It's been interesting to watch the evolution of Select International's work in healthcare. Initially, because of our longstanding work with Toyota, hospitals trying to adopt lean principles wanted to evaluate the behavioral skills of front line staff to see if they would thrive in a lean environment. Then HCAHPs came along, and hospitals were focused on hiring people who could help to build a patient-focused, service-oriented culture.
Recently, though, our hospital clients are focused on managers and leaders. They want a more deliberate and effective approach to selecting and developing senior leaders and managers.
Healthcare Managers are a Unique Challenge
Evaluating the behavioral skills of senior leaders is pretty straight-forward – Select International has been doing it for years. Where it gets really interesting, though, is when we start looking at managers.
You could argue that no group is more important to establishing your culture. The task of implementing the vision of senior leaders falls to this group. And healthcare has, traditionally, not been particularly adept or thorough about selecting and developing managers.
Think about culture for a minute. I like to define it as the way the organization thinks and feels about its purpose, and how it goes about solving problems and fulfilling its function. If we are going to think about how culture influences our work, and ultimately how it impacts our patients and drives outcomes, then we need to examine the behaviors that are the result of the culture.
In other words, how do we link culture to behaviors and to outcomes? Senior leaders can paint all of the pictures they want about culture. The problem is getting managers who can implement that vision.
The Manager’s Job Has Changed
Perhaps no industry is more guilty of taking good individual contributors (e.g., an outstanding nurse) and making her a manager – assuming she can manage because she's a good nurse. Trying to overcome that history is a challenge in itself, but we're getting better at it. We’ve started to better define the manager’s role, expectations, and important behavioral skills. Compounding the problem, now, is that we need managers to do more than “manage.”
So, what's the difference?
Management processes seek to produce predictability and order
Managers primarily plan, organize, direct, coordinate, and control
Managers tend to be narrowly focused on specific outcomes and tasks, clinical measures, and deficiencies
Leaders, on the other hand, look at processes as ways to produce organizational change
Good leaders use visionary thinking to develop systems that align all functions with performance excellence
Before moving individuals into a management role, you should:
Make sure they possess basic manager skills
Evaluate their behavioral traits to understand their management potential
Provide training on basic manager skills (still a relatively new idea in most healthcare organizations)
The reality? Whether they realize it or not, most organizations now want managers to be leaders, too! Beyond just fulfilling the basic management/administrative functions, we need that nurse-manager to develop people, to be adept at communicating difficult messages and to not just implement the process, but to constantly evaluate processes with an eye toward organizational change.
Yes, a good manager needs to be laser-focused on the department-specific outcomes, tasks, and clinical measures. The great managers, though, go far beyond these administrative tasks.
A Better Approach
I worked with a community hospital in Iowa for many years. They struggled on many fronts until they got a new senior leadership team. It took a few years, but that hospital eventually dominated the market in all respects – quality metrics, patient satisfaction, reputation, and physician alignment. There was actually very little change of the middle management team. That group always had the talent to succeed. What did happen was that the senior team set a new vision and gave those managers a new task: Do what it takes to implement this vision in your area and work together to drive organizational change. They set a new expectation of what it meant to be a manager, and they realized they had good people in those roles, meaning that they merely needed to empower and support those managers. It was a joy to watch the organization change.
I would have characterized each of those “managers” as “leaders.” Certainly they were adept at the day-to-day administrative tasks, but they each also accepted their role as leaders. I was constantly amazed at the sense of ownership they exhibited and their willingness and ability to collaborate and problem solve as a team.
In some respects, the senior leadership team was lucky. They just so happened to inherit a group of strong managers. I’ve seen many other hospitals fail to make strides because their group of managers definitely did NOT have the same traits as this group. You can’t leave this to chance. What are you doing to ensure that you are selecting and developing managers who can lead?
For more insight into leadership in healthcare, see our whitepaper on the topic: