consequences for the organisation, as clinicians became overburdened with new responsibilities and services suffered as a result. However, our research also identified five steps that professionals can take to cement their position as a vital part of the organisation’s structure. 1 . Be aware of the risks. Our study found those managers who tried too hard to impress and help clinicians temporarily succeeded in triggering change. But after a while they were treated as subservient and replaceable. Recognising that elements of their job could be consumed by ‘internal clients’ meant professionals were able to adapt accordingly. For instance, we found that quality managers would avoid sitting on the same table as executives and clinicians simultaneously, as sharing information with both parties could weaken their own position. 2 . Develop a strategy. We identified two strategies for organisational professionals to avoid blithely handing over knowledge to colleagues until they become replaceable. The first was a ‘selfless strategy’, where quality managers built their knowledge through conversations with executives and clinicians, combined that with their own operational expertise, and shared the resulting insights with others. These ‘selfless’ professionals deliberately co-produced integrated care initiatives with clinicians and executives to impress them and trained them to take over some responsibilities. But, in return, they expected to be rewarded with opportunities in different parts of the organisation. In some cases, they outlined this
in email templates that served as pseudo-contracts. These clarified what clinicians could expect in terms of contribution, time, and outcomes. One template read: “If you don’t agree, we don’t start.” The alternative is what we called the ‘selfish strategy’. Here, quality managers acted more as internal consultants, helping to deliver an innovative service without handing over valuable knowledge to executives and clinicians. These ‘selfish’ managers avoided co-producing initiatives, worked in the privacy of their offices, and only showed the results of the labour so nobody could imitate their ‘craft’. In this model, they remained in charge, rather than delegating responsibility to clinicians. They also protected themselves against being marginalised by approaching executives to develop new opportunities, rather than waiting for clinicians to vouch for them. 3 . Carve out a unique position, Organisational professionals need to increase their interactions with others, else there is a risk of becoming invisible in the organisation or being reduced to clerical workers. In our study, we noted how several quality managers unintentionally isolated themselves from decision makers by locking themselves in their office to perform their demanding tasks. As a result, they were easy to overlook. The more successful quality managers exploited their unique middle management position to interact with executives and clinicians on a daily basis. The ‘selfless’ managers used this to act as bridges between executives and clinicians who interacted far less frequently, and expected to be rewarded for bringing them closer together.
TO THE CORE
1. Professionals can make themselves easy to replace if they are too willing to share their expertise with colleagues in different departments. 2. One way to avoid this is a ‘selfless strategy’, which involves learning from others, combining that knowledge with their own expertise, and sharing the resulting insights with others. 3. A ‘selfish strategy’ is to become a buffer between executives and other teams, then present themselves as the solution. 4. Both approaches require them to develop a unique understanding of how the organisation works and why, then apply that in their role.
P rofessionals in they deserve. This is particularly true for those who are involved in developing new initiatives, only to be sidelined after sharing their expertise. Together with Graeme Currie, from WBS, and Saku Mantere, at McGill University, I explored the role of quality managers in 12 Italian hospitals as they supported the implementation of integrated care pathways. We found those who were too willing to share their knowledge functions such as HR, finance, and quality management play a vital role in the success of any organisation. Yet they do not always receive the recognition risked being replaced once they had taught clinicians how to perform key tasks themselves. This also had negative
Warwick Business School | wbs.ac.uk
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