Open Collections

UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Hospital administration students’ orientation to professionalization Gray, Carol Anne 1977

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

Notice for Google Chrome users:
If you are having trouble viewing or searching the PDF with Google Chrome, please download it here instead.

Item Metadata

Download

Media
831-UBC_1977_A6_7 G73_9.pdf [ 5.54MB ]
Metadata
JSON: 831-1.0094016.json
JSON-LD: 831-1.0094016-ld.json
RDF/XML (Pretty): 831-1.0094016-rdf.xml
RDF/JSON: 831-1.0094016-rdf.json
Turtle: 831-1.0094016-turtle.txt
N-Triples: 831-1.0094016-rdf-ntriples.txt
Original Record: 831-1.0094016-source.json
Full Text
831-1.0094016-fulltext.txt
Citation
831-1.0094016.ris

Full Text

HOSPITAL ADMINISTRATION STUDENTS' ORIENTATION TO PROFESSIONALIZATION by CAROL ANNE GRAY Dip. P.&O.T., University of Toronto, 1957 -A THESIS SUBMITTED UN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN HEALTH SERVICES PLANNING i n THE FACULTY OF MEDICINE HEALTH CARE AND EPIDEMIOLOGY We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA A p r i l , 1977 (c) Carol Anne Gray, 1977 In presenting t h i s thesis i n p a r t i a l f u l f i l l m e n t of the requirements for an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y a v a i l a b l e for reference and study. I further agree that permission f o r extensive copying of t h i s thesis for s c h o l a r l y purposes may be granted by the Head of my department or his representative. I t i s understood that copying or p u b l i c a t i o n of t h i s thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission. The University of B r i t i s h Columbia Vancouver, Canada V6T 1W5 ABSTRACT The purpose of t h i s study was to examine students 1 attitudes towards the p r o f e s s i o n a l i z a t i o n of an occupation. Hypotheses tested the r e l a t i o n s h i p between exposure of Hospital Administration Students to edu-c a t i o n a l influences, and attitudes towards p r o f e s s i o n a l i z a t i o n of Hospital Administration as well as between i n d i v i d u a l , demographic, occu-pat i o n a l and organizational backgrounds of these students and t h e i r attitudes towards p r o f e s s i o n a l i z a t i o n of t h e i r occupation. In order to t e s t the s i x hypotheses data were c o l l e c t e d from two d i f f e r e n t classes of students enrolled i n the H.O.M. programme of the Canadian Hospital Association. One c l a s s had received a p r o f e s s i o n a l i z a -t i o n teaching exposure while the other cl a s s was unexposed to t h i s material at the time the study was conducted. The method of i n v e s t i g a t i o n focussed on association and c o r r e l a -t i o n analysis of students' demographic backgrounds on the one hand and a measure of p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n on the other. A p r o f e s s i o n a l -i z a t i o n index and several sub-indices were constructed based on factor a n a l y t i c procedures. Attitude to p r o f e s s i o n a l i z a t i o n was measured by questionnaire and composite analyses were undertaken to determine whether the two samples of students came from s i m i l a r populations; to generate dimensions of p r o f e s s i o n a l i z a t i o n ; to examine the teaching programme e f f e c t ; to ascertain whether diff e r e n c e s , other than the programme expos-ure, would be associated with differences i n o r i e n t a t i o n to p r o f e s s i o n a l -i z a t i o n ; and to t e s t the hypotheses regarding differences i n o r i e n t a t i o n for groups of students with s i m i l a r demographic c h a r a c t e r i s t i c s . The findings of t h i s study indicated a s i g n i f i c a n t p o s i t i v e r e l a -tionship between exposure to educational input on p r o f e s s i o n a l i z a t i o n and a student's o r i e n t a t i o n to p r o f e s s i o n a l i z a t i o n with regard to the occu-pation of Hospital Administration. Students exposed to educational input had a higher o v e r a l l o r i e n t a t i o n to p r o f e s s i o n a l i z a t i o n . Differences i n degree of o r i e n t a t i o n appear to r e l a t e s p e c i f i c a l l y to the Dimensions of Acceptance and Public Recognition; Work, Standards and Establishment of the Profession; and, U t i l i z i n g Professional Judgement and Sharing of Know-ledge. In addition, nurses and accountants, two sub-categories i n the sample, were found to d i f f e r s i g n i f i c a n t l y i n terms of one p r o f e s s i o n a l index dimension, Realism. Students with a nursing background had a higher p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n towards Standards and the Quality of the Body of Knowledge, the components of the dimension of Realism. This could i n d i c a t e that students with a nursing background wish to i d e n t i f y with a p r o f e s s i o n a l model for an occupation i n order to improve t h e i r own p r o f e s s i o n a l status. Implications of the study findings are discussed as to sample si z e and structure and i t s l i m i t a t i o n s and sponsorship by the Canadian Hospital Association. I t i s recommended that further research should be undertaken on the dimensions of p r o f e s s i o n a l i z a t i o n i n order that occupa-tions could then be provided with an easy index for assessing such a t t i -tudes of the members, of t h e i r organizations. They could then have c r i t e r i a f o r measuring what attitudes should be reshaped i n order to a l t e r the p r o f e s s i o n a l i z a t i o n process of the occupation. i i i TABLE OF CONTENTS Chapter Page 1.0 INTRODUCTION 1 1.1 Overview of P r o f e s s i o n a l i z a t i o n 3 1.1.1 Elements of P r o f e s s i o n a l i z a t i o n 5 1.1.2 Steps Involved i n P r o f e s s i o n a l i z a t i o n . . . 6 1.2 Hospital Administration 7 1.2.1 Professionalism vs. Managerialism as a Model 14 1.3 Attitudes 17 1.3.1 Changing Attitudes 17 1.4 Professional S o c i a l i z a t i o n 19 1.4.1 Attitudes on Professional S o c i a l i z a t i o n . . . 22 1.4.2 Relationships Between Pre- and Post-Academic Training Needs 24 1.4.3 Professional S o c i a l i z a t i o n i n Health Care Organizations . 25 1.5 Individual Motivational Aspects 27 1.5.1 Need Fulfilment and P r o f e s s i o n a l i z a t i o n Attitudes 28 1.5.2 Organizational Factors and Profession-a l i z a t i o n Attitudes 30 1.6 Summary 34 2.0 MODEL AND STUDY DESIGN 36 2.1 Theoretical Model 36 2.1.1 Scope of the Model 36 i v Chapter Page 2.2 Measures 36 2.2.1 Independent Variables and Study Population . . 36 2.2.2 Dependent Variables 38 2.2.3 Independent Variables Influenced by Need Fulfilment 38 2.3 The Study 39 2.4 Research Hypotheses 40 2.4.1 Discussion of the Hypotheses 42 3.0 METHODS AND PROCEDURES 47 3.1 Setting and Subjects 47 3.1.1 Canadian Hospital Association 47 3.1.2 Lesson 10 48 3.1.3 Study Sample 49 3.2 Data C o l l e c t i o n 51 3.3 The Measuring Devices 52 3.3.1 Influence of the Teaching Programme . . . . 52 3.3.1.1 P r o f e s s i o n a l i z a t i o n Themes . . . . 55 3.3.2 Educational and Occupational Variables . . . 60 3.3.3 Organization Structure . . . 61 4.0 ANALYSIS AND RESULTS , 65 4.1 S t a t i s t i c a l Procedures 65 4.2 S i m i l a r i t y of Samples 66 4.3 Dimensions of P r o f e s s i o n a l i z a t i o n 67 v Chapter Page 4.3.1 Restructuring Question 12 68 4.3.2 Decision Concerning Question 15 68 4.3.3 Factor Analysis 69 4.3.4 Assignment of P r o f e s s i o n a l i z a t i o n Dimensions . 71 4.4 Hypothesis Testing and Results 77 5.0 CONCLUSION 83 BIBLIOGRAPHY 87 Appendix A. O QUESTIONNAIRE DESIGN, CODING AND DISTRIBUTION 93 A . l Demographic Questionnaire . 94 A.2 P r o f e s s i o n a l i z a t i o n Questionnaire 96 A.3 Coding System U t i l i z e d 104 A. 4 Letters f o r D i s t r i b u t i o n 104 B. O CROSSTABULATION TABLES OF SECOND YEAR, FIRST YEAR . . . 113 B. l By Higher Education 114 B.2 By Degree Obtained through Education 114 B.3 By Level of P o s i t i o n Group within the Organization . 115 B.4 By Type of Organization Structure 115 C O QUESTION 12 116 C l Restructuring Question 12 117 D.O RESULTS OF HOTELLING1S T-SQUARE TESTS 119 v i Appendix Page D.l P r o f e s s i o n a l i z a t i o n Orientation of Students i n the Two Classes, 1975-76 and 1976-77 120 D.2 Dimension of Realism of Students with Nursing and Accounting Backgrounds 121 v i i LIST OF TABLES Table Page 3.1 D i s t r i b u t i o n of Individuals i n Each Sample on Demographic Variables 53 3.2 D i s t r i b u t i o n of Sample of the Organization Structure Relative to i t s Size 64 4.1 Population Chi-square Values 67 4.2 P r o f i l e of the Dimensions' Mean Scores 80 LIST OF FIGURES Figure Page 2.1 Study Relationships 37 v i i i HOSPITAL ADMINISTRATION STUDENTS' ORIENTATION TO PROFESSIONALIZATION i x 1.0 INTRODUCTION This thesis has been developed to examine students' a t t i t u d e s to-wards the p r o f e s s i o n a l i z a t i o n of an occupation. One area of concern, within the health f i e l d , which i s gaining more importance and requires research, i s the r e l a t i o n s h i p between i n d i v i d u a l , demographic, occupational and organizational backgrounds of students of Hospital Administration and t h e i r attitudes towards the p r o f e s s i o n a l i z a t i o n of the occupation of Hospital Administration. An unanswered question i s : do the demographic, occupational and organizational c h a r a c t e r i s t i c s influence students' a t t i -tudes towards p r o f e s s i o n a l i z a t i o n of t h e i r occupation. The chief reason for t h i s neglect may be due to the f a c t that Hospital Administration i s a r e l a t i v e l y new occupation and one whose importance, u n t i l recently, was not recognized by the p u b l i c , governments, the health care system and to some extent by the majority of Hospital Administrators. The Canadian Hospital Association (C.H.A.) at i t s Convention (June 1971) indicated that "During the past few decades and i n p a r t i c u l a r the l a s t ten years, the greatest impact of change on the health care Admin-i s t r a t o r has been the q u a l i t y and quantity of change i t s e l f . " There have been changes i n the health care d e l i v e r y system, an explosion of knowledge, emergence of new d i s c i p l i n e s , new categories of non-medical health person-nel and medical s p e c i a l i t i e s . The increased population has higher stan-dards of l i v i n g and l e v e l s of education, and patients have become accustomed to higher l e v e l s of service than ever before. There has also been a gradually changing emphasis on the long-run health needs of defined populations, rather than on the short-run maximization of i n s t i t u t i o n a l 1 2 objectives. Consequently, the health care Administrator's r e s p o n s i b i l i t y has increased enormously as health services increase i n q u a l i t y , quantity, complexity and cost. These "Many factors give increased v i s i b i l i t y of the Administrator to the c r i t i c a l eye of the p u b l i c " (C.H.A. 1971). The Administrator i s therefore exposed more than ever before to p u b l i c c r i t i -cism and has l i t t l e or no refuge within a p r o f e s s i o n a l association, i n an union, or as an anonymous s t a f f member i n an organization. In order to improve t h e i r image and p o s i t i o n they are challenged to acquire and demon-stra t e competence and to create a system that appeals to the health care industry and the p u b l i c . U n t i l very recently, research on p r o f e s s i o n a l i z a t i o n was l e f t to the occupational s o c i o l o g i s t s , l i k e Carr-Saunders and Wilson (1933, 1964). Wilensky (1962) and Vollmer and M i l l s (1966), whose major f o c i were on the stages of p r o f e s s i o n a l i z a t i o n within an occupation or within the ranking of occupations as to t h e i r p r o f e s s i o n a l status. Work has also been done on the choice of 'entry' of students into a p r o f e s s i o n a l educa-t i o n career system of medicine and nursing (Krause 1971, p. 115); and the ' s o c i a l i z a t i o n e f f e c t ' such as studies done by Becker et a l . (1961), on physicians i n medical school. To date, l i t t l e has been done that d i r e c t l y r e l a t e s to the p r o f e s s i o n a l t r a i n i n g f or Hospital Administrators. But, as indicated e a r l i e r , with the impact of change within the health f i e l d , there i s a need for research i n t h i s area. The study reported below attempts to examine whether v a r i a b l e s , p a r t i c u l a r l y i n d i v i d u a l v a r i a b l e s , act to influence a student's a t t i t u d e towards the p r o f e s s i o n a l i z a t i o n of h i s or her occupation (Hospital 3 Administration). A d d i t i o n a l questions r e l a t e to whether p a r t i c u l a r a t t r i -butes of i n d i v i d u a l s or organizational variables cause the student to respond to such educational experience i n d i f f e r e n t ways, or whether students are more greatly influenced by an educational exposure. Speci-f i c a l l y , the research questions addressed were as follows: 1) Do i n d i v i d u a l and organizational c h a r a c t e r i s t i c s r e l a t e to the student's attitudes towards p r o f e s s i o n a l i z a t i o n ? 2) Is there an i n t e r a c t i o n between the educational process and the i n d i v i d u a l and organizational c h a r a c t e r i s t i c s with the att i t u d e s towards p r o f e s s i o n a l i z a t i o n ? The l i t e r a t u r e within t h i s area has been researched so an under-standing of the study could be formulated. Coverage of the l i t e r a t u r e on the above has been divided into s i x sections. These sections cover an Overview of P r o f e s s i o n a l i z a t i o n ; Attitudes; Professional S o c i a l i z a t i o n ; Need Fulfilment and P r o f e s s i o n a l i z a t i o n Attitudes; and Organizational Factors and P r o f e s s i o n a l i z a t i o n A t t i t u d e s . 1.1 Overview of P r o f e s s i o n a l i z a t i o n "At l e a s t as early as 1907 arguments for the pr o f e s s i o n a l status of an occupation were presented i n the s o c i a l science l i t e r a t u r e " (Vollmer and M i l l s 1966, p. 34). Wilensky (1962) states that there are more than 30,000 occupa-tion s . He continues by saying that occupations seek pr o f e s s i o n a l status but only t h i r t y to f o r t y have acquired the same. Therefore occupations can be described i n terms of t h e i r p r o f e s s i o n a l c h a r a c t e r i s t i c s as they are placed somewhere on the continuum between the ideal-type 'profession' 4 at one end and a completely unorganized occupational category of a 'non-profession' at the other end. Vollmer and M i l l s (1966, p. 2) state that " P r o f e s s i o n a l i z a t i o n i s a process, then, that may a f f e c t any occupation to a greater or l e s s e r degree." According to Wilensky, the cl o s e r the occupation follows a given sequence of p r o f e s s i o n a l i z a t i o n steps, the more l i k e l y i t i s to be p r o f e s s i o n a l i z e d (Hall 1972, p. 48). Wilensky (1964) discusses professions and t h e i r emphasis on auton-omy, expertise and service i d e a l s . What i s more, members of an occupation tend to develop s o c i a l and c u l t u r a l mechanisms to protect or enhance t h e i r careers. Thus there i s a trend towards e s t a b l i s h i n g more formal occupational associations and more formalized codes of behaviour i n many diverse l i n e s of work. Vollmer and M i l l s (1966, p. 2) describe t h i s as a movement towards p r o f e s s i o n a l i z a t i o n . M i l l e r s o n (1964) and Weaver (1975) make the point that professions have to be o b j e c t i v e l y , and not only sub-j e c t i v e l y , recognized. Membership i n occupational associations endows the member with c e r t a i n a t t r i b u t e s and a t t i t u d e s . Through an association, j u r i s d i c t i o n or authority can begin to be exerted over a technical area by convincing the employer and p u b l i c that services cannot be provided adequately by outsiders and t h i s j u r i s d i c t i o n may become exclusive l a t e r . Legal d e f i -n i t i o n may be brought i n to protect the control of maintaining or ex-panding the p r a c t i c e of an occupation. Through various means profession-a l i z i n g groups w i l l take action to protect themselves, t h e i r status and t h e i r prerogatives. The association's standards and code of ethics controls i t s 5 members and determines t e c h n i c a l and e t h i c a l aspects as they apply to the occupation, and also the behavioural rules regulating r e l a t i o n s h i p s be-tween other members, c l i e n t s and unauthorized p r a c t i t i o n e r s . These stan-dards are usually more exacting than those that the layman would be w i l l i n g to accept. These features apply to the p r o f e s s i o n a l whether he i s self-employed or employed by an organization. The exclusiveness of p r o f e s s i o n a l groups, engaged i n personal service, i s b u i l t around learning ( t h e o r e t i c a l knowledge and p r a c t i c a l s k i l l ) and an e t h i c a l code. The l a t t e r d i f f e r e n t i a t e s them from occupa-tions generally. Carr-Saunders (1966, p. 4) indicates that the s p e c i a l i -zation a r i s i n g around the a p p l i c a t i o n of new s c i e n t i f i c knowledge and techniques of public administration and business organization and c o n t r o l , to perform some s k i l l e d service, has created the emergence of a new pro-fession ( i . e . , c i v i l s e r v i c e ) . Barker substantiates that a profession i s based upon knowledge and s k i l l . He states: The person i n a trade p r a c t i c e s h i s a r t by doing what he learned to do, although he improves his technique through p r a c t i c e . In a pro-fession, a person does what he did not learn to do by using h i s know-ledge to meet new s i t u a t i o n s and apply h i s a r t to these. A profes-s i o n a l i s c o n t i n u a l l y engaged i n making important but i n d i v i d u a l judgements that grow out of p r a c t i c a l experience and a s i g n i f i c a n t body of knowledge. (Barker 1966, p. 5) 1.1.1 Elements of P r o f e s s i o n a l i z a t i o n Greenwood (1966) summarizing Greenwood (1957) and Gross (1958), gives the elements of the p r o f e s s i o n a l i z a t i o n process of an occupation to be: 1) development of a systematic theory and a wide knowledge of a 6 sp e c i a l i z e d technique, acquired through a long period of t r a i n i n g , that requires a degree of personality involvement of the profes-s i o n a l to produce an unstandardized product; 2) s i g n i f i c a n c e of the occupational service to society producing authority which i s recognized by the c l i e n t s of the pr o f e s s i o n a l group; 3) broader community sanction and approval of t h i s authority; 4) sense of o b l i g a t i o n to one's a r t where there i s a code of ethics regulating the r e l a t i o n s of pro f e s s i o n a l persons with c l i e n t s and with colleagues; and 5) sense of a group i d e n t i t y culminating into a pro f e s s i o n a l culture sustained by a formal p r o f e s s i o n a l association. To the above B l a i n (1975, p. 2) and Wilensky (1962) emphasize: 6) service o r i e n t a t i o n p r e v a i l i n g over f i n a n c i a l o r i e n t a t i o n with devotion to the c l i e n t ' s i n t e r e s t guiding decisions when the two are i n c o n f l i c t . 1.1.2 Steps Involved i n P r o f e s s i o n a l i z a t i o n Caplow (1954> 1966) defines the steps of p r o f e s s i o n a l i z a t i o n as: 1) e s t a b l i s h a pr o f e s s i o n a l association, with d e f i n i t e membership c r i t e r i a designed to keep out the unqualified; 2) change the name, to reduce i d e n t i f i c a t i o n with the previous occu-pation's status, confirming a technological monopoly, and pro-v i d i n g a t i t l e which can be monopolized; 3) develop and promulgate a code of ethics which asserts the s o c i a l u t i l i t y of the occupation, set up a public welfare r a t i o n a l e , and 7 develop rules which serve as further c r i t e r i a to eliminate the unqual i f i e d and the unscrupulous; 4) agitate p o l i t i c a l l y to obtain the support of the pub l i c power for the maintenance of the new occupational b a r r i e r s ; and 5) create t r a i n i n g f a c i l i t i e s d i r e c t l y or i n d i r e c t l y c o n t r o l l e d by the p r o f e s s i o n a l society. To the above Wilensky (1962), and also H a l l (1972, p. 144) have introduced the i n i t i a l stage: 6) create a f u l l - t i m e occupation that i s a reaction to the needs i n the s o c i e t a l structure. However an occupation can go through a l l of these steps and s t i l l not be considered a profession u n t i l the c r i t i c a l v a r i a b l e of pu b l i c recognition has been achieved, giving the occupation f u l l p r o f e s s i o n a l status. Weaver (1975, p. 46) states, "Often when we speak of 'profession-a l i z a t i o n ' we are i m p l i c i t l y recognizing the e f f o r t s of pr o f e s s i o n a l associations, academic programs, and pres t i g i o u s i n d i v i d u a l s to e s t a b l i s h a given set of r o l e expectations as a u t h o r i t a t i v e for a p a r t i c u l a r occu-pat i o n a l group." Consequently t h i s leads to the f i n a l p r o f e s s i o n a l i z a t i o n step: 7) e s t a b l i s h status and recognition f o r the profession. 