TERM REPORT

SPRING 2011 ORGANIZATIONAL BEHAVIOR

SUBMITTED TO

TABLE OF CONTENTS
Letter of transmittal 4 Executive Summary. 5 Acknowledgement. 6 Introduction............................................... 7 Mission statement....... .7 Vision Statement.....................................7 Objective of AKUH.. .7 About AKUH 8 Hypothesis. .9 Sources and method of collecting information. .9 Interview Questions. 10 Basic leadership approach at AKUH and its uses...12 Transformational leadership. 12 Dynamic leader follower relationship 12 Need for change.............................................12 Turning doctors into leaders.13 Medical leadership.....................................................14 Situational Leadership at AKUH. 15 Fiedlers Contingency Model ..16 Leader Member relation... 17 Task Structure.17 Position power ..18 Employee motivation 18 AKUH resolves potential problems by following situational leadership style.19 Respect for operational and strategic realities.................................................................19 Set realistic goals...19 Not Just Cutting Costs. ....19

Genuine Interest..19 Build Trust.19 Provide resources20 Building Trust at AKUH20 ETHICS .. .21 The Hospital Ethics Committee.. 21

Patient's Complaints .21

LETTER OF TRANSMITTAL
April 1st2011 Instructor of Organizational Behavior Institute Of Business Management Karachi.

Respected Mam Subject: Report On leadership Approaches at AKUH The group members visited Aga Khan University Hospital (AKUH) located near national stadium to interview few senior management staff to find out their leadership styles used at AKUH. On the basis of their responses to our queries we concluded about their leadership style. The research provided us with the unique organizational behavior and helped us to know that how the leadership styles are implemented at AKUH. Thank you for giving us the opportunity to conduct the interviews.

EXECUTIVE SUMMARY
The purpose of our research study was to find out the unique organizational behavior that how the leadership styles are implemented at AKUH and how these practices are beneficial for employees and organization itself. The hypothesis of our study is that how the leadership approaches at AKUH is affected by different situations that the management faces. For conducting research our group members visited Aga khan university hospital (AKUH) to interview few senior management staff to find out their leadership styles used at AKUH. On the basis of their responses to our queries we concluded about their leadership style. We randomly selected the employees from different departments for interviews. Besides the interview method we also used questionnaires.30 questionnaires were made which means that 30 other participants of AKUH took part in this research study. We came to know that transformational leadership style which influence the decision making and helps to develop changes is being implemented in AKUH. Besides this situational leadership is also applied at AKUH, it has a Hierarchical structure of leadership, where each subordinate reports to the upper Management, and the whole organization works for accomplishing a common purpose. Aside from establishing affective relations with its subordinates, manager's task is to instill a sense of accountability in them. AKUH also keeps a strict check on worker actions, whether employees are following the guidelines given and whether jobs are accomplished on time. AKUH provides for and welcomes the expression of grievances or complaints and suggestions by the patients at all times either by speaking directly to the team leader, supervisor, service coordinator or manager assigned to your care. This style basically focuses on area of ethics.

ACKNOWLEDGEMENT
This report is on AKUH. It has been prepared as a part of Organizational Behavior course. We would like to thank our Organizational behavior faculty, Ms. Shagufta Rafif for her guidance and help and by providing us the opportunity to work on this project and to let us practically perform all that we have studied during the semester. It has definitely been a learning experience for all of us. This report has been very instrumental in applying the theoretical concepts and learning the practical aspects of Organizational Behavior. Ms. Shagufta Rafif demonstrated the real existence of Organizational Behavior, providing us with practical cases examples and cases as well as from work place behavior.

We would also like to pay our gratuitous regards to Mr. Ghulam Karim Sakhi (Manager Bio Medical Engineering AKUH), Mr. Sohail Mateen (Deputy Director Maintenance) for sharing their views on AKUH and helping us make this report a very knowledgeable and a meaningful document. We would also like to thank other AKUH staffs who were kind enough to take out time from their busy schedules for interviews and filling up of the questionnaires.

