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On May 6, 2017, JCJ commented on Managing a Manager :

I would be hesitant to go around the director and he will lose credibility with his staff and most likely not be able to recover. I agree with all of PeterM’s suggestions. In addition, it may also require the division leaders direct supervisor to review the plan of action and be involved in the meetings or brainstorm with the division leader on how to turn things around, suggesting the organizational meeting, etc. The division leader may be “stuck” for lack of a better word, and unable to navigate a turnaround with the division management team. Maybe hands on coaching, as opposed to mentoring, where the division leader can observe or get real time feedback from his direct supervisor will help make a breakthrough.

You may want to consider look at the positions that currently report into the Heads of department to expand their responsibilities and provide more leadership and expand their span of control and then do the same with the next layer down. This helps support the head of department with the larger scope of their position, but also prevents adding another layer, while providing career opportunities for those employees below them. Its hard to know for sure if this is possible without understanding the positions, but we have done this successfully and it really improved morale, productivity and our supported our succession planning initiatives.

On May 6, 2017, JCJ commented on Challenges with In-Patient Throughput :

We have talked about experimenting with a discharge lounge as well. I would love to hear more about how it worked.

On May 6, 2017, JCJ commented on Strategic Decision – Merge or Stay Independent :

From my past experience one of the things most overlooked is the cultural fit. Once the decision is made that from a business perspective the M&A is the right strategic direction, careful planning and analysis of the combination of the two cultures is often overlooked and can make or break the success of the M&A. Understanding the two cultures, the differences, the synergies, how duplicate positions will be addressed, addressing your employee fears of losing their jobs, etc. are critical. Brining people to the table sooner and involving all levels of management within departments work to determine the direction of the specific departments and service lines. As a smaller independent hospital joining a larger system, your employees may feel like they are losing there autonomy. It is also common that the larger hospital system believes since they are bigger they have more best practices and start to push change to their way of doing things. Creating a sense of security and stability is key for your employees, while at the same time helping them to understand the M&A will help your hospital grow and florish. It is a very delicate balance that is difficult to achieve. There are several articles in the Harvard Business Review that excellent on this topic.

We had the same issue several years ago. To address the concerns you state we built a Comprehensive Psychiatric Emergency Program in a separate building attached to our ER. Patients still come in through the ER, but are assessed and then directed to either the adult or child CPEP for a psychiatric evaluation. We have an entire floor for these group of people to stay while they are being evaluated. We also have added several programs to provide our patients support to help mobilize patients so they don’t have extended stays while waiting on state run psychiatric centers including Extended Observation unit, Mobile Crisis Outreach, Crisis Residency, and Home-Based Crisis intervention to help the throughput in the unit. It is important to note we are do have a behavioral health unit and this was built to help through put in the Er as well as support out In Patient Behavioral Health units. Maybe something on a smaller scale would work. Hopefully this helps!

On May 3, 2017, Julia Culkin - Jacobia commented on Team Development :

This is a very tough issue as each person is unique and comes to the table with a different perspective and background. You may want to start with a Myers-Briggs or DiSC assessment for the team. Although this may seem unimportant, it helps the team to get to know and understand the differences that may frustrate them about each other.

Once the team develops a basic understanding of each others styles and what they bring to the table, developing trust among the team is key. There are several books etc, on how to build trust, but in my experience asking the team individually and as a team what they think is needed to build trust is most effective. That way the own the responsibility of building trust instead of you trying to make it happen. Making sure you as the leader create a “safe” environment where the focus is on how to fix a mistake or problem going forward, as opposed to looking for blame is a key aspect to creating trust.

Once you begin to develop trust, hopefully team members will begin to take accountability, step up and want more responsibility, and hold each other accountable. This is a little bit of an oversimplification in this short response, but I hope it helps.