Why is there such a Problem?
There are a myriad of reasons as to why Good Bosses in Medicine might be a rarity. Let’s look at a few of these:
Good Management is a Problem in Most Industries
As we have highlighted already bad management is actually a universal issue. Talk to anyone who has worked in a range of positions in different industries and most people can relate to tales of incompetent, inefficient and often sadistic management.
So what is the base rate of managerial incompetence? In an informal internet survey, 245 employed adults were asked: (1) how many bosses have you worked for? And (2) how many of those bosses would you be willing to work for again? Respondents were only willing to work for 34% of their former bosses. These results parallel those reported by Shipper and Wilson (1992) using actual organizational data, which suggests that successful managers are able to be identified by a set of definable behaviours.
The economic literature also shows that there are principles of good management that enhance organizational performance, and some managers know of and use these principles while many others do not. Companies and organizations that have managers that use these principles make more money or are more successful.
Shipper, F., & Wilson, C., (1992). The Impact of Managerial Behaviors on Group Performance, Stress and Commitment. In K. Clark & D. Campbell (Eds.), Impact of Leadership (pp. 119-129). Greensboro, N.C.: Center for Creative Leadership.
We Are Generally Very Bad at Appraising Ourselves
Most of us have all had the experience of sitting an examination and thinking that we performed poorly or very well to later find out that our own appraisal was far off the mark.
As humans, we are very likely to be blinded to our weaknesses and likely to embellish our strengths.
I remember talking to an experienced Nurse Manager once about the benefits of having a structured written tool to assist here when regularly meeting with her staff. The questions included prompts to ask whether staff needed anything from her as a Manager and to get feedback on her style. I was told quite bluntly by the Nurse Manager that she already asked all the questions on the form regularly of her staff and they knew that they could always bring up issues with her.
When I talked to the staff about the same tool and concept. Staff members gave a very different perspective on the Nurse Manager’s people management approach.
We are particularly unlikely to receive feedback on how effectively we deal with those who work for us or underneath us in the hierarchy. We are probably also unlikely to receive feedback from our own bosses unless we ask for it specifically and even then its likely to be sugar coated.
The consequence of this is the normal state of affairs is similar to the example fo the Nurse Manager above. Most Medical Bosses probably feel that they effectively and fairly deal with the issues of their medical trainees. But this opinion is being held with no evidence to support it with the likelihood that there may be big areas for improvement.
We touch more on how you can get feedback on your performance as a People Manager in Section 4: Becoming A Better Boss
Health has a General Problem with Management
We have also highlighted also that Management is a problem in Health. If this was not the case there would not be a plethora of companies offering Management Consultancy services specifically targetted at health.
But it gets worse. A report into the state of affairs of Management practice in NSW Health published in the 2000s identified that people management above all other management skills, such as finance & planning fared the worse. This is a real problem as people are at the heart of healthcare services.
Not everyone who has a management role in health is called a Manager (or Director or Lead etc…) If we look at those who do have a formal Management title the vast majority have risen from a clinical background often with little preparation or formal training for management beforehand. They have generally risen to the role due to experience and good performance as a clinician.
This phenomenon is referred to the “Peter Principle” in Management Theory. Employees are promoted based on their current performance rather than their ability to perform the new role. The result is that organizations stagnate as people rise to their level of incompetence and things only happen because there are still employees on the rise.
Having a clinical background as a Manager also brings advantages. You need to know the business to know what is needed from a management perspective but sadly this advantage is not leveraged by offering clinicians early training in management practice prior to being given a substantive management role.
Doctor Training is focused on Clinical and Professional Skills
Despite the advent of more rounded Capability Frameworks in Medicine such as CanMEDS undergraduate and postgraduate programs remain very much focussed on clinical knowledge, clinical skills and to varying extent professionalism.
Some of these skills can generalise to leadership and management but it barely touches the side.
College programs in Australia and New Zealand tend to introduce Leadership tasks in the final stages of their training program. Undergraduate curriculum seldom spend much time on this.
The emphasis is, therefore, teaching us as doctors to be good individual clinicians first and professional in our approach by focusing on one on one engagements with patients and colleagues.
We are not given the skills and knowledge to understand how teams form and perform in Medicine, how to manage change projects, how to deal with disengaged staff etc… etc…
Yet I would argue that many of these issues are the real challenges that Medical Bosses face and struggle with.
Leadership is not the same as Management
In the latest version of CanMEDS the Manager role was changed to the Leader role.
This presents a problem as Leadership and Management do overlap to an extent but they are not the same. Good Leaders in Medicine still make Difficult Bosses because they may be attuned to the needs of their trainees but they lack the appropriate Management skills to help them.
Doctors are generally happier to assume the mantle of Leader than Manager and in doing so may fall prone to assuming that this prepares them for being a Better Boss to medical trainees when it probably does not.
C/- of the Royal College of Physicians and Surgeons of Canada
We Often Fail to Transfer Similar Skills
Many Medical Bosses are good Supervisors and even spend some time professionally developing as a supervisor. Many successful Medical Bosses are good Networkers and can use their network to get things done for others. Many are good mentors. Many are good listeners. Many are good problem solvers.
These skills are all transferable skills that can be used to become a Better Boss. It’s just that we often fail to think about them in such a way or are unsure if its okay to use them out of context.
The addition of a Management Coach can help to highlight some of these strengths for a Medical Boss and enable them to transfer them over successfully. We will touch on this again in the Section on Becoming a Better Boss.