1 .2 Hospital Administration The emerging profession of Hospital Administration i s unlike other established professions because, in-Canada there are no mandatory ..academic credentials or p r o f e s s i o n a l c e r t i f i c a t i o n required of i t s members before they can engage i n t h i s occupational a c t i v i t y . "Indeed, i t i s a 8 commonly-voiced complaint among p r o v i n c i a l health a u t h o r i t i e s that there i s decided lack of management t a l e n t i n the health care system" (McLeish and Nightingale 1973, p. 18). Even within the f i e l d i t s e l f , there i s a d i v i s i o n as to the t i t l e which should be utilized—Manager, Hospital Administrator, or Health Service Executive—these are informal and undefined terms which are devel-oping some common usage. Generally the term Hospital Manager i s used to designate the p o s s i b l y l e s s e r q u a l i f i e d (in education and p o s i t i o n held) persons who b a s i c a l l y perform duties that are required f o r the day-to-day operation of the h o s p i t a l f a c i l i t y . H o spital Administrator, as a t i t l e , has p r o f e s s i o n a l connotations and i s often designated for only those who are i n the top echelon of the Hospital f i e l d . They deal p r i m a r i l y with h o s p i t a l boards and governments i n order to integrate and d i r e c t the functions and operations of the health f a c i l i t y as i t i s determined by these bodies. The Health Service Executive i s a name developed for members of the Canadian College of Health Service Executives (C.C.H.S.E.). I t includes those persons with senior managerial r e s p o n s i b i l i t i e s within the health care system throughout Canada whose duties involve planning and p o l i c y making. This concept e s s e n t i a l l y covers the following h o s p i t a l t i t l e s that were operationalized by McLeish and Nightingale (1973, p. 2) i n t h e i r study: " . . . Administrator, Executive Director; Associate Admin-i s t r a t o r , A s s i s t a n t Administrator, Assistant Executive Director; Medical Director, Director of Medical Services; and Director of Nursing." This t i t l e i s applied not only to people within h o s p i t a l s but also t o t h o s e who are i n the vague f i e l d of health. "There i s currently no consensus among 9 o f f i c i a l s surveyed as to the defini t ion of a health service executive (nor is there agreement among the professional associations, such as ACHA [American College of Hospital Administrators] and CCHSE, and among the directors of the master's programmes i n hospital health administration in Canada)" (McLeish and Nightingale 1973, p. 4). According to Brown (1970, p. 13), reviewing the American scene, "The position of hospital administrator has been f i l l e d by many types. Unt i l 30 years ago, the majority of hospital administrators were physi-cians or nurses. Many of the positions, part icularly in rural areas, were also f i l l e d by ex-used-car salesmen, retired ministers, or deposed p o l i t i c i a n s . " L i t t l e is known about what causes people to enter the f i e l d . In a study done by Weaver (1975) on the p r o f i l e of the professional Health Care Administrator in Cal i fornia , he found that few middle- and top-level administrators are without previous administrative experience. As almost one-half of those sampled had health care administration as their only career, this would suggest that there i s a good deal of ver t ica l mobility within the industry. Dolson et a l . (1966) found that in both Canada and the U.S.A. the average age of administrators was forty-six years. Austin and Strauss (1975, p. 53) state that "Careers in health administration follow no set pattern." Weaver (1975, p. 20) and Dolson (1967, pp. 100-105) found that in America women were employed as department heads in large non-profit hospitals, but they were nearly excluded from senior administrative posi -tions in large inst i tut ions . Dolson (1967, p. 100) states that "Although 10 women make up most of the work force i n ho s p i t a l s , only one out of f i v e administrators i s a woman and t y p i c a l l y she i s paid l e s s than a man.'1 Women also hold a les s e r p o s i t i o n , are older than male peers and only h a l f as many as the men have post-graduate degrees. Women are more l i k e l y to be found as administrators of smaller h o s p i t a l s . However, medium-sized h o s p i t a l s varied only a l i t t l e i n the d i s t r i b u t i o n between men and women. Although nuns have previously played an important administrative r o l e within the Catholic Hospital system, t h i s has now been changed as the church believes that acute h o s p i t a l care i s a pub l i c r e s p o n s i b i l i t y and should be funded and operated as such. Therefore the 'church' i s no longer required within the administration of t h i s f i e l d . North American graduate programmes i n h o s p i t a l administration came into being when the University of Chicago, one of the f i r s t pro-grammes, began to teach students i n 1934. In Canada there are presently seven u n i v e r s i t i e s involved i n the t r a i n i n g of hospit a l / h e a l t h adminis-t r a t o r s . "Five of these courses are post-graduate programs, of two years' duration. . . . The s i x t h u n i v e r s i t y involved sponsors a two-year correspondence program which i s not necessar i l y post-graduate" (Pickering 1972, p. 14). The University of Montreal has a three-^year undergraduate c r e d i t programme, i n French (McLeish and Nightingale 1973). The C.C.H.S.E. has had a Kellogg Foundation grant (since 1973) for the purpose of devel-oping baccalaureate programmes designed for a c c e s s i b i l i t y of the prac-t i c i n g health service manager. The Canadian Hospital Association also sponsors a correspondence programme that i s a v a i l a b l e to students who do not necess a r i l y have under-graduate t r a i n i n g , but who are working i n 11 administrative or supervisory positions within the health f i e l d . They are selected by being nominated by their hospital or agency to the pro-v i n c i a l screening board of the C . H . A . , which determines which candidates are accepted. Only a restricted number are taken in each year. Dolson et a l . (1966, p. 103) found then that 45 per cent of Canadian administrators had graduated from college, 22 per cent of these with advanced degrees, while another 13 per cent had some post-graduate work. When C . C . H . S . E . (1975) studied their 1975 membership they found 17 per cent of the members had graduate programmes in health administration, 23 per cent had under-graduate degrees, and 58 per cent had completed one correspondence programme in health administration (some of this group also held under-graduate degrees). "Output of graduates from these [university] programs is now suffic ient to provide administrators for most senior posts in hospitals in Canada" (Pickering 1972, p. 14). Pickering continues by stating that there i s a considerable demand for entrance into most university programmes and only graduates in specified f ie lds gain entrance. The trend is moving away from the medically-trained administrator. "Yet we cannot say, for example, that [in Canada] the professional qualifications of a hospital administrator are equal to, or greater than, his counterpart in industry" (McLeish and Nightingale 1973, p. 19). Hospital Administrators d i f f e r from managers in other f ie lds as they are not generally r isk takers with regard to their consumers, the management of their professional s taff , or the management and control of their i n -dustry. Although i t should not be overlooked that Hospital Administrators 12 are being placed into and f u l f i l i n g the r i s k - t a k i n g r o l e . 1 Managers at the lower l e v e l of the h o s p i t a l hierarchy are b a s i -c a l l y not r i s k takers but tend to be administrators. Often they have come by t h e i r p o s i t i o n s through promotion from a s t a f f p o s i t i o n i n a s p e c i f i c f i e l d . In order to gain s e c u r i t y and knowledge they often take the Hospital Organization and Management (H.O.M.) course and then t r y to r a t i f y t h e i r new p o s i t i o n by seeking membership i n a professional asso-c i a t i o n . One could question whether consciously or subconsciously they want to be perceived as being equal to the physicians with whom they com-pete so that they can at l e a s t obtain the same status. Within the health f i e l d , u nlike management i n other i n d u s t r i e s , Austin (1975, p. 145) indicates that h o s p i t a l administration has been viewed as a function of l e s s s i g n i f i c a n c e , and i n some ways subordinate to, the d i r e c t p r o v i s i o n of patient s e r v i c e s . When discussing E t z i o n i ' s typology, Schein (1965) states h o s p i t a l s have predominantly normative authority, where membership, status and i n t r i n s i c value rewards are u t i l i z e d to gain power and authority. Sheldon et a l . (1970, pp. 37-38) state "Hospitals are large, r e l a t i v e l y self-contained health care units; they have imbedded i n t h e i r several h i e r a r c h i e s an administrative func-t i o n which has undergone a p a r t i a l p r o f e s s i o n a l i z a t i o n . As i s usual, the p r o f e s s i o n a l i z a t i o n process (Vollmer and M i l l s 1966) has included an ''"Miner (1973, p. 81) says that unlike s c i e n t i s t s , managers often have to make decisions with i n s u f f i c i e n t or inadequate data. Managers are frequently faced with problems that cannot be answered with "I don't know." As they must act on the information accumulated i n the time a v a i l a b l e , decisions may have a large element of r i s k as there are no a l t e r n a t i v e s i f judgement cannot be deferred. 13 attempt to e s t a b l i s h a body of knowledge which would legitimate the hos-p i t a l administrator's status." In t h i s manner the administrator s t r i v e s to gain normative authority over h i s organization. "The non-physician h o s p i t a l administrator i s re f e r r e d to by many members of the medical profession as a 'lay' administrator. This i s par-t i c u l a r l y offensive to the trai n e d administrator who has met the c r i t e r i a generally established f o r professionals ( i . e . , attained a prescribed l e v e l of education, subscribes to a defined body of knowledge, upholds c e r t a i n e t h i c a l standards, promotes p r o f e s s i o n a l education, e t c . ) . In other words, the modern administrator considers himself a 'professional' i n the f i e l d of h o s p i t a l administration and a 'layman' i n the f i e l d of medicine" (Brown 1970, p. 14). Austin and Strauss (1975, p. 46) state that "Whether desirable value sets come with an i n d i v i d u a l when he enters health administration education or p r a c t i c e , or can be i n s t i l l e d by the educational system, i s not c l e a r . " E t z i o n i (1964) states that knowledge and c r e a t i v i t y are l a r g e l y i n d i v i d u a l a t t r i b u t e s that cannot be transferred to another person by an organizational decree. As the a p p l i c a t i o n of knowledge i s b a s i c a l l y an i n d i v i d u a l act the inherent managerial s k i l l s cannot be overlooked. But i t must be remembered that Drucker (1954) and Newman (1951) have shown t h a t management as a science can be taught, so that, no longer i s there only an argument that managers are 'just born.' Hospital Administrators, i n addition to formal education, pass on t h e i r s k i l l and value sets through example by trained p r a c t i t i o n e r s , to students i n educational pro-grammes. 14 P r o f e s s i o n a l i z a t i o n of Hospital Administration i s taking place. Some authors l i k e Letourneau (1969, p. 191) taking a subjective view state "Today h o s p i t a l administration i s recognized as a profession and takes i t s place t r u l y along side other esteemed, learned professions who are admired and respected by the p u b l i c . " 1.2.1 Professionalism vs. Managerialism as a Model Although t h i s t h e s i s i s dealing with p r o f e s s i o n a l i z a t i o n of Hospital Administration i t should be noted that Hospital Administrators have two or more models to choose from. Hospital Administrators are placed into a p o s i t i o n where they have to r e l a t e to the 'managerial' oriented Board, as well as the 'professionally' oriented s t a f f . This creates a great deal of uncertainty as to which model should be u t i l i z e d . Sloan (1966) discusses the r o l e of the administrator and h i s need to harness the two contrasting f a c t o r s — t h e s t r i c t l y business and the s t r i c t l y p r o f e s s i o n a l — i n the h o s p i t a l . The administrator, according to Blishen (1969, p. 74), sees the h o s p i t a l as having an i n s t i t u t i o n a l mission of i t s own. The adminis-t r a t o r i s able to undertake some of the things that doctors cannot do, e i t h e r as i n d i v i d u a l s or as a group, as i t i s not always c l e a r where h o s p i t a l care ends and medical care begins. Hospital Administrators want to become pr o f e s s i o n a l and use pro-fessionalism as t h e i r occupational model. At present they appear to be following t h e i r dominant reference group, the medical profession. This i s so they can i d e n t i f y with and become more acceptable to t h e i r i n t e r n a l working environment. Thus they then would be able to meet and become 15 part of the 'normative' pressures of the organization, as discussed by E t z i o n i (1964). This i s necessary i n order f o r Hospital Administrators to bridge the schism between the administrative and hotel services of a h o s p i t a l , and the treatment or curative functions of the h o s p i t a l . In Canada, as h o s p i t a l s are non-profit organizations, and do not handle a marketable commodity (not even h o s p i t a l insurance), they are unable to become independent from t h e i r support systems ( i . e . , govern-ments) . Therefore Hospital Administrators cannot obtain f u l l managerial con t r o l over t h e i r own i n s t i t u t i o n , or industry, and they are faced with f i n d i n g another means of gaining c o n t r o l . Thus they may assume that they can gain a stronger p o s i t i o n i f they adopt the p r o f e s s i o n a l model rather 2 than an i n d u s t r i a l administrative model. Through a p r o f e s s i o n a l model they can obtain s e c u r i t y , freedom, prestige and a corner of the market due to the monopoly that would be accorded to them by s o c i e t a l acceptance and l e g i s l a t i v e d e f i n i t i o n . Also by obtaining a high p r o f e s s i o n a l status they would be on more equal grounds with the medical profession who at present have a considerable free reign within the h o s p i t a l s e t t i n g . One could argue though, that t h i s d e c i s i o n i s behind the times as h o s p i t a l s are moving towards an administrative i n d u s t r i a l model. They are confronted with new pressures. Unions are increasing i n strength and moving towards p a r i t y with other i n d u s t r i e s as well as incorporating 2 H a l l (1967) found the following when he compared administrative with p r o f e s s i o n a l organizations. The administrative organizations were more bureaucratic than the p r o f e s s i o n a l organizations. They had a more pronounced hierarchy of authority, greater d i v i s i o n of labour, more em-phasis on rules and o r g a n i z a t i o n a l l y designed procedures and were more impersonal than p r o f e s s i o n a l organizations. 16 p r o f e s s i o n a l groups into t h e i r membership. Hospital Administrators are also being faced with more managerial pressures. They are becoming i n -volved i n systems pressures of e f f e c t i v e and e f f i c i e n t management methods, budgeting, s t a f f i n g and governmental involvement. In addition Hospital Administrators have gained more authority and con t r o l over the physicians within t h e i r i n s t i t u t i o n . Thus the r o l e of the administrator i s changing and requires more managerial s k i l l s and the development of a stronger more independent p o s i t i o n . Hospital Administrators' a c t i v i t i e s are thus moving towards an i n d u s t r i a l model, f a l l i n g somewhere between E t z i o n i ' s 'normative' model and the administrative model. Consequently one could question the d e s i r a b i l i t y of Hospital Administrators adopting the medical model when p o s s i b l y they should be seeking an i n d u s t r i a l independent p o s i t i o n . The structure of the health f i e l d i s very complex, so much so that very l i t t l e actual c o n t r o l remains at the h o s p i t a l administrator's l e v e l . No other industry i s faced with the same complexities. The r o l e of the Hospital Administrator i s such that he does not have f u l l c o n t r o l over h i s domain. This i s because there i s so much l e g a l d e f i n i t i o n which gives sanction to outside groups, etc., that influence or con t r o l h i s decisions. Hospital Administrators recognizing the erosion of t h e i r domain through r e g i o n a l i z a t i o n and governmental control r e a l i z e that they must now play an active part i n planning and p o l i c y aspects of t h e i r f i e l d . In order to have an impact upon t h i s endeavour they need to e s t a b l i s h t h e i r p r o f e s s i o n a l status so that they w i l l not be overlooked or down-trodden by some other occupational group. 17 1.3 Attitudes As t h i s study looks at the students' attitudes towards profession-a l i z a t i o n of t h e i r occupation, t h i s section of the paper reviews the def-i n i t i o n of at t i t u d e s and the changing of a t t i t u d e s . An a t t i t u d e may be defined as "A mental p o s i t i o n with regard to a f a c t or state, a f e e l i n g or emotion toward a f a c t or state; the p o s i t i o n of something i n r e l a t i o n to a frame of reference" (Merriam-Webster 1969). Bandura (1969, p. 597) c i t e s "An a t t i t u d e i s va r i o u s l y defined as a d i s -p o s i t i o n to behave favorably or unfavorably toward a given object (Brown, 1965); . . . an e f f e c t i v e evaluative response toward an object (Rosenberg, 1960); or an i m p l i c i t a n t i c i p a t o r y mediating response (Doob, 1947)." Bandura (1969) reports that according to most contemporary theories there i s a d r i v e to maintain consistency among b e l i e f s , f e e l i n g s and actions. Mackenzie (1971, p. 12) states that attitudes develop through t r a i n i n g and education with the student observing and thinking f o r himself. 1.3.1 Changing Attitudes There are three general approaches which can be employed, either s i n g l y or i n various combinations, to bring about attitu d e changes. Bandura (1969) c a l l s these three approaches: " b e l i e f - o r i e n t e d " through persuasive communication, "a f f e c t - o r i e n t e d , " and "behaviour-oriented." Only the f i r s t i s applicable to t h i s t h e s i s . I t attempts to modify people's attitudes by changing t h e i r b e l i e f s about the attitud e object through exposure to persuasive communication. " I t i s assumed that people can be induced to change t h e i r evaluations of an attitu d e object by pre-senting them with new information about i t s c h a r a c t e r i s t i c s " ,(p. 599) . 18 Most of the research generated by the informational or persuasive communication approach has been done by Cohen (1964); Hovland and Janis (1959); Hovland, Janis and Kelly (1953); and Rosenberg et a l . (1960). It has been constructed to isolate the situations under which a given commun-ication w i l l have i t s maximal effect upon the recipient 's attitude. "Studies of the. persons being influenced have generally been concerned with their personality characteristics, the level of their intelligence or sophistication, the nature of their pre-existing attitudes, and the strength of their commitment to a given position" (Bandura 1969, p. 599). Bandura states that the form and organization of persuasive arguments i n -volves such things as the optimal order of presenting weak and major arguments, the sequence of supporting and opposing arguments, the degree of explicitness of the stated conclusions, the amount of repetit ion, the affective properties of the contents, the degree of discrepancy between the subject's views and the ones advocated, and whether the influence programme rel ies upon a one-sided presentation or includes some consider-ation of counter arguments. "Taylor" speaks of the person's previous experiences, psycho-logical set, and functional fixedness which can create perceived con-straints on, or f a c i l i t a t i o n of future experiences. "An individual interacts with his environment by breaking i t down and organizing i t into meaningful patterns congruent with his own needs and psychological make-up" (Harvey et a l . 1961, p. 1). McKenzie (1965) says that an important part of the context of a person's behaviour is the "culture" of the society. This being the 19 background of laws, customs, conventions, values, ways of behaving and ways of thinking that are accepted and taken f o r granted i n a p a r t i c u l a r society. "These c u l t u r a l pressures constantly shape and determine needs, goals, perceptions, and meanings" (McKenzie 1965, p. 38). Sh u l l et a l . (1970) also speak of man's a f f i l i a t i v e tendency. The s o c i a l i z e d man i s dependent upon h i s s o c i a l environment due to cognition and communication. He i s influenced through education, i n d o c t r i n a t i o n , intimidation and s o c i a l t r a d e - o f f s . McKenzie (1965, p. 48) states that the behaviour of an i n d i v i d u a l i s c o n t r o l l e d not so much by his own reasoning power as by the pressure of the group. He c i t e s the s i t u a t i o n where an honours graduate of high i n t e l l i g e n c e took a job as a sem i - s k i l l e d operative i n a factory and within weeks had al t e r e d many of her atti t u d e s towards work such that they were in d i s t i n g u i s h a b l e from those of other operatives. The impor-tant point being that many of her atti t u d e s showed l i t t l e r e f l e c t i o n of her high i n t e l l i g e n c e and c r i t i c a l f a c u l t i e s . This, of course, does not deny that i n p a r t i c u l a r circumstances the contribution of i n t e l l i g e n c e , of education and q u a l i f i c a t i o n s may be c r u c i a l . 1.4 Professional S o c i a l i z a t i o n M i l l s (1966, p. 87) states that "Becoming a pro f e s s i o n a l i s a gradual p r o c e s s — i t doesn't happen a l l at once." There i s a gradualness of career decisions that must generate ambition that w i l l sustain a stu-dent through many years of preliminary t r a i n i n g . Of great importance i s the formal education where the occupational r o l e i s learned. Through an extended period of s o c i a l i z a t i o n a psychological and s o c i a l commitment 20 to a pro f e s s i o n a l career i s developed. Hence the pro f e s s i o n a l becomes "inner-directed." Through s e t t i n g educational standards the pro f e s s i o n a l association c r y s t a l i z e s the norms f or future p r o f e s s i o n a l s . A great deal has been written on the s o c i a l i z a t i o n process of a p r o f e s s i o n a l . The choice of applicants, the education and the internship or apprenticeship have a strong influence i n producing a pro f e s s i o n a l who f i t s the standard norm as prescribed by the profession. In general the longer and harder the s o c i a l i z a t i o n period, the more techniques, culture and deep att i t u d e s are learned. This produces a s i t u a t i o n where each profession has i t s l i m i t e d f i e l d , s p e c i a l environment and group psychology which are not JLikely to be comprehensible to the layman. Westby (1960) and others found that i n many occupations the pro-f e s s i o n a l commitment i s not s u f f i c i e n t to ensure a pleasant and orderly career development. Problems arose as forces within and without the occu-pation undermined the expectations of the i n d i v i d u a l . Beginners must f i r s t perceive the multiple expectations that characterize t h e i r r o l e s , and then acquire complex s k i l l s needed to match those expectations. They must learn the values of t h e i r profession so that they w i l l have moral decisiveness to f u l f i l t h e i r p r o f e s s i o n a l r o l e s i n the presence of others, perceive the evaluation of t h e i r performance and receive confirmation of t h e i r i d e n t i t y . The t r a i n i n g school thus plays a part i n the p r o f e s s i o n a l s o c i a l i z a t i o n of i t s students transform-ing the layman i n t o a self-assured member of the pro f e s s i o n a l "culture." Hughes' th e s i s (1958) substantiates that p r o f e s s i o n a l education involves 21 the replacement of stereotyped images by more subtle, complex and even ambiguous perceptions of the pr o f e s s i o n a l r o l e . Professional thoughts may be i n t e r n a l i z e d more s i g n i f i c a n t l y a f t e r the student graduates as demonstrated by L o r t i e (1966) i n h i s discussion of a study of law stu-dents. H a l l (1972, p. 160) found that the s t r u c t u r a l and the a t t i t u d i n a l aspects of p r o f e s s i o n a l i z a t i o n do not necessa r i l y vary together. Some "established" professions have weakly developed p r o f e s s i o n a l attitudes when compared to some of the les s p r o f e s s i o n a l i z e d groups. The strength of the attitudes i s dependent upon the kind of s o c i a l i z a t i o n which has taken place i n the pr o f e s s i o n a l t r a i n i n g programme, i n the work i t s e l f and the place of the occupation. He found that when an occupation re-ceived r e l a t i v e l y few material rewards, the l e v e l of dedication was usually higher. Also, i f an occupation was allowed to be s e l f - r e g u l a t i n g , i t tended to believe quite strongly i n self-governance. The work s e t t i n g can also act as a s o c i a l i z e s Organizations develop formal norms and through these the employees are influenced to comply. This process leads to i n t e r n a l i z e d behaviours. Vollmer and M i l l s (1966, p. 2) indi c a t e that when people move from job to job, "Whatever s k i l l s or knowledge they have acquired i n one job, they carry to the next." But Whyte (1956) has shown that the s e t t i n g and the organization can subjugate the occupation, as i t has done with most non-academic sc i e n -t i s t s . Conversely Glaser (1964) shows the occupation, e.g., c h i e f physi-cians, may r u l e the s e t t i n g i n the name of t h e i r profession. Krause (1971, p. 52) states that "Settings have t h e i r own informal 22 rules which do not exactly correspond with the occupational ideologies of the settings 1 members, in part because of the need for working out ad hoc compromises between different occupational groups in a setting, in part as a way of coping with a lack of any overt structure." 