Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Clinicians, Volume II
Management Skills for
Clinicians, Volume II
Advancing Your Skills
Linda R. LaGanga
Editors
David Dilts
Larry Fredendall
Management Skills for Clinicians, Volume II: Advancing Your Skills
Copyright © Business Expert Press, LLC, 2019.
10 9 8 7 6 5 4 3 2 1
Keywords
management; hiring; business skills; budgeting; workplace culture; health
care administration; strengths assessment; conflict management
Contents
Preface...................................................................................................ix
Acknowledgments................................................................................xxiii
Notes..................................................................................................131
References............................................................................................137
About the Author.................................................................................143
Index..................................................................................................145
Preface
Help is our promise. Health is our passion. MHP provides immediate ac-
cess to expert mental health and substance use care so people can enjoy
healthy and fulfilling lives. Our vision is for Healthy minds. Healthy lives.
Healthy communities. We accomplish this through our core values:
practices from prior work settings, then adapting them to fit new set-
tings to enhance our work cultures and help our people develop. This is
reflected in many of the examples you will see in this book.
To help you in your development as a health care manager, chapters
are developed around the skill areas identified by this book’s editors and
author, from our experience in health care, as crucial to the success of
health care managers.
Successful health care leaders need a variety of skills to manage effect-
ively in the complex and challenging arena of health care, where risks and
rewards can have major impacts on the well-being and safety of our pa-
tients and care recipients. Such skills are described and illustrated with the
actual experiences shared by many health care management professionals,
along with recommendations from many management books and articles.
Learning activities and discussion questions are offered in each chap-
ter to help you assess your proficiency, apply new knowledge, and increase
your mastery of the material. Personal skills and abilities are included to
focus on how you relate to and communicate with other people, some-
times referred to as “soft” and “people skills” or with the ability to recog-
nize and manage our emotions, as “emotional intelligence.”4 While some
of the chapters focus on more “technical” or “nuts-and-bolts” skills such
as hiring and budgeting, integrated throughout the book are the softer
leadership skills that you need to successfully manage in these other areas.
Objective
We introduce new managers working in health care to the basic skills and
competencies to support them in transitioning to their managerial roles.
We guide readers in the activities they will handle initially and later as
they arise in organizational cycles, such as budgeting and hiring. We also
offer topics and examples that can help more experienced managers reas-
sess and revitalize their skills.
Target Audience
We target clinical staff who have been promoted recently into managerial,
supervisory positions. The targeted reader has clinical training and experience,
and little or no business management training and experience. More experi-
enced managers can benefit, too, from collected insights of other managers
who were interviewed and from examples in recent and revisited literature.
PREFACE
xv
Chapter Descriptions
Volume I: Making the Transition from Patient Care to Health
Care Administration
This chapter introduces the unique challenges of new health care managers,
explains their importance, and provides practical guidance to help you suc-
ceed in these new situations. Insights and themes from interviews and con-
versations with 64 health care managers and administrators are summarized.
We identify some special features of managing in health care and the par-
ticular challenges in refocusing your clinical training to succeed as a health
xvi PREFACE
care manager as we apply some of the lessons gleaned from interviews. Initial
activities are proposed to help you get started in comprehending the scope
and skills that health care managers need to learn and master.
You are in a new role now with supervisory responsibilities. This requires
you to transition from being a team member to the team’s leader. You
need to establish credibility and earn the respect of others for new capa-
bilities you are developing. You will need to treat others fairly and avoid
granting special treatment to those who have been your friends. Mentors
and peers can help you in your development so you do not have to figure
things out all by yourself.
We will show you how to communicate your expectations for behav-
ior and performance to help your people perform well. We also look at
what you need to do when things do not work out and improvement is
needed, or you need to fire people who report to you.
This chapter in Volume I focuses on how you get started in your new
role with responsibility for managing others. Soon, you will develop more
skills for creating a positive working culture, building a strengths-based
team, selecting and hiring new people. Further information on these and
other topics related to work culture, employee strengths, and hiring, are
found in Volume II, Chapter 2.
