CHAPTER 4

Where Do You Go from Here? Keeping the Motivational Fire Burning

Chapter Overview

In this final chapter, we wrap up your journey toward being an effective health care manager. We shift from the skills you have been learning in earlier chapters to do your job now, consider how you sustain your momentum, and look ahead to your future. We will look at how you balance areas of your life and renew yourself, sustain your success, address challenges that signal the need for changes, foster your growth and development, benefit from others helping you to improve, move from success to significance, and continue to fuel your passion for the work you do.

Topics in this chapter:

• Highlights of your journey to here
• Leaders who are burning bright
• Balance and renewal
• Sustaining your success at work
• Your growth and improvement
• Outward and onward!
• Chapter summary and key points
• Learning activities for this chapter

Highlights of Your Journey to Here

As you have read through this book, you have heard from many different people who participated in interviews and conversations to share their experience and advice about working in health care management. They come from many different roles, specialized training and practice focus, and levels of responsibility, and they represent a wide range of styles, preferences, goals, and interests. All of them demonstrate their passion for the work they do and caring for the lives they touch. Many were fortunate in finding organizations to work in that aligned with their interests and supported them in their growth for long and satisfying careers there. Others found new ways to apply their valuable capabilities in new settings and organizations.

You have seen recommendations and examples for building relationships at work, organizing your activities, taking action, initiating conversations, resolving conflict, developing leadership in yourself and others, and building your business management skills. Now we will look at ways to sustain all the progress you have made, so you can continue to build on your momentum and leverage the strengths and skills you brought with you and continue to develop in your work as a manager.

At this point it could be helpful for you to pause and identify which recommendations from interviews and sections of both volumes of these books are timely for the activities and issues you are working with right now. Then, consider how you might apply the recommendations in ways that fit you and the organization and situation where you are working. Think about what keeps you interested and engaged in your work, and how your contributions have contributed to success for you, the organization, patients, and the community you live in.

Leaders Who Are Burning Bright

What motivates you and inspires you to stretch and attain new goals? To help you envision possibilities for your road ahead, let us consider a few examples from senior leaders who have worked in health care for many years. These represent some of the people I interviewed who continued to thrive and evolve over several decades.

Dixie Casford, LPC, MBA, started as a clinician and was offered a supervisory role in 2 years. She continued to learn after completing her clinical master’s degree, earned an MBA, and enjoyed the opportunity to apply her analytical and business skills in helping others understand important aspects of running the clinic.¹ She advanced in her current organization from a Director to the position of Vice President by using her clinical skills to fill in staffing gaps and applying her growing business skills to continuously improve clinical operations. As funding streams shifted and required new approaches to operating efficiency, she stepped in to fill organizational gaps, as she is completing further education in legal and compliance issues to contribute additional value to her organization in her current role.²

Barbara Becker, PhD, JD, became a nationally recognized leader in suicide prevention. It started as a personal interest because there were several suicides among her daughter’s friends and classmates. She got involved in grassroots programs, received encouragement and support at top levels of her organization for her community work on this. With her varied background and experience, she needed change and challenge. She advises seasoned, ongoing managers to always be open to new ideas, to not become complacent, to know yourself, figure out what gets you excited, and talk to others about how to make that happen.³

Jim Monk earned his DDS in 1984, and then spent 29 years running his own dental practice. He had some coursework in basic, rudimentary accounting in dental school. He learned Human Resource management in his own dental practice. Later he attended classes on HR and hiring as part of required continuing education, self-directed so he could choose what he needed. He learned many of the business skills he needed to manage his business and perform some tasks himself, such as payroll and some bookkeeping, to keep his overhead costs low. He sold his dental practice, partially retired, and now works for Boulder County Dental Aid, where he understands the funding and billing complexities of working with Medicaid insurance. He values the teamwork among the staff required to manage funding.

Jim is very interested now in coordination of care and whole-person health across health care disciplines, such as the role of dentistry in cancer prevention and early detection. Medicine changes slowly, he said, and we are learning more about inflammation and its impacts on health, and the role of oral health. Reading health books on food and nutrition helps him continue to learn and fuel his interests in service to the health of his patients and the community.⁴

Roy Starks, MA, worked in psychiatric rehabilitation since the 1970s and retired from a successful and impactful career at the Mental Health Center of Denver (MHCD), where he worked for 28 years. A big motivator for him was helping people get better and live more meaningful lives. He has always focused on strengths rather than weaknesses. He built a strong reputation in his profession, earned a leadership position as chairperson of the board of the Psychiatric Rehabilitation Association, and published in its journal on groundbreaking work he led in his organization. He emphasized the importance of reporting to a CEO who is aligned with what you believe. Alignment with the mission of the organization was an important motivator for Roy. His boss and organization supported Roy in creating new opportunities and growth for him and his teams that contributed to the organization’s success in living its mission.⁵

We will see more in this chapter about continued growth and sustained enthusiasm like what these leaders demonstrate.

