Success inevitably requires a difficult choice: either refer out the excess referrals or hire staff to handle the overflow (see “The dilemma of success: Do it myself or delegate” for more on that decision.) Personally I chose to hire staff. When I did, I soon realized that I needed to learn how to manage staff as well. It turns out that becoming a manager as well as a therapist was a far more fateful choice than I knew at the time. As the years have gone on, I’ve realized that it was one of the most significant choices I’ve made. It has shaped a very large part of my professional life. (For more on the topic of managing the hiring and firing process, see “The training we never had, Part 1: Hiring and Firing”.)
Once I decided to hire help, my first challenge was to find others who were willing to join me. In those early days I did not have much to offer except a space and a few excess referrals. I did not even know what I needed to pass on to the other therapists to help them be successful. And yet some clinicians were willing to join me in order to grow a caseload. I muddled my way through, and the organization continued to grow. I was just glad for the help.
Responding to growth
In the 1980s and 90s, as the mental health system was being reshaped by managed care, I realized that my organization needed a more coordinated approach. We needed more administrative support to help us stay on track. The insurance companies was creating more demands.
Our growth required more thought and effort in order to organize the business.. I was coming to terms with the reality that a large part of my job was as a manager. New and existing staff were looking for guidance, support, and direction They were looking to me as the founder and the most experienced of the clinical staff. I needed to embrace my manager role–to get good at it.
The cycle that does not end
This cycle continued—hiring required systems for training and guidance. These tasks required more administrative attention on my part. We now have nearly forty clinicians and ten support staff keeping the business flowing. We have a regular process for hiring, training, and managing all our clinical or support staff. As much as is possible, we have standardized all our processes. We need to do everything as well as we can over and over again.
In 2002 I read a wonderful business book by Joan Magretta with Nan Stone (see Resources) which introduced me to a management approach summarized by this quote:
“Most people are deeply—and rightly—resistant to being managed. In fact, the real insight about managing people is that, ultimately, you don’t. The best performers are people who know enough and care enough to manage themselves. . . . Management [has the] responsibility to provide a context of values within which individuals can manage themselves and . . . take responsibility for their own performance.”
I have tired to hire good people, make clear the expectations for the job. We then come alongside to support them doing the job. Let me say a little more about this process.
Create a job description
When considering hiring someone, the first task is to figure out what you want the employee to do. If I am going to delegate to an employee, I need to know exactly what am I delegating. This requires a brainstorming session, by myself or with others. The goal is to sort out useful tasks to delegate. We need to define what is included and what is excluded from the duties you are assigning. In the end, we want a job description that captures our ideas of what job duties we anticipate for this new employee.
For us, the clinical tasks are the easiest to define and assign. Many years ago we defined the clinical job as having three parts: to do good therapy, to get out of one’s office and connect with the community (i.e., marketing), and then to be a good teammate and invest in our community. Clinicians could and in fact must do these tasks if we are to be successful. From the first interview on, we emphasize these three components of the clinical task.
The job descriptions for support staff are much harder to define. At the stage of posting, interviewing, and hiring support staff, we need some delineation of what we expect the new support person to be doing. We can always rework things later.
Clarifying expectations with the employee
One of my early errors was leaving things vague with employees. I often hoped they would just figure it out. It rarely has worked out well that way. The clearer I or other managers were about what is expected, the more successful the employee became. My goal now is to lay out what I want done and how I want it done. Again, we can rework it later.
This is a tricky area. Monitor too closely and the employee will feel micromanaged. Too little awareness of what the employee is actually doing can lead to serious problems down the road. I have made both types of errors multiple times. It turns out to be quite difficult to get just the right sort of monitoring in place. The key insight in this area is to focus on monitoring employee tasks and not the employee him/herself, a distinction of great importance. Ask lots of questions as the employee is figuring things out. Learn about what the employee is learning if for no other reason than to deepen your knowledge of the tasks involved in your business.
These days much of my monitoring is via watching certain numbers. I cover this topic in another post (See: “The language of numbers: What numbers I track and why”). But numbers do not do the whole job. Especially early on, I or one of my other managers would sit down with a new employee and go through what they are learning as they are doing the job. I always wanted to know, at least in broad strokes, what the new employee’s experiences are; what they are learning; what they enjoy.
I never found a formal system that works very well for the giving and receiving of feedback. We tired regular reviews but found them too stiff and inflexible for managing the flow of daily work. We found that it was better to not wait for a review to deal with things. Rather we found that constant communication created the feedback loop we needed to sort out the tasks at hand.
This daily communication became the main method for monitoring the flow of daily business. There were not many days when I did not sit with my office manager to touch base on any topics that might be arising. The topic might be technology issues, personnel issues, cash flow issues, or any other type of issue. Creating a daily space for those conversations became a key part of managing the business. Of course in the beginning, all this happened on a smaller scale, but the essential process was the same.
Re-creating the job plan
There are times when the assignment of tasks so deviated from our original plan that we needed to redo the plan altogether. I remember several years where we struggled to keep up during our busy season. Consistently we felt overwhelmed from late winter and into spring. Each year we would gear up and reorganize in preparation for the flood of activity in winter. And as we worked through the season, we learned more about what we needed to do. Our conversations became the foundation for figuring out how to be ready for the next season. We were constantly re-creating processes.
For example, when we began, our accounting system was a pegboard and ledger card system (Google it and see. Here is one sample.). As we became computerized we grew through three complete software vendor changes. Eventually we got to a company that could manage the flow of what we now do. And with every one of these system changes, we had to develop different processes for doing the daily activities of scheduling, recording that a session occurred, billing, and collecting. During these years, our most important job followed this pattern: try things out, scrap what doesn’t work, and then re-create new ways to do things. This re-creation process is what growing a business really is and part of what makes it fun.
Manage systems, not people
You may notice that in this post, I have written mostly about managing business tools and business tasks. That is not by accident. I believe that Joan Magretta and Nan Stone were correct to point us toward managing of business systems rather than managing people.
For example, whenever their was an error or mistake, I tried to focus on what went wrong with the system, with the process; not the person. In my view, people are doing what they do because they truly are trying to do what is most comfortable for them. In conclusion, the sooner managers can figure out how to work within the constraints of the people they employ, the faster we will find the methods we need for getting the job done without anyone being excessively overwhelmed.