Is micromanagement killing your staff? The administrator who "has to do it all" can end up undoing everything.

Perhaps the essence of micromanagement is best summed up by the colloquialism, "When you want something done right, do it yourself." The micromanager, the self-appointed, beneficent overseer of all staff operations, would posit that he or she is merely exercising efficient, necessary oversight, indispensable for ensuring successful task completion. Subordinate staff members, however, often view such oversight as oppressive, demeaning, and counterproductive. These viewpoints can be so polarized as to be irreconcilable.

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In a long-term care facility, an administrator with an inherent or derived penchant for micromanagement will generally, at best, create a perpetual environment of dependency, inefficiency, and unease and, at worst, render irreparable harm to staff morale. Facility goals collaboratively envisioned and planned for by the board of directors and administrator can be abruptly derailed by an administrator's relentlessly intrusive and deleterious management style.

The administrator may take corrective action, or an involved board of directors may need to intervene by directing or replacing their chief executive so that the detrimental individual and organizational effects may be identified and corrective measures implemented for the facility to thrive and prosper.

Increased Tension and Decreased Confidence

An administrator's micromanagement motivation may originate from fear or anxiety caused by a demanding board of directors, job insecurity, or a compulsion to control. An otherwise healthy and vibrant management staff will initially feel tense and intimidated when experiencing the direct effects of the administrator's micromanagement style. These feelings will be particularly acute if the administrator is newly appointed, having succeeded a leader who fostered independence. Tension will eventually trickle down to all staff members when they are occasionally confronted by the administrator in the work area and/or because their immediate supervisors have also become micromanagers.

Staff members at all levels will begin to lose and ultimately lack confidence after experiencing the cumulative effects of intolerable day-to-day scrutiny of every aspect of their duties. Persistent adversarial questioning will lead staffers to second-guess themselves. A focus on minutiae may program staff members to believe that narrow, individual details outweigh the ultimate purpose of their jobs and the mission of the facility. For example, an otherwise competent office manager was known to spend an inordinate amount of time keeping her office decor and file documents specifically arranged to the practical exclusion of all else because the administrator's relentless supervisory focus strongly implied that those areas were of utmost importance.

Decreased Initiative, Productivity, and Teamwork

Once staffers feel they are no longer able to exert control over their employment obligations, they lose motivation and initiative and their productivity decreases. Since many tasks are no longer truly delegated, staff members may wait for direction because of the intense, underlying implication that someone else knows how to, and will, perform their jobs better than they can. In essence, they will steadfastly, without variance, complete their specific assignment only. A narrowly selective, task-oriented rigidity will preclude them from initiating important tasks well within the scope of their job descriptions. Examples may include a dietary assistant's failing to deliver to the appropriate unit a food cart left in the hallway for no apparent reason, a housekeeper discovering but failing to clean a small but potentially hazardous spill on a coworker's unit, or an activity assistant failing to transport several residents requesting to participate in an activity because their names are absent from her list of scheduled attendees.

Staff members who once enjoyed mutually respectful communication with their supervisors may now hide mistakes because of an unreasonably inculcated fear of being reprimanded. Such misguided conduct might not only prove counterproductive, but also harmful to resident care. During a state public health survey, one knowledgeable CNA hesitated to address an issue posed to her by a surveyor. When the supervisor also hesitated and moreover lacked the initiative to rectify the issue, the result was a repeat deficiency.

Individual lapses may eventually expand to a general breakdown in team spirit and cooperation. Rather than resorting to their former collaborative efforts, so crucial and effective in the delivery of quality resident care, staff members might choose to function in a limited, isolated, individualized manner, and may even lash out in anger and recrimination at coworkers they once relied on. A disintegration of team cohesion may evidence itself most conspicuously on "off" shifts, where once independent, decisive, team-oriented unit managers begin more frequently calling their supervisors at home for direction.

Stunted Growth and Staff Turnover

One well-rounded, productive CNA, who was liked by residents and families, took it upon herself to perform "extra" enjoyable services, but suddenly ceased doing so unless prompted by her supervisor. This created a profound sense of sadness, anger, and dissatisfaction on the part of many residents and families.

On the other hand, the administrator (and other micromanagers) may relegate former staff duties to their own job descriptions. The aforementioned office manager's responsibility for accounts receivable, for example, was in large part assumed by the administrator. Many managers unable to deal with self-imposed increased hours and demands will eventually resign.