Balance and Renewal

The Importance of Self-Care

Stephen Covey (1989) provides in his book, The 7 Habits of Highly Effective People, a parable of a man who complains of exhaustion because he is too busy sawing to sharpen the axe. Covey identifies four dimensions of your nature that need to be renewed and balanced to preserve and enhance “the greatest asset you have—you.” These dimensions are:

• Physical: Exercise, Nutrition, Stress Management
• Social/Emotional: Service, Empathy, Synergy, Intrinsic Security
• Spiritual: Value Clarification and Commitment, Study and Meditation
• Mental: Reading, Visualizing, Planning, Writing

He explains that “the single most powerful investment we can ever make in life [is] investment in ourselves, in the only instrument we have with which to deal with life and to contribute. We are the instruments of our own performance, and to be effective, we need to recognize the importance of taking time regularly to sharpen the saw in all four ways.”⁶

Covey (1989) describes your spiritual dimension as “your core, your center, your commitment to your value system. It’s a very private area of life and an extremely important one. It draws upon the sources that inspire and uplift you and tie you to the timeless truths of all humanity. And people do it very, very differently.”⁷

Many interviewees mentioned self-care as a necessary skill. For some, this involves time alone to reflect or create. For others, being with other people or physical activity is necessary and energizing. Be aware of what works for you. Focus on activities that feel refreshing and help you feel calm, energetic, happy, well, or in control. The important thing is that you find what works for you and feels rejuvenating, and do it! This includes both doing things that are fulfilling in your life away from work, as well as what keeps you functioning well at work.

Your Purpose and Values

Think about why you are doing the work you do. Jim Donovan (2014) recommends you consider how your work brings you satisfaction and how you are serving humanity. “Regardless of how important or menial you feel your work is, it is an essential part of something bigger. When you understand this you will find it easier to derive pleasure and meaning from your work. You will feel better, and, as a result, be happier. You may even be promoted!”⁸ Many people working in health care have expressed the purpose of helping people live better, healthier lives. Perhaps you would state other aspects of your purpose, such as helping to develop others to provide effective care and treatment, developing and sharing knowledge that contributes to population health, or improving health and happiness in your community.

Your purpose is closely related with your values. Donovan (2014) explains how alignment with our values contributes to our happiness and satisfaction with our work. “By values I mean those principles and qualities that you hold dear . . . such as love, success, compassion, freedom, contribution, adventure, and security . . . . Our happiness or satisfaction in any situation depends on our most important values being met.” “If you align your life and work with your unique order of values, you will be happier and more productive.”⁹

What Makes Life Worthwhile?

An important way to take care of yourself and keep your life balanced is to pay attention to your overall well-being. The Gallup organization conducted extensive research to identify the five elements that are essential for a thriving life. These are things we can do something about to improve our lives. As described by Tom Rath and Jim Harter (2010), the five elements of well-being are summarized in Table 4.1.¹⁰

“When we strengthen our well-being in any of these areas, we will have better days, months, and decades. But we’re not getting the most out of our lives unless we’re living effectively in all five.”¹¹ So, while career is vitally important for you to thrive, you need to pay attention to all five elements to continue to sustain yourself in work and life.

Sustaining Your Success at Work

According to Marcus Buckingham (2005), “Sustained success means making the greatest possible impact over the longest period of time.”¹² He believes that having a great impact requires that:

1. You apply your natural talents and enthusiasm to become good at something.
2. You stay good at something and more than likely get better.

Getting better, particularly in today’s rapidly changing work environment, requires that “you be resilient, flexible, open to learning, innovative, confident, optimistic, and all the while, sufficiently devoid of stress to maintain your energy for the long haul.”¹³

Sustaining in the Face of Boredom, Unfulfillment, Frustration, Draining Experiences

Marcus Buckingham (2005) identifies some things that challenge our sustainability in our jobs, and offers remedies. Some challenges and remedies for sustaining in our jobs is provided in Table 4.2.

