Part 2 of this 2-part series explains how you can develop as a leader and retain quality employees

In Part 1 of this two-part series (see “The Many Misdemeanors of Management,” PSP, August 2011), each physician-owner learned to circumvent the first two misdemeanors of management: hiring for the wrong reasons, and not knowing when to say farewell to team members.

At this stage, you have hired for talent and not just experience or appearance, side-stepped hiring based on personal connections or referral alone, and have elected to pay a fair rate. Further, you have the proper personnel on and the improper people off the team. There is recognition that loyalty is a two-way street, that the best people require your time to train, and that some turnover can be healthy. Last, you know that it may be ideal, if the office is well established, to hire a consultant or management company to assist with those functions that are not core competencies.

Too often, however, owners take the right person and put them in the wrong position; or, after finally getting the right people in the proper roles, lack the knowledge as to how to fortify relationships with them to cultivate greatness within the organization. Results and morale slip as misdemeanors of management are again committed, which can lead to management felonies. What follows are the next pitfalls to avoid.


“He is good at everything.”

In short, he is not. Even the most talented employees have areas of proficiency and areas of weakness. The goal of managing the team is to identify the true “core talents” of the employee and ensure a vast majority of his time is spent on those functions.

The Foundations for Hair Restoration and Plastic Surgery (Foundations) have patient consultants who are able to manage effectively, but may not love to do so. The assumption that an extraordinary salesperson will make an impressive manager, and vice versa, is rarely correct.

Excellent salespeople sell; excellent managers manage. A few do both, but only if they have demonstrated both to be core talents. Take the time to evaluate your team members and consider that each person’s strengths and weaknesses—their personal “topography”—must be taken into account.

“I’m short staffed, so we all pitch in.”

When your practice is in its infancy, this is a frugal, rational short-term solution. If you have only one worker, then it is common-sensical to have him multitask. Commonly, however, even a decade later practices still have three or more people working as jacks-of-all-trades.

Though the origin of the quote, “If you chase two rabbits, both will escape,” is arguable, its message holds true. Once it is affordable to add another staff member, separation of duties must occur. Further, the new employee should be selected to compensate for the greatest deficiencies of the primary employee, allowing the second to focus on his areas of expertise while simultaneously removing those tasks from the first employee’s repertoire. The tertiary employee should be selected to compensate for weaknesses in the first two employees, and so forth. This, over time, allows each employee to get nearer to performing only core competency tasks.

With this system, you build a varied team with myriad core talents and little overlap. It is sensible for you to cross-train to ensure that help is available in case of employee illness or similar. But the preponderance of time for each employee is to be spent on areas of proficiency or budding greatness.

Last, communicate this plan to each employee at the time of selection so that he has the expectation that core talents will eventually be the focus while, in the short run, he may be required to wear many hats.


At this stage, you have a superlative team of people, without weak links, selected for and focused on core talent and trained for greatness. They are paid fairly, but how do you retain these superstars, ultimately saving countless hours of future frustration and lost income?

Broadly, innumerable management consultants and authors concur that the key to team retention comes from leading authentically and embracing personal growth.

Kevin Cashman, in his book, Leadership from the Inside Out (Executive Excellence Publishing; 1999), reminds us, “As the person grows, the leader grows. The missing element in most leadership development programs is growing the person to grow the leader.” Quite simply, the team grows and is retained when you use your own commitment to personal development and your willingness to share evolution and learned lessons with your people.

You must begin by understanding that employees are never in stasis. Instead, each day they are, metaphorically, “green and growing” or “brown and dying.” The Foundations believes each person within a specific career, including each individual reading this article, is perpetually rotating around a “career axis” in an upward or downward spiral and never in circular stasis. Each choice made as managers leads our people one step closer to long-term dedication or to working elsewhere.

When your people believe you are on a personal quest for enlightenment and self-improvement, your authenticity as a leader permeates and true bonds form. Employees begin to look at not just your actions but their underlying intent, allowing your inevitable mistakes that lead to turnover to often be disregarded or overlooked due to belief in these good intentions of the company’s leadership.

As an authentic leader, you strive to not only grow yourself, but your people as well. Here are several key philosophies and tips on growing your people, and in turn, their daily productivity (when people feel good, they do good), which will ultimately improve retention. Let’s start with Maslow’s hierarchy of needs.

Abraham Maslow, in his groundbreaking 1943 article, “A Theory of Human Motivation,” outlines what individuals need before becoming truly triumphant and evolved. Maslow’s hierarchy of needs (shown at right) suggests, intuitively, that nothing matters until a person’s health, food, water, and other basic needs are met.

