Managing highly-qualified specialists is something which most health service organisations have to embrace - but it is far from simple and requires excellent management skills.
Specialists have often spent considerable effort in achieving a well-qualified job. They tend to focus on the technical challenge, stretching their brain and adhering to professional codes of conduct and values. For them, being managed can often be seen as getting in the way of doing their job. Organisational requirements, such as annual appraisals and regular one-to-ones, can feel like hoops they have to jump through which take them away from activities where they can really add value (eg, helping patients, diagnosing illnesses and preventing disease).
Managers, regardless of professional background, focus on the overall output of the team and how different people can come together to offer a great service. A primary function of their role is to help the individuals on their team to be the best they can be at their job.
If this relationship breaks down, dysfunctional behaviour can result and start affecting the quality of service. This may look like intolerance of peers to the point of bullying, withholding information from others, and/or behaving arrogantly and disrespectfully to colleagues. All these behaviours undermine the overall ability of their team to deliver a great service and make it a challenging time for both the manager and the individuals on the team.
A highly effective manager will encourage individuals to become aware of what they excel at, what are they not so good at and make an honest assessment of how this compares against the objectives of their job. The manager works with the individual to identify any gaps and ask how this can be bridged or whether the role can be restructured. Exceptional managers take the time to understand what really motivates and inspires each person on the team,
and works out how to give them opportunities to express this at work.
Likewise, an effective manager also needs to build their self-understanding. They make use of tools like 360-degree feedback (feedback that comes from members of an employee's immediate work circle) to ensure they are aware of their strengths, development needs and impact – and how they can become a better manager.
People differ in the way they prefer to receive and digest information. Some are more likely to want to know the context and big picture, others prefer to get into the detail first. Managers will improve communications by establishing how individuals prefer to receive information. If the audience is wider than one person, a mix of approaches is usually best, for example, combining talking it through with written information. Some people will be more interested in solving a complex problem, while some will be motivated by helping others. Particular professions might be encouraged to focus on one of these over another, but individuals within any professional group might vary widely, so it is always best to get to know the person rather than making generalisations.
It is important to clarify what people expect from each other at work. This helps to establish an informal contract otherwise known as 'the psychological contract' between an individual and their manager. The individual may expect a clear vision to be provided, outcomes made explicit and to be given guidance on how best to communicate with their manager, eg, infrequent informal catch-ups or copying into key emails. The manager may need to make clear their expectations about how they want to be kept up-to-date. For example, do they want to see the detail of how the individual plans to achieve their objectives; or are they happy to assume everything is going to plan unless they are otherwise informed? As a team, how do they expect to keep each other informed? It is worth revisiting these from time to time to check how they have changed. It establishes a baseline for behaviour, much like a baseline for measuring health statistics.
Trust is key to any successful relationship. Where an individual has a high level of responsibility and impact, the successful manager should trust them to do a good job. Some aspects of this are easily tracked through achievement of targets and healthcare quality outcomes. Real trust comes when both parties believe that they have common ground over what they are trying to achieve. Knowing each other's agenda is only developed through open communication and spending time together. When someone makes a mistake or has a negative impact, the manager should take some time to try to understand their intention. Trust develops when both parties begin to understand what the other was trying to achieve, even if their impact was not helpful.
It is also important to take responsibility for any problems and get these out in the open. Most people would rather know the bad news to enable them to prepare for and deal with it. If it comes out as a nasty shock later on this will undermine trust. People will also watch carefully to see if others are true to their word.
Respect for each other
Respect is a value which most people agree with, however in practice can be forgotten. In simple terms, respect is about listening to and valuing what is important to others. A highly qualified individual is very likely to view themselves as a peer to their manager. Respecting each other as an expert in their own right is important. For the manager, it is about demonstrating this through action and encouraging team members to respect each other, challenging them when they are not. It is also about feedback, both positive to encourage the right behaviour, and the developmental feedback to identify how people can bring about improvements.
Looking after the basics
Managers need to look at the basic needs which enable an individual to carry out their role. Simple aspects such as parking, desk space, chair, monitor, etc, can significantly impact a person's effectiveness, as they become distractions to their work. Other aspects of flexibility should be looked at too, eg, start/end times fitting with domestic commitments, providing quiet space or working from home if required, supporting research and other professional development activities that motivate people. Where possible, accommodating issues like these can make the difference between a fully engaged or disengaged team.
Being clear about the outcomes and vision
People like to know what the outcomes of their work should be and the aims of the overall service to which they are contributing. Some people prefer more detail around this, others may simply prefer an overarching vision or context. Whichever the case, a good manager repeats it often and at every opportunity. This will enable individuals to make specific day-to-day decisions in their job that align with the overall outcome and vision of the team.
Understanding what motivates them
What gets people out of bed in the morning? Understanding what individuals are motivated by and sharing this with others will enable them to be given more opportunity to fulfil their needs. Self-awareness has a big impact. Many people do not really understand what they are motivated by, so by offering a range of sources of motivation the manager will start to get to understand what drives each individual. Money may not be the key motivator. It might be helping others, gaining new knowledge, self-development, work-life balance, promotion or visibility and status. Building these into objectives and ways of working can improve satisfaction and retention of team members.
People can react very differently when under stress. A good manager knows their team and can spot unusual behaviour early on. Building up this picture, successful managers can also begin to anticipate how particular individuals may react to specific events or situations and be ready to provide the appropriate support. As well as reacting to different stressors, individuals also have different reactions. For example, someone who usually only sees the big picture view may suddenly get obsessed with specifics or details. Someone who is usually very considerate of others may become critical and make personal attacks. Having an understanding of the personality of the individuals on their team will help managers to prepare for and manage that person when they are under stress.
Helping them feel part of a team
When individuals working together in a team are all highly specialised they can become disparate. It is key to a manager's role to identify opportunities for individuals to work together to allow them to get to know each other and build trust. Their role is to help the individuals understand the importance of a collective service and help them feel part of that. People getting to know each other and gaining an understanding of each others' similarities and differences can help overcome some of the barriers to team working. In many instances, understanding the impact of each service on the patient pathway and working together to improve quality outcomes for patients will enable different professionals to see the value in each other's contribution.
Rebecca Stevens is chair of the North West Association of Business Psychologists and director of Work Brighter Ltd. As an occupational psychologist Rebecca helps businesses understand and address their people problems.
Rachael Lewis is managing director of Envision and an Associate Fellow of the British Psychological Society. She has worked extensively within the NHS providing talent assessment and leadership development to clinical and non-clinical staff.
Work Brighter Ltd
Association of Business Psychologists