INTRODUCTION
MISSION STATEMENT
The mission of AKUH is embodied in a summary statement which is as follows:

To provide exemplary care to patients; To develop and test innovations in care, education, and research; To support the teaching and research missions of the Faculty of Health Sciences; To contribute to the development of a system encompassing primary, secondary, and tertiary care, and not geographically confined to the existing Hospital facility; To provide access for needy patients who may not, on account of financial difficulties, be able to afford normal Hospital charges, and to reach out to those who might not otherwise present themselves at the Hospital; To develop new services in response to public expectations as resources permit on an economically viable and sustainable basis; and To carry out programm and assigned missions in a manner that would demonstrate the ability of the institution to attain self-support in a developing nation environment.

VISION STATEMENT
"AKUH will be recognized as one of the best health care institutions in Pakistan and the developing world. We will achieve this: By providing compassionate, ethical, accessible and high Quality care that meets or exceeds the needs and expectations of our patients, their families and others whom we serve.

By providing an outstanding work environment that fosters motivation and commitment in our staff. By enabling leadership in education and research that improves the health of the people in the region."

OBJECTIVE OF AKUH
AKUHs objective is to promote human welfare by disseminating knowledge and providing instruction, training, research and services in health sciences, education and other disciplines. The only goal of the management is to have the AKUH as an institution of international repute and standard and remain operational as national role model for other institutions related to medical education and healthcare.

ABOUT AKUH
Aga khan university hospital (AKUH) was established in 1985, as a health care component. It is a not-for-profit organization committed to provide the best possible options for curing the diseases. The services of AKUH are backed up by the highest doctor-to-patient and nurse-topatient ratios and support services. The hospitals multidisciplinary approach to diagnosis and care ensures a high quality care and superior value delivering service to their patients. The hospital contains around 563 beds and services are being given to above 50000 patients who are hospitalized and over 600000 patients who come for a regular checkup. Patients, who are unable to pay for their treatment, receive assistance through a variety of subsidies and the hospitals patient welfare program. In 2000, AKUH was the first teaching hospital in Pakistan to be completely ISO 9002 certified and it was awarded for the prestigious JOINT COMMISSION INTERNATIONAL ACCREDITATION (JCIA) for practicing the internationally recognized quality standards in health care. The AKUH quality assurance program serves as a model for other health institutions in the private and public sectors and in the Aga khan development network.

FACILITIES OF AKUH
The hospital is equipped to diagnose and treat medical, surgical, obstetrics and gynecology, pediatrics and psychiatry patients, and its inpatients have an average length of stay of 3.4 days. The hospital also provides comprehensive oncology services. A total of 563 beds include 4 VIP, 123 private, 121 semi-private airconditioned rooms and 260 general ward beds. State of the art pharmacy, laboratory, cardiopulmonary, neurophysiology and rehabilitation services are available at AKUH. 24 hours emergency room is also available for all patients. The hospital draws a large number of referrals from outside Karachi and Pakistan and operates patient information and referral desks in Hyderabad and Quetta and a representative office in Dubai, ukase. These offices provide assistance by coordinating all necessary arrangements, including review of medical history by consultants prior to the patient's arrival at the hospital.

HYPOTHESIS
The leadership approach at AKUH is affected by different situations that the management faces.

SOURCES AND METHODS OF COLLECTING INFORMATION

We used primary sources as well as secondary sources to know the different leadership styles of AKUH. Our main focus was Primary source which has two approaches they are qualitative and quantitative. Our decision was the selection of qualitative approach as our research was based on knowing the leadership styles and strategies at AKUH. The best way for getting qualitative data was the interview method of some employees of AKUH and for that we went to the organization to collect our data Being a group of 6 each of us interviewed one person each which means that 6 employees were interviewed. We randomly selected the employees from different departments for interviews. The people whom we interviewed were personally known. By conducting an interview with so many leaders we got the clear idea and learned how effective interviews can be. Personal interviewing was an adaptable method and was more advantageous as in this type of interviewing we could ask more questions and in this way we were able to observe the body language etc of such leaders. Besides the interview method we also used questionnaires. 30 questionnaires were made which means that 30 other participants of AKUH took part in this research study. These questionnaires were filled by 15 males and 15 females. It was divided equally.