Counterintuitively, each of you influences this key first level of the hierarchy. Do you eat healthfully, exercise regularly, and demand a healthy work and family life balance to serve as an example to your people? Do you then encourage your people to live similarly, to leave early on rare occasions, to stay fit and eat well, and to visit their doctor regularly? Physicians and managers who do so find more allegiance from their team, as the workers subconsciously realize you care about their most basic well-being.


  • Physiological — Requirements for human survival (air, water, and food; clothing and shelter).
  • Safety and Security — In addition to personal security, job security and a feeling that the employees and office leadership are moral and fair.
  • Belongingness — Includes friendship, intimacy, and family (such as the social group in your practice and the office culture).
  • Esteem — Respect of others, status, recognition, fame, and attention; as well as self-respect, strength, competence, independence, and freedom).

All of these lead to:

  • Self-actualization — In order to reach a clear understanding of this level of need, one must first achieve and master the previous needs.

From “Motivation and Personality” (1954) by Abraham Maslow.

Thereafter, Maslow suggests people need a deep feeling of safety. Safety refers to job security and a feeling that the employees and office leadership are moral and fair. Avoiding management misdemeanors Numbers 1 through 3 engenders this feeling of safety by ensuring the employee is the right person, in the right role, is trained properly, and has the appropriate tools for success. He can then always reach the highest rung within his role and feel stable through knowledge of his own achievement.

Subsequently, Maslow proposes that people need to feel love and belonging to ultimately achieve at their highest and most productive levels. Each of you is vital in this stage, as well. Devoting time to your people is the singular and paramount method of instilling a feeling of love and belonging in your team members. It is said that team equals time.

Understand Maslow’s hierarchy and how you influence it. Authentic leaders are self-aware—they evoke emotion from team members as they are relatable and vulnerable, and they are open about having fears and stress, happiness and success. They master an understanding of what they personally require to thrive so they may share it with others.

Deservedly or not, each of your employees think of you as their mentor. If this were not the case, they would not stick around. They respect you for identifying them as great people, and appreciate you because you placed them in the right roles and trust them to succeed on your behalf.

As busy surgeons, businesspeople, and heads of families, it is often taxing to take time out of the office—let alone in the office—with your team. Despite this, I recommend that you spend 30 minutes a week one-on-one with each key team member without phone, e-mail, or live interruptions.

In addition, buy each new employee lunch and sit with them for 1 hour on their first day at work. Beyond that, for long-term retention you must have a true rapport and respect, which is only built outside the office. Time with employees cannot be an anomaly, but rather must be a norm.

Authentic leaders gain joy from sharing good times with their team members. Just an hour or two monthly is repaid in spades in team member retention and results. Consider finding ways, beyond a simple holiday party or birthday card (also good ideas), to spend downtime with your people. Take a different team member to lunch one day per week at least once every quarter. Have team members visit your home for a simple barbecue with spouses and kids invited. Eat a meal with an employee after a long day at the office. Involve team members in your hobbies, like golf or other sports, or going to a play, concert, or sporting event.

Blanchard’s Situational Leadership Development Framework

All people experience four stages or “situations” on their way to mastery of their job. They need to be managed in different ways at each stage.

  • Situation 1: The employee demonstrates high commitment and low competence. As the manager/leader, you must be directive.
  • Situation 2: Extremely low commitment/low or medium competence. Be supportive.
  • Situation 3: Varying or medium commitment/medium-to-high competence. Be empowering.
  • Situation 4: High commitment/high competence. Promote the employee to the next level or create new challenges.

From Situational Leadership® II by The Ken Blanchard Companies (

Each time you are doing something alone, ask yourself if it would have been simple and enjoyable if shared with others. If you have extra tickets to an event you cannot attend, give them to a team member, but include a handwritten note saying he deserves it and you appreciate his service.

Personally, I love live concerts, poker, playing in and attending basketball games, and grilling poolside on the weekends. I make an effort to invite one or all of my teammates to these events, as I genuinely believe what I do is more than just a job. Indeed, this is my life if I spend half of my waking hours per week doing it.

If you believe you are building a second family, your people will mirror you, sense your authenticity, and will commit more deeply as the job becomes something more for them, as well. If the contemplation of downtime with certain team members conjures feelings of dread, consider if they are the right people and review management misdemeanor Number 2. Part of maintaining authenticity is to surround yourself with people whose company you truly enjoy.

Applying these steps, you will develop as a leader. Your people will see your personal growth by example and feel your positive intent. They will be retained and excited to strive with you for Maslow’s final steps of achieving true esteem and full enlightenment. They will perform exceptionally as their fundamental needs of health, stability, love, belonging, and, ultimately, happiness, will be fulfilled.


Many doctors perform a quarterly or annual employee review. There can be value in long-term evaluations, but to truly effect change and teach, employees need timely feedback. They must be “managed in the moment.”

