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Management Skills for

Clinicians, Volume II
Management Skills for
Clinicians, Volume II
Advancing Your Skills

Linda R. LaGanga

David Dilts
Larry Fredendall
Management Skills for Clinicians, Volume II: Advancing Your Skills
Copyright © Business Expert Press, LLC, 2019.

All rights reserved. No part of this publication may be reproduced, stored

in a retrieval system, or transmitted in any form or by any means—
electronic, mechanical, photocopy, recording, or any other except for
brief quotations, not to exceed 250 words, without the prior permission
of the publisher.

First published in 2019 by

Business Expert Press, LLC
222 East 46th Street, New York, NY 10017

ISBN-13: 978-1-94999-132-1 (paperback)

ISBN-13: 978-1-94999-133-8 (e-book)

Business Expert Press Health Care Management Collection

Collection ISSN: 2333-8601 (print)

Collection ISSN: 2333-861X (electronic)

Cover and interior design by S4Carlisle Publishing Services Private Ltd.,

Chennai, India

First edition: 2019

10 9 8 7 6 5 4 3 2 1

Printed in the United States of America.

Volume II helps readers advance their skills to thrive in administration.
The focus is on enhancing relationships, your workplace culture, and
your comfort with business practices for effective budgeting, financial
management, hiring activities, and human resource management while
building your momentum and growth. Advancing your communication
skills will help you grow and improve as you foster the growth of those
you manage and lead. You will learn to embrace conflict and handle
it constructively. Developing your business skills in hiring, human re-
source management, and financial management will help you garner
and administer the resources that support your team’s important work.
Recognizing and developing the strengths of you and your team mem-
bers strengthens performance and motivation to sustain your success as
a health care manager.

management; hiring; business skills; budgeting; workplace culture; health
care administration; strengths assessment; conflict management

Chapter 1 Enhancing Your Relationships at Work: Managing

Communication, Feedback, and Conflict...........................1
Chapter 2 Hiring and Engaging People in a Culture of Well-Being......27
Chapter 3 Business Basics: Finance and Budgeting Are Not Just
for Accountants!...............................................................65
Chapter 4 Where Do You Go from Here? Keeping the
Motivational Fire Burning..............................................103
Appendix A Grant Funding: Why or Why Not?................................129

About the Author.................................................................................143

Continuing Your Journey, from Volume I to Volume II

As a health care manager, you know there are many skills for you to learn
and practice. These help you leverage your valuable clinical training and
experience to maximize your effectiveness as a health care manager and
administrator. These books focus on the management skills you are likely
to need at appropriate points in your professional journey. Topics are
­organized into two volumes:

• Management Skills for Clinicians, Volume I: Making the Transition

from Patient Care to Health Care Administration
• Management Skills for Clinicians, Volume II: Advancing Your Skills
to Thrive in Administration

In the first volume, Management Skills for Clinicians, Volume I:

Making the Transition from Patient Care to Health Care Administration,
we helped you shift your focus from working with individual patients to
working within a system of care where you manage people and administer
resources to serve your organization’s populations of patients. The chap-
ters in that volume helped you understand the special features of manag-
ing in health care settings. You learned how to take charge to lead your
team, manage the performance of those who report to you, involve others
in planning, organize your activities, and influence others around you
to collaborate with you. You gained skills to build relationships with the
people you manage, such as your boss, and others around you. ­Volume I
prepared you to manage in all directions. You learned to lead other pro-
fessionals and administer many necessary activities that keep health care
organizations running smoothly.
Here in this second volume, Management Skills for Clinicians, Volume II:
Advancing Your Skills to Thrive in Administration, we delve further into
your growth and development in your management role. As you develop

and gain experience as a manager, you will encounter continuing oppor-

tunities to advance the skills you worked on in the first volume and to
learn new specific business skills we will cover now in this second one.
Here you will learn more about enhancing your relationships along with
building a positive workplace culture on your teams and more broadly
throughout your organization. You will gain familiarity and comfort with
business practices for effective budgeting, financial management, hiring
activities, and human resource management while building your momen-
tum and growth.
Advancing your communication skills will help you grow and improve
as you foster the growth of those you manage and lead. You will learn to
embrace conflict and handle it constructively. Developing your business
skills in hiring, human resource management, and financial management
will help you garner and administer the resources that support your team’s
important work. Recognizing and developing the strengths of you and
your team members strengthens performance and motivation to sustain
your success as a health care manager.
More information is provided in the following text to help you navi-
gate these books to provide timely help in your managerial journey. First,
I would like to offer a view of where and how the material for these books

Background from the Author

As the author of these books and a health care manager myself, I have
been there with you, experiencing joy and enrichment with new op-
portunities to develop mastery of skills that stretch our capabilities, and
struggling with unexpected challenges revealed by new situations we had
not yet experienced.
Before writing these books, I worked for almost 30 years in progressive
levels of management. After completing an advanced degree in a clinical
field, I earned clinical credentials through testing and experience, made
the transition from clinician to manager, and progressed to executive lev-
els of leadership leading large departments in two large behavioral health
centers. I am a Licensed Professional Counselor, National Certified Coun-
selor, and certified Mental Health First Aid Instructor. Before becoming a

therapist, I was in high-technology settings and the computer software in-

dustry, where I worked my way from customer service and technical con-
sultant positions to become a supervisor, then a manager, and continued
to progress into senior and executive management. I have led clinical,
technological, quality, customer service, and analytical operations. While
experiencing the challenges of operating effective health care delivery with
limited resources, I decided to update my skills to optimize the allocation
of clinical resources. I returned to school and earned my PhD in Oper-
ations Research. My doctoral dissertation and research have concentrated
on improving access to health care services.
Many of the people I have worked with provided helpful leadership
by example that inspired descriptions in this book. This book reflects
valuable lessons from the Mental Health Center of Denver (MHCD),
where we built the foundation for a thriving culture that promotes the
well-being of its employees and clients. The mission of MHCD is “En-
riching Lives and Minds by Focusing on Strengths and Well-Being,”
founded on the philosophy that “people can, and do, recover from mental
illness and that treatment works.”1
MHCD is focused on making a difference in the lives of tens of thou-
sands of people every year, on mental health literacy inspiring people to
become messengers to the larger community, and on expanding access
to effective and compassionate treatment. MHCD has been named as a
Top Workplace by the Denver Post for 6 years in a row, was honored as
the Top Company in 2017 in Health Care by ColoradoBiz Magazine,
has earned numerous awards for innovative projects that enhance the
well-being of the community, and is recognized internationally for mea-
suring and improving treatment outcomes.
MHCD is where I experienced the initial transition in my career from
clinician to manager—first, from providing direct clinical care, then to
managing teams and staff, and later to higher levels of executive manage-
ment responsibility. Lessons from this exemplary workplace, and inter-
views with many of my colleagues there, are included in this book.
I gathered helpful input from many others, including my colleagues at
Mental Health Partners (MHP). As a member of MHP’s executive man-
agement team, I participated in the development of its Mission, Visions,
and Values: “In alignment with our mission—Healing is our purpose.

Help is our promise. Health is our passion. MHP provides immediate ac-
cess to expert mental health and substance use care so people can enjoy
healthy and fulfilling lives. Our vision is for Healthy minds. Healthy lives.
Healthy communities. We accomplish this through our core values:

Empathy: Putting ourselves in others’ shoes.

Hope: Believing in positive possibilities for every person.
Healing Environment: Providing a safe space where people feel
Wellness: Supporting long-term health and well-being.
Teamwork: Realizing the power of working together with humility
and trust.
Partnership: Building relationships to strengthen our communities.
Excellence: Pursuing the best in everything we do.”

