefs in professional  personnel;  teaching,  q u a l i t y c o n t r o l , or research. Managers possess limited power to a f f e c t each of these outcomes.  One  concludes, then, that i n r e l a t i o n to the above outcomes,  management's e f f e c t on outcomes. supported.  For  a l l the  the  outcomes i s greater  above l i s t e d  tangible  than on b e l i e f s about those outcomes, Statement 2 i s  not  79  Conclusion Regarding Managerial Influence on B e l i e f s About Tangible Outcomes Table V (p. 72) indicates that b e l i e f s related to 4 (out of 15) tangible outcomes were influenced influenced tangible affect the  by  laboratory  managers.  In a l l 4 cases managers  tangible outcomes through a f f e c t i n g b e l i e f s ;  outcomes was  i n addition  tangible outcomes.  other  11  tangible  to  the  and  the influence  on  manager's discretionary power  to  Managers possess discretionary power to influence  outcomes.  Overall,  then,  management's  effect  tangible outcomes i s greater than on b e l i e f s about these outcomes.  on  Statement  2 i s not supported. ( i i ) Managerial Assessments of Their Impact Statement 2 leads to the expectation their  influence  symbolic stated  on  the  organization  than substantive  that  which he  he  was  shared  the  with  outcomes.  would The  conceptualizer,  the  planning and implementing.  laboratory  director  university he  has  reports  effective lab.  and  is  laboratory analyzer  and  in  i n convincing  a  greater  impact  on  d i r e c t o r at Hospital A decision maker, roles for  This does not c l e a r l y support Statement 2; but the  three  eludicates the director's impact,  roles.  As  director  of  pathology  through this  As head of a c l i n i c a l d i s c i p l i n e he a  regarding  Others were responsible  to the dean of medicine; and  an input at that l e v e l . president,  indicate  manager.  statement of a h o s p i t a l administrator laboratory  that managers' statements  position people  and  to  lobby  the  obtaining  board.  He  at  "The the  channel has  reports  to the  i s enormously  a d d i t i o n a l resources  for  the  For example, a large amount of space has been allocated to the new  lab  because he lobbied so e f f e c t i v e l y . " The lobbying suppliers  laboratory manager at Hospital A claims to devote most of his time to hospital and  administrators,  rationalizing  Ministry  decisions  to  of  Health  division  officials,  heads.  The  reagent influence  80  attempts  of  the  manager  and  obtaining tangible outcomes.  director  at  Hospital  A  are  mostly  aimed at  Their influence on b e l i e f s i s intertwined with  their e f f e c t on tangible outcomes.  Which influence i s greater cannot e a s i l y  be determined. The  laboratory director at Hospital B stated,  percent of my  time on administrative  functions, l i k e obtaining equipment and  getting time for s t a f f to go on educational  leave.  used to do t h i s , but she wants me to do i t now. pathology". division  He  heads  d i v i s i o n heads operate  spends and  some energy  likely  has  (though this was  largely on  '  (the manager)  I spend most of my time doing  legitimating equipment  considerable  e f f e c t on  not v e r i f i a b l e ) .  substantive,  "I spend approximately 25  not  symbolic,  This  allocations to  shared  meanings  of  individual's actions  outcomes.  His  influence  on  substantive outcomes with organizational significance i s discretionary; but he has a primary impact on pathology related outcomes. The  laboratory  technologists attending  are  manager's time sick,  to problems  i s devoted  adjusting  the  of communication  and ward personnel (symbolic outcomes).  to finding replacements when  payroll and  (substantive  co-ordination  outcomes)  between  and  laboratory  In Hospital B, managers' assessments  of their impact do not support Statement 2. In summary, managers at Hospital A claim to have considerable on  beliefs;  influence determined.  on  but  such  beliefs  influence or  often  tangible  achieves  outcomes  tangible  i s greater,  outcomes.Whether cannot  be  easily  In Hospital B, managers' assessment of their influence indicate a  greater impact on tangible outcomes than on b e l i e f s about outcomes. then, managers' statements regarding 2.  influence  Overall,  t h e i r influence do not support Statement  81  ( i i i ) Managerial Impact on Shared Meanings. One of  of the tasks of management involves the construction and maintenance  shared  systems  of  meaning.  One  anticipates  influence on shared meanings w i l l be large. outcomes have already b e l i e f s unrelated Holzner  that  laboratory  managers'  Since b e l i e f s related to tangible  been examined, shared meanings i n this study refer to  to tangible outcomes.  (1968)  states  that  authority  structures  structure of i d e o l o g i c a l systems are deeply connected.  and  the  nature  and  Also that  the s o c i a l structure of authority must be related by the i n d i v i d u a l to his own conception of i d e n t i t y . The central question i s whether the processes of i n d i v i d u a l i d e n t i t y formation take the shape which permit i d e n t i f i c a t i o n with the e x i s t i n g authority structure or lead to an a l i e n a t i o n from i t . In either case, "ideology" provides the bridge. The symbolic system of ideologies connects the functional contexts of authority i n the c o l l e c t i v i t i e s and t h e i r legitimation on one side with the legitimation of an individual's claim to self-acceptance. Where the l a t t e r process i s impossible i n terms of the established c o l l e c t i v e ideology, there emerge alienation a l t e r n a t i v e s . Where i t i s possible, loyalty to the group and to i t s symbols r e s u l t s . (Holzner, 1968, p. 150) Ideology systems i n laboratories A and the  B differ  greatly.  The  dream of  laboratory director i n Hospital A i s that a small network of laboratories  producing outstanding attempts  to  direction.  mobilize With the  research the  will  become i n t e r n a t i o n a l l y recognized.  energies  exception  of  one  of  professional  personnel  He  in  i n d i v i d u a l , who . i s alienated,  this he  is  successful. The  laboratory  d i r e c t o r i n Hospital A meets with a l l professional  once a month and also meets with them i n d i v i d u a l l y . socially;  for example, he  i n v i t e s those who  staff  He spends time with them  have recently published  or been  promoted to dinner. There i s l i t t l e evidence that the much impact on  laboratory  manager i n Hospital A  shared meanings of organizational p a r t i c i p a n t s .  Most of his  energy i s directed towards influencing people outside the laboratory. the  manager nor  the  director  i s motivated  to influence  has  Neither  shared meanings of  82  technologists.  As  Holzner  (1968) says,  legitimations  are  always directed  on a modified  fee for service  towards the most s i g n i f i c a n t audience. Professional personnel at Hospital B are system.  The  services  laboratory  to the  director  hospital.  is  Energies  concerned  with  The  d i v i s i o n heads at Hospital B meet d a i l y for lunch.  periodically; occasions.  and It  i t is likely seems  likely  that company p r o f i t s that  laboratory  of professional personnel are  less toward research and more towards p r o f i t making. and  "selling"  the  d i r e c t o r has  directed  laboratory d i r e c t o r They dine  are  discussed  some impact  lavishly on on  these shared  meanings. The  manager i s viewed by many laboratory personnel as incompetent.  technologist expressed her feelings this way, for  ten  years  and  present p o s i t i o n was the her.  wasn't good on  She sends delegates summarize, there  organizations  the  (manager) was  benches.  Putting  about the only place they could put her.  chairman of the Board at the  To  The  she  "  influence  time.  her  into  her  Her father  was  attend."  i s evidence that laboratory directors i n these  manager i n laboratory B has  meanings little  here  Everyone i n the h o s p i t a l laughs at  to important meetings she should  shared  One  of  professional  staff  two  members.  impact on shared meanings; while the  energy of the manager i n Hospital A i s directed c h i e f l y towards lobbying. Conclusion Data  on Findings Related to Statement 2 related  to  Statement  2  consist  of  three  parts.  First,  findings  indicate that laboratory management has a greater impact on tangible outcomes than on b e l i e f s about these outcomes.  Second, managers i n one  organization  claim they devote more time to tangible outcomes than to influencing attitudes and b e l i e f s , while i n the other organization, managers have a strong impact on both b e l i e f s and tangible outcomes.  Third, there i s evidence that laboratory  83  directors of  are i n v o l v e d  meaning w i t h i n  i n the c o n s t r u c t i o n  the o r g a n i z a t i o n  combined f i n d i n g s of the t h r e e managers'  total  impact  t a n g i b l e outcomes. Findings outcomes beliefs  describing  a  on b e l i e f s  than  precise  on t a n g i b l e testing  the o r g a n i z a t i o n  legitimating  organizations,  cannot  be s a i d  beliefs  time  total  The  influence  the manager's impact that  outcomes.  on  ideas, What  legitimation,  on t a n g i b l e  the manager's  While  Pfeffer's  activities  social  to lobbying  and t a n g i b l e  t o be g r e a t e r  manager i n f l u e n c e s  managers.  this  e f f e c t on  research  evidence  are possible  and  outcomes;  i s not  gathered  in  reasons f o r  but  e f f e c t i v e because  o f i n d i v i d u a l s were unambiguous.  i n creating  considerable both  their  under f i n d i n g s r e l a t e d t o Statement 4.]  energy  affect  (e.g.  that  few l e g i t i m a t i n g e f f o r t s were  fully  devoted  of  organizational  are  much  than  P f e f f e r a n t i c i p a t e s managers w i l l devote much energy  and p r e f e r e n c e s  invest  than  i s instructive.  were t a n g i b l e discussed  i s greater  but not h i s contention  t h i s unexpected f i n d i n g ? to  extent  a s p e c t s of Statement 2 do n o t i n d i c a t e t h a t the  support P f e f f e r ' s claim  i s greater as  to a greater  systems  Statement 2 i s thus not s u p p o r t e d .  i s limited,  intended  and maintenance of shared  lobbying) beliefs  than  consensus. external  outcomes.  on the l a t t e r ) .  appears  to influence  and a t t i t u d e s .  This  Managers  the outcomes [These  ideas  i n Hospital  influence Type  these  Managers d i d not  power h o l d e r s ; (ie.  in  e f f o r t s which on  the former  o f symbolic  the e x t e n t  i s explored  A  action  t o which the  fully  i n Chapter  4. Another substantive  factor  affecting  the manager's  outcomes i s m a n a g e r i a l m o t i v a t i o n .  r e c o g n i t i o n by managers i n H o s p i t a l A served efforts.  This, too, i s explored  influence  on  The d e s i r e  symbolic  for international  as an impetus f o r t h e i r  i n Chapter 4.  versus  lobbying  84 Statement 3 Statement 3 asserts that conditions of power and dependence have a small effect  on  symbolic  outcomes.  In  terms of  the  statement means that external power holders who (such  as h o s p i t a l administrators  little  effect  on  beliefs,  organizations  influence laboratory  and Ministry of Health  attitudes  and  studied,  this  operation  o f f i c i a l s ) have very  feelings of  laboratory  personnel.  P f e f f e r seems to be r e f e r r i n g to i n t e n t i o n a l influence. There  are  10  external  power  holders.  Since  the  study  purpose  is  i d e n t i f i c a t i o n of extremes i n terms of the impact of external powers, i t was decided  that  external  i f laboratory  power holders  personnel  claim  that  influenced b e l i e f s and  less  than  attitudes of  50  percent  laboratory  of  staff  and external powers concur with this claim, Statement 3 w i l l be supported. laboratory  personnel  influenced  the  claim  beliefs  that  of  Findings  will  percent  external  powers  personnel. Hospital  The  than  laboratory  supported. of  more  be  percent  members,  considered have  50  external  Statement  inconclusive  influenced  of  the  3  will  If  powers not  be  i f approximately  beliefs  of  50  laboratory  influence of each external power i s discussed below.  Administrators  As chairman of the hospital finance committee, the director of laboratory A has the opportunity the  hospital  "Accountants  and (on  to influence b e l i e f s about f i s c a l a l l o c a t i o n s throughout  hospital the  priorities.  committee) want a  But token  according doctor  on  to the  the  manager,  committee  and  haven't taken his advice". U n t i l recently there was operation.  of  the  incentive to reduce costs of  However, cost reduction has  administrators that  little  at Hospital A. laboratory  Their  d i r e c t o r and  laboratory  become an important goal of hospital  philosophy  differs  s u b s t a n t i a l l y from  manager.  Administrators  assert  that  85  resources are limited and  that the laboratory must reduce expenditures.  The  director and manager, on the other hand, maintain that they have minimal power to  control costs. The  hospital  administrator at Hospital A  influencing b e l i e f s and  claims  to have succeeded i n  attitudes of the laboratory manager.  have seen the manager change his attitude over the l a s t year. 'well I have l i m i t l e s s resources.'  Now  He stated, "I It used to be,  he realizes this i s not true."  The manager at Hospital A did not d i r e c t l y admit that the administrator had  affected  occurred. You  his  beliefs  and  seemed to want to convey  that this  He said, "There are two types of power, s t r u c t u r a l and  had  not  sapiential.  get s a p i e n t i a l power from being recognized as knowing what you're talking  about.  Administrators are there to manage the h o s p i t a l and have an accounting  mentality.  There  are  some  structural  things  they  d i f f i c u l t f o r us, l i k e not replacing technologists who  can  do  to  make  life  leave.  But i n r e a l i t y ,  there are always ways of getting around that type of issue.  They don't have  s a p i e n t i a l power." That  the manager recognized  reduce expenditures, was,  that resources  were limited and  however, evident i n other statements:  able to obtain anything we wanted i n terms of supplies and incentive to cut costs. people  to  look  at  This i s no longer the case.  different  (less  expensive)  I'm  reagents  "We  he had  used to be  there was  little  beginning to force or  reagents  d i f f e r e n t suppliers ..."  His b e l i e f s have changed - l i k e l y  administrators' statements  and the r e a l i t y of receiving fewer resources.  At Hospital B,  to  from  the outcome of  administrators did not claim to i n t e n t i o n a l l y influence  b e l i e f s of the laboratory director, manager or other personnel.  Reasons for  the lack of motivation to do so appear twofold. F i r s t , the laboratory d i r e c t o r and d i v i s i o n heads consider themselves an entity separate from the h o s p i t a l .  86  One d i v i s i o n head expressed the h o s p i t a l . " affairs. the  the f e e l i n g i n this way.  "We're not employees of  This attitude i s reflected i n lack of i n t e r e s t  i n hospital  One h o s p i t a l administrator stated, "The director doesn't understand  concept  of department head.  director should.  The manager comes to meetings when the  He doesn't understand the type of things that go on there."  Second, administrators consider the laboratory d i r e c t o r and manager to be incompetent.  According  to one h o s p i t a l administrator,  doesn't know what's going on. member.'  Director  says,  "  (director)  (manager) says, 'We need another s t a f f  'Oh, okay,"  They go and present  'That's rubbish!  this  President, Medicine).  He says,  lower than l a s t year!'  And they go away with egg on their faces."  to (Vice  Your volume i s 50 percent  Administrator motivation to influence b e l i e f s of management i s present i n Hospital A and lacking at Hospital B.  Findings do not support Statement 3, i n  that administrators influenced b e l i e f s of some managers. Physicians The expectation of Statement 3 i s that physicians ordering tests w i l l not attempt to a f f e c t b e l i e f s of laboratory personnel i n any way. medical  staff  and technologists  i n both  organizations  D i v i s i o n heads,  reported  that  physicians i n t e n t i o n a l l y influence b e l i e f s of laboratory personnel.  some  They do  this i n various ways including i n d i c a t i n g that a test i s "stat" (urgent) when, on  investigation, i t i s not; and by phoning to ask that the results be made  available more quickly than usual.  A medical  staff  way, "Most doctors know the system and use i t w e l l .  member phrased  i t this  Others know the system  and think that something can be adjusted for t h e i r benefit." One d i v i s i o n head explained,  "They sometimes pressure  accommodate within  the l i m i t s  us to get this  of our resources".  done more quickly. These  We  findings do not  support Statement 3 i n that some physicians do influence b e l i e f s of laboratory  87  personnel. There was  no evidence  (namely, Ministry of Health union o f f i c i a l s , College  that  any of the other  Officials,  external  power  Regional Hospital D i s t r i c t  officials,  the Canadian Society of Laboratory Technologists,  of Physicians  and Surgeons,  the P r o v i n c i a l Medical  holders  the Royal  Association,  Canadian Council on Hospital Accreditation and the head of pathology at the university,  economic  conditions  or  technology)  intentionally  influenced  feelings, attitudes and b e l i e f s of laboratory personnel i n the short term. The  p o s s i b l i t y that such influence may occur i n the long term cannot be  excluded.  Study findings are summarized i n Table VI.  Conditions of power and  dependence have a small e f f e c t on symbolic outcomes i n that only 2 out of 10 power  holders  personnel.  (less  than  50  percent)  influence  beliefs  of .laboratory  Statement 3 i s thus supported. Statement 3a  According to Statement 3a, conditions of power and dependence have a p o t e n t i a l l y powerful e f f e c t on symbolic outcomes i n that they allow those with power to influence symbolic outcomes at the organizational, subunit and individual levels. When and how this occurs depends on the motivations of those with power. Findings been influenced explanation  i n d i c a t i n g that  of organizational  participants have  by some of the external power holders  and that the primary  f o r such influence appears to be motivation  of the power holder,  w i l l support Statement 3a. holders  beliefs  No evidence that motivation  of the external power  was the primary reason f o r the influencing of b e l i e f s w i l l  indicate  lack of support for Statement 3a. As  described  administrators influence  under  and  beliefs  findings  physicians  of laboratory  were  related the only  personnel.  to  Statement  external  Both  3,  power  were motivated  hospital  holders  to  to a f f e c t  b e l i e f s of laboratory personnel.  I t i s i n t e r e s t i n g to note that, i n contrast  to other  h o s p i t a l administrators  external power holders  and many  physicians  88  TABLE VI INFLUENCE OF EXTERNAL POWERS ON BELIEFS OF LABORATORY PERSONNEL  External Force  Influenced Beliefs (Intentionally)  Hospital administrators  Yes  Physicians  Yes  Ministry of Health Officials  No  Regional Hospital District Officials  No  Union O f f i c i a l s  No  Head of Pathology at University  No  Canadian Council on Hospital Accreditation  No  P r o v i n c i a l Medical Association  No  Canadian Society of Laboratory Technologists  No  Royal College of Physicians & Surgeons  No  Economic conditions  No  Technology  No  89  are  located  that  in  close  proximity  outcomes.  proximity  is  as  to  important  Statement 3a  i s not  the  laboratory.  as  motivation  It is in  likely,  therefore,  influencing  symbolic  accepted.  Statement 4 Statement 4 notes t h a t s u b s t a n t i v e and symbolic a s p e c t s of a c t i v i t y are l i n k e d , but the c o u p l i n g between them i s l o o s e . According activities closely  will  (such  with  example,  to  statement,  tangible  as equipment a l l o c a t i o n s and  beliefs  that  differ  this  about  reasons  these  aspects  organizational  of  organizational  promotions) w i l l n o t  activities.  correspond  P f e f f e r ' s expectation  f o r p a r t i c u l a r equipment a l l o c a t i o n s i n the  s u b s t a n t i a l l y from  beliefs  of  division  heads  and  i s , for  laboratory  technologists  about these r e a s o n s . Beliefs  of  laboratory  laboratory costs of  people  and  personnel  regarding  a c c r e d i t a t i o n were e l i c i t e d .  interviewed  were not  outcome, Statement 4 would be  the  hand,  the  majority  of  accepted  beliefs  Findings  will  be  considered  r e l a t e d t o an outcome are and  half tightly There are  50  percent  of  inconclusive  t a n g i b l e outcomes.  these outcomes, the  not  be  accepted.  data or more than 50 p e r c e n t Table VII of  f o r that  i f approximately  half  the  If,  a on  tangible outcome. beliefs  linked.  15  a whole w i l l  outcome.  as  majority  a s p e c t s of  c l o s e l y with  accepted  such  l o o s e l y l i n k e d w i t h t a n g i b l e a s p e c t s of t h a t outcome  I f Statement 4 i s a c c e p t e d f o r more than  Statement w i l l  i s not a c c e p t e d f o r more than 50 p e r c e n t as  be  of the  tangible  for that  corresponded  a s p e c t s of t h a t outcome, Statement 4 would not  outcomes  If b e l i e f s  c l o s e l y c o r r e l a t e d with  particular other  tangible  be  o f i n d i v i d u a l outcomes t h a t Statement  Findings  will  of outcomes are  be c o n s i d e r e d  outcomes.  Beliefs  of  inconclusive i f  inconclusive.  summarizes r e l a t i o n s h i p s between t a n g i b l e and  organizational  I f Statement 4  accepted.  individuals  who  symbolic are  aspects  knowledgeable  90  TABLE VII RELATIONSHIPS BETWEEN TANGIBLE ASPECTS OF OUTCOME & BELIEFS ABOUT OUTCOME  Substantive Outcome  Tightness of Coupling Those with Those with l i t t l e knowledge knowledge of of outcome outcome  Funding for equipment  Tight  Loose  Operating budget (supplies)  Tight  Loose  Operating budget (personnel)  Tight  Loose  Laboratory costs  Tight  Loose  Hiring, prof, personnel  Tight  Loose  F i r i n g , prof, personnel  Tight  Loose  Promoting, prof, personnel  Tight  Loose  Payment, prof, personnel  Tight  Loose  Hiring, tech. personnel  Tight  Loose  F i r i n g tech. personnel  Tight  Loose  Promoting tech. personnel  Tight  Loose  Teaching  Tight  Loose  Research  Tight  Loose  Quality control  Tight  Loose  Accreditation  Tight  Loose  91  about an whereas  outcome corresponded closely with tangible aspects of that outcome; beliefs  correspond  very  of  individuals  little  who  possess  the  with tangible aspects  equipment, promotion of  technical  knowledge  of  of  the  that outcome.  personnel and  accreditation  outcome  Funding for are  discussed  below to i l l u s t r a t e this point. Funding for Equipment Statement 4 leads one  to expect to f i n d l i t t l e correspondence between the  manager's reasons for equipment a l l o c a t i o n and technologists about these allocations. B d i f f e r s and  equipment a l l o c a t i o n  b e l i e f s of d i v i s i o n heads  and  Resource a l l o c a t i o n at Hospitals A  and  i n these organizations i s thus discussed  separately. At  Hospital A,  requests  from the  the  laboratory director  divisions.  The  a l l o c a t i o n of equipment dollars l i e s and  continues to l i e .  that d i v i s i o n and  we  laboratory  i s not  So a l l we  breaks out - then we put him  and  can  no  equipment  manager acknowledges that  always equitable.  "One  do i s to put him  i n another box.  give him  manager p r i o r i t i z e  d i v i s i o n head  i n a box;  u n t i l he  There's no research coming out  resources."  He  added that he  The  division  head  a major portion of the  who  had  (according  to  "personality probable  cause  technologist pathology division  conflict" of  between  small  expressed  the  manager) been  administration i s aware of  resource  and  the  allocated  over the past 4 or  Technologists i n t h i s d i v i s i o n spoke of a  their  i t thus:  have  pie."  s i g n i f i c a n t l y fewer equipment dollars than other divisions 5 years expressed anger about t h i s .  of  legitimates  minimal resource a l l o c a t i o n to this d i v i s i o n head by saying, " "Divisions to take turns i n receiving  his  "Our  division  head  allocations division  whole  to  and  the  their  head does not  division  these animosities." B e l i e f s  suffers. of  manager  as  division. get  a One  along with  Everyone  in  the  these technologists  and  92  this d i v i s i o n head about reasons f o r lack  of equipment a l l o c a t i o n  correspond  remarkably closely with the manager's reasons f o r minimal equipment a l l o c a t i o n to this d i v i s i o n .  (Findings do not support Statement 4).  As noted under findings related to Statement 2, equipment i s allocated to those  areas  the  laboratory  director  and  manager  wish  to build  up.  All  d i v i s i o n heads acknowledged f e e l i n g i n competition with other d i v i s i o n s . expressed the b e l i e f that the  manager,  tangible  received  the d i v i s i o n head who exerted the most pressure on  the  largest  allocations.  Beliefs  correspond  with  aspects of equipment allocations and do not support Statement 4.  At Hospital these  Two  to  the  B, d i v i s i o n heads p r i o r i t i z e equipment requests and submit manager  prioritization  to  prioritization  i s not  and  the  director,  who,  in  Hospital  Equipment  necessarily  heeded  manager and d i r e c t o r at Hospital  turn,  submit  Committee. by  a  The  the Equipment  department departmental  Committee.  The  B have less power to a l l o c a t e equipment than  at Hospital A, and hence less motivation to legitimate  allocations.  Four d i v i s i o n heads spoke of equipment a l l o c a t i o n as a r a t i o n a l process. One  expressed  i t this way:  "You j u s t i f y the request —  the old equipment i s  broken or t h i s one i s more e f f i c i e n t .  You document technologist  servicing,  the  And  decision."  One d i v i s i o n head claimed to lobby the director  cost  of  reagents.  the hospital  time, cost of  committee  makes the  about the issue;  "I lobby the d i v i s i o n head and t r y to convince him of the importance of my division's limits  need f o r t h i s equipment".  of the director's  She  power. B e l i e f s  also  expressed  of d i v i s i o n  awareness  of the  heads  about equipment  a l l o c a t i o n decisions correspond c l o s e l y with these decisions;  a finding which  does not support Statement 4. . In  both  knowledge,  and  hospitals, perhaps  technologists' interest,  in  beliefs the  were  allocation  marked process.  by  lack  of  Numerous  93  technologists  expressed  the b e l i e f  equipment the d i v i s i o n obtained.  that  the d i v i s i o n  head determined what  Decisions regarding equipment a l l o c a t i o n and  b e l i e f s of technologists about these decisions correspond very l i t t l e .  These  findings support Statement 4. Findings  related  to Statement  4 are inconclusive  i n that  b e l i e f s of  d i v i s i o n heads (knowledgeable i n this area) and technologists with an i n t e r e s t in  the outcome correspond c l o s e l y with equipment a l l o c a t i o n decisions; while  beliefs  of many  technologists  (who possess  little  knowledge i n t h i s  area)  correspond very l i t t l e with these decisions.  Promotion of Technical Personnel In  both  organizations,  the promotion  delegated  to the head  constrain  the head technologist's  choice. first and  Regulations  technologist.  of technical personnel has been  Union regulations  ability  regarding  promotions  to promote the person of his/her  state that union members i n the h o s p i t a l are to be given  consideration when f i l l i n g a vacancy; and that c a p a b i l i t y , performance  q u a l i f i c a t i o n s should  be considered  primary factors i n promotion.  When  such factors are equal between employees, s e n i o r i t y s h a l l be the determining factor. The  expectation  related to Statement 4 i s that b e l i e f s about promotions  of technical personnel w i l l correspond very The  majority  qualification  of  technologists  as judged  important i n promotion.  expressed  by the head  little the  with promotion decisions. belief  technologist  that  and medical  ability  and  staff  were  Their b e l i e f s correspond with factors considered i n  promotion decisions; findings which do not support Statement 4. Accreditation Accreditation occurs a t several l e v e l s : (i)  Hospital  accreditation  by  the  Canadian  Council  on  Hospital  94  Accreditation includes an assessment of laboratory f a c i l i t i e s , q u a l i t y control systems c l i n i c a l reports. ( i i ) The P r o v i n c i a l Medical control.  Association Accreditation focuses  staffing on  quality  ( i i i ) The Royal College of Physicians and Surgeons i n Canada accredits the pathology resident t r a i n i n g program. (iv) The Canadian Society of Laboratory technologist t r a i n i n g programs.  Technologists  accredits  Power i n each of these cases i s centralized and l i e s with the accrediting body.  If a part of the laboratory i s not accredited by the Canadian Council  on Hospital Accreditation, that part may  have to cease operation  temporarily.  Loss of P r o v i n c i a l Medical Association accreditation means that h o s p i t a l w i l l not  be  paid  for  laboratory  tests  performed  on  outpatients.  Loss  of  accreditation for teaching means that teaching i n a p a r t i c u l a r d i v i s i o n of the laboratory must cease. Statement  4  leads  accreditation decisions  one and  to  expect  beliefs  little  correspondence  about those decisions.  between  Study  the  findings  were that b e l i e f s of d i v i s i o n heads and head technologists about accreditation were,  for  the  most part,  technologist stated, "The areas of chemistry.  tightly  accrediting body has  lack  these  of  knowledge  r e a l l y don't know anything  decisions.  