Buckingham advises, “The longer you put up with aspects of your work that you don’t like, the less successful you will be. So, as far as you are able, and as quickly as you can, stop doing them, and then see what the best of you, now focused and unfettered, can achieve.”¹⁴ He reminds us that it is always our responsibility to make the adjustments that allow us to sustain our highest and best contributions at work. “The more skilled you are at this, the more valued, and fulfilled, and successful you will become.”¹⁵

Do You Really Want to Be a Manager?

Recently, when I told an MD I met in a social setting that I was writing this book, her eyes widened as she said, “I love taking care of my patients! I have no background or interest in doing administrative things. I can’t imagine being a manager or why I’d want to do that!” She is like many others who are clear about the kind of work they choose to do.

Other clinically trained people move to management roles, still value seeing patients, and are reluctant to give up that part of their work. They try to fit in both types of activities, but feel they cannot give patients the attention they deserve when so much of their time and energy is focused on administrative tasks. They may realize that what they truly love to do is to work directly with patients, so they feel that the administrative requirements of their management jobs are unwelcome burdens that weigh them down or distract them from their most important focus. If this feels familiar, it may be time to honestly ask yourself, do you really want to be a manager? Why?

Bill Milnor, MA, my colleague at MHCD, has hired, promoted, and coached many new managers who had been clinicians. He advises new managers to dig into what it means to be a manager, and tells them, “Your identity is going to change . . . . What do you know about management?” He has noticed that there are managers who might be happier as clinicians.¹⁶ As he explains in an Executive Briefing from Open Minds,

I have hired many managers out of the clinician pool and have paid very close attention to their specific motivations, and I want to believe that most hiring processes are similarly informed. What I pay most attention to is how enlightened a candidate is to what management is as a discipline and practice regardless of their previous experience, clinical or otherwise. Succeeding that, I look for the potential they possess in talent and interest toward management.

I can recall a couple of excellent clinicians who I promoted to managers, of course, after competitively interviewing, that after a period of time figured out they preferred to be clinicians. They were becoming very good managers but were not feeling the satisfaction. I regularly say that one has to “really want to be a manager.” It’s really not hard to spot a clinician in manager’s clothing although sometimes it is quite hard for them to see that themselves.¹⁷

As you have been developing more understanding of what managers do, you may be discovering more about how well suited and interested you are in developing the skills required to be successful as a manager. Of course, there are challenges in learning new skills required for any new roles and responsibilities; you have worked your way through them to earn your clinical degrees and credentials.

If you feel some doubts about whether you are in the right role, it may be time to reconsider your values, interests, and what will sustain you. Many other managers have moved back to clinical roles and felt much more satisfied with their work, and this might turn out to be the appropriate path for you, too. Be honest about what is and is not working for you. The previous section can help you explore and choose an appropriate resolution for your discomfort. Here are some recommendations to help you sort out this specific decision of whether to move to a direct clinical position or continue as a manager.

Give Yourself Time to Adjust and Learn

As repeated by many people I interviewed, moving from clinician to manager is a big change that will stretch you in new ways. There is a lot of learning required to become a competent manager. Be patient, do not expect to know everything right away. Your day-to-day routine, and perhaps even the environment, will be different and will require some time to adjust and feel comfortable in a new setting, different tempo, and new procedures to master. Expect some discomfort as you adjust for the first several weeks or months.

Review What You Really Want to Accomplish at Work

Think about where you see yourself having the most impact. Consider how your particular skills and interests help patients and contribute to healthy communities. Some ways to do this are by applying your clinical knowledge to help develop other clinicians, or to help shape the overall health care system in your organization or at the broader community level. These are things you will be particularly focused on as a manager. On the other hand, if you see your biggest contributions and primary satisfaction coming from the clinical work you do directly with patients to provide care and treatment, then perhaps you really would be happier and more effective being a clinician rather than a manager.

What Other Activities Can You Emphasize or Add?

You spent a lot of time and effort in your clinical education and training. Keep in mind how valuable this is as you help other clinicians learn and grow and as you make decisions that support effective clinical operations in your organization. Even if you are currently managing a function that does not provide direct clinical services to patients, you are using your clinical knowledge to support key service-oriented goals for the organization and to collaborate with others.

