Submitted by Lucy Bonanno, RRT MA MBA CAE CHE
Chief Executive Officer, Geraldton District Hospital

It is clear the healthcare sector is changing and fast. Managers are under more stress today than ever before. They are held accountable and must deliver in many facets. Not only is the expectation to deliver excellence in care to the patient base they oversee (this actually should be the primary), but they must do so while meeting all standards, reporting on many different types of stats monthly, and participating in the organizations strategic plan and goals.  Quality, safety, staff and patient satisfaction indicators should all be part of our healthcare system with each individual facility keeping track of what they are meeting and where they are lacking.

In the past, there were departments or staff specifically assigned to some of these performance indicators…years back managers had departments that helped with overseeing safety.  Now, more and more seems to fall onto the managers’ plate.  Infection rates are now looked at by department, along with regular patient satisfaction scores, and let’s not forget wait times and Accreditation Canada.

These contribute to the makings of a manager under a lot of stress, and it may begin to show by one demanding unrealistic outcomes or placing high pressure on staff to take on more during their shifts and overall, may lead to management exerting dominance over those that report to them in order to feel a sense of having everything under control; stressed managers are alienating their staff in doing so.

Managers and Stress

Healthcare is an ever-changing sphere of indicators and goals to be met. What can be done better? Everything is now measured, dissected and reported on.   We have a plan for everything!  There are now courses on how to get along with physicians and angry family members.  Fundraising is now the norm. Strategic plans and goals remain front and centre, along with yearly quality improvement plans.

With less staff and more measuring to do, you can see that more will fall to the managers to complete and oversee. This all has an effect on them. When these positions are placed under a microscope (as we tend to do with managers and their portfolios), the manager may try to regain a sense of control by exerting dominance or control over their teams.

There is a high cost to treating people poorly; it comes out in many facets. The main one is people leaving the organization or department for another. A study done by the Human Resources Professionals Association (HRPA) showed that over 50% of the respondents stated they leave their boss, not the organization, meaning the majority of people that leave their jobs leave it due to not getting along with their manager or whomever they report to, not because they don’t like the organization or the work.

So, treating people poorly has a high cost.  A manager’s aggressive behavior, be it in comments, tone (i.e. shouting), or in body language and facial expressions, may trigger a person on the receiving end to feel threatened. That threat response will hurt that person’s ability to think clearly; they may struggle to remember things, perhaps they won’t be as creative due to fear of reprisal, they may not problem-solve due to fear of not doing so correctly, or perhaps they won’t take in new information properly. They may also stay quiet during conversations when the manager is asking for feedback, due to fear of being attacked in front of others or made to look foolish.

Clearly, when an organization has these types of managers and fails to recognize it, they will ultimately begin to question why they have a poor culture permeating the organization and such a high staff turnover, leading to recruitment and retention concerns. This isn’t meant to be a hit on managers; I’m simply stating that pressure can change ones personality. However, there are some steps to take to begin to turn things around:

Listen with curiosity – stop interrupting when people speak and really listen to what they are saying. Try to look at things from that person’s perspective and not your own. Listen to the feedback being given with an eye of wanting to improve, not as a criticism of something that you are failing at.

Start small – overachievers try to take on too much and as a result pass that load on to their teams. This approach is like running a marathon with no training. Manage the top 3 or 4 goals on your priority list first. Then as the team completes those, move on to others.

Calibrate your responses when asked – when staff is asking questions, don’t make faces and huff and puff as you respond. Take a breath.  Respond clearly and calmly, always trying to understand why they are asking.  It may be as simple as needing to improve on communications when giving out orders.

Set expectations – be up front about what you need from your team. Be transparent. If you will be asking them to do something that you know they won’t like, call a meeting and be open about it but be clear about your expectations.  Ask them to come to you should they face any obstacles. When they do, do not be punitive, but thank them for being honest, and together, try and solve it.

Be aware of what day it is – some managers have a habit of emailing a huge amount of emails to staff on weekends or Sunday night, when they’ve had time to think about work in a calm setting. Make your emails short and realistic as to work expectations for the next day. Prioritize the multiple requests. And again, listen to them if they come to you and say they couldn’t complete something. Don’t assume you know everything.

Feedback – if you’d like to know how some of your new team members are performing, ask some of their teammates.  However, remember that not everyone is truthful, and always make your final decision based on how you have found them to be as a worker and on completing tasks. Another’s feedback is fine but remember it’s one person’s opinion. Don’t lay your hat on just the feedback of others; come to your own conclusions as well. Gather many perspectives together and decipher what is real and what isn’t. Again, don’t only rely solely on others to inform your opinion about someone…make your own conclusion

“When I look back on all these worries, I remember the story of the old man who said on his deathbed that he had had a lot of trouble in his life, most of which had never happened.”

Winston Churchill

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