How to Manage a Productive Prima Donna: Twelve Strategies

Prima donnas in medical organizations often are the biggest producers, and at the same time, the biggest pains in the neck. Prima donnas think of themselves as valuable and special—and, in truth, they are. That is why they often assume that the rules for everyone else don’t apply to them. They look for loopholes and workarounds. Or they simply ignore rules outright because they know how valuable they are. Prima donnas often think that they know better than everyone else. They may find it difficult to work under direction or as part of a team, and don’t think they should have to. It is not unusual for them to think they’re the smartest, most highly educated, and most valuable people in the room. Often, they’re right. So, prima donnas come to work late if that’s what suits them. They think mandatory meetings are for everyone else. Their reports may be sloppy or incomplete. They may say that they’ll do one thing but do another and not tell you. In short, prima donnas try to get away with behavior that you would never tolerate from the average employee.

It is no wonder, then, that prima donnas present such a complicated management challenge for the medical administrator. On the one hand, we all know how important it is to hold everyone in the organization accountable, for the good of the team and the bottom line. We know that applying rules consistently is fair and just, and that consistency helps to build morale. On the other hand, we also know that it is a huge risk to confront prima donnas who step out of line. Unfortunately, unhappy prima donnas can easily take their marbles with them and go play elsewhere. Your competitors will be very happy to welcome them, probably with open arms and perhaps a ticker tape parade. This is especially true if your prima donnas have earned big reputations in your community and draw patients to them in large numbers. That puts you in an unenviable quandary. You may not be able to afford to lose your prima donnas’ productivity and talent to another medical organization. But you may not be able to afford the damage they do to the rest of your employees and to your organization either.

So where exactly does that leave the medical administrator? Should you hold prima donnas to the same performance standards as everyone else and let the chips fall where they may? Let prima donnas slide on some things? Let them get away with murder just so you keep them producing for your medical organization? Unfortunately, the exceptions you make for prima donnas can come back to bite you. If team morale and the overall performance of your organization plummet, you’ll have a bigger problem on your hands than an out-of-control prima donna. There are no quick or easy answers here. But, fortunately, there are strategies you can use when you find yourself walking this very difficult management tightrope.

The Psychology of Prima Donnas: Entitlement, Narcissism, Myths, and Denial

A good place to begin our discussion is with an exploration of the prima donna’s psychological underpinnings. The term prima donna originated in opera and refers to a difficult-to-work-with principal female singer. However, the term prima donna more broadly has come to mean anyone who acts like a difficult star of the show, whether that person is female or male. Like prima donna opera stars, prima donnas in medical organizations are very good at what they do, and they know it. Some will be the most brilliant, intelligent, and productive colleagues you will ever meet. They will act as though they have extremely strong self-confidence, whether or not they do. They will be assertive, if not demanding. They will be very comfortable issuing advice and directives, even if that means going over your head. And they will expect to get their way.

As Dekker(1) suggests, managing prima donnas is difficult because of their value. As Dekker explains, “They [prima donnas] are recognized for their high technical competence, assertiveness and self-confidence, yet can have an insensitivity to larger organizational goals and difficulty working under direction or as part of a mixed-composition team.” In fact, Girard(2) suggests that this managerial difficulty is so widespread that popular organizational literature has referred to it as the “prima donna syndrome.” What’s at the core of this syndrome? Power, or, more aptly, who has power, and who doesn’t. As Mintzberg(3) explains, when an organization relies on specialized knowledge, skills, and value, “certain experts attain considerable informal power.” As Dekker suggests, that power often causes prima donnas to exhibit several unsavory behaviors. According to Dekker, prima donnas:

• Often feel that they do not have to play by the rules;

• Resent being held accountable for their performance like other employees;

• Have unrealistic expectations about what the organization will do for them;

• Become resistant to negative feedback;

• Believe that their expertise and value trumps other organizational concerns;

• Become hard to get along with and work with;

• Have an inflated sense of self-importance;

• Become accustomed to being praised and coddled, and to receiving extra attention;

• Become rude;

• Corrode the team and organization cohesion; and

• Thrive in workplaces with a high level of ambiguity, especially when credit and blame can be easily manipulated.

