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The Quarterly 2013

This article was written by Dr Susan Keam, derived from material presented by Dr Tony Austin AM on the 5th of August 2011 for the RACMA Interact Webinar series. A recording of the webinar can be found on the RACMA website here.

Views and thinking on leadership most often take a "look-down" approach - how we interact with our peers and lead those who report to us - which can be both dangerous and can diminish our effectiveness as a leader.

Competent leaders should spend about 25% of their time managing upwards, either being responsive to those who lead them, or trying to sculpt the environment above them. Medical administration is a complex, hierarchical environment in which leadership is difficult. There are never enough resources for the job at hand, so tasks must be prioritised and re-prioritised. It is often people other than medical administrators who set these priorities. It is thus extremely important to know what the priorities are, who is setting them, and the authority they have to do so. To be an effective servant of, and partner to those we report to, we need to understand the environment in which they are operating, equally as well as our own. Boundaries in the job are usually set by those we report to, and we need to clarify these boundaries with our bosses, so that we know exactly what is expected of us.

Medical Managers - Bridging a Complex Gap

The rules that govern the environment in which medical administrators operate is constantly changing in terms of structure and responsibilities, and medical administrators often feel trapped between managers above (few of whom have a clinical background and understanding) and clinicians below. A big conundrum is how to bridge the gap between these two (often opposing) groups. Leadership is a pivotal task in the role of medical administrator, but often we find ourselves in situations where we cannot effectively lead, and all we can do is achieve a compromise, which is not ideal. This may result in a sense of disempowerment, because the needs and expectations of both groups (the managers above and the clinicians below) cannot be fully met. In addition, the further up the management hierarchy we move, paradoxically, our ability to control the environment, resources and productivity can actually diminish.

In the health sector, politicians set the national agenda, drive policies and procedures, and allocate resources. As health administrators we cannot change this, but we can work with it, trying to understand the practical ramifications of the policy and the philosophy behind it, because any solutions we propose will only work if they are congruent with the current government position and policy. Rather than participate in the adversarial approach that underpins politics, medical administrators can be far more effective if they are able to neutralise the negative effects the political process may have on policy implementation. This can be achieved by building constructive alliances with politicians across party lines, providing them with opportunities to understand how you operate and gain insights into the initiatives you undertake.

Leadership 101

Good leadership goes beyond competent management, and requires vision, motivation, enthusiasm, and a passion for getting people to achieve organisational goals and outcomes. Leaders also need to remember that they are also led, and there are always more leaders above leaders above leaders. An effective leader needs to gain from their boss a good understanding of the direction in which they should lead. While you may conduct the orchestra, it is your boss who writes the score. In order to see the big picture, manage effectively and achieve the right goal, we need to understand this "score" and the intellectual and philosophical basis on which it is built. By focusing on the "end state" (i.e. the scenario we want to have in place when our efforts are complete or the what the goal looks like when it is achieved) we can create an environment in which the desired goal can be achieved.

We need to understand the characteristics that those who lead us are looking for in their future leaders. For instance, General Colin Powell, Lesson 13 ("Powell's Rules for Picking People") of his Leadership Primer states that when picking people, look for intelligence and judgement, and most critically, a capacity to anticipate, to see around corners. Also look for loyalty, integrity, a high energy drive, a balanced ego and the drive to get things done.

Policy should drive plans. However, policy changes frequently, which means that we must keep up with the changes, critically analyse the likely effects of the change and anticipate outcomes (seeing around corners). When managing upwards, we need to recognise that bosses are there to make decisions, and it is our job to provide well thought through options and recommendations for them to consider. The credibility of our boss is important for the credibility of the organisation. To help them maintain credibility, we need to keep our bosses well informed, and especially making sure they know about potential problems before they become a reality.

Followership is a Critical Part of Leadership

Effective leaders also need to be effective followers. As leaders in health, we need to look at ourselves and ask whether our journey as a leader has been built on a solid foundation of being a good follower. We need to be critically aware, not only of the environment in which we are working, including the priorities, policies and procedures of the formal constructs, and the strengths and weaknesses of others we work with, but also our own strengths and weaknesses. It is only when we consider all these factors that we are able to work together as an effective management and leadership team.

How we see things is dependent on where we are in the hierarchy. As medical practitioners, we have been trained to be highly observant, and we need to apply the principles useful in a clinical setting to the environment in which we operate as medical administrators. We need to observe our bosses, noting how they behave, identifying things about their behaviour that we like and things that irritate. We need to learn from their behaviours and identify those that will be effective for us and will fit with our own personality and style. We also need to create an environment where subordinates and peers feel empowered to share with you when they see behaviours and decisions that they don't like.

