The Manager as Helper

In his tireless search for excellence in project management, the late Alexander Laufer sought the expertise of those in professions not typically associated with project management, but who still had to manage a diverse group of people for endeavors that were either temporary or in flux. One such expert, Linda Procci, during her forty-year career served as a clinical nurse specialist, a director of training in nursing, and as vice president of operations at two major hospitals in Los Angeles. This article is based on Laufer’s interview with her.

Over the course of her career, Procci has become very skilled at dealing with people in positions of power. Unlike in many other professions, in healthcare, those being managed—the doctors—often have more clout than those managing them. But Procci swears by two strategies to help her handle such high-maintenance team members.

Facts Over Emotion

The first is to rely on facts rather than emotion. Doctors can get pretty worked up when things don’t go the way they want, but Procci learned to appeal to their scientific orientation—in particular, their trust in facts and evidence. Early in her career, she sometimes met their anger with anger, but she discovered that “arguing or expressing frustration are not workable strategies; they actually only backfire on you. “

So she learned to remain calm in the face of hot tempers and anchor the discussion in factual evidence.

I’m Here to Help

She also discovered the value of presenting herself as a helper rather than a boss. As Procci says, “I learned over the years that most people, when they’re feeling their back against the wall, are going to lash out at whoever is sitting in front of them. It’s very difficult not to take it personally, but it’s not personal. I found the best thing for me to do would be to just say, ‚ÄòI am here to help you. Think about it, stop yelling. In the last few weeks, last few months have I generally helped you when I said I would help you?’ “

Of course, before she could say that, Procci needed an established track record of reliably helping. But once she did establish her approach consistently, it was easy to remain calm and tell her team, “Let’s look at the evidence and solve this. “

The Rankings Problem

Procci recalls one specific challenge that required her to put her strategies to the test. She was in a meeting with several doctors, who began grilling her about why they weren’t getting as many patients as other hospitals in the area. The doctors claimed they were better than their competitors and thus blamed management for not providing effective marketing.

But Procci challenged them: “Show me the evidence [that we’re better], ” she said. She pulled up the publicly-accessible Medicare data, which showed that their institution had a higher mortality rate than many of the competitors in the area.

The doctors said that couldn’t be true, to which Procci responded, “Why don’t we review all the charts from last quarter and see where these numbers are coming from? ”

Of course, she already knew the answer: the doctors weren’t killing patients; rather, their documentation and coding for the observed-to-expected mortality ratio was failing to account for the patient’s severity of illness beyond the control of the doctors or the hospital. She had been trying for a while to talk the doctors into being more thorough in their documentation and to eliminate abbreviations. They seemed to be unaware that the medical records coders could not read minds and that, according to federal regulations, they were not allowed to alter the documentation to express what they thought the physician might have intended.   

In helping the doctors understand the nature of the problem, she was able to get them to see that such a change was actually serving their interests. She “was just there to help. ”

In the end, the doctors created new forms that prompted them to more completely document the patient’s condition/illlness, and in “a few quarters when the data came out on the publicly reportable website, suddenly the hospital moved from the 65th position up into the top ten. ”

Finesse the Power

Procci’s experience with the doctors is as much a lesson for how to deal with a team working for you as it is for how to deal with your higher-ups. If stakeholders aren’t seeing the problem from your point of view, consider some or all of her strategy:

1. Frame your role as a helper.
2. Demonstrate how the target group is affected by the problem.
3. Present a factual analysis of the problem’s root cause.
4. Involve them in coming up with a solution.

Procci’s principle skill may have been her ability to finesse the power dynamics of the stakeholders in any given project. And she accomplished that by having a very good idea of where those stakeholders were coming from.

A Final Tip

While you can accomplish a lot just by talking to people, Procci advises actively attempting to understand how organizational decisions get made. She suggests joining the board of directors for a small community organization. Why? To get some experience being in a “different place in the org chart. ”

If you serve on a board, she explains, “suddenly you’re looking down while before you were used to looking up; you actually need to see the view from another place at the table. ” Procci says her experiences working on various boards gave her insights into power dynamics and organizational decision-making that she got nowhere else.  

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