- Ambiguity
Lack of certainty or dependability of meaning of communication, action or knowledge
Firstly, uncertainty has been associated with human conceptions and understandings that may not be objective. For example, health managers may be uncertain whether the services provided to consumers are valued or seen as high quality. These are situations which can be addressed through obtaining facts from consumers (directly or indirectly), but given the large and varied number of consumers, there can be ambiguity in understanding their views on service needs and quality of care. Secondly, clarity is important in leadership, as it is the mechanism by which to ensure that staff or followers in an organisation understand requirements, directions, interpretations and purposes. The opposite of clarity is ambiguity. Health managers aim for clarity in direction and communication. Finally, vagueness – where communication and language about facts in a matter or situation are not certain or firm in imparting understanding – is also relevant. A healthcare leader might aim to use feedback from consumers as part of the organisation’s quality review process. A vague approach here might result in consumer feedback that is not useful.
- Uncertainty
Limited or no understanding of knowledge or information regarding a given state or situation
- Clarity
Intelligible and comprehensible thoughts, actions and purposes
- Vagueness
Imprecision in communication or language regarding a situation
Healthcare
In health organisations and in leading them, two aspects of ambiguity are important.
Organisation ambiguity
Organisation, or bureaucratic, ambiguity concerns the development and values of the organisation. Best (2012) highlights the central role that ambiguity plays in the complex organisation. Organisations are formed for many reasons, and it is in the architecture and operation of their structures that ambiguity can be both identified and valued.
Health organisations operate in uncertain, risky and changing service and environmental contexts (Leatt & Porter, 2003). They need to work towards dealing with uncertainty (addressing and mitigating an environment of uncertainty through key activities including planning, developing systems and processes, and setting strategic and operational directions), standardisation to support efficiency and effectiveness (developing policies and procedures for the whole organisation and for localised and specific applications) and measuring and quantifying processes, goals and outcomes (expressing and valuing activities to support planning, operations and achievements).
Standardisation and development of policies and procedures support effective management in these contexts and enable clear communication and agreement with staff members. Quantification supports both operational clinical and non-clinical activities and establishes the basis for process and outcome evaluation. Leaders in health organisations are able to capitalise on the management of ambiguity through a bureaucratic organisational framework of systems and planning, policies and procedures, and qualification of performance. Casting of situations and paradigms onto these frameworks enables the leader to reduce complexity and ambiguity and therefore focus on interpretation and action.
Role ambiguity
Problems associated with ill-defined or ill-formed roles and lack of understanding about roles have a negative impact on organisation performance, as well as causing stress and lowered job satisfaction for individuals (Rizzo, House & Lirtzman, 1970). Key requirements associated with role ambiguity in an organisation or among workers include the existence of comprehensive role delineation, management of new or changing roles, and general or wide communications regarding roles. In relation to healthcare, a study of nurse executives found that role conflict and ambiguity can be associated with stress in professional roles (Tarrant & Sabo, 2010).
- Role ambiguity
Lack of clarity about expected actions and behaviours associated with roles or positions in an organisation
When discussing ambiguity in health organisations, it is useful to consider ambiguity in the role of leadership. Leadership is a complex role with complex actions. At times and in some contexts, leadership is difficult to define and evaluate. Leadership behaviours, characteristics and styles can make assessing the effectiveness of leadership and its impact on the performance of an organisation difficult. Pfeffer (1977) examines the concepts of leadership, the effectiveness of leaders and the attribution of leadership. This brings into focus the need for leaders to connect impact and effectiveness to the key organisational issues, including dealing with ambiguity.
The healthcare organisation and the key resource of the health system – its workforce – are important elements in the management of ambiguity. Complex healthcare organisations (as opposed to complexity in the organisation) provide both an operational and an environmental setting for ambiguity, but they also provide structures, processes and problem-solving constructs that can be used to address the issues of ambiguity.
Stromlo, in the Australian Capital Territory, is a relatively large health service and has a broad spectrum of care, across primary, secondary and tertiary sectors. The development of long-term regional health workforce plans presents several ambiguous elements. There are two key long-term goals. Firstly, the workforce will do things differently, in working within different models of patient and client care and organising operations and the business of healthcare differently. Secondly, to be effective, with new and dynamic models of care and operations, the workforce will need to have different skills, training, abilities and roles. Stromlo’s health professionals will have a significant influence in the health workforce development agenda and will be affected by the workforce environment in over the next 10 to 15 years.
Stromlo managers understand that there are key areas where ambiguity exists as it relates to their long-term planning. These include the following:
Stromlo managers need to seek clarification in all of these areas, as a key aspect of implementing new ways of working in professional groups is ensuring clarity, in order to avoid role ambiguity.
Management and ambiguity
Ambiguity affects key areas of planning, development and decision-making and requires a comprehensive approach. In most complex organisations, the management of ambiguity is not handled alone or in a simple, straightforward way. Two key areas where ambiguity interrelates are in an organisation’s change management program and processes and in strategies and processes of evaluation. Both are discussed below.
Change management approaches
Healthcare managers use change management approaches with varying degrees of sophistication. The nature and complexity of the reform and development agenda that organisations face and develop influence the different types of changes and transformation approaches. Related here is the issue of ambiguity, which can be affected by timeframes (planning over medium and longer terms), the clarity of the growth and development agenda and the capacity of the organisation in the development of the change process and in all forms of its resourcing.
Changes in an organisation evolve at different rates, and variations in the organisation’s activity levels, tolerance and resourcing affects these rates. The ability to describe and instil key aspects of organisational development is an important factor in the change management process. Whether processes enable review and understanding of internal and external environments will affect the content, quality and rates of change. Nadler and Tushman (1995) identify four key types of changes in organisations:
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