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Newsletter: October 2009

Transitioning Middle Managers

The pages of healthcare management journals are filled with articles stressing the importance of properly transitioning senior executives into new positions. The ability for these individuals to "hit the ground running" is critical to their integration into the hospital/organizational structure and their ultimate success in that position. These articles are essential, but they often leave out a crucial corollary—the transition of middle managers into their new positions. Middle managers are integral to an organization's ability to further people in these positions, but they do not always get the attention they deserve.

Middle managers play a vital role in the success of an organization by effectively and efficiently implementing the strategy set by senior management. Clearly, it is equally as critical for an organization to invest time and resources in transitioning this key person into his or her new position and/or new environment—and executives are pivotal to this process. The following five focus areas spell out the necessary ingredients to help executives successfully find, hire and transition middle managers.

1. Define the Challenge. The first step to a successful transition is hiring the right person for the job. To accomplish this, healthcare executives need to define the goals for that position. What kind of work needs to be done? What skills are needed? For example, a different skill set is needed to turnaround a department versus sustaining its performance. Does the department need to move in a different direction? Does it need to perform better? Or does it just need to sustain its current focus? Finding the right person with the requisite talents is key--many times the wrong person is hired for the task and failure is the result.

Defining the challenge is not as easy as one might think. Making decisions based on perceptions will bring unfortunate results. To truly understand a situation, executives should conduct a 360 degree review of a given department to ascertain the challenge and its solution--thereby outlining the correct person to hire for the job. This involves talking with the executive team, department staff, peer department representatives, and department users such as nurses, physicians, technicians and other managers.

These discussions identify both positive and negative aspects of the department services, and may show areas where all participants agree, representing a focal point for the new middle manager. If it is positive, then it is important to continue. If it is negative, then it represents areas requiring attention and improvement.

2. Define the Expectations. A new middle manager needs a clear explanation of the parameters of his/her new position—an unambiguous understanding of the executive's expectations and definition of success. What needs to be solved and what is the timeframe to accomplish these tasks? What does success look like? A clear delineation of success, timeframe and performance-related parameters must be communicated between the executive and the middle manager.

These metrics must be definable, known, realistic and achievable—and sometimes, they must be negotiated between the executive and the middle manager. Although the executive bears the majority of the responsibility in this area, middle managers must be willing to "manage" the executive if these expectations are murky. Executives should do their best to avoid creating uncertain expectations, but managers should be on the lookout for roadblocks such as mixed messages or obstacles placed in their way.

3. Define the Working Relationship. The path to open communication can be tricky to navigate and doesn't always come with a map. It is up to the executive to provide that map for new middle managers to ensure that the working relationship is a smooth and productive one. Does the executive prefer e-mail or voice mail? Frequent meetings or weekly briefings? Detailed summaries or just highlights? Written or oral reports? Formal vs. informal agendas? All of these preferences can make or break a working relationship, and it is important to identify them early to ensure its success.

4. Identify a Mentor Within the Organization to Guide the New Manager. Having a mentor can help middle managers be successful in their positions, especially when transitioning into a new position. Employees will tend to fail or succeed on the informal side of doing business—not based on the skills that they bring to the table.

Regardless if these individuals are new to the organization or just new to the position, mentors help them navigate through the unfamiliar and point them toward sound decisions based on the culture and needs of the organization, in addition to providing important feedback about the organization. Mentors can teach these managers how things are achieved in an organization--who makes the decisions and why. Mentors also can identify the politics that exist within all organizations.

5. Hire an Outside Coach. Sometimes middle managers have the technical skills to perform a job, but do not have the managerial experience to be successful. Using a neutral, outside coach to help that individual acquire the requisite skills needed is an important means to his or her success in that position.

Devoting time, resources and energy into the transition of middle managers into an organization is a sound investment because actual dollars can be lost through the termination and replacement of a failed manager. Also, additional costs can be accumulated by potential vacancies as an executive struggles to refill that position— costs associated with momentum stoppage, department staff turnover and loss of employee morale. Lastly, an executive should consider how long it will take the new manager to get up to speed and run a productive department. Given the dual challenges of high turnover rates and a shrinking pool of appropriate candidates for these positions, the successful transition of middle managers has never been more important.

Middle managers may possess technical skills, but success in a leadership role requires more than technical competence. It requires organizational communications skills, political and cultural sensitivity and the ability to get things done through other people. Educational preparation will help, but it is not sufficient because success within an organization is only in part due to formal management education. Middle managers, like executives, need support with developing and implementing a transition plan. Healthcare organizations should have a formal transition plan to help middle managers acclimate to their new role.

Transitioning Middle Managers was first published in Healthcare Executive Volume 23, Number 2 (March/April 2008)

A Note to Healthcare Leaders:
Maximizing Departmental Performance – FOCUS^SM

Are the departments within your organization performing to your expectation? If not, why not? Are you being told there is not enough resources, not enough cooperation, not enough …? Do you have the right people in the right positions? Do you have a succession plan for your key department leadership positions? Do you know what is or is not contributing to your performance concerns?