MHP collaborates with many organizations throughout the com-

munity to deliver integrated and coordinated care, with work in shared
locations with primary care physicians. An innovative comprehensive
health home brings together treatment providers in one location for men-
tal health, physical health, and dental services. “The health team works
together to meet all of a patient’s needs and improve their overall health”2
MHP was one of four community mental health centers accepted into
the Colorado State Innovation Model (SIM), a federally funded, gover-
nor’s office initiative that helps health care providers deliver whole-person
care. According to Colorado Lieutenant Governor Donna Lynne, “SIM
providers must focus on the entire patient, which means addressing
mind, body and mental wellness. That complete approach to health is
what makes the SIM initiative so valuable. Patients get the care they need
when they need it, and providers learn how to succeed with new payment
models. It’s a great example of meaningful reform in our state.”3
To broaden my perspective outside the settings where I have worked,
I also spoke with nurses, MDs, and many professionals with experience
in other health care systems and hospitals throughout the United States.
Some of them I met through professional associations and applied re-
search activities on improving health care systems. Together, many of
us have collaborated in bringing effective management and leadership

practices from prior work settings, then adapting them to fit new set-
tings to enhance our work cultures and help our people develop. This is
reflected in many of the examples you will see in this book.
To help you in your development as a health care manager, chapters
are developed around the skill areas identified by this book’s editors and
author, from our experience in health care, as crucial to the success of
health care managers.
Successful health care leaders need a variety of skills to manage effect-
ively in the complex and challenging arena of health care, where risks and
rewards can have major impacts on the well-being and safety of our pa-
tients and care recipients. Such skills are described and illustrated with the
actual experiences shared by many health care management professionals,
along with recommendations from many management books and articles.
Learning activities and discussion questions are offered in each chap-
ter to help you assess your proficiency, apply new knowledge, and increase
your mastery of the material. Personal skills and abilities are included to
focus on how you relate to and communicate with other people, some-
times referred to as “soft” and “people skills” or with the ability to recog-
nize and manage our emotions, as “emotional intelligence.”4 While some
of the chapters focus on more “technical” or “nuts-and-bolts” skills such
as hiring and budgeting, integrated throughout the book are the softer
leadership skills that you need to successfully manage in these other areas.

Contents and Organization of Management Skills

for Clinicians, Volumes I and II
This two-volume set of books consists of:

• Management Skills for Clinicians, Volume I: Making the Transition

from Patient Care to Health Care Administration
• Management Skills for Clinicians, Volume II: Advancing Your Skills to
Thrive in Administration

Volume I guides readers through the essential knowledge and under-

standing they need to develop as soon as they transition to new manag-
erial roles. The emphasis is on shifting focus from caring for individual

patients to taking broader responsibility for leading other professionals

and administering the necessary activities that keep health care organiza-
tions running smoothly. The chapters focus on understanding the special
features of managing in health care settings, taking charge to lead your
team, managing performance of those who report to you, essential skills
for planning and organizing, and building relationships with the people
you manage, your boss, and others around you.
Volume II helps readers advance their skills to thrive in administra-
tion. The focus is on enhancing relationships, your workplace culture,
and your comfort with business practices for effective budgeting, financial
management, hiring activities, and human resource management while
building your momentum and growth. Advancing your communication
skills will help you grow and improve as you foster the growth of those
you manage and lead. You will learn to embrace conflict and handle it
constructively. Developing your business skills in hiring, human resource
management, and financial management will help you garner and admin-
ister the resources that support your team’s important work. Recognizing
and developing the strengths of you and your team members strength-
ens performance and motivation to sustain your success as a health care


We introduce new managers working in health care to the basic skills and
competencies to support them in transitioning to their managerial roles.
We guide readers in the activities they will handle initially and later as
they arise in organizational cycles, such as budgeting and hiring. We also
offer topics and examples that can help more experienced managers reas-
sess and revitalize their skills.

Target Audience

We target clinical staff who have been promoted recently into managerial,
supervisory positions. The targeted reader has clinical training and experience,
and little or no business management training and experience. More experi-
enced managers can benefit, too, from collected insights of other managers
who were interviewed and from examples in recent and revisited literature.

How to Use These Books

We cover both “hard” business skills and “soft” people/organizational

skills. These books draw from books, articles, examples and managerial
experience of the author and colleagues at different organizational levels
and throughout health care settings and professions.
As you see examples from health care managers who were interviewed
for these books, consider how you could apply their approaches effectively
to align with your strengths and the characteristics of the organization where
you work. Tables developed in these books provide a foundation for you to
develop tools tailored to what would work effectively in your environment.
Review the frameworks described from other literature and practice apply-
ing them in your managerial and administrative activities. As you gain ex-
perience as a manager, experiment with what is offered and build your own
tool sets to boost your effectiveness and to contribute to your organization.
Health care management is complex with a wide range of interrelated
activities that a manager will likely encounter, often in the same day or
workweek. Volume I covers the things most needed from your first day
as a new manager. You also may encounter other topics—such as hiring
and budgeting, which are examined in Volume II–early in your new role.
As your needs unfold in your management role, you may find it helpful
to shift from reading sequentially the chapters in each volume to delving
more deeply into specific chapters and sections that address the issues you
are encountering.

Chapter Descriptions
Volume I: Making the Transition from Patient Care to Health
Care Administration

Chapter 1. Introduction to Health Care Management

This chapter introduces the unique challenges of new health care managers,
explains their importance, and provides practical guidance to help you suc-
ceed in these new situations. Insights and themes from interviews and con-
versations with 64 health care managers and administrators are summarized.
We identify some special features of managing in health care and the par-
ticular challenges in refocusing your clinical training to succeed as a health

care manager as we apply some of the lessons gleaned from interviews. Initial
activities are proposed to help you get started in comprehending the scope
and skills that health care managers need to learn and master.

Topics in This Chapter:

• Motivation for developing management skills
• What’s so special about health care management?
• Interviews from a variety of perspectives
• Interview questions
• Themes from interviews
• Who can help? Get a mentor!
• Chapter summary and key points
• Introductory activities to get you started

Chapter 2. So, Now You Are in Charge! Leading Your Team

and Managing When Others Report to You

You are in a new role now with supervisory responsibilities. This requires
you to transition from being a team member to the team’s leader. You
need to establish credibility and earn the respect of others for new capa-
bilities you are developing. You will need to treat others fairly and avoid
granting special treatment to those who have been your friends. Mentors
and peers can help you in your development so you do not have to figure
things out all by yourself.
We will show you how to communicate your expectations for behav-
ior and performance to help your people perform well. We also look at
what you need to do when things do not work out and improvement is
needed, or you need to fire people who report to you.

Topics in This Chapter:

• What is different about being a manager
• Delegating responsibility to others
• Power and trust in your new managerial role
• Setting expectations and communicating them
• Accountability without fear and blame
• Performance expectations

• Coaching for performance and development

• Performance tracking and planning
• Performance problems
• Chapter summary and key points
• Learning activities for this chapter

This chapter in Volume I focuses on how you get started in your new
role with responsibility for managing others. Soon, you will develop more
skills for creating a positive working culture, building a strengths-based
team, selecting and hiring new people. Further information on these and
other topics related to work culture, employee strengths, and hiring, are
found in Volume II, Chapter 2.

Chapter 3. Planning and Organizing

You will face new challenges and be expected to make decisions in your
role as a health care manager. Learning to lead with structure and apply-
ing some management tools can help you to take charge confidently as
you plan, organize, and get things done.

Topics in This Chapter

• Planning and being proactive
• Organizing and leading meetings
• SBAR: a tool for effective meetings and other decision making
• How decisions are made
• Honoring your commitments for getting things done
• Managing your time and yourself
• Managing my time and myself: What I have learned and
• Chapter summary and key points
• Learning activities for this chapter

Chapter 4. Managing Up, Down, and All Around!

Being a manager involves supervising and leading the team of people who
report to you, and communicating clearly what you expect them to do.

In Chapter 2, we looked at how you take charge and get started in that
part of your role, and continued in Chapter 3 with structured techniques
to help you plan and organize. Now, let us consider other important
people in your new world of management.
It is vitally important that you build a positive relationship with your
boss and ensure you are meeting your boss’s needs and expectations of
you. Those you work with as colleagues and peers also are important in
your work world. We explore ways for you to build and sustain important
relationships in multiple directions. You will gain wider perspective and
effectiveness as you practice managing up, down, and all around! These
are essential skills as you make the transition from providing direct pa-
tient care to managing the people and other resources involved in health
care administration.

