Jeff was a gifted clinician and carried a very full load of ER shifts while being Chair. With tensions rising, small issues became big ones, even when the entire team needed to focus on more important matters. One that bubbled to the surface involved Richard. Richard was a physician who was always late; not a few minutes late, but 20 to 30 minutes late for his shift on a regular basis. The charge nurse spoke to him. Jeff spoke to him. His colleagues nagged him, but his behavior didn’t change. Jeff spoke to him a second and third time and for a while Richard managed to come to work only ten minutes late before slipping back into his old pattern. His behavior held up the entire ER during the change of shift. This especially infuriated the nurses who felt Jeff was failing to hold Richard accountable while their own nurse leader held them to clear standards. Irritating them further, the doctors were continuing to have drinks at the clinical computer stations when a decision had been made that this was no longer allowed.

Jeff explained to me that Richard was an excellent doctor, one of the best. He lived far away and his wife’s parents were aging and having difficulty. He didn’t want to lose Richard. High quality ER docs were hard to attract to this gritty city and he couldn’t understand why the nurses were making such an issue. He also thought the no drink rule was ridiculous, even though he had agreed to it. It became increasingly clear just how much difficulty Jeff was having managing the department.

The real issue was that Jeff wanted to remain “one of the team” and did not want to “pull rank” and hold Richard or the other doctor’s responsible for more professional behavior. He thought the frequency of Richard being late was being exaggerated but he didn’t actually have good data on it. Mostly, he didn’t know how to set a limit or how to help Richard, who he knew had a lot on his plate.

I asked Jeff what being a “boss” meant to him and what he assumed it meant to his colleagues. He understood he needed to improve the finances and work flows of the ER and even embrace the role of the consultant. He was torn however, between his desire to protect his providers from the “often unreasonable demands of administrators” and the work of leading the ER into the future.

In my 360 interviews, Jeff’s colleagues (both nurses and physicians) desperately wanted him to step up and into his leadership role. They thought he was the best physician in the ER but they wanted a boss who would both defend the ER and also make tough decisions and lead. Jeff did not know how to translate the 360-feedback into managing people. Our work began with helping Jeff redefine his ideas of what being the chairman really meant. What does “professional behavior mean?” How do standards for behavior and establishing team norms help drive respect and the work? How could he support Richard while also setting clear expectations with specific consequences?