One  head  said changes are needed i n two we have to have these  This corresponded with the documented accreditation  decision; a f i n d i n g which does not a  with  B a s i c a l l y , we need more space and  changes made by June 1."  expressed  coupled  support Statement 4.  regarding  accreditation procedures,  about those things."  coupled with accreditation decisions.  Most technologists eg.  "I  Their b e l i e f s were loosely  (This supports Statement 4).  Overall,  findings related to accreditation are inconclusive.  Conclusions  Related to Statement 4  In summary, Statement 4 notes that b e l i e f s about an outcome and aspects of that outcome usually correspond very  little.  Findings  tangible  related to  95  the  statement  are  inconclusive,  i n that  findings  related  percent of i n d i v i d u a l outcomes are inconclusive. knowledgeable about beliefs  of  the  those with  outcome correspond little  Beliefs  closely with  knowledge/interest  to more than of those who  50 are  the outcome; while  i n the  outcome  correspond  l i t t l e with the outcome. Statement 4a According to Statement 4a, how strongly or loosely substantive and symbolic aspects of organizational a c t i v i t y are linked depends on managerial motivations; c h a r a c t e r i s t i c s of the outcomes and c h a r a c t e r i s t i c s of recipients of outcomes. Statement 4a notes for example, that how to  allocate  equipment  coincides with  the  closely the manager's decision beliefs  of  division  heads  and  technologists about that decision w i l l depend on these factors: the manager's motivation to explain the decision d i f f e r e n t l y from the way tangibility  of  the  outcome  (equipment) and  equipment care about the a l l o c a t i o n . the  allocation  (equipment)  differently  i s intangible  p a r t i c u l a r l y care how  from and  much people  receiving  the  If the manager i s motivated to explain the  the  how  i t occurred, the  way  people  it  occurred,  receiving  the  if  the  outcome  equipment  do  not  much and what type of equipment they receive, then the  decision and b e l i e f s about that decision are l i k e l y to correspond very l i t t l e . Evidence  that the strength of coupling between substantive and  symbolic  aspects of more than 50 percent of organizational a c t i v i t i e s can be explained in  terms  of  characteristics these  factors  managerial of  motivations,  recipients  explain  characteristics  of outcomes, w i l l  strength  of  coupling  in  of  support less  the  outcome  and  Statement 4a.  If  than  organizational a c t i v i t i e s , Statement 4a w i l l not be supported. be  considered  inconclusive  i f strength of  50  percent  of  Findings w i l l  coupling i s explained by  these  factors i n approximately 50 percent of organizational a c t i v i t i e s . Findings  indicate  that  managerial  motivation,  characteristics  of  the  96  outcomes and  c h a r a c t e r i s t i c s of  coupling between substantive when the  manager attempts  recipients of  and  outcomes explain  strength  symbolic aspects of organizational  to redefine/legitimate  an  activity.  of  activity  Examples of  managerial attempts to legitimate actions are outlined below. As  described  allocations Decisions  of  under  findings  equipment  regarding  dollars  related in  to  Hospital  equipment a l l o c a t i o n and  4,  A  always  i s not  the  manager's equitable.  b e l i e f s of d i v i s i o n heads about  these decisions are f a i r l y c l o s e l y correlated. about equipment allocations are  Statement  Preferences  unambiguous i n that  the  of d i v i s i o n heads q u a l i t y of  service  offered by a d i v i s i o n and the pride a d i v i s i o n head has i n his/her d i v i s i o n i s intimately  connected  allocation  with  the  utilization  of  i s a d o l l a r figure which represents  equipment and  as  outcome i s tangible  and  the  The  D i v i s i o n heads were not  offered by management, l i k e l y because  preferences  of  the  recipients of  outcomes  the are  This provides support for Statement 4a.  B e l i e f s of technologists i n a d i v i s i o n which had resources  equipment.  power to purchase p a r t i c u l a r  such i s something quite tangible.  convinced by r a t i o n a l explanations  unambiguous.  advanced  been allocated minimal  i n the past 4 to 5 years were remarkably close to managerial reasons  for not a l l o c a t i n g resources. but i t was  How  they became aware of inequities i s unknown  evident that they f e l t strongly about the issue.  technologist,  "The  majority  don't think he  According  to  r e a l l y runs the department.  He's  almost l i k e a figure head.  Pathology administration  they don't get on with him.  I t seems l i k e we don't get our f a i r share because  of t h i s .  lab, yet we  equipment. their  We're the biggest Their preferences  beliefs  and  don't have enough space or adequate  were unambiguous, the  about equipment a l l o c a t i o n decisions  with those decisions.  controls everything  one  This supports Statement 4a.  outcome i s tangible  and  were c l o s e l y correlated  97  As noted e a r l i e r , head technologists are constrained by union regulations regarding  the  promotion  of  personnel.  However,  three  head  admitted having rewritten a job description so as to preclude certain people and to promote the person of t h e i r choice. the head technologist explained  technologists  the promotion of  In a l l three cases  the decision (promotion) to technologists i n  that section i n r a t i o n a l terms.  One  explained  i t thus,  "The  person i n t h i s  position must l i k e , and be able to cope with a l o t of r e s p o n s i b i l i t y . " In  two  instances,  the  technologists  interviewed  involved i n the promotion and their preferences i . e . they did not promotion and  care  greatly about the  the  outcome  (promotion)  is  One  in  the  stated,  "The  This supports Statement 4a.  The  decision d i f f e r e n t l y  tangible,  directly  Their b e l i e f s about  reasons for the promotion did not correspond.  motivated to explain the  not  can be described as ambiguous;  outcome.  most q u a l i f i e d person i s always promoted." manager was  were  the  sense  than i t occurred;  that  the  new  job  is  associated with difference r e s p o n s i b i l i t i e s and perhaps increased salary. the  outcome  accepted  was  e s p e c i a l l y important  managerial  explanations In  not  about  instance,  unambiguous.  He  was  unjustly,  however, a  close  and  he  the  friend stated,  were  tightly  coupled  technologist's claim otherwise. although  the  outcome was outcome  the  technologists.  decision  preference of  the  "The  description around the person she wanted." decision  these  They  although  these  corresponded l i t t l e with the decision.  one  apparently  legitimations  for  But  manager was tangible and  resulted  in  with  tight  the  person who  head  technologist was  technologist  not wrote  was  promoted, the  job  His b e l i e f s about the promotion decision  in  spite  of  the  head  This f i n d i n g supports Statement 4a, i n that  motivated the  that  of  to redefine  the . promotion decision,  unambiguous preference coupling  between  of the  beliefs  r e c i p i e n t of  about  the  the the  promotion  98  decision and that decision. Conclusions  Related to Statement 4a  A l l the outcomes i n this study were tangible i n nature. I t was thus not possible  to compare  strength  of coupling  between  substantive  and  symbolic  aspects of a c t i v i t y with tangible and intangible outcomes. Managerial motivation,  c h a r a c t e r i s t i c s of outcomes and c h a r a c t e r i s t i c s of  recipients of outcomes explain strength of coupling when legitimation i s the symbolic  action being  linked substantive  employed.  These factors do not explain  how  tightly  and symbolic aspects of a c t i v i t y w i l l be when other types  of symbolic actions are used (e.g. lobbying, creating s o c i a l consensus).  Thus  Statement 4a i s accepted only for situations i n which the symbolic a c t i v i t y i s legitimation. Summary of Findings Statement 1 asserts limited. outcomes  Since  that  findings  i s constrained  the manager's  impact on tangible  indicate that the manager's by  external  factors  outcomes i s  influence  i n more  than  on tangible  50  percent  of  outcomes, Statement 1 i s supported. That the manager has a greater impact on b e l i e f s and attitudes than on tangible  outcomes  i s P f e f f e r ' s central claim  (Statement  2).  The combined  findings of the three aspects of this Statement 2 do not support this claim. According  to Statement 3, conditions of power and dependence have a small  e f f e c t on symbolic outcomes. than 50 percent) were  Only two out of ten external power holders (less  found  to influence  beliefs  of laboratory  personnel.  Thus Statement 3 i s supported. Statement  3a asserts  that  conditions  of power  and  dependence have a  p o t e n t i a l l y powerful e f f e c t on symbolic outcomes i n that they allow those with power  to influence  symbolic  outcomes  at  the  organizational,  subunit  and  99  individual  levels.  those with power.  When and The  two  how  this occurs depends on  external power holders  the motivations  which influence b e l i e f s of  laboratory personnel are located i n close proximity  to the laboratory.  proximity  in  is  likely  as  important  as  of  motivation  influencing  Since  symbolic  outcomes, Statement 3a i s not accepted. Statement 4 notes that substantive and symbolic aspects of organizational a c t i v i t y are linked, but the coupling between them i s loose. to  this statement  are  inconclusive  in  that  with  more  Findings  than  50  related  percent  of  tangible outcomes, half the b e l i e f s related to the outcome are loosely linked with tangible aspects of the outcome.and half t i g h t l y linked. According  to  Statement  4a,  how  strongly  symbolic aspects of organizational a c t i v i t y are motivations,  or  loosely  substantive  linked depends on  and  managerial  c h a r a c t e r i s t i c s of the outcomes and c h a r a c t e r i s t i c s of recipients  of outcomes explain  strength  of  coupling  when other types of symbolic action (e.g.,  when legitimation i s used but lobbying) are employed.  4a i s accepted only for situations i n which legitimation i s used.  not  Statement  100  CHAPTER IV  CONCLUSIONS  Theories considerable  of management have t r a d i t i o n a l l y  assumed  control over organizational a c t i v i t i e s .  that managers  exert  Some theorists argue  that external forces such as unionization l i m i t managerial freedom.  Almost  a l l have focused on the tangible results of managerial action. Pfeffer  (1981)  developed  a new conception  of managerial functions.  He contends that the  manager's role i s largely that of influencing b e l i e f s , attitudes and feelings and that management exerts a limited impact on tangible outcomes. Some of the claims  i n Pfeffer's theory  were  empirically investigated.  Claims and findings are summarized i n Figure 6.  The primary claim of this  theory  effect  i s that  substantive  management  has a  f a r greater  outcomes. Findings do not support  this  on  symbolic  than  statement nor the claim  that substantive and symbolic  aspects of organizational a c t i v i t y are loosely  linked.  the statements  Data  do  support  that  management's  effect  on  substantive outcomes i s limited and that conditions of power and dependence have a small e f f e c t on symbolic  outcomes.  Findings related to each statement  are discussed, conclusions drawn and ideas for future research  The Manager's Impact on Substantive Pfeffer  claims  that  limited (Statement 1).  presented.  Outcomes  the manager's  impact  on substantive  Study findings support this statement.  outcomes i s The manager's  freedom to influence each substantive outcome was constrained; but the manager  101  FIGURE 6  PFEFFER'S CLAIMS AND STUDY FINDINGS REGARDING THESE STATEMENTS  Pfeffer's  Substantive & symbolic outcomes are loosely coupled.  Manager has limited e f f e c t on tangible outcomes  Claims  E x t e r n a l power h o l d e r s have l a r g e e f f e c t on t a n g i b l e outcomes  J  Manager has g r e a t e r e f f e c t on b e l i e f s than on t a n g i b l e outcomes  External powers have small impact on b e l i e f s  Study Manager has limited e f f e c t on tangible outcomes  Strength of coupling between sub/ s t a n t i v e * Manager and 'p^has s m a l l e r symbolic e f f e c t on outcomes b e l i e f s depends than on on type tangible of symbo-| outcomes lie action employed  *"| T o t a l i t y of y tangible outcomes  T o t a l i t y of b e l i e f s of ypeople i n organization and i n c o n t a c t with organization  Findings  E x t e r n a l power h o l d e r s have l a r g e e f f e c t on t a n g i b l e outcomes  [ T o t a l i t y of ^tangible outcomes  J Manager has unintentional influence on b e l i e f s  Other influences on b e l i e f s e.g. c o workers  External powers have unintentional intentional effect  External powers have small| intentional effect  Totality of b e l i e f s of people i n 'organization and i n contact with organization  102  always possessed  some formal  between laboratory  managers at  approximately equivalent had  a  f a r greater  Hospital  B.  The  Considerable  Hospitals  A and  differences were  B.  In  spite of  evident  possessing  amounts of power, laboratory managers at Hospital A  impact strong  outcomes appears  power.  on  c e r t a i n tangible  motivation  to explain  this  of  the  outcomes than did  former  difference.  to  In a  those  at  lobby for p a r t i c u l a r sense, then, power i s  latent, i . e . , i t comes into play when a manager wishes and attempts to a l t e r the  status  quo.  outstanding  International  research  recognition  for  a  laboratory  i s the goal of managers at Hospital A.  t h i s goal requires updated equipment and  producing  Achievement of  an adequate budget and  hence t h e i r  e f f o r t s to influence these outcomes, through lobbying. That formal power can be  increased  through  e f f e c t on substantive to  the  fact  symbolic  that  lobbying  negate findings  outcomes i s l i m i t e d .  substantive  outcomes.  meanings.  does not  He  outcomes may  emphasizes  Figure 7 i l l u s t r a t e s  the  manager's  P f e f f e r devotes l i t t l e  attention  be  affected  legitimation  that substantive  external (contextual) factors and motivation  and  that  through influencing influencing  shared  outcomes are the r e s u l t of  to lobby.  The Manager's Impact on Symbolic Outcomes P f e f f e r ' s c e n t r a l claim that management has a greater impact on b e l i e f s , attitudes  and  supported.  feelings  than  on  tangible  Reasons for t h i s appear to be  outcomes i s contingent  on  managerial  outcomes  (Statement  2),  was  not  that managerial e f f e c t on symbolic  motivation,  type  of  symbolic  action  employed, l e v e l of management, type of organization and time i n organizational l i f e cycle. (i) motivation  Each of these factors i s discussed below: managerial and  motivation.  personality  across  There managers.  