The Management Mountain: Strategies for Effective Clinician-Manager Collaboration

Explore the management challenge in healthcare, the tools of effective practice and the collaborative path ahead.

This blog was inspired by topics covered in Episode 9: Power, Managers & The Science of Teams with Professor Sara Singer.

If you haven’t listened to it yet, check it out on Apple, Spotify, Substack or wherever you get your podcasts.

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Photo by Rohit Tandon on Unsplash

The Mountain.

In healthcare organizations, managers are key to achieving operational effectiveness. To do so, they focus on various management practices to make the most of organizational resources to improve overall performance.¹

At a manager’s core, their responsibility is to execute day-to-day tasks and ensure the work of the organization is done.

This is a role that is varied and complex, potentially consisting of planning and utilization of human, financial, and material resources, the implementation of operational efficiencies, the development, and supporting team members, the implementation of new programs, compliance, reporting, and risk management.

However, there are more subtle roles such as figurehead for ceremonial duties, messenger of news (both good and bad), hiring (and firing), motivator, disciplinarian, liaison, spokesperson, and negotiator.²

Between a Rock.

Managers are in a tight spot, squeezed between leadership’s lofty strategic goals (usually involving some sort of change), and clinicians’ complex clinical needs (usually involving some sort of grey area).

This balance is further complicated by their own needs to navigate bureaucratic constraints and fulfill the objectives of their manager.

It’s a tough gig.

Photo by Artem Kniaz on Unsplash

The Terrain.

In non-healthcare environments, managers use many techniques to be successful.

One such technique is using standardization to create efficiencies, thus reducing the variability of outputs, all the while maintaining quality. By creating predictable and repeatable outputs, they can reduce waste and cost, which helps with planning for the future.

However, healthcare has some challenges that make it a unique;

• Healthcare teams are composed of highly skilled, autonomous, interdisciplinary professionals, navigating non-deferrable work.

• Success is measured by quality, and values rather than purely financial or operational measures.

• Healthcare operates via the inverse care law, where typically the people who most need health care are least likely to receive it.³

• Clinical processes can be opaque, dynamic, and highly interdependent.

• Defining and measuring outcomes is difficult and is sometimes only a proxy for ‘good care’.

• Healthcare is a relational endeavor and therefore standardization can impact the ability to tailor care for complex and personalized needs.

Photo by Kurt Cotoaga on Unsplash

Crossroads.

Clinicians, who have deep clinical expertise can find themselves at odds with managers due to contested hierarchies and conflicted organizational goals. To address these (and the many issues above), many experienced clinicians take on management roles. This transition can be met with a steep learning curve and potential hostility if time and support are not adequately allocated for the role.

In some instances, promotion is based purely on seniority or team attrition, rather than management potential or attributes - setting up clinicians and teams for failure.

You might be the best surgeon, but not the best manager… and that’s OK, people shouldn’t be managers if it doesn’t align with their strengths.

The Tools.

There are many strategies and tactics that managers (and specialist clinician-managers) can deploy to better prepare, execute, and thrive in this terrain.

Photo by Jamie Street on Unsplash

Setting Up the Environment.

• Norms and Values: From the outset, creating a collaborative environment is key. This means clear norms and values for how you and your team will work together. By co-creating an explicit set of expectations, you can ensure guardrails to support appropriate behaviour and empowered decision-making going forward. It can also encourage self-regulation within the team.

• Communication: A healthy communication culture, that is open, honest, and timely, is another vital component for running an effective team. No manager or team member can know all things, at all times. This can be built through structured means, such as regular one-on-one meetings and team huddles. Non-structured approaches are also effective, such as reinforcing a positive culture by reminding others of the interdependence of their work and actively seeking others’ views to create psychological safety.⁴

A great manager might say; “I could be missing something here, what do you think?”

Setting Up the People.

