Prior to the receivership, the highest position within the division was a director of nursing . When the CPHCS structure was later formalized by clinical functional area, the statewide chief nurse executive developed a mirror position at the prison level with the same title to replace the DON role. As an entirely new state classified position, it carried new aspects of responsibility. This process was replicated within the other clinical departments, with the receivership level having a statewide head to which a prison-level clinical administrator indirectly reported in matrix style. The prison-level clinical head reported directly to the prison-level head of health care , which in turn directly reported to the federal receiver. This position was a structural anomaly; this position existed as the only clinical-area lead role that did not have a CPHCS-mirrored lead position. This is to say that no statewide chief executive officer of health care was created. The healthcare CEOs reported directly to the receiver, with no indirect supporting relationship within the CDCR structure. This complex reporting structure is shown in Figure 4. Among the greater challenges created by this structure was the negative impact on managerial capacity.
Due to the variance in scope between the CDCR and CPHCS managers,best indoor vertical garden system the concentration of resources for important tasks differed based on what the manager determined as important. While CPHCS executives were only interested in output related to projects, CDCR managers cared about the goals—measures of patient outcomes. Organizational structure dictated the managerial capacity to move the organizational-level mark of success. As discussed in previous chapters, it is necessary to understand management behavior at the program or project level in order to analyze and match motivations to actions.The disengagement from daily operational issues on the part of the receiver was due to the necessary bifurcation of duties between the political and operational. This situation is akin to the division of labor observed in the private sector between a chief executive officer and his or her chief operating officer or president . The practice, however, of having two rather disjointed administrative layers between three organizations reporting to the same individual did lead to operational issues. The reasons behind this were the often-differing requirements of the individual statewide executives as compared with those of the local healthcare CEOs. The CEOs tended to embrace a more short-term, day-to-day focus on operations and the allocation of scare resources therein. Statewide leadership was more project-oriented because their mutual supervisor, the receiver, required them to develop and implement the turnaround plan of action that was defined by the receivership mission.
The healthcare CEOs, in turn, were expected to assist in the smooth implementation of the various and often simultaneous projects related to the mission, while also serving as the operational head of the prison health care unit. The consequences of this clash of perception, objectives, and decision timing were unfortunately only briefly studied and captured in post-implementation interviews. This was due to the timing of the establishment of the CEO position, which occurred toward the end of the CCM implementation. It was previously noted that within the CPHCS structure two distinct groups of administrators existed: There were the individuals hired to serve within the receivership entity at the end of their civil-service careers, bringing decades’ worth of invaluable experience of CDCR operations and institutional knowledge. The other group consisted of those bringing a fresh perspective, having no significant correctional environment experience within the state but providing decades of private-sector health care operational expertise to the new organization. Due to the state’s budget crisis and renewed focus on eliminating high-dollar programs, the legislature of the state focused on the prison system and the proposed $8 billion dollar budget, seeking to cut the program in part or whole.
While the federal courts underlying the receivership did not make it possible for many of the proposed legislature reductions to occur, the strong political emphasis placed on the spending decisions within the receivership created the need for a change to occur. Managers that were recruited for higher-ranking headquarters vacancies and for prison level healthcare CEO roles were only those with strong fiscal management experience in their backgrounds. The group of administrators reporting to the receiver was initially a diverse group of people with many at the statewide executive layer selected from the private sector. These individuals brought immense experience from private health care sector work such as running departments or systems in leading health care organizations around the nation. Much of this labor pool was secured on a contract basis, and their reimbursement arrangement was commensurate with their vast experience. During this time , which was the period coinciding with the start of the pilot phase of the CCM program, there were only a handful of high-ranking administrators on the clinical side who were drawn from existing posts within CDCR. During observations made under this study, a cost cutting change was made in which many of the early-phase administrators were dropped in favor of lower-cost, full-time employee executives having years of experience within the state’s correctional system. Much of the vision of private-sector program leadership had already been put in motion prior to the shift, and it was part of the new cohort of managers’ role to complete the implementation started by managers who had different thought processes and objectives. The focus of the new group of executives was guided largely by habits learned over a career’s tenure within CDCR, which differed from the modus operandi of the previous, more innovative set of managers. It was assumed that continuity of work in progress would be natural because the incoming managers had years of agency experience.
