It Is Always Tough: Challenges for a Healthcare Manager

We all know the phrase: When the going gets tough, the tough get going.

But no one really knows who said it originally. One tradition attributes it to Joseph P. Kennedy, best known as father of U.S. President John F. Kennedy. Another version insists that renowned football player and coach Knute Rockne came up with it. (Hopefully, you do know that pop singer Billy Ocean didn’t invent it with the release of his 1980s top-10 hit by the same name!)

Building a team that performs well under pressure doesn’t happen by accident.

The best-run medical practices almost invariably enjoy the benefits of employee teams that perform well under pressure. It’s one thing to handle the routine tasks of making appointments, seeing patients, and collecting fees—it’s quite another to survive, or thrive, in the face of crisis and adversity.

Understand this: Building a team that performs well under pressure doesn’t happen by accident. The medical office that endures trials that might cause a meltdown in an ordinary practice doesn’t achieve that level of performance by sheer luck! Building a team that excels during a crisis requires extraordinary leadership.

Former U.S. Navy officer and aerospace entrepreneur Ben Williams described how he led sailors in the face of physical dangers, emotional tests, and ethical dilemmas. He says that stress management became a way of life. His military experiences taught him five “battle-tested” strategies for building a team that performs well under pressure.(1)

Avoid Freaking Out

Your team members will look to you and use your actions to guide their own behaviors. It’s critical that they see you as calm and solution-oriented, even when you don’t feel all that calm. Depending on your personality and style, you may find it challenging to demonstrate a confident demeanor when the wheels are falling off the cart, but your ultimate success depends on your trustworthiness.

Adjust your mindset to focus on fixing the problem at hand—as opposed to “fixing the blame” on someone responsible for the problem. A panic-driven “witch hunt” will only drive your team members into hiding. They’ll be rendered ineffective by self-preservation and fear.

Maintaining your overall perspective goes a long way towards controlling your “freak-out” instincts. There are more important things in your life than the immediate problem. In fact, there are more important things than your organization—or even your job. If you recognize that the “worst thing that can happen” won’t destroy you, you can face the crisis at hand with renewed courage and confidence to solve the problems.

Your staff members are watching you—even when you wish they wouldn’t—and you will see your attitudes reflected in their performance.

Make Plans

Williams reminds us of the old military axiom: “Plans are worthless, but planning is everything.” That paradoxical saying acknowledges that plans often fall apart, but the planning process itself helps you understand your goals more clearly and discover and analyze all your options.

I’ve seen physicians and managers doggedly stick to plans that obviously weren’t working. While determination and “stick-to-it-iveness” are generally admirable qualities, inflexible attachment to your big ideas can prove disastrous.

Make your plans—you seldom achieve your objectives without a strategic roadmap—but anticipate adjustments, alterations, and even abandonment when your boardroom theories crash into day-to-day realities.

Check in Regularly

More important than formal meetings, your (apparently) casual conversations with teammates will prove essential. Ironically, it’s easy to let this critical process drift off your radar when you get busy in a crisis.

Stopping by a teammate’s desk, or informal chats at the water cooler or in the lunchroom, can help you maintain awareness of what’s really going on around the practice. Taking a manager or department supervisor for a cup of coffee will not only strengthen your relationship, but will encourage the staff member to open up and share insights you might not gain otherwise.

I once served as administrator for a multisubspecialty orthopedic group. Its managing partner would frequently drop by my office, take me to lunch, or invite me for a drink. He made it easy to open up about what was going on. Away from the hypercritical attitudes of a couple other owners, I felt safe to be completely frank and open. He was able to take difficult issues to his peers—and we often had viable solutions to offer at the same time. We became an extraordinarily effective management team.

Teach Priorities

At critical times, tasks for you and your team can pile up rapidly—to the point where it’s no longer humanly possible to get everything done on time. Employees who don’t understand your (and your organization’s) priorities soon feel overwhelmed and hopeless.

Years ago—before electronic billing—I had to terminate an insurance-processing clerk from our multispecialty clinic’s billing staff. Her supervisor discovered a large stack of HCFA-1500s in her desk file drawer. The forms had been printed by our data processing department and delivered to her workstation over the course of many weeks. Her job was to check each one for accuracy, attach necessary documentation, and get the bills in the mail. She also had to detach the carbon copies and file them for follow-up.

Admittedly, hers was a high-volume job. We allocated billing work by payer, and her responsibilities included some of our major commercial insurers. She was very busy—and was never seen goofing off or wasting time while on the job. We only discovered her stash (which represented thousands of dollars in unbilled charges) after the accounts receivable (A/R) for her payers started to rise sharply. Thirty years ago, we felt lucky to keep “average days in A/R” below 45 or 60 days, so it took a while to detect the problem.

Even if they don’t admire or like you, your team members look to you for cues for their own responses.

In the end, the clerk lost her job for multiple reasons, but I’ve always felt bad about how we failed her. We trained her in the mechanics and responsibilities of her position, but we didn’t teach her how to manage the volume—how to recognize and sort out her priorities. Other clerks were handling even greater numbers of claims each day, but she became overwhelmed by it all.

Make Good Habits Reflexive

Throughout nature—including human nature—creatures under stress usually revert to instinct. Unguided, natural instincts focus on survival and self-preservation—priorities that can destroy a team and lead a project to disaster. A popular anecdote about the signing of the American Declaration of Independence has Benjamin Franklin commenting on the need for unity in defying the English throne: “We must, indeed, all hang together, or assuredly we shall all hang separately.”

Even if they don’t admire or like you, your team members look to you for cues for their own responses. Are you instilling confidence and focus, or fear and panic? Are you offering thoughtful planning and effective communication? Do your teammates understand what’s important?

Sometimes the secret of the best-run practice is YOU!

Reference

1. Williams B. Five Battle-Tested Strategies for Building a Team that Performs Under Pressure. SmartBlog on Leadership. September 25, 2015;

   https://medium.com/@bentropy/5-battle-tested-strategies-for-building-a-team-that-performs-under-pressure-c05dbb608c8d