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Don’t Dump – Delegates

By Elizabeth Hofheinz, MEd, MPH
Orthopaedics This Week
December 9, 2008

Dr Cole

The surgeon instructs someone, “Here, do this.” He then thinks, “Good, that’s off my plate. What’s next?” This manner of delegating, however, can result in misunderstandings and poor outcomes. It also doesn’t take into account the complexity involved in the task at hand, the relationship with the person to whom you are delegating, and his or her own expectations, motivations, and skills.

Dr. Brian Cole, Professor in the Departments of Orthopaedic Surgery and Anatomy & Cell Biology at Rush University Medical Center, explains, “Delegating is not a matter of passing the buck. Among other things, it requires planning and consideration for the skill level and career plans of the person you would like to do the job. The most common question that I am asked is, ‘How do you do it? How can you possibly accomplish so much in so many spaces seemingly simultaneously?’ In short, a team approach and responsible delegation is the only way to achieve a high-value work output.”

Fundamental to the delegation process, says Dr. Cole, is the need to take a look at how you got yourself in the position of having so many things to accomplish. “Like everyone else, orthopedic surgeons can accumulate too much on their ‘to do’ lists. So the first issue is to examine how you make the decision to take on additional responsibilities. It is one thing if a new task is a lateral one; i.e., it takes advantage of existing activities, interests, and resources, and you want to take on something else that makes your work more achievable or predictable. But if you take on a vertical responsibility that has nothing to do with the existing infrastructure and requires too much intellectual energy, it is likely that things won’t get done. For example, when I am asked to write books by publishers, I make sure that the topics are all somewhat related and are ones for which I can use a similar contributor base. The bottom line here is that people overload themselves. The worst thing you can do is accept responsibility and then not be reliable. It affects people’s confidence in you and will eventually affect your career.”

Instead of looking at delegating as task assignment, it would be more prudent to view it as an opportunity to develop a relationship with someone and to give that person the chance to feel like a competent, vital team member. Dr. Cole: “The most classic model of delegation is having a reliable assistant. In these situations the most important element is trust; the learning curve with an individual you don’t trust is a serious blockade to delegation. People grow in their roles when you trust them because they end up taking a larger sense of personal responsibility. The individual must also possess the appropriate skill set, motivation, and responsiveness to get the job done.”

If the person to whom you have assigned a task sees the back of your white coat and thinks, “I guess I’m on my own…won’t see him again,” then you’ve got a problem. “It is important that the person remains committed to the process,” advises Dr. Cole, “as sometimes assigning responsibility is construed as dumping. That is dangerous, but it can be prevented by sitting down in a calm setting and giving details on the task, what is expected, and letting the person know that you will connect about this later on. When you follow up do so in a way that doesn’t seem like you are checking up on the person. You can tell him or her to let you know when the job is done, perhaps asking that they send a spreadsheet of which tasks are done and which are pending. In my experience, asking this of people results in them being proactive, taking pride in doing something efficiently, and feeling a sense of accomplishment.”

And then there are the nuances of the type of person receiving the assignment. Dr. Cole notes, “If you are in an academic environment you are often delegating to individuals with a Ph.D. Instead of ‘delegation,’ which implies hierarchy, I often use the term ‘collaboration’ as it levels the playing field. In this milieu there are no unequal partners. Another way that I foster a team environment is through regular meetings. I coordinate research across multiple departments, which means that both M.D.s and Ph.D.s are present and need to feel included. We meet biweekly for an hour; everyone has received the agenda ahead of time. Each person has the chance to give a verbal update of his or her project; if there are people in the room for whom things don’t seem to be progressing, I ask if they would like assistance in meeting their milestones. Even if someone’s project is in a down, inactive phase, I want him or her to participate so as to feel involved.”

Mysteries in the medical field are often what keep clinicians and researchers intrigued and involved. But leave the mystery to the medical end of things; when delegating, be as clear as possible and leave little unanswered. Dr. Cole, “It is critical to fully understand the task before you delegate it. If not, things will be exponentially confusing and you will have a bad end product. Also, be sure the person understands that you are fully available to answer his or her questions and that he or she can come to you with any concerns. A typical example is a busy clinician who has an idea for a project on the effects of growth factors on cartilage cells. He has no idea who the players are, where to get the materials, what models to use, etc. … basically a recipe for disaster if he tries to delegate the work. The highest risk of failure is when you depend on someone to take it to the next level and don’t take time to explain the details. You will likely come back and nothing has been done because the task is too daunting. If, however, the person is apprised of deadlines, milestones and expectations, he or she is more likely to be successful. Lastly, you as the delegator should prioritize things for the person receiving the assignments. If you rattle off 10 things that need to be managed, they are obviously not going to happen simultaneously; you must tell the person what is less and what is more important.”

A philosophical pause is in order, from time to time, says Dr. Cole. “If at some point in your career you have been delegated to, then you will better understand the nuances of how to delegate. If, in ascending the academic and clinical ladder you were delegated to, succeeded, and were cued into the enthusiasm and attention to detail required, then you will probably be a great delegator. But if you lose sight of that – because, frankly, how we ‘operate’ becomes second nature – things could go awry. We must look inside and reflect on our strengths and weaknesses.”

As for the qualities inherent in the people you are delegating to, Dr. Cole advises, “It is important to surround oneself with people who are highly motivated; these will often be individuals seeking residencies or fellowships. In the end, they all expect something… you should know what that is. I routinely ask, ‘What would you like to get out of this experience?’ and keep their answers on file. Then when I delegate I can do a better job of ensuring they are getting something that matches their interests.”

Putting one’s ego aside affords up-and-coming surgeons a chance to experience a taste of life as a successful orthopedist and/or researcher. “Give up the reins,” urges Dr. Cole. “Once you reach a certain level in your career there is no reason you need to be on the podium all of the time. If I am the principal investigator and I have fellows, residents, or medical students, there are certainly forums where they can be present in my stead and thus share in the success of the work. I remember my early presentations and what it was like to put together a talk. These are high-impact moments for young surgeons and are a superb chance to help them grow.”

As an example of delegation gone wrong, Dr. Cole notes, “Let’s say you are asked to write an article for a peer-reviewed journal. Your first step is correct in that you delegate to responsible individuals (who are also trying to accumulate publications). If, however, you do not take the time to review the end product, problems can arise. The ultimate responsibility for the work is yours, and in this instance you have lost out on the potential to impart your knowledge and flavor. And, depending on the quality of the work that goes out, your reputation may be affected. People can tell when you are not involved. I can often look at the name of a senior author, read the paper, and know that this person has never read it.”

In short, the person to whom you delegate is an extension of yourself, a surrogate whose work reflects on your own. Ideally, that person is someone in whom you feel comfortable placing your trust and who has an appropriate skill set and motivation to do the job in a professional manner.

Brian J. Cole, M.D., M.B.A.

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