Topics in This Chapter

• Your new world and who is in it
• Managing up: your important relationship with your boss
• The importance of influence
• Building positive relationships
• Up, down, and all around for your successful transition to
• Chapter summary and key points
• Learning activities for this chapter

Volume II: Advancing Your Skills to Thrive in Administration

Chapter 1. Enhancing Your Relationships at Work: Managing

Communication, Feedback, and Conflict

Your success as a manager requires that you build positive relation-

ships. In Volume I, Chapter 4 titled “Managing Up, Down, and All
Around!” we examined the essential relationships you need to estab-
lish with the people who report to you and with your boss whom
you report to. We also looked at ways to connect with others in your
organization to help you gain comfort in reaching out and building
important relationship foundations. These topics helped build your

awareness and skills for managing up, down, and all around the or-
ganization you work in.
Now it is time to enhance your relationships and work through some
more advanced skills. It is natural that the various people you work with
have different perspectives, so you can expect disagreements to arise. In
this chapter, we extend your skills and effectiveness in communicating,
giving and receiving feedback, and handling conflict. You will gain wider
perspective and more experience as you practice building relationships
and strengthening them all around you at work!

Topics in This Chapter:

• Reflecting on related topics in Volume I
• Communication guidelines
• Giving and getting feedback
• Conflict in work relationships
• Chapter summary and key points
• Learning activities for this chapter

Chapter 2. Hiring and Engaging People in a Culture of Well-Being

Health care is all about people, who deliver treatment and keep the or-
ganization running effectively to meet the needs of the people we serve,
our patients. In this chapter, we focus on these crucial human resources,
the people who do the work on the team you manage. We will look at
the value of creating a great place to work and the profile of a health care
organization that built a work culture where people can thrive.
Then, we examine the specific things you need to do to hire people
and get them started in their work on your team. We will look at how you
hire, engage, and retain these people to do their best work. We show you
the value of your Human Resources team and identify the things they can
help you with, and when you must consult with them to hire new people
and bring them onboard.

Topics in This Chapter

• The importance of people!
• What makes an organization a great place to work?

• Using strengths in your team

• Your roadmap to hiring and human resources
• Hiring: Getting started
• Organizing your selection process
• Interviewing and selecting: What are you looking for and what
should you ask?
• Compensation, terms, and job offers
• Welcome aboard and setting the tone
• Chapter summary and key points
• Learning activities for this chapter

Chapter 3. Business Basics: Finance and Budgeting Are Not Just for

Why do you need to know budgeting and finance? This chapter will
answer this question by explaining some basic financial and budgeting
concepts, why they are important for every manager to know, and how
an effective manager uses these ideas. We will look at financial aspects of
your organization that you need to know about to manage effectively. We
start by reviewing why money is important to keep your organization
and team running. We will explain budgeting and examine an example
of a team budget to help you see what you need to track and manage. We
will look at some financial measures for your organization and help you
interpret them to understand the financial health of your organization.

Topics in This Chapter:

• Why money matters
• Profit: What it means and why it is important, even in nonprofit
• Budgeting for what you are managing
• Your budget: What does it look like and what does it tell you?
• Big picture financial health of your organization
• Recommendations for successful financial management
• Applying financial principles in clinical practices
• Chapter summary and key points
• Learning activities for this chapter

Chapter 4. Where Do You Go from Here? Keeping the Motivational

Fire Burning

In this final chapter, we wrap up your journey toward being an effective

health care manager. We shift from the skills you have been learning in
earlier chapters to do your job now, consider how you sustain your mo-
mentum, and look ahead to your future. We will look at how you balance
areas of your life and renew yourself, sustain your success, address chal-
lenges that signal the need for changes, foster your growth and develop-
ment, benefit from others helping you to improve, move from success to
significance, and continue to fuel your passion for the work you do.

Topics in This Chapter

• Highlights of your journey to here
• Leaders who are burning bright
• Balance and renewal
• Sustaining your success at work
• Your growth and improvement
• Outward and onward!
• Chapter summary and key points
• Learning activities for this chapter
I am grateful to my family, friends, and many colleagues for your enthusi-
astic support, encouragement, and helpful suggestions along the way.
I appreciate your patience and understanding as I dedicated my time and
attention to writing this book.
I am grateful to the editors of this Health Care series, David Dilts
and Larry Fredendall, for approaching me with the idea of developing
this book to fill a need you noticed in your work with health care orga-
nizations. Many thanks to you and publisher Scott Isenberg at Business
Expert Press for your guidance, encouragement, feedback, and great sug-
gestions that strengthened the usefulness of this book to the clinicians
and managers we intend to reach. Thank you to Charlene Kronstedt for
guidance on technical publication requirements.
I appreciate many helpful conversations with Ginny Trierweiler, PhD,
a licensed psychologist and professional coach who has helped many or-
ganizations and leaders to build their managerial effectiveness. In helping
me conceptualize important areas to address in this book, she pointed out
how power differences between managers and those they supervise can af-
fect the transition for clinicians who are promoted to manage teams they
worked in with former peers. I appreciate her wisdom about the clarity
needed to transition from the role of individual clinician to manager and
her suggestions for doing that successfully.5
Special thanks to Curtis V. Smith for volunteering to proofread and
offering helpful writing suggestions.
Thank you to the many professionals and organizations who gener-
ously shared their experiences with me in interviews and other conver-
sations that helped to develop this book. They are all people whom I
noticed and admire, or were referred by trusted colleagues, for their ap-
proaches, skills, experience, and contributions to the arena of health care
management. Their insights and comments are included throughout the
book. Everyone is listed in Appendix A of Volume I, along with selected
highlights of interviews and conversations.

Enhancing Your
Relationships at Work:
Managing Communication,
Feedback, and Conflict

Reflecting on Related Topics in Volume I

Your success as a manager requires that you build positive relation-
ships. In Volume I of this series, our chapter on “Managing Up, Down,
and All Around!” examined the essential relationships you need to es-
tablish with the people who report to you and with your boss whom
you report to. We also looked at ways to connect with others in your
organization to help you gain comfort in reaching out and building
important relationship foundations. These topics helped build your
awareness and skills for managing up, down, and all around the organ-
ization you work in.

Chapter Overview
Now it is time to enhance your relationships and work through some
more advanced skills. It is natural that the various people you work with
have different perspectives, so you can expect disagreements to arise. In
this chapter, we extend your skills and effectiveness in communicating,
giving and receiving feedback, and handling conflict. You will gain wider
perspective and more experience as you practice building relationships
and strengthening them all around you at work!

Topics in this chapter:

• Reflecting on related topics in Volume I
• Communication guidelines
• Giving and getting feedback
• Conflict in work relationships
• Chapter summary and key points
• Learning activities for this chapter

Communication Guidelines
Take initiative for communicating with others. This helps you build
positive relationships, shows your loyalty to those you work with, dem-
onstrates your capabilities for managing proactively, and often leads to
better solutions and results.

Listening to Build Understanding and Open Dialogue

Stephen Covey advises, “Seek first to understand, then to be under-

stood.”1 Covey recommends listening with empathy to fully and deeply
understand another person, the way she feels and sees the world. Good
listening builds positive relationships and helps us avoid jumping to
Gene Dankbar of Mayo Clinic heightened his skills by taking classes
in improvisational comedy, where there is practice in open communi-
cation by accepting and building on the ideas of others.2 With the ap-
proach known as, “Yes, And,” people learn to improvise by agreeing with
the previous statement by someone else (with “Yes”), then building on
that idea with something new (linking it with “And”). This promotes the
flow of creativity and helps teams create more ideas, rather than shutting
down contributions with a response such as “No, But.”3 When we say
things like, “No, that won’t work here,” or, “But we already tried that and
it didn’t work,” we communicate our resistance to other people’s ideas.
Instead, try building your alignment with others by communicating your
agreement or acknowledgement that their ideas have merit, and then add
what you think could enhance it.

ABCs of Dialogue with Agree, Build, and Compare

An option for building dialogue with others is the “ABC” approach of

Patterson et al. (2012) to Agree, Build, and Compare.

Start with Agreement

Look for and start with the points of Agreement. If you completely agree
with where another person is going, say so and move on.

Agree and Build

If you disagree with some of the points, then Agree and Build. Similar to
the “Yes, And” approach, you could say, “Absolutely. In addition, I no-
ticed that . . . ” to add the pieces that are important to you and missing
from his position.