You will face new challenges and be expected to make decisions in your
role as a health care manager. Learning to lead with structure and apply-
ing some management tools can help you to take charge confidently as
you plan, organize, and get things done.
Being a manager involves supervising and leading the team of people who
report to you, and communicating clearly what you expect them to do.
xviii PREFACE
In Chapter 2, we looked at how you take charge and get started in that
part of your role, and continued in Chapter 3 with structured techniques
to help you plan and organize. Now, let us consider other important
people in your new world of management.
It is vitally important that you build a positive relationship with your
boss and ensure you are meeting your boss’s needs and expectations of
you. Those you work with as colleagues and peers also are important in
your work world. We explore ways for you to build and sustain important
relationships in multiple directions. You will gain wider perspective and
effectiveness as you practice managing up, down, and all around! These
are essential skills as you make the transition from providing direct pa-
tient care to managing the people and other resources involved in health
care administration.
awareness and skills for managing up, down, and all around the or-
ganization you work in.
Now it is time to enhance your relationships and work through some
more advanced skills. It is natural that the various people you work with
have different perspectives, so you can expect disagreements to arise. In
this chapter, we extend your skills and effectiveness in communicating,
giving and receiving feedback, and handling conflict. You will gain wider
perspective and more experience as you practice building relationships
and strengthening them all around you at work!
Health care is all about people, who deliver treatment and keep the or-
ganization running effectively to meet the needs of the people we serve,
our patients. In this chapter, we focus on these crucial human resources,
the people who do the work on the team you manage. We will look at
the value of creating a great place to work and the profile of a health care
organization that built a work culture where people can thrive.
Then, we examine the specific things you need to do to hire people
and get them started in their work on your team. We will look at how you
hire, engage, and retain these people to do their best work. We show you
the value of your Human Resources team and identify the things they can
help you with, and when you must consult with them to hire new people
and bring them onboard.
Chapter 3. Business Basics: Finance and Budgeting Are Not Just for
Accountants!
Why do you need to know budgeting and finance? This chapter will
answer this question by explaining some basic financial and budgeting
concepts, why they are important for every manager to know, and how
an effective manager uses these ideas. We will look at financial aspects of
your organization that you need to know about to manage effectively. We
start by reviewing why money is important to keep your organization
and team running. We will explain budgeting and examine an example
of a team budget to help you see what you need to track and manage. We
will look at some financial measures for your organization and help you
interpret them to understand the financial health of your organization.
Enhancing Your
Relationships at Work:
Managing Communication,
Feedback, and Conflict
Chapter Overview
Now it is time to enhance your relationships and work through some
more advanced skills. It is natural that the various people you work with
have different perspectives, so you can expect disagreements to arise. In
this chapter, we extend your skills and effectiveness in communicating,
giving and receiving feedback, and handling conflict. You will gain wider
perspective and more experience as you practice building relationships
and strengthening them all around you at work!
2 MANAGEMENT SKILLS FOR CLINICIANS, VOLUME II
Communication Guidelines
Take initiative for communicating with others. This helps you build
positive relationships, shows your loyalty to those you work with, dem-
onstrates your capabilities for managing proactively, and often leads to
better solutions and results.
Look for and start with the points of Agreement. If you completely agree
with where another person is going, say so and move on.
If you disagree with some of the points, then Agree and Build. Similar to
the “Yes, And” approach, you could say, “Absolutely. In addition, I no-
ticed that . . . ” to add the pieces that are important to you and missing
from his position.
Compare
Then, rather than suggesting the other person is wrong, you could suggest
where you differ by moving to Compare to describe how you see things
differently and “invite the other person to help you compare it with his
or her experience. Work together to explore and explain the differences.”
This approach can help you avoid turning differences into arguments that
interfere with healthy relationships and good results.4
Here are some illustrations of how this could work.
