It is well known that organizations work well when
subordinates know how to manage managers. Experienced work groups often need to
teach their new and inexperienced manager what routines are important because
they work much better than the alternatives. Work groups facing new conditions
often need to tell their experienced manager that the world has changed and that
their work needs to change with it. Managerial effectiveness starts with the
ability to listen to subordinates and learn from them.
When organizations need to change, can the subordinates
managing their managers be a good tool for making it happen? Research published in the Administrative Science Quarterly by Katherine C. Kellogg answers this
question. The managers she studied were actually medical doctors who do a range
of managerial tasks and are at least as protective and assertive of their own
ideas and ways of working as regular managers. If a hospital wants to change
its overall activities, who are best situated to manage the medical doctors: medical
directors or medical assistants? Kellogg’s research showed what happened when
two hospitals tried to implement patient-centered reforms in their clinical
practices.
As you might have guessed from the title, medical directors
were not very useful for getting doctors to change their practices. A doctor
can easily ignore instructions from higher levels in the organization, or even
protest them. A doctor can also ignore suggestions from lower levels in the
organization, but one of the hospitals found a set of tactics that made the
suggestions coming from subordinates very persuasive. Those subordinates were medical
assistants, who help to manage doctors’ patient inflow, time, and information.
Each medical assistant works with multiple doctors, so they are central nodes
in the doctor network. By having medical assistants meet without the doctors in
the room, the hospital let them benefit from the experience of other medical
assistants in their networks and become even more central. The hospital could
also use the meetings to motivate the medical assistants, teach them how to
influence doctors, and have them teach each other how to do so.
The medical assistants ended up with a wide range of
influence tools and with a network that gave them exactly the information
needed to use those tools well. They put together information for the doctors
that helped the doctors follow reforms while still feeling that they were in
charge. After all, the doctors felt they were reacting to better information,
not to the assistants assembling it. The medical assistants would ask the
doctors to change practices to help the assistant work better, and the doctors
would grant such favor requests because they knew they were dependent on the
assistants and felt that favors were a good reward. The medical assistants
would strategically choose which doctors to approach first for changing
practices and would let other doctors know when those first doctors had agreed
to make changes. That way doctors felt they were not following assistants but
other doctors.
Why do we know that these tactics for managing the manager
work? As I wrote earlier, two hospitals tried to implement patient-centered
reforms, but only one succeeded – the one using these tactics. Maybe not all of
these tactics were needed in the hospital, or are needed elsewhere, but Kellogg’s
research certainly shows how managers can be managed to make changes in an
organization.