Then, rather than suggesting the other person is wrong, you could suggest
where you differ by moving to Compare to describe how you see things
differently and “invite the other person to help you compare it with his
or her experience. Work together to explore and explain the differences.”
This approach can help you avoid turning differences into arguments that
interfere with healthy relationships and good results.4
Here are some illustrations of how this could work.

Example 1

• Start with Agreement: “Absolutely, the new automated shift

­scheduling system made it much easier to plan for coverage over
the holidays.”
• Continue to Build: “In addition, I saw there were still some last-
minute schedule adjustments.”
• Next, Compare: “Did you see that, too? What do you think we could
do to build some backup staffing plans now to cover unexpected
changes quickly without disrupting the affected staff members?”

Example 2

• Start with Agreement: “It sounds like our new on-site pharmacy is
convenient for our patients and they report they get quick refills
and good customer service.”
• Continue to Build: “And the nurses on my team tell me they aren’t
getting timely information when something changes.”
• Next, Compare: “Do you know how the pharmacists on your team
handle these changes and if they’ve had any problems communi-
cating with nurses?”

As you listen attentively, you can ask questions that help you under-
stand other people’s perspectives and priorities as you build alignment
with them. It goes a long way toward preventing some uncomfortable
conflict, and can be useful in working constructively with it when it in-
evitably emerges. We consider conflict more deeply in the final section of
this chapter.

“Be Mindful of the Weight Your Words Carry”

This advice from Chris Radigan, LCSW, considers how our words can
set the tone for people’s reactions and acceptance of us and our plans.
It is important to remember that different people interpret words dif-
ferently, especially with e-mail and the interpreted tone of requests and
questions, which might differ from what you intended. Some things are
best communicated in person; it is helpful to explain changes, why they
are happening, and to ask for feedback. When Chris was a new manager,
this approach helped establish trust with his staff to enlist the buy-in and
support of his team members.5

Written Communications

If you do communicate via e-mail or written memos and reports, summa-

rize succinctly in the subject or opening words the purpose of your com-
munication and what, if any, action is needed from your boss or others.
This helps bosses (and others in your communication loop) manage the
information overload coming their way in many organizations, and to

understand clearly and appreciate the good work you are doing. Imagine
how helpful this can be for you if your boss’s boss hears of a problem and
asks your boss about it and your boss can confidently respond about the
constructive and proactive activities you are already planning and leading.

Be Alert to Communication Omissions

Communicate with your peers and others in the organization about changes
and activities that impact their work or lie within their areas of responsibil-
ity. Make sure you never make commitments to others or communicate
decisions that were someone else’s responsibility to make or approve!
Have you ever been in a situation where you found out something
was decided or happening, and you did not know anything about it, even
though it was something you had the authority to approve, veto, or re-
shape? Imagine how you would feel in your personal or family life if you
were told you were going to be cooking dinner for your large extended
family, whose members have a long list of dietary requirements and par-
ticipants, you would never have agreed to do it, and perhaps you do not
get along with that branch of the family!
Or someone in your household or neighborhood informed you that
you would be picking up all the local soccer team members after their
practice, on the same afternoon you had committed to facilitating a train-
ing session for an organization you lead. Or what about those friends of
yours, back in high school, who you discovered were planning a party at
your house the weekend your parents were going away? It is lucky that
you found out about it and curtailed that one before having to explain
to your parents why there was something different about the house when
they returned!
Things like this happen at work, too. Maybe someone who reports to
you executes a plan that should have had your support or approval but
they failed to include you in the planning and communications. Suppose
that plan or decision interferes with other activities in the organization,
alienated your colleagues, and required you to intervene to fix the dam-
age. Did that make you want to support the activity or decision that was
dropped onto you, or the person who instigated the situation? Do not be
that person to your boss or others!

Situations like these often happen when people assume that others
support their plans, but they do not take the time to check or have direct
conversations with those who need to be involved. Being intentional in
our communications cultivates more productive flows of information and
mutually supportive relationships.

Healthy Communication

You may hear people referring to communication and power issues as

merely “office politics” and not to be taken seriously. They may be confus-
ing healthy awareness and communication with unhealthy indirect com-
munication and gossip about other people who are not present, which,
indeed, should be avoided. As career expert Dale Dauten (2011) explains
bluntly in a column to a reader who wrote in for advice,

I know there are people reading your remarks and getting huffy
about “company politics.” One of the dumbest things I hear smart
people say is, “I do good work, and that should be enough—I re-
fuse to play politics.” Corporate politics is merely the art of getting
things done by communicating with people in the most effective
way, and that means using language that they understand and re-
spond to. If you declare yourself to be “above office politics,” then
you have declared you don’t really care about being effective and
don’t deserve to be promoted.6

You, in contrast, have already demonstrated through your qualifica-

tions and successful work that you do deserve to be promoted, and now
you are a manager! Keep in mind that while the label of politics may
carry negative connotations, influencing others is a very real and neces-
sary component of leading and managing at work.
Practicing clear communication skills as we have discussed here will
help you build the working relationships around you that help you in-
crease your effectiveness in leading your team and influencing others to
collaborate with you and support your goals. And, in addition to what
you say and how you say it, it is important to consider channels of com-
munication and making sure you include the right people—those who
have a need to know, the authority to decide, or the expertise to imple-
ment decisions effectively.

Including Others: Who Else Needs to Know?

At the Mental Health Center of Denver, we found it helpful to consider

“Who Else Needs to Know?” People quickly adopted this as WENK soon
after it was introduced to the organization by Mary Peelen, Director of
Health Information Management Systems, from her earlier experience in a
home health organization. The approach helped prevent problems by mak-
ing sure all relevant information and requirements were identified and con-
sidered ahead of time. This approach improved teamwork, collaboration,
communication, and project implementation throughout the organization.
It was especially helpful when we were awarded funding through
grants to start new clinical operations that required new tracking codes,
clinical outcomes analysis, service delivery, quality monitoring, and re-
porting across multiple functions and departments. WENK can be
implemented with a simple checklist and commitment throughout the
organization to follow it. The example in Table 1.1 is about a new clinic
funded by a community foundation to increase access to health care treat-
ment for low-income preschool children. You could develop a checklist or
adapt Table 1.1 for use in your organization.

Table 1.1  Example application of “Who Else Needs to Know?” model

Departments or How to Representative
teams that need inform and (Name or
Activities to know include position)
Allocate and Facilities and Invite to Post- Facilities director,
furnish space for Purchasing teams grant Award Purchasing manager
new clinic Meeting
Hire treatment Human resources Initiate hiring HR recruiter,
staff with recruiting team, requisition, Director of Children’s
experience in Program managers Review and services or designee
early childhood in early childhood update job
care treatment teams description for
clinical providers
Update electronic Accounting, Invite to next Controller,
health and Health Information Post-grant Award Director of Health
accounting Systems Meeting, Information Systems,
systems Log change Help desk coordinator
request in
Systems Support

Breaking Down Silos and Barriers

Several interview participants talked about “silos” and the importance of
breaking them down. Picture silos as distinct towers or receptacles hold-
ing resources that remain separate and do not get mixed with those from
other silos. Breaking down silos in organizations means working coop-
eratively across functional areas to share efforts and pool information and
other resources for the greater good of the organization. It requires that
we raise our vision beyond the confines of our individual goals and team
responsibilities and consider the broader mission and vision of our organ-
ization. Breaking down barriers can start with communication and appre-
ciation for the contributions of other people, especially in functional areas
outside your own team or department. We saw in the preceding text how
we could involve and include others in implementing changes by actively
considering who else needs to know and inviting them to participate in
Many people who were interviewed for this series of books men-
tioned the importance of building relationships with people in other
departments or functions in their organizations, especially in admin-
istrative areas such as human resources and accounting where their
guidance and expertise is valuable and often necessary. We will offer
more specific recommendations in the later chapters focused on those

Example 1: Working Across Internal Departments

When I assumed responsibility for a team that produced reports of services

that were paid for by county funds, it appeared that we were responding
to frequent ad hoc requests for information. In the past, clinical managers
had been responsible for handling the reports themselves, without a solid
system of scheduling and technology to assist them. Because the respon-
sibilities were distributed among so many different people, we lacked a
coordinated schedule for when the reports were due and expected by our
external customers.
Then I discovered that our contracts manager in the Finance depart-
ment had recently acquired a contract tracking system where due dates

were visible and responsibilities for reporting and delivering could be as-
signed and communicated to the right people. Now we had the tools,
and even the analytical team members available, to handle this efficiently,
which alleviated a reporting burden from the clinical managers who had
been scrambling to work these administrative reporting tasks into their
other responsibilities. We coordinated the right resources to establish a
predictable schedule for when the reports were due and expected by our
external contacts at the county.
My analytical team members knew ahead of time what they were re-
sponsible for and could manage their work schedules and due dates. They
began to communicate actively with external report recipients to clarify
expectations and negotiate what they could deliver if there were special re-
quests for customized reports. By planning, organizing, and communicat-
ing across teams and departments, we built more effective workflows and
more satisfying and productive relationships with our internal colleagues
and our external customers.

