CCHF - Leadership for Non-Managers

Who’s the Boss?Team Leadership for Non-

ManagersKyle Vath, BSN, RNClinical Coordinator

Crossroad Health Center

Saturday, May 10, 2014, 9am-10am

5 E. Liberty Street ∙ Cincinnati, Ohio 45202 ∙ www.crossroadhc.org ∙ 513-576-1017 ∙ kylev@crossrd.org

2 C r o s s r o a d H e a l t h C e n t e r

Team Leadership for Non-Managers

Topic:• The effectiveness of care teams often hinges heavily on the

leadership of that team. Providers, nurses, and others without formal management training often do not have the tools, training, or desire to lead their teams effectively. This session will offer take-aways for those “non-managers” that include tools and practical suggestions for leading their teams. It will also offer pragmatic advice to managers and administrators working in collaboration with team leaders and assist them in guiding team leaders.

Objectives:• Give examples of effective communication for Team Leaders• Discuss the difference between leadership and management• Provide practical leadership tips for Non-Managers• Provide practical tips for Managers working with Team Leaders• Discuss Team Leadership in light of the Patient-Centered

Medical Home model of care

Definitions:• TEAM LEADER: An individual who has the authority and

responsibility to lead a team, but whose primary function in not managerial (i.e. Provider, Lead MA, Staff Nurse).

• MANAGER: An individual who has the authority and responsibility to lead a group of people, and whose primary function is managerial (i.e. Clinical Coordinator, Head Nurse, DON, HR, Administration, etc.).

CASE STUDY #1:

Dr. Peter Panick, one of your family practice physicians, comes into your office and states, “We were out of Depo again this morning! [Now 3pm] It’s Heather’s job and she is never keeping enough of these on the order list! You need to talk to her! You just need to fire her if she can’t do her job! When are you going to get your MAs to do their job?”

*Note: Heather is the MA on Dr. Panick’s team.

Problems When The Team Leader Doesn’t Lead:• Issues are not handled promptly• Often the manager does not know all of the details or the

events surrounding the situation• The employee feels sabotaged/undermined• The event is often blown out of proportion• No ownership on the part of the team leader• Manager is “jump-started”• The team leader’s bad behavior is enabled• No relationship is formed• Morale on all sides is depressed

Leadership & Management:“On Becoming a Leader,” Warren Bennis• The manager administers; the leader innovates.• The manager is a copy; the leader is an original.• The manager maintains; the leader develops.• The manager focuses on systems and structure; the leader

focuses on people.• The manager relies on control; the leader inspires trust.• The manager has a short-range view; the leader has a long-

range perspective.• The manager asks how and when; the leader asks what and

Leadership & Management:“On Becoming a Leader,” Warren Bennis• The manager has his or her eye always on the bottom line; the

leader’s eye is on the horizon.• The manager imitates; the leader originates.• The manager accepts the status quo; the leader challenges it.• The manager is the classic good soldier; the leader is his or her

own person.• The manager does things right; the leader does the right thing.

Leadership & Management:

Often, team leaders do not have have time to manage. But if they aim to have an effective team they must make time to lead.

“Don’t “D.U.M.P.” problems…deliver them by S.T.O.R.K.!”

Don’t “D.U.M.P.” Problems …•D - Dodging Responsibility•U - Under-/Over Exaggerating Situation•M - Murmuring/Mumbling/Moaning•P - Passive-Aggressively Communicating

Deliver Messages Instead By “S.T.O.R.K.”•S - Summarize Simply•T - Talk about the Tension•O - Own the Interventions•R - Request Assistance•K - Keep following-up *Leave out any “letter” of the process, and you could be “dumping.”

CASE STUDY #1:

Dr. Peter Panick, one of your family practice physicians, comes into your office and states, “We were out of Depo again this morning! [Now 3pm] It’s Heather’s job and she is never keeping enough of these on the order list! You need to talk to her! You just need to fire her if she can’t do her job! When are you going to get your MAs to do their job?”

*Note: Heather is the MA on Dr. Panick’s team.

•S - Summarize Simply •T - Talk about the Tension •O - Own the Interventions •R - Request Assistance •K - Keep following-up

Deliver Messages Instead By “S.T.O.R.K.”•S - Summarize Simply • (“We are out of Depo injections.”)

•T - Talk about the Tension • (“We have two patients coming in 1 hour who have depos scheduled.”)