Communication is The Key

Effective two-way communication is important when leading upwards, especially when seeking to influence behaviour or to ensure that your leadership is aligned with the goals of those further up the hierarchy. A problem often faced is that each boss will like to communicate in different ways – some will communicate face-to-face, others by email, and some will limit communication to editing written submissions. This needs to be managed well, because face-to-face communication is by far the most effective modality (40% of what we communicate is in our tone of voice, 50% is in our body language, and only 10% is the actual content). If the only form of communication is electronic, we lose the opportunity to influence our bosses, to understand how they are thinking and why they are acting as they are. One strategy is to sit down with your boss and ask how they want to receive various types of communication, and the degree of urgency that each should have.

Having secured the opportunity for face-to-face communication, it is very important to prepare yourself for the meeting, thinking about the potential barriers to communication in each scenario (e.g. gender, age, professional qualification, cultural background, generational differences in thinking and communication style, their priorities and what satisfies/irritates them). Handled well this meeting can be the basis of a strong working relationship. Never lose sight of the fact that all communication (written or by email) is in the public domain and can be accessed under the Freedom of Information Act or subpoenaed as evidence.

Culture - the Glue that Sticks the Organisation Together

To be effective at our job and enjoy our work, we need workplace harmony, with people working together as a team to achieve the organisational purpose. There should be no destructive or destabilising behaviours (e.g. backstabbing). The culture of an organisation is set by the leadership, and each level of leader has the potential to undermine the culture. People who breach rules need to be seen to be disciplined, and it must be evident that leaders are not turning a blind eye to bad behaviour, as this is corrosive to the output and productivity of the team, and the effectiveness of the organisation as a whole. Leaders must treat all staff equally, and should not be seen to have favourites.

As leaders, we need to provide our followers with a big picture view that clearly outlines priorities and important issues. If people have the big picture they know the direction they are moving in and in turn they can effectively prioritise their work. We need to be upwards champions for our people to ensure that communications both up and down are effective.

Sometimes the decisions we make and policies we implement will be unpopular and we will upset people. However, the long-term effect of this is minimised if we demonstrate honesty, integrity and trustworthiness, and have earned the respect of those who work for us and those we work for. We need a clear set of values (organisational or personal) and we need to test every decision we make against these.

Understanding Self, Understanding Others

In order to be effective as leaders of others we need to really know ourselves. While self-examination is important (e.g. using Myers Briggs personality evaluations), feedback from those we lead (e.g. 360 degree reports) is extremely helpful. We need to make sure that the things we are passionate about don't get in the way of achieving the bosses priorities, and that we are equally passionate about the bosses priorities as our own. In the words of General Colin Powell's lesson 10 from his Leadership Primer, "Never let your ego get so close to your position that when your position goes, your ego goes with it".

It is helpful to understand where our personal "comfort zone" is.

Many of us sit in quadrants 3 & 4, and need to move to quadrants 1 & 2, which is in line with what our bosses and organisations require of us.

Understanding the Boss

Understanding your boss requires more than just understanding their personality. It requires getting inside their head, understanding what motivates them (e.g. if they are ambitious, are their ambitions professional or private or both), what their background and previous experience is, what has worked well or not worked well for them, what management theories they espouse and what their priorities are (what really drives them). Their leadership styles and vision, the way they solicit engagement and the way they manage conflict also need to be understood clearly. Understanding what is important in their personal life also gives important insights into them as a person.

Never lose sight of the fact that your boss is task rich and time poor, so don't waste their time. Make sure that your time management skills are well developed, because your reputation depends on it, and you need to make sure that your priorities are right and reflect those of your boss and that you know what the deliverable is.

When dealing with your boss there should be no surprises - bad news does not improve with the passage of time. Keep your boss apprised of sensitive or potentially problematic issues, as well as the good news.

Summary

You can control your future, and be an effective leader if you:
  • understand the big picture
  • keep your eyes firmly fixed on the mutually agreed final goal
  • work at understanding your boss and the way they think (to the point that you are able to anticipate the decisions they will make)
  • work hard at making the boss and the organisation look good
  • show personal integrity, ethics and honesty
  • are seen as a hard-working and respected member of the bigger management team
  • seek honest feedback and take it seriously
  • are an honest broker of news (both good and bad) upwards and downwards
  • are the first to identify your own errors and work out strategies to mitigate them
  • interact as a human being, not as a "job title"
  •  make work fun
  • make sure that you have the right team - it's amazing what can be achieved when no one person gets the credit.


Dr Tony Austin AM
MBBS, MPH, FRACGP, FRACMA, DipAVMED, GAICD


The Royal Australasian College of Medical Administrators
Dr Tony Austin, , p645
racma.edu.au /index.php?option=com_content&view=article&id=645&Itemid=366