Leadership and Professional Development

Hire Hard, Manage Easy

© 2019 Society of Hospital Medicine

The socio-adaptive (or “nontechnical”) aspects of healthcare including leadership, followership, mentorship, culture, teamwork, and communication are not formally taught in medical training. Yet, they are critical to our daily lives as Hospitalists. The LPD series features brief “pearls of wisdom” that highlight these important lessons.

“If you can hire people whose passion intersects with the job, they won’t require any supervision at all. They will manage themselves better than anyone could ever manage them. Their fire comes from within, not from without.”

—Stephen Covey

When you initiate a quality or performance improvement project, you want to find someone who can help you do the necessary work and find that someone quickly. But be warned: leaders must learn to go slow when hiring for their team. Do not settle on whoever has available time or interest—they may have time to give or be eager for a reason.

We see this unfold in several ways. For example, individuals are sometimes “offered” up for a role: “This person has experience reviewing charts and abstracting data­­—and they have some time available. Would you like to hire them?” Similarly, eager students or faculty may be willing to jump on a project with you—“I am looking to join a project,” or “Yes, I can help with that,” are all too often heard in this context. Both scenarios share in common one truth: easy availability and willingness to help make it tempting to say, “Sure.”

While some of these individuals might be ideal, many are not. When hiring, you have to think hard about the role and an individual’s skill set that makes them well suited for it. Based on experience, we can tell you that once you go “soft” by selecting a suboptimal candidate, you are in trouble for at least three reasons. First, hiring the right people is the key to achieving success for your initiative. And success in your project reflects directly on you. People will make inferences about you based on the people you surround yourself with: if they are terrific, the assumption—right or wrong—is that you are as well. Second, we tend to compensate for underperforming employees, often at great cost to ourselves or others. When data collection for a project does not go well, we have found ourselves behind the screen filling in various portions of a data collection form. For example, a colleague once told us, “I hired this person to help, but they ended up needing so much assistance that it was often easier for me and others to do the work. The environment quickly became toxic.”

Third, it is often difficult to remove an underperforming employee or have them change positions. Health organizations (especially universities or other public institutions) can be rigid that way. An infection prevention leader told us of waiting a whole year to fill a crucial vacancy before she found the right person. It was ultimately the right decision, she said, adding, “My life is so much better.”

How can you be sure you have found the right person? Regardless of whether you are hiring for a permanent or temporary position, staff or faculty member, we recommend the following:

  • Ensure recruits meet with several people. The more eyes on a candidate, the better. Often, someone will catch something you may not—and having many people involved helps get the team invested in the success of your hire.
  • Standardize and solicit feedback. For example, we use a standardized template to garner feedback on administrative recruits, project managers, and faculty. This way, we all are evaluating potential colleagues through the same structured approach.
  • Ensure skills match the role. For example, an ethnographic study would benefit from someone skilled in qualitative methods. Similarly, a project manager experienced in clinical trials would be best suited for patient recruitment and managing investigators at several sites. Identifying what is clearly needed in the role is a key step in hiring.

Management guru Jim Collins writes: “The moment you feel the need to tightly manage someone, you’ve made a hiring mistake. The best people don’t need to be managed. Guided, taught, led—yes. But not tightly managed.”1 True in management, and true in the world of healthcare. Hire Hard. In the long run, you will be able to manage easy.


Drs. Chopra and Saint are co-authors of the upcoming book, “Thirty Rules for Healthcare Leaders,” from which this article is adapted. Both authors have no other relevant conflicts of interest.


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