Example 2: Cultivating External Relationships

“Relationships and sponsorships matter a lot. I was loyal to the people

I built relationships with. It’s important to be protective of them.”
Jesús Sanchez, PhD, built and protected his external relationships
throughout his career in clinical, management, and administrative
roles. He fostered relationships with other units and organizations,
and knew it was important to get along with the people whom he
valued. He found that his relationships were helpful in getting the
job done.
For example, when he was an outpatient clinic manager, his posi-
tive and mutually helpful relationships with his counterparts in hospi-
tals helped the patients they both served to access the right levels of care
promptly and smoothly. He removed barriers for his team members by
working with his hospital counterparts to obtain needed resources such as
parking access so his clinicians could more easily do their work when they
needed to visit the hospital to coordinate with staff there. He valued the
help he got from his external working partners and preserved trust and

integrity in these relationships by making sure commitments he made

to them were upheld by his organization.7 This required him to com-
municate actively within his organization about the importance of these
external partners. He enlisted the support of others “up” and “all around”
in his organization whose help he needed to fulfill commitments and sup-
port the people who reported to him.

Example 3: Recognizing Cross-Functional Collaboration

Kelly Phillips-Henry, CEO of Mental Health Partners, supported and

communicated successes throughout her entire organization. She ex-
plained that in organizations that provide clinical services, administrative
contributions might not always be as visible or celebrated as direct clini-
cal activity, yet it is important for all staff members to recognize how the
activities throughout all of the organization have value and support the
organization’s work and mission.8 She recognized efforts from all parts of
the organization, including the fee collection project led by an admin-
istrative director, by sending an e-mail message to all staff to praise the
efforts of the leaders and everyone who had participated throughout the

Giving and Getting Feedback

Feedback takes many forms. When it conveys recognition or praise, it can
encourage more of a desired kind of behavior. On the other hand, it can
let people know when they need to correct or change something. Let us
start by looking at how you can give feedback positively.

Providing Positive Feedback

It is important that you offer positive feedback to the people who work
with you. This helps you build positive relationships by showing others
that you notice and appreciate their contributions and what they do well.
This demonstrates your goodwill toward them and establishes mutual
support and alliance. It is especially important that you provide positive
feedback to the people who report to you because it reinforces to them

that they are on the right path in doing what you want them to do. This
enhances their performance by making it likely that they will continue to
do the right things to achieve the goals you desire.
Motivation author Barbara Fielder (1996) suggests using a systematic
approach to track and ensure that you are giving positive feedback regularly
by putting 10 coins in a pocket to remind you to give someone positive
feedback, praise, or recognition. Each time you do it, move one coin to the
other pocket.10 I heard of a manager who was told he did not give enough
recognition to those who reported to him. He established a daily goal to
get all 10 coins moved to the other pocket by the end of the day. People
noticed a difference and felt more motivated in their work with him.
A colleague of mine, Bill Milnor at the Mental Health Center of
Denver, was intentional in developing the habit of noticing what others
were doing well and deliberately praising them. This earned him the
reputation of being a supportive mentor to many emerging leaders who
developed their skills and grew their managerial effectiveness through
his feedback and guidance. This illustrates Ken Blanchard’s and Spencer
Johnson’s recommendation for you to catch people “doing something
right” and offer immediate and specific praise and encouragement,
along with your positive feelings about their progress and contribu-
tions to the organization.11 Regardless of your method, the key point is
to notice the positive things people do and express appreciation. This
strengthens the performance of others along with your relationships
with them.

For Corrective Feedback, Start with Permission

A good way to set the stage for giving and receiving feedback is to apply
Harley’s (2013) recommendation that you ask permission at the start of
your working relationships. Ask people to be honest, encourage them to
tell you if they notice something you need to change or improve, and ask
for their permission for you to tell them if you see something getting in
the way of their success. Do not assume you are doing a good job because
no one has told you that you are not. You need to take control, verify
others’ perceptions, and let them know that you welcome their feedback.
This is crucial to your success.12 Her approach is effective with your boss,

peers, and those who report to you. Because of your positional power
as their manager, the people you supervise may be reluctant to tell you
the truth, but understanding their perceptions helps you know what you
should adjust or continue doing to be as effective as possible.
I noticed that my colleague, Vicki Rodgers at Mental Health Partners,
was straightforward and effective in using this approach. She explained
that she had learned to do this in earlier settings and had talked with
someone she had reported to about how to ask for feedback. She was
comfortable asking people she worked with, “If you’re ever uncomfort-
able with me or something I’m doing, feel welcome to call me on it.” This
allowed permission for someone who reported to her to tell her directly
when they were in supervision that the person felt that Vicki, her super-
visor, was distracted by other things, “I need your undivided attention.”
This prompted Vicki to refocus her attention on her supervisee, which
improved their interaction at that moment and in the future.13

Open Up to Receiving Feedback

“The physics are clear: close down and get worse. Or, open up and get bet-
ter.” According to Henry Cloud (2013), leaders are hungry for feedback.
Getting feedback means opening up to take in new information, beyond
your own perspective, about your performance and its effectiveness, along
with suggestions for improving it. He advises that you look outside of
yourself and even go outside your organization, as many of the managers
interviewed for this book did to learn from others with different experi-
ence and other points of view. This can help you open up and be honest
about your difficulties and vulnerabilities with independent and unbi-
ased external colleagues with whom you can be mutually supportive in
encouraging each other’s growth and development. Cloud recommends,
“Get coaching, join a leadership group or forum, avail yourself of con-
tinuing education, attend a leadership conference, and so forth.”14

Ask with “Start, Stop, Continue”

A simple and effective framework for getting feedback about your perfor-
mance is the “Start, Stop, and Continue” approach. It can be posed as a

question to others as, “From what you experience in working with me,
what should I start, stop, and continue to do?”
I was reminded a few weeks ago that it also can be used to reinforce
learning and assess progress of yourself or others in working toward goals.
Jean Rosmarin, PhD, my co-facilitator for a Mental Health First Aid
training class we conducted for our county sheriff’s department, asked
participants at the end of the class, “From what we covered today in class,
what will you start, stop, or continue to do to practice good self-care?”
This helped participants consider what they had learned and express an
intention to practice it, and it provided feedback to us as facilitators about
what they took away from the training experience. It helped us gauge how
effectively we had covered some of the topics, and helped us understand
some differing perspectives among our audience.

Conflict in Work Relationships

“Don’t take it personally if others don’t agree. Explain it and move for-
ward.”15 This advice from Jeff Zayach, MS, Executive Director of Boulder
County Public Health, reminds us that you must learn to be comfortable
managing people who have different perspectives and be able to move
forward even if not everyone agrees with your decisions. This requires
recognizing conflict when it happens, responding to it promptly, and re-
solving it with your words and actions.