• Get the Basics Right: Your team is not going to perform at its best if the basic workplace needs are not met. This means ensuring that team members are paid on time, have access to leave, take time off, and have work after-hours boundaries. Some team members are too shy, polite, busy, or just unaware of their respective benefits - which is a recipe for burnout and turnover. This basic workplace hygiene demonstrates basic respect and sets up a level playing field for everyone.

• Understanding your Team: What are the strengths, weaknesses, and motivations of your team? Understanding these can highlight unanticipated challenges and opportunities early, while also highlighting areas for focused effort. Supporting the development of professional goals that include mastery, autonomy, and purpose will tap into the key intrinsic motivators of the team.

• A Philosophy of Managing: ‘Theory Y’ offers an approach to managing people that emphasizes an optimistic and participatory style of management, where team members are encouraged to take ownership of their work⁵. This method opts for a more collective and empowered approach to teamwork.

Photo by Jon Hieb on Unsplash

Setting Up the Work.

• Understand the Core Work: Open-up discussions about the ‘jobs to be done’ (what work is actually needed), is a way to draw out the core tasks.⁶ This is useful whether or not you are not a technical expert in this area, as it may unearth untested assumptions about the work. Using this information to then inform the operational goals and align with organizational values can bolster commitment to the values and mission.

• Adaptive Delegation: Effective delegation is another crucial component of management. This can be particularly challenging in healthcare, due to multiple roles, levels of experience, comfort, and hierarchy. Remaining flexible and having open communication about the ‘jobs to be done’ and members’ levels of comfort with a task - may reduce some of this complexity.

• Review then Enhance: Regularly reviewing the processes and outputs, with sessions for team-based reflection, offers an opportunity for work adaptation and decompression. Given the chance, the front line can offer keen insights to improve processes, remove redundant measures, and enhance care. Methodologies such as ‘Quality Improvement’ and ‘Time-driven Activity Based Costing’ offer ways to review and then enhance care.⁷

A New Path.

Healthcare organizations should prioritize creating closer relationships between clinicians and managers. This includes formal and informal environments that help to bridge gaps in understanding and respect.

An emphasis on collaboration is needed to reduce the ‘othering’ of each professional group.

Photo by Claudio Carrozzo on Unsplash

When clinicians step into management roles, it should be recognized they are venturing into a demanding role that can be as nuanced as any medical specialty. The success of their colleagues, patients, and the organization itself can hinge, on their managerial performance.

People don’t leave their jobs, they leave their managers.

If we are to succeed in our healthcare goals through enhancing operational effectiveness, we must invest in clinician-manager hybrid roles. This means that organizational leaders need to proactively foster and facilitate the maturation of this specialist skillset. It would likely require a long-term strategy and access to post-graduate education, tailored training, mentorship, and coaching.

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Thank you,

Jono

1. Michel E. Porter. What is Strategy? HBR. https://hbr.org/1996/11/what-is-strategy#:~:text=Operational%20effectiveness%20(OE)%20means%20performing,is%20not%20limited%20to%20efficiency.

2. Mintzberg H. 2012. Understanding the Dynamics of Power and Influence in Organisations. Second Edition. Chapter 3 The Manage’s JobL Folklore and Fact.

3. 50 Years of the Inverse Care Law. The Lancet. 2021 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00505-5/fulltext

4. Amy Edmondson. Building a Psychologically Safe Workplace. TEDx. Youtube.

5. Douglas McGregor. The Human Side of Enterprise. 1957. https://web.mit.edu/curhan/www/docs/Articles/15341_Readings/Motivation/McGregor_The_Human_Side_of_Enterprise.pdf

6. Clay M. Christensen et al. Know your customers’ “Jobs to Be Done”. HBR https://hbr.org/2016/09/know-your-customers-jobs-to-be-done

7. Robert Kaplan. Time-Driven Activity-Based Costing in Healthcare. 2020. https://www.isc.hbs.edu/Documents/pdf/2020-cost-measurement-kaplan.pdf