Who’s The Boss? Why Docs and Ops Managers Must Be Leadership Partners

healthcare leadership“I want everyone to close their eyes.  I’m going to count to 3 and I want you to point to the person that you think is the answer to this question…

Who’s in charge? 


And that’s when I started to figure out the problem.

I was asked recently to do some staff development work with an outpatient specialty practice facing a number of challenges. Conflict was a constant between members of the team. Cliques existed within the group, each aligned to a different “leader” in the office. Communication between the two full-time physicians, the practice manager, and the office team was convoluted at best. And it was clear from the outset that the relationship between those in charge of running the practice was devoid of any trust.

What happened when they answered the question? Fingers pointing every which way. Some in the room pointed to the lead physician. Several others pointed to the practice manager. One person pointed to the office manager and 3 people didn’t point at all.  They confessed later they didn’t know the answer to the question.

This is an all too common occurrence in many organizations.  But it seems to me it’s especially frequent in healthcare settings where the organizational leadership roles bestowed on operations managers can be overshadowed by the clinical and organic leadership role of the physicians. And sometimes this creates conflict, mixed messages, dysfunction, and if it’s especially bad, mistrust.

So who’s the boss?

Success in almost any healthcare organization means only one answer: Both. Physicians and operations managers need to share a leadership partnership.

If you are in one of these roles there are a few things you need to know about your counterpart. As you develop this partnership keep their perspective in mind:

Managers need to remember that when it comes to physicians, it’s their name on the door. In the eyes of the team, they are the boss, the final word, the person in charge. They set the tone in the practice for how patients and families will be treated. The volume of patients seen, wait times, and patient flow are tied directly to the doctor. The practice will live and die by the performance, demeanor and clinical expertise of the physician. They are asked to evaluate, diagnose, and treat. Everything else comes second. And never forget that if something goes wrong, they’re the one that gets sued. Their name is the one reported and publicized. For these reasons they need to be heard, involved, and connected to everything going on in the practice especially the work of the managers.

Physicians need to remember that when it comes to operations managers it’s their name on the org chart. In the eyes of human resources, they are the direct supervisor for the personnel in the office. They are the employee’s boss, the one who writes their annual review.  They set the tone daily for how personnel carry themselves and work together. The practice will live and die by the people management expertise of the manager as well as their ability to coordinate check-in, scheduling, staffing, on-boarding, and customer service processes effectively. They are asked to run a well-oiled machine without excuses. Everything else comes second.  And never forget that if something goes wrong they will get the first phone call. They will be asked to verify that institutional policies were followed, staff completed required training, and that all appropriate documentation is in order. They will be expected to assist the investigation, will likely testify if legal action results, and in most states can be terminated at will. Most operations managers don’t have employment or incentive contracts. For these reasons they need authority, credibility, and respect from all on the team, most especially the physicians.

Clearly both have a lot at stake. A successful leadership partnership starts with trust and communication.  Meet frequently to shape that partnership. Discuss ongoing challenges and share info. Agree to present a united front to the team at all times and know what kinds of issues the other prefers to take the lead on. For example the physicians may ask the manager to defer all clinical, procedural, and patient care issues to them. The manager in turn may ask that all scheduling, staffing, organizational policy and team interpersonal issues be steered to them. Disagree in private and work to avoid the intrusion of ego.  Back each other up. Involve other supervisors and clinicians on the team with management responsibilities as appropriate with everything flowing up to the leadership partnership.

By the way…if this sounds a lot like co-parenting. Yeah…it’s kinda like that.

A leadership partnership can be a fulfilling and powerful one in a healthcare setting. It won’t develop without the investment of time and trust and it won’t happen overnight.

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