Why does it follow that informal power leads to such outrageous behaviors? Dekker explains that two psychological phenomena are at play: the psychology of entitlement and narcissism. Psychological entitlement refers to the prima donna’s belief that he or she should receive preferential treatment that is not matched to actual deservingness. As Naumann et al.(4) explain, prima donnas expect more benefits, attention, power, and input without seeing the need to reciprocate with higher levels of performance or other sacrifices. Narcissism, according to Freud,(5) refers to a collection of cognitions and behaviors that help in the regulation of self-esteem. For prima donnas, their narcissism thrusts them into a constant, unpleasant dilemma. As Dekker explains, “For their self-esteem, positive regard, and affirmation, they depend on the very people whom they hold in contempt or even feel threatened by.” This central dilemma and the denial that goes hand-in-hand with it are what cause prima donnas to behave the ways that they do. Specifically, prima donnas may:

• Seek to disavow or disclaim awareness, knowledge, or responsibility for faults that might otherwise attach to them;

• Create myths to conceal conflicting or contradictory information and exclude other equally valid interpretations (such as that they could possibly be in the wrong);

• Rationalize to justify their unacceptable behavior and present it in a form that they feel is tolerable and acceptable;

• Overestimate their abilities and accomplishments;

• Find or create explanations for events that are self-serving (favorable outcomes are attributed to them; unfavorable outcomes are attributed to everyone else);

• Believe that they have the right to exploit others; and

• Find it difficult—if not impossible—to empathize with others.

In short, prima donnas are so difficult because their behaviors feed their psychological needs. Of course, it is not your responsibility to provide therapy for the prima donnas in your medical organization, nor are you qualified to do so. However, there are some takeaways from this psychological discussion that will help you to choose the best strategies for managing them:

1. When you find yourself exasperated by the prima donnas you manage, remember that they have probably not been treated like most people. Their unusual treatment is what has led to their unusual behaviors.

2. Prima donnas behave in ways that feed their psychological needs first and foremost. It may seem that they are trying to hurt others, and sometimes they are. But that is not their primary goal. Always, they act as they do to meet their needs.

3. Prima donnas’ specialized treatment may have caused them to create myths about themselves and the world in which they live. They may have to deny reality to preserve those myths.

4. Prima donnas may act as though they are extremely self-aware and confident. However, they may not be. In fact, they may behave in ways that mask their low self-esteem and anxiety.

5. Prima donnas will usually push away or lash out at anyone or anything that threatens their feelings of entitlement and narcissism. They may seem like they don’t need anyone, but, in truth, they cannot perpetuate their myths without the cooperation of others. In fact, they need to receive accolades, applause, and special treatment or they may not be able to perform as well as they do.

6. You will need to tread lightly if you try to jolt prima donnas into reality. They won’t like it if you confront their faults and shortcomings directly and will be likely to push back or storm off. And, if you confront prima donnas too often or too harshly, they will probably go elsewhere so they can perpetuate their myths with new people.

How Bad Is the Problem? Six Assessments

Understanding the psychology behind prima donnas’ behaviors is a good first step. But there’s more to do. Complete the following six assessments before you decide your next steps. As you do, try to remain as objective as you can.

1. Assess the prima donna’s worth to your organization. Look at his or her actual, not perceived, worth. As you work through this, Girard warns that you must assess worth with “respect and consideration.” Don’t underestimate the prima donna’s worth because you’re angry, hurt, and fed up with his or her behavior. And don’t overestimate the prima donna’s worth based on what he or she tells you or your own fears. Remove your emotions from your assessment. Look at numbers. Objectively consider what you’ve observed. If you feel unsure, ask others you trust to help you make this assessment.

2. Assess why the prima donna may be acting the way he or she does. What’s your hunch about what may be going on? As Dekker suggests, “Recognize that low self-esteem and anxiety may drive the behaviors you have observed.” Is there something or someone that seems particularly likely to set off your prima donna? What do you think your prima donna may be trying to hide or avoid? What do you think may threaten him? If the arrogance stems from the great work the person is providing for your organization, that’s one thing. But as Dubois(7) points out, “If the employee is causing problems with a clear agenda that works against your business goals, that’s when you have a problem.”

