Who’s the Boss?

CCL coverThe following is an excerpt from my forthcoming book Cure for the Common Leader: What Physicians & Managers Must Do to Engage and Inspire Healthcare Teams, scheduled for release on November 1.

Ask your front desk person who is in charge of the practice overall. What will she say? Ask her who her boss is. Does she give the same answer?

In many healthcare settings employees interact with two levels of supervisory authority: the operational leaders charged with their day-to-day supervision, and physicians. The office manager, unit director, nurse coordinator, or practice manager oversees the day-to-day operations of the site and the duties of team members. These managers often hire, train, and supervise the employee. They coordinate the employee’s schedule, answer their questions, and serve as the primary liaison between employee and employer. Physicians, on the other hand, possess a different kind of power. In most healthcare environments, but especially in out-patient settings, the employee experiences the physician as the ultimate authority and decision maker. Employees know that the manager often has to answer to or take orders from the physicians. Physicians set the tone for what happens at a site, how people interact, and the overall culture of the environment. This is why BOTH physicians AND managers must work to cultivate engagement. One leader doing so without the other limits the potential for engagement. That is not to say that if you are reading this book and work alongside a manager or physician who has NO interest in attending to engagement that you should give up. You alone can still have a significant impact for your direct reports. However that impact becomes magnified greatly when both levels of leadership put forth the effort.

The problem in healthcare, unfortunately, is that many teams roll-up to managers with underdeveloped “soft skills” and physicians unaware of or unprepared for the key people management role they need to fill.

Healthcare is like many other industries in that we select, promote, and rely on underdeveloped managers. When someone is installed as a manager they are often selected based on clinical knowledge, operational experience, or technical expertise. Indeed, many healthcare executives will tell you plainly they seek out this kind of background first when searching for management personnel.

But once that manager is selected, steps into the role, and begins going about the business of managing and leading others, they figure out quickly that many of the problems they face every day are not of a clinical, operational, or technical nature: they’re people problems that require the ability to communicate, negotiate, mediate, delegate, and evaluate. This is not a problem exclusive to healthcare. It’s long been a management problem across most fields. Many managers ultimately come to the realization that the skill set that brought them to their role fails to aid them fully in succeeding in it.

For many physicians, the problem is greater. It’s not that their people management skills are underdeveloped. It’s that they have not been given the chance to build them at all, or even told that such skills are necessary for success. In 2012 the Accreditation Council for Graduate Medical Education (ACGME) admitted in their Leadership Development Curriculum for Chief Residents in Medicine that there is “a significant void in the training and education of today’s young physician leaders” as it relates to leadership development. ACGME advocates for physicians to develop several leadership competencies related to people management, including listening skills, teambuilding, trust-building, and consensus-building. In 2011 the Center for Creative Leadership made a similar case in their white paper Addressing the Leadership Gap in Healthcare. After analyzing leadership effectiveness data from tens of thousands of people working in healthcare, they identified the top priority for leadership development in the healthcare sector as “the ability to lead employees and work in teams” strongly encouraging leaders at all levels to “develop a more participative management style, improve their ability to build relationships and lead teams, and learn to deal more effectively with problem employees.”

We have reached a unique crossroads in healthcare. The challenges faced by providers are more complex than ever before. Patients and families are in distress, confused, cynical, and vulnerable. The interactions we ask employees to execute daily – and the myriad emotions that accompany them – require that physicians and managers embrace their role as leaders of people with complex professional needs who must experience certain conditions in the workplace in order to succeed. Indeed, the success of any healthcare team depends on it.

Cure for the Common Leader translates the latest research on leadership, employee engagement, and motivation into SEVEN actions physicians and managers must take to engage and inspire healthcare teams. Written for physicians, practice managers, unit directors, chief nursing officers, or anyone else serving as someone’s boss in a healthcare setting, it’s a powerful primer on successfully building teams and leading people. It will be available exclusively through Amazon.com in November 2014.


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