How to redesign manager’s role for PFC

New skills needed in changing workplace

By Janine A. Kilty

Vice President, Human Resources

Albert Einstein Healthcare Network

Philadelphia

President, Einstein Consulting Group

(a subsidiary of AEHN)

Jenkintown, PA

Wendy Leebov, EdD

Associate Vice President, Human Resources

Albert Einstein Healthcare Network

Philadelphia

Founder and former president

Einstein Consulting Group

Jenkintown, PA

When we at Albert Einstein Healthcare Network in Philadelphia restructured our care delivery model by creating new job roles, we realized we also needed to redesign the managers’ roles.

The traditional manager’s role is not equipped to support a care model in which employees are cross-trained and multiskilled, enabling them to shift responsibilities in response to changes in patient volume and service location.

We also had another reason to rethink management jobs. Like most large health care organizations, AEHN needed to shrink management ranks. We sought a rational and fair approach to this task. As a result, we formed a committee on management role redesign consisting of human resource and operations leaders from every AEHN entity.

At first, the committee tried to derive a formula for redefining management and supervisory jobs that would support the new blended and flex jobs. Blended jobs combine work formerly done by specialized staff, such as respiratory technicians, phlebotomists, and nursing assistants. Flex jobs require employees to expand their skills so they can shift locations or from one level of care to another depending on patient volume (e.g., from inpatient care to outpatient care or from acute care to rehabilitation or home care).

Focus on new job roles

Eventually, though, we decided to have individual teams focus on each new job. The teams would examine the current management structure surrounding the various specialist jobs we were combining, and then figure out a workable management structure to fit the circumstances relevant to each new role.

At the same time, the committee decided we needed to define the "generic" manager’s role. Based on the assumption that AEHN’s management needs would change constantly, we focused on the following objective: to redefine the manager’s role to reflect the need for versatile, multiskilled managers who can effectively supervise and coach multiskilled workers, and who can shift from one responsibility to another and from one setting to another in response to changing needs.

To create this generic manager job, the committee pursued an approach that uses core competencies to drive job descriptions, hiring, assessment, development, and performance management and accountability. In defining the core competencies of the multiskilled, flexible, agile manager, we decided specifically to:

• revamp the manager’s job description, communicating that these core competencies are the role expectations for managers of the future;

• develop methods for screening both internal and external management candidates for the core competencies and for making downsizing decisions at the management level. We also determined to develop a policy for hiring managers, including having a specially trained interviewer assess candidates on the leadership competencies (see sample questionnaire p. 10);

• align performance review and feedback tools/systems using the competencies as the basis;

• build concrete, inexpensive assessment methods that fit our current time and resource constraints (e.g., employee and peer assessments, self-assessment, and performance tasks with behavioral criteria);

• assess current managers on these competencies;

• provide development opportunities (training, coaching, mentoring, reading) to upgrade people’s skills on needed competencies.

Process for developing core competencies

Drawing on the literature from the competency movement (e.g., Lyle Spencer and Signe Spencer, Competence at Work; John Wiley and Sons, 1993), the committee developed a strategy for identifying the core competencies suited to AEHN’s vision for the future. This strategy included:

• meetings with administrative teams from each AEHN entity, asking administrators, "What competencies do you consider critical for the future?" and "If you could have managers with 10 competencies, which would be the top 10?";

• interviews with managers identified as "peak-performing, ideal managers," asking them what they think are the core competencies for the peak-performing, value-added manager and to describe situations in which they felt their own competencies were pulled "to the hilt";

• focus groups with employees to identify the characteristics of peak-performing managers from their perspectives;

• benchmarking with other hospitals.

We consolidated and cut our lists to create behavioral sub-items related to each key competency.

The committee held meetings with the AEHN executive team, presenting the competencies and seeking feedback on their definitions, their behavioral components, and on methods to:

— assess and train managers on these competencies;

— present the competencies and accountability strategy to all levels of management.

We invited all managers in AEHN to attend one or more "Competency Work sessions" where we presented the competencies, focusing the attending group on one competency and inviting their reactions and input into five categories: definition, behavioral elements, hiring questions, assessment techniques, and development resources.

We held eight of these work sessions in October 1996. As a result, we are refining the competencies using the input received.

Special focus on systems thinking

Because of our organization’s strategic direction, AEHN executives perceived a pressing need to develop the managers’ ability to engage in a process called systems thinking. Systems thinking is a discipline for seeing wholes; a framework for seeing patterns and interrelationships. It’s especially important to see the world as a whole as it grows more complex. Complexity can overwhelm and undermine, resulting in the exclamation "It’s the system. I have no control!"

Systems thinking makes these realities more manageable. It is the antidote for feelings of helplessness. By seeing patterns that lie behind events and details, we can actually simplify life.

For this reason, we introduced systems thinking to the executive team in a pilot session that drew on the tools of the experts. In this session, to promote systems thinking rapidly and in real time, in meetings, task forces, and in individual project planning, we used the following four tools:

1. Job aid to advance AEHN integration. This tool is a checklist that prompts people to make sure they considered each appropriate AEHN entity when planning a meeting or project, or issuing a communication.

2. Mind-mapping. Engages a group or individual in generating associated ideas and relationships by entering the core idea and then showing through offshooting arrows related ideas or needs.

3. Fish bone or cause-and-effect diagram. A continuous quality improvement tool, it helps people brainstorm all of the elements of a problem or project that they need to pay attention to. It triggers a comprehensive look at all of the elements involved.

4. Force field analysis. Targets a goal and then has people identify the forces in place that push toward the goal vs. the forces in place that impede achievement of the goal. The idea is to identify all of these "driving" and "restraining" forces and then to analyze further the most important ones, asking such questions as, "Which are amenable to change? Which driving forces can we strengthen? And which restraining forces can we weaken?" all in an effort to push toward goal attainment.

Next steps

The executive team then decided to take the following three courses of action:

• Field-test the systems thinking tools. We conducted a session with all AEHN managers, including executives, administrators, and physician leaders to present the competencies. We then field-tested these systems-thinking templates. We used the tools in the planning for a specific project, the development of a comprehensive women’s program at the Albert Einstein Medical Center in Philadelphia.

• Conduct a test roll-out with a cross-section of managers who performed well on the competencies. We evaluated and modified the program. Then, these managers, whom we considered to be role models with inherent credibility to influence acceptance of and respect for the competencies, led a rollout session with their peers.

• Pilot the use of these systems thinking tools with the development team for the women’s program at Albert Einstein Medical Center.

In addition, the management role redesign committee is integrating all of the input from the work sessions and administrative team meetings into the refinement of the competencies. Special attention is being given to ensuring that process-oriented competencies are explicitly defined to yield the desired results. Also, the team is integrating the leadership competencies with AEHN’s strategic initiatives.

Meanwhile, the organization and staff development team began developing assessment methods, including:

— a self-assessment;

— an immediate discussion with your boss about "how you see me";

— tools for peer and staff feedback;

— performance tests for skill level assessment;

— learning options related to each competency.

Also, human resource professionals began the realignment of performance management tools, particularly job descriptions and the performance appraisal process, with the new competencies. These included both technical competencies relevant to specific jobs, and "generic" leadership competencies.

[Editor’s note: For more information about redesigning a managers’ role, contact Janine Kilty or Wendy Leebov at the Einstein Consulting Group, 501 Washington Lane, Suite 302, Jenkintown, PA 19046. Telephone: (800) 765-9975. E-mail: kiltyj@aehn2.einstein.edu.]