3. Estimate how set the prima donna is in his or her ways. As Girard asks, “Are they [prima donnas] good technicians and know it, or do they think they are the best in the world just because they exist?” From your experience working with your prima donna, and from others’ experiences, how open to change do you think your prima donna may be? Is his mind clamped shut? Or do you think it is possible that he is malleable and can bend and change?

4. Determine where, when, and how long the prima donna has acted as he has. Does your prima donna instigate unrest, either overtly or covertly? Are the claims against your prima donna true? Is the behavior new? Or have the prima donna’s behaviors been going on for a long time? If so, have they been consistent? Or have they worsened over time? When and where are these behaviors most observable in your organization, to whom, and with what consequences?

5. Assess the impact of the prima donna’s behavior on others. How are your other employees, your patients, and other stakeholders responding to the behaviors? Do they find them disruptive? Has anyone complained to you? Are their claims true and accurate? What do you think will happen if those behaviors go unchecked? What could happen if they worsen?

6. Assess which behaviors are tolerable, and which are not. You probably can’t change everything you’d like to change about your prima donna. You may find yourself having to choose your battles. If so, you need to choose wisely. Somewhere, there is a line that can’t be crossed; or, if there isn’t, there should be one. Where is that line? How far is too far when it comes to your prima donna?

Twelve Effective Strategies for Managing the Prima Donna

With your psychological foundation and assessments in place, you’re ready to figure out your next steps. It may feel as though your prima donnas are holding all the cards. But they aren’t. As Girard suggests, “Almost all . . . prima donnas can be salvaged if you have the time and energy to work with them.” Following are 12 of the most effective strategies for managing prima donnas.

Document your prima donnas’ behaviors.

Compile and maintain a detailed record of their behaviors, especially those that can’t be tolerated. Stick to the facts—what they said or did, who observed or heard it, how others reacted, who commented to you on it, when it happened, where, and how long it lasted. A detailed, factual record will be much harder for a prima donna to dismiss than your impressions of his or her behavior. It also will be valuable and necessary should you someday need to take disciplinary action against your prima donna, or even fire him or her.

Commit to working with your prima donnas.

Keep your expectations reasonable. Prima donnas often need additional mentoring, handling, or what some might call coddling, even if they tell you they don’t. As Dubois suggests, “Early on, be ready to invest the individual time and attention as a manager to build a rapport that will yield the business benefits you’re looking to attain from this employee.” If you’ve sidestepped or given up on the issue of their attitude in the past, Dubois says, “You have only yourself to blame—not the employee—for the frustrations or lost customers that may follow.” Listen and observe. Don’t try to work with them when they are too angry or too upset. However, do keep trying to build a healthy managerial relationship with them.

Align your treatment of prima donnas with their performance.

It’s easy to be dazzled by a prima donna’s talent and value. It’s easy to let fear keep you from intervening when you know you should. Do a reality check. Review your six assessments and add new information as new data become available. As Dubois suggests, “Make sure that the treatment you give them [prima donnas] is commensurate with his or her performance.”

Give your prima donnas independence when you can.

Prima donnas need applause, but they also need their space. Let them have it. As Dubois explains, “By allowing them time on their own to think without guidance, not only about your organization but about themselves, they may come to realize that they are troublesome.” For example, give your prima donnas assignments that require them to spend time away from your other team members, away from the applause and their ability to exercise their informal power. Says Dubois, “You typically do not have to worry about their work ethic, and by isolating them, it ensures they will not cause issues for other employees.” Isolation also can help you figure out what’s really been going on, Dubois suggests. For example, it may turn out that other members of your team made your prima donnas look better or that they have been covering for them for a very long time. This is important for you to know.

Establish clear expectations for their behavior.

