Do you read the comic strip “Dilbert” by Scott Adams? I read it most every day. It tells the story of an engineer named Dilbert and the people with whom he works, including notables such as Wally, Alice and the pointy-haired boss. Mr. Adams daily relates amusing situations of the dysfunctional relations at Dilbert’s work site. While the situations are hilarious at times, they reflect the actual work processes at many businesses; many of the story lines, according to Mr. Scott, are taken from real situations at his readers’ work sites.
A recent comic tells the story of the pointy-haired boss telling Alice, another engineer, why he cannot give her a raise—she would be making more than he does. Alice asks why that would be a problem. His reply: it would mean that she was smarter than he is. His reply is amusing but absurd. Unfortunately, such attitudes and reasoning are commonly found in businesses, including healthcare. I have seen and experienced such incidents a countless number of times.
Healthcare businesses need much better managers and bosses than the type represented by the pointy-haired boss in order to thrive financially and to provide the best service to their patients. Let me describe and illustrate briefly two habits of effective managers and bosses, whether or not they are physicians or clinical staff. The two are listening and the ability to use authority effectively.
Recently Christie Rampone, the captain of the U. S. women’s soccer team which won the gold medal at this past summer’s Olympics, described the characteristics of good leadership in an article on the Inc.com website. Her first principle for leaders to follow: Stop talking so much. She went on to say, “ A good leader is a good listener. My role is about less talk and more keen observation.” I agree with her completely. It is one of the principles that I promote to my clients.
This principle for effective management is so important that it is written into the contract of one of my clients. The payer in the contract has included a metric of evaluation that the service provider hold monthly meetings with frontline staff where the staff can make recommendations to their bosses on how to provide better service to its clients. These suggestions are recorded in meeting minutes and provided to the payer. Success in achieving the metric means that the managers implement the good suggestions.
The Toyota Production System, which many successful hospitals and other healthcare providers have adopted, is successful because it relies on the middle managers and their relationships with employees on the production lines. The managers are taught that listening to those who they oversee is very important.. Virginia Mason Medical Center, a well-known provider of excellent healthcare, has adopted and uses this approach at its sites.
Another skill that is important for managers and leaders is the proper use of authority. In the conclusion of the recent “Dilbert” the pointy-haired boss is seen saying, “When I don’t have a reason for things, is that called intuition or common sense?” Obviously, he uses his own faulty reasoning to decide how to act and to tell others how to act. He misuses and abuses his authority.
Good leaders and managers use their authority to keep employees using processes that have been agreed upon by their teams or use processes that have been delineated in contracts or agreements with payers. If a team has decided that a certain process will achieve a better product or outcome for clients and patients, then it is the responsibility of the manager to see that everyone use the process.
Let me illustrate this with an example from another one of my clients. The provider for whom my client worked held a government contract that specified that monthly reports at each of the work sites be filed. These reports involved supplying data on certain outcomes as measured by staff clinicians and workers. In a team meeting with site leaders my client had the team come to the agreement that it was very important that the reports be accurate and filed on time. All agreed that the manager (my client) should post monthly on the company intranet those who had achieved the specified outcome. The first month one of the more recalcitrant site leaders failed to file the monthly report. The manager along with his superior met with this site leader and told him to file the reports on time or there would be serious consequences for the leader. The next month, all reports were on time and the pattern continued.
In summary, I advise that you take a close look at the management style at your work site. Do most of the managers act like the point-haired boss, relying on their own “intuition and common sense” to make important decisions and often ignoring input from employees? If this is true then the best outcomes in financial terms and for the customers or patients are not being achieved. In order to reach these optimal goals management staff must be taught how to listen to their employees in team settings and to use their authority judiciously to insure that the best processes are being used.
Donald Tex Bryant is a consultant who helps healthcare providers meet their challenges. He can be reached at Bryant’s Healthcare Solutions.
