VOLUME 12 ISSUE 12 DECEMBER 2004 ISSN 1533-2292
INSIDE THIS ISSUE
Unsentimental Education
PAGE 1 Today’s Emerging Healthcare Managers Need Practical, Hands-On Training More Than Ever Before, But Few Actually Receive It
A PUBLICATION OF
AMERICAN GOVERNANCE & LEADERSHIP GROUP
UNSENTIMENTAL EDUCATION
TODAY’S EMERGING HEALTHCARE
MANAGERS NEED PRACTICAL,
HANDS-ON TRAINING MORE
THAN EVER BEFORE, BUT FEW
ACTUALLY RECEIVE IT
By Betty J. Noyes
Many of us remember our own first days in
management
and the angst of taking administrative
calls, appearing before the board, presenting our first
budgets and other milestones. We were all novices at
one time.
But these days, it seems the transition period f rom novice to seasoned veteran has tele-scoped interm i n a b l y.
Having spent 30 years in senior h e a l t h c a re management positions, I know that I was most successful when I had a s t rong, experienced, talented and trained managerial staff supporting me. The fro n t l i n e ’s perf o rmance is the only way to achieve excellence in patient care and finances.
In my previous careers as hospital chief executive officer and chief nursing o ff i c e r, I had to ensure the success of my p romoted managers by personally becom-ing their coach, mentor and teacher. I wish I had a stru c t u red program like the ones my o rganization delivers; I would have had fewer 15-hour workdays.
I can vividly recall critical times in the budget review process with deadlines looming, only to encounter a floundering manager who caused me to “redo” all the calculations and have misgivings about the assumptions. I can recall a suddenly
s k yrocketing number of “step one” employee grievances — only to discover their linkage to a manager’s insecurity in dealing with shop stewards and conflict resolution. Conversely, I remember when all p e rf o rmance evaluations from certain man-agers rated every employee as “exceeding expectations” and worthy of only accolades.
A senior healthcare manager will invariably face at least one such dilemma during their career, and more likely all of them. Yet such man-agers currently face a serious conundrum that continuously divides their time between the grind of daily opera-tions and the fire f i g h t-ing duties inherent in crisis management. Quite simply, the more complex the healthcare system has become in the past decade, the m o re we have tended to jump onto complex or critical issues, leaving the practical skills-training and their applica-tion behind. As a result, the skills founda-tions of our management teams are often weak and unrealized. Those front-line work-ers who were staff yesterday and managwork-ers today are then left in a sinkhole of insecurity, s t ress, burnout, and lack of staff re t e n t i o n .
PRIMARY CULPRIT:
CHANGING TIMES, PACE
In the old, slower-moving days, we could aff o rd to promote new managers and let them learn managerial skills on the job.
Quite simply, the more complex the
healthcare system has become in the
past decade, the more we have tended
to jump onto complex or critical issues,
leaving the practical skills-training and
their application behind. As a result, the
skills foundations of our management
teams are often weak and unrealized.
But today — p a rticularly in an era of continu-ous post-redesign and re - e n g i n e e r i ng — most tables of organizations have been flattened. As a result, many education d e p a rtments have been relegated to pro v i d e only necessary in-service and orientation p rograms, and there exists a lack of support-ive and practical management education. With the mandated learning curve becoming similarly flat, the inevitable result is a 50% manager attrition rate and large numbers of resignations from staff re p o rting to those failing managers. And when a managerial vacancy occurs, senior administration wants an immediate skilled replacement available so that time, money and policy initiatives are not lost.
Despite such a dire personnel situa-tion, we ironically desire our managers to envision themselves as “retention off i c e r s . ” We logically expect that their staff’s attrition rates be kept low and that their staff is i n f o rmed, motivated and supportive of the o rg a n i z a t i o n .
Given the circumstances, it is little wonder that 85% of staff leave their jobs because of dissatisfaction with their immedi-ate superv i s o r. I have surveyed more than 700 participants enrolled in my firm ’s managerial skills program and have come to recognize their lack of self-confidence and knowledge and their own personal dissatis-faction with their roles. I am convinced that much of that dissatisfaction and stress is simply because they do not know how to do what is being asked of them.
On the face of it, the development of such a loggerhead seems obvious. Yet many o rganizations have, sometimes for decades, re w a rded good clinicians and technicians by placing them into management roles. These
new managers were then expected to mirac-ulously acquire expert skills in the areas of finance, human re s o u rce management, conflict resolution, process impro v e m e n t , labor relations and more.
WHAT SENIOR EXECUTIVES WANT
VERSUS WHAT THEY ACTUALLY GET
Most of us in executive positions know that what we really wish for are 10 s t rong managers. We then wish that those managers would work together eff e c t i v e l y, p roviding employees, patients, physicians, d e p a rtments and re f e rral organizations with consistent interactions. And of course, we wish them to maintain missions and marg i n for the organization.