INTERVIEW QUESTIONS
As expected our personal interviews had similar responses. Below is the general response of our interviews. Q. What are the staff motivational strategies at AKUH? AKUH Employees are fully motivated providing them various fringe benefits including a very good and cooperative working environment, discounted meals, staff performance evaluation linked with annual increments, holding appreciation evenings where hardworking workers are rewarded for their efficiency and devotion, holding 10. 20 and 25 years service awards, sports and swimming facility. Staff are also trained and developed on management and technical skills, quality awareness through in-house and overseas programs Employees have defined career path linked with performance, qualification and competencies Q. How is authority delegated to AKUH employees? AKUH has a documented system where each department has policies and procedures clearly defining each employees job responsibilities and authorities. Q. How AKUH staff encouraged taking initiative? Employees suggestions on system and working environment improvements are encouraged which are reviewed by various departments periodically and good suggestions are rewarded. Q. What type of Leadership style is implemented at AKUH? Leadership at AKUH is democratic style where staff is consulted on decision making and improvements. Employees are empowered to carry out their job responsibilities with authority independently Q. Is Leadership at AKUH affected by the circumstances? Leadership at AKU has established proactive policies to deal with any contingency and emergencies. Further there is clear and defined structure to deal with any abnormal circumstances.

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Q. How does Leadership at AKUH communicate to staff what organization is trying to achieve? Leadership at AKUH utilizes following options to communicate: E-mail Grand Round Presentation Meetings

Q. How does leadership empower staff? It uses following empowerment strategies o o o o o o o Avoid competition for power, status, recognition Delegate Create and communicate a vision Insist that others diligently work to achieve meaningful goals Help others believe in their own worth and potential Create a culture in which fear and intimidation are replaced by trust Demonstrate a willingness to be supportive of others

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BASIC LEADERSHIP APPROACH AT AKUH AND ITS USES

In AKUH, doctors with leadership skills can improve the level of others work environment. This helps others like trainees and employees to have a positive attitude towards work, daily task and responsibilities, treating patient and able to reach personal goals and objectives. TRANSFORMATIONAL LEADERSHIP It helps in decision making like when to call the doctor. It encourages others to work out leadership. Transformational leadership also helps develop changes in AKUH system. In this method, the supervising doctors motivate other doctors to provide better feedback. It builds basic leadership with a new doctor. DYNAMIC LEADER-FOLLOWER RELATIONSHIP Helps to identify patients stress and needs of patient. The doctor can therefore develop the ability of achieving objectives through interpersonal relation. The basic fact behind this theory is that the leader follower exchanges are dynamic. This help in increasing the motivation and commitment of doctors. New doctor can therefore develop the ability of leadership. NEED FOR CHANGE As a result of new health policy a lot of changes have been made in organizational structure. So now the nature of leadership in an individual depends more on interaction between lower-staff and top-management.

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TURNING DOCTORS INTO LEADERS Due to wide health care era which is exploding in knowledge, therefore many health care systems are so disorganized which results in chaos. The management of AKUH believes that organizing the chaos requires a new kind of leadership at every level of the healthcare system- one that value quality of care over quantitative care and understand how to use performance measurement as a motivating tools for the new staff. At AKUH the shift to value-oriented, performance-driven healthcare has required doctors to adapt or even reject traditional ways to treat patients and manage their work. This change is difficult to be adopted by the staff and slowly and gradually they are buying it because the top management believes that defending the AKUH status is no longer viable.

