Healthcare's Dangerous Manager Ratios

A while back I did a video on the optimal number of direct reports per manager and that varies somewhere between five and eight people. And you know when you get over eight there tends to be a couple of issues. One, no one gets coached. Two, the manager if they're coaching more than that tends to have really really intense issues with stress and with insomnia which is almost without fail.

But there were a lot of comments in that video about the number of about healthcare institutions and how the number of or the ratio of managers to employees is so perilously low. So if you're in, and a lot of them came from the nursing function. And I'm sure there were some other specialty roles in there as well, but I just noticed a lot of them were nurses. So I'd hear things or see things like, hey, we have one manager for every 45 employees or one manager for every 90 employees.

And I think it even got worse than that in a couple of cases. And If we're lucky, we get coached once a quarter. And as someone who sees this happen in business every day, actually has healthcare clients, and I do have a client that is in healthcare with nurses right now, that is putting patients in lives in jeopardy on a day-to-day basis. So here's what you have to realize, that when you are not doing one-on-one coaching consistently, you are getting worse results.

I have replicated this again and again in the companies that I have coached. You know, you do have companies sometimes that will be very rigid and thorough with their one-on-one coaching. And you find that those that are not bottom three in terms of results. So what are the results in healthcare?

The results are better patient outcomes, right? And we are getting suboptimal patient outcomes, meaning there are more failures, more errors, more lives lost because there is just less coaching going on. So pretty unacceptable in something that, you know, healthcare, something we call a practice, something we want to get better at. There is no practice.

There is no practicing with a lot of our healthcare professionals on a consistent weekly basis where they're meeting with their supervisor, they're working on their priorities, things they have to get better at, improve upon, working on how to get better at outcomes, live the core values more consistently so they are in line behaviorally with what is expected to create patient outcomes. That is a failure of leadership. And there are some ways around it. Again, there are some states that have a mandated patient to nurse ratio, for instance.

Maybe a little bit harder in those states, but states that don't, you can get by with fewer nurses and be able to pay everyone a lot more money, get rid of all your C player nurses, which usually about 25% of any team that isn't using a structured interview process like top grading. And pay more to your A's and your B's and promote some of those team members to be able to have an opportunity to be a team lead and do consistent weekly one-on-one coaching. So it's not all the head on all the heads of one manager. And what's going to happen in that scenario?

If you create a culture of coaching, your outcomes are going to improve drastically. So there's a million ways around it. There's a million ways to do something better. And I guarantee you that within a few months and even probably faster weeks, you would see an improvement in several patient outcomes.

Previously unforeseen in any healthcare organization if they were able to get into a habit of good one-on-one coaching. So, you know, if you're in that scenario where you're managed as part of a team of 45, I would say, you know, try to advocate for a change or number two, get out. Like that is no one's getting better or improving in that scenario.