is  considerable  The  director at Hospital A i s i n t e r n a t i o n a l recognition.  dream of  variation the  in  laboratory  The route to recognition  103  FIGURE 7 FACTORS INFLUENCING SUBSTANTIVE OUTCOMES  EXTERNAL FORCES Ministry of Health Regional Hospital D i s t r i c t Canadian Council on Hospital Accredition P r o v i n c i a l Medical Association Royal College of Physicians & Surgeons Canadian Society of Laboratory Technologists Head of department of pathology at u n i v e r s i t y Unions  HOSPITAL FORCES Hospital administrators Physicians ordering tests  Division heads and Head Technologists  Laboratory Management  Substantive Outcome The r e s u l t of the i n t e r p l a y of external forces and managers' motivation to lobby forces d i r e c t l y influencing substantive outcomes opportunities to lobby  104  is  publication  researchers. largely  of  The  on  high  quality  favourable  working  equipment.  resources  ( c a p i t a l equipment,  altered by lobbying in  which  requires  highly  qualified  a b i l i t y to a t t r a c t such people to one's i n s t i t u t i o n depends  laboratory  B,  research  contrast,  The  laboratory  efforts.  devote  conditions  no  in  particular,  on  modern  i s assured of receiving some l e v e l of  staff The  and,  and  supplies)  but  a l l o c a t i o n s can  laboratory director and manager at  energy  to  lobbying  hospital  be  Hospital  administrators  or  Ministry of Health o f f i c i a l s . Managerial  impact  on  b e l i e f s and  attitudes  at  each  hospital  is  very  s i m i l a r except for influences on symbolic outcomes aimed at achieving  tangible  results.  the  The  difference  between  managers  and  directors  i n s t i t u t i o n s i n terms of p o l i t i c a l orientation personality and considerable  and  highlights the  manager attempts to influence  symbolic  to  substantive  two  motivation i s  f a c t that i n d i v i d u a l motivation i s a c r u c i a l  factor determining managerial impact. Motivation the  at  a f f e c t s the extent to which  symbolic outcomes (and  outcomes) as  well  as  the  type  hence the r a t i o of of  symbolic  action  employed. (ii)  the type of symbolic action employed.  adequately  between  three  types  creating s o c i a l consensus and employed influences are  influenced.  of  symbolic  lobbying.  The  Pfeffer does not d i s t i n g u i s h action,  namely  legitimating,  type of symbolic action c h i e f l y  the extent to which symbolic versus substantive  Since  lobbying  i s aimed  at  influencing  both  outcomes  beliefs  and  tangible outcomes, whether one i s affected more than the other i s d i f f i c u l t to assess.  Legitimation  individuals  were  was  found  unambiguous.  to be A  less  manager's e f f o r t s to  outcomes i n such situations w i l l l i k e l y be who  devotes much energy to lobbying  e f f e c t i v e when preferences  and  care greatly about those outcomes, may  influence  less e f f e c t i v e .  symbolic  Thus, a manager  legitimating outcomes to people  not have a greater  of  impact on  who  symbolic  105  than substantive outcomes; whereas a manager whose time i s devoted legitimating  organizational outcomes  to  people  who  do  not  largely to  have  strong  preferences about the outcomes, w i l l l i k e l y have a greater impact on symbolic than substantive outcomes. (iii) analysis  the type of organization. Pfeffer's ideas regarding two levels of (observable  outcomes  and  how  they  are  perceived)  come  from  the  writings of Edelman (1977), which describe ways i n which p o l i t i c a l actions get some groups what they  want and  what these  actions mean to others.  Public  organizations are the focus of Edelman's work; and i t i s l i k e l y that managers of government organizations w i l l be largely concerned with resource a l l o c a t i o n and  hence legitimation  organization product,  selling  adapting  and to improving  (which a  Pfeffer  commodity  devote  the organization to changing  much  A manager of a private time  to  structures,  Mintzberg  professional  improving  the  conditions i n the environment  the advertising campaign; a c t i v i t i e s which may  tangible than symbolic outcomes. simple  may  emphasizes).  focus more on  (1979) c l a s s i f i e s organizations as  bureaucracies,  machine  bureaucracies,  d i v i s i o n a l i z e d forms and adhocracies.  A top l e v e l manager i n a professional  bureaucracy,  devote more attention to  symbolic  such  as  a hospital,  may  influencing  outcomes than his/her counterpart i n a machine bureaucracy.  organizational type may  Thus,  influence whether managers have a greater impact  on  symbolic than substantive outcomes. (iv)  l e v e l of management.  responsibility  and  control,  Parsons  namely  (1960) i d e n t i f i e s  technical,  managerial  three levels of and  institutional  levels. (a)  At  the  level  of  the  technical  suborganization, problems focus  on  the  e f f e c t i v e performance of the technical function (effective performance of tests i n the  laboratory s i t u a t i o n ) .  The  nature of the technical  task  (e.g. types of tests to be done) and kinds of cooperation required are  106  the primary exigencies to which the sub-organization i s oriented. (b)  The  managerial l e v e l mediates between the technical suborganization  users of i t s products and obtains required resources. nature of inputs (c)  The  the  technical operation  and  It decides on the  controls the  kinds  of  the  institutional  level  is  articulation  functions and rights to the wider s o c i a l system (Parsons, level  span  environment.  boundaries  between  The environment may  the  resource  political  actions  of  organizational processes  of  goals,  1980).  Jobs at  and  external  organization  be homogeneous or heterogeneous; i f the  l a t t e r , jobs w i l l require the exercise of d i s c r e t i o n . jobs,  of  obtained.  function  this  and  i n d i v i d u a l s are  most  In discretionary  likely  to  influence  (Thompson, 1967).  Head technologists function at the technical l e v e l , d i v i s i o n heads at the managerial l e v e l and  managers at the  shared  processes  of  that  percentage  meanings and  contended, symbolic at at  however,  the  institutional  level.  legitimation occur of  The  at each l e v e l .  managerial  actions  institutional  level  may  have a  greater  impact  on  It i s  which  (vs. substantive) impact i s lowest at the technical l e v e l and  the i n s t i t u t i o n a l l e v e l . This i s i l l u s t r a t e d i n Figure 8. the  creation of  have  highest  While managers beliefs  than  on  tangible outcomes, this w i l l l i k e l y be less true of managers at lower l e v e l s . (v)  the  time  in  the  life  cycle  of  the  organization.  Issues  of  importance i n the organization change over time. Consequently, the amount of energy a manager devotes to a f f e c t i n g symbolic fluctuate  over  stages  development i n the  of  organization  time.  includes  Quinn and  two  activities.  life  marshalling  s o c i a l i z a t i o n of members. latter  Cameron of an  versus  (1980) and  substantive Miles  organization. The  resources,  creating  issues  (1980) i d e n t i f y creation of  an  may  ideology  the and  Symbolic a c t i v i t y i s l i k e l y to be important i n the  In the m i d l i f e of the  organization, emphasis i s on  107  FIGURE 8  T a n g i b i l i t y of  Outcome  108  producing an output e f f i c i e n t l y ; and symbolic a c t i v i t y may  be less important  here. In  summary, i t appears  that whether a manager has a greater e f f e c t  on  symbolic than substantive outcomes depends on his/her motivation, the kinds of symbolic action employed, the type of organization, the l e v e l of management and the time i n the organization's l i f e cycle.  Future research might examine  these ideas.  The Influence of External Power Holders on Symbolic Outcomes Pfeffer contends and  attitudes  claim.  that external powers have l i t t l e  of organizational members  This statement  refers  (Statement  influence on  3).  Data  to i n t e n t i o n a l influence.  The  support  unintentional impact  f r u s t r a t i o n about were  required  conditions  perform  the  and  province  considered  were  an  the number of tests  unnecessary.  important  technologists who  the wrath of public had  General  factor  imposition of c e i l i n g s on wage increases of public aimed at incurring  Examples  Many technologists expressed  physician ordering patterns and  to  in  are presented below.  in  the  employees.  large  salary  they  economic premier's  Though not  employees, h i s statement  been a n t i c i p a t i n g  this  unintentional  nature of influence of external powers i s not addressed by P f e f f e r . of  beliefs  infuriated  increases i n upcoming  union negotiations. Advances i n technology (e.g. at  have allowed  certain  types  of  laboratory work  chemistry) to become very automated. The head technologist i n chemistry Hospital  technologists stated,  A  claims and  "People  procedures.  that  automation  consequently  don't  help each  their  has  decreased  readiness  other as much now  The nature of the work has changed.  other with reporting. Now  to  interdependence help as  one  another.  when we  People used  the reports come out of machines.  among She  d i d manual to help each  And  even when  109  they're  not  busy  they don't go  and  help  the  others,  because they work so  independently that there's no f e e l i n g of commitment to others." Head technologists and d i v i s i o n heads expressed feelings of f r u s t r a t i o n , even anger, regarding  the constraints imposed by union regulations on  freedom to promote, h i r e and  f i r e whom they wished.  expressed her f r u s t r a t i o n thus:  One  head  their  technologist  "With the H.E.U. contract (typists, c l e r k s ) ,  everyone has two working days off i n a row.  We need coverage on weekends; so  i n order to schedule 10 working days i n every 14, we have to do i t so that the same i n d i v i d u a l always has Wednesday and Thursday o f f . they leave. Actions  We've had to cope with rapid turnover.  of bodies accrediting laboratory  control and  They don't l i k e i t and  And you can't change i t . "  function and  organization, q u a l i t y  teaching evoke feelings and influence b e l i e f s only at those times  when accreditation or evaluation i s occuring. External powers can be categorized along two dimensions, namely: (i)  physical proximity to the organization being affected;  (ii)  the intentional/unintentional nature of the influence.  Figure 9 locates each external power along these dimensions. in  close  proximity  to  members  of  the  laboratory  Only those  i n t e n t i o n a l l y influence  symbolic outcomes. Powers which are removed from the organization usually have an unintended impact on symbolic outcomes i n the organization. The Linkage Between Symbolic and Substantive Outcomes Pfeffer  contends  that  substantive  and  symbolic  aspects  of  managerial  a c t i v i t y are imperfectly linked (Statement 4), but there i s l i t t l e evidence to support t h i s  claim.  j u s t i f i c a t i o n s and  His  statement i s based on  the  belief  that  organizational action w i l l almost always d i f f e r .  examples of both loose and t i g h t coupling were found when there was by management to make the use of power unobtrusive. Figure  10.  managerial However, an attempt  These are summarized i n  110  FIGURE 9  EXTERNAL POWERS AFFECTING HOSPITAL LABORATORIES CATEGORIZED ACCORDING TO INTENTIONALITY OF INFLUENCE AND PROXIMITY TO LABORATORIES  Intentional Influence Close proximity  Hospital administrators  Unintentional Influence Physicians  Physicians Head of pathology, university Physicians Accreditation bodies  Physically distant  Ministry of Health Unions College of Physicians and Surgeons Canadian Society of Laboratory Technologists Economic conditions Technology  111  FIGURE 10  LINKAGE BETWEEN SUBSTANTIVE AND SYMBOLIC OUTCOMES WITH AND WITHOUT MANAGERIAL LEGITIMATION  Decision/resource important  I  Power dispersed  Decision/resource unimportant Power centralized  Manager ^ motivated to redefine s i t u a t i o n (Statements 4 and 4a)  No motivltion to redefine s i t u a t i o n  Loose coupling between symbolic and substantive outcomes  usually when preferences of recipients of outcomes are ambiguous, e.g. technologists not involved i n promotion  (1) when a c t i v i t y i s outside sphere of knowledge or i n t e r e s t of organizational participants, e.g. technologists and accreditation (2) when there i s no freedom to express b e l i e f s i n tangible ways, e.g. low morale and test performance  Tight coupling between symbolic and substantive outcomes  usually when outcome i s tangible and preferences of recipients of outcomes are unambiguous, e.g. technol o g i s t s involved i n promotion, d i v i s i o n heads and equipment requests  (1) when power cent r a l i z e d or decision r e l a t i v e l y unimportant and people have some knowledge of the a c t i v i t y , e.g. d i v i s i o n heads and accreditation (2) when there i s freedom to express b e l i e f s and feelings i n tangible ways e.g., low morale S equipment maintenance  112  Managerial little  legitimations concerning  about,  outcomes.  will  likely  But when  technologists  result  people  involved  outcomes which individuals care very  i n loose  care  a  great  coupling deal  between  about  i n promotion) substantive  substantive  an outcome  and symbolic  (e.g.,  outcomes are  l i k e l y to be t i g h t l y linked. Of  interest  here  i s Holzner's  (1968)  notion  that  the process  legitimation occurs at various levels of the authority structure.  of  The wider  the scope of the audience and the higher the l e v e l of authority involved, the broader i s the scope of legitimation and the greater i s the number of vague symbolizations authority.  used.  More s p e c i f i c  symbols  D i v i s i o n heads are located high  laboratories.  are used  at lower  levels of  i n the authority structure of  But legitimation of equipment a l l o c a t i o n to these individuals  was s p e c i f i c ;  i t can, perhaps, not e a s i l y be made vague.  The vague/specific  nature of the legitimation and the l e v e l of authority to which legitimations are directed are a d d i t i o n a l factors which may influence strength of coupling. Pfeffer substantive  never outcomes  unobtrusive. circumstances outside  mentions when  Examples  there  of  correspondence  i s no e f f o r t  of loose  (see Figure 10).  the sphere  the  and t i g h t  between  to make  coupling  symbolic  the use of power  were  found  i n such  Loose coupling was found when the a c t i v i t y was  knowledge  or  interest  of  the  i n d i v i d u a l (e.g.  technologists' knowledge of accreditation and equipment a l l o c a t i o n ) . correspondence  between  occurs  power  when  resource/decision  symbolic is  i s seen  and substantive  centralized as r e l a t i v e l y  (as  with  outcomes  (tight  unimportant  (teaching  College  i n teaching  of Physicians  Close  coupling)  accreditation)  control) and when people have some knowledge of the a c t i v i t y . heads involved  and  or  the  or q u a l i t y  Thus d i v i s i o n  are aware of the decision powers of the Royal  and Surgeons  and technologists  involved  i n quality  113  control  are well  aware  of the power  of the BCMA Accreditation  Committee  decisions. . Budget cutbacks resulted i n low morale. certain substantive with  outcomes and not with others.  