TRAINING
Leadership training at any organizational level has become the most mandatory part so that all members can cope up with the team work. AKUH has implemented a wide array of programs aimed at physicians and administrators to develop their professional roles and improve operation and services of their hospitals. Every skilled learn person have proved himself to be the beneficial for the organization in future. The leadership training courses at AKUH have been designed to help employees become catalysts and it provides an opportunity to share practical experiences in solving many problems in the health care industries. It focuses mainly on practical experience rather than theoretical approach. Some of the issues dealt in these programs include: Managing meetings, Creating goals Handling disruptive coworkers.

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MEDICAL LEADERSHIP
It has not only helped the members of AKUH have a clear vision, but has also developed the skills to communicate them. Administrators and physicians alike benefit from leadership training that illuminates the inner workings of a healthcare institution including the various roles of management, the board of trustees, and the medical staff. They are now prepared to deal with the politics of the organization as well as have a more effective relationship with their colleagues; their professional goals have become clearer, making them much more effective employees and assets to the organization.

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SITUATIONAL LEADERSHIP AT AKUH

FIEDLERS CONTINGENCY MODEL
The theory that effective groups depend on a proper match between a leaders style of interacting with subordinates and the degree to which the situation gives control and influence to the leader.
This theory states that if a leader needs to be effective, he should mould his leadership style to go according to the situation. For example, if the situation requires the leader to execute a task oriented sort of behavior but the leader is high in need for achievement and is more relationship oriented, then either of the two situation or leadership style, would have to be modified in order to attain effectiveness. AKUH stresses managers to develop healthy leadermember relationships, as this would help give the manager a greater degree of control over his subordinates and make him enjoy a stronger position power. This helps the manager to create a favorable image in the organization, for which the top management appreciates them in the form of wages computations, check writing loan or by providing a higher position and authority in order to increase job commitment. AKUH has a hierarchical structure of leadership, where each subordinate reports to the upper management, and the whole organization works for accomplishing a common purpose. Organizational structure allows the expressed allocation of responsibilities for different functions and processes to different entities such as the branch, department, workgroup and individual. Individuals in AKUH are usually hired under time-limited, work contracts, work orders or permanent

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employment contracts basis. As AKUH is a large organization containing a hospital and a medical college under its responsibility, the structure is mainly centralized with the decision making power lying with the top management. They have the authority to give orders to the top management but as authority goes with responsibility, they're also responsible for the subordinates doing their jobs well. Task of managers at AKUH is to make their subordinates clear about the mission, vision and goals of the organization and to provide them a proper guidance in order to achieve these goals. The facilitation provided to workers by the top management helps develop strong working relationships amongst various entities in AKUH and improves working efficiencies within the organizational units. AKUH tries to retain control in order to strongly monitor its processes. A set of commands are taken to account for any sort of divergence. The organization encourages worker creativity and values the ideas and opinions of every individual within the organization so that individual skills applied enable flexibility and innovation. In order to further motivate their employees, following strategies have been designed: Effective ways of communication, communication to go with others accommodating your way of

Showing confidence, this means that manager should show both selfconfidence, and that he has confidence in what his subordinate is doing Constructive criticism, which instead of demotivating the individual instills hope and confidence in himself Effective goal-setting, for yourself as well as your team Developing of effective strategies to achieve these goals Delegation, through distributing tasks amongst individuals

Creating a healthy environment, so that individuals like their work and enjoy doing it Appreciating the team members for a job well done

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In AKUH, different styles of leadership approaches are undertaken as required under different situations, in order to reach organizational effectiveness.

LEADER-MEMBER RELATIONS
AKUH values the skills of its subordinates and provides them with a healthy environment to encourage mental comfort and avoid peer pressure.

A variety of management styles are practiced according to the changing requirements of the environment and the situations in which they operate, and also according to the different needs of its customers. These can have a dramatic impact on the working of the organization either positively or negatively, depending on manager's skills.

