Practical Application


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Theories generally refers to concepts that have not been verified but which attempt to explain a certain phenomena.  One such theory is cognitive dissonance theory.    This is a theory developed by Leon Festinger in 1957 that attempt to explain the process of self justification in human (Jarcho J. Berkman E. & Lieberman M., 2010).  According to this theory, when a person is confronted by facts that are inconsistent with his or her beliefs the person tends to be very uncomfortable with this situation.

This feeling of being uncomfortable when a person is confronted by two inconsistent cognitions is what is referred to as cognitive dissonance.  Cognitive dissonance theory advances the argument that when a person is in a state of dissonance the mind will attempt to bring consistency between the two conflicting cognitions.  The human mind does this in three ways; by either reducing the importance of one or both cognitions or adding more cognitions or by changing the dissonance cognitions so that they are no longer in conflict with each other.

There are various key elements involved in cognitive dissonance theory. According to proponents of cognitive dissonance theory, dissonance is brought about when an individual is confronted by facts that are inconsistent to his beliefs (Knobloch & Meng, 2009).  Therefore the first element is existence of two inconsistent cognitions.  It emphasizes on how an individual actions can lead to change of attitude or values that were in conflict with that action.  

The second element is the element of trying to achieve consistency (Greg, 2008).  The effort of justification or rationalization is clearly brought out in this theory. The aspect of reward is also included. High rewards connected to the cognitive sources of the dissonance reduce the tension experienced due to dissonance (Jarcho J. Berkman E. & Lieberman M., 2010). Another important element to this theory is choice. When an individual is compelled to perform an action that is contrary to his beliefs, the fact that he had no other choice will result in lower levels of dissonance.

Theoretical concepts are usually applied in different fields such as; management, healthcare provision, research and learning. Specifically, cognitive dissonance theory has also been applied in various fields and one of them is healthcare administration. Health administration is broad field that consist of various aspects such as; healthcare facilities management, healthcare policies formulation, healthcare services provision, quality management and marketing among many other duties. Cognitive theory can be applied on all these aspects that make up the field of healthcare administration.

Application of Cognitive Dissonance in Healthcare Administration


Cognitive Dissonance and Decision Making


One aspect that is very important in healthcare administration is decision making. Healthcare administrators are often confronted by situation that compels them to make decision and sometimes these decisions that can mean the difference between life and death for a patient.  Proponents of cognitive dissonance theory argue that cognitive dissonance can influence the decision making process of an individual (Jarcho, Berkman & Lieberman, 2010).

Cognitive dissonance theory has been applied to explain reasons as to why people usually commit errors in logic and reasoning when making decisions. Cognitive dissonance has been found to be the factor behind humans justifying illogical and irrational decisions that people make.  Through cognitive dissonance individuals can rationalize the decisions they make by reducing the importance of the alternatives that they did not select. Cognitive dissonance therefore may be responsible for providing hindrance to proper decision making

A study conducted by Jarcho, Berkman & Lieberman (2010) came up with finding that decisions made can induce attitude changes in individuals.  The findings suggest that there is usually a rationalization process that occurs quickly at the moment of decision making which may inhibit careful deliberation on issues.  This means that the human ability to justify actions may be a source of wrong decision making in a health care setting.

Healthcare administrators therefore ensure that right decisions are made in healthcare setting by reducing the aspect of cognitive dissonance in decision making. To eliminate this phenomenon of cognitive dissonance, healthcare administrators are now required to enforce standards, codes of ethics and procedures that should be adhered to by everyone while making decisions. Dissonance may is also reduced by influencing the optimism pessimism in decision making (Chen, 2010).  According to Chen optimism and pessimisms influences individual perception of the world and therefore is a determinant of levels of dissonance.

Cognitive Dissonance and Quality Management


Cognitive Dissonance also influences levels of performance by employees within an organization setting (Spencer & Hinks, 2007).   A basic concept derived from the cognitive dissonance theory claims that human attitude can be influences by their behavior and actions.  According to various researchers, dissonance can influence the perceptions of employees in regard to performance of duties.  Poor performances by employees on their duties can easily be rationalized through the cognitive dissonance processes.

 A study conducted by Baker and Heaven (2006) gave the finding that cognitive dissonance has a way of influencing role performance.  The study examined performance 108 nurses and 101 police officers and came to a conclusion that cognitive dissonance can negatively influence the performance of employees. Impact of cognitive influence on services performance has huge implications for healthcare administrators. Through cognitive dissonance healthcare employees may rationalize negligent behaviors on patients, unethical medical practices, criminal acts and unsatisfactory services to clients.

