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  • Writer's picturePaul DeChant MD, MBA

Getting Aligned in the Healthcare Setting - Up, Down, and Sideways

Updated: May 13

How well aligned are you with:

  • Your peers,

  • Your direct reports, and

  • Your boss?

This week I was checking in with a client, let’s call him Bob, and asked how he was doing. Bob reported a challenge in working with his boss, let’s call him Jeff, who blamed him for strained relationships with some teammates.

To his credit, Bob’s been working to improve those relationships and making some progress, not as much as he’d like, but definite improvement.

I asked Bob how he did this and he reported meeting with them individually, and talking about their priorities - where they were similar and where they differ from Bob’s.

Bob's boss Jeff is a strong believer in holding his people accountable to achieve the metrics that have been set for each of them. That’s all well and good. The challenge is that he holds them each individually accountable to perform. Jeff has not held them collectively accountable.

I asked Bob if he had talked with his teammates about their individual metric goals. He thought for a moment and realized that he has not. He really doesn’t know specifically what his teammates are working to accomplish.

These metrics are important - they directly impact the performance of the health system as well as each team member’s individual incentive bonus.

Bob realized that he did not know if work that he was doing to improve performance on his individual goals had any impact on his fellow team members ability to succeed and realize their goals (and bonuses).

At a higher leadership level, this gap is on Jeff who, as the team leader, had not brought the team together to ensure everyone knew each other’s goals and were committed to mutual success. As frustrating as this is, it’s not all that uncommon.

Executive Leadership Can Impact Physician Burnout

In this hectic world where leaders are often reacting to the latest crisis, it’s easy for something that is important, but not urgent, to remain under the radar .

So what is Bob to do? He could get frustrated that his boss is not the most effective team leader, and then use that as an excuse for poor performance and strained relationships with his team members.

He likely will be careful to not upset Jeff, his boss, by pointing out this gap in leadership. He’s been burned before by this less-than-supportive boss.

One thing he can do, and now will do, is schedule meetings with his teammates to discuss their individual performance goals, with a commitment to helping his teammates succeed.

It seems simple. It seems like this should have already happened.

But it hasn’t, and that’s not uncommon with highly stressed executives.

However, now armed with this insight, and committed to making relationships better with his teammates, I know that Bob will start changing the culture of this leadership team.

He’ll do it one relationship at a time.

He’ll do it by managing up, filling a void in the way the team is led.

But he will do it, and he will be a better leader for having done so.

A personal note from Dr. Paul DeChant

I would like to thank you for what you do, whether you take care of patients or take care of those who do.

If you would like more information, or specific recommendations, you can email me at

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