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Opinion: Doctors don't have to choose medicine over management

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While the world of health care continues to change rapidly, here’s one thing that hasn’t really changed: Doctors are in charge of making medical decisions.

Maybe I’m stating the obvious, but hear me out.

When a doctor is in the room with a patient, it is the doctor who is assessing the situation and giving out orders to the staff for treatment. The nurses are expected to follow those instructions. Furthermore, nurses who work with multiple providers are expected to learn about the specific preferences and customize their work for each provider.

In most cases, except for privately owned practices, once the provider and the patient leave the room, the nurses now report to someone else, usually a nursing manager, office manager or administrator. This presents interesting organizational and cultural challenges for these health care practices that also include some insights for other organizational leaders.

One challenge is that despite having four years of undergraduate school, four years of medical school and an additional several years in residency, most doctors are never trained on how to manage people. Most doctors fall back to an authoritative leadership style which applies well to patient care but not to all situations in managing a team. This is not limited to health care. A research study by Grovo found that 98% of managers feel like managers would benefit from more training and 87% say they wished they had more management training when they first became a manager. Gallup points out the impact of this lack of training with another study that showed 70% of disengagement is caused by poor management practices. While this trend is prominent in all organizations, it is particularly prevalent in health care as doctors rightly focus on practicing medicine rather than managing people.

Another challenge is poor accountability that comes when someone has more than one boss. This is particularly prevalent in health care, especially when multiple locations or different shifts are involved. Some nurses who work off shifts in a remote location might work for multiple providers, a shift supervisor, a nursing supervisor and a site hospitalist. This creates serious issues. First, it makes it extremely difficult for nurses to have clear expectations. Second, it creates a situation where there is a potential lack of accountability as it is unclear who is truly judging the performance of individual nurses and who is responsible for supporting their development.

Fortunately, there are solutions to these challenges that involve systems and processes.

1. Management training. Managing people is a challenging job that requires training. Doctors are trained on how to work with patients, but if a doctor is expected to lead a team, they need additional training on how to do it effectively. This not only impacts morale and turnover, but also performance.

2. One boss. Few things have hurt organizational clarity more than the concept of the “dotted line.” Every employee should have one clear boss who is ultimately responsible for their performance and development. This doesn’t mean that nurses shouldn’t follow the orders of a doctor while working with a patient. An attending doctor is absolutely in charge of the process, and nurses should follow their instructions. However, if the nurse isn’t performing well or needs additional training or development, it should be the responsibility of the nurse’s supervisor to set expectations and provide development resources.

3. Deliberate communication cadence. Literally every health care organization we have worked with reports that communication is one of their most significant challenges. The answer to improving communication isn’t always to have more communication. Instead, a good way to improve communication is to establish regular opportunities for communication to occur. For example, we recommend that providers and nursing supervisors meet regularly to discuss the performance of their nursing staff. This collaboration gives both parties a place to make improvements and to address issues. Another communication cadence that we recommend is regular one-on-one discussions between supervisors and each of their employees beyond a performance appraisal. These check-ins should focus on development.

4. Reasonable number of direct reports. If a supervisor has too many employees to meet with on a regular basis, then they simply have too many employees. A nursing supervisor with 60 direct reports simply can’t do their job effectively. Breaking up that group with lead supervisors helps improve performance and accountability.

The complex nature of health care creates some natural cultural issues that do more than impact morale. Cultural challenges that decrease employee engagement can adversely impact patient satisfaction – and therefore reimbursements – while also impacting patient safety. The good news is that by implementing some cultural systems, medical practices can earn engagement and make significant improvements.

Don Harkey is the owner and CEO of People Centric Consulting Group. He can be reached at


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