Great organizations, whether they are medical practices, medical schools or hospitals, are the product not only of dynamic leadership but, perhaps more importantly, a dynamic following. While most physicians assume some sort of leadership role in their organizations and indeed in the health care system at large, they also often find themselves accountable to a medical director, physician manager, administrator, etc. Yet for many, this role can be difficult. Some days, they perceive the “boss” as a roadblock to success; other days, they believe the only way to succeed is to follow blindly. How do you strike the right balance? The answer is in learning to manage upward.

Managing up is the process of consciously working with your boss to obtain the best possible results for you, your boss and your organization. This is not political maneuvering or “kissing up.” Rather, it is a deliberate effort to bring understanding and cooperation to a relationship between individuals who often have different perspectives.

Managing up may seem counterintuitive in a world of top-down organizational structures. Physicians often invest significant time and effort in managing the nurses or office personnel they directly supervise, yet they take a passive approach to managing their supervisors. Doing so can harm the individuals and the organization. For example, failure to manage your boss can result in misunderstandings about what you expect from one another and cause you to waste time on tasks that are not in line with organizational goals. Furthermore, career progress and satisfaction rarely occur if you don’t manage your boss. In fact, some suggest that the primary duty of all employees is to have a successful relationship with the boss. Are you up to the task?

Recognize the value of the relationship

Managing your boss begins with an understanding of the value of the relationship, which has been described as “a mutually dependent existence between two fallible individuals.”¹ You depend on your boss for direction, feedback and support, while your boss depends on you for new ideas, hard work and cooperation to achieve the organization’s goals. Both sides have needs, and both sides have something to offer. It is a critical relationship worth tending to. Here’s where to start:

Get to know your boss. The first rule for managing bosses effectively is to understand who they are and what they want. In other words, put yourself in their shoes. While many physicians have a superficial understanding of their bosses’ goals and pressures, they often fail to assess the individual strengths, weaknesses, aspirations and work styles of their supervisors. Exploring these issues will help you think outside of your own needs, identify commonalities you never knew existed and gain insight on how to interact more effectively with your boss. For example, some bosses are “readers,” meaning they prefer to receive information in written form (e.g., e-mail and memos). Others are “listeners,” meaning they prefer to receive information verbally (e.g., face-to-face or telephone conversations). If you want your ideas to be heard, make it easy for your boss by communicating in the manner he or she prefers. You’ll be meeting your boss’s needs as well as your own.

Get to know yourself. Developing an effective working relationship with your boss also requires that you understand yourself. Recognize your strengths, weaknesses, goals and personal needs, and pay particular attention to how you respond to being managed. For example, do you tend to be rebellious or overly compliant?

Rebellious physicians often resent their bosses’ authority and rebel against their decisions. This type of behavior is common among those who are used to being the experts or authorities in their relationships. Subordinating themselves or having to respond to or comply with the desires and demands of a boss can be very unpleasant to them. They may, in fact, view the boss as a hindrance to progress and react impulsively and negatively to the boss. If you are a rebellious physician, what you need to remember is that how you deal with your negative feelings toward your boss will often determine the course of the relationship. Failure to recognize your tendencies and actively manage the situation early on can lead to a dysfunctional relationship.

Overly compliant physicians are at the other behavioral extreme. They swallow their emotions and become passive even in the face of poor decision making by their supervisors. Because these individuals always want to agree with the boss, they often fail to provide needed input on key decisions. If you are an overly compliant physician, what you need to remember is that your inaction can cause great harm to the organization, in part by perpetuating poor decision making by those at the top.

While not all individuals fall into these two extremes, it is important to understand your tendencies. If you can predict your reactions (or overreactions) to your boss, you may be able to avoid distressing situations and build a more productive relationship. You will also be better prepared to advocate for your own needs.

Dare to follow well

Managing up is no easy task. It requires patience, emotional maturity and the courage to take action, but its rewards are worth the effort. Here are some specific ways to practice the art of managing up:

Solicit clear expectations and priorities. One of the worst mistakes you can make is to assume you know what your boss expects. Most bosses do not spell out their expectations, and the burden of discovery falls on those below them. Don’t wait for your boss to provide you with this information. Instead, initiate a series of informal discussions on “our objectives,” helping your boss clarify and communicate his or her ideas – and making sure you communicate your own ideas as well.

Provide adequate information. Information is power, and for many physicians, withholding information from their boss is a way to feel some sense of power. However, ultimately this tactic works against you. A poorly informed boss cannot advocate for your needs or make the best decisions for your organization. Be willing to share what you know and to keep your boss informed at the level that fits his or her work style.

Relay good and bad news. Some supervisors give both verbal and nonverbal clues that they only want to hear good news; they don’t want to hear about problems. These bosses can represent a particular challenge. Great organizations do not ignore their problems or try to sweep them under the rug. Instead, they face them head on with courage and innovation. For the good of the organization, you must communicate failures with successes, but do so delicately and appropriately. In addition, you should be prepared to accept good and bad news yourself, whether it focuses on your individual performance or the organization at large.

Build trust. A key element in managing your boss is building trust in the relationship by being trustworthy. Most physicians are dependable, hardworking and well-meaning, but because of misunderstandings or mismatched priorities, they can be inappropriately labeled as problem physicians. To combat this, make every effort to maintain honesty and dependability by honoring commitments and deadlines. Your positive example will impact not only your boss, but others around you.

Help your boss manage his or her time. For most supervisors, time is a precious commodity. Effectively managing your boss will require that you respect his or her time. Every request made of the boss uses up resources, so make sure your requests are necessary. Don’t take every issue to your boss for his or her opinion. Instead, come up with your own ideas to solve problems and then act on your own, where appropriate. You might even want to try doing something intentionally to make life easier for your boss. Perhaps your boss will spend that free moment advocating for your needs.

Sell your issue. Bosses aren’t mind readers. To get what you want in your organization, you have to ask for it and you have to sell your boss on the issue. This isn’t manipulation but a legitimate set of techniques to make it easier for your boss to understand and accept your ideas. Don’t expect your boss to understand your issue automatically. Learn how to present it, for example, by “bundling” (connecting your issue to another important issue for the organization) or by “framing” (placing it in a moral or business context that your boss can understand). You should also carefully select your language (e.g., speak numbers if your boss is a numbers person) and, where appropriate, involve other individuals in the selling effort. With some bosses, you’ll be more successful selling your issue in private versus trying to convince them in a public setting. And of course, pay attention to your timing, making sure you present the issue when other more pressing issues are not consuming your boss’s attention.

Give positive reinforcement. Everyone within an organization needs positive reinforcement. You need it; your boss needs it. Some experts even suggest that the most important objective for employees is to appear supportive of their bosses. Empathize with the boss. Praise his or her achievements without appearing sycophantic. And express appreciation whenever it can be honestly conveyed. It will help your boss do his or her job better, which is ultimately in your favor.

Choose your words. Physicians often are meticulous and critical in their clinical work; however, in organizations this critical nature can be threatening. Learn not to pass judgment immediately as you learn about a new technology or a new way of practicing. Where you are right to pass judgment, do so with tact and good intentions. For example, if you disagree with a policy, thoughtfully explain your reasons, rather than saying simply “this is bad and should be axed.”

Focus on what you can change. Let’s face it. There are a lot of terrible bosses out there, and it is unlikely that you will successfully change anyone. While you can’t control your boss, you can control your attitude. And to a large extent, managing up is simply that: having the right attitude. Being angry, disgruntled, accusatory or passive will only make things worse. When you realize that you do have the power and influence to make things better, you are on your way to creating a more effective organization, a more fulfilling career and a better boss indeed.