The reality is that experienced staff do not make experienced managers. The skill-set is different, and transformation does not occur overnight. Even individuals who appear to be “seasoned” in a given organi-zation will be faced with a myriad of new challenges the day they become managers.
Ask yourself some simple questions: when was the last time you stopped and s u rveyed your managers to pass a simple finance test to illustrate their understanding of your budget and variance re p o rts? When did you last observe them conducting a hiring interview or disciplining an employee? How was their level of self-confidence?
You might be shocked by the answers. Based on the pre - p rogram testing my firm administers to the personnel of our client h e a l t h c a re organizations, we know that 50% of managers will fail a very basic knowledge test. A similar percentage will rate them-selves low on self- PLEASE TURN TO PAGE 10
confidence in 67 typical areas of first line managerial re s p o n s i b i l i t y.
The conclusion is clear: the eff i c i e n t use of management education dollars is a priority for all healthcare org a n i z a t i o n s . Yet the core question remains: to ensure successful managers, how do we identify managerial educational needs, and targ e t those needs to receive the scarce dollars re q u i red?
My firm strives to determine how to s u p p o rt managers within organizations to be e ffective discharging their re s p o n s i b i l i t i e s , building a strong skill base and the self-con-fidence to tackle leadership and managerial responsibilities. Here are some of the ways to achieve such goals:
1. Start with an assessment of the current
managerial skills of front-line
man-agers. It is essential to measure both
knowledge and levels of self-confi-dence. A manager can know “the answers” but lack the self-confidence to complete the task. Self-confidence can be clearly effected by not only lack of skill and practice but also encum-bered by lack of comfort to take on the task within the given organization’s cul-ture. Novices tend to be risk-avoidant.
2. Customize your program content. Yo u r
re q u i red perf o rmance is based upon your org a n i z a t i o n ’s protocols, pro c e s s-es and forms. Providing theory that does not match your manager’s daily tasks will not be effective.
3. Have faculty that are healthcare leaders.
C redibility is critical to the novice. T h e o ry is great from a pro f e s s o r, but what the novice wants is someone to
show them the real world who has walked in their shoes, and can re l a t e their battle stories in an informative way.
4. Assign a mentor to each novice. T h i s
element often re q u i res careful pairing, monitoring and teaching mentors the skills of mentoring, which are very dif-f e rent than direction and supervision.
5. C a reful tracking of the mentoring re l
a-t i o n s h i p . Mentoring re q u i res time and
commitment to provide valuable oppor-tunities, open doors and provide safe havens for practice of skills and experi-ences. Having a meeting that lasts for five minutes in the corridor is not going to have the impact that is re q u i re d . Conversation guides are essential to both the mentor and the protégé.
6. P rovide causes for celebration and
recognition of achievement. F re q u e n t l y,
novices have not “succeeded and been recognized” in their new role by the senior administrative team. Tr a n s-f o rming what a novice manager knows into a new process that will result in an e n e rgized and positive experience is an essential element to the “coming of age” of a novice.
7. S t ru c t u re your educational program so
that it provides for a non-thre a t e n i n g e n v i ronment that is very interactive. Engage the participants in frequent ro l e -playing, exercises and discussion. Avoid lectures presented by good oper-ational people but who are often poor teachers. Likewise do not have good p rofessors who are not good opera-tional people.
8. M e a s u re your results, particularly on
the bottom line. Impact is the final
i n g redient in the success of a manage-ment education program. If your p rogram fails to have a measurable impact on business results, it has failed. You will not have had a leader with a successful learning experience.
Another indication of the success of a management education program is the change in the tone of feedback you get f rom your managers. If you’re hearing quotes such as “I have been given the tools now to do my job,”; “This has helped me to better understand the full scope of being an e ffective leader”; “(We) have never had p rocess improvement explained so clearl y ” ;
“I never understood finances and now I get it”; “I no longer fear Dr. ______ I now know I can talk with him”; “my staff has a ‘team commitment’ and we are sticking to it… it has been a great help’; “It is taking me less time and I have more e n e rgy”; “I now believe that I will stay in healthcare manage-ment… I believe I can do the job”, then you’re obviously on the right track.
Novice managers should have the opportunity to have a c redible impact on the business of your organization and be intimately familiar with the change process, stake-holder involvement and be ready for their next career step. We all were there once, and we have an obligation to get the next class of graduates over the hump.
s
Betty J. Noyes, R.N., M.A., is President of Noyes & Associates Ltd. Based in Bainbridge Island, Wash., the firm special-izes in healthcare management education, recruitment and consulting. She may be contacted at (206) 780-8142, or by e-mail at [email protected].