•O - Own the Interventions • (“I have had Heather call the West facility and they have 4 doses we can

borrow.”)•R - Request Assistance • (“I would like to have one of the other staff drive over to West and pick-up the

doses. Would you please find someone to do that?”)•K - Keep following-up • (“I will talk with Heather and let you know why we ran out of doses after I

investigate the problem. I will let you know if I need some help from you as her manager.”)

Deliver Messages Instead By “S.T.O.R.K.”

…or better yet…

“How could we have avoided this entire fiasco?”

CASE STUDY #2:Jenny Jumpstarter, one of your RN managers, storms into your office with her face all red and her voice elevated. “I cannot believe I got another call-off from another one of your Medical Assistants today again! I just can’t take this anymore! We aren’t going to have any staff today, patients are going to be complaining because the wait times are going to be horrible and our patient satisfaction surveys that you are pushing so hard for are going to be awful! How are we supposed to be a ‘Patient-Centered Medical Home’ (making quotation fingers) if you never get your staff to come to work! No wonder this place always gives me headaches!” Jenny then storms out of the room and slams the door.

The next day, Jenny calls off work stating that she had a bad migraine.

CASE STUDY #2:Jenny Jumpstarter, one of your RN managers, storms into your office with her face all red and her voice elevated. “I cannot believe I got another call-off from another one of your Medical Assistants today again! I just can’t take this anymore! We aren’t going to have any staff today, patients are going to be complaining because the wait times are going to be horrible and our patient satisfaction surveys that you are pushing so hard for are going to be awful! How are we supposed to be a ‘Patient-Centered Medical Home’ (making quotation fingers) if you never get your staff to come to work! No wonder this place always gives me headaches!” Jenny then storms out of the room and slams the door.

The next day, Jenny calls off work stating that she had a bad migraine.

Deliver Messages Instead By:•S - Summarize Simply •T - Talk about the Tension •O - Own the Interventions •R - Request Assistance •K - Keep following-up

Deliver Messages Instead By “S.T.O.R.K.”•S - Summarize Simply • (“We have had two call-offs.”)

•T - Talk about the Tension • (“This puts us below our minimum staffing level.”)

•O - Own the Interventions • (“I have called everyone on the list…”)

•R - Request Assistance • (“I would like authorization to give gift cards to anyone who picks up a shift.”)

•K - Keep following-up • (“I will let you know when I get the shifts covered.”)

The Seven Myths of Leading From The Middle of an Organization:1. The Position Myth: “I can’t lead if I am not at the top.”2. The Destination Myth: “When I get to the top, then I’ll learn to lead.”3. The Influence Myth: “If I were on top, then people would follow me.”4. The Inexperience Myth: “When I get to the top, I’ll be in control.”5. The Freedom Myth: “When I get to the top, I’ll no longer be limited.”6. The Potential Myth: “I can’t reach my potential if I’m not the top leader.”7. The All-or-Nothing Myth: “If I can’t get to the top, then I won’t lead.”

John C. Maxwell, The 360° Leader

Love Works: Seven Timeless Principles for Effective Leadership 1. Patient: Having self-control in difficult situations2. Kind: Show encouragement and enthusiasm3. Trusting: Show confidence in someone4. Unselfish: Think of yourself less5. Truthful: Define reality corporately and individually6. Forgiving: Release the grip of the grudge7. Dedicated: Stick to your values in all circumstances

Joel Manby, Love Works: Seven Timeless Principles for Effective Leadership

Adapted from John C. Maxwell’s, The 360° Leader, p. 45

Demands From

Customers

Expectations From Vendors

Demands From Leaders At the Top

Expectations From Followers

Non-Managers

Demands From

Customers

Expectations From Vendors

Demands From Leaders At the Top

Expectations From Followers

Non-Managers

Clinical

Responsibilities

Adapted from John C. Maxwell’s, The 360° Leader, p. 45

The Tension Challenge (it’s tough being a “non-manager”):1. Empowerment – How much authority and responsibility does the person

above you give you, and how clear are the lines?2. Initiative – How do you balance initiating and not overstepping your

boundaries?3. Environment – What is the leadership DNA of the organization and leader?4. Job Parameters – How well do you know your job and how to do it?5. Appreciation – Can you live without the credit?