Other activities you might be able to add include mentoring or supervising other clinicians. After I obtained my clinical license and was managing several administrative teams that supported but did not provide direct clinical services, I let clinical program managers know that I was available to provide clinical supervision to their new license-eligible clinicians who needed supervision in my clinical discipline. This led to several satisfying opportunities for me to apply my clinical knowledge to help new clinicians build their clinical skills and credentials.

There could be other opportunities, or even requirements to maintain clinical licensing, for clinically trained managers to provide direct care and services to patients. For many people, this works very well when the time is clearly allocated and protected to see patients and provide high-quality care. This requires the support of the manager’s boss and the organization to honor the time commitment and protect clinical scheduling from being overridden by frequent competing demands for administrative time.

If providing direct clinical care is of high value to you but your organization does not support the time commitment for you to allocate to this during regular working hours, then you might need to think about moving to a different role in your organization, or to an organization that allows you to balance and fulfill your needs in both areas. Or could you spend some time outside of work providing clinical services as a volunteer or in a separate practice?

Sections below show you how to get some new experiences and how to use feedback from others to help you land where you will thrive. If you are seriously pondering, “Do I really want to be a manager, or would I rather be a clinician?” you can apply the learning activities at the end of this chapter to this question. The activities can help you gain clarity about this, as well as other areas for you to explore about your focus and direction.

New Experiences and Changes

Do you need some new experiences or changes in your work? Cherie Sohnen-Moe (2016) advises that you recognize and prevent boredom that can seep in when an overrepeated rhythm turns into a rut. Find and engage in work activities that motivate or inspire you and can help you grow. This could require that you move into a different role or find new activities to enhance your enjoyment and motivation in your current role.

Boredom or dislike of repeated routines came up in some of our interviews. Some people reported that after many years of clinical practice, they felt they had mastered the needed skills and were looking for new challenges. In another case, a person still enjoyed working in health care, but was not enjoying being on-call and performing treatment activities he had learned in his years of clinical training and which he no longer found interesting. In these cases, people found great rejuvenation in new roles that they find fresh and interesting.

Fred Michel, MD, remarked that after 10 years, direct medical practice can get boring, particularly if you are not learning new things. Administration, on the other hand, he finds fresh and interesting. He is never bored because he feels he has not mastered it yet.

Some people pick up interesting ideas through reading. For example, Michael Sullivan, MD, enjoys biographies of successful people such as Abraham Lincoln, Steve Jobs, and others to consider what made them successful. Others stories can give you inspiration and motivation to discover ways to thrive in your current role, or to move to something new. He recommends embracing change rather than avoiding it.

“At some point in everyone’s career, go back to school or get some kind of training for deep thinking to re-engage the brain and rejuvenate,” Dr. Sullivan advises. This is above and beyond required continuing education that is an expected part of the job. Formal training may be necessary for learning the language of business, especially in finance; course work can be online. Even with soft skills there is a science to it and common language. “Leaders aren’t just naturally born, it requires working at it. Get involved! Seek opportunities, join committees, champion clinical improvement projects.”¹⁸

Look for ways to contribute in your current role. It is better to shape what you are working with and create a brighter future rather than struggling to manage in an environment that is not working.¹⁹,²⁰ Volunteering to participate in special projects, committees, or workgroups can provide avenues for you to influence the changes you would like to see.

Adding new experiences and activities can be invigorating to you and your career. When David Bachrach, MBA, FACMPE/LFACHE, works with an internal candidate who was not chosen for a promotion, he recommends the person compare his curriculum vitae (CV, or resume) to that of the successful candidate and suggest ways to overcome some perceived limitations. If the person only has experience in one place, would other assignments, such as a visiting professorship, help expand his experience?²¹

Cherie Sohnen-Moe (2016) recommends, “Keep in mind that any career has its ups and downs. The key is to recognize the difference between a natural phase and a downward spiral. Step back and objectively evaluate the situation. Determine why you’re encountering boredom and what might work best to remedy it. After you’ve assessed the situation and brainstormed possible solutions, discuss the issue with an advisor. Getting feedback from a trusted advisor can often shed new light on a challenging situation.”²²

Mentoring and Guiding Others

Early chapters, particularly in Volume I, and many interviewees explained the value of having a mentor to guide your own growth. In their book, One Minute Mentoring, Ken Blanchard and Claire Diaz-Ortiz (2017) explain the mutual benefits of mentoring relationships. “Your mentoring relationship will bring you new perspectives and ideas. Whether you’re a mentor or a mentee, stay alert and open to the new opportunities that arise through your mentoring experience.”²³