Example 1
Example 2
• Start with Agreement: “It sounds like our new on-site pharmacy is
convenient for our patients and they report they get quick refills
and good customer service.”
• Continue to Build: “And the nurses on my team tell me they aren’t
getting timely information when something changes.”
• Next, Compare: “Do you know how the pharmacists on your team
handle these changes and if they’ve had any problems communi-
cating with nurses?”
As you listen attentively, you can ask questions that help you under-
stand other people’s perspectives and priorities as you build alignment
with them. It goes a long way toward preventing some uncomfortable
conflict, and can be useful in working constructively with it when it in-
evitably emerges. We consider conflict more deeply in the final section of
this chapter.
This advice from Chris Radigan, LCSW, considers how our words can
set the tone for people’s reactions and acceptance of us and our plans.
It is important to remember that different people interpret words dif-
ferently, especially with e-mail and the interpreted tone of requests and
questions, which might differ from what you intended. Some things are
best communicated in person; it is helpful to explain changes, why they
are happening, and to ask for feedback. When Chris was a new manager,
this approach helped establish trust with his staff to enlist the buy-in and
support of his team members.5
Written Communications
understand clearly and appreciate the good work you are doing. Imagine
how helpful this can be for you if your boss’s boss hears of a problem and
asks your boss about it and your boss can confidently respond about the
constructive and proactive activities you are already planning and leading.
Communicate with your peers and others in the organization about changes
and activities that impact their work or lie within their areas of responsibil-
ity. Make sure you never make commitments to others or communicate
decisions that were someone else’s responsibility to make or approve!
Have you ever been in a situation where you found out something
was decided or happening, and you did not know anything about it, even
though it was something you had the authority to approve, veto, or re-
shape? Imagine how you would feel in your personal or family life if you
were told you were going to be cooking dinner for your large extended
family, whose members have a long list of dietary requirements and par-
ticipants, you would never have agreed to do it, and perhaps you do not
get along with that branch of the family!
Or someone in your household or neighborhood informed you that
you would be picking up all the local soccer team members after their
practice, on the same afternoon you had committed to facilitating a train-
ing session for an organization you lead. Or what about those friends of
yours, back in high school, who you discovered were planning a party at
your house the weekend your parents were going away? It is lucky that
you found out about it and curtailed that one before having to explain
to your parents why there was something different about the house when
they returned!
Things like this happen at work, too. Maybe someone who reports to
you executes a plan that should have had your support or approval but
they failed to include you in the planning and communications. Suppose
that plan or decision interferes with other activities in the organization,
alienated your colleagues, and required you to intervene to fix the dam-
age. Did that make you want to support the activity or decision that was
dropped onto you, or the person who instigated the situation? Do not be
that person to your boss or others!
6 MANAGEMENT SKILLS FOR CLINICIANS, VOLUME II
Situations like these often happen when people assume that others
support their plans, but they do not take the time to check or have direct
conversations with those who need to be involved. Being intentional in
our communications cultivates more productive flows of information and
mutually supportive relationships.
Healthy Communication
I know there are people reading your remarks and getting huffy
about “company politics.” One of the dumbest things I hear smart
people say is, “I do good work, and that should be enough—I re-
fuse to play politics.” Corporate politics is merely the art of getting
things done by communicating with people in the most effective
way, and that means using language that they understand and re-
spond to. If you declare yourself to be “above office politics,” then
you have declared you don’t really care about being effective and
don’t deserve to be promoted.6
were visible and responsibilities for reporting and delivering could be as-
signed and communicated to the right people. Now we had the tools,
and even the analytical team members available, to handle this efficiently,
which alleviated a reporting burden from the clinical managers who had
been scrambling to work these administrative reporting tasks into their
other responsibilities. We coordinated the right resources to establish a
predictable schedule for when the reports were due and expected by our
external contacts at the county.
