Clinicians, Volume I
Management Skills for
Clinicians, Volume I
Transitioning to Administration
Linda R. LaGanga
Editors
David Dilts
Larry Fredendall
Management Skills for Clinicians, Volume I: Transitioning to Administration
Copyright © Business Expert Press, LLC, 2019.
10 9 8 7 6 5 4 3 2 1
Keywords
management; supervisory; leadership; meetings; time management;
employee performance; employee coaching; healthcare administration
Contents
Preface...................................................................................................ix
Acknowledgments.................................................................................. xxi
Notes..................................................................................................151
References............................................................................................163
About the Author.................................................................................167
Index..................................................................................................169
Preface
funded, governor’s office initiative that helps health care providers deliver
whole-person care. According to Colorado Lieutenant Governor Donna
Lynne, “SIM providers must focus on the entire patient, which means
addressing mind, body and mental wellness. That complete approach to
health is what makes the SIM initiative so valuable. Patients get the care
they need when they need it, and providers learn how to succeed with new
payment models. It’s a great example of meaningful reform in our state.”3
To broaden my perspective outside the settings where I have worked,
I also spoke with nurses, MDs, and many professionals with experi-
ence in other health care systems and hospitals throughout the United
States. Some of them I met through professional associations and ap-
plied research activities on improving health care systems. Together,
many of us have collaborated in bringing effective management and
leadership practices from prior work settings, then adapting them to fit
new settings 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
chapter 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, sometimes referred to as “soft” and “people skills” or with the
ability to recognize and manage our emotions, as “emotional intelli-
gence.”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.
Preface xiii
Objective
We introduce new managers working in health care to the basic skills and
competencies to support them in transitioning to their managerial roles.
xiv Preface
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 manager-
ial, supervisory positions. The targeted reader has clinical training and
experience and little or no business management training and experience.
More experienced managers can benefit, too, from collected insights of
other managers who were interviewed and from examples in recent and
revisited literature.
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
succeed in these new situations. Insights and themes from interviews and
conversations with 64 health care managers and administrators are sum-
marized. We identify some special features of managing in health care and
the particular challenges in refocusing your clinical training to succeed as
a health care manager as we apply some of the lessons gleaned from inter-
views. Initial activities are proposed to help you get started in comprehend-
ing 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 capabilities
xvi Preface
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. For further information on these
and other topics related to work culture, employee strengths, and hiring,
please see Chapter 2 in Volume II.
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.
Preface xvii
Being a manager involves supervising and leading the team of people who
report to you, and communicating clearly what you expect them to do. 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 patient care to managing the
people and other resources involved in health care administration.
Health care is all about people, who deliver treatment and keep the
organization 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
Preface xix
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 organi-
zation 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.
Chapter Overview
This chapter introduces the unique challenges of new health care man-
agers, explains their importance, and provides practical guidance to help
you succeed in these new situations. Insights and themes from interviews
and conversations with 64 health care managers and administrators are
summarized. We identify some special features of managing in health care
and the particular challenges in refocusing your clinical training to suc-
ceed as a health 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.
People who work in health care really care about the people they help and
the work they do. Everyone I interviewed cares deeply about the people
and communities they serve and the teams of people they lead. Paul Bretz,
LCSW, DDiv, Executive Director of Centus Counseling, has a wide col-
lection of educational degrees, has earned professional certifications in
clinical practice, quality, and compliance, and has in-depth experience
in clinical, spiritual, administrative, and leadership roles. He expressed
this commitment vividly when he said, “In a meeting, every person who
talked about a client teared up. It doesn’t get much better than that!”1
When I asked Preston Simmons, MHA, DSc, FACHE, “What is spe-
cial about working in health care?” from his perspective as the administra-
tor of one of the largest health care organizations in the United States, he
explained that people working in health care want to make a difference;
clinicians have a passion for patient care and pay attention to good out-
comes. High integrity is particularly important.2
Indeed, the complicated operational levers that drive health care deliv-
ery can be very difficult to understand. Vonderembse and Dobrzykowski
(2016) explain managerial challenges that are specific to health care. For
example, supply and demand for health care services can be difficult to
balance because of insurance payment systems that insulate patients from
true costs of care and may lead to overutilization of services. Rapidly shift-
ing reimbursement models can be difficult to comprehend and imple-
ment, especially when technological infrastructure for information sharing
is still evolving. And, the total cost of health care is driven not only by
the number of units of care delivered, but also by the price of each claim
or unit of care, thereby causing increasing pressure to enhance efficiency,
reduce waste, and improve collaboration and resource management.4
In health care settings, you may find that as you rise to higher levels of
management, you spend more time dealing with people and organizations
outside of your own. Patients, clients, and their family members may seek
a manager, someone in charge—you! —when they are dissatisfied with
the care and treatment they received from a clinician. You are also likely
to deal with external administrative functions involved in the payment
for health care services, assurance of compliance with health and safety
rules and regulations, and patient privacy laws. You will be responsible for
ensuring that the work of your team or department conforms to standards
of clinical care, documentation, and billing, along with internal perform-
ance targets that are needed to keep the organization running well.
