WHO'S AFRAID?

Think for a moment about this question and try to decide on an honest answer: Are you at all-even marginally or just once in a while-afraid of your boss?

Next, consider answering this follow-up question of even greater importance to the individual manager: Are your employees afraid of you?

A wise and well-experienced manager once said to a group of employees: "I can't work effectively with you if you're afraid of me." This manager went on to explain how the presence of fear distorts the working relationship between manager and employee. An employee who fears the manager will likely expend a great deal of energy in defensive behavior and in trying to stay out of trouble. Surely, many readers of this have, at some time, reported to managers around whom it was deemed necessary to "walk on eggshells." One who fears the boss often works under a chronic state of stress brought about by fear.

Fear is a "motivator" only to the extent that one avoids an immediate threat or sanction through compliance. Many a misguided leader who applies the "swift kick" form of "motivation" finds that once the sting of the "kick" goes away, performance returns to its former level, but employee resentment remains.

Some leaders are admired and respected; some leaders are feared; some are disliked in varying degrees; some are openly hated. Although there can be a great many factors at work in defining any individual leader's style, the leader's use of authority is usually a strong determinant of the followers' regard for the leader.

Whether your employees fear you or respect you will ultimately be determined by the manner in which you utilize the authority of your position. Use positional authority like a hammer to force employees to do your bidding, and the result will usually be fear. However, use positional authority to appropriately organize resources, support your employees, and facilitate the work of the department, and the result can be respect.

Some managers mistakenly believe that employees' deference to them and their wishes denotes respect for them as individuals. After all, the employees do as they are told and usually do so with apparent willingness. However, these occasional managers have missed an extremely important point: It is often not they who the employee respects or defers to, but rather the authority of the management position. Most employees accept the fact that we all have bosses and we are expected to do what the boss tells us to do. One can readily defer to the authority of the management position without respecting the manager.

The point is that the manager acquires employees' respect by earning it. Respect is not automatically conferred with the management title, and automatic deference to management authority is not respect.

Back to the questions about fear: As the manager must earn respect through behavior, the manager also engenders fear in the employees through behavior. So with this issue, as with so many other issues of management practice, we return to the basics of interpersonal relationships. Know each employee as a person, and treat each person with respect.

Do your employees fear you? One test for this condition involves questions and complaints and differences of opinion arising from the work group. If none of your employees ever bless you with negative feedback or just plain bad news, it is highly likely that they are afraid to do so. If all is always quiet and seemingly rosy, then you may have something to fear, for if your employees are afraid of you, they will not bring you problems or complaints or troublesome issues and you will be operating largely in the dark, denied information essential to the effective performance of your job.

This issue of The Health Care Manager (Issue 34:4, October-December 2015) includes the following articles for the reader's consideration:

* "Transformation of the Urban Health Care Safety Net: The Devolution of a Public Responsibility" identifies and explores several factors that have contributed to the incremental demise of the publicly funded urban health care safety net and how local entities and the federal government are responding to the care of the poor and uninsured.

* "Health Care Affordability: How to Make It a Reality" addresses the need to find a health care financing methodology that will make health care affordable for all patients and families and explores an alternative method for funding health care that includes establishment of a government-funded annuity during the first decade of one's life.

* "Leadership Characteristics for Health Care Managers: Perspectives of Chief Executive Officers in US Hospitals" reports on a study undertaken to determine the perceptions of chief executive officers in US hospitals regarding the most important characteristics aspiring health care executives should possess and compares the results of this 2012 study with an earlier study to determine whether perceptions had changed.

* "Use of Smartphones in Hospitals" reports on a literature review and analysis addressing the impact that mobile technology is having in altering the landscape of the medical profession with more than two-thirds of physicians regularly using smartphones.

* "The Concept of Advocacy in Nursing: A Critical Analysis" addresses the important question of advocacy as part of the role of the nurse through an examination of significant documents and reports of empirical research that reveals conflicting conceptions and opinions.

* "Patient and Practice Characteristics: Impact on Career Satisfaction of Obstetrician-Gynecologists" reports on a study undertaken to examine demographic and practice characteristics that affect the career satisfaction of obstetrician-gynecologists, using data retrieved from the 2008 Health Tracking Physician Survey conducted by the Center for Studying Health System Change.

* Case in Health Care Management: "Sylvia's Choice" asks the reader to consider what a manager might do in addressing the problems created by an employee whose attitude and performance have been negatively affected by losing out on a desired promotion.

* "Impact of the Relocation of a Long-term Residential Care Facility on Staff" describes the relocation of residents and staff on a long-term residential care facility into a new state-of-the-art building and the apparent effects of the move on residents and staff alike.

* "User Satisfaction With Telehealth: Study of Patients, Providers, and Coordinators" reports on a study of which the aim was to examine the satisfaction with telehealth technologies of all users: patients, health care providers, and telehealth presenters, recognizing the rapidly increasing use of such technology.

* "Early Careerist Interest and Participation in Health Care Leadership Development Programs" reports on a study undertaken to determine how early careerists working in health care organizations view leadership development programs and their participation in such programs offered by their employers.

* "Lower Nurse Staffing Levels Associated With Occurrences of Inpatient Falls at a Large Pediatric Hospital" reports on a study undertaken to examine the relationship between nurse staffing levels and pediatric patient falls in a large children's hospital using a case-control study design to compare the nurse staffing level during the shift of patient falls with the staffing level in the same units on shifts when patient falls did not occur.

* In "Organizational Failure in a National Health Service Hospital Trust: A Qualitative Study," the objective was to explore the key factors associated with organizational failure in a National Health Service hospital trust in Tehran through semistructured interviews and document analyses.