Does your facility suffer from VPS?

That's Vice Presidential Syndrome, a.k.a. the "shrinking assistant administrator"

Years ago one of the more successful TV shows was called "What's My Line?" On this program, a panel of celebrity "experts" were tasked to ascertain the vocation or avocation of a guest by asking a series of questions intended to narrow the possibilities down. How do you suppose they would have identified these gentlemen?

1) Alben Barkley (not Charles) 2) George Clinton (not Bill) 3) Schuyler Colfax (not Sandy Koufax) 4) Hannibal Hamlin (not Lecter)

If they had said Vice President of the United States, what bright celebrities they would have been! More likely Dorothy Kilgallen, Bennett Cerf et al would have said "Beats me!"

Yet these men were but a "heartbeat" away from the presidency.

Does your facility have a possible problem with what I'll call VPS: Vice Presidential Syndrome? How well-defined are the duties and tasks of the assistant administrator (AA)? Does he/she truly know what is expected of him/her by the administrator? Does anybody know his/her name?

An AA with clear, defined job expectations that incorporate delegated authority can be of vital importance to the accomplishment of a facility's mission. A properly trained and, therefore, most likely confident AA can be of incalculable value to an administrator whose workload in recent years has expanded in so many significant ways, particularly in light of OBRA and the growing demands of marketplace competition and survival.

In essence, the administrator has two fundamental or basic obligations toward his/her AA: 1) to teach him/her in a practical supportive fashion, employing reasoned criticism as necessary, all within a climate of genuine expectation vis-a-vis positive outcomes; and 2) to nurture signs of professional and personal growth on the part of the AA within an atmosphere of honesty, openness and trust.

These obligations are more easily fulfilled by those administrators who evidence, as Burton Grumner puts it, "extraordinary confidence in themselves... who can inspire others with their vision... and can freely express confidence in the AA's capabilities to help in realizing the mission of the facility." I might add another important factor: the ability of the administrator to acknowledge (and take genuine pride) in the accomplishments of subordinates.

The AA, in turn, has a clear and steadfast obligation to be open to constructive comment, to continually learn and to be willing to accept accountability. The AA should also engage in a process of ongoing self-evaluation, while evidencing a positive attitude.

The AA should also be willing to reflect candidly on his/her strengths and liabilities. The AA should understand and accept the importance of extending reasoned loyalty, not solely to the administrator, but also to the goals and mission of the facility.

The AA will progress in task competency when the administrator evidences, through action and style, an ability to inspire a willingness in others to take risks and to learn from their failures.

Most importantly, the AA will function best when he/she recognizes the administrator as a person of integrity, a leader who is honest, whose word is good, and in whom he/she may trust.

What are some tasks or duties which could be considered to fall within the purview of the AA? The following are but a few possibilities for delegation:

1) Overseeing the facility's Quality Assurance program - for example, conducting audits, helping department heads develop QA monitors relative to various operational issues and co-chairing, with the administrator, Quality Assurance Committee meetings.

2) Establishing systems to regularly execute facility-wide compliance rounds, thereby monitoring the integrity of the physical environment. These rounds can also ensure that residents' rights, in their entirety, are being respected.

3) Preparing the facility to produce positive outcomes related to the survey process - for example, reviewing the past three years of survey reports by the state Department of Health and Life Safety Code regulators to ensure that deficiencies were, and continue to be, corrected.

4) Overseeing the admissions process to be certain that decisions regarding admissions are made with sufficient information. This would also include monitoring to ensure that vital issues are addressed, e.g., advance directives, PASARR requirements, payer sources, etc.

5) Assisting in executing progressive marketing and public relations activities, e.g., developing brochures, publishing a newsletter, creating a resident handbook, visiting local hospital discharge planners/case managers, etc.

6) Accomplishing the preparatory work with departments in developing operating as well as capital budgets. Also, monitoring monthly budget statements and obtaining variance reports.

7) Observing and, as needed, critiquing the care planning process. This could further include participating in care planning conferences when family members and/or residents opt to be present.

8) Attending and assisting whenever family conferences are convened to discuss problematic issues and concerns.

9) Developing realistic avenues affording residents and families genuine feelings of empowerment.

10) Conducting inservices on a variety of keystone subjects, e.g., changes in Federal/state regulations, the meaning of being "consumer-oriented," conflict resolution, etc.

11) Observing the facility dining processes, as well as kitchen operations, to make certain resident choices and input are respected and the environment is sanitary. This could also include unannounced audits of the dietary department to monitor temperatures of food and equipment, tray accuracy, cleaning procedures and the proper use of adaptive eating equipment.

12) Lastly, the AA should have a number of departments on direct report and should be responsible for their overall operation.

When an administrator takes the time to challenge his/her AA to surpass the traditional, potentially mundane responsibilities sometimes assigned to them, all stand to gain. With clear administrative support and persistent encouragement, the AA will often reach beyond pre-conceived limitations to become a truly competent partner to the administrator.

Any administrator would do well by an AA if he/she adhered to the Leadership Secrets of Attila the Hun (Warner Books, 1987), particularly the following paraphrased points:

1) Delegation is a sign of strength.

2) To strengthen his/her leadership abilities, a good leader takes the risk of delegating to an experienced subordinate.

3) A leader's duty is to make an assistant's strengths prevail.

4) A wise leader never reprimands a subordinate bearing bad news, but rather reprimands those who fail to do so.

5) The leader seeks the most capable assistant, gives him/her responsibility and authority, and hold him/her accountable.

6) If it were easy to be a leader, everyone would be one.

If the AA is simply a figurehead, with little or no authority, the dreaded VPS (remember Vice Presidential Syndrome?) will inevitably creep in. When an AA is properly nurtured, extended genuine challenges and allowed to take risks, the administrator will eventually be rewarded with a strong, competent colleague. The resulting teamwork will enhance the administrator's strength. And, to the extent that the AA of today is the administrator of tomorrow, the AA will be the administrator's legacy to the future.

Ken Lewis is Assistant for Planning and Program Development, Catholic Health Care Services, Philadelphia, PA.