Self-Direction Versus Selfless Service
As a healthcare professional, you are in a position that is more self-directed. Your job description reflects a range of activities that you pretty much control and that require mastery of some technical discipline. (Here, technical discipline includes specific medical skills, as well as acumen in accounting, information technology, customer care, and a host of other specific skills.) In your daily work, you make technical judgments without undue reliance on others, and external and internal organizational dynamics have little impact on your daily activities.
The Peter Principle of H/C leadership.
In essence, professionals are responsible first and foremost for their own performance: you are the key factor in determining the level of success you experience and what contribution you make to your organization.
As a physician leader, by contrast, you are in an area of selfless service (Figure 1–1), which depicts the applicable of The Peter Principle to health care. Rather than focusing on self-performance, healthcare managers supervise the activities of others. You have a great degree of control over and responsibility for others' activities. Your time is governed by the work activities and needs of your reporting staff, as well as the needs of your organization. Your work is constantly interrupted by people problems, organizational mandates, and change in work direction generated by upper management. Furthermore, your first responsibility is to the individuals you supervise, not to yourself. This means that your priorities and interests often take a backseat.
Autonomy Versus Circumstantial Control
As a healthcare professional, you have autonomous control over your work responsibilities. In many cases, your work activity is primarily governed by a job description, and you perform your tasks based on deadlines, processes, and procedures. Unless an emergency arises, you can work at your own pace and accomplish the goals you desire, based on your own performance and motivation.
As a manager, circumstances and situations control your action flow. The organizational contribution your department makes is the main factor in determining your workflow and your daily responsibilities. As emergencies arise, you must mobilize your entire department and determine who will work to attain specific objectives. Flexibility is a key factor in your success; you must be positively reactive, adaptable, and versatile in undertaking your management responsibilities.
Quantitative Versus Qualitative Outcomes
The roles of most healthcare professionals usually lead to a variety of quantitative outcomes. In general, performance as a professional is assessed based on meeting quantitative outcomes on a regular basis.
A laboratory technician conducts analysis and assays, which produces numerical (quantitative) outcomes.
A staff pharmacist is responsible for filling a set amount of prescriptions on a daily basis.
A staff nurse has a certain number of procedures and activities that, if successfully undertaken, indicates that you had a good day.
In a similar manner, as a physician you deal largely in quantitative outcomes as well; however, moving to the management billet of a physician leader, measuring your success will be more difficult, as you will begin to work with personalities and perceptions rather than measurable results. Consider that even the most important indicator of successful healthcare management performance—patient satisfaction—is very difficult to measure numerically and is definitely qualitative in scope.
Focusing on Definitive Criteria Versus Focusing on Overall, Comprehensive Goals
Healthcare professionals deal with definite outcomes. For example, you either complete a laboratory analysis or not; fill a prescription correctly, or fail to note contraindications. Having clear-cut criteria provides a degree of satisfaction: You can recognize clearly the contribution you make toward providing stellar health care. Furthermore, this clarity of outcome provides a building block–like sequence, whereby you can improve your performance each day and compare it with a previous goal.
Healthcare management offers few black-and-white performance criteria. Given all the dynamics of change and expectations mentioned earlier in this chapter, it is very difficult to measure performance, clearly identify key performance criteria, and establish reliable goals for optimum performance. As a result, you must adapt your thinking to look at the breadth of activity, as opposed to the depth of activity. This means looking at the big picture as it relates to all of your department's activities, establishing overall, comprehensive goals, and closely monitoring performance with an open mind—all without ever losing sight of the objective of providing excellent health care.
Certainly, this dimension of professional responsibility is not a new factor to your work life, as it is the guiding beacon for physician action. Accordingly, the initial decisions required in your role as a physician leader will be made with an already established frame of reference based on your professional experience to date. Numerous guidelines for making ethical decisions exist, but the following 7-step process offers a convenient, concise method for confronting ethical dilemmas.
In particular, the following process serves as a reminder that good decision making typically involves double checking before taking action. For example, the key issue in the checklist may well be Step 6, which requires you (and the organization you're making decisions for) to essentially look in the mirror and evaluate the risk of public disclosure of your action and your willingness to bear it.
Step 1: Recognize the ethical dilemma.
Step 2: Get the facts.
Step 3: Identify your options.
Step 4: Test each option: Is it legal? Is it right? Is it beneficial?
Step 5: Decide which option to follow.
Step 6: Double-check your decision by asking two basic questions:
Step 7: Take action.