Sharing your experience with others can bring new insight and meaning for yourself. For example, Jean Rosmarin, PhD, finds that conducting training classes is “renewing, it reminds us why we do the work.” Training others, either in classes or sharing your skills and experience in supportive interactions, can provide you with growth and renewal. Jean also has run a successful private psychotherapy practice for many years and offers mentorship to others in opening their own practices.²⁴

There are various ways you can mentor others, within your own organization or in other arenas. Stay open and watch for ways to do this. This reminds me of experiences I appreciate from when I was an executive leader at MHCD. MHCD began to focus strategically on building our community relationships, so we belonged to several local chambers of commerce and participated in their social activities.

Attending the networking events at several chambers felt inspiring and invigorating to me because I enjoyed meeting new people and discovering new resources for our organization. It was fulfilling to engage others in supporting MHCD and attending our events in the community, and to form other friendships. New relationships led me to join the board of directors of another nonprofit organization. Joining boards of other organizations can provide a valuable avenue to mentoring leaders in other organizations while you learn new skills to contribute to your community or profession.

As MHCD increased our efforts to extend our organizational reach into these chamber groups, I joined an MHCD planning team of senior leaders. We organized and conducted training seminars to engage more of our managers and staff in learning networking skills. Sharing my experience in representing the organization in networking situations brought me new insights from working with several managers and other staff on our clinical teams to support them in becoming chamber ambassadors. They brought new perspective from their roles and work at other locations that helped me learn and grow as a senior leader.

Mentoring connections can arise in several ways. Here are some examples:

1. Mentoring connections can arise within relationships you already have with people at work or other areas of your life when they seek you out for help or advice.
2. You may find yourself working on projects, either at work or in activities in outside organizations where you volunteer or participate. There you could develop relationships with others who benefit from your wisdom and guidance.
3. People in your social and professional networks might recommend that others contact you when they are seeking guidance from someone with your experience and abilities to help them.
4. You can be intentional in seeking others to mentor by spreading the word within your network or volunteering for organized mentoring activities in your local community, alumni associations, professional societies, and other avenues.

Your Growth and Improvement

Carol Dweck (2006) explains that great leaders have a growth mindset. “They are constantly trying to improve. They surround themselves with the most able people they can find, they look squarely at their own mistakes and deficiencies, and they ask frankly what skills they and the company will need in the future. And because of this, they can move forward with confidence that’s grounded in the facts, not built on fantasies about their talent.”²⁵

Confront the Facts, and Keep Faith that You Will Prevail

Jim Collins’ (2001) book, Good to Great, was mentioned frequently in interviews as offering valuable lessons for leaders. Collins dedicates a chapter to confronting the brutal facts yet never losing faith. He provides the Stockdale Paradox as a powerful illustration, drawn from his conversation with Admiral Jim Stockdale. Stockdale survived as a prisoner of war for 8 years during the Vietnam War, under abominable conditions with no release date in sight. Yet he did everything he could to create conditions that would help the prisoners under his command survive unbroken, and he never doubted that he would get out.

When Collins asked Stockdale which prisoners did not make it out, Stockdale explained that it was the optimists, who counted on getting out at set points in time, and after they lived through numerous dates coming and going without their release, they eventually “died of a broken heart.” Collins frames the Stockdale Paradox as,

Retain faith that you will prevail in the end, regardless of the difficulties,

AND at the same time,

Confront the most brutal facts of your current reality, whatever they might be.²⁶

Collins explains how the great leaders he studied focused on just the few things that have the greatest impact because they “operated from both sides of the Stockdale Paradox, never letting one side overshadow the other.”

While it can be challenging for you to manage in the face of rapid changes in health care funding and requirements, you can choose to focus on the important things you, your team, and organization perform that impact the health of your patients and well-being of your community. You can continue to develop your management skills and support your team members in improving clinical skills and developing their leadership skills. Together, you can find better ways to do things to satisfy requirements for organizational efficiency, high service value, and excellent clinical outcomes.