1.4.1 Attitudes on Professional Socialization McLeish and Nightingale (1973, p. 14) say that l i t t l e i s known about what causes people to enter the f i e l d of Hospital Administration. But i t i s f e l t that to f i l l the future needs individuals w i l l come more and more from a variety of d i s c i p l i n e s . The selection procedure also has implications. In selecting administrators i t i s d i f f i c u l t to discover accurately and objectively the characteristics and a b i l i t i e s that are actually needed by people to produce effective performance on the job. As mentioned the C.H.A. selects people already working within the health f i e l d for the H.O.M. programme. It i s interesting to note the contrast in educational exposure between dentistry and hospital administration. Dentistry has "captive" students who are given relat ively long high educational exposure as com-pared to the C.H.A. students who are "non-captive" and given low exposure. More and Kohn (1960) describe certain subjective factors that induce individuals into dentistry. Their findings indicate that as in other high status but less professionalized occupations, individuals are apparently motivated to enter dentistry in part because of i t s general social prestige, i t s f inancial rewards and i t s opportunities for human service and, probably in contrast to many less professionalized occupa-tions, by the independence i t offers in relation to managerial control. 23 In this study the need for autonomy is the most decisive. Krause (1971, p. 115) says according to Sherlock and Cohen (1966) dentistry was an example of a "second-choice" medical career, with medicine not being chosen due to i t s longer training period, greater expense and s t i f f e r enrolment competition. Hughes (1966) states that in North America people are class se l f -conscious and seek social advancement in two manners. The f i r s t i s i n -d i v i d u a l ; a person w i l l try to get into an occupation of high prestige, or to achieve special success in his occupation. The second is collective,-the effort of an organized occupation to improve i t s place and to increase i t s power, in relation to others. This leads us to examine in more detai l the ways in which groups of people use professionalization as a means to contribute to their social mobility. Krause (1971) found that for nursing the recruitment pattern varied for the type of programme. The hospital-based programmes tended to recruit from the lower middle-class; whereas college programmes re-cruited from the middle- and upper-class. He found that these patterns are central to the question of career commitment. The college programmes aim to create "nursing administrators" and stress social science jargon, whilst the hospital-based programmes are more pract ical ly oriented. Within the hospital setting the hospital-trained nurses appear to be able to stand the stress and strain , the long hours, and the frustrations better than the college nurses, who appear to have higher rates of drop-out from the profession. 24 1.4.2 Relationship Between Pre- and Post-Academic Training Attitudes  Attitudes are not formed i n i s o l a t i o n but are d i f f e r e n t l y i n f l u -enced by a host of e x t r i n s i c and i n t r i n s i c f a c t o r s . However, educational programmes have to be based on a common ground. Therefore, a c e r t a i n l e v e l of background experience w i l l be assumed so that students can com-prehend and benefit from knowledge and concepts being taught. White (1972, p. 5) developed d i s t i n c t conclusions from h i s inves-t i g a t i o n into the effectiveness of various management t r a i n i n g s t r a t e g i e s , developed by the Faculty of Health Service Management at the University of Missouri. He was t r y i n g to i d e n t i f y learning methods appropriate to the capacity of students who were mainly i n t h e i r t h i r t i e s , f o r t i e s , and f i f t i e s , many years out of school, not p a r t i c u l a r l y good at conceptualiz-ing, or even at systematic reading or concentrated l i s t e n i n g to unfamiliar material. But he found that "What they do have, c o l l e c t i v e l y , i s an enormous amount of experience of endeavoring to 'manage' within health organisations and that c o l l e c t i v e experience already possessed by the wide v a r i e t y of health professions represented on the course i s i t s e l f the most important teaching resource a v a i l a b l e to the i n s t r u c t o r " (White 1972, p. 8). I t was found that management courses are only l i k e l y to improve the q u a l i t y of management within the h o s p i t a l s i f : a) there is emphasis on the use of specific skills rather than on the mere acquisition of knowledge (retention of which is in any case very limited in the absence of reinforcement); b) lectures are acceptable to the health care audience and, if reliance is placed on technical college staff, teaching is based on health situations to which participants can readily relate rather than on "industrial" models; c) the organisation which nominates participants understand the 25 objectives of the courses and put value on the development of competence by their nominees such that they will expect them to demonstrate their improved ability on return to the job and will create opportunities for them to do so, in conscious reinforce-ment and follow-up of the course learning. (White 1972, pp. 6-7) He also found that teaching by face-to-face contact over an extended period offered the best learning opportunities. And for t h i s age group emphasis should be placed on participative learning such as the p r a c t i c a l exercise, r o l e - p l a y i n g , videotape recording, demonstration and group problem solving assignments. "Tutored project work on the job and prac-t i c a l assignments ins i d e an organisation were thus i d e n t i f i e d as the type of teaching method most l i k e l y to f a c i l i t a t e a permanent increment of managerial effectiveness. Purposeful a c t i v i t y of t h i s kind serves both to r e i n f o r c e external learning (by re q u i r i n g the a p p l i c a t i o n of new s k i l l s , knowledge and attitudes on the job) and to promote i n t e r e s t s of the host organisation, which must be committed to the learning objectives and to t h e i r successful accomplishment" (White 1972, p. 8). 1.4.3 Professional S o c i a l i z a t i o n i n Health Care Organizations  In a h o s p i t a l there i s an i n t e r a c t i o n of people of d i f f e r e n t sub-cultures as indicated by McKenzie (1965, p. 40). Doctors are trained to stand on t h e i r own two feet, to be i n d i v i d u a l i s t i c , i f not competitive. Yet, s t i l l they are bonded together by common t r a i n i n g , exclusive secre-t i v e and powerful p r o f e s s i o n a l membership and by the status accorded them by society. Nurses, another group of 'people apart,' have threads of r e l i g i o n i n t h e i r sub-culture from the hospice run by female r e l i g i o u s orders. 26 This i s echoed by H a l l ' s (1972, p. 151) findings that the b e l i e f i n ser-vice to the p u b l i c and a sense of c a l l i n g to the f i e l d , a t t i t u d e s which are r e l a t e d to a sense of dedication to the profession, emerge as strongly developed p r o f e s s i o n a l i z e d i n the nursing profession. The p o s i t i o n of the Hospital Administrator i s quite an ambiguous one. He models on the service professions, medicine i n p a r t i c u l a r , but t h i s may not be a s a t i s f a c t o r y model. Administrators are s t r i v i n g f or public recognition and are entertaining the thoughts of licensure through which at l e a s t o f f i c i a l recognition i s acquired. In the United States the S o c i a l Security Amendment of 1967 re-quired the states to enact nursing home administrator l i c e n s i n g laws by 1 July 1970 (Somers 1969, p. 80) i n order to q u a l i f y for Medicare p a r t i -c i p a t i o n . But there i s no such requirement for Hospital Administrators as the United States does not have an un i v e r s a l governmental h o s p i t a l / health plan, and h o s p i t a l s f a l l under a l l types of ownership and j u r i s d i c -t i o n . In Canada there are no licensure requirements for e i t h e r adminis-t r a t i v e ..group . A true p r o f e s s i o n a l i s not an employee but instead he negotiates p r i v i l e g e s set out i n by-laws which he abides by and may be dismissed from, whereas Hospital Administrators are employees and are dependent upon the Hospital Board for a job i n which the Board has the r i g h t over h i r i n g and f i r i n g . Also t h e i r r o l e and function i s determined by the Board, and the Board's expectations may not even be set out i n a good job d e s c r i p t i o n , and thus i n turn may i n t e r f e r e with the professional's job. This r e l a t i o n s h i p constrains the Hospital Administrators' struggle for professionalism. 27 Possibly by belonging to. the Canadian College of Health Service Executives, Hospital Administrators can convince Trustees that they are p r o f e s s i o n a l l y competent. Hospital Administrators are seeking more pro-f e s s i o n a l d e f i n i t i o n through professional or educational standing, and there are i n d i c a t i o n s that they are beginning to negotiate work contracts. But mainly they are seeking s e c u r i t y . Licensure provides exclusiveness over the use of the t i t l e and gives the profession a monopoly which i s said to be i n the p u b l i c ' s i n t e r e s t . The c o n t r o l over entry into the profession, the q u a l i t y and quantity of t h e i r education as well as the c o n t r o l over p r o f e s s i o n a l standards are important by-products. "Further, since the work of a pro-fession involves an e s s e n t i a l service which no one else can perform, no one else can claim the r i g h t to t e l l the members of the profession how to do i t or even how i t should be evaluated. Consequently, professionals a t t a i n great autonomy and power" (Somers 1969, p. 80). But the p r o f e s s i o n a l model may do a d i s s e r v i c e as stated by Brown (1969). Licensure does not discourage p r o f e s s i o n a l and educational obsolescence but may provide l e g a l and p r o f e s s i o n a l r e s p e c t i b i l i t y which can serve to deceive the p u b l i c , and mask incompetence. The rules and regulations are often b a r r i e r s to new approaches and use of health pro-f e s s i o n a l s even for the sake of increased p r o d u c t i v i t y . Also licensure may hamper the mobility of p r a c t i t i o n e r s i n t h e i r career development. 1.5 Individual Motivational Aspects I t i s contended that there are other factors which motivate or formulate people's a t t i t u d e s . This section w i l l look at c e r t a i n aspects 28 that can contribute towards i n d i v i d u a l 1 s a t t i t u d e s . 1.5.1 Need Fulfilment and P r o f e s s i o n a l -i z a t i o n Attitudes • Maslow (1970) argues that needs are e x i s t i n g i n and i n t r i n s i c to human nature. He has i d e n t i f i e d sets of needs and ordered them as to t h e i r prepotency, i n the sense that a p a r t i c u l a r need has to be at l e a s t p a r t i a l l y s a t i s f i e d before the next category of needs, i n the prepotency hierarchy, emerges and has a stronger influence. A d e s c r i p t i o n of the f i r s t f i v e needs, as discussed by Maslow, follows: 1) Physiological Needs—These needs serve to sustain l i f e and are undoubtedly the most prepotent of a l l needs. 2) Safety Needs—Safety, or s e c u r i t y needs, are required for per-sonal safety, basic s a t i s f a c t i o n , understandable and predictable s i t u a t i o n s and for c e r t a i n t y about the future. For most people i n i n d u s t r i a l s o c i e t i e s these needs are believed to be well s a t i s -f i e d . In such s o c i e t i e s safety needs are only expressed i n such phenomena as, a preference for job tenure and protection, mone-tary s e c u r i t y , and for various kinds of insurance schemes. A broader aspect, though, i s demonstrated i n the common preference for seeking f a m i l i a r rather than unfamiliar things or the known rather than the unknown. 3) Belongingness and Love Needs—Next emerges the need of love and belonging. Here the i n d i v i d u a l deserves and s t r i v e s for a f f e c -tionate r e l a t i o n s h i p s and for a place i n h i s peer group. 4) Esteem Needs—All people i n our society (with a few p a t h o l o g i c a l 29 exceptions) have a need or desire for a stable, f i r m l y based, usually high s e l f - e v a l u a t i o n of s e l f - r e s p e c t , and for the esteem of others. Most i n d i v i d u a l s never progress beyond functioning p r i m a r i l y at the l e v e l of s o c i a l or the esteem needs. 5) Self-Actualization Needs—These are the growth needs. They r e f e r to the desire of becoming more and more what one i s , or that which one i s capable of becoming. The needs for s e l f - a c t u a l i z a t i o n may be seen to operate to a c e r t a i n extent as the desire to do a good job, to be cr e a t i v e or to use whatever c a p a c i t i e s one has. Maslow's theory of need hierarchy has been widely accepted i n the l i t e r a t u r e of organizational behaviour. However, the theory has not been used to explain differences i n psychological attitudes towards profession-a l i z a t i o n of an occupation. In the present research study, an attempt has been made to use need hierarchy theory to p r e d i c t i n d i v i d u a l s ' attitudes towards profes-s i o n a l i z a t i o n of an occupation. Maslow's theories have many areas of a p p l i c a t i o n . Clark (1965) discusses the problem of educational q u a l i f i c a t i o n s . He states: One q u a l i f i e s for work through education, and the threshold of q u a l i -f i c a t i o n constantly r i s e s as the bottom of the occupational structure shrinks (decrease i n u n s k i l l e d jobs), the middle i s upgraded i n s k i l l s , and the top (professional and technical) expands r a p i d l y . . . . This pressure, already greatly expanded since 1945, i s i n t e n s i -f i e d by the emerging task of keeping men q u a l i f i e d to work through repreparation, as a r a p i d l y changing technology makes obsolescent o l d s k i l l s and jobs and new demands on competence. (pp. 225-26) This process places demands that may cause the i n d i v i d u a l s to seek ways to s a t i s f y t h e i r Safety Needs, as defined by Maslow, as t h e i r s ecurity i s threatened. Thus one might hypothesize that those who have le s s e r 30 educational q u a l i f i c a t i o n s would respond at the l e v e l of t h e i r safety needs. Fulfilment of the safety needs would also be sought by those who are i n lower socio-economic occupations. People who are secure i n a high status occupation, may seek to f u l f i l Esteem or S e l f - A c t u a l i z a t i o n Needs. They may attempt to do t h i s through the further p r o f e s s i o n a l i z a t i o n of t h e i r occupation or by involvement within a broader as s o c i a t i o n , i . e . , a c t i v i t y within a p r o f e s s i o n a l a s s o c i a t i o n . Maslow's theory could thus be used to explain differences between student's attitudes towards p r o f e s s i o n a l i z a t i o n of t h e i r occupation. 1.5.2 Organizational Factors and Professional Attitudes Two organizational f a c t o r s — s i z e and structure of the organization —may a f f e c t the degree of need for p r o f e s s i o n a l i z a t i o n of an occupation. I t i s to be argued that the larger the s i z e of the organization inversely a f f e c t s attitudes towards p r o f e s s i o n a l i z a t i o n as H a l l (1972, p. 159) says that increased bureaucratization threatens p r o f e s s i o n a l autonomy. A small-size organization represents a r e l a t i v e l y simple system compared with the l a r g e - s i z e organization. The small organizations have fewer people, fewer l e v e l s i n the organization hierarchy and less sub-d i v i s i o n of labour (Worthy 1950). An organization p r i m a r i l y operates through a personal r e l a t i o n s h i p of i t s members and only secondarily through impersonal, i n s t i t u t i o n a l i z e d r e l a t i o n s h i p s . As the s i z e of the organiza-t i o n increases, there tends to be at the lower h i e r a r c h i c a l l e v e l s an increasing amount of r e l i a n c e upon impersonal bureaucratic forms of c o n t r o l 31 (Indik 1963). Therefore, one might hypothesize or argue that i n a large organization structure the r e l i a n c e on bureaucratic, i n f l e x i b l e controls over workers' behaviour creates a work environment i n which i t i s d i f f i -c u l t f or workers to incorporate a t t i t u d e s of t h e i r occupation towards p r o f e s s i o n a l i z a t i o n . H a l l (1972, p. 151) says that " . . . professionals working i n large organizations are not, by d e f i n i t i o n , confronted with s i t u a t i o n s which reduce the l e v e l of p r o f e s s i o n a l i z a t i o n . " Thus i t would appear that a t t i t u d i n a l v a r i a t i o n s should probably be a t t r i b u t e d to the organiz-a t i o n a l "climate" i n which they work. Parsons (1956) expresses s i m i l a r views saying that i n the conduct of an organization there are rules or norms which govern conduct independently of any p a r t i c u l a r organization membership. "They are u n i v e r s a l i s t i c a l l y defined for the society as a whole or f o r transorganizational sectors of the society's structure" (p. 84). The e s s e n t i a l point i s that the conduct of an organization must .. generally conform with the norms of "good conduct" as recognized and i n s t i t u t i o n a l i z e d by society. Katz and Kahn (1966, p. 201) report that members of formal organizations respond to v i s i b l e environmental pres-sures and are often motivated by shared values. They stress that the dominant s o l u t i o n to achieve r e l i a b l e performance or lawfulness i s f o r organizations to promulgate and enforce rules of conduct. But there i s a contention that organization s i z e a f f e c t s workers' a t t i t u d e s . Durkheim (1960, p. 267) stated that small industry displays r e l a t i v e harmony between worker and employer which i s not n e c e s s a r i l y present i n large-scale industry where with more points of contact they 32 are exposed to c o n f l i c t . In the nineteen-fift ies investigators started to examine the relationship between organization size and workers' a t t i -tudes. Most empirical studies have made comparisons across different sized sub-units of larger organizations rather than across independent total organizations. These studies show a remarkable consistency in their findings. Evidence shown by Kerr et a l . (1951); Worthy (1950); Indik and Seashore (1961); Katzell et a l . (1961); and Cummings and ElSlami (1970) tend to support the negative consequences of increased organization size on workers' job attitudes. This would lead to the question concerning organization size and i t s effect on attitudes towards professionalization. Hall (1972, p. 160) says that "The organizations in which profes-sionals work vary rather widely in their degree of bureaucratization. . . . There i s , however, a general tendency for the autonomous profes-sional organization to be less bureaucratic than either the heteronomous organization or the professional department. This suggests that the nature of the organizational groups in an organization affects the organ-izational structure. The workers (professionals) import standards into the organization to which the organization must adjust." To this Austin (1975, p. 139) adds that professionals identify more closely with profes-sional goals than organization or sub-system goals. Austin (1975, p. 138) proclaims that the health and medical care industry is the most highly professionalized industry. Hall (1972) states that there is generally an inverse relat ion-ship between the levels of bureaucratization and professionalization, except for technical competence. Autonomy, as a professional attribute, 33 has the strongest inverse r e l a t i o n s h i p . To prevent c o n f l i c t , profession-a l i z a t i o n may require a c e r t a i n l e v e l of bureaucratization i n order to maintain s o c i a l c o n t r o l . "Too l i t t l e bureaucratization may lead to too many undefined operational areas i f the profession i t s e l f has not devel-oped operational standards for these areas" (Hall 1972, p. 161). In turn, a more bureaucratic system f or les s p r o f e s s i o n a l i z e d groups may act as an i n h i b i t o r to t h e i r further p r o f e s s i o n a l i z a t i o n . Gibson et a l . (1973) r e f e r to an organization structure as being the r e l a t i v e l y f i xed r e l a t i o n s h i p that e x i s t s among the employees of an organization. L i t e r a t u r e i d e n t i f i e s two types of organization s t r u c t u r e — t a l l and f l a t . The d i s t i n c t i o n between these two i s based on the number of l e v e l s i n the organization r e l a t i v e to the t o t a l s i z e of the organiza-t i o n . A f l a t organization structure has few l e v e l s r e l a t i v e to the t o t a l s i z e of the organization while a t a l l organization structure has many le v e l s r e l a t i v e to the t o t a l s i z e . The degree to which a structure i s t a l l , or f l a t i s therefore determined by the average span of c o n t r o l within the organization. F l a t organizations, therefore, have a large average span of c o n t r o l . In a f l a t organization subordinates usually enjoy greater freedom and autonomy to make decisions about t h e i r work a c t i v i t i e s . In such a s i t u a t i o n , pro-f e s s i o n a l groups would also be allowed to enjoy more freedom to introduce t h e i r 'sub-culture.' With the degree of bureaucratization occurring within the health system, one could question whether the organization structure within a ho s p i t a l would have any e f f e c t on the p r o f e s s i o n a l i z a t i o n attitudes of 34 i t s employees. Canada i s d r i f t i n g into a national health system where a l l levels of government are becoming concerned. This has the consequence of the development of regionalization. Although progress in the ef f i c ient development of organization of services i s slow and f u l l of p o l i t i c a l and personal stumbling blocks, Pickering (1972, p. 15) s t i l l feels regionaliz-ation by provincial governments is imminently expected. Already there i s a considerable impact upon the hospital systems where budgets, programmes, number of personnel, building and equipping, and standards are regulated by the provincial governments through their f inancial and legal control. Consequently, the hospital industry i s not l e f t solely to the prerogatives of i t s managers but i t i s under surveillance of the public authority. Keeping these bureaucratic or standardization tendencies in mind, one should then question i f the health organizations (size and structure), in which the students are employed, have an impact on professionalization attitudes. Consequently, this thesis examines the organization struc-tures to see i f there are any such implications. 