A Sign of the Times: Multiple Bosses
The manager of a small group of professionals complained, "Ever since we got caught up in merger mania and became part of a larger system with 3 other formerly independent organizations, I've had to report to 2 superiors. At the system level, I have a boss who is in charge of my function for the entire system. But I have another boss, an administrator I report to at the facility to which I'm assigned. I don't like the arrangement; I seem to be in trouble with one boss or the other much of the time. Do these split-reporting relationships really make sense? And what can I do to make the situation I'm stuck in work better?"
For years, working managers and would-be managers were told that split-reporting relationships were to be avoided, that generally the disadvantages far outweigh the advantages. These days, however, it seems that an increasing number of first-line managers are stuck with reporting to 2 superiors. As the complaining manager noted, this has indeed been one of the results of mergers and other affiliations and the formation or expansion of health systems.
Much of the time the 2-boss system does not work well because of differences between the bosses' leadership styles and their senses of priority, and often the reporting requirements of the 2 superiors are conflicting. If either superior behaves as though he or she automatically deserves first call on your services at any time, these are bound to be occasions when you are pulled in opposite directions. In split-reporting arrangements, it is much too easy to find yourself caught in a pull-and-tug between conflicting priorities and conflicting expectations.
There can also be performance appraisal problems in a split-reporting relationship. One's evaluation should be an honest reflection of one's overall performance, but it will not be such if both superiors do not give the process equal attention or, ideally, accomplish the appraisal cooperatively.
Your behavior in a split-reporting arrangement and your responsiveness to both bosses' demands can also contribute to the overall problem. When one boss is more demanding than the other, you may tend to lean toward the greater source of pressure. Following the path of least resistance, you find that you are giving one side of your role extra attention at the expense of the other side. Also, if both of your bosses seem lax or indifferent, you may be inclined to take advantage of the situation and "do your own thing," which may or may not be appropriate for the organization.
A split-reporting relationship can be made to work satisfactorily, but only if all 3 parties conscientiously make it work. You may be able to improve your situation in such a relationship by considering the following:
(1) Analyze your situation, identifying apparent points of conflict. Write out the analysis, reinforcing each point with examples.
(2) Ask for a 3-way meeting, you and both superiors, to help determine how you can best fulfill all of your job responsibilities and meet the expectations of both bosses. It is essential that this be an actual, 3-way, in-person meeting; all parties have to get on the same wavelength, and this cannot be accomplished if the subordinate is trying to do this while shuttling between bosses.
(3) Spell out the problems and your needs for both managers, specifically pointing out instances in which you fell short of one boss's expectations because of conflicting demands. Let them know you understand that they both cannot always be aware of what the other needs, and that you see it as a part of your role to let them know when a conflict arises.
(4) Ask both bosses to give you the authority to set your own priorities in balancing the 2 sides of your role. They may surprise you by giving you that authority-if they can see that doing so may simplify their lives as well as yours.
(5) Promise to keep both superiors fully informed of what you are doing for both of them. Do your best to ensure that neither gets any surprises concerning incomplete tasks or missed deadlines.
(6) Make certain that you do not show obvious favor to one superior over the other.
(7) Resist all temptations to play off one boss against the other. In the long run, doing so will hurt only you.
Finally, a split-reporting arrangement rarely if ever represents an ideal reporting relationship. However, it can perhaps be made tolerable if you take the initiative to keep both managers continually informed and if you take the lead in working on the relationship.
This issue of The Health Care Manager (Issue 37:4, October-December 2018) includes the following articles for the reader's consideration:
* "The Lived Experience of First-Year Nurses at Work" reports on a qualitative phenomenological research study undertaken to gain insight into the lived experiences of newly licensed nurses; first-year nurses describe poor experiences and struggles in their first year of practice, leading to high turnover and burnout.
* "Social Capital, Community Capacity, and Health" relates a study examining existing literature in relation to social capital, health, and community capacity; bonding social capital shows the average value of the extent to which individuals trust each other and participate in groups, whereas bridging social capital shows the average value of the extent to which individuals participate in different formal groups.
* "Resource Dependency and Hospital Performance in Hospital Value-Based Purchasing" addresses a study utilizing the lens of Resource Dependency Theory to evaluate the effect of the external environment on hospital performance as measured by the HVBP program; the association between external environment and hospital performance is assessed through multiple regression analysis.
* "Factors and Preferences in Patient Selection and Location of Care" addresses a variety of factors that influence the decisions patients make regarding where they receive care; the study sought to determine patient satisfaction and characteristics that led patients to seeking treatment at primary care offices, urgent care centers, or emergency rooms.
* "The Effects of Implementing an Accreditation Process on Health Care Quality Using Structural Equation Modeling" reports on a study that was undertaken to investigate nurses' perceptions of and attitudes toward the effects of hospital accreditation on their service quality in an Eye Hospital in Tehran in 2016. This was a cross-sectional and descriptive-analytic study conducted in the second half of 2016.
* "Case Study of Nurses' Experiences Related to the Deaths of Their Patients" describes how a qualitative case study methodology was applied to explore how nurses cope when their patients die. The study utilized a sample of 16 participants at a rural 123-bed community hospital
* "The Nationwide Health Information Network: The Case of the Expansion of Health Information Exchanges in the United States" reports on research undertaken to determine the impact of the Nationwide Health Information Network and Epic Care's Care Everywhere on health care to determine whether their use has increased.
* Case in Health Care Management: "Off The Fence: Jump, Fall, or Pushed?" asks the reader to consider how the person who now supervises the group to which he or she formerly belonged handles the potentially divided loyalty between work group and "management."
* "Nurses' Perceptions of Engaging With Patients to Reduce Restrictive Practices in an Inpatient Psychiatric Unit" describes a study intended to explore nurses' perceptions of engaging with patients to reduce the use of restrictive practices in an inpatient psychiatric unit.
* "Wolcott-Rallison Syndrome With Different Clinical Presentations and Genetic Patterns in Two Infants" addresses 2 instances of this rare disease, examined for the purpose of learning more about how this syndrome might be approached in future cases.
* "Interpersonal Competence in the Management of People" addresses communication skills essential skills in dealing with and relating to other people largely on a one-to-one basis, suggesting that one must work conscientiously to develop the interpersonal competence essential for long-run success in the management of people.