Article Analysis

Please select a peer-reviewed article from the library on the topics for the current week. Analyze the article and correlate to your personal ethics assessment results. You are encouraged to share some specific examples of your assessment results to support your opinion. However, if you would like to keep your results private, you can speak to your results in general terms.
Write a 1-2 page summary on your analysis of the article to your assessment results and how you believe this content has increased your ethical self-awareness. Please include alternatives, analysis, application, and action.
businessethics
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Administrative Theory & Praxis Vol. 28, No. 4, 2006: 642–645 R
Book Review
O’LEARY, ROSEMARY.The Ethics of Dissent:Managing Guerrilla
Government.Washington, DC:CQ Press, 2006.
REVIEWED BY BRETT S. SHARP, UNIVERSITY OF CENTRAL
OKLAHOMA
The Ethics of Dissent illustrates an unusual and provocative concept.
In short, guerrilla government is O’Leary’s metaphoric term for govern-
ment employees who actively and covertly dissent from policies. These
guerrillas take advantage of a variety of strategies. They work behind
the scenes to assist favored interest groups. They leak information to
the media. They covertly transfer data to other agencies. They sabotage
projects. They bring unwanted attention to decisions that supervisors
hope certain stakeholders would otherwise ignore. They let supervisors
self-destruct from their own mistakes. Or, they simply drag their feet in
performing their duties. According to O’Leary, the quintessential guer-
rilla in the American context is W. Mark Felt, a.k.a. “Deep Throat” of
the Watergate era.
This book richly illustrates the natural friction that occurs between
career civil servants and political appointees. O’Leary contends that
guerrilla government is a natural “manifestation of inevitable tensions
between bureaucracy and democracy that will never go away” (p. 3).
Although guerrillas often act on their own, they usually capitalize on a
wider network. In conspiratorial fashion, they will go so far as to coor-
dinate their efforts with other staff members and external groups.
O’Leary’s guerrillas believe that their own professional roles extend be-
yond the restraining boundaries of an agency’s mission statement. In a
sense, these employees are loose cannons whose personal agendas often
conflict with the direction preferred by agency administrators.
The Ethics of Dissent is a powerful book. It covers a lot of territory
for such a short work. The large amount of information is framed by the
author’s high level of critical analysis. Like other offerings in the “Pub-
lic Affairs and Policy Administration” series by CQ Press, The Ethics of
Dissent would make a wonderful supplementary text. It would certainly
be appropriate for those interested in public sector ethics, public ad-
ministration, and even environmental politics. In fact, the book empha-
2006, Public Administration Theory Network
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Sharp 643
sizes environmental management to such a degree that it should have
been included in the title. However, O’Leary understandably wants her
work to have a broader application. She touches upon a wide variety of
ethical management concerns such as malicious compliance,
whistleblowing, groupthink, policy entrepreneurship, and the politics of
expertise. O’Leary pays homage to a previous book by Needleman and
Needleman titled Guerrillas in the Bureaucracy (1974). Their work pri-
marily concentrated on community planners surreptitiously co-opted by
particular clientele in disregard to the larger public interest. O’Leary
differentiates her own book from their initial analysis by a broader ap-
plication of guerrilla government.
O’Leary taps into several existing streams in public administration
research and then reintegrates them into a whole. For example, she uses
her guerrilla concept to reframe Kaufman’s The Forest Ranger (1960) as
describing an effort to quell guerrilla activities among the rangers
before they flourished beyond administrative control (pp. 12-13). She
further connects her guerrilla concept to Hirschman’s Exit, Voice, and
Loyalty (1970), Lipsky’s administrative discretion described in Street-
Level Bureaucracy (1980), the politics of bureaucratic power first de-
scribed by Appleby (1949) and Long (1949), and many other notable
examples of political science literature (pp. 8, 13-14). The author chan-
nels her analysis through the three perspectives of bureaucratic politics,
organizational management, and ethical decision making. In doing so,
O’Leary successfully distills an enormous amount of social science liter-
ature in her first chapter alone. Her discussion of ethics, for example,
takes the reader from the pragmatic American Society for Public Ad-
ministration’s Code of Ethics to discussions of ethical philosophy as ap-
plied to the public sector (pp. 16-22).
O’Leary goes well beyond an exclusively descriptive approach by
providing advice both for guerrillas and those who manage them. In
what may be the administrative equivalent to The Anarchist Cookbook
(Powell, 1970), O’Leary presents a set of “Guidelines for Guerrillas
from Guerrillas” (p. 92). These helpful hints include filing lawsuits,
ghostwriting letters for external interest groups, and filing official com-
plaints. She follows through with a set of ethical questions that public
employees should ask themselves before undertaking guerrilla
activities.