the maintenance of laboratory  technologists  Morale i s c l o s e l y coupled with Morale i s c l o s e l y linked  equipment i n that, when morale i s high,  maintain equipment; when i t i s low, they  do not.  However,  b e l i e f s and feelings are loosely coupled with other technical outcomes such as performance of t e s t s .  Technologists  their  and substantive  mood.  Symbolic  continue to perform t e s t s , regardless of outcomes appear, then, to be t i g h t l y  coupled when there i s some freedom to express b e l i e f s and feelings i n tangible ways. P f e f f e r does not d i s t i n g u i s h adequately between three types of symbolic action (lobbying, legitimation and creating s o c i a l consensus). substantive  and symbolic  aspects  of organizational  activity  His claim that are loosely  linked, appears to be based on the legitimating role of the manager.  He says  that the symbolic role of the manager i s l i k e l y most important i n contexts i n which assessment of organizational outcomes i s d i f f i c u l t , connections between actions  and  incompletely  results involved  applies c h i e f l y  are uncertain and have  and  ambiguous  organizational preferences.  to the legitimating r o l e .  Factors  participants are But this  statement  influencing the linkage  between b e l i e f s related to legitimations of outcomes and those outcomes d i f f e r from factors l i n k i n g symbolic and tangible outcomes of lobbying attempts. Factors substantive  affecting outcomes  the  varies  strength with  of  coupling  the type  between  of symbolic  symbolic  action  and  employed.  Methods of meaning creation include ceremonies, organizational restructuring, symbols and language. with  laboratory  Since managers i n both organizations spend l i t t l e time  personnel,  the researcher  was afforded  few opportunities to  114  observe  managers i n t e r a c t i n g with other i n d i v i d u a l s .  obtaining  information  consequently, language.  about  managers'  The  effects  on  primary method of individuals  was,  Rituals related to coffee breaks, etc. were observed;  but such actions were not the focus of t h i s study. The  ways i n which factors influencing the strength of coupling between  substantive  and  symbolic  outcomes  vary  with  employed, are summarized i n Table VTII. manager or others.  the  Symbolic  type  of  symbolic  action may  action  be taken by the  With legitimation, the motivation of the legitimator, the  t a n g i b i l i t y of the outcome and preferences of recipients of outcomes influence the strength of coupling. tangible  outcome,  the  If people  likelihood  have strong preferences concerning a  that  they  will  accept  statements  which  contradict tangible evidence, i s small. Lobbying person  with  often has power,  the  symbolic and control  tangible e f f e c t s . P r i o r b e l i e f s  he/she  exerts  over  the  outcome  of the  and  the  a v a i l a b i l i t y of the outcome a f f e c t strength of coupling between the symbolic and substantive outcomes of lobbying e f f o r t s . to influence laboratory s t a f f than  usual.  The  staff  For example, physicians attempt  to provide them with test results more quickly  member's  compliance  depends  on  beliefs  about  the  legitimacy and f e a s i b i l i t y of the request. When  symbolic  action  is  aimed  at  creating  social  consensus,  the  motivation of the person influencing shared meanings affects the strength of coupling between substantive and symbolic outcomes. to influence b e l i e f s i n such a way referents  of  that  outcome.  He/she may  be motivated  that they d i f f e r from objective, physical  If t h i s  person  i s held  i n high  regard,  the  p o s s i b i l i t y that symbolic and substantive outcomes w i l l be t i g h t l y coupled i s increased.  Festinger  (1954)  said  that  p a r t i c u l a r l y when physical r e a l i t y was  social  communication  would  be  not present to anchor b e l i e f s .  used Asch  115  TABLE VIII FACTORS INFLUENCING STRENGTH OF COUPLING BETWEEN SUBSTANTIVE AND SYMBOLIC OUTCOMES WITH VARIOUS TYPES OF SYMBOLIC ACTION  Intentional  Influence  Factors Influencing Strength of Coupling  Symbolic action related to legitimating  Motivation of legitimator T a n g i b i l i t y of outcome Preferences of recipients of outcomes  Symbolic action related to lobbying  P r i o r b e l i e f s of power holder Control he/she exerts over outcome A v a i l a b i l i t y of outcome/options for compliance  Symbolic action related to creating s o c i a l consensus  Motivation  Unintentional  (a) Sphere of knowledge/interest of organizational participant Centralization of power Importance of issue  Influence  of person creating consensus Esteem with which this person i s regarded Preferences of recipients Degree of conformity among recipients  (b) Amount of freedom/discretion to express b e l i e f s and feelings i n a tangible way.  116  (1958) examined variables affecting degree of conformity (or s o c i a l consensus) and found that degree of conformity was reduced  i f even one person took the  subject's p o s i t i o n . Future research might examine the following hypotheses: (i)  The motivation of the legitimator, the t a n g i b i l i t y of the outcome and  preferences of recipients of outcomes w i l l influence the strength of coupling between  substantive  and  symbolic  outcomes  when  the symbolic  action i s  legitimation. ( i i ) Prior beliefs  of the person with power, the control he/she exerts over  the outcome and the options f o r compliance  will  influence the strength of  coupling between substantive and symbolic outcomes when the symbolic action i s lobbying. (iii)  Motivation of the person  he/she i s regarded,  creating  consensus,  the esteem with  which  preferences of recipients, and the degree of conformity  among recipients w i l l influence the strength of coupling between substantive and symbolic outcomes when the purpose of symbolic action i s creating s o c i a l consensus. Significance of Findings Empirical studies on managerial and external influences on organizational outcomes  have  attributable  been  directed  to each source  toward  determining  of influence.  the variance  i n outcomes  These studies u t i l i z e d  existing  data (such as p r o f i t s over 20 years) and as such were not close to data. They also ignored the s o c i a l nature of organizational r e a l i t y . In this study, the researcher observed a c t i v i t i e s and interactions and spoke with organizational members about t h e i r perceptions of events and influences.  S o c i a l and tangible  aspects of r e a l i t y were considered equally important. Pfeffer's  ideas about the symbolic  role  of management have never  been  117  examined.  This  was  Pfeffer's claims.  thus primarily an  exploratory  study to examine some of  The study did not seek to e s t a b l i s h causal linkages between  actions of management and symbolic and substantive  outcomes. Findings give an  i n d i c a t i o n of patterns of relationships between managerial action and tangible and symbolic outcomes and factors l i k e l y to a f f e c t these r e l a t i o n s h i p s . results i d e n t i f y factors which future researchers Categories  might attempt to control.  developed p r i o r to data analysis (based on P f e f f e r ' s writings)  were used, as well as categories which emerged from the data i t s e l f . concepts captured  ideas  for example, i t was may  be  Study  not brought out by simply  using a p r i o r i  found the e f f e c t s of managers and  unintentional  as  well  symbolic versus substantive  as  i n t e n t i o n a l , and  outcomes may  Emergent  categories;  external power holders a  manager's  impact  on  be moderated by several factors.  It  i s contended that the use of both a p r i o r i and emergent categories strengthens study findings. Study findings give  some i n d i c a t i o n of the  utlity  of P f e f f e r ' s  theory.  His d i s t i n c t i o n between symbolic and substantive outcomes i s useful i n that i t serves  to focus  attention on both kinds  of outcomes.  Study findings support  his claims that the manager has a limited e f f e c t on tangible outcomes and external contention  power  holders  have  a  that the manager has  outcomes did not  small  a greater  receive support.  symbolic versus substantive (managerial motivation,  effect  The  on  symbolic  e f f e c t on  that  outcomes.  symbolic  than  His  tangible  magnitude of managerial influence  on  outcomes appears to be moderated by f i v e factors  type of symbolic action employed, l e v e l of management,  type of organization and time i n organizational l i f e c y c l e ) . P f e f f e r ' s claim that substantive activity  are  loosely  linked, was  not  and  symbolic aspects of organizational  supported.  possibly, that factors influencing strength  The  reason  for this i s ,  of linkage vary with the type of  118  symbolic  action employed.  Concepts which emerged from the data were as follows: (i)  The intentional/unintentional nature of the influence of external power holders and managers on symbolic  (ii)  outcomes.  the e f f e c t s of proximity to/distance from the organization on the extent to which external power holders a f f e c t symbolic  ( i i i ) magnitude of managerial influence on symbolic on managerial motivation,  type of symbolic  outcomes.  outcomes may be contingent  action, l e v e l of management,  type of organization and time i n organizational l i f e cycle. (iv)  type  of symbolic  attempts  action employed and existence/absence  to redefine  the s i t u a t i o n may  between substantive and symbolic There symbolic  has  been  outcomes  influencing  no  research  strength  of  coupling  influence strength  of linkage  outcomes.  on  i n organizations.  of managerial  the  linkage  This depend  between  study on  substantive  identified  that  and  factors  (a) the presence/absence of  managerial attempts to redefine the s i t u a t i o n and  (b) the type of  symbolic  action employed. Future Research This  study examined relationships which P f e f f e r contends e x i s t between  actions of managers and external power holders  and substantive  and  symbolic  outcomes; as well as the linkage between substantive and symbolic  aspects of  organizational  were  established. findings  activity.  Cause  important.  effect  relationships  not  Actions of only four managers i n two settings were examined and  are not generalizable  research  and  precede  the  statistical  Study findings  P f e f f e r postulates e x i s t .  to other  have  settings.  testing  increased  of  That  such  hypotheses  understanding  exploratory  i s , however,  of relationships  They support some of the relationships he proposes,  119  but not others; and enrich understanding of variables a f f e c t i n g relationships between symbolic and substantive outcomes and the magnitude of the manager's impact on substantive vs. symbolic outcomes. more rigorous inquiry. below.  The study has set the stage for  A set of statements based on study findings i s l i s t e d  Future research might examine  some of these.  1.  The manager has a limited impact on substantive outcomes.  2.  The magnitude of managerial impact on symbolic versus substantive outcomes i s contingent on managerial motivation, type of symbolic action employed, l e v e l of management, type of organization and time i n organizational  life  cycle. (a)  managers  who  are motivated to influence b e l i e f s  and attitudes are  l i k e l y to a f f e c t symbolic outcomes more than those less motivated i n this d i r e c t i o n . (b)  managers who devote much time to legitimating outcomes to people who care greatly about those outcomes, w i l l  l i k e l y have less impact on  symbolic than substantive outcomes. (c)  managers  whose  energy  is  devoted  largely  to  legitimating  organizational outcomes to people who do not have strong preferences about the outcomes w i l l  likely  have a greater impact  on symbolic  than substantive outcomes. (d)  the percentage  of managerial  actions  which have  symbolic  (versus  substantive) impact w i l l l i k e l y be lowest at the technical l e v e l of management and highest at the i n s t i t u t i o n a l l e v e l . (e)  the extent to which a manager influences symbolic versus substantive outcomes  will  organization cycle.  likely  than  be  at any  greater other  time  during  the  creation  of  an  i n the organization's l i f e  120  Conditions  of power  and  dependence  have  a  small  effect  on  symbolic  outcomes. (a)  External  power  holders  organization may  located  intentionally  in  close  proximity  influence b e l i e f s  to  the  and attitudes of  organizational members. (b)  External often  power  have  holders  an  physically  unintentional  removed  impact  on  from  the organization  beliefs,  attitudes  and  feelings of organizational members. (a)  When there i s no e f f o r t to make the use of power unobtrusive, coupling  between  substantive  and  symbolic  outcomes  tight  i s likely i n  situations where (i) (ii) (iii) (iv) (b)  power i s centralized the resource/decision i s r e l a t i v e l y unimportant people have some knowledge of the a c t i v i t y there i s freedom to express b e l i e f s and feelings i n tangible ways.  When there i s no e f f o r t to make the use of power unobtrusive, coupling between substantive and symbolic there  i s no freedom  to express  beliefs  loose  outcomes i s l i k e l y when and feelings  i n tangible  ways. (c)  When the manager i s motivated coupling between symbolic  to legitimate an action/outcome, t i g h t  and substantive outcomes i s l i k e l y when  preferences of recipients of outcomes are unambiguous. (d)  When the manager i s motivated coupling  between  situations  symbolic  i n which  to legitimate an action/outcome, loose  and substantive  preferences  of  outcomes  recipients  of  is likely in outcomes are  ambiguous. (e)  Factors i n f l u e n c i n g the strength of coupling between substantive and symbolic outcomes vary with the type of symbolic action employed.  121  (i)  With  legitimation,  tangibility  the motivation  of the legitimator, the  of the outcome and preferences  of recipients of  outcomes influence the strength of coupling, (ii)  When the symbolic action employed i s lobbying,  p r i o r b e l i e f s of  the  exerts  person  with  power,  the control  he/she  over the  outcome and the a v a i l a b i l i t y of the outcome a f f e c t strength of coupling. (iii)  When  symbolic  motivation esteem  action  i s aimed  of the person  with  recipients  which  this  and degree  at creating  influencing  person  shared  i s regarded,  of conformity  consensus, the meanings, the preferences of  among recipients a f f e c t  strength of coupling, (iv)  Ceremonies,  settings  and the use of symbols  are forms of  symbolic action not examined i n t h i s study. Future research may investigate  factors  between substantive  influencing  the strength  of  coupling  and symbolic outcomes with each of these  forms of symbolic action. Berger and Luckman (1966) do not distinguish between legitimation and the creation of s o c i a l consensus. transmission level. third  of kinship  They i d e n t i f y four levels of legitimation. The  vocabulary  to a c h i l d  i s an example of the f i r s t  The second contains t h e o r e t i c a l propositions level  consists  legitimated. identify  of theories  by which  a part  Symbolic universes form the fourth l e v e l .  