Guest post: Managing up and over

by Barbara A. Anderson, RN, MSM, CCDS

When we think of management, we’re often picturing a hierarchical system with direction coming from above. Managing up, however, has been a career theme over the past few years. It is a means of working with your manager in a way that manages the relationship and outcomes. It involves identifying ways to step in and provide value to your manager while at the same time ensuring that your priorities are also known and met.

At the outset, you may feel a bit like a teacher’s pet, but it’s about growing a mutually satisfying relationship that benefits you, your manager, and the company—a win-win-win situation. The more effective you are as an employee and the more advocates you build, including your manager and his or her managers, the more successful you can be in the role.

According to a Harvard Business Review article from January 2015 by Rousmaniere, a few key points are involved to successfully manage up:

1. Clearly communicate your priorities and get feedback
2. Understand (as much as you are able) where your manager is coming from, his or her priorities and motivators and what keeps them up at night
3. Figure out the right way and right timing to discuss problems with your manager
4. Establish yourself as a well-rounded source of knowledge and assistance

Our responsibility as CDI leaders is to continually inform and educate those outside industry who may not understand the value CDI brings, nor the tools and structure required to make it work. If we’re successful, we can help those outside the bubble avoid bad decisions.

Take, for example, a small community hospital that was financially strapped and looking somewhat desperately for ways to cut costs. The CDI manager of two years had just completed a rollout of a new CDI tool that robustly captured data and provided all the reports needed for management of her department. She reported to the chief financial officer (CFO) who was new and had every intention to succeed in turning the facility around financially.

The CFO had many strengths, but his knowledge of CDI was limited. One idea he immediately put on the table was to end the contract for the CDI data tool, confident that he could have IT work on an internal tool with an interim Excel spreadsheet that could serve the same purpose. The CDI manager had her work cut out for her as she quickly began building a strong working relationship with the CFO, figuring out how best to work with him, and get her ideas and information across.

She had to help him understand the value of CDI in the quest for financial viability, the journey she had been on to get the right tool in place, and the positive outcomes the tool provided. In addition, she painted the picture of what the loss of a robust tool at this critical juncture would mean, and the gains and potential gains as a result of the tool. She also brought other suggestions to the table such as holding off on replacing two CDI staff positions for six months, showing a willingness to work with the CFO, for the benefit of the organization. With all her efforts, she was able to convince the CFO to look for other options for cost-cutting and she had established herself as a strong source of knowledge and assistance.

In this example, we see that the CDI manager did a good job of managing up. By quickly rallying her efforts to communicate clearly with the CFO, she was able to convince him that removing the tool was not a good decision in the long run. In order to argue her case, she had to understand where the CFO was coming from and figure out how best to work with him.

Never underestimate the value of questions to help you get to the understanding phase quickly and identify how best to work with your manager. I remember sitting across the desk from a CFO in my consulting role and seeing firsthand how a question could cut down barriers and get to the core of his perspective.

At the time, I was working on a CDI implementation project for an inner-city hospital and I had 10 minutes with the CFO, who managed the CDI program and who came across abrupt and gruff. To make the most of my time, I asked him what kept him up at night. I was surprised to get a heartfelt answer.

He said that he worried nightly about having enough nurses to take care of the patients and making sure that there was enough money to keep the hospital doors open. He got a little emotional as he spoke. He went on to say that was why he brought us in; they needed the CDI program to shore up their efforts. Those were motivating moments and became a solid foundation for the work that we undertook. Knowing where he was coming from meant everything.

Besides managing up, we can use the same concepts to manage over as well. This means working with managers in other departments in the same ways we just discussed. Building and maintaining alliances in departments you work closely with can go a long way in your effectiveness as a leader.

CDI leaders who have built ongoing relationships with nursing, nutrition, wound care, respiratory therapy, case management, quality, denials, and rehab fare better when there are changes in regulations and/or CDI opportunities effected by other departments. If the CDI manager has taken steps to build foundational working relationships, partnerships work more smoothly and effectively. Everyone wins.

Managing over also includes outpatient departments as well, from the emergency department, to observation units, to outpatient surgery centers, and clinics. Understanding each other’s roles in the continuum of care, the coding and payment mechanisms, and how you can interface are key to overall healthcare system success.

Editor’s note: Anderson is an RN by background, having worked in various roles and settings. She has worked in performance improvement consulting for more than eight years, specializing in CDI, and currently is a manager at Huron Consulting Group. She also holds certifications in professional coaching and in Emotional Intelligence.  Contact her at baanderson@huronconsultinggroup.com. Opinions expressed are that of the author and do not necessarily represent HCPro, ACDIS, or any of its subsidiaries.