1.6 Summary The researcher questions i f a short correspondence teaching pro-gramme w i l l develop the same attitudes towards professionalization in a l l students. This f i t s with M i l l s ' (1966) opinion, as stated ear l ier , that to become a professional i s a gradual process requiring an extended period of socialization so that the professional can become "inner directed." However, there are other forces to be contended with such as stereotype images (Hughes), perceived constraints (Taylor), culture of his society (McKenzie), a f f i l i a t i v e tendencies (Shull et a l . ) , organizational 35 influences (Vollmer and M i l l s and Whyte), and undermining forces within and without the occupation (Westby) that would appear to outweight the "persuasive communication" (Bandura) that would be provided through an exposure to one lesson i n a correspondence programme. The researcher can conceive that to undertake, or be exposed to the teachings could a f f e c t the attitudes of the students since the students have chosen t h i s form of educational exposure and are thus motivated to learn. Consequently, i t i s accepted that there i s the p o s s i b i l i t y of i n t e r a c t i o n between the p r o f e s s i o n a l i z a t i o n teachings and the predisposed attitudes of the stu-dents but that t h i s educational experience only acts as a moderator. However, i t i s argued that the predisposed attitudes which are r e l a t e d to c e r t a i n i n d i v i d u a l demographic and organizational c h a r a c t e r i s t i c s of the students are the main determinants. These would act as a c o n t r o l mechanism i n r e l a t i o n to the teaching exposure and i t s outcome. 2.0 MODEL AND STUDY DESIGN 2.1 Theoretical Model The t h e o r e t i c a l model of t h i s study, represented i n Figure 2.1, indicates the p r i n c i p l e s of the study and t h e i r linkages. 2.1.1 Scope of the Model The scope of the model, as shown i n Figure 2.1, was as follows: 1) educational exposure a s o c i a l i z i n g e f f e c t ; 2) 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 plus an educational exposure -*• profes-s i o n a l i z a t i o n a t t i t u d e s ; 3) 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 •+ p r o f e s s i o n a l i z a t i o n a t t i t u d e s ; 4) occupational c h a r a c t e r i s t i c s -»• p r o f e s s i o n a l i z a t i o n a t t i t u d e s ; and 5) organizational c h a r a c t e r i s t i c s -*• p r o f e s s i o n a l i z a t i o n a t t i t u d e s . The model would also allow other linkages and i n t e r a c t i o n between the variables but these were not pursued for t h i s study. 2.2 Measures The study variables were operationalized as shown i n the follow-ing sections. 2.2.1 Independent Variables and Study Population  1) E d u c a t i o n — a) Exposure—to teachings on p r o f e s s i o n a l i z a t i o n as outl i n e d by Lesson 10, of the C.H.A. correspondence programme, to the clas s of 1975-76. The Lesson was considered as the treatment e f f e c t . b) Non-exposure—class of 1976-77 had not been exposed to Lesson 36 37 Independent Variable Study Population Dependent Variable Measure Education 1) P r o f e s s i o n a l i z -ation Training Exposed 3 Attitudes towards! Non-exposed Professlohallza-tlori Index Educational Impact Individual Characteristics 2) P r o f e s s i o n a l i z -ation Training Previous profes-s i o n a l background j( Non-professional background Attitudes towards P r o f e s s i o n a l i z a -t i o n index Educational Impact 3) Low educational Attitudes towards background s p e c i f i c — _ _ _ _ _ _ High educational" P r o f e s s i o n a l i z a -background i t i o n dynamics Security Dimension Occupational Characteristics 4) Nursing back-ground 'Accounting back-| j ground  Attitudes towards s p e c i f i c w j - iH P r o f e s s i o n a l i z a - I t i o n dynamics Altruism vs. Realism Dimensions Organizational Characteristics 5) T a l l Structure F l a t Structure Attitudes towards s p e c i f i c 4| P r o f e s s i o n a l i z a -t i o n dynamics Bureaucratic vs. Professional Freedom Di-mensions 6) High P o s i t i o n Level Attitude towards s p e c i f i c P r o f e s s i o n a l i z a -t i o n dynamics ) Low P o s i t i o n Level Community of Interest vs. Operational Commi tment Figure 2.1 Study Relationships 38 10 and therefore acted as a c o n t r o l group. 2) Individual c h a r a c t e r i s t i c s — a) E d u c a t i o n — p r o f e s s i o n a l ; non-professional. b) Education—minimal; c e r t i f i c a t e / d i p l o m a ; u n i v e r s i t y degree. 3) Occupational c h a r a c t e r i s t i c s — a) Nursing; accounting; other occupations. 4) Organizational c h a r a c t e r i s t i c s — a) S t r u c t u r e — t a l l ; intermediate; f l a t . b) P o s i t i o n l e v e l — t o p one-third; middle one-third; lower one-t h i r d . The method u t i l i z e d and the d i s t r i b u t i o n of the samples across these independent variables are expanded i n Chapter 3.0, "Methods and Procedures." 2.2.2 Dependent Variables 1) P r o f e s s i o n a l i z a t i o n dimensions— a) Themes--developed through a l i t e r a t u r e review and from the material on p r o f e s s i o n a l i z a t i o n i n Lesson 10. b) Outcome—students' att i t u d e s were obtained by a questionnaire that was designed to seek attitudes towards s p e c i f i c aspects of p r o f e s s i o n a l i z a t i o n . These aspects were arranged as a set of dimensions. 2.2.3 Independent Variables I n f l u -enced by Need Fulfilment 1) I t was assumed by the researcher that students with le s s education have more i n s e c u r i t y about t h e i r academic q u a l i f i c a t i o n s f o r the 39 occupation of Hospital Administration than those with a high de-gree of education. They would e a s i l y f e e l threatened by better educationally q u a l i f i e d personnel who were ei t h e r i n or entering the f i e l d of Hospital Administration. Therefore i t was argued that educational q u a l i f i c a t i o n s would be negatively r e l a t e d to job s e c u r i t y and degree of need f u l f i l m e n t . Consequently, the students' basic Safety Needs, as outlined by Maslow, could be threatened by the p o s s i b i l i t y of l o s i n g t h e i r job or through job mobility being blocked by better educated personnel. 2) Students who were employed i n high h i e r a r c h i c a l p o s i t i o n s have at l e a s t p a r t i a l l y s a t i s f i e d t h e i r basic Safety Needs and have now moved on to f u l f i l t h e i r S o c i a l and Esteem Needs. This could be represented by the students looking outside of the organization i n order to s a t i s f y t h e i r need f u l f i l m e n t . Need f u l f i l m e n t at these l e v e l s could be d i s p e l l e d through i d e n t i f i c a t i o n and the development of comradeship, and boundary spanning r o l e s . There-fore, i t was argued that a high p o s i t i o n l e v e l within an organiza-t i o n hierarchy i s p o s i t i v e l y r e l a t e d to the S o c i a l and Esteem Needs and the necessity to f u l f i l these needs. In turn, people i n low l e v e l p o s i t i o n s who are involved i n day-to-day routines and a c t i v i t i e s would seek means that would a s s i s t them with t h e i r operational commitments. 2.3 The Study The study was an attempt to analyze i f c e r t a i n variables i n f l u -enced students' a t t i t u d e s towards the p r o f e s s i o n a l i z a t i o n of t h e i r 40 occupation, or i f an educational exposure was the main determinant of t h e i r a t t i t u d e s . In so doing, s p e c i f i c i n d i v i d u a l , occupational and organizational c h a r a c t e r i s t i c s and t h e i r e f f e c t on p r o f e s s i o n a l i z a t i o n attitudes were examined. In turn these were reconsidered i n l i g h t of the educational exposure to see i f education had an o v e r a l l e f f e c t or acted as a moderator to enhance attitudes already present. The issue being studied was whether various demographic character-i s t i c s ( i n d i v i d u a l , occupational, organizational) create or shape, par-t i c u l a r a ttitudes of an i n d i v i d u a l regarding p r o f e s s i o n a l i z a t i o n . These preconditioned views may be: 1) consistent with the educational teachings; 2) inconsistent with the teachings; or 3) neutral or of no consequence. Education may be a moderator, therefore, as i l l u s t r a t e d i n the t h e o r e t i c a l model. These pre-programme views thus make a student: 1) susceptible to the lesson content so that t h e i r views become broadened or reinforced; or 2) doubtful or questioning of the lesson ideas being presented. Therefore, t h i s paper looks at the various backgrounds to see which set of variables has the strongest e f f e c t upon s p e c i f i c p r o f e s s i o n a l i z a t i o n a t t i t u d e s . 2.4 Research Hypotheses I t may be r e c a l l e d that the model postulates s i x types of r e l a -t ionships, to be tested, between the students and t h e i r attitudes towards 41 p r o f e s s i o n a l i z a t i o n of t h e i r occupation. These r e l a t i o n s h i p s lead to d i f f e r e n t kinds of p r e d i c t i o n s about the students' a t t i t u d e s ; and the influence of the educational exposure. The predictions r e l a t e to the degree of acceptance of p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n and to the accep-tance of c e r t a i n s p e c i f i c dimensions, or aspects, of the p r o f e s s i o n a l i z a -t i o n process. The hypotheses tested were: 1) Hospital Administration students who have been exposed to educa-t i o n about p r o f e s s i o n a l i z a t i o n by Lesson 10 w i l l have a s i g n i f i -cantly higher degree of p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n than students who have not been exposed to such education. [H-l] 2) Hospital Administration students; with a previous formal profes-s i o n a l background, who have had a previous exposure to 'profes-s i o n a l ' education w i l l have a s i g n i f i c a n t l y higher degree of p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n than 'non-professional' students who have had no previous p r o f e s s i o n a l i z a t i o n educational ex-posure. [H-2] 3) Hospital Administration students with poorer academic q u a l i f i c a -tions have a s i g n i f i c a n t l y higher degree of p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n towards the p a r t i c u l a r aspects of p r o f e s s i o n a l i z a t i o n that represent s e c u r i t y than students which are better academic-a l l y q u a l i f i e d . [H-3] 4) Hospital Administration students with a nursing background have a s i g n i f i c a n t l y higher degree of p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n towards the p a r t i c u l a r aspects of p r o f e s s i o n a l i z a t i o n that 42 represent at t i t u d e s of altruism and dedication, than students from an accounting background who are train e d to be more ca l c u -l a t i n g and thus would have att i t u d e s towards realism. [H-4] 5) Students from a t a l l - s t r u c t u r e d organization have a higher degree of p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n towards the p a r t i c u l a r aspects of p r o f e s s i o n a l i z a t i o n that represent bureaucratic rules and standards, than students from f l a t - s t r u c t u r e d organizations who would seek pr o f e s s i o n a l freedom. [H-5] 6) Students employed i n t o p - l e v e l h i e r a r c h i c a l p o s i t i o n s have a higher degree of p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n towards the p a r t i c u l a r aspects of p r o f e s s i o n a l i z a t i o n that represents a 'com-munity of i n t e r e s t , 1 than students i n low-level h i e r a r c h i c a l p o s i t i o n s who are involved i n day-to-day operational commitments. [H-6] 2.4.1 Discussion of the Hypotheses Hypothesis 1: Hospital Administration students who have been exposed to education about p r o f e s s i o n a l i z a t i o n by Lesson 10 w i l l have a s i g -n i f i c a n t l y higher degree of p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n than students who have not been exposed to such education. Exposure to education on p r o f e s s i o n a l i z a t i o n should influence at-titudes towards the p o s i t i v e acceptance of such teachings. As M i l l s (1966) believes that to become a pro f e s s i o n a l and have pr o f e s s i o n a l attitudes i s a gradual process re q u i r i n g an extended period of s o c i a l i z a t i o n , i t i s questionable i f a one-lesson correspondence exposure can influence stu-dent's a t t i t u d e s . Due to the lack of 'persuasive communication' the r e -searcher believes that t h i s type of educational exposure can only act as 43 a moderator. Even though the educational exposure was brief and i t s i n -fluence expected to be s l ight , i t s effect was tested. If the education exposure influenced professionalization attitudes, the exposed class of 1975-76 would then have a higher degree of professionalization orienta-tion than the unexposed class of 1976-77, holding other influences con-stant . Hypothesis 2: Hospital Administration students, with a previous formal professional background, who have had a previous exposure to 'pro-fessional ' education w i l l have a s ignif icantly higher degree of professionalization orientation than 'non-professional' students who have had no previous professionalization educational exposure. This hypothesis would test M i l l s ' (1966) belief that profession-alism requires an extended period of social izat ion. Consequently, stu-dents with previous 'professional' educational background would be similarly predisposed to professionalization attitudes and would display a higher acceptance of professionalization teachings than students who have non-professional backgrounds. Hypothesis 3: Hospital Administration students with poorer academic qual-i f ica t ions have a s ignif icantly higher degree of professionaliza-tion orientation towards the particular aspects of professional-ization that represent security than students which are better academically q u a l i f i e d . Jones and Jeffrey (1964), Nealy (1963), and Larke (1953) found that non-professional personnel tend to value job security, opportunities for advancement, interesting work, and interesting co-workers as the most important motivators. This could be explained by Maslow's need hierarchy. This would lead to the belief that 'non-professional, ' or students with a poorer academic qual i f ica t ion , would have strong attitudes towards those 44 aspects of p r o f e s s i o n a l i z a t i o n that represent s e c u r i t y . Consequently the 'non-professional' student should have more support of organizational r e s t r i c t i v e dynamics than the l a i s s e z f a i r e p r o f e s s i o n a l dynamics of pro-f e s s i o n a l i z a t i o n . Hypothesis 4: Hospital Administration students with a nursing background have a s i g n i f i c a n t l y higher degree of p r o f e s s i o n a l i z a t i o n o r i e n -t a t i o n towards the p a r t i c u l a r aspects of p r o f e s s i o n a l i z a t i o n that represent a t t i t u d e s of altruism and dedication, than students from an accounting background who are trained to be more ca l c u -l a t i n g and thus would have att i t u d e s towards realism. I t has been shown by McKenzie (1965) and H a l l (1972) that nurses believe i n service to the p u b l i c and have a sense of dedication or c a l -l i n g . Nurses, therefore, would demonstrate these c h a r a c t e r i s t i c s by having more a l t r u i s t i c attitudes towards p r o f e s s i o n a l i z a t i o n than students from many other occupational backgrounds. One profession expected to d i f f e r i n degree of altruism i s accountancy. While nurses t y p i c a l l y are concerned with people and have a service o r i e n t a t i o n , accountants t y p i c a l l y focus on things, data and administrative e f f i c i e n c y . Hypothesis 5: Students from a t a l l - s t r u c t u r e d organization have a higher degree of p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n towards the p a r t i c u l a r aspects of p r o f e s s i o n a l i z a t i o n that represent bureaucratic rules and standards, than students from f l a t - s t r u c t u r e d organizations who would seek p r o f e s s i o n a l freedom. Indik (1963) indicates that T a l l (bureaucratic) organizations have a great need for operational rules and standards as means of con t r o l than do F l a t organizations."'" Students working within a bureaucratic structure, The researcher believes that regardless of a standardization ef-fe c t within the health f i e l d due to 1 r e g i o n a l i z a t i o n , ' the health industry i s not unlike other i n d u s t r i e s . In both s i t u a t i o n s , t a l l organizations 45 according to Hall (1972) would therefore have less exposure to profession-al izat ion attributes, with professional autonomy being threatened, and more exposure to operational rules and standards. The students would l i k e l y be influenced by the degree to which operational rules and stan-dards exist in their organizations. Due to organizational influences (Vollmer and M i l l s 1966) and a f f i l i a t i v e tendencies (Shull et a l . 1970) students in T a l l organizations should demonstrate support for the bureau-cratic aspects of professionalization, i . e . , standards, code of ethics, restricted entry and licensure. It would therefore be assumed that in these areas they would have more positive or supporting views than stu-dents who are employed in Flat organizations. In turn, students from Flat organizations would demonstrate attitudes supporting decisions allow-ing freedom to work independently and to use professional judgement. Hypothesis 6: Students employed in top-level hierarchical positions have a higher degree of professionalization orientation towards the particular aspects of professionalization that represents a 'com-munity of interest , ' than students in low-level hierarchical positions who are involved in day-to-day operational commitments. The level of a position within an organization hierarchy creates different needs. People within top-level positions may seek to f i l l their Belongingness and Esteem Needs by developing interest outside of the organization as they reach to identify with para l le l organizations would demonstrate more bureaucratization. While f l a t organizations would allow more personal freedom to express professional attitudes and to make work decisions which enhance feelings of responsibil i ty . Consequently, the organizational structure would influence the attitudes of the employ-ees, and in turn their attitudes towards professionalization of their occupation. 46 and seek camaraderie, or a community of i n t e r e s t , with outside sources. These are known as 'boundary spanning a c t i v i t i e s ' as defined by Thompson (1967). In addition Abraham (1967, pp. 59-60) states ". . . there are pragmatic pressures toward c o l l e g i a l i t y based upon the need to share i n -formation i n an environment which generally i s o l a t e s the professionals from t h e i r colleague groups located outside of the organization." Subsequently these outside needs influence a t t i t u d e s towards p r o f e s s i o n a l -i z a t i o n . The researcher, therefore contends that people i n t o p - l e v e l p o s i t i o n s require outward i d e n t i f i c a t i o n through a community of i n t e r e s t . Consequently they would have a strong p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n to-wards such aspects which are represented by such things as a p r o f e s s i o n a l association and p r o f e s s i o n a l a c t i v i t i e s , while students i n low-level p o s i t i o n s w i l l have attitudes towards operational commitments. 3.0 METHODS AND PROCEDURES 3.1 Setting and Subjects The following discussions d e t a i l the s e t t i n g and subjects r e l a t e d to t h i s study. 3.1.1 Canadian Hospital Association The Canadian Hospital Association has offered correspondence courses, over a period i n excess of twenty years, for people who are work-ing i n administrative or management posit i o n s within the health f i e l d . The educational programmes have been undertaken by students representing extremely diverse backgrounds. " I t [the programme] was i n i t i a l l y developed to meet a recognized void i n the a v a i l a b i l i t y of administrative knowledge and expertise i n the h o s p i t a l f i e l d . The objectives at that time were set out as follows: 1. To provide an organized program of t r a i n i n g i n the basic p r i n -c i p l e s of h o s p i t a l organization and management to persons employed i n senior executive p o s i t i o n s i n ho s p i t a l s and r e l a t e d agencies who are unable to enrol i n e x i s t i n g graduate or undergraduate u n i v e r s i t y programs i n h o s p i t a l administration. 2. To provide a recognized yardstick by which an i n d i v i d u a l ' s t r a i n -ing might be assessed and evaluated. 3. To improve the q u a l i t y of administration i n Canadian h o s p i t a l s " (Stefanuk 1973). The C.H.A. i s an association that represents employers and thus has the employers' (hospitals') needs at heart. Therefore, the C.H.A.'s 47 48 educational programmes are administratively based so as to improve the qu a l i t y of h o s p i t a l administration i n Canada. In contrast the C.C.H.S.E., which i s a pr o f e s s i o n a l association, p r i m a r i l y represents the i n d i v i d u a l Hospital Administrators' (Health Service Executives') i n t e r e s t . Cpnse-quently the perspective of the College i s d i f f e r e n t as i t s main a c t i v i -t i e s dwell around the needs of the profession and i t s members. 3.1.2 Lesson 10 Each year the C.H.A. sponsors an Extension Course i n Hospital Organization and Management (H.O.M.). This two-year programme commences i n September and continues u n t i l the end of May. I t i s presented through a correspondence teaching format, concluding each year with an educa-t i o n a l seminar i n Winnipeg. Lesson 10, "The Chief Executive O f f i c e r , " i s presented within the f i r s t year of the programme. Assignments f o r t h i s lesson are due at the end of January, but the f i n a l deadline i s the beginning of A p r i l . This Lesson discusses the Chief Executive O f f i c e r i n the health f i e l d and the profession of Hospital Administration. Contents include the following: 1) h i s t o r y and the evolution of the chief executive o f f i c e r as a pro f e s s i o n a l ; 2) the publ i c ' s knowledge, a t t i t u d e , demands and acceptance of the chief executive o f f i c e r and the profession of h o s p i t a l adminis-t r a t i o n ; 3) the r o l e , duties, r e s p o n s i b i l i t i e s and r e l a t i o n s h i p s of the chief executive o f f i c e r ; 49 4) c h a r a c t e r i s t i c s or composition of a profession; 5) evaluating the performance of a h o s p i t a l administrator; 6) ways to develop executives within the work s e t t i n g ; and 7) the r o l e of the wife. This thesis does not examine the whole lesson content, but focuses on areas which p e r t a i n to the p r o f e s s i o n a l i z a t i o n process of an occupation. I t contains no discussion as to the q u a l i t y of the teaching material or as to how the lesson themes had been addressed or presented to the students. The int e n t i o n of the research was not to assess the programme, or i t s approach, but to assess the impact of one segment, p r o f e s s i o n a l i z a t i o n , of Lesson 10 on the students. I t should be r e a l i z e d that the subject of p r o f e s s i o n a l i z a t i o n was embedded with other subjects within Lesson 10. This had the consequence of being a weak but never-theless e x i s t i n g educational treatment. The teaching impact was evalu-ated by assessing the change i n the students' attitudes towards profes-s i o n a l i z a t i o n due to Lesson 10 exposure. A d d i t i o n a l hypotheses were tested which r e l a t e i n d i v i d u a l and organizational variables to attitudes towards p r o f e s s i o n a l i z a t i o n , independent of the educational exposure of Lesson 10. 