How 'quiet management' cuts through the noise of healthcare

There is no one-size-fits-all when it comes to managing teams, and managers may take different approaches based on team size, organization size, organizational needs and other factors. However, one approach has risen to the surface recently: "quiet management." 

Career coach Adam Broda posted about the topic on LinkedIn last year. He said quiet managers stop checking employee start and stop times, let people choose to work where they want, encourage guilt-free time off, remove unnecessary meetings and distractions, listen to team feedback about how the manager manages, and give workers what they need to be successful, then step away and trust them to deliver.

"Quiet managers operate with a high level of trust in their employers and don't micromanage," Mr. Broda wrote. "This way, the job becomes more of a support role and gives managers the time to get out in front and lead by example instead of leading by structure and administration."

To gain insight into what quiet management may look like in healthcare, Becker's discussed the topic with three leaders: Kevin Mahoney, CEO of the University of Pennsylvania Health System, part of Philadelphia-based Penn Medicine, which also includes the Perelman School of Medicine; Karen Frenier, BSN, RN, senior vice president of human resources and chief nurse executive at Orlando (Fla.) Health; and Mitch Cloward, president of Salt Lake City-based Intermountain Health's Desert Region.

Mr. Mahoney leads health system operations, spanning six hospitals, 11 multispecialty centers and hundreds of outpatient facilities in Pennsylvania, Delaware and New Jersey. He said he demonstrates quiet management by emphasizing the "why" behind Penn Medicine's business, rather than the "how." 

"At Penn Medicine, we believe we were founded to create and disseminate knowledge, and that's what we try to do," he said. 

The organization has found success with this approach; the breakthrough messenger ribonucleic acid technology that enabled the COVID-19 vaccines from Moderna and Pfizer-BioNTech came from the organization.

"So when you're doing your job, you're not just doing your revenue cycle job," Mr. Mahoney said. "You're also creating a hospital margin that allows us to fund research."

He said he also works to be visible and assumes positive intent.

"I think everybody comes to work to do their very best," Mr. Mahoney added. "We give them guidelines, we set priorities, but we need to let them get the job done." 

Ms. Frenier described her management style as authentic and transparent. This means clearly and frequently communicating with team members.

"With quiet management, I think, communicate once and get out of the way," she said. "And my conflict a little bit [with that] is you can do quiet management and have visibility at the same time. And I think that is so important. What is important for us, Orlando Health, our culture, my leadership style is very clear expectations, what our goals are, what our priorities are."

Ms. Frenier also subscribes to the lean management philosophy of leaders "going to the gemba" — a Japanese term for "actual place" — a principle that involves direct observation to improve work processes. 

"It doesn't make any sense for me to say, 'Here's how to fix the problem.' The problem needs to be answered by the team members who do the work," she said. "Our role [as managers] is to remove obstacles, move things along sometimes. So to me, that's part of quiet management. However, my conflict is that there's nothing quiet about it."

The approach is one Mr. Cloward said is woven throughout the healthcare workforce.

"Quiet leadership and quiet managers are frequently observed in healthcare," he said. "This may be associated with our primary purpose and our mission of selflessly devoting ourselves to caring for our patients and the communities we serve. I also believe that most caregivers and leaders that choose a career in healthcare do so because they want to help others."

Refining meeting strategy

Meetings are an important part of a manager's responsibilities, but too many meetings could leave some employees overwhelmed and less clear on the task at hand. A 2022 report from and the University of North Carolina at Charlotte found nearly one-third of meetings are unnecessary and that organizations waste millions of dollars on them.  

From Mr. Mahoney's perspective, the productivity of meetings can get lost in the virtual world and in Zoom meetings, so his focus is on getting back to productive meetings.

"You wouldn't go into a conference room and put a brown bag on your head," he said. "But people get on a Zoom meeting and they'll turn the camera off, and we're losing the engagement."

To maximize engagement, his overall philosophy is that daily huddles on units are better than meetings to solve a problem, interact and move forward with a solution. He said video and online tools have also been helpful to disseminate his words to 50,000 employees.

Ms. Frenier also expressed support for huddles over formal sit-down meetings. She said 259 nurse leaders across the company attended a huddle Jan. 11. 

"That excites me," she said. "That number is as good as when we started it a little over a year ago. And, when I start with my updates, if Hospital Consumer Assessment of Healthcare Providers and Systems, our customer experience and emergency department throughput is our top work, then I'm very consistent in giving us an update on how that work is. [Managers must] be clear with your expectations. You can't talk about a new one every day. But you've got a follow-up [via huddles]. The best way for us to connect is to be visible, develop relationships."

To help with that connection, Orlando Health recently rolled out new behavioral expectations for workers across all teams. The expectations center around communication, connection, commitment and curiosity. 

"We have written out what that means," Ms. Frenier said. "The next step for that is to make our coaching plans easier for leaders to have that conversation [about those expectations]."

Facing conflict head-on

No matter the leadership style, managers at one time or another likely will have to handle challenging conversations or conflicts within their team. Mr. Mahoney's approach: "Handle them straightforward first thing in the morning, get it resolved, get it behind us, and then don't let it linger and carry forward."

He said it is especially important to address the obstacle or problem rather than the individual.

"I do that with a lot of data, not just Penn data, but industry trends," Mr. Mahoney said. "We all think we're an island unto ourselves. [But no matter the organization], the issues are very similar. 

"We can't control our external environment; we can just control our response to it. So a lot of the confrontational meetings that we have are because we have to change the way we're doing business. Not because we're doing it wrong, but because of the macroeconomic headwinds that we're facing."

Approaching challenging situations as a quiet manager often reflects the style of "servant leadership," Mr. Cloward said. 

"I strive to understand what they hope to accomplish in their current job and what they hope to achieve over time with career goals and aspirations," Mr. Cloward said. "I dedicate time to helping them remove barriers to reduce frustration and increase satisfaction as we serve. I establish clear direction so that expectations are fully understood and in doing so, I strive to inspire rather than force, coerce or incite fear."

Being effective — quietly

There are other practices or habits that quiet managers use outside of handling challenging conversations or conflicts within their team. Mr. Mahoney, for example, stands at a connecting hallway between two buildings that is frequented by workers and answers people's questions in between shifts. 

He is also in favor of asking workers more open-ended questions such as, "What can I do to make your job easier?" and "What obstacles did you face today that I could work to eliminate?" instead of a question like, "How many bills did we collect today?" 

"Because, again, people know their jobs," Mr. Mahoney said. "They don't need me to do their jobs."

Ms. Frenier agreed.

"It is our role [as managers] to allow the team members to be the best they can be and get out of the way," she said. "... Supporting them with the right tools and documentation that's not so burdensome, and, if there's technology that helps us do our job better, that's the work we should be doing."

However, being effective as a quiet manager does not begin only once someone is hired and part of a team. Rather, it can start as early as the hiring process, Mr. Cloward said, and approaching the process from this angle can improve workplace culture. 

"Quiet leaders are leaders who have been disciplined in the hiring process," he said. "They hire the very best caregivers who not only have technical/clinical skills, but also human skills — caregivers who are altruistic, who devote themselves to serving our patients and our communities." 

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