Understanding the Counterproductive Effects of Micromanagement in Leadership Using the Lenses of Subordinate’s Employees.

Understanding the Counterproductive Effects of Micromanagement in Leadership Using the Lenses of Subordinate’s Employees.

Misheck Samakao and Dr Rosemary Mulenga

Kwame Nkrumah University, Kabwe, Central Province, Zambia

DOI: https://dx.doi.org/10.47772/IJRISS.2023.701159

Received: 30 September 2023;  Revised:  18 October  2023; Accepted: 20 October 2023; Published: 22 November 2023

ABSTRACT

Some managers believe in micromanagement system of leadership that are generally perceived to be safe, effective and assures them full control on workers and productivity. Micromanagement is a style of management where there is control of workers through excessive observation and control throughout the stages of completion of workflows within the organisation.  It entails closer supervision of the subordinates throughout all the stages of the complete workflow engagement. In real essence, micromanagement type of leadership has been observed for many years to exhibit tendencies of counter-productivity amongst the workers as it robs them the rights to execute their assigned duties to the best of their abilities and skills. Micromanagement has been known for many years for its ability to stifle worker’s innovations and creativity and hence rob them their self-esteem.  It has further been also observed as one of the highest sources of employee demotivation. Besides, it also tends to promote mistrust, and creates an atmosphere of insecurity thereby leading to counter productivity. This study is grounded on the theory of socialisation. Socialisation is the theory that helps individuals to be socially accepted. In return their behaviours helps society function smoothly. The principals of socialisation helps to learn new values, norms and customs. The main objective of this study therefore was to establish the counterproductive nature of micromanagement system in leading employees.  The study was significance in that it highlighted the demerits of micromanagement through the lenses of the individual employees. This study employed qualitative research methods. The research used a case study research design. Data was collected using semi-structured questionnaires, focused group discussions and observations while the research results were presented using thematic analysis.

Keywords: micromanagement, radical leadership, equity, counter-productivity, employee motivation

INTRODUCTION

Leadership is the ability of an individual to initiate guidance and influence on a group or an organization in order tomaximize its performance. Leadership could further be defined as the ability to influence the followers to share in your vision to actualise that which otherwise they could not.  It can be stated that leadership determines both the present and the future of any organisation. The modern business, environment is characterised with uncertainty and unpredictability. It has posed more questions than answers. In order to be successful in the present competitive markets, there is need therefore to build superior leadership qualities that builds teams, encourages innovations, creativity and unprecedented ideas that can help outweigh the present and future competitors.  In view of this conceptualisations, many managers think success would entirely rely on their abilities to secure firm control and manipulation of the subordinates. They might decide to pursue a style of administration that would use excessive control and very tight supervisory mechanisms. This system of management may be called micromanagement.

Micromanagement leadership is a form of leadership style where the managers closely monitors and directs their subordinates. Although few managers and employees could benefit from such a practice, micromanagement, as a leadership style has relatively more negative implications on an employee’s behaviour. Mostly, the effects of the micromanagement on both the organisation and subordinates themselves have been under-estimated. Generally, micromanagement tends to create a sense of perceived stress leading to employees to behave in account er productive manner. Further more, micromanagement has been observed to portray characteristics that lower down the growth and development of employees who are being micromanaged. It also tends to obstructs the individuality of team and its growth because of continuous interferences of a leader

In this article, we have intended to develop a theoretical framework by investigating from a micromanagement perspective. Thus, highlighting the various implications of micromanaging could help lead to awakening a sense of responsibility amongst managers to opt for alternative forms of leadership styles that are more appealing to the subordinate’s employees. Interrelating the concepts of employee disengagement, perceived stress and deviant behaviour, our study provides several implications for organizations and managers alike apart from a theoretical literature on the suggested methods to avoid this course of action.

