As a child, you may have worked the parenting system by telling dad that “Mom said it’s okay,” or convincing mom that “Dad lets me do it.” Unless mom and dad caught onto the ploy, joined forces, and made it impossible for you to pit one against the other, this tactic may have been an effective means for you to get your way.

The same type of thing can happen in work settings between staff and leaders, particularly when leaders are not aligned with one another around their expectations. In healthcare settings, this lack of alignment between physician and administrative leaders is very common. Although the pair shares responsibility for staff and clinical outcomes, there are often disparities that range from subtle to flagrant.

On paper, the reporting hierarchy is usually between the manager and staff, but in reality, the physician plays a huge role in setting expectations, modeling behavior, and influencing staff. What happens when the two are not aligned?

According to my colleague, Tom Ludwig, a seasoned practice administrator, “When the manager and physician are not keeping in close touch with each other, you’re really setting the staff up to have to deal with two different sets of rules that may conflict or diverge from each other. I’ve seen numerous examples of this leading to frustration, job dissatisfaction, and turnover among employees. In addition,” Ludwig notes, “patients may feel the impact as well. Patients, like staff, may be confused by multiple sets of rules. This often creates the perception that staff don’t know what they’re doing,” he says. “And if staff are unhappy, the patients will feel that reflected in the work environment.”

One of the other ramifications of misalignment is a breakdown in systems. When a manager instructs staff to manage a process one way, and the physician dictates another, the processes break down, causing frustrations and inefficiencies that impact the staff, the provider, and, ultimately, the patient.

Another example of a common breakdown is when a physician or manager implements a workflow or schedule change and fails to tell the other leader. Neglecting to openly share changes in a timely manner results in confusion, frustration, and dissatisfaction for the physician and manager as well.

On the flip side, when physicians and managers work together as a team, articulate a shared set of goals, and support one another by speaking in a unified voice, great things happen.

What can healthcare leaders do to become more aligned?

• Create strong physician/administrator pairings at all levels of the organization.
• Ensure that physician/administrator teams understand their roles in the organization’s mission, vision, and values.
• Articulate shared goals between the physician/administrative leaders.
• Create opportunities for interaction and open communication.

“Opportunities for ongoing interaction between the leadership pair serves to strengthen relationships,” notes Ludwig. “Over time, you develop an understanding of how the other person is going to think or react, and you develop a mutual respect for each other. With a positive relationship, you really do speak with one voice.”

During many of our culture assessments, we talk with managers, employees, and physicians who define the disparity between physicians and management as one of the greatest barriers to creating a positive culture. High-performing organizations need to foster an environment where employees want to work, where providers want to practice, and—importantly—where patients want to receive their care. Collaborative leadership is one of the fundamentals for achieving that type of culture.