Aside from establishing affective relations with its subordinates, manager's task is to instill a sense of accountability in them because workers at AKUH are responsible for saving lives. The reason why AKUH is considered a reputable organization is that, with the provision of facilities to its employees, AKUH also keeps a strict check on worker actions, whether employees are following the guidelines given and whether jobs are accomplished on time.

TASK STRUCTURE
AKUH has formed policies and makes sure that they are strictly followed in order to maintain the quality of its operations, as the main aim of AKUH is the provision of high quality to its customers. A separate department exists for resolving any disciplinary issues and taking appropriate action. To maintain discipline in its actions, it initially trains its employees and specializes it in their respective fields. A constant effort is made to improve worker skills and work methods in order to attain efficiency. Regular training is provided to keep the employees updated with the new technology and new and improved working methods in order to achieve

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accuracy as there is no room for any sort of malfeasance because accuracy is the foremost need in AKUH.

POSITION POWER
At AKUH all the related activities are put under one group. This group is then led by a manager who forms out a plan of action which is implemented by the workers. This way there is coordination of strength and efforts. Managers try their level best to be just and fair while dealing with all their employees as they have authority and power. Top management believes that this authority will bring responsibility and accountability. Recruiting new employees is one of the biggest challenges in regards of maintaining their reputation as employees are the key component of organizational success and the representations of an organization. AKUH made a human resource department for doing this critical job fairly, recruitment at all levels is done in an open, transparent and equitable manner, which reflects the hospitals commitment to quality, meritocracy and equal opportunity. It is an organization where mentoring and training programs exist to further employees growth. In addition to an attractive compensation and benefits package, AKUH offers various on-campus facilities and services for faculty and staff. In case of firing, hiring, fixation of remuneration, promotion and for the recruitment of any employ all powers are in the hands of top management that help them to avoid malfeasance.

EMPLOYEE MOTIVATION
In case of AKUH they motivate their employees by targeting their current need according to Alderfers ERG Theory (Existence, Relatedness and Growth), affiliation at work place, highly organized structure task etc and high remuneration is not the main concern at AKUH as it is a non-profit organization and therefore it does not pay well as compared to the other multinationals in our country. However they provide very good benefits as it is a hospital and so medical benefits are provided to all their employees and their families.

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AKUH RESOLVES POTENTIAL PROBLEMS BY FOLLOWING SITUATIONAL LEADERSHIP STYLE

RESPECT FOR OPERATIONAL AND STRATEGIC REALITIES
Productivity targets are carefully tailored to individual departments based on a thorough understanding of circumstances, strengths and challenges of the department. These circumstances include strategic initiatives of the hospital for instance expanding a cardiology program that have definite consequences for a department. SET REALISTIC GOALS The process of establishing productivity targets is fair and all-inclusive. No sector or department is left out of the process and politics should not influence the setting of targets. NOT JUST CUTTING COSTS Although expense reduction is the ultimate goal, the credibility of the standard setting process is enhanced by the stated willingness to add to staffing whenever it is indicated. GENUINE INTEREST The supervisors make sure that the doctors listen to their concerns about issues in their department. For instance how could process changes assist them in meeting a reasonable target? How can they help improve the situation and bring positive changes by working as a team in tasks? BUILD TRUST At AKUH doctors are taught to build trust with supervising doctors. This is because if they are open to changing a standard as new information evolves, changes occur within the department or new insights emerge as well. PROVIDE RESOURCES The supervising doctors make sure that they provide tools and resources to the staff members. This way they are not only giving them the objective, but also the means of reaching the objective so that the chance of achieving that particular aim grows.