Many studies have vividly shown that Micromanagement contributes to fear, stress, low morale, and lower job satisfaction (Chamners, 2004). The behavioural characteristics of these managers consist of someone who oversees their workers too closely and spends an excessive amount of time supervising a particular project, and telling people exactly what to do and how to do it (White, 2010), leaving little or no autonomy or personal initiatives for subordinates. The proposed research identified the factors contributing to micromanagement behaviours through lived experiences from the worker’ sperspectives.

Micromanagement can be advantageous in certain short-term situations, such as while training new employees, increasing productivity of underperforming employees, controlling high-risk issues, and when there can be no question of who is in charge. However, the costs associated with long-term micromanagement can be exorbitant and irrepairable. Symptoms such as low employee morale, high staff turnover, reduction of productivity and worker’s dissatisfaction can be associated with micromanagement. The negative impacts are so intense that it is labelled among the top three reasons employees resign. Ultimately, micromanagement leads to decreased growth potential in a department.

Managers who put too much emphasis on daily operational details can miss the broader picture and fail to plan for departmental expansion. Eventually, many micromanagers find themselves at considerable risk of burnout. Changing behaviour associated with micromanagement can be a lengthy and difficult process. As with most problems, the first one of the most important things to realise is the step to realize that there is behaviour that needs to be changed and to understand how it negatively impacts the department. Conducting a self-assessment of one’s leadership style can be advantageous in this process. The true task is to find a balance between effectively performing daily obligations and strategically planning for the future. This task typically involves proper delegation of duties, and that in itself is a difficult challenge. Proper delegation of tasks may be the primary key to combating micromanaging behaviour. essentially, it is the principle duty of every manager to ensure that they develop the required vision of how the organisation will look like in the present and the future. Once the mission and the vision are fully and strategically developed, there is need to hire the personnel with the right skills, talents and core competencies. There is need to develop a policy and procedural manual that will give clear guidelines, standardization, consistency and efficiency in decision making process. The manual will make the process of delegation efficient and effective. Mangers need to then develop clear solid lines of communication between the managers and the general staff. Effective communication begins with a clear line of communication.  However, there shall always be errors and room for mistakes from the subordinates which can be corrected. Mistakes are very important in the employee learning curve.Employees who are allowed to be self-directed will be motivated to be more productive. Staffing issues such as low morale and high turnover will decrease; patient satisfaction will increase simultaneously.

Study Objectives

• To explore common characteristics of micromanagement as style of leadership
• To establish the negative effects of micromanagement on subordinate employees
• To suggest possible solutions to the negative effects of micromanagement

Research Hypotheses

• To explore common characteristics of micromanagement as style of leadership

H1: There are common characteristics of micromanagement as a style of leadership

H0: There is no common characteristics of micromanagement as a style of leadership

• To establish the negative effects of micromanagement on subordinate employees

HI: There is a negative effect of micromanagement on subordinate employees.

H0: There is no negative effects of micromanagement on subordinate’s employees.

• To propose possible measures to be taken in order to address the negative effects of micromanagement.

H1: There are measures that can be undertaken to address the negative effects of micromanagement.

H0: There are no measures that can be undertaken to address the negative effects of micromanagement.

Conceptual Framework

A Conceptual framework is a useful tool that can be used to show relationships and linkages in order to give more understanding to the phenomenon under investigation (Baxton and Jack 2008). In view of this, we can therefore indicate that the themes in this study have been put together to build an integrated conceptual framework work (Figure 1).

Figure 1: An Analysis of the Effects of Micromanagement

Source: Adapted from Kumar 2016

From the above figure 1, it can be observed that micromanagement leadership stylet ends to promote auto cratictendencies that have negative influences on the behaviour of employees. Mainly the micromanager does not perceive the extent of his or her actions. When the employees are controlled using excess control and close manipulations, it tends to build huge levels of stress that is often chocking and suffocating to workers.

Micromanagement leadership Styles: This is a type of leadership style that promotes close monitoring and supervision of employees. However, it tends to create much pressure on the workers as they are closely checked upon by their supervisors.

