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    MGMA Staff Members

    The first 90 days on the job for a new healthcare leader are especially demanding, and the potential for things to go wrong is high. As John Kaszuba, regional vice president, PFCUSA, noted in his 2024 MGMA Summit presentation, the importance of preparation is just as high as the lofty expectations for not just your individual performance, but also your team’s success. 

    “One of the unfortunate things about the healthcare industry” is that new leaders rarely get the right guidance or training for people leadership when they are promoted into a new role, Kaszuba said. Handling the potential failure stemming from that lack of preparation can be especially hard on individuals who were star performers prior to entering management. 

    The realities of leadership

    It’s important for healthcare organizations to equip new leaders with knowledge about how their work lives will change: “You are no longer judged on your individual performance, you’re actually judged on your team’s performance,” he noted, as well as decision-making and the ability to inspire team members to achieve success, all while maintaining positive relationships with employees and upper management. 

    Achieving success necessitates balancing and blending management skills — focused on directing processes, completing tasks and achieving specific goals and objectives — with leadership qualities that prioritize interpersonal relationships. “We all know who natural leaders are because those are the folks that we want to follow, we aspire to follow them,” Kaszuba said. “They influence us, they engage us. They make us want to do something personally for them.” 

    Kaszuba emphasized that building trust and respect within a team cultivates loyalty, resulting in a high-functioning team dynamic. These elements are forged by leading by example, being honest, keeping promises and being supportive, he added. He also stressed the importance of frequently congratulating and showing appreciation to team members as a way to build trust. 

    “When it comes time to maybe have a critical conversation, make a correction or offer some constructive criticism, you want that trust bank to be built up, so that information is taken in a non-threatening way by your employee,” Kaszuba said. “You can move forward, and they recognize that you're not doing it in a punitive way — you're there to help and grow their career and their professional abilities.”

    Communication skills for success

    Communication skills are often what set good leaders apart. Kaszuba called communication the “No. 1 trait that people look for in their leaders … [yet] we don’t spend a lot of time on bettering ourselves in communication.”  

    A great starting point for that improvement is becoming a good listener, he noted — it’s not just about hearing but also understanding the perspective of others. “Good communication is a two-way process,” Kaszuba said.  

    Effective communicators typically are approachable, personal and authentic. Without this, “you come across as false, and then nobody will trust what you say,” Kaszuba cautioned. Being honest and transparent about even tough topics will, over time, encourage team members to feel comfortable engaging. 

    Another key component to improving communication is making the team feel heard and validated. “As you're rolling out plans and working on projects, bring your team members in — don't do it by yourself,” Kaszuba said. “The more you include your team, the more they feel valued, that their input is valued by you and the organization. 

    Emotional intelligence and physical communication

    Developing emotional intelligence is key to good communication, as it allows leaders to understand and respond to the diverse emotions and motivations of their team members. 

    “Let's say you're bringing in a new EHR into your facility, and some people will dread that” while others will welcome it, Kaszuba said. “How you communicate those messages to those two different folks have to be very different, and you have to be cognizant of where they are emotionally.”  

    Developing personal awareness of barriers like attitudes, emotions, culture, language and gender helps a new leader leverage diverse communication styles to reach people where they are and build trust. 

    Additionally, Kaszuba suggested that physical communication, such as walking around and having casual conversations away from computer screens, also helps strengthen trust and respect. Additionally, it gives leaders time to observe and evaluate the vibe of the team. “Put it on your schedule, random times during the week,” he suggested.

    Delegation and balance

    “You will not survive in a leadership position if you do not learn how to delegate and trust yourself and your team,” Kaszuba cautioned regarding the need to strike work-life balance while also empowering team members. “It’s about not burning out.” 

    Recognizing what can and cannot be delegated is crucial, and communication is key. “Always tell the person why you want them to do this — why it's important to you, why it's important to their career growth, and make it about them and the benefit about them,” Kaszuba suggested. “Also let them know that you have their back, and they probably will make mistakes … and it's OK to make mistakes.” 

    However, leaders still need to stay on top of projects to ensure they run smoothly. “You’re there to help them circumvent or remove barriers … [and] provide them with the resources,” Kaszuba said. 

    The first 90 days: an action plan

    • Clarify your role and goals with your boss and team, including key objectives, goals/targets and how they align with organization-wide strategy. 
    • Set up casual, collegial conversations with subordinates in a comfortable environment to foster open communication and build trust. Ask for feedback on how to improve, creating a safe space for constructive criticism and valuable growth. 
    • During check-in meetings, make things about the employee and encourage them to share their aspirations and goals to help you understand what support and resources they need to grow professionally. 
    • Understand individual team members' strengths, weaknesses, communication preferences and goals. Ask them for their preferences on how to communicate about goals and expectations. 
    • Seek out how your predecessor performed to understand the dynamics of the team and avoid repeating any previous mistakes. 
    • Establish yourself as an authority and avoid generic statements when discussing your standards and expectations. Consider creating a “charter” with the team to set expectations for behavior, communication and standards and to recalibrate goals and rules on your leadership style and vision.  


    Leaders should influence, not command, and Kaszuba noted that communicating clearly through the early days in a new role is a crucial way to generate willing followership.  

    “You're [there] to grow people … to grow them professionally, to grow their skills, their knowledge and their experience,” Kaszuba said, stressing that it may take well beyond the first three months on the job. “It's not about efficiency — it's about the long-term outcome.” 

    However, new leaders should not wait for a quarterly or annual review to speak to team members about mistakes and how to improve performance. When you, the leader, engage in conversations that recognize team members as individuals, treating them with respect and dignity, it goes a long way toward building a foundation of long-term trust, loyalty and high performance.  

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