My analytical team members knew ahead of time what they were re-
sponsible for and could manage their work schedules and due dates. They
began to communicate actively with external report recipients to clarify
expectations and negotiate what they could deliver if there were special re-
quests for customized reports. By planning, organizing, and communicat-
ing across teams and departments, we built more effective workflows and
more satisfying and productive relationships with our internal colleagues
and our external customers.
It is important that you offer positive feedback to the people who work
with you. This helps you build positive relationships by showing others
that you notice and appreciate their contributions and what they do well.
This demonstrates your goodwill toward them and establishes mutual
support and alliance. It is especially important that you provide positive
feedback to the people who report to you because it reinforces to them
ENHANCING YOUR RELATIONSHIPS AT WORK 11
that they are on the right path in doing what you want them to do. This
enhances their performance by making it likely that they will continue to
do the right things to achieve the goals you desire.
Motivation author Barbara Fielder (1996) suggests using a systematic
approach to track and ensure that you are giving positive feedback regularly
by putting 10 coins in a pocket to remind you to give someone positive
feedback, praise, or recognition. Each time you do it, move one coin to the
other pocket.10 I heard of a manager who was told he did not give enough
recognition to those who reported to him. He established a daily goal to
get all 10 coins moved to the other pocket by the end of the day. People
noticed a difference and felt more motivated in their work with him.
A colleague of mine, Bill Milnor at the Mental Health Center of
Denver, was intentional in developing the habit of noticing what others
were doing well and deliberately praising them. This earned him the
reputation of being a supportive mentor to many emerging leaders who
developed their skills and grew their managerial effectiveness through
his feedback and guidance. This illustrates Ken Blanchard’s and Spencer
Johnson’s recommendation for you to catch people “doing something
right” and offer immediate and specific praise and encouragement,
along with your positive feelings about their progress and contribu-
tions to the organization.11 Regardless of your method, the key point is
to notice the positive things people do and express appreciation. This
strengthens the performance of others along with your relationships
with them.
A good way to set the stage for giving and receiving feedback is to apply
Harley’s (2013) recommendation that you ask permission at the start of
your working relationships. Ask people to be honest, encourage them to
tell you if they notice something you need to change or improve, and ask
for their permission for you to tell them if you see something getting in
the way of their success. Do not assume you are doing a good job because
no one has told you that you are not. You need to take control, verify
others’ perceptions, and let them know that you welcome their feedback.
This is crucial to your success.12 Her approach is effective with your boss,
12 MANAGEMENT SKILLS FOR CLINICIANS, VOLUME II
peers, and those who report to you. Because of your positional power
as their manager, the people you supervise may be reluctant to tell you
the truth, but understanding their perceptions helps you know what you
should adjust or continue doing to be as effective as possible.
I noticed that my colleague, Vicki Rodgers at Mental Health Partners,
was straightforward and effective in using this approach. She explained
that she had learned to do this in earlier settings and had talked with
someone she had reported to about how to ask for feedback. She was
comfortable asking people she worked with, “If you’re ever uncomfort-
able with me or something I’m doing, feel welcome to call me on it.” This
allowed permission for someone who reported to her to tell her directly
when they were in supervision that the person felt that Vicki, her super-
visor, was distracted by other things, “I need your undivided attention.”
This prompted Vicki to refocus her attention on her supervisee, which
improved their interaction at that moment and in the future.13
“The physics are clear: close down and get worse. Or, open up and get bet-
ter.” According to Henry Cloud (2013), leaders are hungry for feedback.
Getting feedback means opening up to take in new information, beyond
your own perspective, about your performance and its effectiveness, along
with suggestions for improving it. He advises that you look outside of
yourself and even go outside your organization, as many of the managers
interviewed for this book did to learn from others with different experi-
ence and other points of view. This can help you open up and be honest
about your difficulties and vulnerabilities with independent and unbi-
ased external colleagues with whom you can be mutually supportive in
encouraging each other’s growth and development. Cloud recommends,
“Get coaching, join a leadership group or forum, avail yourself of con-
tinuing education, attend a leadership conference, and so forth.”14
A simple and effective framework for getting feedback about your perfor-
mance is the “Start, Stop, and Continue” approach. It can be posed as a
ENHANCING YOUR RELATIONSHIPS AT WORK 13
question to others as, “From what you experience in working with me,
what should I start, stop, and continue to do?”