The Foundations encourages its physicians to coach people as successes and mistakes transpire. Reminding employees of blunders from months ago tends to frustrate and come across as inauthentic. If an employee does something well, it is important to “vomit praise,” a drastic term that I think truly sums up the mission. Employees need to know you are impressed and should feel amazing. That feeling will stick with them for years, and they will want to replicate that action to gain further praise.

Alternatively, when a mistake is made, bringing it up calmly, in person and right away, gives the best chance of change as well as acceptance. Stating, “May I be honest with you?” followed by reconfirming with, “Great. You are comfortable with my sharing a little feedback with you?” followed by, “I saw an area of opportunity just a moment ago, and I wanted to share it with you candidly and promptly as I know you are committed to being great,” is a good introduction for giving feedback.

If you feel the feedback was taken poorly or the conversation was awkward, it is typically because you did not ask permission, reconfirm permission, and present the feedback in a positive tone and demeanor. Feedback must be given in an authentic style, with a feeling of true leadership and passion for the business—in the moment—and is likely to be accepted and acted upon immediately.


According to the Situational Leadership theory developed by Ken Blanchard and Paul Hersey in their book of the same title, all employees (and all people in all situations) go through the same growth when placed in any situation. This means that even similar people with analogous jobs may be at dissimilar stages as they work through the four stages or “situations” of leadership. Thus, they require different styles of management from their leader. Authentic leaders recognize that these situations or steps exist, and they master identifying in which stage each employee resides at any given moment.

Employees all begin their job in Situation 1: high commitment and low competence. They begin with a low level of competence and a high level of commitment to their job—it is new, they are excited, but they don’t know what they don’t know. Think of the first day back to school when everything is fresh and exciting, but you do not know of all the exertion around the corner. It is here that you must truly manage and direct the employee, according to Blanchard and Hersey. The employee will need clear direction: “This is what needs to be done, and this is exactly how to do it. Now replicate what I have shown you.”

Soon after, the employee graduates to Situation 2: low competence and extremely low energy. The employee still knows little and is now less motivated. (“Wow, school is hard, and the semester just began 2 weeks ago.”) At this stage, most employees give up or quit.

At this point, you must remember to stay directive and to teach, but also be highly encouraging and supportive. The disconnect is that most business owners echo the employee’s lack of motivation and negativity—often called “management mirroring”—failing to recognize that every employee must get through this low-medium knowledge/low-energy stage. The result is, frequently, turnover.

Instead, you must remember that you selected the person for good reasons originally—he had core talent and a proper hunger to succeed—and that all employees will go through Situation 2 before they go through Situations 3 or 4.

Show the employee you support him entirely as he learns, and that you are completely committed to his success and long-term achievement. Time outside the office at this stage is critical. The true leader knows the employee cannot get past this stage of instability without the feeling of safety.

Situation 3 is varying or medium commitment/medium-to-high competence. At this stage, the employee has graduated from the doldrums, but can be manic, having alternating good and bad days. You can now allow the employee some liberty to figure things out, can ask him how he would decipher problems to challenge him, and can empathize but no longer sympathize with the challenges of the job. Indeed, the student has settled in and recognizes there are good and bad parts of school, but there is also opportunity to blossom.

Eventually and often after years in a specific role, the employee graduates to Situation 4, in which he maintains a high level of energy and high level of competence. At this stage, he needs only occasional encouragement and feedback, but mostly freedom. He still achieves results continuously, regularly exceeding those at the pinnacle of the industry.

Situational Leadership suggests there is no way to skip these stages in any relationship or job.


Summarily, the best physicians, owners, and managers recognize that team members must, over time, be able to work almost exclusively in their areas of core competency, and realize that people cannot do everything even if they believe they can. They take as truth that great leaders become great through authenticity, which is communicated to the team by embracing their own personal growth and development. They surround themselves with talented people who they truly like and respect, spend time with them to cultivate authentic relationships, and see them for what they can be and not as they are presently.

When necessary, they manage in the moment, constantly knowing what level or situation of leadership the employee is working through, remembering to be directive and supportive early, and coaching, if not laissez-faire, later.

Last, at their core, great leaders bear in mind that each person has fundamental needs that must be met in a specific order. They are personally quite often the means to help each team member fulfill those needs.

Indeed, each great leader comprehends that there is great bounty that waits, in both monetary success and personal joy, through mastery of authentic leadership. It is the Foundations’ hopes that through avoiding this litany of management misdemeanors and embracing these lessons in authentic leadership, each of you will grow personally and professionally while helping others grow.

Jon Hoffenberg is executive vice president at Foundations for Hair Restoration and Plastic Surgery, based in Miami and New York. He can be reached at .