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BUILDING TRUST AT AKUH

AKUH main objective is to train good doctors and leaders who will go on to raise the quality of care in developing countries for which building trust relationship is the top most requirement. Building trust can in two ways doctors patient trust relationship and doctor relationship with management. Doctors are required to improve the doctor and patients relationship and trust. They are to be friendly and kind towards their patients and share necessary information. If mistakes are made they should inform patients and try to compensate them. They should give and receive constructive feedback. Also maintain confidentiality with their patients. In the same way all faculty and staff are expected to maintain certain standards and relation to their work and in representing themselves as a part of AKUH. All employees are required to communicate ideas and opinions to the next higher level of supervisor, either voluntarily or when requested. They should support their own position on any matters still under consideration. Decisions made contrary to their expressed position should be accepted and supported. The highest standards of ethics, integrity and honesty are to be followed.

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ETHICS

THE HOSPITAL ETHICS COMMITTEE

In case of conflict or ethical concern arising from care and treatment given to the patient, they can always consult the Hospitals Ethics committee and the matter can be sought by the patient through the physician/nurse in charge of his care.

PATIENT'S COMPLAINTS
AKUH provides for and welcomes the expression of grievances or complaints and suggestions by the patients at all times either by speaking directly to the team leader, supervisor, service coordinator or manager assigned to your care. They may file a formal complaint in writing by filling the Complaint/Suggestion Form, which is available at all service counters, and depositing it in the complain/suggestion boxes available at several locations throughout the hospital. At this academic medical centre, they are committed to providing the highest standards of quality care and are striving to not only meeting but exceeding people expectations. The facility personnel who care for the patient are qualified through education and experience to perform the services for which they are responsible as per set standard and policies. Keeping in mind the code of ethics the hospital staff has provide some rights to the patients these include:

NO BIASNESS: Patients will be provided with the best possible care available,
regardless of age, gender, nationality, ethnic background, religious origin or financial means. The care will be respectful of their culture, religion and beliefs.

GUIDENCE: Patients will be provided with proper guidance in seeking financial

assistance if they are in need of such help in connection with your care and treatment at AKUH.

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COMMUNICATION: Patients will be informed of their rights in a manner that

you can understand. In addition, other relevant information such as services available in the faculty, the mechanism to lodge a complaint, making a suggestion, accessibility to ethics consults, etc. will be provided to you and/or to your family.

FEEDBACK: Patients family will be provided with education about our disease
process after assessing your learning needs. Upon discharge, patient will be provided with a discharge summary.

PRIVACY: Care will be provided with full recognition of the individual need for
privacy in treatment and care along with protection of confidentiality of your health information.

RIGHTS OF PATIENT: Patients have a right to refuse treatment and to seek

discharge.

TRANSFER: A critical care patient being considered for transfer to an alternate

treatment facility will be provided with all possible support and facilities.

PARTICIPATION IN RESEARCH: Patients have the right to be informed, to

agree to or to refuse to participate in any research/educational projects affecting your care or treatment. Your refusal will not in any way affect the quality of care available to you. Therefore AKUH has always recognized the importance of ethical behavior. It promotes the moral reflection and leadership needed to create a health care system to meet the diverse society needs with limited resources.

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QUESTIONNAIRE

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1. Does AKUH provides its employees fringe benefits and give them a space to work and appreciate them? YES NO

2. When facing any problematic situation do all the employees report it to the authority? YES 3. Are the employees encouraged at AKUH? YES NO NO

4. Do you try to do best when the upper management delegates any work to you? YES NO

5. Having an autocratic leadership is appreciable or democratic? AUTOCRATIC DEMOCRATIC

6. Do you accept the leadership style done in AKUH? YES NO

7. In any kind of emergency do the upper level managers handle the situation in an organized manner and try to tackle the problem instead of creating chaos? YES NO

8. Have you ever felt that the work given to you is not according to your capabilities? YES NO

9. Were you trained by the AKUH to make your work a bit easy in the organization? YES NO

10. is there a friendly environment in the organization to work? YES NO

11. The training sessions are helpful to cope up with the situations in AKUH? YES NO

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