Deviant Behaviour: micromanagement is perceived to build huge amounts of stress on the workers or employees. It is the same levels of stress that could lead to staff resorting to anti-social behaviour such as high levels of absenteeism, theft, corruption, conflicts, alcohol and substance abuse.

Employee Engagements: Essentially workers desire some space and freedom to think independently while they are discharging their responsibilities. Never the less, micromanagement has higher tendencies of depriving workers their right to innovations and creativity. The engagement between the supervisor and the supervisee is so close, tight and choking hence, it tends to create stress and unnecessary pressure. Many workers on average, they do not like this interaction.

The employees mostly the skilled personal feel less appreciated as this leads to total lack of trust between the mangers and the employees.  It then results in deviant behaviour as workers resort to counter productivity and underperformance. In extreme cases it may even cause staff high turnovers, frustration and demotivation. Micromanagers mostly portrayelements of stubbornness and indifference behaviours that continue to cause more damages amongst the workers.  If it is not counterchecked, it might result into more complex problems for the company and thereby leading to more in efficiencies in the running of the organisations.

This is the reason why it is very important to engage more efforts in the quality leadership styles that could help boost staff morals, trigger high levels of innovations and creativity within the organisation.

LITERATURE REVIEWS

Introduction

Micromanagement has been viewed differently by different people. Many studies that have been conducted have shown that micromanagement might have both positive and negative effects on work and productivity. In most cases, it has been found that micromanagers mostly do not consciously feel that they are into micromanagement of their subordinates. This is because it is deeply entrenched into them and they tend to believe that what they do is in the best interest of the organisation. They often lack empathy, sympathy and the drive to take extra care to see how the general population of the employees receive it.

Chambers (2004) stated that Micromanagement lowers down the growth and development of employees who are being micromanaged. It also obstructs the individuality of teams and its growth because of continuous interference of a leader.  This is because workers are held up from using their abilities, initiatives and creativity.  In fact, due to too much close supervision, there is fear that is instilled in the workers to the extent that they begin to retrain themselves from action that might cause disagreements with their team leader. In the process, workers become so frustrating due to the fact that the leader has to approve even minute details before it can be executed. The associated delays and routine cumbersome procedures work against efficiency and tend to generate high amounts of stress.

Further studies have also depicted some of the reason behind the manager’s micromanagement style as their lack of patience, emotionally insecure andincreased pressure. (Walters 2015).  Most managers feel insecure and lack trust towards their subordinates and as such, they tend to micromanage them.

Some studies however, have argued that in some contexts micromanagement is useful and can bring about some temporal positive benefits. Bobinski (2009) for instance postulates that Micromanagement certainly helps in upgrading the skills and abilities of employees and helps them to perform better, if the subordinates are not able to perform properly without nurturing. Micromanagers may be referred as perfectionists, as they are very structured and organized leaders.

It has also been observed that micromanagement could yield some positive feedback to unskilled employees such as general workers who might need that close supervision. On the other hand, the skilled workers might not need that close supervision because they are specialised and they know what to do. Skilled workforce is mainly more knowledgeable, exposed and more experience. This is what causes it to be frustrated once its micromanaged. General workers on the other hand have limited skills, and knowledge and abilities.

Another study shows that employees who felt that they are being observed constantly perform at a lower level. Decaro et al (2011). Most employees interviewed indicated that micromanagement style of leadership tends to cause high levels of demotivation. It further tends to make workers feel inferior and incapable of performing in their current jobs. It is this same feeling that makes them to underperform or lose focus of concentration. Employees desire to do their jobs freely and professionally. Once there are elements that are causing them to feel timid and unfriendly, they tend to withhold themselves and do less. This means they can withhold part of their investment into productivity and profitability of the firm.