Accepting Help for Improving

In their book, Tribal Leadership, Dave Logan and John King (2008) consider how leaders can advance along with those they lead to the highest stage that maximizes organizational potential and innovation. They caution against leaders relying too much on only themselves. “Effectiveness is capped by their time, which is a limited resource. The more the person can accept help from others, the more he will see that help from others is not only helpful but necessary to his becoming a fully developed leader. Once he begins to form strategies that rely on others, and in which others rely on him, he will have taken a big step.”²⁷

This is about more than just delegating specific tasks, which we examined in Volume I. This is about your development and improvement. Let us look at how you use feedback and your own coachability for improving your skills and capabilities.

Accepting and Following Up on Feedback

Kay Martin, LCSW, has been a health care manager for over 35 years. She started off doing purely clinical work for 5 years, then worked as a program manager for 5 years, and recently retired as Chief Operating Officer at Solvista Health. She advises that you keep your focus, keep your heart, and recognize that you have a long career ahead of you. “Don’t take yourself too seriously,” Kay advises. “Be able to turn the lens inward to evaluate yourself and accept feedback.”²⁸

Accepting feedback requires humility and openness to accepting help from others. Some people I have talked with believe that their most valuable growth came as the result of feedback they received in formal reviews that may be described as 360-degree feedback. In such reviews, input is gathered from multiple perspectives of people who work with the person up, down, sideways, and could include the perspective of patients and customers. One of the managers I interviewed learned from this process that he needed to listen more to the people who worked with him. He made this a goal, practiced, and concentrated on improving his listening skills.

You can improve by accepting feedback, acting on it, and checking back for other people’s perceptions of the results. As Marshall Goldsmith (2007) explains in his book, What Got You Here Won’t Get You There, “Follow-up shows that you care about getting better. Following up with your coworkers shows that you value their opinions . . . . Becoming a better leader (or a better person) is a process, not an event . . . . Follow-up turns changes for the better into an on-going process—not only for you but for everyone around you who is in the follow-up mix. When you involve other people in your continuing process, you are virtually guaranteeing your continuing success.”²⁹

Another manager’s 360-degree feedback revealed that one person thought she needed to treat people more respectfully. She admitted that this feedback was unexpected and hurt initially. She reflected on it and realized that she might have developed some undesirable habits from emulating a boss she’d had who was known for his abruptness. She decided that if even one person felt that she was not treating people well, then she needed to address it. She brought all of the feedback to her team meeting to discuss and work on, and found that it raised awareness of how people were talking to one another and the effects they had on each other. Now her whole team is consciously working toward communicating more constructively, and this has strengthened the positive work culture of the entire team.

Coachability

In the words of Gary Markle, “Coachability sets [the] stage for performance improvement.” This means being open to change and using the feedback you receive from your boss and others to help you improve and advance into roles and responsibilities you desire. For example, when a manager was told by his boss that one of the areas to concentrate on for improvement was to stand up and take a more visible leadership role in meetings, the manager stood up that same day in a meeting, and spoke from notes he had prepared.³⁰

Author Marshall Goldsmith (2007) demonstrates how a coach helps him follow up on his important goals. His coach calls him every night and asks him a set of questions that he answers honestly. The questions include some things that are hard for him to do, that matter, and require discipline. Questions start with,

• “How happy are you?”

There are health-related questions such as,

• “How many hours of sleep did you get?”
• “How much walking did you do?”

along with work productivity,

• “How much time did you spend writing?”

and questions about what he did that was nice for his wife and other family members. There are questions about behaviors that are getting in the way:

• “How many times did you try to prove you were right when it wasn’t worth it?”
• “How many minutes did you spend on topics that didn’t matter or that you couldn’t control?”

Goldsmith believes that having someone else to help him follow up on his goals provides encouragement and input and helps him measure his progress. He suggests that if you do this kind of follow-up regularly with another person, that you will meet your goals for change.³¹

Feedforward to Improve in the Future

Goldsmith (2007) recommends the feedforward approach to engage others in giving you suggestions that help you change. Instead of focusing on reports of what you did in the past (feedback), feedforward elicits ideas on what you can do to improve in the future. Here is how it works.

1. Pick one behavior that you would like to change that would make a significant positive difference. For example, “I want to be a better listener.”
2. Tell other people what you want to change, in a one-on-one dialogue with each person.
3. Ask each person for two ideas about how you could do that in the future. The people you ask could be people you know at work, home, or family. Some of the best ideas could even come from strangers because they are not biased by what they have seen you do in the past.
4. Listen attentively and thank the other person. Do not judge or critique the ideas, just accept them as input.