factors  influencing  the strength  such as proverbs.  The  of an i n s t i t u t i o n i s Future research  of coupling  at each  might  l e v e l of  legitimation. The of  influence of the manager has,  tangible  outcomes.  This  research,  t r a d i t i o n a l l y , been measured i n terms based on P f e f f e r ' s writings  about the  122  symbolic r o l e of management, emphasizes the importance of examining managerial impact  on  tangible  and  intangible  outcomes  and  factors  affecting  such  influence. The  i n s t i t u t i o n a l world i s e x p e r i e n c e d as an  objectivity influence External  humanly  substantive power  substantive and  is  holders  outcomes.  a t t i t u d e s are  action i s socially the  produced. domains may  and  limit  Numerous  a f f e c t e d - not structured,  Those the the  authority  social ability  variables the  with  objective reality;  that  have  the  construction  of  reality.  to  influence  of  influence  a how  manager  effectively  l e a s t of which i s t h a t though  i t i s a l s o shaped by  i n d i v i d u a l ' s p a r t i c i p a t i o n i n h i s world.  but  the  specific  power  to  beliefs cognitive  dynamics  of  123 REFERENCES  Adams, J.S. Inequity i n S o c i a l Exchange. In Berkowitz, L. (Ed.), Advances i n Experimental S o c i a l Psychology, Vol. 2, New York: Academic Press, 1965. Agreement Between Hospital B and the Laboratory Director and Associates, 1981. A f f i l i a t i o n Document Between the University and Hospital A, 1980. A f f i l i a t i o n Document Between the University and Hospital B, 1977. A l d r i c h , H.E. Organizations Prentice H a l l Inc., 1979.  and Environments.  Englewood  C l i f f s , N.J.:  Asch, S.E. "Effects of Group Pressure Upon the Modification and D i s t o r t i o n of Judgements". In Maccoby, E.E., Newcomb, T.M. and Hartley, E.L. (Eds), Readings i n S o c i a l Psychology. New York: Holt, Rinehart and Winston, 1 958. Bachrach, P. and Baratz, M.S. Power and Poverty; York: Oxford University Press, 1970.  Theory and Practice. ,  Berger, P.L. and Luckman. The S o c i a l Construction Doubleday & Company, 1966.  of R e a l i t y .  New  New York:  Bouchard, T. F i e l d Research Methods: Interviewing, Questionnaires, Participant Observation, Systematic Observation. In Dunnette, M.D. (Ed), Handbook of I n d u s t r i a l and Organization Psychology. Chicago: Rand McNally Publishing Co., 1976. Canadian Council on Hospital Accreditation, 1977.  Accreditation.  The  Guide  to  Hospital  Culbert, S.A., & McDonough, J . J . The I n v i s i b l e War: Pursuing S e l f Interests at Work. New York: Wiley, 1980. Dahl, R.A. and Lindblom, C E . Politics, University of Chicago Press, 1953.  Economics and Welfare.  Dornbusch, S.M. The M i l i t a r y Academy as an Assimilating I n s t i t u t i o n . Forces, 1955, 33, 316-321.  Chicago: Social  Edelman, M. P o l i t i c a l Language: Words That Succeed and P o l i c i e s That F a i l . New York: Academic Press, 1977. Festinger, L. A Theory of S o c i a l Comparison Processes. Human Relations, 1954, 7, 117-140. Freeborn, D.K., Baer, D., Greenlick, M.R., and Bailey, J.W. Determinants of Medical Care U t i l i z a t i o n : Physicians' Use of Laboratory Services. American Journal of Public Health, 1972, 62, 846-853. Frost, P.J. Associate Professor, Faculty of Commerce, University of B r i t i s h Columbia. Personal Communicaton, October, 1981.  124  Goodman, P., & Friedman, A. An Explanation of Adams' Theory of Administrative Science Quarterly. 1971, 16, 271-288.  Inequity.  Gouldner, A. The Problem of Succession i n Bureaucracy. In Merton, R. Reader In Bureaucracy. Glencoe, I l l i n o i s : Free Press, 1952. Hannan, M.T., & Freeman, J.H. The Population Ecology American Journal of Sociology, 1977, 82, 929-964. Holzner, B. R e a l i t y Construction Schenkman Pub. Co., 1968. Katz,  D., & Kahn, R.L. John Wiley, 1978.  The  i n Society.  (Ed.),  of  Organizations.  Cambridge,  Massachusetts:  S o c i a l Psychology of Organizations.  New  York:  Lieberson, S., & O'Connor, J.F. Leadership and Organizational Performance: A Study of Large Corporations. American S o c i o l o g i c a l Review, A p r i l 1972, 37, 2. March, J.G. Bounded Rationality, Ambiguity, and B e l l Journal of Economics, 1978, 9, 587-608. March, J.G.,  & Simon, H.A.  Organizations.  New  the  Engineering  York: John Wiley,  of  Choice.  1958.  Martz, E.W. and Ptakowski, R. Educational Costs to Hospitalized Patients. Journal of Medical Education, 1978, 53, 383-386. Miles, R.H., Findings and Implications of Organizational L i f e Cycle Research: A Commencement. In Kimberley, J.R. and Miles, R.H. and Associates (Eds.), The Organizational L i f e Cycle. Washington: Jossey-Bass Publishers, 1980. Mintzberg, H. The Structuring of Organizations: Englewood C l i f f s , New Jersey: Prentice Hall,  A Synthesis 1979.  of Research.  Morrow, P.C, & McElroy, J.C. Interior Office Design and V i s i t o r Response: A Constructive R e p l i c a t i o n . Journal of Applied Psychology, 1981 , 5, 646-650. O'Reilly, C.A., & Caldwell, D. Informational Influence as a Determinant of Perceived Task C h a r a c t e r i s t i c s and S a t i s f a c t i o n . Journal of Applied Psychology, 1979, 64, 157-165. Parsons, T. Structure and Process Press of Glencoe, 1960. Patton, M.Q. Qualitative Publications, 1980.  i n Modern S o c i e t i e s . New  Evaluation  Methods.  Beverly  York: The Hills:  Free Sage  Peters, T.J. Symbols, Patterns and Settings: An Optimistic Case for Getting Things Done. Organizational Dynamics, 1978, 7, 3-23. P f e f f e r , J . The Ambiguity January 1977, 104-112.  of  Leadership.  Academy  of  Management Review,  125  P f e f f e r , J . Management as Symbolic Action: The Creation and Maintenance of Organizational Paradigms. In Cummings, L.L. & Staw, B.M. (Eds.), Research i n Organizational Behaviour, Vol. 3, Greenwich, CT: JAI Press, 1981 . Pfeffer, J . Power i n Organizations. 1981a.  Marshfield Mass.: Pitman Publishing Co.,  P f e f f e r , J . Personal communication, San Diego, August 1981b. P f e f f e r , J . , & Salancik, G.R. The External Control of Organizations: Resource Dependency Perspective. New York: Harper and Row, 1978.  A  P h i l l i p , P.J., and Hai, A. Growth i n Lab Tests Indicative of Increases i n Service Intensity, Hospitals, 1979, 53, 467. Pondy, L.R. Leadership i s a Language Game. M.M. (Eds.), Leadership: Where Else University Press, 1978.  In McCall, M.W., J r . , & Lombardo, Can We Go? Durham, NC: Duke  Quinn, R. and Cameron, K. Organizational L i f e Cycle Stages and Models of Effectiveness. Paper presented at A.P.A. Convention, Montreal, 1980. Salancik, G.R., & Pfeffer, J . Constraints on Administrator Discretion: The Limited Influence of Mayors on City Budgets. Urban A f f a i r s Quarterly, June 1977, 12, 475-497. Salancik, G.R., & Pfeffer, J . A Social Information Processing Approach to Job Attitudes and Task Design. Administrative Science Quarterly, 1978, 23, 224-253. Spradley, J.P. The Ethnographic Interview. Winston, 1979. Thompson, J.D. Organizations i n Action.  New York:  Holt,  Rinehart and  New York: McGraw H i l l , 1967.  Van Maanen, J . Notes on the Production of Ethnographic Data i n An American Police Agency. In Luckham, R. (Ed.), Anthropological Methods i n the Study of Legal Systems. Stockholm: Scandanavian Institute for African Studies, 1978. Van  Maanen, J . Some Thoughts (and Afterthoughts) on Context, Interpretation and Organization Theory. Paper presented at Annual Meeting of the Academy of Management, San Diego, 1981.  Van Maanen, J . Fieldwork on the Beat: An Informal Introduction to Organizat i o n a l Ethnography. Presentation a t Conference on Innovations i n Methodology for Organization Research, 1981a. Weick, K. The S o c i a l Psychology of Addison-Wesley Publishing Co., 1979.  Organizing.  Reading,  Mass.:  126  Weick, K. Systematic Observational Methods. In Lindsey, G. and Aronson, E. (Eds.), Handbook of S o c i a l Psychology. Reading Mass.: Addison-Wesley Publishing Co., 3rd edition, forthcoming. Weiner, N., & Mahoney, T.A. A Model of Corporate Performance as a Function of Environmental, Organizational and Leadership Influences. Academy of Management Journal, 1981, 24, 3, 453-470.  If?  APPENDIX A  QUESTIONS ASKED OF STUDY PARTICIPANTS The Manager As I explained to you some time ago, my research i s concerned with the factors and people influencing what happens i n a h o s p i t a l laboratory. The purpose of my questions i s to i d e n t i f y which a c t i v i t i e s i n the lab are under your control (or the control of the director) and which are largely influenced by people outside the lab. This consent form states that you may withdraw from the study at any time and that your responses w i l l be completely c o n f i d e n t i a l . I s h a l l not repeat what you say to anyone and results w i l l be presented i n a way that disguises i n d i v i d u a l i d e n t i t i e s . W i l l i t be okay i f I take notes while we talk? I would l i k e , f i r s t , to ask you about v i s i b l e , measureable a c t i v i t i e s events such as h i r i n g s t a f f and acquiring equipment.  and  What influence do doctors have on the volume and nature of tests that get done? Are people i n managerial positions such as you and director) able to influence performance of tests? (Yes/No) (If Yes)  How  (the  do you do this?  Do heads of d i v i s i o n s have an influence on t e s t performance? (If Yes)  (Yes/No)  In what way?  In what way  does new equipment influence the performance of tests?  How does new knowledge (such as developments i n knowledge about diabetes) a f f e c t this whole area? Do you have any documents that indicate how a f f e c t tests that get done? (If Yes)  In what way  I'd l i k e now  any  of these  people/factors  do the documents i n d i c a t e t h i s ?  to focus on acquiring c a p i t a l equipment.  What people or factors outside the lab influence equipment you  acquire?  it*  (If several are does  l i s t e d , inquire regarding influence this?  (If not already mentioned) process?  How,  each one  individually)  then, does the d i r e c t o r influence  Are you able to influence the a c q u i s i t i o n of equipment? (If Yes)  How  Could you give an example of how  the  (Yes/No)  you have done this?  Do you have written documents supporting what you've said about any of these people having a major influence on acquiring c a p i t a l equipment? (Yes/No) (If Yes)  How  do they indicate supporting  evidence?  Would i t be okay i f I had a look at those at some point? Could we talk about the operating budget for a while — about factors which or people who influence the size of the budget allocated to the lab? Which people or factors influence the size of the supply budget allocated to the lab? (Further questions were aimed at i d e n t i f y i n g the power of people/ organizations outside the laboratory as well as that of the laboratory manager and d i r e c t o r to influence the process.) 1  Which people or factors determine the size of the salary budget allocated to the lab? (Further questions were aimed at determining the power of external organizations and individuals as well as that of the laboratory manager and d i r e c t o r to influence these allocations.) Is there any written evidence of what we've been t a l k i n g about? (Yes/No) (If Yes)  Could I have a look at these documents l a t e r  Which people i n this professional s t a f f ?  laboratory  are  responsible  on?  for  the  hiring  of  (If more than one) How would you rank the influence each of these people has on the decision making process? What are the reasons considerably less?  for  some  having  much  influence  and  others  As noted on page 44, questions could not a l l be s p e c i f i e d p r e c i s e l y i n advance. In such cases an interview guide was utilized. I t keeps i n t e r a c t i o n focused but allows i n d i v i d u a l perspectives to emerge.  Are you able (Yes/No) (If Yes)  to influence the h i r i n g of professional s t a f f i n any way?  Would you describe how  Are there people outside the professional staff? (Yes/No) (If Yes)  Who  you do this? organization  who  affect  the  hiring  of  are these people/Who i s this person?  How strong i s the influence of this person i n r e l a t i o n to people i n the lab? Could you give examples to support what you've said? (If more than one) How would influence on decision making? How  you  rank  these  people  according  to  i s this documented?  Could I have a look at these documents sometime? Which person/people i s responsible for promotions of professional staff? (If more than one) How would influence on promotion decisions?  you  rank  these  people  according  to  Do any i n d i v i d u a l s outside the lab influence decisions about promotions? (Yes/No) (If Yes)  Who  are these people?  Why  i s i t that they do influence these decisions?  How  does t h i s influence occur?  What power do you personnel?  or the d i r e c t o r have, i n terms of f i r i n g professional  Further questions explored factors management to f i r e personnel.)  limiting  the  power  of  laboratory  Which people were responsible for establishing the method of payment of professional personnel i n t h i s hospital? (Further questions were aimed at determining this choice of method of payment.)  the reasons/motivation  for  Which organizations are responsible for accrediting aspects of laboratory functions? What happens i f the lab i s found d e f i c i e n t i n some area? (Further questions sought to c l a r i f y that of laboratory management.)  the power of a c c r e d i t i n g bodies and  1^0  We have talked about pay, h i r i n g , f i r i n g , promotions, c a p i t a l equipment, budget allocations and lab t e s t s . Are there any other tangible things you are able to influence? (Yes/No) (If Yes) Would you describe this/these? The next questions focus on whether groups or individuals outside the laboratory try to influence the views of laboratory personnel in any way; and whether you, i n turn, attempt to convince certain people about the importance of an issue. Have h o s p i t a l administrators influenced your b e l i e f s laboratory personnel? (Yes/No) (If  or those  of other  Yes) Could you give examples of this?  Have you j u s t i f i e d or explained a c t i v i t i e s recent months? (Yes/No) (If Yes) Could you expand on these — and what i t was about?  or decisions  to anyone i n  to whom your explanation was given  Do you find that you sometimes explain a d e c i s i o n / a c t i v i t y d i f f e r e n t l y from the way i t occured? (Yes/No) (If Yes)  a  little  Could you t e l l me about some such occasions?  