Paul et al (2009) further observe that Micromanagers are accused of being control freak, suspicious, incompetent and their psychopathic personalities are always a hindrance to organizational effectiveness. In view of this assertions we can argue that, micromanagers are incompetent at personal levels. This assertion makes sense because it shows that micromanagers trend to hide their in competence in the haze of closely following up their subordinates.

However, it can be observed that such incoherent tendencies are counterproductive and forces many employees to opt to leave an organisation in preference for a better work environment.

Despite raising some positive development associated with micromanagement, it can be stated to a large extent that macro management often comes with many disadvantages both in the short and long term basis.  The effects of micromanagement in the organisation may be characterised with low employee morale, high staff turnover, reduction of productivity and worker’s dissatisfaction.

Additionally, micromanagement comes with more negative impacts that are so intense such that it is labelled among the top three reasons employees resign. Ultimately, micromanagement at both narrow and wider perspectives tend to leads to decreased growth potential in a department. Managers who put too much emphasis on daily operational details can miss the broader picture and fail to plan for departmental expansion. Eventually, many micromanagers find themselves at considerable risk of burnout. Changing behaviour associated with micromanagement can be a lengthy and difficult process.

How to Identify Micromanagement Leadership Style?

It’s often very difficult to notice oneself when practising micromanagement. It mainly reflectsit self within the levels of conflict, arguments or disagreements that exist when people are resisting or protesting again it. The owner will normally feel workers are a problem when in the actual sense he or she could be the sources of such problems. Scholars have shown that one way to identify this is through conducting a self-assessment of one’s leadership style. The true task is to find a balance between effectively performing daily obligations and strategically planning for the future. This task typically involves proper delegation of duties, and that in itself is a difficult challenge.

Proper delegation of tasks may be the primary key to combating micromanaging behaviour, however, some other suggestions include developing a vision of what the department will look like in the future. Once the vision is clear, you may be needed to hire the right people with the right skills for the job. Essentially, the qualified staff would help develop a policy and procedures manual respectively.  Within the policy frameworks managers need to develop solid lines of communication between managers and subordinates. Basically, one expect to see some employee errors. Mistakes are an important process in the learning experience and should be viewed as a training expense. Employees who are allowed to be self-directed will be motivated to be more productive. Staffing issues such as low morale and high turnover will decrease; patient satisfaction will increase simultaneously.

Underlying Factors that Promote Micromanaging Behaviours

It has been argued that both operational, structural and environmental factors tend to promote micromanagement behaviours. What is clear in this regards are the propounding factors that incubate micromanagement tendencies amongst managers.  The culture of the organisation may be psyched to promote the behavioural conducts of micromanagement. On an individual level, micromanagers may have insecurities, distrust, fear of failure, or even time constraints, spurring them to dictate in an authoritarian manner. In regards to the work environment, micromanagement thrives in hierarchical working environments because of the strict boundaries placed on people

RESEARCH METHODOLOGY

This study used qualitative methodological design in an explorative perspective. It used strategies of explore, describe and predict whereby all the respondents were required to share their views openly and freely. They brought out their opinions, experiences and values in order to understand the full meaning of the phenomenon under investigation. The study was a real situation problem looking for clear answers to the problem of student’s participation. Therefore, a qualitative research design was more suitable as it aimed at exploring in details the nature of the problems and the possible solutions to it.

Sampling Methods and Data Collection

Both probabilistic and non-probabilistic sampling techniques were used to investigate the counterproductive effect of micromanagement in leadership.   A sample size of 30 respondents were used which included members of staff who were randomly selected using simple random sampling techniques. Data was collected using semi-structured questionnaires and focused group discussions and systematic observations.

DATA ANALYSIS AND INTERPRETATIONS

The data was analysed using thematic analysis methods whose findings was presented using themes as shown in the diagram below.

Data was collected using the open-ended structured questionnaires. All the data was transcribed and coded as shown from the above diagram. Common themes presenting a pattern of responses were drawn from the coded data and logically presented.