I was reminded a few weeks ago that it also can be used to reinforce
learning and assess progress of yourself or others in working toward goals.
Jean Rosmarin, PhD, my co-facilitator for a Mental Health First Aid
training class we conducted for our county sheriff’s department, asked
participants at the end of the class, “From what we covered today in class,
what will you start, stop, or continue to do to practice good self-care?”
This helped participants consider what they had learned and express an
intention to practice it, and it provided feedback to us as facilitators about
what they took away from the training experience. It helped us gauge how
effectively we had covered some of the topics, and helped us understand
some differing perspectives among our audience.
Embracing Conflict
People really enjoy working with Fred Michel, MD, a former teammate
of mine, who recommends that we engage in conflict rather than avoid
it. He suggests some approaches he uses successfully, such as a cue to ease
into it without offense. For example, in team meetings, we recognized his
opening of, “Now, hear this with love . . . ” and accepted willingly what
followed because we trusted his integrity as he respectfully offered his op-
posing views or criticism of how things were working.
In working with others such as the medical team members Dr. Michel
manages, he sometimes starts with, “Good, bad, right, or wrong . . . ” to
set the stage for the clear direction about “this is what we need to do.”
He suggests aligning with others by starting with an apology to recog-
nize something difficult or uncomfortable in their world before making
a request. For example, consider starting with, “I’m sorry the weather is
so cold when you had to come out here today for our team meeting.”20
This could be the preface for a request such as, “Now I need to ask for
everyone’s cooperation in making sure our documentation is solid for the
coming Medicare audit.”
How might you apply these suggestions in working through conflict situ-
ations or challenging requests you need to communicate? You could adapt
16 MANAGEMENT SKILLS FOR CLINICIANS, VOLUME II
the cues to wording that is more natural for you. Here are a few examples
for illustration:
If the other person wants to know more about why you want to talk,
you might offer a brief, objective explanation, such as, “I want to make
sure we’re in alignment on who’s handling which parts of the discharge
process so we’re communicating clearly with the family and prevent con-
fusion.” This opens the door to a nonjudgmental conversation that il-
luminates the activities that are occurring and who is handling them,
which can lead to constructive and collaborative consideration of how
things are working and what might be adjusted.
With an approach like this, it is less likely the person will refuse to talk
with you than if you had approached him more confrontationally, but if
he does refuse, then Murphy recommends you respond with a question,
such as “May I ask why?” to get more information about his perceptions.
As Stone, Patton, and Heen (1999) point out, feelings matter, and they
are often at the heart of difficult conversations. Unexpressed feelings
make it difficult to listen to others, and take a toll on our self-esteem
and relationships. People may dismiss their feelings as unimportant or
unjustified, but your feelings are as important as the other person’s.22 As
many experienced managers have shared, when they delayed talking to
people about their concerns, they prolonged stress and discomfort in the
relationships that they could have avoided by speaking up sooner.
For example, a manager admitted that he delayed talking to someone
who reported to him because he felt uncomfortable after she had over-
stepped her bounds by communicating to others a decision she made on
his behalf without talking to him about it ahead of time. The manager
had mixed feelings about the decision itself, and thought it might actually
help the team function better, but he felt unpleasantly surprised and that
his decision-making authority had been usurped. He avoided talking to
the employee until several months later when he was annoyed with her
about a different situation. When he finally blurted out his dissatisfaction
about the earlier situation, she was astounded, and declared, “Why didn’t
you just tell me? I don’t want my boss to be mad at me for all this time!”
