Managing a Manager

Managing an Underperforming Division

We have been able to develop and execute a strategy of growth that has led to an overall increase in patient clinic volumes, surgical procedures, and referrals. The usual problems associated with enhancement of the call center, maintaining patient satisfaction, and appointment templates are increasingly complex but manageable. One problem we did not anticipate resides in one of our key divisions, which has languished (no growth) with physician productivity at or below the 25th percentile (as measured by RVU (relative value unit)) generation compared to nationwide peers.  The members of the division are highly competent in their fields, excellent and dedicated teachers of residents and fellows, and collegial.

Our executive/leadership structure includes the division director of the team that has lagged. A variety of suggestions have been proposed at this level of the organization that might enhance the visibility of the unit within and external to the medical center, but the division leader has not developed an action plan for his portion of the organization.

Our department is transparent about its operations and members of the division are aware of the productivity data, and understand the need for improvement. However, the division leader is clearly not providing the leadership required to advance his division.

Thus far, we have allowed the division director leeway in advancing his division. What would be the best plan of action for more senior leadership? We have considered organizing a meeting of all members of the division to brainstorm solutions, but are somewhat reluctant to undermine the division director. Mentoring by direct supervisors and immediate has not been effective. Should we ask for assistance from others in the institution? Your comments would be appreciated.


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Participant comments on Managing a Manager

  1. Has your leadership met with the director in question and given him/her a clear goal, and direct ownership, of improving physician productivity within his division to whatever the desired number is? Even though it may be obvious to others, it sounds like this director may not be aware that his department is languishing compared to the expectations of others. We have some within our group that are perfectly happy with the 25th percentile, they have their own justifications for why that is an acceptable number, we don’t see as many patients, but we do more research, or we have better patient satisfaction scores, or we didn’t go into this to make the hospital more money etc.

  2. I would agree that this sounds like an issue of accountability of the division director to the department leader to deliver on clearly defined goals, deliverables and timelines which are mutually agreed upon by both the department leader and division director. Having these in writing at the time of a face-to-face meeting of both individuals may help to ensure understanding and eliminate misinterpretation. Perhaps this has already been done. Follow up meetings at key milestones or time periods to assess progress would be needed e.g. monthly or quarterly, and would also identify that appropriate supports are in place and barriers addressed to permit success. These would also be coaching opportunities. If progress is still sub-optimal, then the department leader will need to assess what the underlying issues are – key competencies missing, lack of commitment, internal issues in the division that haven’t been addressed etc. which may lead to a different conversation with the division director and appropriate interventions by the department leader to bring about the desired strong leadership and outcomes.

  3. If you have clearly given ths division director KPI’s on paper he/she is not meeting, I would recommend to rapidly change leadership and with that change create a sense of urgency within the department

  4. 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.

  5. “””the division leader is clearly not providing the leadership required to advance his division”””
    I think this quoted statement needs further analysis; is he resistant or is it the lack of ability to lead and achieve, is it personality, does he listen to his colleagues, is he aware he is behind etc
    I believe the right diagnosis is needed for the remedy to work.

  6. I see the division director as part of the team? So if you are thinking about teaming up / organising a brainstormsession, the division leader is part of the team and has to be there? it has to become a joined responsibility and I think it is too easy to blame it on the division leader alone. Most of the times this issue is also about the team not taking responsibility in realizing needed targets, not being open to eachother, not knowing targets, not caring, etcetcetc. So even if you change leadership, then still it is at least a very good point to talk with the total team why they as a team don’t realize that they underperform and/or are not ably to take the lead to transform to success. And as a team they have to come up with targetbased improvement efforts in joined responsibility. And then one of the issues is the division leadership. If it is clear that he/she is underperforming and allready a lot of improvement effort has been put in, than you have to make the decision that this is not the right person in the right place? But in my opinion: the problem is broader then only the formal leadership.

  7. I agree with a lot of the comments. The division director needs to be given a clear set of goals and expectations. Additionally, at that level most organizations would also expect this leader to take on initiative and set goals and expectations for his/her division to thrive. Assuming that at this point, leadership has had conversations with the director, then one needs to consider the root cause of why this person is struggling. Is it lack of skill? Lack of interest and accountability? Is the culture fostering his ability to under perform and in some way undermining the potential for someone to step in and lead successfully? I would not recommend going around him but making sure that the problem is faced head on. Have an honest conversation with the individual around expectations. Set clear goals and explore what barriers may pose challenges to the director’s success so that you can work together to remove them. If those barriers are actually imposed by the director, then that can be a conversation around how to change his behavior. Ultimately, organizations need to make difficult decisions on whether leaders and/or team members that are not contributing to overall goals need to move on. To allow an under-performer to remain in their role sends a dangerous message to the rest of the team. I recommend making a genuine attempt at working with the director to help them be successful. If that is not working, then making the decision to move on from the individual.

  8. I agree with IPIE. A KPI should help us understand how well a company, hospital,business unit or individual is performing compared to their strategic goals and objectives. If the KPI is not well aligned with the corporate strategy and there is no communication and monitoring from the top leadership to the employees the practice might become obsolete. The KPI of the leader and those of the employees should address all the critical business questions and should be meaningful and informative. If this is lacking the board should seriously interrogate the current leadership in the company.

  9. The person in question is resistant to change and believes that our role/prominence as a tertiary care organization should cause the patients to come to us solely for that reason. Our goal is to build bridges to community physicians and educating them about our research and clinical capabilities. Convincing the division director to proceed along these lines remains frustrating, but the group’s suggestions are very helpful. Thanks to everyone for your comments.

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