Feedforward is effective because:

1. It requires that you ask for other people’s ideas.
2. It brings out the best in others because they have the opportunity to be helpful to you.
3. People prefer to get helpful ideas for the future rather than painful criticism about the past.³²

Remember, pick something that will really have an impact, something that is getting in the way of your performance or that will truly make a difference to your team or organization. Do not pick something to improve just because you know it is achievable!

Outward and Onward!

Consider the impact you and your team contribute not only within your organization, but also in your community and in other settings where your skills and values contribute to these other missions. This could include volunteer work, professional societies, and other activities. Go beyond just showing up at meetings and become an active contributor. Running for election or accepting appointments to officer positions in other associations or professional societies will help you establish valuable contacts that strengthen your professional and personal network, and can enhance your organizational and leadership skills. Several of the people I interviewed have experience and helpful suggestions about this.

Success and Onward: To Significance and Impact

Gene Dankbar, MS, MBA, of Mayo Clinic suggests showcasing a team’s work at conferences and helping them build an academic resume through research, publishing, and presentations about the results of projects you commission to improve areas such as patient turnaround and scheduling. For your own development, take on committee roles to build skills and find mentors. “A person looking to move up can build skills and contacts contributing to the community. Look for organizations in your community that may appreciate your help and give you the opportunity to learn new skills.”³³ Several of the people I interviewed, and I have volunteered to review applications for grant funding with community foundations, and we have found the experience valuable for gaining more insight into what funders are looking for so we can better position future proposals for our organizations.

Elvira Ramos talked about building pipelines of future leaders and succession planning. Encourage your employees to get out in the community to build skills. Toastmasters is a valuable resource for developing public speaking skills and getting practice. People who have participated often find it helps them in multiple areas of their lives, not only at work and volunteer roles but at family events too. The repeated practice can build confidence in speaking and leading more effectively. Fellowships, such as the Leadership Fellows program that Elvira developed and leads, helps its members build contacts and set goals that help them earn appointments to boards of directors or elections to public office, so the fellows are prepared to make significant impacts in their communities.³⁴

Carl Cark, MD, always values learning something new. For the more experienced managers to sustain their passion, he advises, “Move from success to significance. An example is the Dahlia Campus that MHCD built with deep and meaningful engagement with the community, which initially didn’t want us, a community mental health center, in their neighborhood.”³⁵ The senior leader who envisioned a welcoming campus that addressed comprehensive well-being needs for children and families in the community went out and developed relationships to build a base of community
collaboration and philanthropic support that enabled her to attain her
vision.³⁶ And, Carl added, “The Sanderson Apartments were built to house long-term homeless people, who had been homeless 10 years or longer. Trauma-informed principles informed all components: the architecture, Denver Housing Authority, and others.”³⁷ These projects demonstrate the power of moving from individual achievement to team collaboration onward to impactful significance in the community.

Annette Canon, PhD, MSN, MA, RN, continues moving her impactful work to influence the health and well-being of her community. When we both worked at MHCD a number of years ago, I appreciated her initiative in contacting me to offer helpful suggestions for quality improvement from her perspective as a nurse in our outpatient clinics. When I had an opening on my team for a Health Information Systems Manager, I invited her to apply and hired her into this new position where she applied her valuable health care knowledge and skills in a new leadership role. She has continued to grow and contribute her skills in many different roles as a health care leader.

As a Nursing Instructor at Platt College, Annette has enjoyed teaching and mentoring nursing students to help them launch successful careers in health care. She has been very active in networking. She contributes to the nursing profession by getting involved in projects, taking on leadership roles, representing nursing and other health care interests in meetings, conducting and publishing research, and presenting at conferences. She enlists others in her network to get involved in community health-promoting activities such as health fairs, and serves on boards of directors of organizations helping to meet the needs of disadvantaged children in the community.³⁸

As Annette has demonstrated throughout her career as a nursing professional and manager, contributing to the profession and your network could get you noticed, and earns support that can increase your impact in creating healthy communities. She continues to be reelected in nursing leadership roles and recently won the election in her county for the public office of coroner. Watch for her advocating for important change and continuing to model caring and impactful health care leadership in her new highly visible and important role.

Remember Your Passion!