The challenge for the manager is to determine whether the guerrilla
is a “canary in a coal mine that needs to be listened to or a delusional,
single-issue fanatic” (p. 93). For managers of guerrillas, she suggests
creating an open organizational culture which includes many well-de-
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644 Administrative Theory & Praxis ❖Vol. 28, No. 4
fined conduits for dissent. She finally arrives at perhaps the most inter-
esting thesis in the book:“guerrillas just might be creative assets to
public organizations” (p. 108). Despite the risks posed by the presence
of guerrillas in an agency, O’Leary suggests they may in fact serve im-
portant functions. The author relates how she protected one of her own
guerrilla subordinates when her supervisor ordered his termination. Al-
though her decision proved to be career suicide, she believed that her
guerrilla employee was “the leading edge of a system” whose creative
force should be harnessed (p. 5).
The author wrestles with the uncomfortable balancing act between
guerrillas as “ethical crusaders or insubordinate renegades” (p. 90). She
notes, “Guerrillas run the spectrum from anti-establishment liberals to
fundamentalist conservatives, from constructive contributors to deviant
destroyers” (p. xi). As the book proceeds, O’Leary displaces such over-
tures to objectivity with an increasingly obvious admiration for most of
the guerrillas in her research. Moreover, she often portrays guerrillas of
the progressive, activist persuasion with heroic flavor. The frequency of
liberal-minded guerrillas might be explained as an artifact of her em-
phasis on cases involving environmental protection. But O’Leary cer-
tainly doesn’t reveal any sympathies for more conservative guerrillas
(e.g., Oliver North) the few times they are mentioned. The author does
not explore whether or not guerrilla government is more likely under a
conservative regime. After all, career bureaucrats typically believe in
the active role of government and especially in the missions of their
own agencies. An energetic public service squelched by political leaders
with a more conservative ideology would seem to create the optimum
circumstances for guerrilla activities to emerge.
The Ethics of Dissent complements other contemporary readings. In
particular, O’Leary’s book dovetails well with Unmasking Administra-
tive Evil by Adams and Balfour (2004). Both books describe different
sides of the same coin. The concept of guerrilla government seems to be
one answer to the dilemma posed by administrative evil. Unfortunately,
O’Leary herself seems to have completely misunderstood the work of
Adams and Balfour as “acknowledging the potential dark side to guer-
rilla government” (p. 100). The Adams and Balfour book is not about
the dark side of guerrilla government at all. If anything, Unmasking
Administrative Evil begs for guerrillas who won’t follow blindly the pol-
icy direction of political leaders. That book portrays the classic example
of administrative evil as an efficient public service mindlessly facilitat-
ing the Holocaust through seemingly normal bureaucratic routine.
O’Leary’s examples may not be as extreme, but she does offer several
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Sharp 645
instances in which her guerrillas potentially save lives. In one instance,
an EPA employee defies agency directives and publicly releases infor-
mation about the health dangers of a deadly pesticide used on Idaho
potatoes (p. 60).
The real value of this book is in its stories. O’Leary authoritatively
writes from her own experience working in the public sector. She draws
upon case studies written by graduates of the Maxwell School and she
relates various experiences based on student feedback and her own sur-
vey research. Each of her vignettes provides enough descriptive detail
to capture the flavor of the prevailing organizational culture and the
mythology that surrounds key staffers. Long after readers put down this
book, they will remember its stories.
REFERENCES
Adams, G. B., & Balfour, D. L. (2004).Unmasking administrative evil (2nd
ed.). Armonk, NY:M. E. Sharpe.
Needleman, M. L., & Needleman, C. E. (1974). Guerrillas in the bureaucracy:
The community planning experiment in the United States. New York: John
Wiley.
Powell, W. (1970). The anarchist cookbook. Mattituck, NY: Amereon.
Harvard Business Review on
Managing Health Care
Boston: Harvard Business School
Press, 2007, 184 pages, $19.95.
Perhaps the greatest service and
benefit that the Harvard Business
Review provides in the publication of
Harvard Business Review on Managing
Health Care is that it relieves today’s
busy healthcare executive, trustee,
supervisor, or provider from the need
to search for past-published literature
that may be relevant and helpful. The
book comprises eight articles previ-
ously published from 2000 to 2006.
The editors of this collection do not
explain how these articles were cho-
sen. I briefly summarize each article
in the book and highlight the most
relevant points.