Such action has major implication on healthcare facilities as they may results in loss of lives, hefty laws suits and even close down of the establishment. Therefore application of cognitive theory is very important in term of controlling the process of rationalizing the mentioned practices in healthcare setting. Cognitive dissonance in performance of healthcare services may is reduced through standards, code of ethics and behaviors, performance contracts and standardized procedures.

On the similar note, cognitive dissonance also plays a major part in influencing service quality perceptions by consumers of a particular service or product (Palmer et al, 2006).  Like any consumer, healthcare services consumers come to hospital with expectations of receiving better quality treatment.  Perception of quality is the difference between the expectations that a consumer has before the service encounter and the actual experience of the consumer during or after the service is rendered (Spencer & Hinks, 2007).

When the experience from the service is greater than the initial expectation the consumer will be perceive the service to be of higher quality and reverse is also true. However, recent studies have indicated that these perceptions of quality can easily be influenced by cognitive dissonance (Palmer et al, 2006).  When experience of a service (which is one of the cognition) does not meet the initial expectations (the second cognition) of the client, the client will perceive the quality of the services to be poor.

But through cognitive dissonance, a consumer end up rationalizing the services he or she receives by changing his cognition which in this case may be his experience of the services or his prior expectations. The client may end up giving excuses for the service convincing him self that the service was not that bad or fur from what he expected. A study conducted by Palmer et al (2006) had the finding that there exist an inverse relationship between the level of post consumption dissonance and both initial and subsequent rating of service quality.  

This has the implication that when a client experience of services is rated poorly, the client is likely to have high levels of post consumption dissonance.  The client will attempt to rationalize his or her poor experiences from the service. This application is very important for healthcare administrators especially when developing measurements for quality of services and customer satisfaction.

Many of the measurements developed as indicated by Spencer and Hinks (2007) on his study of the “FM paradigm and quality assessment practices” are usually influenced by cognitive dissonance therefore giving the wrong reflection of consumer experiences derived from the services rendered. Cognitive dissonance also influences levels of consumer tolerance and is applied as management tool in the scope of service consumers’ zone tolerance (Spencer & Hinks, 2007). Through dissonance consumers may become tolerant to below standard services.

Cognitive Dissonance in Managing Human Resources


Cognitive dissonance theory also has implications on how organization manages it human resources. In order to ensure that there is optimum productivity by the human resources, organizations must ensure that there is a peaceful coexistence between workers. Peaceful coexistence can only be achieved when employees treat each other with respect and conduct them selves in manner that does not offend others.  Cognitive dissonance can however lead to some employees rationalizing negative behaviors towards their colleagues (Safavi, 2006).

Unkind actions, discrimination in the work place or unkind words of an employee towards other employees may be rationalized by cognitive dissonance making the employee in question not to feel guilty about his deeds. For example an employee may strike another employee and justify his violent behavior by modifying his belief about violence behavior or interpret his action as something apart from violent behavior.  This will definitely lead to a conflict with the organization which may end up affecting the productivity of an organization.

The above described scenario would be more serious in a healthcare setting. This is because healthcare employees deal with life threatening situations and hindrances to effective performance by healthcare workers may have devastating impacts. Therefore, healthcare administrators put in place strategies which will ensure dissonance that rationalizes illogical behaviors are reduced (Safavi, 2006). However, the concept of cognitive dissonance is not only viewed in the negative perspective in healthcare setting as described above.

There are some instances where cognitive dissonance can be positive. These are such as when there are undesirable traits in the normal ways in which business is conducted within an organization. Cognitive dissonance can be used to change such beliefs and attitudes. One concept emphasized in cognitive dissonance theory is the significant of reward in changing an individual’s attitude (Jarcho J. Berkman E. & Lieberman M., 2010). The theory states that if the reward that led to dissonance experience is large enough to offset the dissonance then an individual will not move towards reducing the dissonance.

According to proponent of the theory higher amount of reward reduces the amount of dissonance. Therefore, using this concept determination of employee remuneration has become an important aspect in determining whether the management will be able to influence their attitudes into what is desired for the organization. Therefore cognitive dissonance can be applied to change employee behavior.

