Hospital First-Level Supervisors: Did COVID-19 Expose Weakness?

Entry-level associates in scrubs looking distraught

First-level supervisors/managers in U.S. health systems have many things demanding their attention each day. And that is during “normal” times! The 2020–21 virus pandemic created more challenges for managers in care delivery organizations, including inadequate capacity, supply shortages, and adjusting workforce capacity to cope with changing needs and patient demand.

Even before the pandemic, many managers were not executing on the right behaviors to lead high performing teams. Did the pandemic show that your managers were not prepared for leading during intense times?

Managers have always mattered in hospitals/systems, but challenges have changed. Management now is about making employees the best at their role, while operating a cohesive team that can adapt during stressful times.

There are widespread reasons why managers are not prepared. One reason may be that management training and development is generally under invested in, especially for first-level supervisors. Also their associates are often just taught to “do their job” and are not invested in themselves. Many frontline health workers for example (nurses, CNAs, environmental, nutrition, administrative, tech positions, patient intake/registration) are not given behavioral skills education, leadership and development training, and don’t see how their own role contributes to the success and vision of the hospital/health system.

So…… how can we help our first-level managers?

Prepare them with emergency scenario information and to be adaptive

Don’t let your managers get caught flat-footed the next time a health crisis happens, be it a mass trauma event, natural disaster, terrorism, etc. Prepare communication chains from the top-down, then teach managers how to communicate and collaborate in a coordinated manner, giving managers autonomy to communicate how they feel is best for the team.

Improve hiring and promoting decisions, then focus on development

Systems need to evaluate and hire managers based on ability to serve the team. Do managers have the communication and people skills to get the most out of the team? Teach managers to hire or promote employees who seek to find operational answers to tough questions, not to answer all these questions themselves. Encourage managers to use skill and experience to develop the team, not to be the most “hands on” working member of it. This could lead to burnout, and will assure managers are not focusing on the right things.

Teach managers to focus on key behaviors of associates, and hold managers accountable

Managers tend to be evaluated by immediate and operational standards, such as were patients rooms cleaned quickly, is food service running effectively, or are patients and their families in the right spots for proper care or services. And at a higher level, hospital administrators look at HCAHPS and performance success indicators/patient scores to indicate how well a hospital is performing. But for evaluating a manager, these operational metrics can give an incomplete picture of management value. Other suggestions could be:

  • Making sure managers have a pulse on their intentional retention rates: Every manager should be able to identify who the performers are they want to keep, who are highest performing who may be lost to promotion, and which employees are not meeting expectations or could be more successful in other departments.
  • Keep managers focused on promotion rates: Managers are the first window into employees’ career pipelines, and/or career ladders for the organization. Managers should be preparing individuals to be promoted, and to take on more responsibilities and to learn more skills. If a manager never loses associates to promotions, they may not be developing their people well. See our related article, Geisinger (PA) Builds Career Pipelines for Individual Contributors.
  • Teach managers how to coach: While employees may understand tasks needed to perform in their daily job, they may struggle with more basic concepts such as time management or communication. A good manager helps frontline employees learn these and other soft skills because it makes the workers more effective in their jobs, and more satisfied with the work they do. See our related article, Frontline Employees: Coaching For Success.

Teach Managers to think about increased productivity and retention of their employees

Healthcare, just like retail, hospitality, and agriculture, struggle with frontline employee turnover and consistent productivity. It is difficult to simultaneously keep employee productivity high and turnover low. But there are a few tactics that can help our managers with productivity and retention:

  • Measure ROI from an organizational level
  • Teach managers to brainstorm moral improvement tactics for their team
  • Teach managers to give praise and better communication techniques
  • Encourage managers to help employees to build a personal development plan

See our related article, Increase Productivity and Retention of Entry-Level Employees.

Now we’re entering a new, brighter reality, with the world getting “back to normal” quickly after COVID-19. That is a really good thing! But when we look back at where we can improve on in the future, especially knowing that other traumatic events will occur, lets ask “were our hospitals managers prepared?” Did the pandemic push managers to the brink, or did it expose that they didn’t have the right skills to lead high performing teams in any environment? In all sectors of the U.S. economy, one thing we learned in the last 15 months is that front-line managers are critical to team success, and that many were not ready for the challenge. This is a risk going forward, so be proactive in how you prepare managers.

“Health Care Management During COVID-19: Insights from Complexity Science,” James W. Begun PhD, H. Joanna Jiang, PhD, NEJM (New England Journal of Medicine) Catalyst, October 9, 2020

“6 Healthcare leaders share the most difficult aspect of their job,” Kelly Gooch, Beckers Hospital Review

“COVID-19 didn’t challenge managers, it exposed them,” Brian Watkins, Chief Learning Officer, May 27, 2021

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