John C. Maxwell, The 360° Leader, p. 26

PCMH: ELEMENT 1G - The Practice Team:1G1: Define roles (job descriptions, etc.)1G2: Regular team meetings and communication processes1G3: Using standing orders1G4: Training and assigning care teams to coordinate care1G5: Training and assigning care teams to teach self-management1G6: Training and assigning care teams to manage populations1G7: Training care teams in communication skills1G8: Involving care teams in QI

NCQA, Patient Centered Medical Home Standards

PCMH: ELEMENT 1G - The Practice Team:1G1: Define roles (job descriptions, etc.)• As team leader, clearly define expectations (individualized)• Huddle!• Build relationship• Help team members develop a niche• Create a daily vision for the day• Address discrepancies on the spot, at the time• “People buy into the leader, then the vision”*

*John C. Maxwell, The 21 Irrefutable Laws of Leadership

Team Leaders Managers

Readiness for Day Time and Attendance

Productivity Poor Productivity Leading To Overtime

Initial/Episodic Lacking Initiative Trend of Lacking Initiative

Initial/Episodic Poor Performance Trend of Poor PerformanceCoaching Discipline

Poor Customer Service Serious Customer Service Errors or Trends

Emergent Clinical Concerns Systems the Lead to the Clinical Concerns

PCMH: ELEMENT 1G - The Practice Team:1G2: Regular team meetings and communication processes• Communicate!• Huddle! (lead the huddle)

PCMH: ELEMENT 1G - The Practice Team:1G3: Using standing orders• Trust the people you work with or get a new team• Let go and delegate!

PCMH: ELEMENT 1G - The Practice Team:1G4: Training and assigning care teams to coordinate care1G5: Training and assigning care teams to teach self-management1G6: Training and assigning care teams to manage populations• Care teams have the relationships with the patients• “The most important thing about poverty medicine is

everything but medicine.”*• Repetition, repetition, repetition, repetition, repetition

NCQA, Patient Centered Medical Home Standards*Dr. David Hilfiker, Not All of Us Are Saints

PCMH: ELEMENT 1G - The Practice Team:1G7: Training care teams in communication skills

PCMH: ELEMENT 1G - The Practice Team:1G8: Involving care teams in QI• Build QI into every level of your culture• Orientation• Meetings• Skills Training• Signage• Tests

Benefits of Non-Managers Leading:• Often they are the experts/rank (positional leadership)

*John C. Maxwell, Developing the Leader Within You

John C. Maxwell, Developing the Leader Within You

Benefits of Non-Managers Leading:• Often they are the experts (positional leadership)• Often they will have the closest relationship with the staff

Benefits of Non-Managers Leading:• Often they are the experts (positional leadership)• Often they will have the closest relationship with the staff• Often the staff will see you in your area of expertise

Benefits of Non-Managers Leading:• Often they are the experts (positional leadership)• Often they will have the closest relationship with the staff• Often the staff will see you in your area of expertise• Non-Managers have the opportunity to teach

Benefits of Non-Managers Leading:• Often they are the experts (positional leadership)• Often they will have the closest relationship with the staff• Often the staff will see you in your area of expertise• Non-Managers have the opportunity to teach• Often the staff will see you at your very best• Proximity (time and space)

Challenges of Non-Managers Leading:• Often they are the experts (positional leadership)• Often they will have the closest relationship with the staff• Often the staff will see you in your area of expertise (which is

often not personnel management)• Often the staff will see you at your very worst• Perceived lack of time to “manage”• Motivation for leadership (or lack there of)• The challenge of wearing multiple “hats”

The Multi-Hat Challenge:1. Remember that the hat sets the context when interacting with others.2. Don’t use one hat to accomplish a task required for another hat.3. When you change hats, don’t change your personality.4. Don’t neglect any hat you are responsible to wear.5. Remain flexible.

Recommendations for Non-Managers Leading:• Do not rely on positional leadership• Form relationships with the staff• Share your knowledge and trust• Ask for forgiveness when the staff sees you at your very worst• Educate yourself on leadership• Address concerns immediately and decisively• Involve managers only when necessary• Provide continual feedback• Start the day off right

How To Relieve the Tension Challenge (how to succeed as a “non-manager”):1. Become Comfortable With the Middle2. Know What to “Own” and What to Let Go3. Find Quick Access to Answers When Caught in the Middle4. Never Violate Your Position or the Trust of the Leader5. Find a Way to Relieve Stress

Recommendations for Managers/Administration:• Deflect back to Non-Managers appropriately• Involve Non-Managers in Performance Evals/Raises/Hiring• Encourage Non-Managers to form relationships with the staff (provide

consistent staff)• Encourage Non-Managers to share knowledge and build trust• Educate Non-Managers on leadership• Encourage Non-Managers to address concerns immediately and decisively• Get involved only when necessary• Gather continual feedback• Encourage staff to start the day off right• Encourage them – they do not have time to manage, but they must make

time to lead

Recommendations for Managers/Administration:• Have Fun!

(Postprandial Hypoglycemia Prophylaxis)

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