Innovation in Healthcare
Regina Herzlinger contributes two
articles (2006 and 2002). In the first,
she discusses the trials and tribula-
tions associated with trying to make
innovation a necessary and essential
component of healthcare for the dis-
tinct purpose of making healthcare
efficient, effective, and user friendly.
She presents an interesting frame-
work, which helps to identify three
distinct types of innovation, as well
as six forces that affect them, to insti-
tute and encourage change. Herz-
linger also argues for a securities and
exchange commission for healthcare
that would verify outcome data of
individual providers of care. How-
ever, she stops short of explaining
how this would be financed and
would interconnect with a variety of
transparent systems that are already
in the market.
Consumers in Charge
Regina Herzlinger’s second con-
tribution is an article that calls for
placing consumers in charge of
healthcare, noting that costs have
exploded precisely because consumers
are not in control. She believes that
consumers can and should be edu-
cated to help reduce healthcare costs.
She calls managed care a “bust” and
wants employees to have control over
costs and direct their own healthcare.
Perhaps with a highly educated,
strongly motivated workforce, this
concept holds some promise. But in a
world where science and medicine are
imperfect at best and where market
forces encourage more prescriptions,
more technology, and the continued
power and influence of the physician
as referral and provider agent not to
be questioned, this approach may be
more dream than reality. The problem
is that even educated, enlightened
healthcare consumers face numerous
obstacles to obtaining sound com-
parative pricing and care.
Presenteeism
Paul Hemp’s (2004) article identi-
fies a somewhat invisible but signifi-
cant drain in productivity (some $150
billion) by discussing presenteeism
(i.e., people who are sick or who are
in poor health but who are working)
and its negative effect on productiv-
ity. Hemp rightly notes that produc-
tivity can be an elusive, ghostlike con-
cept but there really is not anything
new for combating the disease of
presenteeism, which I believe is more
existential and unavoidable.
Clues and Customers
Leonard Berry and Neeli Benda-
pudi’s (2003) article is an intriguing
5-month observational marketing-
type study of over 1,000 patients
and employees with countless hours
spent at the Mayo Clinic. It is more
of a phenomenological piece in that
the place (i.e., Mayo Clinic) speaks
to the authors about Mayo’s successes
in a triangle comprising of people,
collaboration, and tangibles, while
the authors emphasize that all is good
and rewarding about the Mayo expe-
rience. It would be fascinating to see
how this is experienced today and why,
if it is so positive and uplifting, more
healthcare facilities have not copied
it by now. Nevertheless, the article
may help readers to understand how
Mayo developed some of these best
practices and what processes ensure
continuation and maturation of these
practices and processes.
Saving Money and Lives
Jon Meliones (2000), an insider
as chief medical director of Duke
Children’s Hospital, discusses how his
debt-ridden-should-have-collapsed
hospital transformed itself into a
vibrant, profitable entity. The pri-
mary principle that he extols seems to
be that with collaboration and com-
munication, anything can be turned
around. This article offers plenty of
simple solutions that just may help
Harvard Business Review on Managing Health Care
BOOK REVIEW
38
or at least create a more humanistic,
interactive healthcare environment
for all. For example, Meliones wants
everyone to “share the pulpit. People
with other expertise can help build
consensus” (146), and “cultivate your
sense of humor—people will respond
if you can laugh at yourself” (146).
These are just two of his numerous
tips for success.
Disruptive Innovations
In the article titled “Will Disrup-
tive Innovations Cure Healthcare?”
(2000), Clayton M. Christensen,
Richard Bohmer, and John Kenagy
seriously question expensive healthcare
by recommending, advocating, and
illustrating sometimes simpler alterna-
tive care. The authors discuss how the
medical establishment (i.e., the sta-
tus quo) is fighting and resisting this
notion of disruptive innovations rather
than embracing it. Although they offer
a number of intriguing insights, the
authors appear at times naive to the
complexities and entrenched inter-
ests in healthcare by making recom-
mendations that often would fall on
deaf ears. For example, the authors
state, “Overcome the inertia of regu-
lation” (168), and they suggest that
“regulators need to frame their jobs
differently” (169). In reality, perhaps
some of the regulations and regulators
should be removed, deregulated, or
eliminated.
Change and Knowledge
Management
Two of the articles are case studies
in which researchers attempt to illus-
trate dramatic changes. In “Change
Through Persuasion” (2005), David A.