Interview Questions
I started with a structured form to elicit specific information from those I
interviewed about their backgrounds and experience as new and evolving
health care managers, along with their recommendations and advice for
others starting out as new health care managers. I asked:
1. When and where (in what organization) did you have your first ex-
perience as a manager?
2. What were you doing before this transition to manager?
3. Why did you want to be a manager?
4. Why do you think you were selected to become a manager?
5. How much were your initial expectations met about your new role?
6. What pleasant surprises and unexpected challenges did you find?
7. What do you think contributes to the success of a new manager?
8. What worked well for you in getting started in your new role?
9. What would you have done differently?
10. What helped you get started in your new position as a manager?
11. Was there particular training, support, mentoring, materials, or
other resources that you found helpful?
12. What else would have been helpful to you in getting started as a new
manager?
13. How did you fill the gaps or get these other things?
14. What advice do you have for other clinicians moving into manager
roles?
15. What other things would you like to share about your experience?
Expectations
Most of the clinically trained people mentioned the value and importance
of earning credentials, experience, and in many cases licensure that estab-
lished their credibility and responsibility. This willingness and ability to
step forward helped prepare these clinicians for greater responsibility and
facilitated their selection for promotion and expanded roles that became
available within their current workplaces or to transition to higher levels
of responsibility and leadership in new settings.
Several nurses talked about the value and importance of being cre-
dentialed as registered nurses and how it helped establish their leadership
8 MANAGEMENT SKILLS FOR CLINICIANS, VOLUME I
there was a gap. “Be that person leadership can count on,” she advises,
and “volunteer to do lots of different things to expand viewpoints and
perspectives, while continuing to be a high performer in your primary
responsibilities.”14
Constructive Engagement
Several said that although they did not see the transition to administra-
tion coming, they embraced it. Donald Penning, MD, of Denver Health,
sought education and training in management, and continues to pro-
actively handle culture change. It means getting truly involved with the
work and people, continuing to build clinical competence, and not focus-
ing on job titles. When Dr. Penning was at Denver Health as director of
anesthesia, he broadened his reach by assuming responsibility for all oper-
ating room functions, while conducting research and applying operations
research methodology to increase efficiency. He later moved to Henry
Ford Health System as vice chair of research, head of neuroanesthesia,
and professor of anesthesiology and neurosurgery.
When Dr. Penning invited me to visit and observe him and his Denver
Health team in action, I found it inspiring to see him actively leading his
staff in a daily check-in. His team members were busily engaged in work-
ing collaboratively on their team when they were recognized by their lead-
ers and their peers for the successful events of the previous day, followed
by constructive conversation with the team on what could be improved.
Dr. Penning attributes his success to a collaborative attitude and willing-
ness to “not just have the job but do the job,” which he learned in a man-
agement course he completed.15
A leader who has led in many different settings is licensed clinical psych-
ologist Jesús Sanchez, PhD, who has worked in medical rehabilitation,
community mental health, a state psychiatric hospital, private practice,
student health center, group consulting practice, and as a member of gov-
erning boards of directors. He has mastered a range of skills as a manager
and administrator. Like others I spoke with, his strong performance as
10 MANAGEMENT SKILLS FOR CLINICIANS, VOLUME I
a clinician and his abilities to organize and take responsibility for stra-
tegically important preparation for managed care implementation were
noticed by top management, and soon he was promoted into a program
manager role. “I didn’t know anything about management, but I knew
my job was to help my team do their job. Managers need to facilitate
the team doing its work more efficiently,” he explained, and added that
facilitating is not just telling people to do things; it involves building
relationships with other teams and organizations that foster productive
collaboration that helps people get the work done.16
Many people had assessed their strengths and those of their teams. Many
used formal assessment tools, and others learned to recognize what they
and their team members naturally gravitated toward doing. Mary Ellen
Benson, VP of Healthcare Transformation and Development at Aspen
Pointe, started as a physical therapist and advanced to leadership roles and
high levels of executive management through her abilities to work well with
people and get things done effectively. She shared good advice she received
from a CEO she reported to, “Be who you are and lead from within.”21
Mentoring
Be honest about what you do and do not know, and be open to learning
from other sources and people to get better at what you do. Do not be
afraid to ask questions and admit what you do not know. Build relation-
ships with people in other departments to support you in handling new
business areas where you do not have training or experience.
