Urgent Message: An established chain of command clearly delineates roles and accountability among staff in an urgent care center. When this chain is broken by upper management “dipping down,” it creates confusion among staff, undermines supervisors’ authority, and brings inefficiency to operations.

Case: Ian is the administrative director at a local urgent care center that’s part of a multi-unit operation. His responsibilities include scheduling the clinical support staff, approving time cards and writing performance reviews, addressing patient experience concerns, ordering supplies, managing vendors, and generally making sure everything runs smoothly. He has a solid team working under him, but one day he discovers that he has a problem. Normally his supervisor, the Area Operations Director responsible for all of the company’s centers in that community, gives him a list of things that need to be communicated to his team, and he executes those tasks as soon as possible. Ian has learned, however, that his boss has been giving a couple of his employees instructions personally, completely bypassing Ian. This goes on for quite a while, to the point that Ian gets fed up with finding out that the employees under him can’t do anything he asks because they’re already busy with assignments from his own supervisor.

This practice is called “dipping down,” and it happens in the workplace far more often than it should. Put simply, the practice of dipping down is when a boss decides that he will bypass the chain of command and go right to the people that will be doing the job. In this example, bypassing Ian to tell Ian’s employees to change patient flow and documentation processes. While this method of getting things done can seem more efficient and helpful, in the long run it will cause snags in the chain of command and an overall loss of productivity.

There are four main reasons that managers need to stick to the chain of command:

  1. It standardizes communication
  2. It keeps the best people doing their best jobs
  3. Supervisors know tasks and people better than upper management
  4. Supervisors need to know what people are doing, so they can effectively manage their time

In a business, especially process-driven operations that require consistency in execution, it’s very important to have set standards of communication. Multiple “bosses” shouldn’t be giving orders; there should be (ideally) one person from which all instructions come, per team. People tend to resist change and uncertainty, so limiting the authority to give orders to as few people as possible is likely to keep productivity as high as possible. If you are able to relay instructions to your employees through managers that they know and trust, they are much more likely to get those tasks done quickly and efficiently. That’s because the immediate supervisor is best positioned to assure front-line staff is held accountable for their activities. A higher-level boss bypassing an employee’s supervisor can cause angst among the employee, who now has to please two “masters.” It’s almost cruel for management to put employees in a position where they may feel as if they’re betraying their supervisor’s trust. And although front-line staff may seemingly bend over backwards to please upper management, it doesn’t mean those employees like and trust that executive as much as they do their supervisor.

And speaking of that: Immediate supervisors know their team members better than anyone else in the organization. If an urgent care center normally operates by a nurse supervisor giving commands to medical assistants, don’t assume that a physician assistant knows who will do each job best just because he’s technically higher on the chain of command! All orders should go through the supervising nurse, because he or she might know something about the front-line staff that a higher-up might not.

At best, bypassing the nurse supervisor can lead to frustration when that supervising nurse sends someone to do something and that person is already occupied by a job given to them by someone else.

At worst, this can lead to massive scheduling conflicts and confusion in the ranks—especially when upper management’s commands contradict those of the immediate supervisor.

When the leadership of an urgent care operation creates an organizational hierarchy, managers and supervisors were added for a reason; let them do their jobs! They know their team members and work environment best because that is where they spend all of their time. You don’t need to butt in on them and tell them how to do their job.

One urgent care center medical director said that the “office jockeys” (administrative management) tried to tell him the ideal number of clinicians to have on the floor at the same time; however, that number was light years short of the number they actually needed. In reality, that should have been the head physician’s call to make; he knows how the clinic flows, and how its providers function.

When you bypass the chain of command, you tend to overlook things about the workplace and make calls that cause inconvenience and/or upset people without good cause.

Follow the chain of command because it standardizes communication, keeps the best people doing the best jobs, and takes advantage of the manager’s knowledge of the work environment. Managers are managers of their areas for a reason. Don’t get in their space! Let them do their jobs.

Alan A. Ayers, MBA, MAcc is Vice President of Strategic Initiatives for Practice Velocity, LLC and is Practice Management Editor for The Journal of Urgent Care Medicine.

Follow the Chain of Command

Alan A. Ayers, MBA, MAcc

Chief Executive Officer of Velocity Urgent Care, LLC and is Practice Management Editor of The Journal of Urgent Care Medicine
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