Garvin and Michael A. Roberto illus-
trate change by advocating a persua-
sion campaign of the kind that was
used to dramatically turn around
Beth Israel Deaconess Medical Cen-
ter in Boston, Massachusetts. This
article contains a helpful list of six
dysfunctional routines that can stop
change in its tracks, which are good
to know about to enable avoiding
them. According to the authors, Beth
Israel went from a $58 million loss in
2001 to a $37.4 million net gain at
the end of fiscal year 2004 by using a
persuasion campaign with four phas-
es. Again, I wonder how much of this
advice could be translated into other
hospital turnarounds.
In “Just-in-Time Delivery Comes
to Knowledge Management” (2002),
Thomas H. Davenport and John
Glaser discuss how Partners Health-
Care used a just-in-time knowledge-
management system to reduce medi-
cal errors and help providers stay cur-
rent by embedding knowledge into
the technology that doctors use in
their jobs. This initiative used com-
munication and collaboration among
physicians as a means to implement
and institute positive change.
Conclusion
In sum, Harvard Business Review
on Managing Health Care is one in a
series of more than 60 “Ideas With
Impact” paperbacks that Harvard
Business Review has published.
Although it does hold some merit, it
seems more likely that the Harvard
Business Review is attempting to
recycle ideas for profit rather than
publishing real-time, new knowledge.
Adding more references and relevant
Web sites would have strengthened
this effort by the Harvard Business
Review. Last, using 2006 and 2007
articles, instead of those from 2000,
seems more current. But at $19.95,
the book might be a bargain for
some people.
Dennis S. Palkon, PhD
Executive Editor, Hospital Topics
Professor, Health Administration
Florida Atlantic University
Boca Raton, Florida
Copyright © 2008 Heldref Publications
HOSPITAL TOPICS: Research and Perspectives on Healthcare 39
Ashish Chandra, PhD, MBA, MMS, is professor and department chair of health administration at the University of Houston–
Clear Lake in Texas. Dr. Chandra has served as a healthcare marketing consultant. He has published extensively in healthcare adminis-
tration, marketing, and management journals such as Health Care Manager, Journal of Medical Marketing, Journal of Hospital Marketing
and Public Relations, Clinical Research and Regulatory Affairs, and Journal of Nonprofit and Public Sector Marketing. Dr. Chandra has pre-
sented at several conferences throughout the United States, Mexico, Turkey, and Hong Kong. He has served as the president of MBAA
International, Business and Health Administration Association, and Association of Collegiate Marketing Educators. He regularly writes
the column “In Context” on healthcare and public policy issues for Hospital Topics.
Kurt Darr, JD, ScD, is professor of hospital administration in the Department of Health Services Management and Leadership at
The George Washington University in Washington, DC. Professor Darr’s research focuses on ethics and healthcare, hospital and medi-
cal staff management and organization, quality improvement, and applying the Deming method to healthcare. He is the author of
Ethics in Health Services Management, coauthor of Managing Health Services Organizations and Systems, and coeditor of Cases in Health
Services Management, all from Health Professions Press, and the Hospital Topics column “Nexus: Ethics, Law, and Management,” which
was awarded a gold in the category of Best Regular Column-Staff Written by the American Society of Healthcare Publication Editors.
After more than 20 years as Executive Editor and columnist for Hospital Topics, Professor Darr now serves as Executive Editor Emeritus
to the journal.
Ahmet “Ozzie” H. Ozturk, MD, MS, FIPP, is medical director of the Cabell Huntington Hospital Regional Pain Management
Center and Pain Rehabilitation Education Program in Huntington, West Virginia. Dr. Ozturk earned his medical degree from Egean
University in Izmir, Turkey, and a master’s in healthcare administration from Marshall University in West Virginia. He is a fellow of
interventional pain practice and holds active medical licenses from three states. Dr. Ozturk has served as an editor for Hospital Topics
since 2005.
Executive EditorsHOSPITAL TOPICS
Research and Perspectives on Healthcare
Dennis S. Palkon, PhD, MPH, MSW, is a professor and former chairman of the Health Administration Department at Florida
Atlantic University in Boca Raton, Florida, where he has taught for more than 25 years. He has received the distinguished Teacher of
the Year award from the schools of business and social science. Dr. Palkon has published in a variety of journals and most recently co-
authored the book Cutting Costs in the Medical Practice, now in its second edition from Greenbranch Publishing. In 2007, Dr. Palkon
placed fourth in the Barron’s Challenge, an annual hypothetical stock-picking contest for college students and professors. He has been
an executive editor of Hospital Topics since 1991.