Purpose The purpose of this paper is to explore the extent to which improving doctor–patient communication (DPC) can address and alleviate many healthcare delivery inefficiencies. Design/methodology/approach The authors survey causes and costs of miscommunication including perceptual gaps between how physicians believe they perform their communicative duties vs how patients feel and highlight thresholds such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) used by hospitals to identify health outcomes and improve DPC. Findings The authors find that DPC correlates with better and more accurate care as well as with more satisfied patients. The authors utilize an assessment framework, doctor–patient communication assessment (DPCA), empirically measuring the effectiveness of DPC. While patient care is sometimes viewed as purely technical, there is evidence that DPC strongly predicts clinical outcomes as well as patients’ overall ratings of hospitals. Research limitations/implications More research is needed to extend our understanding of the impact of the DPC on the overall HCAHPS ratings of hospitals. The authors think that researchers should adopt a qualitative method (e.g. content analysis) for analyzing DPC discourse. Practical implications When a sufficient amount of DPCA training is initiated, a norming procedure could be developed and a database may be employed to demonstrate training program’s efficacy, a critical factor in establishing the credibility of the measurement program and nurturing support for its use. Originality/value The authors highlight clinical and operational issues as well as costs associated with miscommunication and the need to use metrics such as HCAHPS that allow consumers to see how hospitals differ on specific characteristics.

PurposeThe purpose of this paper is to validate the number and order of leadership roles and identify the personality traits which trigger the choice of leadership roles.Design/methodology/approachA survey addressing classification and measurement questions in each of the competing values framework (CVF) quadrants was administered to a sample of managerial leaders across organizations. Multidimensional scaling representing the underlying CVF dimensions in a spatial arrangement was conducted with input derived from LISREL, which was also used to test the degree‐of‐fit between the CVF roles and quadrants as well as to examine the relationships between personality traits and leadership roles.FindingsThe results produced a remarkable synthesis of two separate fields of study within a single competing quadrants grid confirming the causal paths from traits to the compressed CVF latent variables.Research limitations/implicationsThis study raises important questions about the causal effects of personality traits and situational contingencies on the choice of leadership roles.Practical implicationsThe new awareness of precursors to CVF roles calls for significantly shifting the focus of leadership training and education efforts. Leadership development strategies designed to improve current managerial strengths must also target specific weaknesses and their psychological underpinnings.Originality/valueThe paper demonstrates the efficacy of the CVF and at the same time draws more robust conclusions about how traits affect the choice of leadership roles, how they influence the extent of managerial effectiveness and to what extent managerial choice of roles is conscious or just a stimulus response.

Purpose Senior executives in healthcare organizations increasingly display preference for a closer handling of operational levels, bypassing middle managers, and de-emphasizing the need to cultivate the next cadre of leaders, creating the potential for leadership and performance gaps. The authors argue that middle managers are a vital resource for healthcare organizations and review the benefits for including them in leadership development and succession planning programs. The paper aims to discuss these issues. Design/methodology/approach Current theories and common practices in addition to data collected from government sources (e.g. BLS), business and industry surveys and reports (e.g. Moody’s, Witt/Kieffer, Deloitte, American Hospital Association) are used to classify the roles, skills, and strategic value of middle managers in healthcare organizations. Findings The combination of a greater executive span with less hierarchical depth creates a dual effect of devaluing middle management, and a decrease in middle managers’ autonomy. Healthcare middle managers who stay away or lay low further trigger perceptions of low expectations leading to low morale and high levels of stress. Others become hypereffective or develop exit strategies. Major problems are: rising turnover costs; and insufficient attention to succession planning, internal promotion, and leadership development. Practical implications The outcomes of this study are useful for management development, particularly at times of change. Practitioners and researchers can have a better understanding of the value of middle managers and their development needs as well as the factors and dynamics that can influence their motivation and affect retention. Originality/value Understanding and implementing the ideas developed in this paper by healthcare organizations and other companies can lead to a drastic change in the current perceptions of the importance of middle managers and should lead to long-term retention, well-being, and extrinsic benefits for both the company and its employees.

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This article describes how managerial roles change in importance during periods of significant organizational transition. An interdisciplinary approach reveals that (1) the competing values framework is a useful framework for examining this question; (2) the transformational roles increase as expected during downsizing; (3) three of four transactional roles also increase during downsizing. This last counterintuitive finding is illuminated by the interdisciplinary model developed. Overall, managers show significant evidence of hyper‐effectivity—a state of high performance that is likely to be unsustainable in the long term. Implications for human resource practitioners and researchers are discussed. © 1996 by John Wiley & Sons, Inc.

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