Mark and Mike -

I wonder if you guys could slate somewhere down the line a cast (or blog) to address the specific needs of managers of 24 hour organizations? Specifically, I am a manager in a hospital, and we obviously have many 24 hour departments. This creates a number of challenges in regard to communication and connecting with front-line staff. Another issue that complicates the matter further is that industry standards for span-of-control for hospital nursing organizations is WAY out of whack - it is not uncommon for a nurse director in a hospital setting to have 40-60 direct reports working 24/365. While I am not a nurse director myself, I have frequent discussions with these managers and I wish I had more advice to offer them. Any suggestions from you guys or the community would be appreciated. As always, thank you for your outstanding product, and for providing this forum.


PierG's picture

TERRIFIC and VERY interesting topics: tell us something more.

AND I'd love to have podcasts about crysis management: something like managing a ER group in an hospital!

Keep us posted!


Todd G's picture


You bring up a very important issue. One that is continually addressed throughout the nursing community.

For members who have heard of Magnet Hospitals or are not familiar with the terminology. Magnet hospitals are primarily focused on nursing. You may check the information and qualifications defined by the Amer. Nurses Assoc. at

Hope it's OK to post this guys?

The organization I work for is a Magnet hospital. Several years ago, we went to a model of management that embraces open communication. We have the usual Adminstration Hierarchy CEO - CFO - CIO - CNO -Presidents - Vice Presidents, etc.... In the nursing aspect of this, we have RN Clinical Directors who report to the senior management group (SMG)and in turn, we have Clinical Coordinators (managers) of specific nursing units who report to the Clinical Director.

In most hospitals, the Clinical Director is accountable for their departments on a 24/7 basis. We always have a House Supervisor who has the authority to deal with the issues after normal working hours and the weekends. There is always a Senior Management officer on call.

I understand how terribly difficult it is for communication to happen in a place that operates 24/7/365. Communication gets lost, things blow out of proportion and rumors (yes, I said RUMORS) get started and make matters worse.

One way we deal with these issues is to communicate throughout the whole hospital with posters, blanket e-mails, and Employee Forums. Our hospital has been utilizing the Studer method (Hardwiring Excellence). SMG, Directors, and Clinical Coord. have a quarterly Leadership meetings/retreats which encompasses two days of learning various leadership issues. I'd like to hear what Mark and Mike have to say about this style.

Our SMG does Managment by Walking Around (MBWA), something that I have embraced and really like, as this gives the employees the time to discuss any issue with management. I have seen our Hospital System's CEO on the nursing units, talking with staff, buying them breakfast, and truly listening to what staff has to say.

I would like to hear how others manage in a setting like this.

PierG's picture


this topic is getting more and more interesting.

Craig, could you please post links or resources for a deeper understanding on 'Studer method' and MBWA?



pinzraider's picture

PierG -

Todd is referring to the Studer Group, which is a firm that focuses on the development of customer service standards and leadership in the US hospital industry. Quint Studer was once the CEO of Baptist Hospital System in Pensacola, Florida. Under his leadership, Baptist went from one of the lowest ranked performers on several different nationally recognized hospital patient satisfaction surveys to the virtually uncontested supreme champion of patient satisfaction amongst several thousand facilities in the United States. I don't have specific links for you, but you can find a variety of his materials on the web on subjects such as Highmiddlelow (which is a performance management system), AIDET (which is recognized as a customer service Best Practice for the health care industry), or his famous pillar system (which basically demonstrates the way that a hospital organization is supported by 4 or 5 interrelated key values). Management By Walking Around, MBWA, is a technique where the manager literally walks around the work area of his direct reports and thus is available to build rapport with staff and customers, and provide feedback on performance. It is one way to make yourself accessible to staff.
I'm really glad that you gentlemen are getting involved in this discussion! Todd, I jumped in and summarized information from your post. Please feel free to correct me where we have different understandings of those concepts.
From reading your post, it sounds like our facilities are focusing on similar initiatives. I am at University Medical Center in Lubbock, TX. We are a teaching hospital affiliated with Texas Tech Medical Center. I am a manager in the Rehabilitation org, and in that regard I am on the outside looking in for many nursing related issues. When I visit with my nursing counterparts, I see that some of the communication obstacles (not to mention holding people accountable) are daunting. It is interesting to me that out of all of the initiatives I see around the country (I must admit my ignorance of international matters) focused on improving patient and employee satisfaction, I rarely see anything that targets the astonishing span-of-control problems that seem to exist in most nursing organizations.

Best wishes,

Todd G's picture

Pier, is the link for Quint Studer's group. Craig thanks for the updated information. I didn't go into great detail, but you said it best.

Mark's picture
Admin Role Badge


Clint Studer's stuff is routinely excellent. I have consulted to hospitals and medical offices, and he is insightful and valuable. Excellent resource.

We will be covering the 24 hour theme in the future.

Crisis management and ER's are NOT the same. ER's don't manage crises - they are throughput organizations like many others.

I actually think that 24 hour operations and hospitals might be better looked at separately. Many conclusions one might draw from the hospital world are skewed by the life and health issues involved...


pinzraider's picture

Mark -

Glad to know that 24 hour operations are a potential cast for the future. While I have read and heard much about how to effectively manage a 24 hour organization, I look forward to the M-T send-up of the topic. On other topics, you guys have helped me put a lot of other "good advice" to bed.


JTrapp's picture

Just a couple of quick pointers for 24 hour operations.

I'm the Operations Chief for a University Fire Department and ideas below pertain to administrative an operational issues. Emergency notifications have their own set of rules.

My direct reports (Fire Captains) work 24 hour shifts and with their rotating days off and my m-f 8-5 schedule there are times I will go over a week without direct contact with a direct report.

Here are a couple of things I do to make sure I get some face to face time on a regular basis.

1. I try to be in the office at least 30 minutes before shift change on my work days. This allows me to see both off going and on coming shifts. It also lets me find out first hand about issues that came up overnight or over the weekend (we call them “Chief’s Suprises.”).

2. If I haven’t seen one of my reports in a few days, I'll make a point of stopping by the fire station over the weekend to touch base. I've found that making time available on their schedule pays dividends.

3. Make sure that everyone knows when its ok to contact you at home. Some problems don't age well and can be dealt with most effectively when they happen. It helps to have a list of "Must Call - Critical Events" so everyone is on the same page. My personal policy is that it's ok to call 24/7, most people don't abuse it.

Hope some of this helped.


Todd G's picture

Hi J.

Your info is invaluable. I am going to start doing this more often. I believe that if you can get in to see your staff either when they are going off or coming on, gives them the sense the you are genuinely intune with them.

I also believe that over time, this builds trust and a better rapport with all the staff.

Thanks for the post.