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By Dorothy F. Olshfski

Reviews how state-level public executives and bosses in Tennessee come to a decision and enforce coverage.

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Additional resources for Agendas and Decisions: How State Government Executives and Middle Managers Make and Administer Policy

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A middle manager attempting to change the hospital reimbursement policy in response to a federal initiative included hospital representatives in the planning and design stages of the policy. We know by law that the hospitals have to be involved in this process. They don’t have to be the decision makers but we know if they [are unhappy] . . they can fight hard enough and lobby hard enough to stop us at the hearing, and we won’t get it done. Should hospitals perceive themselves as shut out from the decision process, they have legal remedies to impede state action.

Well, I wrote the memo on a Thursday, and that Friday I got a promotion and I was moved to the central office. I moved on Tuesday. On Wednesday, I received my own memo. I had to turn myself down. Participatory management and consultative decision making have become pervasive in the management literature, but such counter-hierarchical notions appear to have shallow roots in management practice. The middle manager’s and executive’s organizational positions influence significantly the issues they face and the problems they identify.

W]e brought the computer people in and were able to generate the kind of reports that we needed when we got to the selling point. We generated printouts county by county of every state employee—where they were in the current system and where they would be in the proposed system; what the current pay range was, and what we recommended the pay range to be. We organized all those and we gave John Bragg every state employee in Rutherford County. We didn’t give to all 132 legislators, but we picked out the key guys like John Bragg and Doug Henry in the Senate and Speaker McWherter and the key people [in the House] and said, “Here they are, I don’t know who they are, you do.

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