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Posted August 31, 2011

The Art and Science of Managing Up

By Dan Smith, MD, FACEP

Study "managing up" in most business journals and you will consistently find this skill set described as a need for one to stretch or go beyond her normal task load in order to enhance a supervising manager's apparent work. In other words, "I do more for the organization and my manager and I am subsequently valued at a different level. Oh, and I may be at an advantage come promotion time!"

At Studer Group®, we coach organizations to use "manage up" in a different way. To us, it's a statement by one member of the team that puts another member at an advantage in the eyes of the patient. So who "wins" here? In contrast to the "strictly business" use of the term in which the manager gets the win (and it might just trickle down to the employee), our "manage up" is designed so that everyone involved benefits. Let's examine the winners:

The "manage up" recipient: Imagine an exhausted Emergency Department technician who is at the end of five shifts in a row. He may see himself as a "minor" contributor to the ED team. (By the way, in my 15 years as an emergency physician in a busy five-hospital system, I've found that this perception is far from the truth!)

Now, imagine me saying: "Mr. Jones, hang in there. My ED tech Josh here is one of our finest techs, and he is going to place your IV and get those tubes to our lab and blood bank so we can get you a needed blood transfusion."

What do you think happens next? I'll tell you what: Josh rises to the occasion, nails the line, and runs the blood to the blood bank. And his follow-up to me will be something like: "Dr. Smith, anything else I can do to help that guy?"

You may be wondering if managing up colleagues really means that much to them. I can assure you that it does. Helping them feel valued not only energizes them, it's a great way to raise their commitment, attitude, and connection to purpose. This will become obvious when you see how they perform after being managed up. I have found it leads to real collaboration. I have never been disappointed by the results.

The "manage up" sender: Because communication about the care being provided is built into the managing up process, the "sender" feels reassured that what's supposed to get done will get done. Plus, when you're handing over the care of a patient to someone else, reminding yourself of how capable and competent that person is will make you feel better about the care provided.

What's more, one who manages up another is viewed as a team player and not as someone who is practicing in isolation (as if such a thing were possible!). The team members who are managed up will view you in a more positive light and, as I suggested above, will be more motivated to do their best work. Patients, too, will sense that you're a leader who knows your staff's and colleagues' capabilities.

I think for me one of the benefits of managing up is the sense of humility I feel as I realize my dependency on so many others to be successful in the unpredictable and fast pace of healthcare.

The patient: Here is the ultimate benefactor! Imagine the perception of the ED patient, a person who is sick, anxious, and in need of all the reassurance you can give her. When she experiences a set of providers who share the care agenda, perform their roles highly, and manage up each others' abilities, she is sure to feel better about her situation. She'll feel less anxious, perceive her care as more timely and compassionate, and will experience a better outcome.

When we talk to healthcare professionals about managing up, they often say, "Our staff and physicians are stretched to the limit as it is. How do we motivate them to do yet another task?"

My reply is this: I don't view managing up as another task. Rather, I see this skill set as an adjunct to AIDET® the communication framework we teach healthcare professionals to use when interacting with patients and families. AIDET, for those who don't know, is an acronym whose letters stand for Acknowledge, Introduce, Duration, Explanation, and Thank You. A common place to manage up is during the Introduction phase: "I see you have gotten to meet Judy. She is a phenomenal nurse whose patients rave about her care and skill. She will place your IV shortly."

If you've never managed up anyone, it will feel awkward the first time. But you will repeat the tactic when you sense the productivity and respect that result.

I invite everyone to make managing up a part of your daily communication. When I think about the obstacles to regular use of this powerful tool, I picture a steeply sloping K-120 hill that Olympic skiers descend in the ski jump competition. The hardest mental part is just pushing off to start the drop—after that, managing up is all downhill!

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