Melissa Stratman

13 May, 2021
Follow Coleman!

Melissa Stratman

13 May, 2021
Follow Coleman!

Equally Hobbling Everyone

I was sitting for what felt like forever in a management team meeting listening to a frustrating circular conversation about a physician who went “too slow to be financially viable.” Then, someone at the table proposed a solution and the conversation went like this:
“What if we pair Luz with Dr. Johnson?”
“Who is Luz?”
“Luz is the newer MA. She’s been working with Patty, but really Luz is so on-the-ball. She’s quick and efficient. Maybe if we switch things up and swap MAs, maybe Luz will rub off on Dr. Johnson and speed her up?”

I leaned in. Why? I had to interject. I had to share what I have seen and learned in my twenty years in health care improvement. After all, this is what the health center is paying me to do… to help them improve. In this case, I’m going to disappoint one of my management allies at the site by not agreeing with this and instead, I need to hit them with the hard truth.

The hard truth is that when it comes to performance, it doesn’t work like that. While greatness certainly can inspire, great people don’t typically “rub off” on low performers and make them great, too.

In the workplace, high performers can instead feel saddled with low performers and slowly allow themselves to step back from the work at hand. For management, this means that instead of having one superstar team and one less awesome team (that the manager needs to confront and coach), they are seeking a softer (but more deadly) solution… to equally hobble everyone.

Where do I start?

Well, in the world of management it’s clear that finding two people who have complementary skills and pairing them together works well. My COO does things in seconds that I struggle to master in weeks, and in turn, I do things she never would have considered doing or saying. We make a great team. Most of my team members are like that. I have long since learned to surround myself with people smarter than I am, especially in ways that I am not sharp. It makes for a brighter collective.

In collaborative work, the more detailed person can help the less detailed person, the more tech-savvy person can help the less tech-savvy person, and the more compassionate person can provide an otherwise missed perspective to the more pragmatic team member. These strengths and weaknesses create situations that allow everyone to succeed. The same can be true in a marriage. The more social partner can create space for the more introverted partner to engage in social events. The more culinary partner can make up for the partner who is an expert at ordering take out, and so the styles are complementary.

This complementary work happens in truly collaborative work places. But when it comes to team-based care and performance issues, some managers seek to apply this same lesson in an arena where it has not been shown to be effective. One individual with skills and engagement does not make up for one who lacks skills or engagement. There is not sufficient evidence to suggest what we might hope to be true… that efficient paired with inefficient actually “fixes” inefficient. I remember chuckling at this practicality when I overheard my mentor, Roger Coleman, tell a health center leadership team that while he thought that this pairing might quicken the step of the slower person, what it did in actually was steal the “good” MA from the “good” provider and saddle the “good MA” with a lower performing provider, therefore “equally hobbling” both teams. In my experience, this is even more pronounced when the inefficiencies lie in the person with higher education, higher pay, higher status, and more clout in the organization. In these cases, the pairing and hopes of a fix are a futile exercise in frustration.

In his book Good to Great, author Jim Collins states that the only way to truly deliver to the people who are performing is to not saddle them with the people who are not performing. (Good To Great: Why Some Companies Make the Leap and Others Don’t. New York, NY, Harper Business 2001).

This act of trying to spread the love, share the strengths, spread the pain, …or equally hobble all (however you wish to label this activity) is a common mistake of managers. It is an honest mistake when looking for a practical fix that fits within the desire for more independent teams. While I am a huge fan of team self-management, this pairing of quick person with slow person has me thinking about the work of Quint Studor (link to him on LinkedIn). To me, this pairing ties directly to his comments about “the wall.” Paraphrasing, Quint states that the wall is a psychological wall in which high performers experience the gap between themselves and the low performers as unbearable, so they throttle back (my phrase not his) their efforts.

I see this wall in my work. I see great employees eventually burn out and stop trying to do so much or work so hard. It’s usually not a conscious choice; it just seems to happen. While it’s not the outcome anyone would hope for, it is understandable. After all, why should a real firecracker Medical Assistant (MA) work so hard to get patients fully ready for a provider who doesn’t share the organizational mission of seeing patients in a timely manner (and doesn’t value the MAs goal of getting patients helped in a timely manner)? That MAs know that the providers get paid way more than they do. And when they see that the provider doesn’t seem worried about delivering timely care to patients and management, they might decide that they should care a little less too. It’s not necessarily even a conscious decision. That’s perhaps the most devastating part. This unconscious choice to care a little less happens without us really knowing it. We ease up on performance unknowingly and we decrease the effectiveness of the entire organization.

So, how do you encourage great teams? Put Stars with Stars. David Cottrell (Monday Morning Leadership: 8 Mentoring Sessions you Cannot Afford to Miss.Cornerstone Leadership, 2002. pp. 33 – 37) refers to stars in his book Monday Morning Leadership. After all, the smart ones, the cool ones, the industrious ones–always want to be seen with like-minded people. They want to be sparked by those who are like them and even stronger. No one minds helping out someone who is struggling now and then; However if you put a star with a group of equally strong and like-minded people (other stars) and you are sure to get some supercharged results!

Making these groupings raises the obvious question: what about that team with low performers? What about their patients? Well, putting them together allows managers to see much more clearly what is happening with the dynamics, since no one on the team is single-handedly making up for or covering anyone else’s weaknesses. This allows the manager to provide more targeted training and coaching to this team if that is what is needed. And, if that isn’t what is needed, we have seen a weaker team feel pressure to raise the bar. They know they are at the bottom and no one wants to come in last. A lower performing team will hopefully feel the pressure to become stronger performers which will benefit the entire organization and their patients.

So, the next time there is a question of how to help low performers move up, don’t entertain the idea of letting a low performer weigh down a high performer. Keep the high performers engaged and excited as high performers. Deliver to them. After all, they got themselves there, now let them shine. Stay focused on delivering stars and keeping them engaged and happy. The low performers and their weak performance must be addressed (and they need to be given that feedback) before harm comes to the patient or the organization. They will sort themselves out when they start to realize the shift in the company that they keep.

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