When staffers in general feel anger and lose respect for their superiors over what they rightly perceive as a mistrusting, stressful, adversarial relationship, excessive turnover may result. Indicative of this, particularly when reliable, tenured employees resign, is inconsistency of care, the most critical symptom of the "revolving door syndrome." Unless the problematic culture is rectified, the facility will be unable to attract and retain quality staff and again realize consistent care.

Solutions

Reinforcing staff roles. Reinforcing employee roles during a general staff meeting chaired by the administrator will clarify the staffer's purpose and importance in fulfilling the facility's mission of providing quality care. Valuable employees also require personal reassurance that arbitrary, de facto job descriptions have been eliminated and management is available once again for leadership, guidance, and support. Providing tangible proof of this will decrease tension and provide a crucial confidence boost; staff will realize that they are capable and trusted to perform their duties absent oppressive oversight. For example, the aforementioned office manager was given complete charge of her department and, with the administrator's ongoing support and encouragement, found that she could again confidently and appropriately prioritize.

Goal setting. The administrator should establish short- and long-term goals with department managers after enthusiastically accepting their input. Departmental goal setting must be sufficiently expansive to include staff participation at all levels. Encouraging independence in achieving those goals and providing and eliciting positive feedback about this at regular, but limited, intervals will enhance confidence and reestablish motivation, initiative, and productivity throughout the facility. Staff members may now initiate broader task completion and confidently address issues with supervisors and public health auditors without fear of disciplinary reproach. All staffers and the organization as a whole will reap the benefits and ultimately secure that critical element of collaborative teamwork.

For example, achieving goals by maximizing teamwork through collaboration at interdepartmental meetings provided the cohesion desperately needed in a Northborough, Massachusetts, nursing facility entering financial receivership in 1994. Awaiting a resurvey by the state department of public health, the newly appointed administrator rallied the staff toward a sense of purpose in saving a facility and jobs that they had grown to appreciate. Their satisfaction resulted in large part from the heightened recognition that their individual and combined expertise was indispensable in resolving systemic logistic issues.

As a result, from 1995 to 1997, the facility achieved three consecutive deficiency-free surveys. Ownership was successfully transferred and the home still thrives today. Promoting and sustaining excellence such as this requires ongoing positive reinforcement of staff.

Rewarding productive employees reinforces a sense of accomplishment among them. Rewards can vary from an informal, impromptu thank-you to formal recognition. The most recurring and satisfying reward for staff members, however, may be the result of ongoing, open interaction and communication with their supervisors. This invaluable reinforcement will instill in the mature, engaged staff member a true sense of responsibility and accountability. Reaching that plateau allows the staffer to grow.

Unlike micromanagers who increase their task load at the expense of growth and efficiency, interactive, team-oriented managers will unencumber themselves by relinquishing numerous, inappropriate tasks and delegating them to competent subordinates. Efficiency and productivity are enhanced and the potential for burnout is eliminated.

Motivated staff members will blossom. Staff members will engage in activities because they want to, not because they have to. Their meaningful resident interactions might range from personally preparing and serving a lunch preference to sharing some time in the residents' vegetable garden. Once reticent, insecure CNAs need no longer hesitate to engage in conversations or perform good deeds with residents and families. Their achievements, witnessed daily, will provide them with a consummate heartfelt sense of fulfillment. This will dramatically minimize staff turnover, and consistency in care will once again be realized.

Conclusion

No policy or practice is absolute, and there are exceptional circumstances--during crisis situations, for example--for which the administrator's intensified scrutiny is temporarily justified. However, since micromanagement otherwise manifests itself negatively and insidiously, preventing or eliminating it is a generally sound approach to promoting a healthy, vibrant organization. To be sure, management that is a bit too "macro" is also an unwanted extreme that might leave a workforce craving leadership and direction. In long-term care, as in most settings, a reasonably balanced management approach is usually the most appealing and strategically effective.

Mark Presutti, JD, MBA, BS, NHA, LSW, is Administrator at Copley at Stoughton Nursing Care Center, Stoughton, Massachusetts. For further information, phone [phone], or visit www.copley-nh.com. To send your comments to the author and editors, please e-mail [e-mail].

BY MARK PRESUTTI, JD, MBA, BS, NHA, LSW