Management Adviser, Trainer and Facilitator
Patricia is an HR specialist in general practice. She was the managing partner of a large practice for more than 10 years, and now provides HR and management advice and training. She is also a trained facilitator and a coach
Practice managers spend much of their time assessing their staff’s performance and giving feedback on how they are getting on. This usually involves a cycle of reviewing the staff’s skills and training needs, being clear about expectations, setting targets, encouraging and sometimes cajoling individuals, reviewing progress, measuring results where appropriate, and giving praise where deserved and constructive criticism when necessary.
It’s a lengthy and often time-consuming process. Just when you think you’ve got things right, something always seems to go wrong! The person you thought was your star performer suddenly develops issues and gripes about the work, which sound extraordinarily petty to you, whereas your “plodder” unexpectedly shifts up a gear and displays talents you never knew existed.
We all work in teams and, particularly in general practice, each staff member’s performance is reliant on everyone else. You could then argue that the most important performance in the practice is that of the manager.
It may sound obvious, but if the manager is performing at a high level it is likely that the staff will emulate this. A hardworking, conscientious and highly performing practice manager is likely to ensure that the organisation is functioning at a high level with excellent patient services and satisfaction, good financial security, a pleasant and safe working environment, and happy, motivated and well-developed staff. All managers hope they are doing a good job, but how do they really know?
Stuck in the middle
Practice managers are in the unenviable position of filtering down the desires and expectations of the GP partners to the staff, while filtering upwards the difficulties, achievements and wishes of the staff to the partners. It feels like an hourglass, with the practice manager squeezed in the narrowest point in the middle!
The GP partners may not be working well as a team themselves. They may not:
Somehow though, the practice manager is responsible, at the least, for trying to get the partnership team to work together, to make sensible decisions, to share the workload equitably, to handle conflict among team members, to support one another when needed, and to recognise the staff’s contribution and reward them appropriately.
Some partnerships are happy to concentrate on doing the day job of seeing patients, while other practices want to develop every possible business opportunity as well as maintaining high standards in the “bread-and-butter” aspects of general practice. It is often the practice manager who is involved in implementing the ideas of the partners, or finding new opportunities to explore while having to ensure that the practice is running efficiently and smoothly.
On top of this, managers have to filter volumes of information and requests coming into the practice from primary care trusts (PCTs) and the like, ensuring that the surgery is keeping on top of communications, maintaining good relationships, responding appropriately and is not missing something really important.
All this can feel like a big responsibility! We all have good and bad days, but managers somehow have to ensure that they rise above personal stresses and remain calm, professional and focused on the organisation, the staff and the partners.
When we are feeling strong and in control, we are more likely to seek information about how we are perceived by others. When we are feeling vulnerable and less in control, we are more likely to avoid asking too many questions!
By taking control of the process and being proactive, you are likely to ensure you are in the right frame of mind to accept and reflect upon whatever feedback comes your way. You may find the feedback useful either to confirm you are doing a good job or that you need to modify certain aspects of your performance.
If you remain reactive to assessments, you may not appreciate nor accept the sincerity of positive feedback – or you may feel defensive and offended by critical feedback.
The first place to start taking control is to ensure that you have an appraisal with the GP partners every year. This should take the form of a normal appraisal, where you use the same paperwork that you supply to your staff.
You might have to help the GP partners to play their part in the process. GPs often have very different ideas about appraisals based on their own peer-review process, which is not a traditional appraisal system.
GP partners are sometimes quite embarrassed at running an appraisal with their manager and being put in the position of providing constructive feedback. They may fear that if they articulate areas where the manager could improve performance, it might destroy an otherwise sound working relationship.
This means that you may have to take a particularly mature and measured view. Actively seek a constructive conversation about what has gone well and what has not gone so well during the previous year, and what you have both learned from this. Showing that you want an open and honest discussion will put the appraising partner at ease.
It should not just stop at an annual appraisal though. You should be having regular constructive discussions with the GP partners about your performance, setting targets and evaluating outcomes. In a busy practice, it can be difficult to hold these discussions opportunistically, so it is likely that you will need to factor them in on a regular basis with one of the partners.
If you don’t have an arrangement like this already in place, it is worth asking for one of the partners to be nominated as your “mentor” or your “managing partner”. Even for a manager who has been in post and has worked with a partnership team for some time, there are definite advantages from establishing a formal manager/employee relationship with one of the partners. This relationship will provide the continuity you really need to understand your issues and difficulties in carrying out your role to a high standard.
Of course, there will always be times when feedback will come from the partners – either good or not so good feedback – which you will need to take on board, but if you have more established systems in place there are not likely to be any surprises. If there are, this probably demonstrates that the formal systems are not functioning properly.
Your next valuable source of feedback is your staff. You may feel a certain amount of trepidation about the matter, but you really do need to know how you are perceived as a manager.
Do you make the staff feel valued? Are you always consistent and fair? Do you always have time for staff when they need it? Do you really listen to them? Are you always encouraging them in their performance? Do you take into account their difficulties? Are you a good leader and an exemplary role model?
Feedback from staff comes from many sources, including everyday interactions and observations. More formal occasions include the staff’s own appraisals, their performance reviews and various one-to-one meetings.
Obviously, the emphasis of their appraisals and reviews is on them, not you. However, a resourceful and sensitive manager will gain a great deal of insight about how well they are doing as the staff’s manager, and highlight areas where they could help the staff more by improving their performance.
Some practices carry out regular 360º appraisals, where everyone in the organisation appraises everyone else, both up and down as well as sideways. There are obvious advantages to each member of the practice finding out how they are perceived by their colleagues. However, for the system to function successfully an established culture of openness is necessary, without fear of reprisal.
Appraisals from outside sources
These 360º appraisals can be undertaken anonymously, which is likely to elicit more honesty, but somehow the responses need to be collated and provided to the recipients without breaking the guarantee of anonymity. In the search for constructive feedback, some managers have used the 360º appraisal system just for themselves and have asked a trusted colleague from outside the practice to collate the information and feed it back to them.
Feedback about your performance can also be gained from colleagues outside the practice, such as counsellors and community staff who share the premises, neighbouring practice managers and PCT and practice-based commissioning staff.
Practice manager forums offering the opportunity to network with other managers often provide useful feedback on how others have tackled problems or developed their role in different ways. Sometimes similarly minded managers form small focus groups where they meet regularly to create a specific discussion forum for issues of commonality, personal dilemmas or particularly challenging situations. This type of discussion is similar to supervisory groups, often established among other groups of professionals such as practice nurses. The idea is to offload and provide peer support to one another.
In a similar way, some managers find it useful to buddy with another manager, or find a mentor who might be a more experienced manager, who can provide guidance, support or just a listening ear when needed.
Coaching and other forms of feedback
Other managers from different walks of life use performance coaches, who help them focus on changes they need to make and keep the managers on track to achieving their goals.
Coaching is usually short term and can be invaluable in helping managers recognise and build on their successes, improve self-awareness and self-confidence, assess their talents and use them more effectively, and identify things they avoid doing while understanding the cause and effect of this.
Apart from all these ways of obtaining feedback, you could also use a simple but effective method of self-reflection and learning: keep a log of what went well during the course of the week and what did not go so well and why. Writing things down depersonalises the matter, making it easier to keep objectives and plan how to improve performance and outcomes in the future.
To ensure that we continue to grow in our jobs and our experiences at work, a manager should never stand still. Training and development is essential to ensure that we are constantly evaluating what we do and how we can do it better.
Selective reading of informative and thought-provoking articles and books, as well as relevant internet research, should be a part of any manager’s daily routine in your quest for continuous improvement and personal effectiveness.