Why do we avoid these conversations? It may be a fear of offending
or alienating the person, or opening up issues that you would rather
avoid, such as your own inexperience or discomfort being in charge.
18 MANAGEMENT SKILLS FOR CLINICIANS, VOLUME II
confrontations later, when they have assumed that you approved of their
behavior or performance because you never told them otherwise!
You could initiate these discussions by calmly stating the facts along with
what you noticed, and asking for the other person’s feedback. Mark M urphy
(2017) recommends a truth-based approach based on the facts of the situ-
ation.27 Let’s apply this approach to our example of the manager whose
employee had communicated a decision without clearing it with him.
Jane, I heard from several team members that you sent a memo
announcing that I had decided that everyone could manage their
own schedules and plan time off without prior approval from me
as long as they found coverage for time when they planned to be
away. I’m concerned because I was not aware that you were plan-
ning to announce a change, which I’m responsible for approving,
about the way our team operates. Now several team members are
confused and have asked for time in our team meeting agenda to
clarify the procedure.
These are the facts as the manager, Sam, is aware of them. Then he
opens up the discussion by asking for the employee’s feedback.
“Could we talk about what happened and how we could work to-
gether to plan and communicate effectively?” It is possible that the em-
ployee believes there are other relevant facts and perspectives to consider.
For example,
Sam, you said you spend too much time approving schedule
changes. And you said you could use my help in finding ways to
run things more efficiently. Other teams I’ve worked with operate
this way and everyone likes it. I wasn’t trying to question your au-
thority, I was trying to use my experience to help you and the team.
Stone, Patton, and Heen (1999) recommend that you distinguish blame
from contribution. Blame is about judging, and looks backwards, in
20 MANAGEMENT SKILLS FOR CLINICIANS, VOLUME II
Sam demonstrated openness and respect for Jane and her perspective
when he opened the conversation for her feedback. The dialogue al-
lowed Jane to contribute her ideas, build more trust with Sam, and
increase Sam’s comfort in delegating more responsibilities to her and
other team members. This demonstrates that with openness to address-
ing conflict constructively, Sam and Jane each could benefit from the
advice and encouragement found in Harley (2013) about “how to say
anything to anyone,”29 especially when a team member needs to clear
the air with a boss!
Remember, conflicts can and do occur up, down, and all around. The
next time, it could be your boss who neglects to include you in needed
ENHANCING YOUR RELATIONSHIPS AT WORK 21
Key Points:
1. In communicating, listen and seek to understand others. Consider
your words and choose them to build alignment.
2. Be mindful of your words and tone in your spoken and written com-
munications. Be clear and direct to ensure others understand accur-
ately what you intend to communicate.
3. When you are involved in change, consider who else needs to know
and include needed people early in planning activities and decisions.
Use a checklist for who else needs to know and be alert to avoid leav-
ing anyone out.
4. Sharing information and pooling resources among different parts
of the organization can break down silos to foster cooperation that
helps get things done more easily.
5. Positive feedback is important for showing appreciation and reinforc-
ing positive actions that you want your team members to continue.
6. Ask for permission to give feedback to others and ask them to tell
you if you need to change or improve something.
7. To gain precise, targeted feedback, ask others what they suggest you
start, stop, and continue to do.
8. Conflict is inherent in the workplace because of the varying perspec-
tives of different people. Learn to embrace conflict and manage it in
healthy ways.
9. Understand your own boundaries that you need others to respect.
Recognize when others violate them, and respond promptly and ap-
propriately to others whether they are up, down, or beside you in the
organizational hierarchy.
24 MANAGEMENT SKILLS FOR CLINICIANS, VOLUME II
10. Be clear, prompt, and direct in handling conflict so that issues get
resolved and relationships thrive.
11. Use conversation, not confrontation, to initiate constructive resolu-
tion of disagreements.
12. Recognize and respect the differences in positional power and au-
thority of people in roles at various levels in relation to yours.
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