Would an ‘unbossed’ culture work in healthcare?

Madeline Ashley – Becker’s Hospital Review

The workforce has seen an influx of changes and trends come and go in a post-pandemic world, with more employees taking the reins and standing up for new, flexible ways to get their jobs done. One such trend catching on lately is the “unbossed culture.”

The term describes a work environment wherein management assumes more of a leadership role than a supervisor role. The hands-off approach makes for fewer check-ins, allowing employees to have more ownership over how they tackle and complete their tasks.

While this new workforce trend spreads across multiple industries, the glaring question remains, “Would an unbossed culture work in healthcare?”

Becker’s connected with multiple healthcare leaders to get their insights on whether this approach to management would click. While there is an agreement that employees should feel empowered to take on responsibilities and “own” their work, healthcare involves saving people’s lives, which might require more oversight from leadership from time to time.

Editor’s note: Responses were lightly edited for length and clarity.

Lisa Carter, President of Ballad Health Southern Region (Johnson City, Tenn.)

Question: Do you think an unbossed culture would be successful in the healthcare industry? Please explain why.

Lisa Carter: Many disciplines within the healthcare industry have been driving toward this type of culture for decades. Nursing has led initiatives related to shared governance, which works to empower individuals delivering care to design the care environment and develop the standards for how that care is delivered. Nurses have also implemented self-scheduling models that allow for flexibility in the shifts they work. These initiatives have created more job satisfaction and a stronger level of accountability in the workplace. I do believe that expanding this model and modeling this type of culture in other areas of healthcare would be successful.

Q: What are some areas where healthcare leadership can improve?

LC: Any time there are external forces creating pressure in the healthcare delivery system, our tendency seems to be to try to work on tighter controls. This is often true when expenses need to be managed and costs reduced. Allowing our frontline team members the opportunity to be a part of those decisions greatly benefits our ability to successfully react to those pressures.

Q: How can healthcare leadership make these improvements?

LC: One area where leadership can make these improvements is through educating our front-line leaders on healthcare finance. Having a deeper level of understanding about their departmental budgets and industry demands would allow for greater input into the process.

Another area is through the shifting of ownership. Often, managers take on the role of “owning” the work and how it is completed. Developing a culture that empowers team members to take on accountability and responsibility is necessary for making cultural changes.

Michael Wukitsch, PhD, Chief People Officer, Lee Health (Fort Myers/Cape Coral, Fla.)

Question: Do you think an unbossed culture would be successful in the healthcare industry? Please explain why. 

Michael Wukitsch: The healthcare industry is the perfect environment for an unbossed culture in that team members are highly aligned with the mission of providing compassionate care to patients and their families. Healthcare is provided in a team-based environment which requires coordination, good communications and a strong esprit-de-corps to meet patients and families where they are in their care journey. The role of the leader then is to facilitate outcomes, coach the team members and help develop their skills in order to enhance their effectiveness.

Q: What are some areas where healthcare leadership can improve?

MW: Healthcare leadership can improve by learning to empower people through effective questioning and support. Teaching team members to think critically and solve problems engages staff much more than traditional command-and-control methods. I also believe that leaders are the meaning makers — helping team members find purpose and joy in their work by connecting them to the mission and greater good. Role modeling the right behaviors — taking the work seriously while not taking oneself too seriously — can create a more balanced and harmonious environment that supports retention and improves patient experience.

Q: How can healthcare leadership make these improvements?

MW: Seek the help of human resources business partners and take advantage of learning opportunities offered by your organization. Good leadership is a craft that requires intentionality and continuous practice.

Tom McCauley, Chief Human Resources Officer, Aspen (Colo.) Valley Hospital

Question: Do you think an unbossed culture would be successful in the healthcare industry? Please explain why.

Tom McCauley: I do think it could succeed, however, there probably is more “healthy tension” that needs to be inserted within a healthcare environment than in other industries. We have strict quality control measures and outcome expectations that cannot be compromised, so there is likely a heavier emphasis at the outset on skills training and setting the employees up for success. That kind of rigorous training, shadowing and mentoring will build confidence. They need to know that they can do a job, and they need to know that we know they can do it as well.

Once the hard skills are there and proper quality assurance procedures are in place, there is no reason why it can’t work. I believe when you have a more decentralized leadership structure where employees are more empowered to run more on their own, the employees will feel a much higher sense of ownership and freedom. That same ownership and freedom comes with a price — if you want more autonomy, you need to be more accountable as well — maybe more than you’re used to. In other words, while enjoying these new freedoms, you also need to be prepared for extra coaching/correction if things are not meeting the unwavering expectations of the organization when operations are under your watch. While management models may ebb and flow, the expectation of high outcomes does not.

Q: What are some areas where healthcare leadership can improve?

TM: I don’t know if healthcare is much different from other industries in this area (less micromanaging, increase the amount of recognition and appreciation, praise publicly and correct privately, etc). I’m a firm believer that the best managers look more like coaches and less like dictators. However, I believe the stakes are much higher in healthcare to focus on maintaining and improving outcomes. If a change in management style is negatively impacting patient outcomes, we have to be much nimbler and course-correct more quickly. People’s lives are at stake, so we in healthcare don’t have the luxury of trying something out for another quarter or two to “work out the bugs.”

Q: How can healthcare leadership make these improvements?

TM: To me, the underlying factor is trust. Leaders need to bring their teams along to the point where they trust their skills and trust their judgment. If trust is lacking, this kind of “unbossed culture” will die on the vine. Trust also flows the other way — if you’re enabling employees to take on more responsibility, they have to know the door is wide open to seek wisdom and advice without a sense of judgment. While there needs to be great clinical training and enablement (hard skills) at the outset, there also needs to be a focus on the softer skills like decision-making, leading under stress, and accountability. The culture needs to be one where all involved (employees and supervisors) can freely bring up concerns or innovations in a risk-free environment, in any direction. The focus is more on improving outcomes and less on punishment, and where that culture is present, this kind of leadership model can flourish.

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