Cognitive Dissonance in Marketing


Another area that cognitive theory has been widely applied is marketing. The main aim of marketing within an organization is to attract and maintain as many customers as possible within your organization (Kessler, 2010). A key driver to the attraction and maintenance of customers is ensuring customer satisfaction. When there are higher degrees of customer satisfaction there is usually more repeat purchases and positive word of mouth which brings in more clients into a business. However, in our earlier discussion we have seen how cognitive dissonance influences levels of satisfaction among clients.

According to Nadeem (2007) cognitive dissonance can result in a lock- in of clients when they become attached to an incumbent service provider. Nadeem (2007) presents the argument that, due to of dissonance on a customer’s perceptions a customer may become attached to the services he or she has experienced for the first time, giving the incumbent party an added advantage.  In this case the concept of dissonance is used to explain why clients tend to remain loyal to services they first encounter.  This application is a double edged sword as it can work for organization in two opposite ways.

First, organization will tend to target first time consumers for their services and products due to the reason that cognitive dissonance will force them to perceive those services as satisfactory (Nadeem, 2007). However, a company may not be able to rely only on the first time client it has obtained and therefore will aim at attracting clients who are already using similar services from other companies.

Since, they are already attached to those other companies; the company in question will be forced to find ways of reversing the dissonance so that the other companies’ clients can be freed from the perceptions that have been tying them to those companies.  These strategies may be such as advertising or sale promotion which may end up changing the customer belief and expectations about the services they are currently attached to. However, these same strategies may also be used to snatch client who were previously loyal to the company in question.

Application of cognitive dissonance theory in marketing is also workable in healthcare setting where organization can use cognitive dissonance mediation strategies to attract clients and ensure level of satisfaction are accurately determined and enhanced. Cognitive dissonance may also influence consumer behaviors. Marketing strategies may influence an individual belief about requiring a service or product.

Organizations develop products and through marketing campaigns convince clients into changing their attitude concerning needing these products. However, this should not be the case for healthcare. Healthcare administrators do not need to develop services and influence consumer into needing them but thy need to observe what the society needs and provide them.

Cognitive Dissonance in Proposed Healthcare Reforms


The US healthcare cost is one of the highest among the developed nations (Karpf, Lofgren & Perman, 2009).  One reason that has been attributed to this high cost is the existence of third party payers. Since most American consumers do not meet their own healthcare cost, they have become less cost conscious on what they spend on their health care. In response to this the third party payers increase their policies while the quality of services in hospital diminishes.

Another reason behind increasing healthcare cost is that hospitals do not compete for patients based on pricing (Karpf, Lofgren & Perman, 2009). Therefore, patient posses limited bargaining power in the American health system. Many American hoped for reforms that would introduce competition and reduce third party payers. However, the reform that has been proposed aims at introducing an option of more insurance players into the health care industry. This means that more third party players are being introduced and more control of the healthcare system by the governments is going to be achieved and therefore reducing further, competition in the industry.

Americans who have for a long time waited for reforms that would reduce the healthcare cost have come to accept and support these new reforms.  This is because the proponents of these reforms have presented the idea that the changes are optional.  The gradual change in the attitude of American healthcare consumers is a good case of cognitive dissonance. After massive campaigns advocating for this plan, the mind set and attitude of the American has come to believe that this plan is not bad after all.


Limitation to the Practical application of Cognitive Dissonance Theory


The concepts of cognitive dissonance theory can be applied in many field such as psychology, canceling, marketing and managements others. This paper has discussed in details how cognitive dissonance theory is being applied in the field of healthcare administration.  However, one major factor that limits further application of this theory is limited research on how to reduce the phenomenon of cognitive theory.  Little has been mentioned on how rationalization of negative deeds can be avoided.

Due to this limitation, there are circumstances where this theory will assist in identifying the origin of a problem and will not be applicable in providing a solution. Creating more understanding on measure that could counter the process of cognitive dissonance would render this theory more applicable. The aspect of reward had been introduced but as part of the element that causes the dissonance.



Theories are very important tools in learning, research, management and understanding phenomena in life. Cognitive theory is an example of a theory that has been widely used in; research, academics, business and as described in this paper in healthcare administration. Cognitive dissonance theory is a theory that attempt to explain how the human mind rationalizes behaviors that are inconsistent with their beliefs.

Understanding this concept has enabled people to better understand human behaviors, a knowledge that is currently very useful in many areas. In healthcare administration, cognitive dissonance theory has been applied in various aspects of healthcare management including; quality management, marketing and human resource management. This theory has been important in managing



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