Aligning Priorities: Who’s a Player

In health care, priorities are not a to-do list. It is primarily about people. Every item is attached to someone. If no one cared about that item, it would have fallen off the list a long time ago.

The previous posts in this series have operated in the realm of awareness. These posts have considered the nature of the problem of conflicting priorities, the source of the problem, and the dynamics that keep the problem in place. Whenever a problem persists after its been recognized as a problem, there must be some active dynamic keeping it in place.


The next step in problem solving is accountability. In this context, accountability does not mean figuring out whom to blame for the problem. The pivotal question for accountability is identifying who has a sense of agency in addressing the problem. As mentioned at the beginning of this post, priorities are all about people. One of the dynamics that aggravates the strain of juggling priorities is anticipating conflict with the people behind the conflicting items.

The accountability stage of problem solving identifies the individuals and groups who have a stake in what matters. The following are all stakeholders in the priorities of first line managers in healthcare.

The Players

Staff Members. They prioritize commitments that increase their capacity to do their jobs. They are also concerned with their personal fulfillment and comfort. Focus issues include staffing, equipment, supplies, schedules, and space.

Bosses. They prioritize commitments the assure efficiency, careful use of resources, and responsibility. In private sector settings, bosses care about the bottom line; in public sector settings, they care more about public perception and liabilities.

Colleagues. Other managers have special interests in maintaining local control of their unit as well as receiving solid support from the larger organization. One unit’s local control can become another units’ burdensome bureaucracy.

Service Recipients. They care about the quality of care for themselves and their family members. Time is also of importance to them, as they want services provided as promptly as possible. Their priorities align considerably with staff members.

External Community. The overall reputation of the hospital matters to the external community. A community is more at peace when they have confidence in the local hospital as part of their infrastructure.

Family. The people in the managers’ personal lives have a special interest in containing the work within specified hours. They may be impressed with the managers’ professional accomplishments but they also want to be their top priority some of the time.

What To Do

The accountability phase means identifying the stakeholders and developing ideas about their priorities. Pinning down priorities may require prolonged conversations and surveys. These activities require time and resources, but without them, the next step of action planning will be unlikely to succeed.

Identifying the players is only the beginning. The next challenge is bringing them into the conversation.


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