Why and When Conflict Occurs

Conflict is part of life. It reflects different perspectives, preferences, and pri-

orities. People may disagree in their values and beliefs. They may have dif-
ferent interpretations of facts and other factors. It emerges with those who
report to you, coworkers, and those at higher levels. Often people just want
and believe different things. It could appear when others react to you in your
new management role and as you assert new authority as you work with
people with different perspectives, goals, and approaches. Sometimes people
violate expected behaviors and communication channels, perhaps uninten-
tionally. Understanding and setting expectations can help you avoid initiat-
ing unwanted conflict; see Volume I in this series for more help with this.16

Conflict was mentioned by a number of our interviewees who had

been selected for a new managerial role ahead of others who had been
with the organization longer and had sought the promotion to a manage-
ment position like the one you have now. Many said they had felt hesi-
tant, uncomfortable, or unsure what to say or do to smooth things over
and get people and relationships working well.
In some cases, the new manager’s boss was helpful in supporting the
new manager and not allowing others to ignore the new manager’s posi-
tional authority and exclude her from decision-making and communica-
tion channels. In other cases, the new manager’s boss was uncomfortable
and avoided direct communications or actions that could ease the disrup-
tion of hurt feelings and nonproductive behavior of those who had not
been chosen. If your boss is not actively reinforcing to others your new
authority, you could try asking him directly for such support. However,
if your boss is not willing or able to do this for you, you need to do it
Conflict can be healthy when it occurs in an open and respectful en-
vironment where productive discussion can reveal new understanding
between people who work together, or open up options and alternatives
that lead to better decisions. However, it can be unhealthy and destruc-
tive when it remains unaddressed and festers bad feelings, people become
entrenched in competing positions, believe they must exert power and
control over others, or view discussions as win-or-lose games in which
they must be the winner.
Although it can feel threatening and tense, there are healthy ways
we can work with conflict, which we should embrace rather than fear.
You have already seen techniques in the preceding text, including “Agree,
Build, and Compare” from Patterson et al. (2012) for listening and align-
ing with others to handle “crucial conversations.”17 Let us look at some
additional ways to manage these crucial turning points and guide them
to productive resolution.

Embracing Conflict

“Conflict can be welcome in helping to elicit and develop new ideas,”

as Jackie Attlesey-Pries, MN, RN, observed.18 Stephen Robbins (2013)

explains that conflict can be constructive when it improves the quality of

decisions by allowing various points of view to be heard, especially those
that are unusual or held by the minority. This can help a group consider
alternatives, challenge the status quo, and create new ideas.

Groups composed of members with different interests tend to

produce higher-quality solutions to a variety of problems than do
homogeneous groups . . . Evidence demonstrates that cultural di-
versity among group and organization members can increase cre-
ativity, improve the quality of decisions, and facilitate change by
enhancing member flexibility.19

“Now, Hear This with Love . . . ”

People really enjoy working with Fred Michel, MD, a former teammate
of mine, who recommends that we engage in conflict rather than avoid
it. He suggests some approaches he uses successfully, such as a cue to ease
into it without offense. For example, in team meetings, we recognized his
opening of, “Now, hear this with love . . . ” and accepted willingly what
followed because we trusted his integrity as he respectfully offered his op-
posing views or criticism of how things were working.
In working with others such as the medical team members Dr. Michel
manages, he sometimes starts with, “Good, bad, right, or wrong . . . ” to
set the stage for the clear direction about “this is what we need to do.”
He suggests aligning with others by starting with an apology to recog-
nize something difficult or uncomfortable in their world before making
a request. For example, consider starting with, “I’m sorry the weather is
so cold when you had to come out here today for our team meeting.”20
This could be the preface for a request such as, “Now I need to ask for
everyone’s cooperation in making sure our documentation is solid for the
coming Medicare audit.”

Adapting Cues for You to Use

How might you apply these suggestions in working through conflict situ-
ations or challenging requests you need to communicate? You could adapt

the cues to wording that is more natural for you. Here are a few examples
for illustration:

• “Now, I know this might sound far-fetched, but I wonder what

would happen if we applied some tools from our technology team
to remind ourselves to tell patients about our new clinic hours.”
• “I’m listening to the ideas our team came up with, and I have to
admit, I’m confused about what the goal is. Could someone ex-
plain how this helps our patients?”
• “It’s difficult to comply with these new safety regulations, and I
wouldn’t ask this if I thought we had a choice. Now, can we figure
out how we’re going to put these in place by the federal deadline?”
• “I’m sorry we’re all struggling with this new electronic health rec-
ord. These transitions always seem to be difficult, and we have to
do it because the old system is shutting down at the end of the
month. Shawn, I saw you working with our vendor to pick up
some helpful shortcuts. Are there some things the rest of us might
learn to make it easier?”

Conversation, not Confrontation

“Start a conversation, not a confrontation,” Mark Murphy (2017) ad-

vises. He suggests asking the other person if she has time to talk with you,
letting her know the topic, offering a few possible times and asking which
would be convenient for her. This approach can be received by the other
as more collaborative and less confrontational than a direct statement that
you have a problem and want to talk to her about it.21
Imagine that it appears to you that a colleague has proceeded on his
own in resolving a problem without considering your team’s responsibil-
ities and the work your care team members already have in progress. In-
stead of expressing to him your feelings of frustration, you might approach
him with a question to request time to talk about the situation, like this.
“Marc, do you have some time to talk with me about our response to
the Denton family’s complaint about their mother’s discharge? I’d like to
coordinate with you on our communications.” If the other person agrees
to talk, you can offer some times, such as, “Would you like to do it now
or would it be better after lunch?”

If the other person wants to know more about why you want to talk,
you might offer a brief, objective explanation, such as, “I want to make
sure we’re in alignment on who’s handling which parts of the discharge
process so we’re communicating clearly with the family and prevent con-
fusion.” This opens the door to a nonjudgmental conversation that il-
luminates the activities that are occurring and who is handling them,
which can lead to constructive and collaborative consideration of how
things are working and what might be adjusted.
With an approach like this, it is less likely the person will refuse to talk
with you than if you had approached him more confrontationally, but if
he does refuse, then Murphy recommends you respond with a question,
such as “May I ask why?” to get more information about his perceptions.

Discomfort with Conflict

As Stone, Patton, and Heen (1999) point out, feelings matter, and they
are often at the heart of difficult conversations. Unexpressed feelings
make it difficult to listen to others, and take a toll on our self-esteem
and relationships. People may dismiss their feelings as unimportant or
unjustified, but your feelings are as important as the other person’s.22 As
many experienced managers have shared, when they delayed talking to
people about their concerns, they prolonged stress and discomfort in the
relationships that they could have avoided by speaking up sooner.
For example, a manager admitted that he delayed talking to someone
who reported to him because he felt uncomfortable after she had over-
stepped her bounds by communicating to others a decision she made on
his behalf without talking to him about it ahead of time. The manager
had mixed feelings about the decision itself, and thought it might actually
help the team function better, but he felt unpleasantly surprised and that
his decision-making authority had been usurped. He avoided talking to
the employee until several months later when he was annoyed with her
about a different situation. When he finally blurted out his dissatisfaction
about the earlier situation, she was astounded, and declared, “Why didn’t
you just tell me? I don’t want my boss to be mad at me for all this time!”
Why do we avoid these conversations? It may be a fear of offending
or alienating the person, or opening up issues that you would rather
avoid, such as your own inexperience or discomfort being in charge.

As Cloud (2010) points out, it is important to distinguish between the

temporary “hurt” that can be a necessary part of providing uncomfort-
able feedback, and the longer-term “harm” to the organization caused by
allowing performance problems to persist.23
The example illustrates additional principles to keep in mind as you
begin to manage and lead others. Keep in mind that most employees
really want to do a good job,24 and they want to please you as their boss.25
Think about feedback as an opportunity to coach employees so they can
grow and develop. When you withhold your timely feedback, they are de-
nied the information and opportunity they need to correct off-course be-
haviors and improve performance. They may unknowingly repeat things
that hinder their effectiveness and annoy you, which detracts from overall
team performance that you are responsible for.
Think about how you claim your authority and leadership responsi-
bilities as boundaries, in terms of what you expect, will accept and toler-
ate, along with limits that you will protect. Henry Cloud (2013) explains
how this helps to position you to be an effective leader, or in his words, to
be “ridiculously in charge”26 by establishing and reinforcing your position
as the manager and leader of your team.
Keep in mind that situations that trigger conflict can arise among
people at different levels of hierarchy. It could be a peer-level colleague
who says something in a meeting that you feel is unjustifiably critical to-
ward you or your team. Or it might even be your boss who seems overly
involved in making decisions about responsibilities she had delegated to
you. In any case, do not delay. Open the conversation to share your obser-
vations, ask for feedback, and create understanding to prevent lingering
problems and discomfort.