3.1.3 Study Sample As stated, p r i m a r i l y the thesis was an analysis of the attitudes of the H.O.M. students to the p r o f e s s i o n a l i z a t i o n of Hospital Administra-t i o n . The sample for the study was composed of the 120 students of the 1975-76 c l a s s and a comparative group of 128 students from the 1976-77 H.O.M. class of the Canadian Hospital Association. These students are 50 employed i n various types of p o s i t i o n s within the health f i e l d across Canada. They have diverse occupational and educational backgrounds. Due to the timing of the research project, pre- and post-lesson evaluations could not be obtained from the same sample. Consequently, the 120, 1975-76 students were surveyed i n terms of demographic charac-t e r i s t i c s and for post-lesson assessment of t h e i r p r o f e s s i o n a l i z a t i o n a t t i t u d e s . The new 1976-77 H.O.M. clas s was surveyed for pre-lesson pro-f e s s i o n a l i z a t i o n attitudes and also for demographic c h a r a c t e r i s t i c s . I t was assumed that people entering the programme, who had s i m i l a r back-grounds, had c o i n c i d i n g attitudes on p r o f e s s i o n a l i z a t i o n and that they could be compared to other s i m i l a r samples. As such, the 1976-77 c l a s s were considered representative of the students' a t t i t u d e s of the 1975-76 clas s before exposure to Lesson 10, the assumption being that the 1976-77 students have attitudes towards p r o f e s s i o n a l i z a t i o n of Hospital Admin-i s t r a t i o n which were only r e l a t e d to the students' demographic charac-t e r i s t i c s . As the 1976-77 group of students had not been exposed to Lesson 10, a "base l i n e " was a v a i l a b l e which described and measured an a t t i t u d e towards the p r o f e s s i o n a l i z a t i o n of Hospital Administration. The use of the 1976-77 sample thus provided a "base l i n e " from which the influence (success) of Lesson 10 on the attitudes to p r o f e s s i o n a l i z a t i o n could be determined, given that the 1975-76 sample only had received Lesson 10. The composition of the two classes was analysed for s i m i l a r i t i e s i n t h e i r demographic c h a r a c t e r i s t i c s . Analysis of p r o f e s s i o n a l i z a t i o n attitudes was then done on comparable groups, i . e . , those with s i m i l a r 51 demographic c h a r a c t e r i s t i c s . Also analyses of the pre-lesson findings were conducted to examine whether the 1976-77 group of students d i f f e r e d amongst themselves regarding t h e i r p r o f e s s i o n a l i z a t i o n a t t i t u d e . D i f -ferences i n atti t u d e s were correlated with i n d i v i d u a l demographic char-a c t e r i s t i c s . In explaining a t t i t u d e differences or s i m i l a r i t i e s amongst i n d i v i d u a l s , s p e c i f i c demographic a t t r i b u t e s were d i r e c t l y linked to the diff e r e n c e s . For example, i t was possible to investigate whether the teaching material had a d i f f e r e n t impact on people of d i f f e r e n t educa-t i o n a l backgrounds. 3.2 Data C o l l e c t i o n Data were c o l l e c t e d i n three ways. The C.H.A. records were used to obtain demographic material r e l a t i n g to student enrolment. On the basis of the t h e o r e t i c a l model described, two questionnaires were devel-oped. One to obtain the necessary demographic and organizational informa-t i o n , and the other to assess the students' attitudes on p a r t i c u l a r dynamics of the p r o f e s s i o n a l i z a t i o n of Hospital Administration. The response to these questionnaires plus information obtained through the C.H.A. records provided the data base for t h i s study. Both questionnaires were d i s t r i b u t e d through the auspices of the C.H.A. with a covering l e t t e r i n d i c a t i n g a study of students was being conducted regarding the H.O.M. course. The content of the l e t t e r s (see Appendix A) indicated the study was concerned about the occupation of Hospital Administration with Lesson 10 being the main resource for anal-y s i s . The questionnaires were d i s t r i b u t e d through the mail with s e l f -addressed stamped envelopes included so that the students could return 52 the completed questionnaires d i r e c t l y to the researcher. A l l students i n both classes received the questionnaires. A second mailing was undertaken to those students who d i d not respond. The second mailing improved the response rate by an a d d i t i o n a l 0.8 per cent for the 1975-76 cla s s bringing i t s t o t a l to 65.8 per cent while 3.9 per cent was added to the 1976-77 c l a s s , f o r a t o t a l of 65.6 per cent of the students returning the questionnaires. Questionnaires continued to be returned well a f t e r the Closure of the study. By the middle of November, six weeks l a t e r , 89.2 per cent of the 1975-76 c l a s s and 78.9 per cent of the 1976-77 c l a s s had returned the questionnaires. These l a t e responses were not included i n the study. Consequently for the study, of the 120 students i n the 1975-76 c l a s s , complete information was obtained on seventy-nine students. Eighty-four of the 128 i n the 1976-77 cla s s responded to both question-naires . The demographic c h a r a c t e r i s t i c s of the students i n these two classes are i l l u s t r a t e d i n Table 3.1. 3.3 The Measuring Devices The measures used to tap the variables i n the study are described below. Copies of these measures may be found i n Appendix A. 3.3.1 Influence of the Teaching Programme Influence of the educational exposure on at t i t u d e toward profes-s i o n a l i z a t i o n was assessed using a P r o f e s s i o n a l i z a t i o n Questionnaire. The items f o r the questionnaire were developed from themes on profession-a l i z a t i o n that were i n d e n t i f i a b l e and defined i n the l i t e r a t u r e on 53 Table 3.1. D i s t r i b u t i o n of Individuals i n Each Sample on Demographic Variables Variable 1975-76 Class Frequency Tot a l 1976-77 Class Frequency T o t a l Educational Level none/minimal t r a i n i n g c e r t i f i c a t e / d i p l o m a u n i v e r s i t y degree missing data Educational Background* 12 25 37 5 no t r a i n i n g 4 general management 8 laboratory tech. 1 radiology tech. 2 res p i r a t o r y tech. 2 fi n e arts 1 computer 1 B.A.-B.Ed. 8 B. Comm.. -B. Admin. 9 B.Sc. 1 s o c i a l work 1 phys iotherapy 3 d i e t e t i c s 2 engineering 1 mathematics 1 nursing 11 accounting 12 pharmacy 3 medicine 3 missing data 5 79 o c c u p a t i o n a l therapy 79 17 33 31 3 4 15 2 2 3 1 1 10 2 1 1 3 1 4 0 15 12 3 2 2 84 84 non-professional 18 pr o f e s s i o n a l 18 Position within Organization top 1/3 14 middle 1/3 44 bottom 1/3 15 missing data 6 Organization Structure t a l l 15 intermediate . 44 f l a t 15 missing data 5 79 79 27 17 10 48 18 8 21 41 14 8 84 84 54 p r o f e s s i o n a l i z a t i o n , as covered i n Chapter 1.0, and i n Lesson 10. The questionnaire i s reproduced i n Appendix A. Questions concerning the pro-f e s s i o n a l i z a t i o n themes were designed so student's attitudes could be ascertained. The study could thus explore the differences i n the degree of o r i e n t a t i o n to p r o f e s s i o n a l i z a t i o n that existed between students. The students were asked to i n d i c a t e t h e i r f e e l i n g s to each question by marking the point, using a L i k e r t ' s (1932) f i v e - p o i n t a t t i t u d e scale, which best represented t h e i r respective opinions. The coding system u t i l i z e d to score the questionnaire i s explained i n Appendix A. Thirty-three items of the questionnaire were used to compare the degree of p r o f e s s i o n a l i z a t i o n a t t i t u d e s of the two samples of students. A measure of the degree of p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n of i n d i v i d u a l s p r i o r to the lesson exposure was obtained using the 1976-77 respondents' r e p l i e s to the t h i r t y - t h r e e items of the questionnaire. Degree of profes-s i o n a l i z a t i o n o r i e n t a t i o n subsequent to Lesson 10 exposure was measured using the responses of the 1975-76 respondents. This approach was adopted as a means of control i n the study, the 1976-77 sample representing the pre-exposure condition and the 1975-76 sample representing the post-exposure condition. Mean scores for the two d i f f e r e n t classes were used to t e s t f o r differences i n a t t i t u d e to pro-f e s s i o n a l i z a t i o n . Thus the study was conducted i n the nature of a S t a t i c -Group Comparison design as described by Campbell and Stanley (1973). This design appeared as the best to u t i l i z e i n the face of the s i t u a t i o n and time const r a i n t s . This 'one shot' type of analysis i s not affected by h i s t o r y or 55 motivation, although t h i s could be questioned because of the time delay between the lesson exposure and the completion of the questionnaire. In the study there was some s e l f - s e l e c t i o n of subjects as only j u s t better than 65 per cent of the students had returned the questionnaires by the time the analysis was conducted. 3.3.1.1 P r o f e s s i o n a l i z a t i o n Themes The following l i s t s the conceptually i n t u i t i v e l y derived profes-s i o n a l i z a t i o n themes that were used to seek the student's a t t i t u d e s : 1) F u l l time o c c u p a t i o n — s e r v i c e to society 6. The work of the Hospital Administrator holds s p e c i a l c h a l -lenges . 9. Even though Hospital Administrators are employees, they should have the freedom to use t h e i r p r o f e s s i o n a l judgements i n order to carry out t h e i r duties and r e s p o n s i b i l i t i e s . 10. Hospital Administrators should delegate some of t h e i r l e s s important duties to other personnel. 28. Hospital Administrators should spend the majority of t h e i r time exercising the s k i l l s that are d i s t i n c t to t h e i r occupa-t i o n rather than everyday administrative s k i l l s . 2) E s t a b l i s h a p r o f e s s i o n a l a s s o c i a t i o n — group i d e n t i t y to sustain culture  1. Hospital Administrators should not seek to be recognized as a separate profession but j u s t be part of a management group that would include business executives i n various types of organizations. 56 17. An association membership, which i s l i m i t e d to q u a l i f i e d Hospital Administrators, i s necessary i n order to further the cause of Hospital Administration. 18. An association of Hospital Administrators should be able to cont r o l how membership within the Hospital Administration f i e l d i s maintained. 21. An asso c i a t i o n of Hospital Administrators should speak on be-h a l f of Hospital Administrators' i n t e r e s t . 23. The occupational a s s o c i a t i o n as well as the Hospital Trustees, should have d i s c i p l i n a r y and expulsory powers over Hospital Administrators. 24. The occupational association should protect i t s members against Trustees' d i s c i p l i n a r y actions when matters of moral conduct are involved. 25. The judging and d i s c i p l i n i n g of members by an occupational association, i s only appropriate when the members are employed on a fe e - f o r - s e r v i c e basis. 3) Change name—new i d e n t i f i c a t i o n 34. I t i s important f o r the occupation of Hospital Administration to undergo a name change to further i t s p r o f e s s i o n a l i z a t i o n process. 4) Obligation to the art-—code of ethics and standards  7. Hospital Administrators should perform t h e i r managerial duties without having to adhere to a set of standards that are l a i d down by a pro f e s s i o n a l association. 57 8. When there i s a d i f f e r e n c e , i t i s more important that Hospi-t a l Administrators adhere to t h e i r occupational code of ethics than that they follow the i n s t r u c t i o n s of the Board of Trustees. 20. Proof of continuing education should be required to maintain membership within an association of Hospital Administrators. 22. R e s p o n s i b i l i t y for r a i s i n g standards and q u a l i t y within the occupation of Hospital Administration should be held by: (Indicate opinion for each group): The U n i v e r s i t i e s ; The Pre-ceptors; and The Occupational Association. 5) Community sanction—acceptance of authority 2. I t i s important for Hospital Administrators to have an appre-c i a t i o n of the unique h i s t o r i c a l background that d i f f e r e n t i -ates Hospital Administration from other administrative occupations. 31. I t i s important that c l i e n t s (patients) and the general com-munity recognize the s p e c i a l expertise of the Hospital Admin-i s t r a t o r . 32. I t i s important that the patients and the public accept the authority of Hospital Administrators because of t h e i r s p e c i a l expertise. 6) Service o r i e n t a t i o n above personal goals 11. Hospital administrators should work hard to share with Hospi-t a l Administrators i n other organizations, a l l of t h e i r work information concerning new ideas, solutions and experiences. 58 27. Hospital Administration i s a s a t i s f y i n g career. 29. Hospital Administrators should give p r i o r i t y to t h e i r c l i e n t s ' (patients and public) needs before t h e i r own per-sonal needs. 30. The Hospital Administrator should be oriented towards ser-vice as opposed to seeking monetary rewards. 7) Agitate p o l i t i c a l l y — p o w e r for new b a r r i e r s 19. There should be a r e s t r i c t i o n of, or quota on, the number of people who can enter the f i e l d of Hospital Administration. 26. I t should be compulsory for a l l Hospital Administrators to be licensed under government l e g i s l a t i o n . 33. A government Act i s required to close the f i e l d of Hospital Administration to members only, before the state of the occu-pation can improve. 35. Most l e g i s l a t i o n concerned with the occupation of Hospital Administration should be shaped by Hospital Administrators as a body acting through t h e i r occupational association rather than through p o l i t i c a l decision-making. 8) E d u c a t i o n — t r a i n i n g and d i s p e r s a l 3. The f i e l d of Hospital Administration has developed a body of knowledge based on s c i e n t i f i c and t h e o r e t i c a l p r i n c i p l e s . 4. Hospital Administrators use a vocabulary, or terminology, that i s unique to them alone, and i s not used commonly by administrators i n other management f i e l d s . 5. Hospital Administrators have d e f i n i t e and d i s t i n c t work 59 s k i l l s that d i f f e r e n t i a t e s them from administrators i n other types of organizations. 12. The job of the Hospital Administrator can be done e f f e c t i v e l y only by people who have undergone t r a i n i n g i n Hospital Administration at the l e v e l of: (indicate opinion for each l e v e l ) ; No A d d i t i o n a l Training; Diploma; Undergraduate Degree; Masters Degree; Doctoral Degree. 13. S a t i s f a c t o r y completion of a prescribed course should be a mandatory requirement for anyone who i s hired as a Hospital Administrator. 14. Hospital Administrators should undertake the r e s p o n s i b i l i t y of providing students who are preparing for careers i n Hospital Administration with p r a c t i c a l experiences by acting as preceptors. 15. In the u n i v e r s i t y s e t t i n g , Hospital Administration should: (indicate opinion for each s e t t i n g ) : E s t a b l i s h i t s own f a c u l t y or school; Be placed under the f a c u l t y of Medicine; Be placed under the f a c u l t y of Commerce/Administration; Be j o i n t l y under Medicine and Commerce/Administration. 38. During the past year my opinions have changed a great deal as to how Hospital Administration can become more profession-a l i z e d . E s t a b l i s h recognition and status 16. Research on the Administration of health care should be pro-moted i n order to r a i s e the status of the occupation of Hos-p i t a l Administration. 60 36. Hospital Administration now constitutes a profession. 37. Developing the pr o f e s s i o n a l status of Hospital Administration i s important to me. 39. The profession of Hospital Administration has gone too far and i n t e r f e r e s with the d a i l y functional r o l e of the Hospital Administrator. 3.3.2 Educational and Occupational Variables Educational background information was obtained by questionnaire. The information was c l a s s i f i e d on l e v e l of education acquired and on the nature of the educational background. The categories are shown i n Table 3.1. Education l e v e l ranged from no a d d i t i o n a l education to that of a physician. Occupational background information was determined by re-c l a s s i f y i n g the educational background. This was done i n two ways i n order to acquire a Professional/Non-professional c l a s s i f i c a t i o n plus a Nursing/Accountant c l a s s i f i c a t i o n . Answers to the following question were used to determine the edu-c a t i o n a l and occupational backgrounds of the respondents: 2. EDUCATION—Course, years completed, c e r t i f i c a t e or degree obtained. Canadian Hospital Association H.O.N.—1st year — 2 n d year DMC HFSS HRT ( E ) _ _ ECON C e r t i f i e d Hospital Course Technical College University Other .  61 Grouping professionals and non-professionals was determined according to how occupations were judged on pr o f e s s i o n a l status i n the l i t e r a t u r e , as outlined i n Chapter 1.0. In addition, students i n the Health Care and Epidemiological Planning Course, University of B r i t i s h Columbia, were asked to assign the educational backgrounds of the stu-dents i n the study sample to p r o f e s s i o n a l or non-professional c l a s s i f i -cations. For t h i s undertaking they were given the f i v e c r i t e r i a that determine a profession as defined by Lewis and Maude (1952). The f i v e c r i t e r i a being, Registration or State C e r t i f i c a t i o n ; P r a c t i t i o n e r - C l i e n t Relationship; E t h i c a l Code; Ban on Advertising of Services; and Indepen-dent but Service of a Fiduciary Nature. Students i n the study samples were assigned to the p r o f e s s i o n a l or non-professional c l a s s i f i c a t i o n s through a consensus of opinion where there was between 75 per cent and 100 per cent agreement of the Health Care students. The grouping of the educational backgrounds i s i l l u s t r a t e d i n Table 3.1 (see * notation). 3.3.3 Organization Structure The organization structure of the student's place of employment was obtained using the following questionnaire items: 5. ORGANIZATION STRUCTURE OF PRESENT EMPLOYMENT FACILITY—To a s s i s t consistency f o r t h i s question an example Organization Chart i s i l l u s t r a t e d i n d i c a t i n g various l e v e l s . This i s only a guide. Please use your own (hospital) organization chart to answer. Level No. 1. Board of Trustees 2. | Medical Board 3. Executive Director 4. -Medical Director 5. Associate Director Finance 6. I -Director Employees Service 62 Level No. 7. 8. D i v i s i o n Director •Administrative Resident •Division Director . i > _ i _ v ^ - w ^ A ^ — — — — — 9. I—Assoc. Dir. Planning — N u r s i n g Executive Committee 10. Dept. Head «-Dept. Head Dept. Head—I—Dept. Head 11. 12. 13. -Ass. Dept. Head -Senior S t a f f •Junior S t a f f 14. *-Staff No. of l e v e l s within your Organization_ Your P o s i t i o n Level No. of People that You D i r e c t l y Supervise No. of Personnel within your Dept. or Sub-unit_ No. of Personnel within the t o t a l Organization_ Information provided from the answers allowed the c l a s s i f i c a t i o n of respondents according to the s i z e of the organization ( i . e . , the number of employees within the organization), the number of h i e r a r c h i c a l l e v e l s within the organization, and the student's p o s i t i o n l e v e l within the hierarchy. To measure the concept of Top Level h i e r a r c h i c a l p o s i t i o n s vs. Lower Level p o s i t i o n s each student's p o s i t i o n l e v e l was assigned accord-ing to which one-third of the hierarchy l e v e l s within the organization he or she was located. The assigned p o s i t i o n l e v e l was determined by d i v i d -ing the number of l e v e l s within the student's organization into three equal parts. Each student was then assigned to an organization l e v e l category i n accordance to which one-third h i s or her p o s i t i o n l e v e l be-longed . The concept of T a l l vs. F l a t Organizations was measured using a r a t i o of l e v e l s as defined by Porter and Lawler (1964). Porter and Lawler's method controls f o r the s i z e and l e v e l s of the organizations. Consequently comparisons then could be made between independent t o t a l organizations. From the information gathered by Question 5 above, a r a t i o between the 63 number of h i e r a r c h i c a l l e v e l s i n the organization and the t o t a l s i z e of the organization could be computed. Thus organizations could be divided into T a l l ; Intermediate; and F l a t structures. In turn, respondents were c l a s s i f i e d as one of these three, dependent upon which type of structure they were employed. To compute t h i s r a t i o of l e v e l s method, organizations were f i r s t grouped by siz e (number of employees) into four groups. The four si z e categories were Very Small--less than 200 employees; Small—between 200 and 599 employees; Large—600 to 999 employees; and Very Large—over 1,000 employees. These s i z e categories were then subdivided into three where the subdivisions r e l a t e to the number of l e v e l s within the p a r t i c u l a r organiz-ations that f e l l i n t o an established group s i z e range. The organizations within each s i z e category were ordered as to the number of h i e r a r c h i c a l l e v e l s they contained. The s i z e ranges were then subdivided so that ap-proximately one-quarter of the organizations i n the group that had the le a s t number of h i e r a r c h i c a l l e v e l s was rated as a F l a t organization. In turn, approximately the one-quarter of organizations that had the most l e v e l s with a group were ranked as a T a l l organization. The remaining organizations which f e l l between these two ends were designated as Inter-mediate shaped organizations. The four s i z e groups were subdivided i n t o the three structure categories i n the following manner: Very S m a l l — F l a t , less than 5 l e v e l s — T a l l , more than 8 l e v e l s . S m a l l — F l a t , less than 7 l e v e l s - - T a l l , more than 10 l e v e l s . 64 L a r g e — F l a t , less than 7 l e v e l s — T a l l , more than 11 l e v e l s . Very L a r g e — F l a t , le s s than 8 l e v e l s — T a l l , more than 13 l e v e l s . Students were thus assigned to the number of l e v e l s within t h e i r organization r e l a t i v e to i t s s i z e . Table 3.2 demonstrates the student sample breakdown. Table 3.2. D i s t r i b u t i o n of Sample of the Organization Structure r e l a t i v e to i t s Size Organization S i z e G r o u P Total N for Structure 0-199 200-599 600-999 1,000-3,000 Structure Type F l a t 7 8 8 6 29 Intermediate 18 16 26 25 85 T a l l 119 8 9 10 36 Tot a l N for Size Group 34 32 43 41 150 missing 13 TOTAL 163 4.0 ANALYSIS AND RESULTS 4.1 S t a t i s t i c a l Procedures The f i r s t and foremost focus of the study was the influence of education on the students' at t i t u d e s towards p r o f e s s i o n a l i z a t i o n of Hos-p i t a l Administration. The i n v e s t i g a t i o n focused on c o r r e l a t i o n s between the independent variables of the student's demographic background on the one hand and the dependent va r i a b l e of the p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n (treated as an index and as a set of sub-indices) on the other. There was a hypothesized expected influence of educational ex-posure to p r o f e s s i o n a l i z a t i o n material on the students' a t t i t u d e to pro-f e s s i o n a l i z a t i o n . In addition sub-categories of students, d i f f e r i n g i n terms of demographic c h a r a c t e r i s t i c s such as educational background, l e v e l i n the organization, and so f o r t h , were expected to be d i f f e r e n t i a l l y influenced by exposure to the educational treatment. E f f e c t of indepen-dent variables was measured i n terms of differences i n mean scores of students i n each sample on the o r i e n t a t i o n to p r o f e s s i o n a l i z a t i o n , the dependent v a r i a b l e . The data i n t h i s study was subjected to a s s o c i a t i o n and c o r r e l a -t i o n a n a l y s i s . Investigations were c a r r i e d out: 1) to see whether the two classes used as samples came from s i m i l a r populations; 2) to generate dimensions of p r o f e s s i o n a l i z a t i o n ; 3) to examine the programme e f f e c t that occurred when students had been exposed to Lesson 10; 65 66 4) to ascertain whether differences other than Lesson 10 exposure would be associated with differences in orientation to profes-sionalization; and 5) to test the hypotheses regarding differences in orientation for groups of students with similar demographic characteristics. 