FINDINGS AND DISCUSSION OF THE STUDY

Common Characteristics of Micromanagement

The study established that the most common characteristics of micromanagement included the tendency to avoid delegation. Managers that practice micromanagement often find it difficult to delegate duties to their subordinates. They tend to hold on to everything partly due to lack of trust and confidence from their subordinates.  Sometimes, they might delegate but still give minute details on the how, when and what should be done such that the person who has been given the tasks to work feel they are not still in charge. Micromanagers often experience unknown fears, insecurities and pressure from the inside themselves. This forces them to exercise excessive absolute powers, stern controls. Most the respondents indicated that their supervisors appeared to be power hungry,disrespectiveness and exercised more autocratictendencies,while discharging absolute power and firm control. One respondent lamented that when he started work, he thought he would apply all his skills and knowledge but it was contrary to the reality. Another responded yelled that their supervisor had taken away their job indirectly. Furthermore, one responded complained that work was no longer inciting and there was no need to work hard anymore.

Negative Effects of Micromanagement

Increased levels of stress

The study highlighted the possible effects of the macro management and they were diverse and completely different one from the other.  The majority of the interviewees mentioned that micromanagement is so devastating to the extent that it deprives one the ability to enjoy their jobs. Micromanagement tends to make jobs so dry as there is no longer room to practise one’s job professionally and technically. Due to excessive control and interruptions from the supervisor, micromanagement tends to demotivate the workers and stifles the job thereby creating more stress, frustrations and unnecessary contributions. Most skilled work force do not like this interactions and interruption in their daily duties.  This being the case highly trained and skilled professional opt to leave the organisation where jobs are stressful and lack professionalism. Since most workers spend most of their time at work, they desire some levels of freedom whereby they can use their creativity and ingenuity to discharge their work in a less tense work environment.

When the workers are not given enough freedom and a leverage to engage their intellectual and professional acumens, they so tend to be less create and less innovative. Once the workers reach this stage, they tend to become less productive and this easily becomes contagious to the rest of the organisation due to the infiltration of the communication through informal channels. Collectively, within the organisation when the influence become widespread, the organisation is chocked to the extent where productivity and profitability begin to dwindle in a disadvantaging manner to the aspiration of the organisation.

Chritency (2019) established that macro management causes counter productivity at both micro and macro levels of the organisation. Human beings are very sensitivity but very critical at the same time to the successfulness of the organisations. Human capital is the greatest assets of the all resources that the organisation may have. If the human resources are not taken care of to the levels of their expectations, they tend to respond in an opposite direction to the detrimental of the aspiration of the whole organisation. There is need to ensure that managers become extra careful when handling human capital. Cally (2002) postulate that human resources need to be constantly motivated in order to achieve and sustain a levels of excellence and productivity.

For this to be achieved, there is need to apply effective human resources skills that tend to inspire trust and confidence both in the short and long terms basis. Specialised and full skilled staff may be difficulty to manage using the autocratic system of leadership. Autocratic style of refers to the leadership style that is characterised with dictatorial tendencies, forceful, and full control of decision making process cantered in one person as opposed to groups. Leaders must use democratic and servant leadership styles in order to extract the best out of the technocrats. This might be a bit different from what may obtain when managing the general workers. The research participants had so much to say during the focused group discussions and classified interviews. The study further showed that many respondents detested micromanagement styles of leadership. One of the respondents claimed that he did preferred to work where there was peace and dignity though earning less as opposed to work in an environment that was predominantly hostile. That simply means that workers desired more of peace of mind rather than unfriendliness that comes with more earnings. Furthermore, employees lamentably expressed their displeasure towards the employers who seemed not to appreciate their efforts.

Findings

It is observed that there is need to reverse the high tendencies amongst the managers to practice micromanagement leadership styles. One most effective way that was established was the need to create strong linkages that could give effective feedback to the supervisors in an honesty and transparent manner. Well this is not easy to the side of the employees as they often trend carefully so and not to tend to offend the employers each time they interact with them.

