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After looking over the draft of an article for The Health Care Manager, a reader, also a working manager, said, "Good advice about managing, but it won't do me any good unless my boss also reads it and takes it to heart. I'm still wondering how I can get him to define his goals and objectives for my group and to explain his expectations of me. At the very least, I'd like him to give me a regularly scheduled meeting time so we could discuss current problems."


There is a valid point buried not too deeply in the foregoing comment: almost any appropriate management technique will work better and its results will be more favorably received if the boss is on the same wavelength. That is, if the boss knows, understands, and generally agrees with the subordinate manager's approach, the boss is more likely to be sympathetic and supportive. Certainly, having a boss whose management philosophy and approach are contrary to one's own only makes an already tough job still tougher.


However, on the matter of defining goals and objectives, one might suggest that waiting and criticizing are not going to get the manager anywhere. The complaint implies that the boss is failing to fulfill some basic management responsibilities, and this may indeed be true. However, the individual manager has planning and operating responsibilities, and these include the formation of goals and objectives.


Should the manager experience the kind of situation suggested in the opening comment, a helpful point at which to start planning to improve relations with the boss is with a review and update of the manager's own job description. The manager should examine the job description in detail and decide what the current structure of the job should be relative to what is known about the goals and objectives of the organization. Next, springing from and consistent with the job description, the manager should develop personal goals and objectives for presentation to the boss as recommendations. In general, personal objectives are most often met when the person who is working toward those objectives has had a strong voice in developing them. "Ownership" of an objective through authorship is a strong motivating force for eventual fulfillment of the objective.


Ideally, the boss should be expecting the subordinate manager to develop goals and objectives. If no such expectation is communicated, the subordinate manager should reach out and establish personal objectives anyway. In the process of doing so, however, it is necessary to ensure that the objectives are reasonable, that they are realistic, and that the chances of attainment are fairly good. The manager should make sure that the objectives are controllable in that he or she has command of the resources necessary to fulfill them and is not highly dependent on the actions of people outside the manager's sphere of authority.


An ideal objective should always include a clear indication of what, how much, and when. For example, it is not sufficient to take on as an objective "Reduce the number of errors made in billing." Rather, a far more appropriate objective statement would be "Reduce billing errors (what) by at least 50% (how much) within 6 months (when)."


Having developed his or her own objectives, it is then appropriate for the manager to ask the boss's help in refining those objectives so they will be consistent with the goals of the organization. If need be, the manager should remind the boss that one can do the best job only when constantly aware of the desired direction and expected results.


The manager should try to stimulate improved communication with the boss by requesting time when necessary. It helps to ask for a brief, regular meeting, perhaps once a week, at which recent events can be reviewed and guidance on specific problems can be requested. If requests for meeting time are denied or ignored, the manager should keep asking unless specifically told to drop the request but should always do so respectfully and under circumstances that never compromise the boss with other members of management.


It should be made as easy as possible for the boss to supply an answer. Therefore, the manager must apply the concept of completed staff work-not going to the boss looking for a solution, rather, doing some homework, developing some alternatives, recommending a solution, and asking for the boss's blessing to act. By arranging the circumstance so that a busy superior can provide an answer in minutes, the manager is far more likely to get that answer than if the boss has to wade through the entire problem personally.


Should the subordinate manager receive a regular annual performance appraisal, and the appraisal interview is a requirement that the superior may not be able to avoid, this is an appropriate time to ask about goals and objectives for the department. If there appear to be weaknesses in the subordinate manager's performance, either in the eyes of the boss or by self-perception, one can suggest how these weaknesses can be corrected and perhaps specifically ask the boss for advice about how to improve these aspects of performance.


A seemingly disinterested or unreachable boss may in fact be anything from a weak or uncaring or burned-out leader to a highly conscientious but overworked manager. Whatever the higher manager's true posture, however, the subordinate manager cannot afford to wait forever for the boss to reach out. Often, the keys to the development of a successful relationship with one's superior are initiative and diplomacy-the initiative to carry the problem or need to the boss and the diplomacy to intrude minimally and only constructively on the boss's way of doing things.


This issue of The Health Care Manager (26:2, April-June 2007) offers the following for reader consideration:


* "Job Redesign and the Health Care Manager" explains what top management is expecting department supervisors and other managers to do when they are directed to participate in "reengineering," "restructuring," "work redesign," or other similarly named process that, in addition to changing work methods and procedures, often results in staff reductions.


* "Gossip and Nurses: Malady or Remedy?" addresses gossip as a natural part of every social setting, including of the work setting; addresses both positive and negative aspects of "grapevine" communication; and describes how this informal means of communication, which can never be eliminated, can be managed effectively.


* "Integration of Health Care Organizations: Using the Power Strategies of Horizontal and Vertical Integration in Public and Private Health Systems" addresses health care's use of integration of facilities and services in an effort to provide all elements in a seamless continuum of care, suggests what has been learned from integration efforts to date, and suggests direction for future study and research into system integration.


* "Pay for Performance: Improving Quality Care" addresses pay-for-performance strategies as a potentially viable means of responding to the ever-increasing pressure for economy, continuity, and consistency in the delivery of health care, focusing considerably on enhancement of the essential physician-patient relationship.


* "We Don't Want to Go There" suggests that among numerous other skills, managers need to develop the ability to carefully choose which challenges and issues should be addressed and which are better left alone.


* "Discharging Patients Earlier in the Day: A Concept Worth Evaluating" introduces a new physician-centered discharge planning process capable of reducing the backlog of waiting admissions, potentially increasing patient satisfaction, enhancing physician efficiency, and improving bed utilization.


* "Nurse-Nurse Manager Conflict: How Do Nurse Managers Manage It?" examines the conflict management style used by nurse managers when in conflict with nurses and suggests that certain nurse managers must be encouraged to use more effective conflict management styles.


* Case in Health Care Management: "The Clinging Vine" asks the reader to address the apparent problems created by an employee who turns to the supervisor in all matters, apparently incapable of personally addressing even the smallest of needs.


* "Creating a Culture for Health Care Quality and Safety" suggests that the need for a culture of quality and safety in the health care organization will enhance communication and cooperation among all members of the health care team, to the ultimate benefit of the patient.


* "Does Having a 'Brand' Help You Lead Others?" is based on the premise that every manager has the opportunity to develop an array of unique characteristics that define a recognizable individual style, or "brand," that can enhance the individual's leadership style.


* "Conducting the Employee Selection Interview: How to Do It Effectively While Avoiding Legal Obstacles" takes an up-to-date look at the employee selection interview as a flawed-but-essential process that, although unavoidable by the individual manager, is a quagmire of potential legal traps.


* "A Manager Asks: What to Do With the Troublesome Employee" shares the advice and experience of a number of working managers in considering how to deal with employees who create problems with their disruptive behavior.