Handle Conflict Promptly

Be clear, direct, and prompt in addressing concerns, to prevent problems

from lingering. If you believe that someone has crossed a line and be-
haved inappropriately in her role, or that his performance is not meeting
standards and requirements of his job, or you have some team members
who violate other expectations you hold for them, it is best for you to
deal with such situations promptly. This helps you avoid more difficult

confrontations later, when they have assumed that you approved of their
behavior or performance because you never told them otherwise!

Initiate Needed Difficult Conversations

You could initiate these discussions by calmly stating the facts along with
what you noticed, and asking for the other person’s feedback. Mark M­ urphy
(2017) recommends a truth-based approach based on the facts of the situ-
ation.27 Let’s apply this approach to our example of the manager whose
employee had communicated a decision without clearing it with him.

Jane, I heard from several team members that you sent a memo
announcing that I had decided that everyone could manage their
own schedules and plan time off without prior approval from me
as long as they found coverage for time when they planned to be
away. I’m concerned because I was not aware that you were plan-
ning to announce a change, which I’m responsible for approving,
about the way our team operates. Now several team members are
confused and have asked for time in our team meeting agenda to
clarify the procedure.

These are the facts as the manager, Sam, is aware of them. Then he
opens up the discussion by asking for the employee’s feedback.
“Could we talk about what happened and how we could work to-
gether to plan and communicate effectively?” It is possible that the em-
ployee believes there are other relevant facts and perspectives to consider.
For example,

Sam, you said you spend too much time approving schedule
changes. And you said you could use my help in finding ways to
run things more efficiently. Other teams I’ve worked with operate
this way and everyone likes it. I wasn’t trying to question your au-
thority, I was trying to use my experience to help you and the team.

Distinguish Blame from Contribution

Stone, Patton, and Heen (1999) recommend that you distinguish blame
from contribution. Blame is about judging, and looks backwards, in

contrast with contribution, which is about understanding and looking

forward. Contribution is joint, interactive, and encourages learning and
Jane had feedback for Sam about their working relationship and
how to make it more positive and productive, and what she needed
from him as the team’s manager. Let us consider how Sam might have
contributed to the problem if he told Jane he wanted more help from
her, but he was unavailable to talk to her about her suggestions. Sup-
pose that he had denied Jane’s requests to meet with him and then
overlooked an e-mail message Jane had sent him with a suggested plan,
and Jane erroneously interpreted Sam’s lack of response as implicit sup-
port for her plan.
Rather than looking backwards and blaming Jane for undermining
his leadership and decision-making authority, Sam could look forward
and talk to Jane about how she could offer her suggestions in helpful
ways that he could understand clearly and respond to promptly. Such a
conversation allows Sam to remind Jane of his willingness to listen to sug-
gestions, and when and how to approach him with them, along with his
expectations for approving decisions.

Be Respectful toward the Other Person and Other Perspectives

Sam demonstrated openness and respect for Jane and her perspective
when he opened the conversation for her feedback. The dialogue al-
lowed Jane to contribute her ideas, build more trust with Sam, and
increase Sam’s comfort in delegating more responsibilities to her and
other team members. This demonstrates that with openness to address-
ing conflict constructively, Sam and Jane each could benefit from the
advice and encouragement found in Harley (2013) about “how to say
anything to anyone,”29 especially when a team member needs to clear
the air with a boss!

Consider Role-Related Power and Authority Dynamics

Remember, conflicts can and do occur up, down, and all around. The
next time, it could be your boss who neglects to include you in needed

communication or decision making that encroaches on your responsibil-

ity and affects your team. Or it may be a coworker who seems to push for
her goals to the detriment of yours. Be respectful and straightforward to
initiate conversation, practice listening, and work toward understanding
and alignment.
Always be mindful of your position in the organizational hierarchy
and be aware of who reports to whom. You do have power in your man-
agerial role that gives you the authority to make many decisions and set
direction for those who report to you.30 In turn, your boss has this au-
thority over you. Adjust your approaches and conversations accordingly.
You can be more directive with your employees than you can be with
your boss.
Consider appropriate approaches for you in your position relative to
the other person’s. What should your stance be along a continuum from
giving direction from a role of authority, to collaborating equally, to re-
questing direction from someone who has authority over you?
For example, the other person made a decision, without your input,
that affects your area of responsibility. Some more examples of re-
sponses with respect to relative roles of participants are provided in
Table 1.2.

Table 1.2  Examples of responses with respect to relative

roles of participants
You and a
You and an employee who coworker at You and your boss or
reports to you your level higher level leader
“I’m concerned that you made “I heard that you “I’m happy that you trust
a decision to change a process told others that my abilities and asked me
without my consent. Please don’t you’d decided to to take over the process
do that again, I need you to run implement a new change project. And I’m
operational changes by me for process. confused that you announced
approval. How can we make sure I have concerns decisions you made that
that happens?” because it affects change the direction of the
my team’s work, work I’d started on. Could
too. Could we talk we talk about how much
about it?” responsibility you want me
to take and what areas you
prefer to handle yourself?”

Guidelines for Handling Conflicts

These guidelines (Table 1.3) summarize approaches we have covered for

handling conflict. We apply them to an example situation of a manager
who was unhappy with a coworker’s criticism of his team, which was dis-
cussed in a larger meeting with other coworkers and the senior manager
they all report to.

Table 1.3  Applying guidelines for handling conflicts

Guideline Application
1. R
 ecognize when you feel your The manager feels taken off-guard, unjustly
boundaries are violated or believe criticized, and unprepared to respond
expectations were disregarded. constructively.
2. Consider the reporting The manager and coworker are peers. Neither
hierarchy, your position relative has formal reporting authority over the other.
to others in the conflict, and It is mutually beneficial for both to maintain a
related dynamics of power and collaborative and supportive relationship with
authority. each other.
3. Resolve tension promptly and The manager could respond briefly and calmly
directly. in the meeting to say he was not aware of his
coworker’s concern and would like to talk to her
after the meeting to learn more.
4. Establish and refer to your The manager expects that coworkers will discuss
expectations for communications directly with each other any performance
and behavior. concerns rather than bring them up in larger
He tells his coworker he wants to hear more
about her concerns in a one-on-one conversation.
5. Stand up for yourself and The manager tells his coworker he is open to
assert yourself when needed to her suggestions on how to improve, and the final
reinforce your authority. decisions on what to change are his responsibility.
He accepts responsibility for his team and is
confident in his ability to resolve any problems.
6. Initiate needed difficult The manager should intentionally schedule a
conversations. time with his coworker to have a conversation
about his concerns with her criticizing him
publicly and without fair warning, and to address
the concerns she expressed.
7. Be respectful of the other person The manager should be open to hearing feedback,
and other perspectives. move from blame to considering shared goals
and new options for achieving them. By asking
questions, he can find out the source of his
coworker’s dissatisfaction and how he and his
team can resolve it.

Chapter Summary and Key Points

In this chapter, we offered communication guidelines and recognized
the ways feedback and conflict are important elements of the work-
place. We suggested ways for you to give and receive feedback in con-
structive ways that foster relationships and help people work together
collaboratively. We examined conflicts and offered guidelines for han-
dling them in ways that build positive relationships and get work done

Key Points:
1. In communicating, listen and seek to understand others. Consider
your words and choose them to build alignment.
2. Be mindful of your words and tone in your spoken and written com-
munications. Be clear and direct to ensure others understand accur-
ately what you intend to communicate.
3. When you are involved in change, consider who else needs to know
and include needed people early in planning activities and decisions.
Use a checklist for who else needs to know and be alert to avoid leav-
ing anyone out.
4. Sharing information and pooling resources among different parts
of the organization can break down silos to foster cooperation that
helps get things done more easily.
5. Positive feedback is important for showing appreciation and reinforc-
ing positive actions that you want your team members to continue.
6. Ask for permission to give feedback to others and ask them to tell
you if you need to change or improve something.
7. To gain precise, targeted feedback, ask others what they suggest you
start, stop, and continue to do.
8. Conflict is inherent in the workplace because of the varying perspec-
tives of different people. Learn to embrace conflict and manage it in
healthy ways.
9. Understand your own boundaries that you need others to respect.
Recognize when others violate them, and respond promptly and ap-
propriately to others whether they are up, down, or beside you in the
organizational hierarchy.

