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Most information published about management is helpful to some extent. However, much management advice seems predicated on the assumption that once it is offered, managers at all levels will behave accordingly. But not all managers at all levels think and act the same way, which causes the supervisor-the first-line manager who oversees the people who do the hands-on work-a great deal of stress. A case in point: A supervisor and her immediate superior both attended an educational series about delegation. The supervisor was enthusiastic about the topic, did a great deal of work, and tried to apply what she had learned. Among other things, she learned that she could be far more helpful to her manager than she had been, and she tried to improve her usefulness. But the manager resented the supervisor's efforts to help, seeing them as intrusive, and even went so far as to suggest that the supervisor was "trying to take over my job."


The manager who regards the conscientious subordinate as a competitor, and thus as a threat, could be acting out of self-doubt and a sense of insecurity. Insecure or not, however, managers can always benefit from their subordinate managers' direct support and assistance. When you properly make yourself more useful to your immediate superior, you create a win-win situation: You both gain in terms of performance, job satisfaction, and career enhancement.


To become more valuable to your manager, you must first ensure that you have your day-to-day responsibilities well under control and that you have the capacity to assume more responsibility and handle it well. Study your job description; be able to show where and how your duties can be expanded productively and to the benefit of the department. Also, be sure that you know the exact limits of your authority and that you never exceed those limits on your own; act only with your superior's blessing of proper delegation.


The following are some points to consider in dealing with your superior:


* Do nothing that directly suggests that you are addressing an apparent weakness in the superior's performance. Do not suggest that your boss is unable to handle certain kinds of situations or needs your help largely to stay out of trouble.


* Rely on the "we" approach, never the "I" approach. Do not attach the problem to your manager alone, but rather, buy into the problem. Never suggest to the boss that you have a problem; rather, go forward from the position that we have a problem and the responsibility for a solution is ours.


* Do not simply take problems to the boss, whether asking for guidance or offering to take them and solve them yourself. Instead, do your homework. When a problem arises, analyze it, define it, prepare alternative solutions, and recommend a course of action. But if the problem clearly lies beyond your immediate authority, do not act on it without your manager's blessing. However, although the decision may not be yours to make, the problem definition and the remainder of the homework lie within the responsibility of a supportive subordinate manager.


* Be openly supportive of your boss whenever you are able to do so. Do nothing that may be interpreted by others as making the boss appear ineffective in any way. Instead, whenever possible, say and do things that will make the higher manager-and thus, the department overall-look good to others. By honestly working for the good of the department, you may be able to generate more trust and confidence from your manager and thus come to be perceived by him or her as less of a threat.


* Do not be overly concerned with receiving credit for your successes. At times, you might even go so far as to allow your manager to take credit for them; it is all for the good of the department and, thus, for the institution's patients. In any case, those people who are closest to the problem will likely know who is responsible for your accomplishments.


* Keep your superior from making serious mistakes. It is one of the most valuable services you can perform for your boss, but it must be accomplished diplomatically, especially with a manager who may be extremely insecure in his or her position. Even the best managers make mistakes, especially when working under pressure. The better managers appreciate subordinates who help them stay out of trouble on those occasions when a decision made in haste or under pressure goes awry.



Neither deliberately exceed your authority nor usurp your manager's authority. Challenge your manager directly only when the potential consequences are serious, and always do so discretely and privately. Continually make yourself valuable by quietly heading off small, smoldering problems before they can become major fires. In the long run, it is the supportive first-line manager, the true team player, who succeeds and advances.


This issue of The Health Care Manager offers the following articles for your consideration:


* "Sexuality in the Workplace: Where Do We Stand?" suggests that given recent changes in the composition of the general workforce, there has arisen a critical need for leaders to manage sexual workplace relationships in a manner that acknowledges both individual and organizational needs.


* "Examining Human Resources' Efforts to Develop a Culturally Competent Workforce" reports on a study that examined current efforts by human resources directors in Alabama to recruit more diverse candidates in recognition of the need for a culturally competent workforce to meet the needs of culturally diverse patients.


* "Consumer-Directed Health Care: Part 2-Implications for Health Care Organizations and Managers" provides the conclusion of a 2-part presentation illustrating the key components of consumer-directed health care, the essential strategy needed for reducing health care costs, and advancing health care reform.


* "A Mechanism of Institutional Morphism in Referral Networks Among Hospitals in South Korea" reports on a study undertaken to assess referral networks according to the institutional isomorphism theory of new economic sociology, suggesting that normative isomorphism on the basis of public domains should be considered an inherent factor in the development of referral networks.


* Case in Health Care Management: "The Alternate Day Off" asks the reader to consider the effects of a policy that, when broadly interpreted, provides an opportunity for potential abuse of time-off practices.


* "A Volunteer-Based Hospital Elder Life Program to Reduce Delirium" reports on the implementation of the Hospital Elder Life Program in a 232-bed community hospital as a means of providing a cost-effective method for enhancing the nursing care of vulnerable elders during hospitalization.


* "Your Workers May Be Contingent, But Your Liability for Them Is Certain: Part II: Issues Under Federal Employment and Labor Legislation," the second of 3 parts, addresses the effects of a number of key pieces of employment and legislation on the employment of contingent workers.


* "Managing Human Resources for Successful Strategy Execution" suggests that the execution of organizational strategy has become increasingly dependent on the effective management of human resources and that people can be managed more effectively to facilitate the execution of strategies and improve organizational performance.


* "Maybe Someone Should Tell the Nurses: Pay-for-Performance" describes the vital role that nurses play in measurable health care outcomes, the basis of pay-for-performance reimbursement, but suggests that attention is lacking to the need to make nurses thoroughly knowledgeable so they might completely do their part in making this form of reimbursement successful.


* "Quality of Internal Communication in Healthcare and the Professional-Patient Relationship" reports on a study undertaken for the purpose of describing internal communication and the professional-patient relationship and establishing a descriptive model for the interaction of these 2 variables.