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This chapter is from the book

Management Versus Leadership

An interesting difference between healthcare and other industries is the common confusion between the roles of management and leadership.

In healthcare there is often a department manager and a department director (the would-be leader). Oftentimes both are engaged in performance improvement, sometimes in alignment, sometimes not. Some days the director gets closely involved in the day-to-day running of the department, others not.

In other industries these roles tend to be more clearly defined: management is about tactics and consistency; leadership is about strategy and change.

The key sustaining role in healthcare is missing: both the manager and the director are measured on process improvement, that is, change. If the manager is not focused on consistency, the push for standardization is lost, thus propagating the differences between care units, shifts, and even within a shift. The role of managers should be ensuring that the process is performed in a consistent manner, and thus their focus is on standardizing across the staff and ensuring that their skill base is grown to the necessary level.

Leaders, on the other hand, should not get too involved in the consistency of practice other than to hold the managers accountable for it. Leadership’s role is to create the vision, to manage and resource the change in a contained way toward that vision, and finally to ensure that the appropriate framework of metrics is in place.

In the traditional healthcare model where roles are mixed, control of change is lost and the standardization of practice doesn’t occur. Any performance improvement implemented thus fails to stick.

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