#MEQAPI – Tweetchat April 19-2018 3:00ET Toxic Bosses

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org

I vividly remember a conference session about 30 years ago in which the speaker fulminated over the poor quality of managerial skills in the workforce. The problem, the speaker explained energetically, was that we were thrusting people into managerial roles for which they had little training, almost no understanding, and very few practical skills. As a result, safety, quality, and cost took continual hits, worker satisfaction was deplorable, and customers were inflamed.

The solution, he suggested, was threefold:

  1. View management as a specific occupation, not as a hobby or sideline.
  2. Establish management training at a graduate study level to prepare managers for their roles.
  3. Split management roles from subject matter expert (SME) or individual contributor roles.

MBA training blossomed in the subsequent decades, and many industries split roles so that taking a management position meant a conscious decision to distance oneself from being an SME or individual contributor, and becoming a professional manager.

However, this has not turned into great success in healthcare.

Firstly, the MBA programs have apparently done very little to prepare anyone for a management role, and some researchers have even suggested that the sole measurable outcome of the millions of dollars spent on MBA programs, has been a reduction in ethics. That’s right, MBA graduates tend to have lower business ethics than when they started. If that wasn’t bad enough, in healthcare, a boss (Chief, director, chair, etc) tends to retain patient duties and have parallel lives in which they are still a researcher or physician, as well as trying to manage and lead team(s) of SMEs.

This has not been optimal, and we can see it in the burnout of both bosses and staff, and few bosses have the time to work on basic managerial tasks such as developing staff careers, being proactive on customer satisfaction, or developing and advancing the strategic business operation. Another outcome is that bosses range in ability as bosses and we get many “types” of bad boss (which will be discussed in a Physician’s Weekly blog).

For example, some bosses “kiss up and kick down”, ingratiating themselves to their bosses, and waging a tyranny against their staff, other bad bosses hide away (in meetings, conferences, and their own work) and are just MIA when staff need them, and still others are the sweetest people ever, but let other managers pillage and destroy, and never seem to stand up to support their staff.

In this chat, we will talk about how this manifests in your experience – the signs, symptoms, and situations of “bad bossing”.


  1. Think of the BEST boss you ever saw- department head, chief, director, or just a team lead. What was special about them, what they did, how they acted?
  2. Think of the WORST boss you ever had – department head, chief, director, or just a team lead. What was special about them, what they did, how they acted?
  3. What did the bad bosses do to your sanity, safety, productivity, and how did this manifest itself?
  4. What did the bad bosses do to patient safety, satisfaction, and outcomes, and how did this manifest itself?
  5. What effect does good or bad management or leadership have on care Safety, Timeliness, Effectiveness, Efficiency, Equitability, Patient-Centeredness, or Affordability?



MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. We expand this to include Affordability, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.


The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.




Published by

Matthew Loxton

Healthcare Analyst using Lean Six Sigma, Knowledge Management, & Organizational Learning to improve healthcare http://linkedin.com/in/mloxton

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