10. Be clear, prompt, and direct in handling conflict so that issues get
resolved and relationships thrive.
11. Use conversation, not confrontation, to initiate constructive resolu-
tion of disagreements.
12. Recognize and respect the differences in positional power and au-
thority of people in roles at various levels in relation to yours.

Learning Activities for This Chapter

1. Think of a problem that needs to be solved in your organization,
which requires cooperation between you and a peer. Consider what
points you both agree on, where your perspectives differ, and how you
might agree to work together to solve the problem. Plan a conversa-
tion you could have using the framework of Patterson et al. (2012)
that we reviewed in this chapter to Agree, Build, and Compare.
2. What projects or situations come up at work, which require careful
consideration of “Who else needs to know?” Construct a table or
checklist, like the example in Table 1.1, which would be helpful to
use in your organization.
3. List three things you have noticed people doing well on your team
in the past few days.
a. Write down what you could say to those people to give them
specific positive feedback that recognizes their good work and
encourages them to continue to build on it. Now, go deliver the
b. Look for at least three more opportunities in the coming week to
offer positive feedback to others who work with you.
4. What will you say to others to encourage them to give you feedback
about how well you are meeting their expectations and what you
need to improve?
5. In this chapter, we introduced a framework for getting feedback by
asking others what they would like you to Start, Stop, and Continue
doing. You can also apply this for self-assessment and goal-setting
for your professional development. From what you saw in this chap-
ter, what will you Start, Stop, and Continue doing to become more

Here’s an example to get you started.

“I will
• Start scheduling regular meetings with my boss to review goals
and get her feedback on my progress.
• Stop avoiding difficult conversations and believing that other
people’s needs are more important than my own.
• Continue to attend monthly skill-building seminars offered by
my professional society’s local chapter to build my skills in man-
aging others.”
6. Identify at least one work conflict or uncomfortable situation that
you need to address. Imagine a conversation you could have to help
resolve this and what you would say to get the conversation started.
a. How would you approach the other person to start the conver-
sation? Consider the other person’s role in the organizational
­hierarchy—in other words, are you peers at similar levels, or does
one of you report to the other, or is one of you higher in the man-
agerial hierarchy with more authority than the other? How do
these relative positions of your role and the other person’s affect
the way you approach the other person to start the conversation?
b. Find an uninvolved person, not connected with the other person,
who could help you practice this conversation by playing the role of
the other person. What mentors or peers could help you with this?
c. What feedback did you get from your mentor or peer-level buddy,
or discover for yourself as you practiced, and what would you ad-
just in your approach to handling the conflict?
7. Think of a situation at work where someone’s actions violated
your expectations for how he should have behaved. Work through
Table 1.3 to apply the guidelines for handling conflicts, and fill in
your application of each guideline. Refer to Table 1.2 for examples
to help you apply Guideline #2 to consider the reporting hierarchy,
your position relative to others in the conflict, and related dynamics
of power and authority.
ABC’s, dialogue of, 3–4 Conflict, relationships and, 13–22
Administrative allocation, 80–81 blame vs. contribution, 19–20
Assessment approaches, 39 conversation and, 16–17
cues, adoption of, 15–16
Balance sheet, 91–94 discomfort, 17–18
Barriers, communication, 8–10 embracement of, 14–15
Behavioral interview questions, 51–53 handling in, 18–19, 22
Boredom, 109–110, 113–115 initiation of, 19
Budgeting, 69–70 perspectives of others, 20
administrative allocation, 80–81 reason for, 13–14
concepts, 84 role-related powers, 20–21
cycles, 71–72 Corrective feedback, 11–12
example, 72–75 Culture, organization and, 33
fiscal year periods, 71–72
formats, 83–84 Diversity, organization and, 34–35
grant funding, 78–79
managing, 70 Employee engagement, organization
way of spending, 70–71 and, 32
Business goals, 97–98 Employee strengths, organization and,
Cash flows, 98
Cash flow statement, 85–88 Feedback, 10–13
Chart of accounts (COA), 77 corrective, 11–12
Clinical practice, financial principles improvement and, 118–119
of, 97–100 interviews and, 58–59
business goals, 97–98 positive, 10–11
cash flow and, 98 receiving of, 12
healthy finance and, 99 “Start, Stop, and Continue”
mastery of business principles, approach, 12–13
98–99 Feedforward, improvement
Coachability, 119–120 and, 121
Communication, guidelines for, 2–10 Financial management, 94–97.
ABC’s of dialogue, 3–4 See also Budgeting; Money;
barriers, 8–10 Profit
healthy, 6 contributions and alignment,
omissions, 5–6 95–96
open dialogue, building of, 2 drivers, understanding of, 95
silos, 8–10 review reports and data, 94–95
WENK model, 7 spending, tracking and managing
written communication, 4–5 of, 96
Compensation, 59–60 variations, recognizing, 97
146 Index

Financial principles, clinical practice Job advertisement, 48

and, 97–100 Job description, review of, 47–48
business goals, 97–98 Job offers, 59–60
cash flow and, 98
healthy finance and, 99 Leadership, 104–106
mastery of business principles, business management skill, 104,
98–99 118
Fiscal year periods, 71–72 meetings, role of, 120, 122

Grant funding, 78–79, 129–130 Mastery of business principles, 98–99

Growth and improvement, 117–121 Meetings, 120, 122
coachability, 119–120 Mentoring, 115–116
feedback and, 118–119 Money
feedforward and, 121 economics, clinical practice and,
Healthy finance, 99 importance of, 66
Hiring, 42–45. See also Selection management of, 67
advertisement, 48 Net profit, 69
contact with HR, 46–47 Nonprofit organizations, 66–67
developing positive working
relationships, 45 Omissions, communication, 5–6
dissemination, 48 Onboarding, 60
form for roadmap to, 63 Open dialogue, building of, 2
job description, review of, 47–48 Open-ended questions, interviews
positions open up, 46 and, 53–54
posting, 48
refilling, evaluate and plan for, 47 People, importance of, 28–30
rehiring needs, communicate and costs and consequences of turnover,
evaluate, 46 28–29
Human resources (HR), 42–45. lower turnover in positive
See also Hiring workplace cultures, 29–30
Place to work, organization and,
Inclusiveness, organization and, 34–35 30–39
Income statement, 88–90 pillars of, 35–36
Interviews, 51–59 unified themes, 36–39
basic requirements, confirmation of Positive feedback, 10–11
matches with, 51 Profit, 68–69
behavioral interview questions, Purpose, description of, 107
feedback from HR, 58–59 Recognition, organization and, 30–31
open-ended questions, 53–54 Relationships, conflict in, 13–22
reference and background checks, blame vs. contribution, 19–20
57–58 conversation and, 16–17
right candidates, selection of, 56 cues, adoption of, 15–16
skills demonstrations, 55–56 discomfort, 17–18
styles and approaches, exploring, embracement of, 14–15
54–55 handling in, 18–19, 22
Index 147

initiation of, 19 Team strengths, 39–42

perspectives of others, 20 assessment approaches, 39
reason for, 13–14 by domain, 40
role-related powers, 20–21 strengths-based employee
development, 41
Selection process, organization of, 48–51 strengths-based leadership,
fairness and employment laws, 48–49 39–40
interview questions, 50–51 strengths-based teams, 42
interview team, 50–51 Training, organization and, 31
reviewing applications, 50
screening, 50 Vacancies, 46
Self-care, importance of, 106–107 Values, description of, 107
Silos, communication and, 8–10
“Start, Stop, and Continue” approach, Well-being, five elements of, 108
12–13 WENK model, 7
Strengths-based employee Work
development, 41 balancing life and, 108
Strengths-based leadership, 39–40 purpose and, 107
Strengths-based teams, 42 success tips, 109–116
Sustained success, 109–116 Written communication, 4–5
David Dilts, Oregon Health & Science University (OHSU)
and Lawrence Fredendall, Clemson University, Editors
• Quality Management in a Lean Health Care Environment by Daniel Collins
and Melissa Mannon
• Improving Healthcare Management at the Top: How Balanced Boardrooms Can Lead to
Organizational Success by Milan Frankl and Sharon Roberts
• The Patient Paradigm Shifts: Profiling the New Healthcare Consumer by Judy L. Chan
• Leading Adaptive Teams in Healthcare Organizations
by Kurt C. O’Brien and Christopher E. Johnson

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