Your assessments have helped you to determine where to draw the line on your prima donnas’ behaviors. It’s time to share that information with them. Make it clear that although you can allow for some individual preferences and differences in working style, there are some behaviors that can’t and won’t be tolerated in your medical organization. Describe these behaviors clearly and provide specific examples. As Dubois suggests, “At the end of the day, you need to reassert to this prima donna that you still are the boss, and will not allow their behavior.”

Ask your prima donnas what you can do to help.

As Dekker suggests, “Recognize that autonomy, mastery, and purpose are the intrinsic motivators that likely attracted them to the job in the first place.” It may be that your prima donnas have some valid concerns and that they may be able to offer helpful suggestions. For instance, if their behaviors stem from frustration, find out what is frustrating them and how you can make things less frustrating. If the behaviors are coming from fear or anxiety, see how you can reassure them. If the behaviors worsen when they feel that they are receiving inadequate support or that the conditions they work in are not adequate, ask them for their suggestions for improving things. Or if they find only some aspects of their job troubling, explore how you can make them less troubling, or even whether your prima donnas must continue to do those tasks at all. In short, don’t discount prima donnas’ ideas and suggestions simply because you have a problem with their behavior. They may have acted poorly. But they may also be right about their frustrations and concerns in your medical organization. Listen to them.

Describe the specific behaviors that need to stop, why, and by when (immediately).

Don’t be judgmental. Simply cite the behaviors you’ve observed and documented and the destructive consequences of them. As Schinkel suggests, “In many cases the person is likely unaware of how they are perceived.” Remind your prima donnas who your customers are and their role in supporting your customers, both external and internal. Explain that the overall success of your medical organization depends not on the prima donna’s individual talents and contributions, but on the overall capability of the team. As Dekker suggests, “All employees are part of something bigger than themselves. No player is bigger than the entire team.”

Continue to monitor your prima donnas’ behaviors.

Meet with your prima donnas regularly to provide ongoing feedback. If their behavior has improved, say so and praise them appropriately. If their behaviors persist, remind them of the line you’ve drawn. Then try to determine what’s going on. Have your prima donnas tried to improve but are finding it hard to do so? Then, continue to encourage and coach them. However, if they are willfully and purposely acting out to exercise their informal power and make a point, remind them that their behaviors won’t be tolerated. Then, describe specifically what will happen if they continue. Make sure you have support from higher management when you feel that the behaviors will lead to your having to take action. Fully document everything.

Give them a test.

Girard suggests that you ask your prima donnas several questions to assess whether they are making adequate progress. For example, Girard suggests that you ask, “Can they now be part of the team? Will they do what everyone else in the department has to do? Are they willing to stay in the trenches or make coffee if that is what the routine and organizational culture expects? Will they participate in committee meetings, projects with partners, or volunteer . . . ?” Let them answer these questions, either directly or indirectly, Girard says. Then, see if they will do what they say. As Girard predicts, “They will either sink or swim, and their coworkers may be the first to let someone know the outcome.”

Do a cost–benefit analysis.

Do the headaches caused by your prima donnas outweigh the benefits? As Girard suggests, “Ask yourself if prima donnas are worth the grief they cause, no matter how good they are.”

Take action.

If you determine that your prima donnas are not worth the grief, begin to take disciplinary steps and be prepared to let them go or walk away. However, if they are worth all the trouble they cause, or if the powers that be insist that you make it work and you can’t fire them, you will have to meet with the rest of your team and tell them know what’s going on. Tell them the truth. You won’t like sharing this with them. They won’t like hearing it. But it’s honest, and if you’re fortunate, they will appreciate that. Offer to provide your support to them and to work with them to make things as good as they can be, given the circumstances. Some members of the team will grumble. Some may choose to leave. But if you must keep your prima donnas and you can’t get them to improve their behavior despite your best efforts, it’s best to face this head on. Look for creative ways to manage the situation. Perhaps some members of your team are better at dealing with your prima donnas than others. Perhaps you can rotate assignments so no one must deal with your prima donnas all the time. Involve your staff in figuring out best strategies for coping.

Continue to document and share information.

