Under-performance exists in the vast majority of work places and it comes in many shapes and sizes. It can relate to any aspect of goals, processes, roles, responsibilities or relationships. It can present itself in terms of time, costs, quantity or quality. It can be the performance of a single individual, the team as a whole, or any sub-set of the team.
In healthcare, there can be significant impacts upon patient care, staff morale or upon the availability of precious, limited resources. Where this is the case it follows that all doctors have a duty to tackle the issue – but where to begin?
The best place to start in addressing under-performance of any type is to establish the root cause of the issue.
Why do people not do what they are supposed to, when they are supposed to, how, where or to the correct standard?
In keeping with many other aspects of leadership and management, the answer lies within general human behaviour. As a doctor, you may find it helpful to look to the reasons that patients are ‘non-compliant’ with their healthcare. This can be considered in terms of three headline categories:
- They don’t know what to do, or
- They know what to do but are unable to, or
- They know what to do but have chosen not to
Each category can be further sub-divided. However, the appropriate general approach which you would choose in order to address any issue is broadly dependent on which headline category the driving reason for the non-compliance relates to. In other words, you would take different actions with a patient who does not know what they should be doing from another who is unable, or another who has chosen not to.
The drivers of under-performance in any workplace, in healthcare or any other, are no different. The reasons will be driven from a lack of understanding over what to do, (how, where, when or with who), a lack of ability, or from choice.
Once you are clear on the cause, consider the impact and the context of everything else that is going on. You then have a number of choices to make:
- Whether to take action, take no action or to adapt
- The leadership style you will adopt
- The influencing tactics you will employ
- To apply constraint or to facilitate innovation
Taking action may well involve some challenging conversations. It is easy to shy away from this. Take care to avoid any under-performance here on your own part. As a leader this may occur through being ‘unable’ to take action or by ‘choosing not to’ for the wrong reasons. If you care about the impact then you have a responsibility to yourself and to any stakeholders – patients; families; carers; colleagues; tax payers etc. – to take appropriate action.
- What under-performance is evident in your own place of work?
- What is holding you back from taking action?
- What are you doing about this?
This blog-post is an abridged extract from our new book The Essential Guide to Medical Leadership & Management
