If you’ve run a group practice for a while, you’ve probably done this. You have a good person who isn’t a great fit for the role she’s in, so you start reshaping the role around what she’s good at. I get why, because it feels kind, and I’ve done it myself, but I don’t recommend it for leadership.
The problem shows up later
When you build a role around a person, you end up with something that doesn’t match anything you’d write on a job posting. She might have three of the things a clinical director needs and two things that belong to someone else, and when you grow and want to hire for that spot, the whole thing is tangled. I don’t mind building tasks around someone’s skills, but leadership is different. Once you piece a role together from other roles, you’re taking responsibilities from one place and handing them to another, and the structure stops making sense.
A common version of this is a practice that names someone a clinical director but gives them only the smaller pieces, like supervision. Hiring and firing decisions stay with the owner, and interviewing and onboarding get tucked in somewhere else, so every time a bigger decision comes up the director sends it back to you. After a while you feel like you have a leader who isn’t leading. At some size that role needs to own the whole clinical side, including who gets hired and who gets a performance plan.
What I do instead
I build the role from what the business needs and then look at who’s in it. If someone isn’t owning the role after coaching, I stop coaching and bring out two documents, the job description with all the responsibilities and the accountability chart. I’m pretty literal and black and white about this part, and it helps.
Say a leader runs marketing and she’s great at lunch and learns. She goes to the office, gives the talk, and checks it off. But if I’m the one deciding whether that lunch and learn was worth the time, she’s doing one marketing task. Leading marketing means she knows how many people we should convert from it and whether it’s earning its keep. So when someone hands a piece of her role back to me, I get curious and ask her to show me how that piece isn’t part of leading this role.
That usually leads somewhere better. Maybe she says she doesn’t know how to measure the return on something like that, and then we can talk about teaching her. Or maybe she doesn’t have that skill and doesn’t want it, in which case she might be one part of marketing while someone else leads it.
Sometimes the business outgrows the person
I went through this with one of my hires. She was a leader and did well for the size we were then, but at some point I had to have a conversation about how what the business needed from the role had changed and now called for a lot more accountability than I’d asked of her before since our business had grown. I think leaders all have a capacity at which they can be good leaders. I’m a good leader, but I couldn’t lead a practice with 5,000 employees. Someone can be a great leadership fit at an eight clinician practice and not at thirty, and that doesn’t make either of you wrong. It’s an uncomfortable conversation, and it only gets harder the longer you wait.
If you plan to stay small
This works differently if you never plan to be a mid-sized practice. If you’re staying away from ten or fifteen providers, you may not need full leaders, just people who own certain results, and you can say “I want you to own this” and build around that. If you do plan to grow, build the roles first and then find the people, which is harder in the short term and a lot cleaner in the long term.
This was one of the questions asked at this month’s Exchange Q & A. If you want to bring your own questions to the next one, you can join The Exchange membership here.