Do you every find that people are unsure about how to interpret events — for example, don't know what to make of the f i r i n g of a s t a f f member they consider competent? (Yes/No) (If Yes) Could you t e l l me about some of these situations and what i f anything, you did about them? Have you t r i e d to influence b e l i e f s of people i n the Ministry of Health during your time as manager? (about your need f o r c a p i t a l equipment, f o r example) (Yes/No) (If Yes) How d i d you go about this? What were the results of your e f f o r t s ? What factors contributed to your success/failure? Do you have documented related to this which I could examine? Have Ministry of Health o f f i c i a l s others i n the lab? (Yes/No)  influenced your b e l i e f s  or those of  (If Yes) How did they do this and what was the issue? Have you ever t r i e d influencing b e l i e f s of doctors about what occurs i n the lab or what should be occurring? (e.g. need f o r computerization) (Yes/No) (If Yes) How d i d you do this?  /3/  How successful were your efforts? Is i t documented? TO LABORATORY MANAGER AT HOSPITAL B Have you ever attempted to influence the behaviour of the head of pathology at the u n i v e r s i t y i n any way? (Yes/No) (If Yes)  How did you do this?  What were the results? Is this documented?  (Yes/No)  Do you find that from time to time you expend energy support of people i n or outside on some issue? (Yes/No)  generating the  (If Yes) Could you give me examples of how you've gone about this? Could you t e l l me about the support you gained i n these attempts? Do you think you influence the importance people attach to c e r t a i n activities i n the lab (by, f o r example, emphasizing innovation)? (Yes/No) (If Yes)  How do you do t h i s ?  TO LABORATORY MANAGER AT HOSPITAL B Have the actions of the head of pathology at the university influenced your b e l i e f s or the b e l i e f s of others i n the lab? (Yes/No) (If Yes) How have they done so? Could you describe how you spend your time? (Further questions explored the extent to which managerial actions were aimed a t influencing substantive vs symbolic outcomes.) What do you hope to achieve during your time as manager here? What aspects of the job do you find rewarding? Which parts do you f i n d frustrating/annoying? What sorts of things would motivate you to stay here? What kinds of things would be reasons f o r you to leave? How would you describe the goals of this lab? To what extent does the lab have the power to achieve these goals? What have been your achievements to date? What would you do d i f f e r e n t l y i f you had your time here over?  Could you t e l l me about the way you, the associate d i r e c t o r and director work together? Do you have a common strategy, or approach, t o running the lab?  (Yes/No)  (If Yes) What i s this? (If No) How do your approaches d i f f e r ? Laboratory Director At Hospital B The research I am doing i s concerned with i d e n t i f y i n g to what extent laboratory a c t i v i t i e s are influenced by people i n the laboratory and to what extent by factors and people i n other parts of the hospital or outside the h o s p i t a l . The questions I'd l i k e to ask you r e l a t e to your influence on laboratory functions as well as the influence of external groups on these a c t i v i t i e s . This consent form states that you may withdraw from the study at any time and that your responses w i l l be completely c o n f i d e n t i a l . I s h a l l not repeat what you t e l l me to anyone, and r e s u l t s w i l l be presented i n such a way that i n d i v i d u a l i d e n t i t i e s w i l l be disguised. W i l l you f e e l comfortable i f I take notes while we talk? Do you influence the a c q u i s i t i o n of lab equipment? (Yes/No) (If Yes) Could you give me some examples of how you've gone about this and how successful you've been? Are you able to influence the size of the operating budget allocated to t h i s lab? (Yes/No) (If Yes) Could you give me some examples of the ways i n which you've done this and how successful you have been? Who i s responsible lab?  f o r appointments of professional personnel i n this  Which people have the greatest influence on these decisions? Who i s responsible f o r promoting professional personnel? What are the c r i t e r i a f o r promotion? Who i s responsible f o r firing/demoting professional personnel? What i s your power i n t h i s matter? Lab a c t i v i t i e s revolve around performing t e s t s . Are you able to influence the performance of tests? (Yes/No) (If Yes) What sorts of things are you able to influence?  How do you do this? How  successful are your attempts?  Does the method of payment of professional personnel (fee for service) influence the number of tests performed i n t h i s lab? Would you expand on that? Who was responsible for i n s t i t u t i n g the modified fee f o r service method of payment here? Are you s a t i s f i e d with the arrangement as i t is? (If Yes) (If No)  In what ways to you find i t satisfactory? In what ways i s i t unsatisfactory?  Have you attempted to change the arrangement? (If Yes)  (Yes/No)  (Yes/No)  What have been the results of your e f f o r t s ?  What factors determine the amount of research produced by d i v i s i o n heads and other professional s t a f f ? (Additional questions attempted to determine factors vs those under managerial control.) 51  power  of  external  We've talked about h i r i n g , f i r i n g , promotions, tests, acquiring equipment and the budget. Are there any other a c t i v i t i e s you are able to influence? (Yes/No) (If Yes)  52  the  Could you t e l l me what these are and how you influence them?  Could you describe how you spend your time? (Questions here were aimed at determining the percentage of time devoted to influencing tangible outcomes vs that devoted to a f f e c t i n g b e l i e f s and attitudes.)  S2  Your p o s i t i o n probably requires a considerable amount of decision making. In recent months, have you j u s t i f i e d or explained decisions to people i n this lab, or i n other labs and departments or t r i e d to influence people's views about any issues? (Yes/No) (If Yes) Could you describe some of the issues you've j u s t i f i e d or advocated, the people involved, how you've gone about doing this and how successful your e f f o r t s have been? Have you ever t r i e d to influence beliefs/views of people i n the Ministry of Health? (Yes/No) (If Yes)  How did you go about this?  What were the results of your efforts?  repeat what you t e l l me to anyone, and results w i l l be presented i n such a way that i n d i v i d u a l i d e n t i t i e s are disquised. W i l l i t be okay i f I use a tape recorder?  (Yes/No)  (If No) W i l l you f e e l comfortable i f I take notes while we talk? Can you think of any occasions i n which doctors influence you views about something? (Yes/No) (If Yes) Could you t e l l me about this? what the issue was and the outcome?  How  have  the doctor  attempted  approached  to you,  Have doctors' actions ever affected your feelings; f o r example, have they made demands which angered you? (Yes/No) (If Yes) Could you give me some examples of what happened, what was and the surrounding circumstances? Does the head technologist ever explain why person and not another? (Yes/No)  she has  said  hired a p a r t i c u l a r  (If Yes) Further questions i d e n t i f i e d the technologist's i n the lab. are under the control of lab. management and which are l a r g e l y influenced by people outside the lab. This consent form states that you may withdraw from the study at any time and that your responses w i l l be completely c o n f i d e n t i a l . I s h a l l not repeat what you say to anyone and results w i l l be presented i n a way that disguises i n d i v i d u a l i d e n t i t i e s . W i l l you f e e l comfortable i f I use a tape recorder? (If No)  (Yes/No)  W i l l i t be okay i f I take notes while we talk?  Can you b r i e f l y outline what your job e n t a i l s ? I'd l i k e , now,  to focus on acquiring c a p i t a l equipment.  What people or factors outside acquire? (If several are does  the  laboratory  l i s t e d , inquire regarding influence this?  influence equipment  each one  individually.)  Are you able to influence the a c q u i s i t i o n of equipment? (If Yes)  Can you give an example of how  you How  (Yes/No)  you have done this?  Could we talk about the operating budget now — about factors which or people who influence the size of the budget allocated to the lab? What people or factors influence the size of the supply to the lab? Are the lab d i r e c t o r and allocation? (Yes/No)  manager able  to  influence  budget allocated  the  size of  the  What factors contributed to your success/failure? Do you have documents related to this which I could examine? Have you ever attempted administrators? (Yes/No)  to  influence  the  beliefs  of  hospital  (If Yes) How d i d you go about this? What were the results of your e f f o r t s ? What factors contributed to your success/failure? S1  Are there groups or individuals, i n or outside the laboratory, who are d i s s a t i s f i e d with some aspect of laboratory operation? (Yes/No) (If Yes) Who dissatisfaction?  are these  people  Do you t r y to keep them s a t i s f i e d ?  and what  i s the nature  of  their  (Yes/No)  (If Yes) What do you do? Do you f i n d that from time to time you expend energy i n generating the support of people i n or outside the laboratory on some issue? (Yes/No) (If Yes) Could you give me examples of how you've gone about this? What support did you gain i n these attempts? Do you f e e l you influence the importance lab personnel attach to certain a c t i v i t i e s i n the lab; by, for example, emphasizing innovation? (Yes/No) (If Yes) How do you do this? S4a  How would you describe the goals of this lab? What do you hope to achieve during your time as d i r e c t o r here? What have been your achievements to date? What would you do d i f f e r e n t l y i f you had your time over? What aspects of the job do you f i n d rewarding? Which parts do you find frustrating? Head of Pathology at the University/ Laboratory Director a t Hospital A This research i s concerned with the extent to which lab a c t i v i t i e s are controlled by the people i n the lab and the extent to which they are . influenced by people outside the lab. This consent form states that you may withdraw from the study at any time and that your responses w i l l be completely c o n f i d e n t i a l . I s h a l l not repeat what you t e l l me to anyone else and results w i l l be presented i n such a way that individual  I2>C>  i d e n t i t i e s are disguised. W i l l you f e e l comfortable i f I take notes while we talk? I'd l i k e , f i r s t , to ask you about some of the v i s i b l e , measureable things that occur i n the lab, such as h i r i n g , and the performance of tests, e t c . The findings of your research on lab costs and u t i l i z a t i o n state that lab managers have l i t t l e control over these factors. Have you presented these findings to h o s p i t a l administrators? (Yes/No) (If Yes)  What was t h e i r reaction to the reports?  (Further questions were aimed at i d e n t i f y i n g the extent to which considered administrators' b e l i e f s had been changed.)  he  Which people make decisions about the appointment of d i v i s i o n heads i n teaching hospitals i n this province? Could you describe your suggesting appointments? Who  role  —  how  actively  you  participate  in  i s responsible for promoting professional personnel?  What are the c r i t e r i a for promotion? What factors determine the amount of research produced by d i v i s i o n heads and other professional s t a f f ? (Additional questions attempted to determine factors vs those under managerial control.)  the  power  of  external  Could you describe how you spend your time? (Further questions were aimed at determining the percentage of devoted to influencing substantive and symbolic outcomes.)  time  Do you f e e l you influence the importance lab. personnel attach to c e r t a i n a c t i v i t i e s i n the lab., by, for example, emphasizing research or innovation? (Yes/No) (If Yes)  How do you do this?  What sort of atmosphere do you t r y to promote? How would you describe the goals of this lab? What do you hope to achieve during your time as d i r e c t o r here?  Assistant Manager - Hospital A My research i s concerned with the factors and people influencing what happens i n a h o s p i t a l laboratory. The purpose of my questions i s to i d e n t i f y which a c t i v i t i e s outside the lab. I'd l i k e to talk to you about some of these issues.  /37  This consent form states that you may withdraw from the the study at any time and that your responses w i l l be completely c o n f i d e n t i a l . I w i l l not repeat what you t e l l me to anyone, and r e s u l t s w i l l be presented i n such a way that i n d i v i d u a l i d e n t i t i e s are disquised. W i l l i t be okay i f I use a tape recorder?  (Yes/No)  (If No) W i l l you f e e l comfortable i f I take notes while we talk? Can you think of any occasions i n which doctors influence you views about something? (Yes/No) (If Yes) Could you t e l l me about this? what the issue was and the outcome?  How  have  the doctor  attempted  approached  to you,  Have doctors' actions ever affected your feelings; for example, have they made demands which angered you? (Yes/No) (If Yes) Could you give me some examples of what happened, what was and the surrounding circumstances? Does the head technologist ever explain why person and not another? (Yes/No)  she  has  said  hired a p a r t i c u l a r  (If Yes) Further questions i d e n t i f i e d the technologist's i n the lab are under the control of lab. management and which are l a r g e l y influenced by people outside the lab. This consent form states that you may withdraw from the study at any time and that your responses w i l l be completely c o n f i d e n t i a l . I s h a l l not repeat what you say to anyone and r e s u l t s w i l l be presented i n a way that disguises i n d i v i d u a l i d e n t i t i e s . W i l l you f e e l comfortable i f I use a tape recorder? (If No)  (Yes/No)  W i l l i t be okay i f I take notes while we talk?  Can you b r i e f l y outline what your job entails? I'd l i k e , now, What people  to focus on acquiring c a p i t a l equipment. or  factors outside  the  laboratory  influence  equipment  you  acquire? (If several are does ^  l i s t e d , inquire regarding influence this?  each one  individually.)  Are you able to influence the a c q u i s i t i o n of equipment? (If Yes)  Can you give an example of how  How  (Yes/No)  you have done this?  Could we talk about the operating budget now — about factors which or people who influence the size of the budget allocated to the lab? What people or factors influence the size of the supply budget allocated to the lab?  Are the lab director allocation? (Yes/No) (If Yes)  How  and  manager able  to  influence  the  size  of  the  v  do they do this?  Are you able to influence the size of the supply budget allocated to t h i s lab? (Yes/No) (If Yes) Could you describe how you have influenced during your time as assistant manager here? What people or factors influence to the lab?  budget a l l o c a t i o n  the size of the salary budget allocated  Are the lab director and manager able to influence the a l l o c a t i o n process i n any way? (Yes/No) (If Yes)  How  do they do this?  Are you able to influence t h i s process? (If Yes) S2  Could you describe  how  (Yes/No)  you have done this?  