The new administrative group enjoyed years of relationship-building experience, which enabled some prison-level staff administration and worker-level personnel to work more in synch with the vision set forth by the headquarters personnel. There is an unresolved debate among researchers about whether public-sector managers differ from their private-sector counterparts . At the core are the differences in managerial capacity between sectors, which may describe some of the underlying factors that constrain or enable managers to act and react. While this study is not designed to resolve that debate,growing strawberries vertically this section will describe a tool used in this program implementation that may be useful to researchers in capturing the elements of managerial capacity. A management-assessment model was developed in conjunction with a survey of the same name to assess how close managers were to the work under their control. Proximity to work was a concept used by this author in previous managerial work experience and is best described as a manager’s knowledge of all relevant information needed to make sound administrative decisions. It is measured by a manager’s involvement in the work carried out by her or his staff. Arguably, traits such as intelligence or even charisma could be attributed to the perception of how close a manager is to his or her work, if an outside observer asserts such perception. When measured directly by the manager, however, and on a self-reported basis, an estimate of the person’s level of engagement or involvement with his or her scope of responsibility can be determined. The knowledge derived from this self-assessment is useful both in rating a manager’s ability to rate staff and in understanding how involved he or she is in the work performed within the department. If a manager is disengaged from the work performed, then it is unlikely that preventative processes are in motion to avoid fatal project delays. Should the manager be disengaged from the day-to-day issues when a project-related task is at risk or slips a deadline, it will already be too late to prevent the resulting consequences. In order to keep projects on target, plans are put together and managers are made aware of issues before they become problems. An informed managed is an engaged manager, and this improves a project’s likelihood of success . It has been asserted that successful program implementation requires managers to be informed about the work for which they are accountable. This is based on the assumption that managers are competent and capable of making decisions.
Unpacking this assumption illuminates an important and fundamental organizational characteristic that must be present. Managers must be empowered to act, and if they are, it is here asserted that their competence in judgment will enable them to guide a company to successful performance. It is not argued here that managers are the sole motivators or even arbiters of organizational or program-level performance. As Barclay states, “buy-in and following orders are necessary from staff to make any change work . . . since it is often up to the employees to make the change work, it should be the employees that are focused upon” . Vlachoutsicos agrees, noting that successful managers rely on skilled subordinates, and additionally the teams that the managers oversee must also be empowered or else the unit is slated for failure. In his work on techniques for success in the clinical environment, Edgar Staren argues that an effective manager enables his or her staff differentially to be empowered according to individual abilities. This relates back to the original point of this section—managers must be close to the work they oversee. The ability to recognize the positive motivators that are effective for each individual staff member requires knowledge of the staff on an individual basis. Familiarity with the work performed on an ongoing basis enables a manager to be effective at understanding staff’s issues as well as providing knowledge of potential barriers to success. For this reason, the manager is studied in this chapter with the hopes of identifying aspects of management behavior that can be improved on to enable program-level success. Managerial capacity is the ability for administrators to understand the work requirements and to make situational specific adjustments accordingly. This definition is more granular than that provided by Meier and O’Toole in their evidence-based analysis of managerial performance. These researchers treat managerial capacity in a manner similar to this study’s approach. They look at public-sector management as their setting of choice, and they define managerial capacity as “the managerial talent and effort that could be mobilized in an organization when needed” . To assess managerial capacity with the goal of linking results to program-level performance, a managerial model of assessment was used. The model selected was previously created for assessing management behavior for a program implementation in the for-profit sector. The assessment model was developed by the author of this paper and successfully used to gauge and intervene on the behavior of leaders in a $500 million dollar health care program implementation. The statewide chief nurse executive who was responsible for the CCM program’s implementation approved the model and survey tool for use. The model used is shown in Figure 5. It relates and maps to a 10-question survey called the Leadership Level Assessment Survey. It was designed to focus beyond the overarching strategic management process , and assess how in touch managers are with the work that is being performed under their responsibility. Previous attempts to define strategic management processes have not focused sufficiently on the process of management and how to improve performance over time. The concept of management levers has been proposed , and information provided about how to plan strategically . However, detail is lacking about the steps to take as an administrator to improve performance. Figure 5 shows the constructs of the managerial assessment behavioral model, and is best read from right to left.The model is based on the theory that administrators who are more involved in the work they are responsible for, and have confidence in the work as it is performed, will improve organizational performance. This theory can be broken up into two distinct parts: confidence and engagement. The first relates to manager’s involvement in the work for which they are accountable. When managers at any level in an organization increase their personal involvement in the work at hand, the result can be an improvement in the oversight of the work product. This is true only if the workers perceive this as genuine interest and solicitation of feedback is made. Receipt of feedback on management vision should be included in order to avoid the perception of micromanagement.