When worker’ sgunner enough courage to give to the managers, this could help to bring about positive reflections on what should be done in order to correct the situation. Ideally, it is suggested that once the managers realise the devastating effects of the macro management, they would more likely to adopt the democratic leadership styles that tend to be more flexible, open to new ideas and inspire high levels of mutual trust and confidence in the workforce.

Furthermore, there is ned to create platforms where by the workers and the managers can learn to socialise,interact more and this process is more likely to bring about the positive outcome to benefit both the workers and the managers. As management training, there is need to carry out more research in this areas whereby the managers and the managed can share knowledge and practical research finding to expose the devastating s effects of micromanagement.

The modern business environment requires radical decisions that can defy the traditions styles of thinking or doing things. A management styles that encourages creativity, flexibility and innovation is what is needed in the modern business environment. This can only happen where there is trust, some levels of independence amongst the workers to exercise their abilities to the best of their potentials without unnecessary interferences. Cardly 2020 argued that the mangers and the managed must be free to work together in order to meet the deemed of the markets and help get the best of the rest possible.

CONCLUSION

It has been observed that macro management is one of the most common styles of management in the modern world. However, there are a few studies that have been undertaken to highlight the effects of the systems form the employee’s perspectives. Most managers’ have continued to underestimate the devastating effects of this system of governance. This has led to much more counterproductive effects as many workers have remained demotivated, discouraged, stressed and frustrated causing high employee turnovers, stifled creativity and inefficiencies. There is need to conduct more awareness’s and sensitization to create awareness’s amongst the workers both in the long and short basis. Once modern managers pay attention to this problem, they would begin to engage workers differently in order to get the best out of them. In every worker there is untapped potential and it takes excellent leadership to solicit the best out of every individual.