Keep your supervisors informed if the situation worsens. At some point, the prima donna’s behaviors could leave your medical organization open to legal action. Make sure your supervisors know when this begins to happen. Even if your supervisors weren’t initially supportive of your taking action, they will be when the prima donnas’ behaviors threaten to destroy the organization. At the end of the day, no one is that valuable, no matter how talented or productive he or she is.

References

1. Dekker SWA. Deferring to expertise versus the prima donna syndrome: a manager’s dilemma. Cognitive Technical Work. June 4, 2014;541-548. http://sidneydekker.com/wp-content/uploads/2014/10/ExpertisePrimaDonna.pdf . Accessed March 24, 2020.

2. Girard NJ. Dealing with perioperative prima donnas in your organization. AORN Journal August 2005;187-189. https://aornjournal.onlinelibrary.wiley.com/doi/pdf/10.1016/S0001-2092%2806%2960310-4 . Accessed March 24, 2020.

3. Mintzberg H. The structuring of organizations: a synthesis of research. Englewood Cliffs, NJ: Prentice-Hall; 1979.

4. Naumann SE, Minsky BD, Sturman MC. The use of the concept “entitlement” in management literature; a historical review, synthesis, and discussion of compensation policy implications. Human Resources Management Review. December 2002;145-166.

5. Freud S. Project for a Scientific Psychology. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume 1. London: Hogarth Press; 1950.

6. Schinkel G. Managing prima donnas at work. Leader’s Beacon. www.leadersbeacon.com/managing-prima-donnas-at-work/. Accessed March 23, 2020

7. Dubois L. Dealing with a prima donna employee. Inc. October 10, 2010. www.inc.com/news/articles/2010/10/dealing-with-a-prima-donna-employee.html. Accessed March 24, 2020.

8. Shelly J. 10 ways to handle a coworker who thinks they’re your boss. Convene. https://convene.com/catalyst/bossy-coworker-advice/ . Accessed March 27, 2020.

What Not to Do when Managing a Prima Donna

You’re only human, so you’re probably peeved, annoyed, hurt, and possibly exhausted by your prima donna and his or her antics. At the same time, you may be afraid of losing your prima donna and what that will do to your bottom line. Nonetheless, you’ve got to overcome these feelings if you are to manage a prima donna effectively. Here is a short list of what not to do:

• Don’t try to knock them down a peg. As Schinkel(6) suggests, “It really isn’t helpful to criticize or point out the person’s flaws or jump with glee when they make a mistake.” Managing prima donnas is not about getting even. It’s about bringing their behaviors in line with those you expect of your other employees. As Dubois(7) warns, “If you slap them on the wrist, they may just throw their hands in the air and give up, which doesn’t help anyone.”

• Don’t look the other way or minimize the problem. You can’t unsee what you’ve seen. Admit when you have a problem. Trust your gut. Don’t tell yourself that it isn’t so bad when your gut tells you otherwise.

• Don’t let the problem fester. Things rarely get better on their own. Mostly, they get worse. As Girard suggests, “Take control of prima donnas as soon as they are identified. The longer the behaviors have been in effect, the harder it will be to intervene.”

• Don’t use language that will inflate their egos. Praise your employees appropriately, but in moderation. Don’t gush or exaggerate. Schinkel suggests specifically that you avoid using words like “you’re the best” and “we couldn’t do it without you.” Such talk is music to a prima donna’s ears and will fuel their undesirable behaviors. As Dubois(7) suggests, “What you don’t want to do is . . . do anything too positive to help inflate their ego even more.”

• Don’t focus on the person, but on his or her contributions and behavior. As Dekker suggests, “Make the conversation about the expertise, not the person (where it is easy either to knock down or overinflate egos).” Prima donnas may be better at some things than other people. But that does not make them superior human beings. They are not entitled to bulldoze their way through life and your medical organization simply because they’re good at what they do.

How to Handle Prima Donnas Who Think They’re Your Boss

It’s one thing to manage a prima donna. It’s quite another when the prima donna tries to manage you. What should you do when a prima donna critiques your work, tells you what to do, delegates responsibility, or talks over you at meetings?

