In healthcare leadership we love our “evidence.” It started with evidence-based medicine (EBM) and morphed into all kinds of analytics for hospital performance. But what does the evidence say about leadership and management in healthcare? The numbers are actually scary…and suggest that we’re not doing half as well as we think we are. So this week’s blog is about the numbers.
Here are some surprising statistics about leadership and management in general, and some about healthcare in particular, that all leaders need to know.
One: Most people aren’t cut out for leadership and management.
Statistically, only 1 in 10 people have the talent to manage others. This is particularly relevant in healthcare as we often promote people based on clinical expertise/success rather than based on any real evidence of leadership skills.
So before you promote someone to the role of manager (or accept the role of manager)…be really sure they have what it takes to become an effective and leader and manager. There are many other great ways that good employees/physicians can contribute in healthcare…it doesn’t have to be as a leader.
Two: More than half of new managers will be unsuccessful in their new roles.
Depending on which study you believe, up to 60% of new managers underperform or fail within their first two years. That’s a lot. Not only is there a human impact, but there are also real financial costs to manager failure.
This means recruiters and senior leaders aren’t successfully identifying leadership talent and we’re not providing the right kind of training and coaching for new managers. It’s also worth some serious reflection about the effectiveness of onboarding programs for new managers.
If you’re a new manager – don’t become a statistic. Get the help you need to transition successfully into your new role. As a start, check out an earlier blog post on the one really big reason new managers fail.
The numbers don’t get much better with senior managers – where as high as 50% of executive transitions fail. In their book “Leading Organizations,” the authors report that 75% of executives feel unprepared for their new role. Once again, lack of effective onboarding is a big contributor. In my years in a variety of leadership positions in several different organizations, only once did I get any significant onboarding – and all of it was dedicated to tangible management responsibilities.
If you aren’t seeing these kinds of failure rates in your organization, you’re either doing a truly amazing job of recruiting and onboarding leaders (statistically unlikely), or ineffective leaders are quietly allowed to remain in their jobs and continue to underperform.
Three: Most leadership development programs fail to improve leadership effectiveness.
Almost all hospitals have leadership development programs, structured around the most common leadership and management skills needed by leaders. These programs, often delivered in partnership with a local university, don’t come cheaply. Unfortunately, research shows they don’t really work. They fail – not because they aren’t teaching the right skills – but because they ignore the importance of organizational context, they don’t build in reflection, they don’t address mind-set and they don’t track leadership performance improvement.
Participants are expected to self-assess, critically evaluating their own shortcomings. It’s a mistake to assume that because a manager has been enrolled in the leadership development program, they’ll do OK. Senior and middle managers have to set aside time personal coaching, specifically focussing on reflection and context-setting for new managers. New managers also need to ask for this support…and if you can’t get it from your boss, find a one or more peer mentors (or consider an external coach). See also the blog post on finding a mentor.
Four: Increasing manager span of control to save money is a mistake.
Good managers are worth every cent – despite all the challenges involved in recruiting, onboarding and coaching them. In healthcare, we’re very quick to combine manager portfolios in order to save money when the annual budget need trimming but this only waters down manager effectiveness.
On the other hand, we’re often reluctant to deal with under-performing managers, keeping them in their roles long after training and performance coaching has failed to lead to improvement. Both are mistakes.
Bad managers cost their organizations in all kinds of ways. Most employees (79%) quit their jobs because they feel undervalued…and it’s not about gifts and awards. The direct supervisor is the most critical factor here. Turnover costs healthcare organizations millions. The all-in cost of replacing a registered nurse is estimated at almost $100,000 and that doesn’t even consider the impact on morale, clinical outcomes and patient experience. Sick time is typically higher in departments with bad managers as well (see next item). Statistically, managers account for at least 70% of the variance in employee engagement.
Good managers make their organizations perform better. Studies have found that replacing a bad manager with a good manager correlated with a 12% increase in productivity. This is a pretty important number when we’re all striving to decrease operating costs in healthcare. Doubling up portfolios to save management costs just waters down leader effectiveness.
Span of control is about influence. Anyone who believes a single nurse manager can effectively influence, coach and lead 100 or more direct reports AND take care of the day-today management of a patient care unit is sadly mistaken.
Five: Good managers create more wellness than wellness plans do.
Healthcare organizations around the world are struggling to deal with record burnout levels in medicine, nursing and other clinical professions. Non-clinical employees aren’t very happy either. Many organizations are responding by implementing comprehensive wellness programs; some are even adding a Chief Wellness Officer. But as with leadership development programs, the data shows they can be ineffective and actually increase employee stress.
Research suggests that, while overall organizational culture matters, inspiring and supportive leaders are the biggest influencers of employee wellness – not wellness programs.
Six: Provider engagement trumps everything else
The past decade has seen a relentless pursuit of patient experience, productivity and better outcomes – often at the expense of employee engagement. While some organizations get it…adding an engaged and productive workforce to IHI’s Triple Aim approach, many haven’t figured it out. They hammer endlessly at eliminating waste, increasing productivity and improving patient experience without considering providers.
In healthcare, provider engagement drives everything. Better engagement leads to better clinical outcomes and mortality (especially with nurses). Better engagement improves productivity. Better engagement improves patient experience.
Healthcare is struggling with maintaining a qualified workforce…and with the aging of the general population it’s projected to get worse. The return on investment for engaging your workforce is pretty clear.
Seven: Performance metrics & ratings matter less than you think.
There’s surprisingly little evidence to support the long term value of using performance indicators to improve quality. Not only is there little research looking at the value or ROI of indicator use, but only 1 out of 21 quality measures reliably indicated a hospital’s patient safety profile. Some indicators turn out not to measure what we think they measure and performance improvements from pay-for-performance programs don’t last.
Rather than being a means to an end, hospital quality indicators seem to have become an end in themselves – especially now that hospital ratings affect reimbursement. Instead of working to maintain overall quality of care, for many organizations, the goal has become to get the numbers that will generate the best hospital ratings, the good report card, the required payments, the accreditation level or other stamp of approval. Overall quality is sometimes secondary.
Once again, organizations would be better off focusing on real manager/leader development programs and supporting managers in driving overall quality. High performing clinical managers have a big impact on patient experience. They also influence staff engagement, which in turn, affect clinical outcomes.
So, there you have it: 7 Surprising facts healthcare leaders need to know. Whether you are an experienced or developing leader I healthcare, hopefully these numbers will get you to take a second look at some of the common practices in healthcare leadership. Effective management and inspiring leadership are critical if we’re ever going to deal with the ongoing challenges in our healthcare systems around the world.
This article was written by Renate Ilse and published on the leadership blog at Ilse Zorn & Associates.