You mentioned, i n the beginning, what your r e s p o n s i b i l i t i e s are. Can you t e l l me about the way you, the manager, director and associate director work together? (Further questions were aimed at i d e n t i f y i n g whether symbolic outcomes differ.) D i v i s i o n Heads I'm doing research on the extent to which lab a c t i v i t i e s are under the control of the director and manager and to what extent they are affected by people/events outside the lab. I'd l i k e to talk to you about some of these issues. This consent form states that you may withdraw from the study at any time and that your responses w i l l be completely c o n f i d e n t i a l . I s h a l l not repeat what you t e l l me to anyone and results w i l l be presented in such a way that i n d i v i d u a l i d e n t i t i e s are disguised. W i l l i t be okay i f I use a tape recorder? (If No)  S1  (Yes/No)  W i l l you f e e l comfortable i f I take notes while we  talk?  Are you able to a f f e c t the number or type of tests that get done? (If Yes)  What do you a f f e c t and how  What factors influence on quality control?  do you do this?  the amount of time s t a f f i n your d i v i s i o n spends  (Questions here w i l l be directed at determining the extent q u a l i t y control i s influenced by i n t e r n a l or external forces.) Do you spend any time on research?  (Yes/No)  to  which  What factors influence how much time you spend on research? S1  What people/organizations are responsible for the number of medical students and pathology residents you are responsible f o r teaching? Who  determines what you teach them (the content)?  Who  influences equipment a l l o c a t i o n to your d i v i s i o n ?  Does the person/people decisions? (Yes/No) (If Yes)  How  Who determines your division? How  making  the  allocations  justify/explain  do you react to these explanations? the size  of the operating budget which i s allocated to  are these decisions made?  Does the decision maker explain these allocations to your? (If Yes) S1  Who  their  (Yes/No)  How do you react to these explanations?  i s responsible for promoting professional personnel?  (Further questions explored the r e l a t i v e power of i n d i v i d u a l s i d e n t i f i e d , c r i t e r i a for promotion and how these had become established.) Do you have any contact with doctors regarding tests? (Yes/No) (If Yes)  What i s the nature of these contacts?  (Additional questions focused on determining whether physicians influenced this individual's beliefs/actions and whether he/she influenced physicians' beliefs/behaviour). 51 52  Could you say something your d i v i s i o n ?  about the impact of the director and manager on  (Further questions were directed at determining the impact director and manager on substantive and symbolic outcomes.) .  of  the  Medical S t a f f I'm doing research on the extent to which lab a c t i v i t i e s are under the control of lab management and to what extent they are affected by people/events outside the lab. I'd l i k e to talk to you about some of these issues. This consent form states that you may withdraw from the study at any time and that your responses w i l l be completely c o n f i d e n t i a l . I s h a l l not repeat what you t e l l me to anyone and results w i l l be presented i n such a way that i n d i v i d u a l i d e n t i t i e s are disguised. W i l l i t be okay i f I use a tape recorder? (If No)  (Yes/No)  W i l l you f e e l comfortable i f I take notes while we talk?  No  Do you have any contact with doctors regarding tests? (If Yes)  (Yes/No)  What i s the nature of these contacts.  (Additional questions focused on determining whether physicians influenced this individual's beliefs/actions and whether he/she influenced physicians' beliefs/behaviour.) Do you spend any time on research? What factors influence how much time you spend on research? Head Technologists I'm doing research on the extent to which lab a c t i v i t i e s are under the control of the director and manager and to what extent they are affected by people/events outside the lab. I'd l i k e to talk to you about some of these issues. This consent form states that you may withdraw from the study at any time and that your responses w i l l be completely c o n f i d e n t i a l . I w i l l not repeat what you say to anyone, and results w i l l be presented i n such a way that i n d i v i d u a l i d e n t i t i e s are disguised. W i l l i t be okay i f I use a tape recorder? (If No)  (Yes/No)  W i l l you f e e l comfortable i f I take notes while we talk?  Are you able to influence the performance of tests i n any way? (If Yes)  (Yes/No)  What do you a f f e c t and how do you do this?  Can you think of occasions i n which doctors have attempted to influence your views about something (for example, the importance of tests being done more quickly)? (Yes/No) (If Yes) Could you t e l l me about t h i s ; how the issues were and the outcomes?  doctors approached you, what  Can you r e c a l l any occasions i n which the behaviour of doctors affected your feelings; f o r example, demands that made you f e e l angry? (Yes/No) (If Yes)  How  often has this sort of thing happened?  Could you give some examples of what happened, what was surrounding circumstances?  said  and  the  I would l i k e , now, to ask you about the h i r i n g , f i r i n g and promotion of technologists and c l e r i c a l personnel. Could we s t a r t with technical personnel? In what way does the h i r i n g of technologists?  (technologists' union) influence the  What sort of power do you have to h i r e the person of your choice?  /V/  Have you found ways to work around union constraints? (Yes/No) (If Yes) What are personnel?  Could you give me examples of how you've done this? union  regulations  regarding  the  promotion  of  technical  What f l e x i b i l i t y / p o w e r do you have to promote the person of your choice? Have you found ways to work around union constraints? (Yes/No) (If Yes)  Could you give some examples of how you've done this?  What are union regulations about f i r i n g employees? What i s your power regarding this matter? Could we examine these same issues i n terms of c l e r i c a l personnel their union? (Questions re h i r i n g , with HEU and c l e r i c a l union respectively.) Approximately this lab?  promotion and f i r i n g of technologists repeated, s t a f f replacing technologists and technologists'  how many hours a week does  (the manager) spend i n  (Questions here were aimed at i d e n t i f y i n g whether actions i n d i v i d u a l a f f e c t the b e l i e f s and feelings of the interviewee.) How much time does  and  of  this  (the director) spend i n the lab?  (Questions here were aimed at determining whether this i n d i v i d u a l affects b e l i e f s and attitudes of the technologist.) Technologists I'm doing research on the extent to which lab a c t i v i t i e s are under the control of the director and manager and to what extent they are affected by factors and people outside the lab. I'd l i k e to talk to you about some of these issues. This consent form states that you may withdraw from the study at any time and that your responses w i l l be completely c o n f i d e n t i a l . I w i l l not repeat what you t e l l me to anyone, and results w i l l be presented in such a way that i n d i v i d u a l i d e n t i t i e s are disguised. W i l l i t be okay i f I use a tape recorder? (If No)  (Yes/No)  W i l l you f e e l comfortable i f I take notes while we talk?  Can you think of any occasions i n which doctors Influence your views about something? (Yes/No)  have  attempted  to  (If Yes) Could you t e l l me about this? what the issue was and the outcome?  How  the doctor  approached  you,  Have doctors' actions ever affected your feelings; for example, have they made demands which angered you? (Yes/No) (If Yes) Could you give me some examples of what happened, what was and the surrounding circumstances? Does the head technologist ever explain why person and not another? (Yes/No)  she  (If Yes) Further questions such explanations.  technologist's  identified  Does the head technologist explain promoted and not another? (Yes/No) (If Yes) Additional questions these explanations. S3  hired a p a r t i c u l a r  reactions  p a r t i c u l a r person  has  to  been  i d e n t i f i e d the technologist's reactions to accouncement about  explored emotional reactions to the announcement.)  Does any person or thing set the tone here? (Yes/No) (If  51 52  a  How did you react to ( p r o v i n c i a l premier's) recent curbing public sector wage increases? (Further questions  S1  why  the  has  said  Yes)  How  does he/she do i t ?  What sort of impact does (Further questions aimed substantive outcomes.) What e f f e c t does (Further questions aimed symbolic outcomes.) Hospital  ay  at  (the manager) have on i d e n t i f y i n g impact on  this division? symbolic and  (the director) have on this division? determining influence on substantive and  Administrators  My research i s concerned with factors influencing what happens i n laboratories. I'd l i k e to ask you about the ways i n which the decisions of administrators a f f e c t laboratory functions. This consent form states that you may withdraw from the study at any time and that your response w i l l be completely c o n f i d e n t i a l . I w i l l not repeat what you t e l l me to anyone, and results w i l l be presented in such a way that i n d i v i d u a l i d e n t i t i e s are disguised. W i l l you f e e l comfortable i f I take notes while we talk? S1  Can you outline the process departments i n this hospital?  by  which  equipment  is  allocated  to  my  (Further questions were aimed at determining the power of the Ministry of Health, h o s p i t a l administrators and department heads in r e l a t i o n to equipment a l l o c a t i o n . ) Has the lab director or manager ever t r i e d about equipment allocation? (Yes/No) (If Yes) were? How  Can you t e l l me  about  to influence your decisions  these attempts  i s the operating budget for each department  and how  successful  they  determined?  Has the lab director or manager ever attempted to convince you allocate a d d i t i o n a l sums to the lab f o r s t a f f or supplies? (Yes/No) (If Yes) efforts?  to  How did they go about this and what were the outcomes of their  Have the lab director or manager ever t r i e d to convince you about other issues (e.g. laboratory costs)? (Yes/No) (If Yes)  Could you t e l l me about this and what the outcome was?  Have you ever t r i e d to convince the laboratory director or manager of the importance/value of something — reducing costs, for example? (Yes/No) (If Yes) had?  Could you expand on t h i s , your approach  and what success you  (Additional questions here aimed at determining the extent to which, and how, the administrator affected b e l i e f s of the manager and/or director.)  Labour Relations Representative My research i s concerned with the extent to which laboratory a c t i v i t i e s are influenced by lab management and to what extent they are affected by factors outside the laboratory. I'd l i k e to ask you about the ways i n which the unions a f f e c t the h i r i n g , promotion and f i r i n g of technical and c l e r i c a l personnel. This consent form states that you may withdraw from the study at any time and that your responses w i l l be completely c o n f i d e n t i a l . I w i l l not repeat what you say to anyone, and results w i l l be presented in such a way that i n d i v i d u a l i d e n t i t i e s are disguised. W i l l i t be okay i f I tape record our conversation? (Yes/No) (If No)  W i l l you f e e l comfortable i f I take notes while we talk?  Perhaps i t would be best to discuss each union separately. Could we with the H.E.U. (Hospital Employees' Union)? What are H.E.U. regulations re hiring?  start  (Further questions were aimed at i d e n t i f y i n g laboratory management and the union.) Have there been any disputes about hirings? What are H.E.U. regulations re  the  relative  of  (Yes/No)  promotions?  (Additional questions focused on i d e n t i f y i n g union and laboratory management.)  the r e l a t i v e  Have there been any disputes about promotions?  (Yes/No)  (If Yes)  power  power of  the  What has been the nature of these disputes?  (Additional questions examined the manager's role i n the dispute.) What are H.E.U. regulations about f i r i n g c l e r i c a l staff? (Further questions to i d e n t i f y r e l a t i v e power of the union and laboratory management.) Have there been any disputes about f i r i n g s ? (If Yes)  Could you give some examples of this?  (Questions about h i r i n g , f i r i n g and promotions of c l e r i c a l personnel were repeated, i n s e r t i n g ' (the technologists' union) f o r H.E.U. and technologists for c l e r i c a l s t a f f . ) Person i n Charge of Training of Technologists i n Laboratory My research i s concerned with the extent to which lab a c t i v i t i e s are controlled by people i n the lab and the extent to which they are influenced by people outside the lab. This consent form states that you may withdraw from the study at any time and that your responses w i l l be completely c o n f i d e n t i a l . I s h a l l not repeat what you say to anyone else and results w i l l be presented i n such a way that i n d i v i d u a l i d e n t i t i e s are disguised. W i l l i t be okay i f I record our conversation? (Yes/No) (If No)  W i l l you f e e l comfortable i f I take notes while we  Who determines laboratory? Who  talk?  the number of medical technology students trained in this  determines what they are taught?  (Additional questions focused on the r e l a t i v e power of the external organization and laboratory personnel over curriculum, methods of teaching, etc.) Is the q u a l i t y of t r a i n i n g assessed/monitored?  (Yes/No)  (If Yes) Can you t e l l responsible f o r this?  me  about the power  of the  people/organization  Have people i n any of the external organizations you have talked about ever attempted to influence your b e l i e f s or those of anyone i n the lab? (Yes/No) (If Yes)  Can you t e l l me about these instances?  Does program?  (laboratory d i r e c t o r ) have any input (Yes/No)  (If Yes)  What i s the nature of this input?  into the t r a i n i n g  Mb  APPENDIX B ADMINISTRATIVE STRUCTURE OF LABORATORY A  Director Associate Director  Manager A s s i s t a n t Manager  r  Data Processing  Dept. Secretary  Pathology Stores  Divisions Nuclear Medicine Division Head  Haematology D i v i s i o n Head  Microbiology D i v i s i o n Head  Anatomical Pathology Division Head  Head Technologist  Head Tech  Head Tech  Hematology D i v i s i o n Head Head Tech  Immuno. Transplantation Medical Staff Head Tech  Clinical Chemistry Division Head Head Tech  ADMINISTRATIVE STRUCTURE OF LABORATORY B  Director Secretary  Manager  I  Dept. S e c r e t a r y  Divisions  Nuclear Medicine D i v i s i o n Head Head Tech  Haematology D i v i s i o n Head  Microbiology D i v i s i o n Head  I  Anatomical Clinical Chemistry Pathology D i v i s i o n Head D i v i s i o n Head  Head Tech Head Tech  Haematology Head Tech  Head Tech  

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0076971/manifest

Comment

Related Items