REFERENCES

1. White, R. D. (2010). The Micromanagement Disease: Symptoms, Diagnosis, and Cure. Public Personnel Management, 39(1), 71–76. https://doi.org/10.1177/009102601003900105
2. Meier, C Paul D; Charlebois, Lisa; Munz (2009) You Might be a Narcissist if: How to identify Narcissism in Ourselves and others and what we can do about it. Minneapolis: Langdon Street Press.
3. DeCaro, M.S, Thomas, R.D, Albert, R.D and Beilock, S. L. (2011) “Choking under Pressure: Multiple Routes to Skill Failure,” J. Exp. Psychol. Gen., vol. 140, no. 3, pp. 390–406, 2011.
4. Bobinski, D (2009) Creating Passion Driven Teams: How to Stop Micromanaging and Motivate People to Top Performance. Career Press
5. Chambers, E (2004) My Way or the Highway: The Micromanagement Survival Guide. San Francisco Press publishers.
6. Johnson, J. M, Meltzer, JK Humphrey, D. O Arora, H.J Am VM. (2009) On-call supervision and resident autonomy: from micromanager to absentee attending. Farnan Med. 2009;122:784–788. [Abstract] [Google Scholar]
7. Pingree EW, Huth K, Harper BD,(2020) Encouraging entrustment: a qualitative study of resident behaviors that promote entrustment. Acad Med. 2020;95:1718–1725. [Abstract] [Google Scholar]
8. Finn KM, Metlay JP, Chang Y, Nagarur A, Yang S, Landrigan CP, Iyasere C (2018) Effect of increased inpatient attending physician supervision on medical errors, patient safety, and resident education: a randomized clinical trial.. JAMA Intern Med. 2018;178:952–959. [Europe PMC free article] [Abstract] [Google Scholar]
9. Crockett C, Joshi C, Rosenbaum M, Suneja M. (2019) Learning to drive: resident physicians’ perceptions of how attending physicians promote and undermine autonomy.BMC Med Educ.;19:293. [Europe PMC free article] [Abstract] [Google Scholar]
10. Rulphad R.T(2020) Signs that you’re a micromanager. [ Aug; 2020 ];https://hbr.org/2014/11/signs-that-youre-a-micromanager
11. Biondi EA, Leonard MS, Nocera E, Chen R, Arora J, Alverson B. J. (2014) Temperingpediatric hospitalist supervision of residents improves admission process efficiency without decreasing quality of care. Hosp Med; 9:106–110. [Europe PMC free article] [Abstract] [Google Scholar]
12. Lachance S, Latulippe JF, Valiquette L, Langlois G, Douville Y, Fried GM, Richard C. (2014) Perceived effects of the 16-hour workday restriction on surgical specialties: Quebec’s experience.J SurgEduc.;71:707–715. [Abstract] [Google Scholar]
13. Gruppen LD, Irby DM, Durning SJ, Maggio LA (2019) Conceptualizing learning environments in the health professions. Acad Med. 2019;94:969–974. [Abstract] [Google Scholar]
14. Solomnos Y.K(2019) If you do these 5 things, it’s obvious you are a micromanager. [ Jun; 2020 ;https://www.forbes.com/sites/terinaallen/2019/08/24/when-you-do-these-5-annoying-things-its-obvious-that-you-are-a-micromanager/ 2019
15. Cleary M, Hungerford C, Lopez V, CutcliffeJR..(2015)Towards effective management in psychiatric-mental health nursing: the dangers and consequences of micromanagement.Issues Ment Health Nurs;36:424–429. [Abstract] [Google Scholar]
16. Ryan RM, Deci EL. Am Psychol. (2000)Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Ryan RM, Deci EL. Am Psychol. 2000;55:68–78. [Abstract] [Google Scholar]
17. Collins SK, Collins KS (2002)Micromanagement-a costly management style.. https://pubmed.ncbi.nlm.nih.gov/12510608/Radiol Manage. 2002;24:32–35. [Abstract] [Google Scholar]
18. Moriarty JA, Vellanki S, Trope LA, Hilgenberg SL, Blankenburg RL. (2020) Righting the autonomy-supervision pendulum: understanding the impact of independent rounds on medical students, residents, and faculty.AcadMed.;95:0–36. [Abstract] [Google Scholar]
19. Delgado O, Strauss EM, Ortega MA. Am J Health Syst Pharm. (2015)Micromanagement: when to avoid it and how to use it effectively. Delgado O, Strauss EM, Ortega MA. Am J Health Syst Pharm. 2015;72:772–776. [Abstract] [Google Scholar]
20. Kerlin MP, Small DS, Cooney E, et al. N Engl J Med. (2013)A randomized trial of nighttime physician staffing in an intensive care unit.;368:2201–2209. [Europe PMC free article] [Abstract] [Google Scholar]
21. Maxfield D, Greeny J, McMillan R, Patterson K, SwitzlerA.(2005)Silence kills: The seven crucial conversations for healthcare. [ Sep; 2020 ]; https://www.aacn.org/nursing-excellence/healthy-work-environments/~/media/aacn-website/nursing-excellence/healthy-work-environment/silencekills.pdf?la=en 2005 2005:1–19. [Google Scholar]
22. Beck J, Kind T, Meyer R, Bhansali P. J Grad Med Educ. (2016)Promoting resident autonomy during family-centered rounds: a qualitative study of resident, hospitalist, and subspecialty physicians.;8:731–738. [Europe PMC free article] [Abstract] [Google Scholar]
23. Edmondson A, Higgins M, Singer S, Weiner J. Res Hum Dev. (2016)Understanding psychological safety in health care and education organizations: a comparative perspective.. 2016;13:65–83. [Google Scholar]
24. Santen SA, Wolff MS, Saxon K, Juneja N, Bassin B. West J Emerg Med. (2019) Factors affecting entrustment and autonomy in emergency medicine: “How much rope do I give them?”.;20:58–63. [Europe PMC free article] [Abstract] [Google Scholar]