For most of us, our clinical education did not include topics on run-
ning the business side of a clinical practice with the need to understand
12 MANAGEMENT SKILLS FOR CLINICIANS, VOLUME I
“Get a mentor!” Mentors are typically wise people with more experi-
ence than you who are willing to help guide you in your development.
Sohnen-Moe (2016) explains that they often serve as trusted confidantes
to help you assess yourself honestly and figure out what you need to work
on to achieve your goals.37
Ideally, the person you report to (your boss) provides some of this mentor-
ing support and guidance to help you grow and develop in your role and
career. However, there are benefits of finding other mentors and people
who can help. One is for candid conversations in which you might want
to be more open to admit your shortcomings and weaknesses to someone
other than your boss, who is in a position to evaluate you to strongly influ-
ence your advancement and rewards. And, as Jeff Zayach, MS, pointed
out, it is helpful when you are new to have other people available to help
you so you do not have to take every question to your boss.38
Your peers in the organization are a valuable resource to help you learn
how things are done in your new role. This can cover your questions
about routine forms and typical activities. For example, you might need
to ask someone how to handle specific activities such as, “How do I
approve time sheets for the people who report to me?” “How do I enroll
in seminars offered by other departments?” as well as questions about
organizational norms and how things get done, such as, “If you have a
technical emergency and can’t reach anyone on the help desk, who do you
work with to get it fixed fast?” or, “Is it okay to approach the controller
to ask for approval of an unexpected large expenditure if I can’t find the
chief financial officer? In your experience, does our director want to be
involved in things like that?”
Craig Iverson, MA, offered a practical suggestion for working with
mentors or other guides, which might include a peer-level “buddy,”
another manager with whom you can talk things over and get feedback.
He recommends as a first step for new managers to sit down with someone
Introduction to Health Care Management 15
Key Points:
1. Managing in health care is complicated by funding and accountabil-
ity from multiple sources aside from patients themselves.
2. Health care managers are under increasing pressure to increase ef-
ficiency, reduce waste, and improve collaboration and resource
management.
3. Shift your perspective from individual patients to developing effec-
tive systems of care.
4. Step up and seek new challenges.
5. Get needed training and experience to earn credentials.
6. Be the person others can count on to get things done.
7. Get a mentor to help guide you.
8. Help your people do their jobs better.
9. Apply your skills and prior experience to help things work better.
10. Build relationships, internally and externally.
11. Know what is expected of you, and let others know what is expected
of them.
12. Collaboration between clinical and nonclinical staff is enhanced with
learning among people who have different training and disciplines.
competency in this area? How do you know how strong you are
in these areas—what feedback have you received or other evi-
dence do you have? What other sources of feedback will you get
as you advance as a manager in your current organization?
b. Which chapter do you have the least knowledge and experience
in? How does this topic relate to your current managerial job and
how do you anticipate that might change?
2. Consider examples of experience or recommendations from the in-
terviews described in this chapter.
a. What ideas would you consider adopting for your own manage-
ment development?
b. What resources could you use for more information (e.g., tar-
geted chapters of this book, people in your workplace or other
mentors, books, articles)?
3. What skills or experiences that you developed before your health
care management role will be valuable to you now? What oppor-
tunities do you see to apply them that will benefit your team and
organization?
4. From your experience working in other kinds of organizations and
your perspective as a customer of different kinds of businesses, what
have you found that is different in your health care organization and
the way it runs?
a. Consider things such as the reason the organization exists, how it
earns money to pay for its expenses, the skills and training of peo-
ple who work there, special risks and benefits of working there.
b. What do these different characteristics suggest that you need to learn
in order to succeed as a manager in your health care organization?
5. What relationships would you like to develop to support your team
and you in your role? How will you cultivate your contact and col-
laboration with these people and their teams or organizations?
6. Many of our interviewees mentioned the importance of having a
supportive and experienced mentor to give you advice and guidance
in your early journey into management.
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