Current challenges that many healthcare leaders face today in improving departmental performance include:

• Recruiting and retaining department leaders
• Transitioning managers into their new position
• Departmental Succession Planning
• Managing departmental growth
• Improving service
• Improving financial / budget performance
• Improving overall performance
• Improving the performance of the team or of a key employee

We believe that improving departmental performance is predicated on two factors:

1. Understanding the work environment and what is really required for improvement, and,
2. Identifying, hiring and promoting talented employees who are capable of improving the work environment.

Too often organizations focus on one of the two issues only to experience frustration and disappointment with the results. Complicating improvement initiatives in healthcare organizations is the challenge of finding talented individuals to fill the management positions.

KLC has developed FOCUS^SM - a methodology to help healthcare leaders understand the factors affecting departmental performance and the initiatives required to improve performance. The FOCUS^SM methodology was developed to provide a structured approach to reviewing department and leadership performance. It replaces innuendo and perception with facts and observations. Improvement strategies are only effective and credible when they are based on observable facts. It is simply too costly to address the wrong problems both in terms of dollars and credibility.

And what are the benefits?

• Clear understanding of what is required to improve performance
• Improved operational and financial performance
• Improved teamwork and intra-organizational cooperation
• Improved individual performance
• Succession Plan to reduce the uncertainty and crisis that develops when a key resource leaves
• Improved overall patient safety

10 Tips for Running Meaningful and Results Oriented Meetings

1. Pre-plan the agenda, including: assigning the role of meeting leader (designated by position or by the group), and with an established timeframe, such as 9:00 A.M - 10:00 A.M. or 9:00 A.M (not to exceed 90 minutes) so people can plan accordingly. Tip: Use a template for your agenda (see sample template on our website) to promote continuity and flow and efficiency in agenda development, results tracking and record keeping. Also, be sure you have planned for necessary equipment and technology needed for delivery. Common equipment and technology items include, a laptop, an LCD projector, a transportable screen (if there is no blank wall space for viewing in the meeting room), a flash drive, and flip chart (with paper and markers).
2. Disseminate the agenda and necessary materials prior to the meeting so people come prepared. We suggest a minimum of two days and up to two weeks prior to the meeting for adequate materials review to ensure a decision making verses discussion-based meeting (whereas people are trying to learn and catch up on what they should already have come prepared for). Tip: Save trees and your time by disseminating electronic packets.
3. Start and end on time! This is the responsibility of the person leading the meeting. This builds trust and credibility in the group and focuses people on the agenda, which fuels results and builds confidence and momentum of the group.
4. Stay on point-- Stick to items on the agenda. This again, is the job of the meeting leader/facilitator. If something urgent comes up, ask for group agreement about what is priority now (by a quick vote of hands or post-it-note-vote if identifying the voter is sensitive); whereas people are clear on the priority and what will be tabled to the next meeting. If an item is not urgent, use the "parking lot" to capture and track future agenda items.
5. If the meeting will be two or more hours, schedule breaks. Most adults need and appreciate a 15 minute break after 90 minutes to two hours. Tip: Breaks also promote informal networking and relationship building among participants. Networking time is commonly indicated as one of participant's highest value take-aways from meetings and events.
6. Provide adequate and comfortable meeting space which promotes group participation. Critical elements are: comfortable seating and work space, seating arrangement that promotes group participation/participant visibility, and a well lit and ventilated meeting area.
7. Assign or rotate (share) the note-taking function to ensure record keeping. Using an agenda template greatly promotes standardization and thoroughness in capture, as notes will follow agenda items, and can even be added into the template for dissemination back to the group. Make sure to capture the "parking lot" (pending items) so they can be prioritized and appropriately placed on future agendas.
8. Always end with Next Steps/Action-ables--that is the list of who, what and by when-- that needs to be accomplished for progress and results. Report on this as appropriate in the next agenda. Tip: You can include Next Steps on the agenda template; it focuses attention on action and results, and lends for easy monitoring.
9. If it is a long meeting (two hrs or more), beverages and snacks or meals are highly recommended, as it is a natural way to encourage group comfort and relationship building (although it has a budget implication).
10. Lastly, remember to assess the effectiveness of your meetings based on the group's experience and results. This can be done simply by asking, What is working? And, What could be done differently or better to improve efficiency and effectiveness? Then use this information appropriately for future meetings. Lastly, evaluation also allows a group to acknowledge and celebrate your success--what is working well and what you are proud of accomplishing. This builds pride and ownership, a sense of team and builds morale. Additionally it helps to keep others apprised of progress, which is especially needed for cross-functional units and inter-departmental meetings. Progress only is best shared early on the agenda, while a brief assessment for continuous improvement purposes is best placed near the end of the agenda. For ongoing (standing) meetings, assessment should be an intermittent agenda item (i.e. quarterly or semi-annually), or as a standalone annual agenda item.