PT Classroom - Reflections as a Rehab Director ׀ by Ben Fung, PT, DPT

Making a Difference

I think just about everyone goes into healthcare management with something in mind to the effect that they want to make a difference. There are systems that could be improved; operations that could be changed and made better; waste that can be eliminated; best practices to promote; bad practices to put a stop to - etc. etc. etc. All these things have been repeatedly met with frustration at the operator level.However, it appears that at the management level, one could better leverage change. The truth is you are right! Unfortunately, it's a bit of a shame that individuals must get so such a point of frustration - all the way to that "I quit!" moment - before seeking management opportunities to positively channel such passion. If anything, I'd prefer to see the healthcare industry move in a manner which creates leadership tracks; selecting for those who have demonstrated aptitude and leadership qualities to help pave our future for prosperity (rather than frustrate good leaders and make them leave organizations to prove their worth).

Being the Boss = Being the servant
You may have heard this in military contexts: As the leader, you need to be the first one in and last one out. It is a rare experience that I get all my work done to the point where I leave before my staff. Why? Haha! See below. But really, this concept is really more of a point of humility; an attitude to adopt if you are to be an effective leader. Now that you're the boss as the rehab director, healthcare administrator, nursing manager, etc. - your job SHOULD BE to position yourself in a way where you can empower your staff to delivery optimum care through best practice. Your job is to serve those who serve at the front line. Your job is to team build, strengthen the unit, and tighten down operations.

Getting Paid Salary
You know what salary really means? You STAY until the job is done - or - something like that. Realistically, if this is your first management position with salary pay, get ready to work some LOOOOOONG hours. In fact, it'll probably take you about 6 weeks or so to get acclimated to all the various operations of the specific facility/department/unit/wing. Salary means you are all in - no backing out. The true challenge is that work-life balance component; making sure that you don't bring the work home with you is vital.

Minding the BUSINESS
Just like before, when your bosses were harping on productivity... guess what!? It's your turn! No seriously. It's your turn. Sucks… it really sucks – especially since you promised yourself you wouldn’t be “one of those managers.” Why does this happen? Well, it sounds a bit simplistic but... it's best described by the best Robin Hood satire production ever:

... then we don't no eat rolls!

If clinics aren't productive, then the profit margins are low. If the profit margins get below a certain point, then the clinics/department/unit/facility starts to lose money. In the end, there can only be so much loss before companies have to close shop. And to be honest, as a director, this is a LOOMING pressure for me. I'm charged with the financial well-being of a facility's rehab practice. In the end, this affects all the residents/patients we care for - sure! However, what I actually find holds more weight is the pressure of making sure all my staff keep their hours, keeps their benefits, and keep their jobs so that they can provide for their families.

Inheriting Problems
Whenever leadership is changing hands, one ALWAYS inherits a bundle of problems. Weeks and months later, you are still finding skeletons hidden in all sorts of fun places. In my opinion, if the leader says "Oh, this was a problem brewing from way back - not my fault" that's a bunch of hooey. However, if the leader says "This is a problem we learned developed from way back; I accept responsibility for this problem and I am developing strategies to resolve this immediately" - NOW you got something closer to leadership and further from politics.

Putting Out Fires
Rehab Director = complaint central! In a management position, much of your time is truly spent putting out fires. This could be anything from a patient/family complaint, an operational process gone haywire, HR issues, staff complaints, other departments unhappy with your department, people calling in sick, etc. As a manager, it is your job to make sure everything runs right, goes smoothly, and produces a positive outcome. Think you get all day to develop best practice guidelines? Think again! You are putting out fires! If you wanted to change clinical practice, then your best bet is actually being a clinical educator/specialist (depending on the role/position in the company).

People, people, people... Oh, did I mention people?
Once in management, it doesn't matter what profession you are in, you have now become in the business of people; making people happy, satisfied, operational, civil, cohesive, engaged, and productive. If you are a people person... better, if you are a skilled herder of cats… is that a yes?! You have management potential! What's interesting in management is that your skills as a clinician really do NOT matter. It's sad, and, it may actually be sickening. Unfortunately, in the business of healthcare, a good manager is judged by the C-level executives and your report card is the bottom line. If you're all in the black, you're okay jack! As a corollary, my respect for the upper management and c-level executives have now truly expanded; having now experienced what happens at the director's level, I can only imagine the amount of pressure and responsibility which weighs upon the shoulders and conscious of a hospital/company/facility CEO.

Final Thoughts
 

I've been given many compliments in the starting month of being a new rehab director. I have to say that much of my success is attributed to good training from my own regional directors as well as inheriting a great staff. Departments are only as strong as the team itself functions to be. While it is my responsibility to strengthen this team, I must recognize that I did not walk into a fire-fight scenario. My team was already well trained, highly functioning, and operationally coherent. My goal is now to tune this instrument into something worthy for the proverbial hands of Yo-Yo Ma, and, prepare for the future changes in healthcare at large.