Left unchecked, bossy employees and peers will undermine your authority. That makes your job much harder, not only for yourself but for the rest of your employees, who may be confused about who the boss really is. If you’re bothered by a bossy prima donna, Shelly(8) suggests that you ask yourself the following questions:

• Are you upset that they’re taking charge because you want to take charge yourself?

• Are you mad that it’s making them—not you—look impressive to upper management?

• Are you just genuinely upset that your decision-making ability is being usurped and you don’t like how they’re talking to you?

If it’s the latter, Shelly says, “You’ve got reason to gripe.” Shelly suggests 10 strategies to help you deal with prima donnas who act like they are the boss when they’re not. They can help you reclaim your decision-making authority and power, as well as your happiness at work:

1. Ask them why they are acting like the boss when they’re not. You want to clarify that you are the boss, or if you’re not, that you’re colleagues. However, Shelly warns, “You don’t want to come off like a crybaby.” What to say: “Is there a reason you’re acting like my boss?” See where the conversation takes you. Be prepared to explain why you asked your question. It’s possible that your prima donnas don’t know that they are doing what they are doing, Shelly says. If so, asking this question may put a stop to the troubling behaviors.

2. Meet outside of work. Get coffee or drinks together, Shelly suggests. It may be that your prima donnas don’t trust you to do a good job because they don’t know you. “You’ll be shocked by how much one-on-one time can strengthen your relationship,” Shelly says.

3. Use reflective listening. For example, if your prima donna says, “You’re going to fit in Mrs. Thompson on Tuesday,” repeat that back to him as, “So you’re telling me that I’m going to fit in Mrs. Thompson on Tuesday?” If your prima donna is paying attention, he will realize how his directives sound to you. As Shelly explains, “They may not hear themselves. When you use reflective listening, they may understand they’re being bossy.”

4. Use “you” statements. You may have learned to use “I” statements to communicate with your supervisors. For example, you may say to them “I feel like I’m being treated unfairly” or “I feel like my ideas aren’t being considered.” That’s a good strategy with bosses because it puts the feeling on you, rather putting blame on them. However, when you’re speaking to equals, or when you’re managing an employee, “you” statements will perform much better. Shelly suggests that you ask your prima donnas “you” questions such as, “Why do you feel like you’re in charge of this project?” or “Why are you talking to me like that?”

5. Tell prima donnas what you need. Explain to them that you don’t perform best when you’re being told what to do, Shelley says. Also explain that both of you are looking for the same positive results. Then, if possible, invite prima donnas to co-lead a project with you.

6. Bring prima donnas back to the common goal. Explain that you’re all trying to reach the goal, and that you’d like to do so through a collaborative effort, Shelly suggests.

7. Identify other colleagues they’re bossing. As Shelly says, “If they’re bossing you around, chances are they’re doing it to other people too. So ask around.” What you learn can become valuable input to help you reclaim your authority.

8. Identify a colleague who is not being bossed by the prima donna. It may be that your prima donna is not bossy with everyone. As Shelly says, “If there’s someone else that seems to handle this bossy coworker well, ask them for some advice.” Consider whether the prima donna bosses certain types of people and not others. If that is the case, consider whether there may be discrimination at play. If so, this is a topic for you to discuss with your supervisor and/or human services director.

9. Go to your actual boss. Ask for clarification on roles and responsibilities. Tell your boss what the prima donna has done and said and ask whether this is what he or she expected. Then see what your boss’s reaction may be, Shelly says.

10. Be direct. Say something like, “Did you hear how you just spoke to me?” or “Why are you barking orders at me?” As Shelly says, “This can help bring the problem to the forefront—and hopefully you can lead to a constructive discussion afterwards.” Many managers aren’t direct, Shelly says. They just get upset or defensive. They go behind the prima donna’s back and complain about it. Or they wait until they hit a boiling point and snap. When you’ve had your fill of a prima donna’s troubling behavior, Shelly says, “stop beating around the bush” and shine a spotlight on it. At some point, enough is enough.