Continuous Improvement Strategies

How to Manage, Motivate, and Retain Staff

Anthony Matthew Hopper

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781351650274
• Edition: 1
• Topic: Commerce
• Subtopic: Gestion des ressources humaines

During this era of continuous improvement, healthcare organizations need to be staffed by engaged, motivated, and hard-working frontline employees. As these clinical and non-clinical personnel handle most of the important tasks in any organization and are often the people who directly interact with patients and customers, it's the job of managers to oversee and motivate their staff members. Using Lean management strategies, this easy-to-read book for leaders and managers provides useful, insightful, and innovative information to help managers engage, motivate, and retain their employees during any Lean or other continuous improvement initiative.

Chapter One
Office-Level Healthcare Leaders: Who They Are and What They Do

1.1 A Brief Introduction

The healthcare field contains a diverse array of corporations that do everything from producing and selling durable medical equipment (DME) to providing on-the-spot emergency care. Additionally, these companies can range in size from small “mom and pop” operations to large, multiregional or even multinational entities, which employ tens of thousands of people. The same can be said for the leaders who work in this field. They might perform any of a myriad of tasks and possess a varied array of skills. Depending on their job descriptions, these men and women might only supervise a few employees, or they may, at least indirectly, manage thousands of workers. At the same time, these leaders might spend their time on the frontlines, in corporate offices, or shifting back and forth between these two areas.

While acknowledging this diversity, I will touch on some key points that I believe distinguish almost all healthcare leaders from other employees. I will delineate the different levels of leadership, running the gamut from the chief executive officer (CEO) to the frontline managers. Next, I will show readers where I think office-level healthcare leaders fall within this hierarchy of positions. Finally, I will demonstrate why I believe that the aforementioned individuals are a healthcare organization’s most important employees.

Given the important roles that office-level healthcare leaders play in helping their organizations to succeed, I find it surprising that many companies devote few resources to training these managers and professionals to become good leaders. Instead, large numbers of administrators are left to fend for themselves—to learn what they can from their everyday interactions with employees and from their life experiences. That might be okay if these individuals imbibed proper management techniques in school (K–12 or college) or through other sources; however, I will demonstrate that, in many cases, they do not get the needed training.

Some office-level healthcare leaders, despite these training deficiencies, will develop into good or great leaders. However, a sizeable portion of this cohort will display at least some suboptimal management traits, and a number of these individuals will fail to master even basic management concepts. In Chapter 2, I will discuss this topic in more detail. As a part of this conversation, I will show how the latter two groups’ lack of administration-related skills might be negatively impacting their own and their organizations’ efficiency, effectiveness, and relationships with key stakeholders.

In Chapter 1, I discuss some of the key reasons why healthcare organizations often do not devote enough attention to properly training their office-level healthcare leaders. I also highlight some potential factors that might lead administrators to use poor management techniques even when they are aware that these methods are not the optimal ones. As part of this process, I spend a significant amount of attention on one potential driver of this phenomenon. It relates to the fact that, at least until recently, many healthcare professionals did not have any incentive to learn and utilize best practices leadership techniques because they could get by with being, to use an old cliché, “just good enough.”

In the final part of this chapter, I briefly touch on some of the key factors that, over the past few decades, have been exerting an ever increasing amount of pressure on healthcare organizations to become more efficient and effective. As the healthcare industry adapts to this changing landscape, more of its executives are espousing corporate cultures that center on the use of best practices management techniques. Ergo, a large number of current and future office-level leaders will soon have to learn to utilize these leadership methods if they want to succeed in the 21^st century healthcare workplace. Why not start now? As a corollary to this discussion, I will include references to continuous improvement (CI) and Lean Six Sigma throughout this chapter. All of the points that I have made with reference to leadership also applies to the healthcare industry’s adoption of these approaches. Later in the book, I will focus more attention on CI techniques and especially on Lean and Six Sigma.

