As presented in a previous post (The Three Domains of the Physician Executive), one of your primary roles as a physician executive is to interact with your direct reports (DRs). These are directors, managers and others over whom you have direct responsibility. This oversight generally includes the following duties:

  • They report to you. So they have a solid line relationship to you on the organizational chart.
  • You may have recruited and hired them when the previous DR moved on.
  • You are held accountable for their performance. The performance of your division is determined by the performance of all of your direct reports' departments.
  • You formally evaluate their performance.
  • You discipline them if the situation demands it.
  • You terminate them if circumstances warrant it.

direct reports

In working with direct reports, there are two primary aspects I'd like to reflect on…

  • What to do
  • How to do it

In this first of two posts, I want to describe what I believe are the major intentions of your interactions, or the “What” that you should focus on. A subsequent post will outline some of the tactics that can be used to achieve these intentions. Since my DRs were generally department directors, I will refer to them as such.

The Five Intentions

1. To Inform


As the Chief Medical Officer, I was meeting weekly with the executive team, including the CEO. So, I was involved in numerous conversations about external threats, opportunities, strategic direction and other important issues. This is one of the areas that I struggled with the most: consistently updating my directors of what was going on at the executive level.

It wasn't that I was concerned with sharing sensitive information. I was simply focused on the director's issues. I had not implemented a routine for summarizing recent updates for them on important topics. Eventually, I came up with a process that helped me to be more consistent with this objective which I will describe in Part 2 of this series.

2. To Assist

lifebuoy assist

My directors and I had essentially the same goals and objectives. Their projects were my projects. Their budgets were my budgets. They ran their departments with their unique style. But they generally did their jobs very well.

Sometimes they met barriers to achieving their goals. Patient volumes and revenues may have dropped, so staffing was being squeezed down. The IT or HR departments may have been slow to respond to requests for support. Other strategic goals would compete for their time. There were countless barriers that could arise.

My job was to reduce or eliminate the barriers to achieving their mission and goals, if I could. I was not there to solve their problems for them. But I could intervene if a manager or director in another department needed some convincing. Or I could free up resources from one of my other departments. Sometimes I would convene interdepartmental meetings to foster cooperation on important projects.

3. To Mentor


A good executive wants the following for his/her directors, because it is good for them and for the organization:

  • To grow intellectually, personally, and emotionally
  • To develop new business, communication, and management skills
  • To advance professionally

I tried to remember to provide opportunities for my directors to participate in learning opportunities and to hone their management skills. Ultimately, in the spirit of good succession planning, I was training them to be able to take on my duties in the future.

4. To Maintain Accountability


My primary duty was to help my directors look at their responsibilities from a strategic standpoint. I encouraged them to adopt stretch goals each year. When we met, my job was to remind them of those goals and assess their progress. I challenged them to stay on track. I pushed back if they made excuses for failing to follow through. Ultimately, I was there to assist them in being accountable to themselves.

5. To Evaluate Performance


Annual evaluations were mandatory. During my tenure, they evolved from fairly subjective opinions in a variety of domains (communication, leadership, citizenship, teamwork, community involvement, etc.) to quantifiable metrics like achieving department goals, meeting budgets, achieving satisfaction scores and improving quality. But, evaluation and feedback should be ongoing and timely, not just an annual event.


If you focus on these five intentions, you will be an effective leader and administrator. You will enrich your DRs' lives and empower them to achieve their goals.

Next time, I will present some means to achieving those ends.

Are there other intentions we should have as we work alongside out directors and managers?