4.2 Similarity of Samples The two class samples were analyzed in terms of several of their independent variables to see i f there was an association between the two populations. The independent variables used for measuring the levels of association were: Type of Higher Education; Educational Degree Acquired: Organizational Level; and Structure of the Employing Organization (Flat versus T a l l ) . In order to test the association between the 1975-76 and 1976-77 classes, specific sets of relationships of independent variables were investigated. Contingency table (cross-tabulation) analysis was per-formed on the number of cases across the above-mentioned variables. Chi -square s ta t is t ics were computed on the relationships of the frequency distr ibution of students across these variables to determine i f the samples were s t a t i s t i c a l l y independent or associated. No significant differences were observed between the two samples on any of the indepen-dent variables. Chi-square values for the variables are given in Table 4.1. From the analysis i t can be concluded that the two samples are not s ignif icant ly different on major variables used in the study and represent the same population. Therefore, the attitudes of the 1975-76 67 Table 4.1. Population Chi-square Values Variable Chi-square Degrees of s i i f i c a n c e Value Freedom Higher Education 2.900 4 0.58 Degree of Education 2.183 2 0.34 P o s i t i o n Level i n Organization 1.053 2 0.59 Organization Structures 1.114 2 0.57 and 1976-77 classes can be compared and analyzed. For d e t a i l e d informa-t i o n of the Cross-tabulation Tables r e f e r to Appendix B. 4.3 Dimensions of P r o f e s s i o n a l i z a t i o n In order to e s t a b l i s h dimensions of P r o f e s s i o n a l i z a t i o n , a Pearson Product-moment-Correlation Matrix was performed on the 1975-76 student's answers to the t h i r t y - n i n e questions of the P r o f e s s i o n a l i z a t i o n question-naire. This b i - v a r i a t e c o r r e l a t i o n analysis was done to measure the r e l a t i o n s h i p or association between p a i r s of v a r i a b l e s , i . e . , p a i r s of questions. Generally the c o r r e l a t i o n values were low. In the c o r r e l a t i o n matrix there was a r e l a t i v e absence of a c l e a r - c u t pattern amenable to v i s u a l inspection. In the approximately 1,200 paired p o s s i b i l i t i e s only ten questions paired to form " r " values above the 0.45 l e v e l of c o r r e l a -t i o n . An a d d i t i o n a l sixty-nine p a i r s were correlated at the 0.001 l e v e l of s i g n i f i c a n c e with " r " values above 0.26. Eighty-nine were s i g n i f i c a n t at the 0.01 l e v e l of s i g n i f i c a n c e , c o r r e l a t i n g between 0.20 and 0.26. Those with " r " values above 0.45 were the following: 68 Variables " r ' s " Variables " r ' s " Q12b with Q12c -0.5539 Q26 with Q33 0.4825 Q12c with Q12d 0.4806 Q29 with Q30 0.4560 Q12d with Ql2e 0.7587 Q31 with Q32 0.4645 Q17 with Q18 0.5712 Q31 with Q37 0.4519 As parts of Question 12 were highly correlated t h i s question was re-evaluated as i t was assumed that the various parts of Question 12 measured the same numerical dimensions (students' a t t i t u d e s ) . 4.3.1 Restructuring Question 12 As parts of Question 12 provided the highest c o r r e l a t i o n scores and were l i k e l y tapping the same idea, t h i s question was recoded to form one composite answer to avoid over-emphasis of the question i n the matrix and to eliminate any confounding e f f e c t s that i t could create i n the factor a n a l y s i s . A composite answer was constructed by using coding values from one to f i v e , where one represented No Post Highschool Trai n -ing; two—Diploma; three—Undergraduate; four—Masters; and f i v e — Doctoral l e v e l s of t r a i n i n g . The l e v e l of education that the student indicated as h i s strongest or highest choice of acceptance provided the basis f o r assigning the scores for t h i s composite answer. Examples of how the new scores were derived are given i n Appendix C. 4.3.2 Decision Concerning Question 15 Only part of Question 15 was used for t h i s study. I t was f e l t that only the f i r s t part of the question regarding the establishment of a Hospital Administration School or separate Faculty produced an index 69 of the student's p r o f e s s i o n a l i z a t i o n a t t i t u d e . This part of the question was chosen since evidence from the l i t e r a t u r e suggests that strong pro-fessions work towards e s t a b l i s h i n g control over the academic aspects of t h e i r p rofession. Consequently the other remaining parts of the question were deleted from the study. Question 15 can be r e f e r r e d to i n Appendix A. 4.3.3 Factor Analysis With the above decisions being made about Questions 12 and 15, the remaining forty-one questions (Question 22 had three parts: Univer-s i t i e s ; Preceptors; and Professional Association having the r e s p o n s i b i l i t y for r a i s i n g the standards and q u a l i t y of the occupation) were subjected to f actor analysis to examine em p i r i c a l l y f or dimensions of p r o f e s s i o n a l -i z a t i o n . Students' at t i t u d e s towards the i n d i v i d u a l questions were factor analyzed to explore for factors i n the matrix. Such factors should represent students' a t t i t u d e s towards p r o f e s s i o n a l i z a t i o n . Factor anal-y s i s was done to determine the minimum number of dimensions or factors that account for the t o t a l pattern of i n t e r c o r r e l a t i o n s among a much larger number of measures. A P r i n c i p a l Factor Analysis with i t e r a t i o n was u t i l i z e d f o r the 1975-76 cla s s of students. This was done by using P r i n c i p a l Factoring with I t e r a t i o n (PA2) i n the S t a t i s t i c a l Package for S o c i a l Sciences (SPSS), Nie et a l . (1975), which replaces the main diagonal elements of the c o r r e l a t i o n matrix with communality estimates and thus produces i n -ferred f a c t o r s . I n i t i a l l y a free factor determination with a mineigen value of 0.5 was assigned and t h i s produced twenty-two i t e r a t i o n s before the 70 communality (the shared determinants that account f or the observed r e l a -t ions i n the data) of one or more variables exceeded 1.0. I t showed that seven Factors accounted f or more than 59 per cent of the variance, with an eigenvalue of 1.94 or greater. Ten Factors included 72 per cent while t h i r t e e n Factors included 81 per cent of the sample variance. Oblimin, or oblique r o t a t i o n , was performed to produce factor pattern loadings where the analyst could c o n t r o l the obliqueness of the so l u t i o n . Runs designating t h i r t e e n , eleven, ten, and seven Factors were performed i n order to e s t a b l i s h acceptable dimensions f or t h i s research. By oblique rotation^ factors could be extracted that were considered i n t u -i t i v e l y "meaningful" and so the r e s u l t s could be interpretable as dimen-sions. In turn f a c t o r s could be named and have t h e o r e t i c a l and p r a c t i c a l u t i l i t y . Oblique rotations allow the factors to become somewhat corre-la t e d with each other i n order to a r r i v e at simple structures that have d e f i n i t i o n . The constructs were expected to be somewhat correlated since i t was f e l t that such fa c t o r s , as i n nature, are r a r e l y independent of one another. To define a " s a l i e n t " factor, u n i t weights were chosen to include v a r i a b l e s which loaded (correlated) 0.40 and above on any given f a c t o r . A l l v ariables which f e l l below the 0.40 l e v e l were not included i n that factor dimension. In cases where there was a va r i a t e loading across more than one factor the va r i a t e was assigned to the factors to which i t had the highest loading value. The designation of seven Factors appeared to provide the c l e a r e s t factor d e f i n i t i o n , as for t h i s number of factors at l e a s t three of the 71 p r o f e s s i o n a l i z a t i o n questions per factor had a value of 0.40 or higher. By e s t a b l i s h i n g a 0.40 unit weight l e v e l for those variables to be i n -cluded within a dimension, the p r o f e s s i o n a l i z a t i o n questionnaire answers then became reduced i n number to t h i r t y - t h r e e questions to be used i n t h i s study. 4.3.4 Assignment of P r o f e s s i o n a l i z a t i o n Dimensions The t h i r t y - t h r e e questions of the seven Factors were assessed i n view of the p r o f e s s i o n a l i z a t i o n themes that they contained. The c l u s t e r of questions per factor were reviewed and t i t l e d and then designated as s p e c i f i c P r o f e s s i o n a l i z a t i o n Dimensions to be u t i l i z e d f or t e s t i n g the hypotheses of the study. The dimensions created by factor analysis are the following: Factor Question Unit Weight Factor 1—Dimension of Establishing the Status and Security, or Position, of the Occupation 16. Research on the Administration of health care should be promoted i n order to r a i s e the status of the occu-pation of Hospital Administration. 0.56 17. An association membership, which i s l i m i t e d to q u a l i -f i e d Hospital Administrators, i s necessary i n order to further the cause of Hospital Administration. 0.58 18. An a s s o c i a t i o n of Hospital Administrators should be able to c o n t r o l how membership within the Hospital Administration f i e l d i s maintained. 0.44 19. There should be a r e s t r i c t i o n of, or quota on, the 72 Factor Question Unit Weight number of people who can enter the f i e l d of Hospital Administration. 0.57 26. I t should be compulsory for a l l Hospital Adminis-t r a t o r s to be licensed under government l e g i s l a t i o n . 0.42 33. A government Act i s required to close the f i e l d of Hospital Administration to members only, before the state of the occupation can improve. 0.61 34. I t i s important f o r the occupation of Hospital Admin-i s t r a t i o n to undergo a name change to further i t s p r o f e s s i o n a l i z a t i o n process. 0.46 The p r o f e s s i o n a l i z a t i o n dimension created by Factor 1 was used to t e s t Security a t t i t u d e s of people with d i f f e r e n t degrees of academic education, as postulated by Hypothesis 3. Factor 2—Dimension of Work, Standards and Establishment of the Profession 1. Hospital Administrators should not seek to be recog-nized as a separate profession but j u s t be part of a management group that would include business executives i n various types of organizations. (A negative answer i s expected for the p r o f e s s i o n a l i z a -t i o n index.) 0.47 6. The work of the Hospital Administrator holds s p e c i a l challenges. 0.47 7. Hospital Administrators should perform t h e i r 73 Factor Question Unit Weight managerial duties without having to adhere to a set of standards that are l a i d down by a profes-s i o n a l a s s o ciation. (Negative answer.) 0.50 22. R e s p o n s i b i l i t y for r a i s i n g standards and q u a l i t y within the occupation of Hospital Administration should be held by: The Professional Association. 0.60 23. The occupational a s s o c i a t i o n as well as the Hospi-t a l Trustees, should have d i s c i p l i n a r y and expul-sory powers over Hospital Administrators. 0.43 37. Developing the pr o f e s s i o n a l status of Hospital Administration i s important to me. 0.55 39. The p r o f e s s i o n a l i z a t i o n of Hospital Administration has gone too f a r and i n t e r f e r e s with the d a i l y f u n c t i o n a l r o l e of the Hospital Administrator. (Negative answer.) 0.46 Factor 2 represented Bureaucratic Rules and Standards when the d i f f e r -ences between students' p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n i n T a l l and F l a t structured organizations were analyzed i n terms of student scores on t h i s dimension (Hypothesis 5). Factor 3—Dimension of Utilizing Professional Judgement and Sharing of Knowledge 9. Even though Hospital Administrators are employees, they should have the freedom to use t h e i r profes-s i o n a l judgement i n order to carry out t h e i r duties and r e s p o n s i b i l i t i e s . 0.44 74 Question Factor Unit Weight 10. Hospital Administrators should delegate some of t h e i r less important duties to other personnel. 0.78 11. Hospital Administrators should work hard to share with Hospital Administrators i n other organiza-tions , a l l of t h e i r work information concerning new ideas, solutions and experiences. 0.46 14. Hospital Administrators should undertake the re-s p o n s i b i l i t y of providing students who are pre-paring for careers i n Hospital Administration with p r a c t i c a l experiences by acting as preceptors. 0.57 Factor 3, representing the dimension of Professional Freedom, was also used i n Hypothesis 5 to t e s t the differences i n the students' o r i e n t a t i o n to determine i f students from F l a t organizations had a stronger profes-s i o n a l i z a t i o n o r i e n t a t i o n to t h i s dimension than students i n T a l l struc-tured organizations. Factor 4—Dimension of A Profession with Distinct Skills Oriented Towards Service 5. Hospital Administrators have d e f i n i t e and d i s -t i n c t work s k i l l s that d i f f e r e n t i a t e them from Administrators i n other types of organizations. 0.42 21. An association of Hospital Administrators should speak on behalf of Hospital Administrators' i n t e r e s t . 0.41 27. Hospital Administration i s a s a t i s f y i n g career. 0.56 75 Factor Question Unit Weight 28. Hospital Administrators should spend the majority of t h e i r time exercising the s k i l l s that are d i s -t i n c t i v e to t h e i r occupation rather than everyday administrative s k i l l s . 0.50 29. Hospital Administrators should give p r i o r i t y to t h e i r c l i e n t s ' (patients and public) needs before t h e i r own personal needs. 0.68 30. The Hospital Administrator should be oriented to-wards service as opposed to seeking monetary rewards. 0.48 Factor 4 was u t i l i z e d as two d i f f e r e n t concepts f o r two d i f f e r e n t hypo-t h e s i s . For Hypothesis 4 i t was used to t e s t Altruism when determining i f nurses and accountants had d i f f e r e n t attitudes towards t h i s aspect of p r o f e s s i o n a l i z a t i o n . Whereas, i n Hypothesis 6, Factor 4 determined the dimension of Operational Commitment. I t was used i n Hypothesis 6 to t e s t i f students i n low-level pos i t i o n s had a higher degree of profes-s i o n a l i z a t i o n f o r t h i s dimension than students who were employed i n top-l e v e l p o s i t i o n s . Factor 5—Dimension of Acceptance and Public Recognition 25. The judging and d i s c i p l i n i n g of members by an occupational association, i s only appropriate when the members are employed on a fe e - f o r - s e r v i c e basis. (Negative answer.) 0.48 31. I t i s important that c l i e n t s (patients) and the 76 Factor Question Unit Weight general community recognize the s p e c i a l exper-t i s e of the Hospital Administrator. 0.48 32. I t i s important that patients and the p u b l i c accept the authority of Hospital Administrators because of t h e i r s p e c i a l expertise. 0.40 Community of Interest was represented by the dimension created by Factor 5. This was used to t e s t Hypothesis 6 to determine i f students i n top l e v e l p o s i t i o n s have a higher degree of p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n to t h i s dimension than students who are employed i n lower l e v e l p o s i t i o n s . Factor 6—Dimension of An Educational Index 12. The job of the Hospital Administrator can be done e f f e c t i v e l y only by people who have undergone t r a i n i n g i n Hospital Administration at the l e v e l of: (no a d d i t i o n a l t r a i n i n g ; diploma; undergradu-ate; masters; doctorate degree—composite answer). 0.47 20. Proof of continuing education should be required to maintain membership within an association of Hospital Administrators. 0.63 38. During the past year my opinions have changed a great deal as to how Hospital Administration can become more p r o f e s s i o n a l i z e d . 0.56 This f a c t o r was not used on i t s own, but i t was included i n the seven dimensions that were tested for Hypothesis 1 and Hypothesis 2. 77 Question Factor Unit Weight Factor 7—Dimension of Standards and Quality of the Body of Knowledge 3. The f i e l d of Hospital Administration has devel-oped a body of knowledge based on s c i e n t i f i c and t h e o r e t i c a l p r i n c i p l e s . 0.40 22. R e s p o n s i b i l i t y for r a i s i n g standards and q u a l i t y within the occupation of Hospital Administration should be held by: (indicate option for each group) — T h e U n i v e r s i t i e s (Negative answer) 0.53 — T h e Preceptors 0.50 The dimension created by Factor 7 was used to t e s t Realism when determin-ing for Hypothesis 4 i f Nurses and Accountants had d i f f e r e n t attitudes towards t h i s aspect of p r o f e s s i o n a l i z a t i o n . the teaching programme to determine the d i f f e r e n c e s i n p r o f e s s i o n a l i z a -t i o n o r i e n t a t i o n between students of the 1975-76 and 1976-77 classes (Hypothesis 1) and students with p r o f e s s i o n a l and non-professional back-grounds (Hypothesis 2). 4.4 Hypothesis Testing and Results Hypothesis 1 was tested by using a l l t h i r t y - t h r e e questions of the seven p r o f e s s i o n a l i z a t i o n dimensions as a s i n g l e index of profession-a l i z a t i o n for the dependent v a r i a b l e . The d i f f e r e n t classes, 1975-76 and 1976-77, were used as the independent va r i a b l e i n order to determine i f A l l . seven factor dimensions were used to t e s t the influence of 78 the teaching programme had a p o s i t i v e influence as hypothesized. Hotelling's T-square t e s t was administered on the t h i r t y - t h r e e questions to e s t a b l i s h whether there were s i g n i f i c a n t differences between the two samples i n t h e i r o r i e n t a t i o n to p r o f e s s i o n a l i z a t i o n . When comparing the attitudes of the two classes there was a Hotelling's T-square value of 71.27 and an associated F-value of 1.722 (P = 0.017). The 1975-76 class had a mean score of 3.56 while the mean score for the 1976-77 cla s s was 3.47. The s i g n i f i c a n t d i f f e r e n c e , as indicated by the mean values, was i n the d i r e c t i o n of the observed 1975-76 class, i n d i c a t i n g that they had a s i g n i f i c a n t l y higher degree of pro-f e s s i o n a l i z a t i o n o r i e n t a t i o n than students i n the 1976-77 c l a s s . Consequently, Hypothesis 1 was sustained. Hospital Administrators, therefore, who were exposed to education on p r o f e s s i o n a l i z a t i o n (Lesson 10) had a s i g n i f i c a n t l y higher degree of p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n than students who had not been exposed to such education. (For more information concerning the Hotelling's T-square r e s u l t s r e f e r to Appendix D.) I n t e r e s t i n g l y , the p r o f i l e s f or the two classes are very s i m i l a r . The differences of the mean scores for the two classes f or each of the various seven factors range from 0.01 to 0.18 and no one question i n f l u -enced the s t a t i s t i c a l outcome. Instead, the s i g n i f i c a n t variance was due to an accumulative e f f e c t of the various question scores. When viewing the mean score values of the seven d i f f e r e n t dimen-sions i t shows that Dimensions 1 to 6 were most p o s i t i v e l y supported i n terms of p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n by the 1975-76 exposed c l a s s . 79 Whereas Dimension 7 was more posit ively supported by the 1976-77 class. Factor 7 deals with the Dimension of Standards and Quality of the Body of Knowledge. As the mean values for the two classes only vary by 0.09 (3.16 and 3.07) with both classes indicating an "Uncertain" opinion as to their attitudes to the questions, a rationale as to why there was a difference on this dimension would be highly speculative. The mean values of the various dimensions (see Table 4.2 below) indicate that only Factor 3, the Dimension of U t i l i z i n g Professional Judgement and Sharing of Knowledge, had a value of four or greater, i n d i -cating the students' Agreement. On the other hand, Factor 1, The Dimen-sion of Establishing the Status and Security, or Position of the Occupa-t ion , had mean scores just below a three value,indicating that the classes showed their most Disagreement with the need for Hospital Admin-is trat ion to raise i t s status through research, limited and controlled membership, government intervention or by changing i t s name. Strong well -established professions achieve these aspects of control . Therefore i f these ac t iv i t ies are to be desired for the profession of Hospital Admin-is t ra t ion , more persuasive communications concerning these aspects should be introduced. The differences between the two classes in scores on individual items were examined to provide some insight into the differences in a t t i -tudes between the two groups. The discussion on questions/items which follows, as well as subsequent discussions, are intended as guides to further hypotheses rather than as a rigorous s t a t i s t i c a l analysis, given the large number of t-tests involved. 80 Table 4.2. P r o f i l e of the Dimensions' Mean Scores Dimension 1975-76 Exposed 1976-77 Unexposed Mean Difference Factor 1 2.91 2.89 0.01 Factor 2 3.81 3.65 0.17 Factor 3 4. 