Challenges arise at work, even for experienced, well-seasoned managers. Sometimes new approaches and fresh perspective can help if you feel stuck and need a burst of insight to energize you. Revisiting relevant sections in this volume and the first one in this series, Management Skills for Clinicians, Volume I: Making the Transition from Patient Care to Health Care Administration, might help you find and tailor new tools long after your initial transition into management. For me, I found that when I was interviewing people and conducting research for these books, I became aware of many techniques suggested by others that I grew eager to apply for myself in appropriate future opportunities.

We conclude with this reminder from Christina Loetscher-Whetsone, RN, who said, “I wouldn’t trade any of it. It’s important to be able to recognize your passion and why you do what you do.”³⁹ Matthew Kelly (2007) tells us that people need the belief that they are moving toward the fulfillment of their dreams, and that work should move people toward those dreams.⁴⁰ Keep believing in yourself and remember what you value in your work as you move toward being the great health care manager you have dreamed of being!

Chapter Summary and Key Points

In this chapter, we saw leaders with long careers who remained energized by building their skills, staying aligned with the mission of their organizations, continually learning new things, and building their interests into their professional work. We looked at the importance of balance and renewal, with a focus on self-care and inclusion of the important elements of life that help you thrive as a person so you can sustain your professional progress and effectiveness. We looked at ways to foster your professional growth and development. We heard from leaders who had significant impact in the community and showed us how to move from success to significance. Finally, we were reminded of our passion for our work and why we do it. As a health care manager, you have not only learned to arrive, now you also know how to continue to thrive!

Key Points:

1. To stay motivated, continue to learn new things and apply your interests to your work.
2. You are your most important resource, so take care of yourself! Take time from sawing to sharpen the axe. Renewal and balance are needed across the dimensions of your life.
3. Mentoring and guiding others can be renewing and enhancing to your own growth.
4. Research by the Gallup organization identified five essential elements that we have some control over and make life worth living. These are labeled as Well-Being in the areas of Career, Social, Financial, Physical, and Community.
5. According to Marcus Buckingham (2005), having a great impact requires that you apply your natural talents and enthusiasm to become good at something, and that you continue to be good at it and more than likely get better.
6. Accepting help from others is important for you to improve.
7. Following up on feedback tells others that you value their perspective.
8. The Stockdale Paradox of Jim Collins (2001) tells us to confront the brutal facts of our situations while having faith that we will prevail.
9. According to Carol Dweck (2006), great leaders have a growth mindset and they are constantly trying to improve.
10. Feedforward asks for ideas from others on something you select for your improvement. It differs from feedback in that it focuses on the future, rather than on criticism of what you did in the past.
11. Experienced managers enhance their success when they move from a focus on personal success to community significance.
12. Remember your passion, purpose, and what you value in your work, and keep believing in yourself!

Learning Activities for This Chapter

Here are some questions to help you focus on what works for you to keep your passion ignited and burning bright.

1. Thinking about your current role, what do you find satisfying about it? What do you wish you could change?
2. How does your current role in the organization where you work align with your values?
3. What would you like to try doing that you are not doing now in your current role? How could you make that happen? Could you do it in your current role and organization, would you need to move to another one, or start a new practice or business on your own?
4. What opportunities do you have, or could you create, to mentor and guide others?
5. What examples and recommendations have you seen from leaders, in this chapter or others, that you might want to do to enhance your growth? How would you adapt their approaches to make them work well for you?
6. What challenges have you experienced, or observed in other people who report to you, that signal boredom, unfulfillment, frustration, or being drained? What remedies did you try for yourself, and what would you recommend now for someone else?
7. What are the brutal facts of your current health care environment and how will you build your confidence in knowing you will prevail and succeed?
8. Pick an area where you need to improve.
   • How do you know you need to improve in this area?
   • What would be the impact of your improving?
   • Conduct a feedforward conversation with three people to get their ideas for how you could improve in the future.
   • What did you do with their ideas?
9. Where would you like to increase your impact in the community or your profession?
   • What activities, groups, committees, work groups, associations, or societies could you join or increase your participation?
   • How will your participation be valuable: to the group, to you, and to the organization where you are working now?
10. Conduct this activity, suggested by Jim Donovan (2014),⁴¹ to uncover the values of others or yourself.
    • Ask an employee, or write down the answer for yourself, “What’s most important to you in your work?”
    • Continue to ask the question to build a list.
    • Then, move down the list and compare each value to the one listed above it. Ask which one is more important, and move values up or down the list accordingly.
    • Now you know the values and order of importance for your employee or yourself. How will you use this information to increase alignment of work activities with values?