1.2 Healthcare Leaders: A Definition

Before I begin to describe office-level healthcare leaders, I first have to define what I mean by the term: “healthcare leader.” For the purposes of this book, I will delineate this type of employee as anyone who, according to a statement from the University of California, Berkeley’s (UCB’s) human resources (HR) department, “exercise[s] independent judgment in determining the distribution of work of at least 2 FTEs [full-time equivalents]” (UCB HR, n.d.). I would add to this definition by stating that healthcare leaders must possess the company-sanctioned ability to give direct orders to subordinates. They cannot rely solely on indirect means, such as audits or general recommendations, to manage workers’ duties. At the same time, these individuals should also have at least partial control over decisions relating to employee motivation and discipline. With that said, healthcare leaders do not necessarily have to maintain continuous oversight over any particular group of individuals; they might find themselves leading one team of people today and managing a different batch of men and women a short time later. Finally, for the purposes of this book, I will not try to differentiate between managers and leaders. In fact, I will often use those two words interchangeably.

In using this definition, I can eliminate some stakeholders who have quasi-supervisory roles or who manage via indirect means. One of the more important classifications of people who would fall into this area include auditors, accreditors, and other regulatory personnel. These men and women can exercise a great deal of ancillary control over a healthcare organization’s staff; however, they usually do not possess any direct administrative powers. Additionally, some senior-level frontline employees might fall into this category. As a result of these individuals’ experiences or knowledge, they may be able to exert influence over their peers; however, they do not have any company-sanctioned oversight roles. I would also include in this discussion a large number of support-level employees, such as many HR personnel, when they are limited to making recom mendations as opposed to giving commands—even if workers usually follow their advice (Fallon & McConnell, 2007, p. 27). Finally, my definition of leadership would exclude some staff who have supervisory titles, including many team leads and team leaders, if they almost exclusively focus on monitoring employees’ compliance with rules or in evaluating whether or not these people meet monthly goals (and reporting their findings back to their department managers).

1.3 Healthcare Leaders: A Significant Part of the Workforce

By many estimates, a relatively sizeable minority of healthcare staff perform management-type tasks. For instance, some researchers believe that almost 25 percent of American workers “supervise others as a major part of their job[s]” (Murray, 2010, loc. 295). Using this figure as a guide, one would find that more than four million men and women in the health services industry alone perform leadership-type functions as a part of their employment responsibilities (Bureau of Labor Statistics [BLS], 2015a). This figure excludes a large number of individuals who work in healthcare but are not employed by companies, such as hospitals, nursing homes, home health agencies, and doctors’ offices, which provide some type of direct patient care. Even using more conservative estimates, one would still find that hundreds of thousands of health-care staff have company-sanctioned leadership roles (BLS, 2015b). Any way one parses the data, he or she will attest to the fact that a large number of people in the healthcare industry shoulder supervisory tasks as part of their job descriptions. What is more, they can be classified into a number of different employee-related groupings.

1.4 Types of Healthcare Leaders

As I noted in the previous section, large numbers of healthcare workers shoulder some leadership-related tasks as part of their jobs. One can divide these individuals into a number of different classifications. I will spend a great deal of time talking about one such group—office-level healthcare leaders. However, before I begin that process, I think it is worthwhile to briefly describe the basic management levels. To simplify matters, I will assume that the companies in question do not have subsidiaries or control multiple facilities.

• The CEO: This individual is the highest ranking executive in the company. He or she “take[s] overall responsibility for leading and managing a company’s operations” (Linton, 2016). Among other things, the CEO will work with staff to help craft overall strategy, to manage stakeholder relations, and to oversee key initiatives (Linton, 2016). As a part of the process, this person takes ownership of the rules and regulations governing his or her employees. Many of these leaders primarily interact with upper-level supervisors and external stakeholders; however, a CEO can theoretically issue direct orders to any staff member. In my experience, CEOs of small companies will sometimes actively intervene in the day-today affairs of department managers.
• The C-Suite (Upper Management): This group, which includes the CEO, consists of the “organization’s most senior executives” (Linton, 2016). Healthcare companies will differ from each other with regard to whom they include in this inner circle; these corporations will also vary in how they refer to (what name they give to) each job title. However, the usual entries include, in some form or another, the chief financial officer (CFO), the chief operating officer (COO), the chief marketing officer (CMO), and the chief information officer (CIO) (Linton, 2016). Many hospitals and other clinical providers will also employ a chief medical officer (CMO), a chief nursing officer (CNO), and a chief legal officer (CLO). In large companies, several layers of management-level personnel might stand between a c-suite executive and the frontline staff under his or her control. However, at smaller healthcare organizations, the executive might only have one manager—and sometimes no one at all—who acts as a liaison between that person and first-line employees.
• Middle Management: The individuals are aptly named. They take orders from at least one higher-level supervisor (not the CEO) within the company. At the same time, these administrators have authority over “at least one subordinate level of managers” (Business Dictionary, 2016). In my experience, healthcare organizations, depending on their size and scope, might possess several layers of middle management; many of these men and women will have almost no contact with first-line staff. Alternatively, these leaders might spend significant amounts of time working with customers or directly interacting with frontline employees (Henricks, 2007).
• Front-Line Management: I have heard businesspeople, in healthcare and in other industries, use one of several terms to describe this group, including first-line managers, frontline managers, lower-level managers, and first-level managers. Regardless of what executives call them, these leaders sit at the bottom of the administrative totem poles at their respective organizations. They directly supervise the frontline employees or teams in both clinical and non-clinical settings. At the same time, these individuals report to one or more supervisors (Fallon & McConnell, 2007, p. 252).
• Professionals with De Facto Management Responsibilities: The health-care industry is different from many other fields in that some of its professionals also possess de facto leadership responsibilities. For instance, doctors and, in some cases, nurse practitioners not only directly care for patients but also often supervise nurses, physician assistants, certified nursing assistants, and other caregivers. They sometimes possess this right even when they do not directly employ these staff members. As a case in point, a surgeon who has privileges at a hospital, and is performing an operation on a patient at that facility, will often have authority over the institution’s employees who are helping him or her perform the surgery.