36 4.34 0.02 Factor 4 3.70 3.55 0.15 Factor 5 3.83 3.65 0.18 Factor 6 3.36 3.24 0.12 Factor 7 3.07 3.16 (0.09) When the dif f e r e n c e of the mean scores of the two classes on each of the i n d i v i d u a l questions were tested by a Fisher two-sample t - t e s t , only Questions 1, 22c, 28, and 32 were s i g n i f i c a n t at a 0.05 l e v e l . These questions r e l a t e to the establishment and acceptance of the profes-sion, and to the p r o f e s s i o n a l association's r e s p o n s i b i l i t y f or r a i s i n g the standards within the profession. Other questions (11, 18, 23, and 25) which had a 0.2 difference between the mean scores d e a l t with c o n t r o l -l i n g and d i s c i p l i n i n g members and sharing information. (Mean scores are shown i n Appendix D.) As the mean scores were greater for the exposed c l a s s i n these important areas of p r o f e s s i o n a l i z a t i o n , these r e s u l t s i n d i -cate where the teaching programme may have had a p o s i t i v e e f f e c t . Ques-t i o n 29 (placing c l i e n t s ' needs before personal needs) was supported by the 1976-77 c l a s s , thus i n d i c a t i n g that with exposure, students moved away from t h i s a l t r u i s t i c concept. Hypothesis 4 supposed that students with nursing backgrounds 81 would have a s i g n i f i c a n t l y higher degree of p r o f e s s i o n a l i z a t i o n o r i e n t a -t i o n towards those aspects representing a l t r u i s m and dedication than students with an accounting background who are trained to be more calcu-l a t i n g and thus would therefore have attitudes towards realism. Hypothesis 4 was tested i n two parts. The f i r s t part examined whether there was a d i f f e r e n c e between students who were nurses and accountants i n attitudes on the Dimension of Altruism, while the second part d e a l t with differences i n attitudes on the Dimension of Realism. Factor 4, the Dimension of "A Profession with D i s t i n c t S k i l l s Oriented Towards Service," was used as the dependent va r i a b l e to t e s t Altruism. The Hotelling's T-square t e s t did not show an observed s i g n i f -i c a n t d i f f e r e n c e at the 0.05 l e v e l of s i g n i f i c a n c e . The Dimension of Realism was tested by u t i l i z i n g Factor 7, the Dimension of "Standards and the Quality of the Body of Knowledge." For the Dimension of Realism the Hotelling's T-square t e s t computed a T-square value of 11.60 and an associated F-value of 3.70 which produced a s i g n i f -icant l e v e l of 0.018 but i n the opposite d i r e c t i o n than that which had been hypothesized. The 0.018 l e v e l showed that students who had a nursing background were observed to have a s i g n i f i c a n t l y higher p r o f e s s i o n a l i z a -t i o n o r i e n t a t i o n to the Dimension of Realism than students with an accounting background. (Refer to Appendix D for the s t a t i s t i c a l breakdown.) The differences of attitudes on t h i s dimension between the nursing and accounting students i n d i c a t e that nurses have a stronger a t t i t u d e to-wards the preceptors s e t t i n g standards, rather than the u n i v e r s i t i e s , and that Hospital Administration has developed a body of knowledge. This could 82 be due to t h e i r own educational background or because they have t h e i r beginnings on a lower h i e r a r c h i c a l l e v e l within a health organization. They therefore f e e l that through the mechanisms being tested by t h i s Dimension t h e i r own p o s i t i o n could be improved. Whereas accountants are less interested i n t h i s Dimension as they strongly i d e n t i f y with t h e i r own profession, which can be construed as being equal to, or superior to, Hospital Administration. They therefore do not have the same need or b e l i e f that Hospital Administration has a developed body of knowledgey also, the u n i v e r s i t i e s and not the preceptors should hold the responsi-b i l i t y of r a i s i n g the standards. When the i n d i v i d u a l questions were submitted to a Fisher two-sample t - t e s t only Question 22b (Preceptors should hold the responsi-b i l i t y f o r r a i s i n g the standards and q u a l i t y within the occupation) showed an observed s t a t i s t i c a l d i f f e r e n c e at the 0.05 l e v e l of proba-b i l i t y (P = 0.013), i n d i c a t i n g that students from a nursing background showed a highly s i g n i f i c a n t support of t h i s question when compared with students from an accounting background. None of the remaining hypotheses (2 through 6) showed s i g n i f i c a n t findings when submitted to Hotelling's T-square t e s t . On t h i s basis as there were no observed di f f e r e n c e s between students i n the two groups i n or i e n t a t i o n to p r o f e s s i o n a l i z a t i o n due to academic; professional/non-p r o f e s s i o n a l ; p o s i t i o n l e v e l ; or organization structure d i f f e r e n c e s ; these f i v e hypotheses were not supported. 5.0 CONCLUSION The findings of t h i s study ind i c a t e that there i s a s i g n i f i c a n t r e l a t i o n s h i p between exposure to educational input on p r o f e s s i o n a l i z a t i o n (Lesson 10) and a student i n Hospital Administration o r i e n t a t i o n to pro-f e s s i o n a l i z a t i o n of the occupation of Hospital Administration. Students who had been exposed to Lesson 10 had a higher o v e r a l l o r i e n t a t i o n to p r o f e s s i o n a l i z a t i o n than students who had not yet been exposed to the teaching materials. Differences i n degree of o r i e n t a t i o n appear to re-l a t e s p e c i f i c a l l y to the Dimensions of Acceptance and Public Recognition; Work, Standards and Establishment of the Profession; and U t i l i z i n g Pro-f e s s i o n a l Judgement and Sharing of Knowledge. Looking at sub-categories of administrators i n the sample that were investigaged i n the study, Nurses and Accountants were found to d i f -f e r s i g n i f i c a n t l y i n terms of Realism. Students with a nursing background had a more p o s i t i v e p r o f e s s i o n a l i z a t i o n o r i e n t a t i o n to t h i s Dimension than students with an accounting background. This could ind i c a t e that students with a nursing background want to i d e n t i f y with the p r o f e s s i o n a l model for an occupation i n order to improve t h e i r own status. No other r e l a t i o n s h i p s were s t a t i s t i c a l l y s i g n i f i c a n t . Organiza-t i o n a l c h a r a c t e r i s t i c s such as structure ( T a l l and Flat) or l e v e l as well as 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 such as education and occupation appear to be unrelated to o r i e n t a t i o n to p r o f e s s i o n a l i z a t i o n as measured i n t h i s study. I t i s always d i f f i c u l t to draw conclusions and make recommendations 83 84 on the basis of a s i n g l e study. Therefore the conventional statement that further research i s needed applies i n t h i s study as i n any other. It i s important therefore to point out some of the l i m i t a t i o n s of t h i s study. F i r s t l y , a true pre- and post-treatment (Lesson 10) measure of a sin g l e sample was not p o s s i b l e . An approximation to t h i s condition was obtained through measures on comparable samples d i f f e r i n g only i n terms of exposure to Lesson 10. Some support for t h i s comparison comes from the analysis of the two samples on several demographic v a r i a b l e s . No s i g n i f i c a n t differences were observed between the samples of any of the demographic variables used. I t i s never possible to be completely compre-hensive i n c o n t r o l l i n g the sampling di f f e r e n c e s , nevertheless, the two-sample feature of the study had some l i m i t a t i o n s . Sample si z e s of seventy-nine (1975-76) and eighty-four (1976-77) are somewhat small f o r use i n a factor analysis of t h i r t y - t h r e e items. A r a t i o of at l e a s t f i v e subjects per questionnaire item i s i d e a l f or factor a n a l y s i s . However, no f i x e d r u l e e x i s t s and accepted p r a c t i c e tends to t r e a t a r a t i o of 2.5 to 3 subjects per questionnaire item as legitimate. Future research on the factor structure of p r o f e s s i o n a l i z a -t i o n , as perceived by Hospital Administrators, ought to involve larger sample sizes and p o s s i b l y a smaller set of questionnaire items. In evaluating the r e s u l t s of the present study, however, i t should be pointed out that s t a t i s t i c a l l y s i g n i f i c a n t differences were observed on mean scores of subjects derived from the t o t a l set of questionnaire items rather than on Factors involved, with the exception of differences between Nurses and Accountants on the Dimension of Realism. 85 A t h i r d feature of the study which must be dealt with i s the sponsorship of the Research by the Canadian Hospital Association. I t i s possible that responses by subjects were biased i n a d i r e c t i o n thought to be required or performed by the C.H.A. I t i s not possible to eliminate t h i s completely as a competing hypothesis for the r e s u l t s obtained. How-ever, every e f f o r t was made to minimize t h i s e f f e c t i n communications with the subjects. The questionnaire was constructed by the researcher independent of any input from the C.H.A. Letters to the subjects d i d not specify d i r e c t l y the intent of the research questions, and a time lapse of seven months occurred between the exposure to Lesson 10 and the administration of the questionnaire, providing as far as possible some "distance" between the C.H.A. course exposure and administration of the research instruments used i n t h i s study. The researcher d e l i b e r a t e l y avoided using Lesson 10 responses of subjects as a measure of education e f f e c t because of the l i k e l y response bias i n these answers. Further research should be undertaken on the dimensions of pro-f e s s i o n a l i z a t i o n so that such dimensions could be u t i l i z e d f o r future studies to assess attitudes towards the p r o f e s s i o n a l i z a t i o n orientations of d i f f e r e n t study samples i n order that occupations could then be pro-vided with an easy index for assessing such attitudes of the members, etc., of t h e i r organizations. They could then have a measure as to what attit u d e s should be reshaped i n order to d i r e c t the p r o f e s s i o n a l i z a t i o n process of the occupation. A d d i t i o n a l v a l i d a t i o n of these findings i s therefore recommended i f empirical research using t h i s t hesis instrument i s to make a 86 contribution to a theory con s i s t i n g of these s p e c i f i c p r o f e s s i o n a l i z a -t i o n themes forming p a r t i c u l a r p r o f e s s i o n a l i z a t i o n dimensions. BIBLIOGRAPHY Abrahamson, Mark. The Professional in the Organization. Chicago: Rand McNally & Co., 1967. Austin, Charles J . "Emerging Roles and R e s p o n s i b i l i t i e s of Health Admin-i s t r a t i o n . " In Education for Health Administration 1: 137-51. Edited by Charles J . Austin and Janet A. Strauss. Ann Arbor: Univer-s i t y of Michigan, Administration Press, 1975. Austin, Charles J . and Strauss, Janet A. Education for Health Administra-tion 1. Ann Arbor: University of Michigan, Administration Press, 1975. Bandura, Alb e r t . Principles of Behavior Modification. Toronto: Holt, Rinehard & Winston, 1969. Barker, W. Daniel. "Professional Self-Reliance or Self-Destruction: The Choice i s Ours." Hospital Accounting 20 (May 1966): 3-5. Becker, Howard S.; Geer, Blanche; Hughes, Everett C ; and Strauss, Anselm. Boys in White: Student Culture in Medical School. Chicago: Univer-s i t y of Chicago Press, 1961. B l a i n , G i l b e r t . "The Professional i n a Bureaucratic Structure." The Hospital Medical Staff 4 (October 1975): 1-6. Blishen, Bernard R. Doctors and Doctrines: The Ideology of Medical Care In Canada. Toronto: University of Toronto Press, 1969. Brown, Bernard L., J r . "The Profession of Hospital Administration. Southern Hospitals 38 (February 1970): 12-14. Brown, Montague. Statement to National Advisory Council on Nursing Home Administration, A t l a n t i c C i t y , N.J., 19 September 1968. Quoted i n A. Somers, Hospital Regulations: The Dilemma of Public Policy, p. 82. Princeton: Princeton University, I n d u s t r i a l Relations Section, 1969. Brown, R. W. Social Psychology. New York: Free Press, 1965. Campbell, Donald T. and Stanley, J u l i a n C. Experimental and Quasi-experimental Designs for Research. Chicago: Rand McNally College Publishing Co., 1973. Canadian College of Health Service Executives. "For the Development of External Baccalaureate Degree i n Hospital Administration." Proposal to the Kellogg Foundation (October), 1975. (Drafted.) 87 88 Canadian Hospital Association Convention. Montreal, 2, 3 & 4 June 1971. Caplow, Theodore. The Sociology of Work. Minneapolis: University of Min-nesota Press, 1954. . "The Sequence of P r o f e s s i o n a l i z a t i o n (General)." In Profession-alization, pp. 20-21. Edited by Howard M. Vollmer and Donald L. M i l l s . Toronto: P r e n t i c e - H a l l of Canada, 1966. Carr-Saunders, A. M. " P r o f e s s i o n a l i z a t i o n i n H i s t o r i c a l Perspective: (General)." In Professionalization, pp. 3-9. Edited by Howard M. Vollmer and Donald L. M i l l s . Toronto: Prentice-Hall of Canada, 1966. Carr-Saunders, A. M. and Wilson, P. A. The Professions. London: F. Cass, 1964. Clark, Burton R. "International Patterns i n Education." Administrative Science Quarterly 10 (September 1965): 224-37. Cohen, Arthur Robert. Attitude Change and Social Influence. New York: Basic Books, 1964. Cummings, L. and ElSalmi, A. "The Impact of Role D i v e r s i t y , Job Level and Organizational Size on Managerial S a t i s f a c t i o n . " Administrative Science Quarterly 15 (March 1970): 1-11. Dolson, Miriam Terry. "Where Women Stand i n Administration." The Modern Hospital 108, no. 5 (May 1976): 100-105. Dolson, Miriam T.; White, Rodney F.; and Van Riper, Paul. "Study Reveals What Administrators Earn." Modern Hospital ( A p r i l 1966): 103-6. Doob, L. W. "The Behavior of A t t i t u d e s . " Psychological Review 54 (1947): 135-56. Drucker, Peter F. The Practice of Management. New York: Harper & Bros. Publishers, 1954. Durkheim, Emile. The Division of Labor in Society. Translated by George Simpson. Glencoe, 111.: Free Press, 1933; 4th p r i n t i n g , 1960. E t z i o n i , Amitai. Modern Organizations. Englewood C l i f f s , N.J.: Prentice-H a l l , 1964. Gibson, J. L.; Ivanoevich, J . M.; and Donnely, J . H. Organizations: Structure Process, Behavior. Georgetown, Ont.: Irwin-Dorsey, 1973. Glaser, Barney. Organizational Scientists: Their Professional Careers. Indianapolis: Bobbs-Merrill, 1964. 89 Greenwood, Ernest. "Attitudes of a Profession." Social Work 2, no. 3 (1957): 44-55. • . "The Elements of P r o f e s s i o n a l i z a t i o n (Social Work." In Profes-sionalization. Edited by Howard M. Vollmer and Donald L. M i l l s . Toronto: P r e n t i c e - H a l l of Canada, 1966. Gross, Edward. Work and Society. New York: Thomas Y. Crowell Co., 1958, p. 77. H a l l , Richard H. "Some Organizational Considerations i n the Pr o f e s s i o n a l -Organizational Relationship. Administrative Science Quarterly 12 (December 1967): 461-78. . " P r o f e s s i o n a l i z a t i o n and Bureaucratization." In The Formal Organization, pp. 143-63. New York: Basic Books, 1972. Harvey, 0. J . ; Hunt, David Ed.; and Schroder, Harold M. Conceptual Sys-tems and Personality Organization. New York: John Wiley & Sons, 1961. Hovland, C a r l I. and Janis, I r v i n L., eds. Personality and Persuasibility. New Haven: Yale University Press, 1959. Hovland, C a r l I.; Janis, I r v i n g L.; and Kelley, Harold H. Communication and Persuasion: Psychological Studies of Opinion Change. New Haven: Yale University Press, 1953. Hughes, Everett C. Men and Their Work. Glencoe, 111.: Free Press, 1958. . "The S o c i a l S i g n i f i c a n c e of P r o f e s s i o n a l i z a t i o n (General)." In Professionalization, pp. 64-71. Edited by Howard M. Vollmer and Donald L. M i l l s . Toronto: P r e n t i c e - H a l l of Canada, 1966. Indik, Bernard P. "Some E f f e c t s of Organization Size on Member Attitudes and Behavior." Human Relations 16, no. 4 (November 1963): 369-84. Indik, Barnard P. and Seashore, S. Effects of Organization Size of Member Attitudes and Behavior. Ann Arbor: University of Michigan, Survey Research Centre, 1961. Jones, L. V. and J e f f r e y , T. E. "A Quantitative Analysis of Expressed Preferences for Compensation Plans." Journal of Applied Psychology 48, no. 4 (August 1964): 201-10. Katz, Daniel and Kahn, Robert L. The Social Psychology of Organizations. New York: John Wiley & Sons, 1966. K a t z e l l , R. A.; Barrett, R. S.; and Parker, T. C. "Job S a t i s f a c t i o n , Job Performance, and S i t u a t i o n a l C h a r a c t e r i s t i c s . " Journal of Applied Psychology 45, no. 2 (A p r i l 1961): 65-72. 90 Kerr, W. A.; Koppelmeier, G. J . ; and Sullivan, J . S. "Absenteeism, Turn-over and Morale i n a Metals Fa b r i c a t i o n Factory." Occupational Psychology 25 (1951): 50-55. Krause, E l l i o t t A. The Sociology of Occupations. Boston: L i t t l e , Brown & Co., 1971. Larke, A. G. "Workers Attitudes on Incentives." Dun's Review and Modern Industry (December 1953), pp. 61-63. Cite d by John P. Campbell, Marvin D. Dunnette, Edward E. Lawler, I I I , and K a r l E. Weick, J r . In Managerial Behavior Performance and Effectiveness, p. 364. Toronto: McGraw-Hill, 1970. Letourneau, Charles U. The Hospital Administrator. Chicago: S t a r l i n g Pub-l i c a t i o n s , 1969. Lewis, Roy and Maude, Angus. Professional People, Chapter 5. .London: Phoenix House, 1952. L i k e r t , Rensis. "A Technique for the Measurement of A t t i t u d e s . " Archives of Psychology 22, no. 140 (June 1932): 5-55. L o r t i e , Daniel C. "Laymen to Lawmen: Law School, Careers and Professional S o c i a l i z a t i o n . " In Professionalization, pp. 98-101.' Edited by Howard M. Vollmer and Donald L. M i l l s . Toronto: P r e n t i c e - H a l l of Canada, 1966. MacKenzie, Norah. The Professional Ethic and The Hospital Service. London: English U n i v e r s i t i e s Press, 1971. McKenzie, R. M. "The Behavioural Sciences and Organisations." In Health Services Administration, Chapter 3. Edited by R. J . Peters and J . Kinnaird. London: E. & S. Livingstone, 1965. McLeish, John A. B. and Nightingale, Donald V. Health Service Executive Manpower Needs for the Seventies in Canada. A preliminary Report fo r Manpower Planning, Department of National Health and Welfare, Ottawa, 1973. Maslow, Abraham H. Motivation and Personality. 2d ed. New York: Harper & Row Publishers, 1970, 1954. Merriam-Webster Trademark. Webster's Seventh New Collegiate Dictionary. Toronto: Thomas A l l e n & Son, 1969. M i l l e r s o n , Geoffrey. The Qualifying Associations; A Study in Professional-ization. London: Routledge & Kegan Paul, 1964. M i l l s , Donald L. "Status, Values and Certainty of Occupational Choice." 91 Ph.D. d i s s e r t a t i o n . Stanford University, 1962. Ci t e d by Howard M. Vollmer and Donald L. M i l l s , Professionalization, pp. 87-88. Toronto: P r e n t i c e - H a l l of Canada, 1966. Miner, John B. The Management Process: Theory, Research and Practice. Toronto: Collier-Macmillan Canada, 1973. More, D. M. and Kohn, Nathan, J r . "Some Motives for Entering Dentistry." American Journal of Sociology 66, no. 1 (July 1960): 48-53. Nealy. S. "Pay and Benefit Preferences." Industrial Relations 1 (1963): 17-28. Cited by John P. Campbell, Marvin D. Dunnette, Edward E. Lawler, I I I , and K a r l E. Weick, J r . Managerial Behavior Performance and Effectiveness, p. 364. Toronto: McGraw-Hill, 1970. Newman, William H. Administrative Action: The Technigues of Organization and Management. Englewood C l i f f s , N.J.: P r e n t i c e - H a l l , 1951. Nie, Norman H.; H u l l , C. Hadlai; Jenkins, Jean G.; Steinbrenner, Karen; and Bent, Dale H. Statistical Package for the Social Sciences. 2d ed. Toronto: McGraw-Hill Book Co., 1975. Parsons, T a l c o t t . "Suggestions for a S o c i o l o g i c a l Approach to the Theory of Organizations." Administrative Science Quarterly 1 (1956): 63-85. Pickering, E r r o l . "Hospital Administration i n Canada." Hospital and Health Administration, Australia 5 (May 1972): 13-15. Porter, L. and Lawler, E. I I I . "The E f f e c t s of ' T a l l ' versus 'Flat' Organization Structures on Managerial Job S a t i s f a c t i o n . " Personnel Psychology 17, no. 2 (Summer 1964): 135-48. Rosenberg, M. J . "An Analysis of A f f e c t i v e - C o g n i t i v e Consistency." In Attitude Organization and Change: An Analysis of Consistency among Attitude Components, pp. 15-64. Edited by M. J . Rosenberg, C. I. Hovland, W. J. McGuire, R. P. Abelson, and J . W. Brehm. New Haven: Yale University Press, 1960. Rosenberg, M. J . ; Hovland, C. I.; McGuire, W. J . ; Abelson, R. P.; and Brehm, J. W. Attitude Organization and Change: An Analysis of Con-sistency among Attitude Components. New Haven: Yale University Press, 1960. Schein, Edgar H. Organizational Psychology. Englewood C l i f f s , N.J.: P r e n t i c e - H a l l , 1965. Sheldon, Alan; Baker, Frank; and McLaughlin, C u r t i s P. Systems and Medical Care. Cambridge: M.I.T. Press, 1970. Sherlock, B a s i l and Cohen, Alan. "The Strategy of Occupational Choice: 92 Recruitment to Dentistry." Social Forces 44 (March 1966): 303-13. S h u l l , Fremont A. J r . ; Delbecq, Andre L.; and Cummings, L. L. Organiza-tional Decision Making. Toronto: McGraw-Hill, 1970, Chapter 4. Sloan, Raymond P. Today's Hospital; A Guide for Trustees, Administrators, and Volunteers. Toronto: Harper & Row Publishers, 1966, Chapter 6. Somers, Anne R. Hospital Regulation: The Dilemma of Public Policy. Princeton: I n d u s t r i a l Relations Section, Princeton University, 1969. Stefanuk, E. N. Extension Course i n Hospital Organization and Management. Revision Project §606-22-4. F i n a l Report. Canadian Hospital Associ-ation, Toronto (July 1973). Taylor, Ronald N. "Perception of Problem Constraints." Vancouver: Univer-s i t y of B r i t i s h Columbia, 1974. (Mimeographed.) Thompson, James D. Organizations in Action. Toronto: McGraw-Hill Book Co., 1967, Chapters 6-7. Vollmer, Howard M. and M i l l s , Donald L. Professionalization. Toronto: P r e n t i c e - H a l l of Canada, 1966. Weaver, Jer r y L. Conflict and Control in Health Care Administration 14. Beverly H i l l s , C a l i f . : Sage Library of S o c i a l Research, Sage P u b l i -cations, 1975. Westly, D. L. "The Career Experience of the Symphony Musician." Social Forces 38, no. 3 (March I960): 223-30. White, D. K. "Management Education i n Health Care." The Hospital and Health Services Review 68, no. 1 (January 1972): 5-9. Whyte, William H. J r . The Organization Man. New York: Simon & Schuster, 1956. Wilensky, Harold L. "The Dynamics of Professionalism: The Case of Hospital Administration. Hospital Administration (Spring 1962): 6-24. . "The P r o f e s s i o n a l i z a t i o n of Everyone." American Journal of Sociology 70, no. 2 (September 1964): 137-58. Worthy, James C. "Organizational Structure and Employee Morale." American Sociological Review 15.(1950): 169-79. APPENDIX A.Q QUESTIONNAIRE DESIGN, CODING AND DISTRIBUTION A . l Demographic Questionnaire A.2 P r o f e s s i o n a l i z a t i o n Questionnaire A.3 Coding System U t i l i z e d A.4 Letters for D i s t r i b u t i o n 93 94 A . l Demographic Questionnaire Please leave Blank 1. NAME (1-3) 2. EDUCATION—Course, years completed, c e r t i f i c a t e or degree obtained. Canadian Hospital Association H.O.M.—1st year (20) — 2 n d year DMC HFSS HRT (E) ECOM C e r t i f i e d Hospital Course (21) Technical College University Other 3. OCCUPATIONAL BACKGROUND—Last 3 po s i t i o n s or jobs held, s t a r t i n g with the most recent p o s i t i o n . Occupation P o s i t i o n T i t l e No. years Held (23) (24) (25-26) 95 Please leave Blank Occupation P o s i t i o n T i t l e No. years Held (27) (28) (29-30) (31) (32) (33-34) 4. TYPE OF FACILITY OF PRESENT EMPLOYMENT—Acute General, P s y c h i a t r i c , Mentally Retarded, Extended Care, T.B., R e h a b i l i t a t i o n , Nursing Home, Community Health Centre, P r o v i n c i a l Authority, Regional Health Programme, Volun-teer Agency, etc. ( i f involved i n more than one type indi c a t e primary and secondary involvement) (36) (37) ORGANIZATION STRUCTURE OF PRESENT EMPLOYMENT FACILITY— To a s s i s t consistency for t h i s question and example Organization Chart i s i l l u s t r a t e d i n d i c a t i n g various l e v e l s . This i s only a guide. Please use your own (hospital) organization chart to answer. Level No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Board of Trustees | Medical Board Executive Director Medical Director Associate Director Finance Director Employees Service • Administrative Resident D i v i s i o n Director Assoc. Dir Dept. Head-J-Dept. Head r-Ass. Dept. Dept Head [-Senior S t a f f hJunior S t a f f S t a f f D i v i s i o n Director Planning j Nursing Exec. Cttee. Head- • Dept. Head No. of l e v e l s within your Organization Your P o s i t i o n Level (counting from top down) No. of People that You D i r e c t l y Supervise No. of Personnel within your Dept. or Sub-unit No. of Personnel within the t o t a l Organization (39) (40) (41) (42) (43) A.2 P r o f e s s i o n a l i z a t i o n Questionnaire QUESTIONNAIRE ON HOSPITAL ADMINISTRATION NAME This questionnaire i s designed to obtain your views about Hospital Administration. There are no correct answers. In answering the survey, please i n d i c a t e your own feelings concerning the various statements and do not s o l i c i t the opinions of others. The information w i l l be handled i n a c o n f i d e n t i a l manner and only seen by the researcher. I would l i k e to thank you i n advance for completing the f u l l questionnaire and for your p a r t i c i p a t i o n . — C . Bortnick, Research A s s i s t a n t , U.B.C. Complete the questionnaire by checking (/) the one category, of the f i v e provided, which most c l o s e l y f i t s your opinion on each of the following statements. 1. Hospital Administrators should not seek to be recognized as a separate profession but j u s t be part of a management group that would include business executives i n various types of organizations. Strongly Agree Uncertain Disagree Strongly Agree Disagree I t i s important for Hospital Administrators to have an ap-p r e c i a t i o n of the unique h i s t o r i c a l background that d i f f e r -entiates Hospital Administration from other administrative occupations. Strongly Agree Uncertain Disagree Strongly Agree Disagree 3. The f i e l d of Hospital Administration has developed a body of knowledge based on s c i e n t i f i c and t h e o r e t i c a l p r i n c i p l e s Strongly Agree Uncertain Disagree Strongly Agree Disagree 4. Hospital Administrators use a vocabulary, or terminology, that i s unique to them alone, and i s not used commonly 97 Please leave Blank by administrators i n other management f i e l d s . Strongly Agree Uncertain Disagree Strongly (7) Agree Disagree 5. Hospital Administrators have d e f i n i t e and d i s t i n c t work s k i l l s that d i f f e r e n t i a t e them from administrators i n other types of organizations. Strongly Agree Uncertain Disagree Strongly (8) Agree Disagree 6. The work of the Hospital Administrator holds s p e c i a l challenges. Strongly Agree Uncertain Disagree Strongly (9) Agree Disagree 7. Hospital Administrators should perform t h e i r managerial duties without having to adhere to a set of standards that are l a i d down by a p r o f e s s i o n a l association. Strongly Agree Uncertain Disagree Strongly (10) Agree Disagree 8. When there i s a d i f f e r e n c e , i t i s more important that Hospital Administrators adhere to t h e i r occupational code of ethi c s than that they follow the i n s t r u c t i o n s of the Board of Trustees. Strongly Agree Uncertain Disagree Strongly (11) Agree Disagree 9. Even though Hospital Administrators are employees, they should have the freedom to use t h e i r p r o f e s s i o n a l judge-ment i n order to carry out t h e i r duties and responsi-b i l i t i e s . Strongly Agree Uncertain Disagree Strongly (12) Agree Disagree 10. Hospital Administrators should delegate some of t h e i r l e s s important duties to other personnel. Strongly Agree Uncertain Disagree Strongly Agree Disagree (13) 98 Please leave Blank 11. Hospital Administrators should work hard to share with Hospital Administrators i n other organizations, a l l of t h e i r work information concerning new ideas, solutions and experiences. Strongly Agree Uncertain Disagree Strongly (14) Agree Disagree 12. The job of the Hospital Administrator can be done e f f e c -t i v e l y only by people who have undergone t r a i n i n g i n Hospital Administration at the l e v e l of: (indicate opinion for each level) Strongly Strongly Agree Agree Uncertain Disagree Disagree -No Additional Training: (15) -Diploma: ; (16) -Undergraduate Degree: -Masters Degree: -Doctoral Degree: 13. S a t i s f a c t o r y completion of a prescribed course should be a mandatory requirement for anyone who i s h i r e d as a Hospital Administrator. (17) (18) (19) Strongly Agree Uncertain Disagree Strongly (20) Agree Disagree 14. Hospital Administrators should undertake the responsi-b i l i t y of providing students who are preparing for careers i n Hospital Administration with p r a c t i c a l exper-iences by acting as preceptors. Strongly Agree Uncertain Disagree Strongly Agree Disagree (21) 99 Please leave Blank 15. In a u n i v e r s i t y s e t t i n g , Hospital Administration should: (indicate opinion for each setting) Strongly Strongly Agree Agree Uncertain Disagree Disagree -Establish its own faculty or school: -Be placed under the faculty of Medicine: -Be placed under the faculty of Commerce/'Administration: -Be jointly under Medicine and Commerce/Administration: 16. Research on the Administration of health care should be promoted i n order to r a i s e the status of the occupation of Hospital Administration. Strongly Agree Uncertain Disagree Strongly Agree Disagree 17. An a s s o c i a t i o n membership, which i s l i m i t e d to q u a l i f i e d Hospital Administrators, i s necessary i n order to further the cause of Hospital Administration. Strongly Agree Uncertain Disagree Strongly Agree Disagree 18. An a s s o c i a t i o n of Hospital Administrators should be able to c o n t r o l how membership within the Hospital Administra-t i o n f i e l d i s maintained. (22) (23) (24) (25) (26) (27) Strongly Agree Uncertain Disagree Strongly Agree Disagree 19. There should be a r e s t r i c t i o n of, or quota on, the number of people who can enter the f i e l d of Hospital Administra-t i o n . (28) Strongly Agree Uncertain Disagree Strongly Agree Disagree 20. Proof of continuing education should be required to (29) 100 Please leave Blank maintain membership within an asso c i a t i o n of Hospital Administrators. . Strongly Agree Uncertain Disagree Strongly Agree Disagree 21. An asso c i a t i o n of Hospital Administrators should speak on behalf of Hospital Administrators' i n t e r e s t . Strongly Agree Uncertain Disagree Strongly Agree Disagree 22. R e s p o n s i b i l i t y f o r r a i s i n g standards and q u a l i t y within the occupation of Hospital Administration should be held by: (indicate opinion f o r each group) Strongly Strongly Agree Agree Uncertain Disagree Disagree -The Universities: -The Preceptors: -The Occupational Association: 23. The occupational a s s o c i a t i o n as well as the Hospital Trustees, should have d i s c i p l i n a r y and expulsory powers over Hospital Administrators. Strongly Agree Agree Uncertain Disagree Strongly Disagree 24. The occupational association should protect i t s members against Trustees' d i s c i p l i n a r y actions when matters of moral conduct are involved. Strongly Agree Agree Uncertain Disagree Strongly Disagree 25. The judging and d i s c i p l i n i n g of members by an occupa-t i o n a l a s s ociation, i s only appropriate when the members are employed on a fe e - f o r - s e r v i c e basis. (30) (31) (32) (33) (34) (35) (36) Strongly Agree Uncertain Disagree Strongly Agree Disagree (37) 101 Please leave Blank 26. I t should be compulsory for a l l Hospital Administrators to be licensed under government l e g i s l a t i o n . Strongly Agree Uncertain Disagree Strongly (38) Agree Disagree 27. Hospital Administration i s a s a t i s f y i n g career. Strongly Agree Uncertain Disagree Strongly (39) Agree Disagree 28. Hospital Administrators should spend the majority of t h e i r time exercising the s k i l l s that are d i s t i n c t to t h e i r occupation rather than everyday administrative s k i l l s . Strongly Agree Uncertain Disagree Strongly (40) Agree Disagree 29. Hospital Administrators should give p r i o r i t y to t h e i r c l i e n t s ' (patients and public) needs before t h e i r own personal needs. Strongly Agree Uncertain Disagree Strongly (41) Agree Disagree 30. The Hospital Administrator should be oriented towards service as opposed to seeking monetary rewards. Strongly Agree Uncertain Disagree Strongly (42) Agree Disagree 31. I t i s important that c l i e n t s (patients) and the general community recognize the s p e c i a l expertise of the Hospital Administrator. Strongly Agree Uncertain Disagree Strongly (43) Agree Disagree 32. I t i s important that patients and the p u b l i c accept the authority of Hospital Administrators because of t h e i r s p e c i a l expertise. Strongly Agree Uncertain Disagree Strongly Agree Disagree (44) 102 Please leave Blank 33. A government Act i s required to close the f i e l d of Hospital Administration to members only, before the state of the occupation can improve. Strongly Agree Uncertain Disagree Strongly (45) Agree Disagree 34. I t i s important f o r the occupation of Hospital Adminis-t r a t i o n to undergo a name change to further i t s profes-s i o n a l i z a t i o n process. Strongly Agree Uncertain Disagree Strongly (46) Agree Disagree 35. Most l e g i s l a t i o n concerned with the occupation of Hospital Administration should be shaped by Hospital Administrators as a body acting through t h e i r occupational association rather than through p o l i t i c a l decision-making. Strongly Agree Uncertain Disagree Strongly (47) Agree Disagree 36. Hospital Administration now constitutes a profession. Strongly Agree Uncertain Disagree Strongly (48) Agree Disagree 37. Developing the p r o f e s s i o n a l status of Hospital Administra-t i o n i s important to me. Strongly Agree Uncertain Disagree Strongly (49) Agree Disagree 38. During the past year my opinions have changed a great deal as to how Hospital Administration can become more pr o f e s s i o n a l i z e d . Strongly Agree Uncertain Disagree Strongly (50) Agree Disagree 39. The p r o f e s s i o n a l i z a t i o n of Hospital Administration has gone too f a r and i n t e r f e r e s with the d a i l y f u nctional r o l e of the Hospital Administrator. Strongly Agree Uncertain Disagree Strongly Agree Disagree (51) What do you f e e l i s the most major change, or requirement, that Hospital Administrators must undergo i n order to en-hance t h e i r future position? Do you wish to receive the findings of t h i s study? [ ] yes [ ] no 104 A.3 Coding System U t i l i z e d The p r o f e s s i o n a l i z a t i o n questionnaire items were scored on a f i v e point L i k e r t ' s scale, with a range from one to f i v e . For each item a score of one represented strong disagreement with the item statement; two—disagreement; three;—uncertainty as to whether the respondent agreed or disagreed; four—agreement; and f i v e — s t r o n g agreement with the item statement. For questions where negative answers were expected, the coding system was reversed, i . e . , a score of one represented strong agreement and a score of f i v e represented strong disagreement. The questions or parts of questions which were coded i n the reverse manner were: Questions 1, 7, 12a, 12b, 15b, 15d, 22a, and 39. The open-ended question number 40 was not used i n the a n a l y s i s . A.4 Letters for D i s t r i b u t i o n See the following eight pages for the research l e t t e r s . CANADIAN HOSPITAL ASSOCIATION 105 Dear Student, The Canadian Hospital Association has requested that I undertake a study of students regarding the H.O.M. course and Hospital Administra-t i o n . In order to complete t h i s work, I require your assistance. W i l l you please f i l l i n the enclosed questionnaire and return i t to me promptly I t i s very important to obtain t h i s information from you so that I may do an adequate study. The information w i l l be handled i n a c o n f i d e n t i a l manner and only seen by the researcher. I am working out of the above address. A return envelope i s en-closed for your convenience. I would l i k e to have the material returned i n one week's time so that i t may be computed i n early February. However, I can add i n l a t e r e p l i e s by hand as I r e a l i z e that some of you may be i n a p o s i t i o n where you are unable to meet t h i s time requirement. I would l i k e to thank you for your co-operation. I a n t i c i p a t e that the p r o j e c t w i l l be completed for the Canadian Hospital Association by l a t e summer. Sincerely, (Sgnd.) Carol A. Bortnick (Mrs.) Carol A. Bortnick Research A s s i s t a n t Department of Health Care and Epidemiology Un i v e r s i t y of B r i t i s h Columbia CAB:ehj 106 CANADIAN HOSPITAL ASSOCIATION M E M O Date: January 19, 1976 To: F i r s t - Y e a r H.O.M. Students From: Erwin Waschnig, Ph.D. Head Reference: Research Project Education Department In order to get research support for the H.O.M. program, the Canadian Hospital Association was very fortunate i n getting the co-operation of the University of B r i t i s h Columbia to undertake a study on the effectiveness and l e v e l of standard of the H.O.M. course. Mrs. Carol Bortnick, Research Assistant, Department of Health Care and Epidemiology, Faculty of Medicine, U.B.C. has very kindly agreed to undertake t h i s p r o j e c t under the supervision of Doctor Anne Crichton. The r e s u l t s of t h i s study w i l l help us tremendously i n our con-tinuous e f f o r t to improve the q u a l i t y and effectiveness of the program which, i n turn, w i l l b e n e f i t the graduates having p a r t i c i p a t e d i n a na t i o n a l l y recognized program of high standard. Your Assignment 10 has been selected to be the main resource for a n a l y s i s . Together with other necessary data we hope to bring t h i s p r o j e c t to a conclusion by September 1976. Please f i n d enclosed a l e t t e r and a questionnaire developed by Mrs. Bortnick. Also, for your convenience, a stamped return envelope for the completed questionnaire. Your kind assistance w i l l be very much appreciated. (Sgnd.) Erwin Waschnig 107 CANADIAN HOSPITAL ASSOCIATION M E M O Date: August, 1976 To: Second-Year H.O.M. Students 1976/77 From: Erwin Waschnig, Ph.D. Head Education Department Reference: Research Project We are s t i l l involved i n the research study undertaken by the University of B r i t i s h Columbia. To complete the project, please be kind enough to f i l l out the enclosed questionnaire. I t i s important to have the f u l l co-operation of a l l the students. Please use the enclosed stamped addressed envelope for the return of the questionnaire to Mrs. Carol Bortnick. Thank you very much for your assistance. Sincerely, (Sgnd.) Erwin Waschnig 108 Dear Student: In order to complete a study for the Canadian Hospital Asso-c i a t i o n I require your assistance. I t i s important to obtain informa-t i o n from you so that an adequate study can be undertaken. I t i s anticipated that the study findings w i l l prove to be useful to the future of the profession of Hospital Administration and the H.O.M. programme. Only students of the Canadian Hospital Association have been chosen f o r t h i s survey. The study has received complete approval of the Canadian Hospital Association. A l l information w i l l be treated with the s t r i c t e s t confidence necessary to ensure t o t a l anonymity. I am working from the above address. A return envelope i s en-closed f o r your convenience. I would l i k e to have the material returned i n one week's time so that i t may be computed by the end of the month. However, i f you are unable to meet t h i s time requirement, please return the questionnaire as soon as p o s s i b l e . The study should be completed by F a l l . I would l i k e to thank you, i n advance, f o r your p a r t i c i p a t i o n and co-operation. Sincerely, C. A. Bortnick Research Assistant Department of Health Care and Epidemiology University of B r i t i s h Columbia 109 Dear Student: Thank you for your p a r t i c i p a t i o n i n the Canadian Hospital re-search p r o j e c t . I appreciate your i n t e r e s t and promptness i n supplying the requested information. While compiling the data I noticed that your questionnaire had two pages stuck together so consequently the t h i r d page was not com-pleted. As I value your opinions I am enclosing that page so that i t can be f i l l e d out and returned for compilation. In t h i s manner the re-su l t s of the study w i l l r e f l e c t your feel i n g s towards a l l of the sub-j e c t matter. I believe i t i s important that your views are included to add the strength of your opinions. Thank you, once again, for your p a r t i c i p a t i o n and co-operation. Sincerely, C. Bortnick Research A s s i s t a n t U.B.C. 110 Dear Student: Recently a questionnaire(s) and a request f o r your assistance i n helping with a study of the occupation of Hospital Administration was sent to you. As there i s an overlap i n mailing time, i f you have already returned the questionnaire(s), thank you. I f not, I am enclos-ing another copy of the same questionnaire(s), with a return envelope fo r your convenience, so that your opinions can be r e f l e c t e d by the study. You can make a valuable contribution to t h i s research by taking a few minutes to complete the enclosed questionnaire(s). Your answers w i l l give an inside view of Hospital Administration and perceptions of c h a r a c t e r i s t i c s of t h i s occupation. With a complete cl a s s sample the answers w i l l then e s t a b l i s h a more d e f i n i t e occupational p r o f i l e for the Canadian Hospital Association. Let me emphasize that your answers w i l l be kept s t r i c t l y c o n f i -d e n t i a l . Should you require further information or assistance, please do not hesitate to write, using the enclosed envelope. As the information which you can provide i s very valuable, I look forward to r e c e i v i n g your completed questionnaire soon. Thank you for helping future students and the Canadian Hospital Association. Sincerely, (Sgnd.) C. Bortnick C. A. Bortnick Research A s s i s t a n t U.B.C. I l l Dear Student: While compiling the data I found that your name appears on the l i s t of both H.O.M. classes that are under study. Therefore I assume material of the H.O.M. teaching programme was received by you during the 1975-1976 course year. Consequently, could you please t e l l me i f since that time, of rec e i v i n g the material, i f you read the Lesson material before completing the questionnaire on Hospital Administration, of the August 1976 study. Knowing i f you had read the material before completing the ques-tionnaire would help c l a r i f y the study populations. In order f o r the study to c o r r e c t l y r e f l e c t your opinions could you please f i l l out the bottom portion of t h i s l e t t e r and return i t to me. Thank you for your p a r t i c i p a t i o n and co-operation. Sincerely, (Sgnd.) C. Bortnick C. A. Bortnick Research A s s i s t a n t U.B.C. NAME PRIOR TO COMPLETION OF THE QUESTIONNAIRE I READ THE LESSON MATERIAL: [ ] yes f ] no CANADIAN HOSPITAL ASSOCIATION M E M O Date: September 27, 1976 To: H.O.M. Students From: Erwin Waschnig, Ph.D. Head Education Department We have received another request from our researcher, Mrs. Bortnick, to follow up on previous mailings. For the completion of the study we would be g r a t e f u l i f you could f i l l out the enclosed at your e a r l i e s t convenience. Should you have already done so, please ignore t h i s memo. Thank you for your cooperation. APPENDIX B.O CROSSTABULATION TABLES OF SECOND YEAR (1975-76), FIRST YEAR (1976-77). B . l By Higher Education B.2 By Degree Obtained through Education B.3 By Level of Po s i t i o n Group within the Organization B.4 By Type of Organization Structure 113 114 B . l Second Year (1975-76), F i r s t Year (1976-77) Compared by Higher Education Year Non-Professional Nurses B.A./ B.Comm. Professional Para-Professional Row Total 1975-76 n= 18 11 18 18 9 74 11.5% 7.1 11.5 11.5 5.8 1976-77 n= 27 15 13 17 10 82 17.3% 9.6 8.3 10.9 6.4 Column n= 45 26 31 35 19 156 Total 28.8% 16.7 19.9 22.4 12.2 100% Chi- square = 2 .90 with 4 Degrees of Freedom Sig n i f i c a n c e Level = 0.57 Number of Missing Observations = 7 B.2 Second Year (1975-76), F i r s t Year (1976-77) Compared by Degree Obtained through Education Year Minimal Training C e r t i f i c a t e Degree Row Tota l 1975-76 n= 12 7.7% 25 16.1 37 23.9 74 1976-77 n= 17 11.0% 33 21.3 31 20.0 81 Column n= 29 58 68 155 To t a l 18.7% 37.4 43.9 100% Chi-square =2.18 with 2 Degrees of Freedom Signi f i c a n c e Level = 0.34 Number of Missing Observations = 8 115 B.3 Second Year (1975-76), F i r s t Year (1976-77) Compared by Level of P o s i t i o n Group within the Organization  Year Top Third Middle Third Bottom Third Row Total 1975-76 n= 14 44 15 73 9.4% 29.5 10.1 1976-77 n= 10 48 18 76 6.7% 32.2 12.1 Column n= 24 92 33 149 Total 16.1% 61.7 22.1 100% Chi-square = 1.05 with 2 Degrees of Freedom Sig n i f i c a n c e Level = 0.59 Number of Missing Observations = 14 B.4 Second Year (1975-76), F i r s t Year (1976-77) Compared by Type of Organization Structure Year F l a t Intermediate T a l l Row Total 1975-76 n= 15 44 15 74 10.0% 29.3 10.0 1976-77 n= 14 41 21 76 9.3% 27.3 14.0 Column n= 29 85 36 150 To t a l 19. 3% 56.7 24.0 100% Chi-square = 1.11 with 2 Degrees of Freedom Signi f i c a n c e Level = 0.57 Number of Missing Observations = 13 APPENDIX QUESTION Restructuring C O 12 of Question 12 116 117 c l Restructuring of Question 12 Q.12. The job of the Hospital Administrator can be done e f f e c -t i v e l y only by people who have undergone t r a i n i n g i n Hospital Administration at the l e v e l of: (indicate opinion for each level) Strongly Strongly Agree Agree Uncertain Disagree Disagree -No Additional Training: -Diploma: -Undergraduate Degree: -Masters Degree: -Doctoral Degree: The assigned new code for t h i s question had one representing No Add i t i o n a l Training; two—Diploma; three—Undergraduate Degree; f o u r — Masters Degree; and f i v e represented a Doctoral Degree. Five i n d i c a t i n g the highest p r o f e s s i o n a l i z a t i o n score. The following coding rules were established: 1. Where various l e v e l s were marked i n d i c a t i n g agreement then the l e v e l that had the highest numerical value that was marked as Agree was u t i l i z e d . An example would be: No A d d i t i o n a l T r a i n i n g — Disagree; Diploma—Agree; Undergraduate—Agree; Masters—Agree; and Doctoral—Uncertain. The scoring would be 4 or Masters Degree. 2. U t i l i z a t i o n of the strongest opinion. When Strongly Agree was scored the highest l e v e l of education indicated by t h i s score 118 was then used as the new question value. If a l l parts of the question were marked Disagree or Strongly Disagree then code one, No A d d i t i o n a l Training, was scored. I f No A d d i t i o n a l Training was marked either Disagree or Strongly Disagree, and the student had not indicated an opinion for any of the other parts of the question, then a value of nine or Missing Value was assigned. In the case where a student marked Agree or Strongly Agree for the l e v e l of No A d d i t i o n a l Training and d i d not ind i c a t e any opinion for the other parts of the question then the composite answer would be coded as one, i n d i c a t i n g No A d ditional Training was required. Nine, the Missing Value code was also used when students only chose Uncertain as t h e i r opinion towards a l l the various parts of the question. APPENDIX D.O RESULTS OF HOTELLING'S T-SQUARE TESTS D.l P r o f e s s i o n a l i z a t i o n Orientation of Students i n the Two Classes, 1975-76 and 1976-77 D.2 Dimension of Realism of Students with Nur-sing and Accounting Backgrounds 119 120 D.l Hotelling's T-square Test f o r P r o f e s s i o n a l i z a t i o n Orientation of Students i n the Two Classes, 1975-76 and 1976-77 Factor Question 1975-76 Mean 1976-77 Mean Left Limit Right Limit Differences Between Means 1 16 3.86 3.91 -1.04 1.13 -0.04 17 3. 30 3.28 -1. 30 1.26 0.02 18 3.52 3.29 -1.41 0.96 0.23 19 2.27 2.39 -1.08 1.33 -0.13 26 2.82 2.82 -1.27 1.26 0.00 33 2.32 2.24 -1.19 1.04 0.08 34 2.30 2. 37 -0.88 1.00 -0.06 2 1 3.58 3.21 -1.82 1.09 0.37 6 4.30 4.23 -0.75 0.60 0.08 7 3.79 3.63 -1.33 1.02 0.15 22c 4.24 4.04 -0.96 0.55 0.20 23 3.28 3.08 -1.60 1.21 0.19 37 3.75 3.73 -1.21 1.17 0.02 39 3.79 3.64 -1.03 0.74 0.15 3 9 4.25 4.38 -0.57 0.83 -0.13 10 4.52 4.48 -0.77 0.68 0.04 11 4.42 4.24 -1.04 0.68 0.18 14 4. 27 4. 27 -0.72 0.73 -0.01 4 5 3.14 2.95 -1.59 1.21 0.19 21 3.86 3.71 -1.13 0.84 0.15 27 4.29 4.19 -0.88 0.68 0.10 28 3.33 2.68 -2.03 0.72 0.65 29 3.72 3.99 -0.89 1.42 -0.27 30 3.86 3.77 -1.24 1.06 0.09 5 25 3.64 3.43 -1.34 0.91 0.21 31 4.01 3.98 -0.98 0.91 0.04 32 3.84 3.54 -1.40 0.80 0.30 6 12 3.24 3.17 -1.80 1.67 0.07 20 3.66 3.55 -1.36 1.13 0.11 38 3.18 3.00 -1.38 1.02 0.18 7 3 3.32 3.42 -1.02 1.22 -0.10 22a 2.64 2.71 -1.17 1.31 -0.07 22b 3.26 3. 36 -1.14 1.35 -0.10 (The figures above have been rounded.) T-square Value = 71.27 Associated E-value = 1.72 Sig n i f i c a n c e Level = 0.02 Degrees of Freedom = 33/126 F-value used i n Determination = 1.53 D.2 Hotelling's T-square Test for the Dimension of Realism of Students with Nursing and Accounting Backgrounds  . , Means Means Lef t Right Factor Question „ . . . T • • r • • *. Between Nurses Accountants Limit Limit Differences eer Means 3 3.62 3.25 -1.09 0.36 0.37 22a 3.67 2.91 -1.59 0.07 0.76 22b 4.27 4.13 -0.58 0.29 0.14 (The figures above have been rounded.) T-square Value = 11.60 Associated F-value = 3.70 Sig n i f i c a n c e Level = 0.02 Degrees of Freedom = 3/44 F-value used i n Determination = 2.80 

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}]}"
                            data-media="{[{embed.selectedMedia}]}"
                            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:
https://iiif.library.ubc.ca/presentation/dsp.831.1-0094016/manifest

Comment

Related Items