1.5 Healthcare Leaders Are a Diverse Group of People

In the previous section, I briefly outlined some of the key leadership levels that one can find in healthcare organizations. However, as anyone who has worked in the field can attest to, many of these supervisors do not fit neatly into any one category. For instance, in smaller companies, c-suite level executives might supervise frontline workers. As noted earlier, many middle managers also perform first-line tasks. At the same time, one cannot always look to an employee’s title to determine the individual’s place in the organizational hierarchy. That is because, at least in my experience, each company will assign different values or meanings to these designations. In many instances, the powers conveyed by these honorifics will be relative to a specific department within a company. As an example, an administrator of a large department might act more like a middle-level supervisor. He or she may not have any first-line duties. Instead, this person will oversee several assistant managers, who will be the ones to actually supervise the frontline staff. In other instances, a department head might directly manage the first-line employees, but he or she will have little to no autonomous decision-making powers. Instead, the individual’s primary task will be to enforce highly detailed company-related policies, which have been created by higher-ups (or by an agreement between a union and management).

At the same time, healthcare is an extremely diverse field. Many of the organizations that are part of this industry have very little in common, except for the fact that they participate—in some way—in keeping people healthy or in helping them to get well. For instance, an organization that sells DME would have little to no experience in directly caring for sick patients. Following this logic, individuals at different companies might be on the same supervisory level but perform radically different tasks. As I have seen firsthand, one can even find this type of divergence between management tasks within individual healthcare firms—especially ones that contain both clinical and non-clinical elements.

1.6 Where Do Office-Level Healthcare Leaders Fit In?

Even given this diversity, healthcare leaders, at every level and in each field, share some key things in common. As I stated previously, all of these people devote at least some time to managing other individuals. In its simplest sense, this means that they have company-sanctioned authority to issue orders to subordinates. At the same time, these supervisors expect their staff to follow directives. As a corollary to this principle, most healthcare leaders, at least the ones I know, have at least a modicum of power to discipline the employees who are under their control. Many business experts would also argue that a healthcare administrator (another term I will use for a healthcare leader) must also possess some authority to “set goals for each member of the group” (Murray, 2010, loc. 246) that he or she manages. At the very least, the supervisor should have some say over how his or her team goes about meeting its goals (Murray, 2010, loc. 246). One can point to other traits that most leaders share in common; however, those are the ones that are key to the discussions in this book.

I view office-level healthcare leaders as people who possess leadership responsibilities, which center on supervising, motivating, and disciplining employees. At the same time, they need to have some control over the establishment of team or department objectives. Additionally, the people I have in mind should spend most of their time overseeing frontline employees. Ergo, my definition of office-level healthcare leaders will include most first-level managers. However, using my definition as a guide, a significant number of professionals with de facto power and a smaller portion of middle managers will also fall into the “office-level healthcare leader” category if they devote a sizeable portion of their time to directly supervising frontline staff.

1.7 Office-Level Healthcare Leaders: The Most Important Cogs in the Corporate Wheel

I think many corporate executives, ...