The Manager’s Role in a Sleep Center

Henry Johns

Connstance Shivers Smith

Robert Hendrickson

Management and leadership are as important to the function of a sleep diagnostic facility as the electrodes and sensors used to measure sleep. Many in our field will find themselves in a managerial/leadership role by choice or necessity as their careers unfold. This chapter is presented to serve as a guide and building block for a technologist’s future in management.

The basic definition of a manager is a person who is responsible for overseeing or administering the day-to-day activities of a business. The most basic job of a manager is to recruit and retain qualified, talented employees, develop and implement budgets, help others meet goals, and get things done. Leadership is the process of enlisting the aid of others to accomplish a common goal. A leader will have basic traits or tendencies that inspire in others the will to achieve.

Management and leadership need to go hand in hand for success. Managers direct activity; leaders inspire the will to achieve. Management can be present without leadership and leadership without management; both concepts will be presented here. Providing motivation, giving direction, removing roadblocks for success, building teams, and providing constructive feedback are the basic tasks of any manager.

MANAGEMENT STRUCTURE

Managers can be categorized into different levels within an organization according to the level of responsibility and the function they serve. Most organizations have three levels of management, which are generally distributed in a pyramid fashion, with upper management at the top, middle managers in the center, and first-line managers at the base. Managers are associated with specific areas, such as finance, marketing, operations, human resources (HR), and administration, as well as specific service lines, such as the sleep center.

Upper or top management is made up of a small group, typically including a president, vice president, chief executive officer (CEO), and so on. Their job is to manage the overall organization. The top managers set the organization’s goals, strategies, and operating policies, and they represent the organization to the world outside.

Middle managers are responsible for implementing plans and policies developed by upper management. They make up the largest group of managers in most organizations. Often referred to as operations managers, division heads, or chiefs, they handle such things as inventory control, equipment failures, and routine union issues. Middle managers coordinate the work of supervisors within the organization. Although sometimes creating excess bureaucracy, they serve as a necessary bridge between the front-line managers and the top management. The middle manager translates the organization’s mission and goals into action.

First-line managers may be called supervisors, shift managers, coordinators, or office managers. Employees
who are entering the ranks of management for the first time hold these positions. First-line managers oversee the day-to-day operations of their respective areas of the organization. They often have authority to hire and evaluate the performance of employees in their section and handle most routine administrative duties. Unlike middle or upper management, first-line managers spend most of their time overseeing the work of subordinates. Many first-line managers are working supervisors, still involved in the hands-on business of patient care.

BASIC MANAGEMENT SKILLS

One of the biggest stumbling blocks a new manager encounters is the realization that he or she is viewed differently by subordinates. Everyone wants to fit into a work group as part of the team, but there are bigger expectations for managers. Successful managers need a number of skills to be at the top of their game. Interpersonal skills and the ability to communicate with both internal and external contacts are necessary to the daily duties of a manager. The ability to convey messages and directions and be clearly understood can often mean the difference between success and failure. Active, empathetic listening assists managers to understand and ensure they are understood. People skills go hand in hand with good communication.

Managers need the ability to think outside the box and envision things in the abstract. This is the conceptual ability to put all the pieces together and grasp how things fit into the organization, which leads to diagnostic skills and the ability to visualize a problem and solution. A good manager is able to examine the organization’s symptoms and develop a solution.

Technical skills are also important to a manager at any level and are necessary to understanding how to accomplish a specific kind of work. The ability to do the job is not always as important to a manager as a grasp of how a job is done. Technical skill is most important to the first-line managers because they spent a great deal of time training staff and answering work-related questions. The CEO needs to understand the process; the supervisor needs to be able to turn the knobs and make it happen.

One of the most important skills for a manager is time management. The ability of a manager to prioritize tasks, work efficiently, and appropriately delegate tasks is key to success. However, managerial work does not always follow a logical or systematic progression through the day or week. It is often fraught with change, interruptions, fragmented activities, and uncertainty that can make time very unproductive. Making a habit of keeping a “day book” or notebook, in which a manager can make notes on the events and challenges of the day, is often very helpful. Some managers include this information on a calendar along with scheduled events. This also helps jog a manager’s memory of daily activities in the past.

Leadership

Leadership is an important part of management. In their book The Leadership Challenge, Kouzes and Posner indicate that some of the most important traits of leadership are intelligence, competency, honesty, the quality of being forward-looking, and inspiration. The level and skill at which these qualities are displayed directly influence the willingness of staff to follow a manager’s lead. It is not sufficient to just possess these qualities; they must be displayed daily. Staff respond positively to seeing them put into practice every day.

Competency in a manager is essential for achieving positive results in the workplace. Managers are often considered to be competent because they are in leadership positions; however, the label of incompetence can be attached to a manager quickly and is difficult to dispel. The ability to make decisions and set the pace for your team is a demonstration of competence. Competent leaders will celebrate the accomplishments and success of the team, thus indirectly pointing out the manager’s competence to lead.

Ethical conduct can make or break a manager. Ethics are often referred to as a moral philosophy and encompass the concepts of right and wrong. Every person makes ethical decisions every day on the basis of the individual’s own paradigms. In some cultures, it is perfectly acceptable to pay or accept a bribe when doing business. In the United States, we often provide a cash tip for services; however, in Japan, this practice can be seen as offensive. Should a manager accept a resort stay for doing business with a vendor? The answer is an emphatic no; however, this was a standard practice for many years. Managers should always strive to avoid even the appearance of unethical behavior.

In the workplace, ethics can be greatly influenced by the organization’s mission, goals, or values and can often influence decisions more strongly than an individual’s personal values. Individuals within an organization share a corporate culture that defines goals and values. Organizations develop mission, vision, and value statements to help focus the members of the team to move in a common direction together. Thus, corporate culture creates an ethical climate for the members of the organization.

The quality of being “forward-looking” is essential for any leader. Knowing where you are and where your organization needs to go is of no help unless you are able to communicate your vision to those you lead. When leaders are not seen as forward-looking, it is generally for one of two reasons: the leader has no vision or the leader
is unwilling to share the vision with others. Leaders may fear that their vision will not come true or bear fruit. The leader’s job is to share a vision of the future with others in the organization, guiding and inspiring them to realize that vision. Ideas and visions may be viewed as a ladder. The leader has an idea, the first rung of the ladder, and a vision of the results, the last rung of the ladder. For success, communication is needed to create all the rungs in between the bottom and top of the ladder. Setting goals for the organization and establishing a timetable to achieve them is leading for success (1).

There are several great myths about management that should be noted.

The Ideal Manager

So what do you need to do to become an ideal manager? Some would argue that there is no such thing, and there may not be. However, we should all strive to become what our staff and our bosses feel is an ideal manager. Success is all about attitude and perception. One of the most popular management styles is that of the “walk around manager.” Being out from behind the desk is the best way to know what is going on in your facility. Spend time in each area of the operation for better understanding and communication. It is difficult to lead from behind a desk; it is best to apply the old US Army Infantry motto of “Follow Me.” Be a catalyst for positive change and a demonstrator of excellence in business, ethics, and professional practice.

Here are a few keys to successful management and leadership.

Managers should

keep up with industry changes; be ready to roll with the punches.
be technically proficient as well as knowledgeable in subject content; you need to be able to provide the answers.
take an active role in every phase of the operation; earn the respect of employees and other professionals.
learn to delegate; you can’t do it all; if you hire competent staff, they can do the job.
recruit and hire people who are the cream of the crop and set them to work.
be there for their staff; support your staff and they will support you.
give credit where it is due; let your staff shine and give praise—it makes you look good too.
be fair and consistent; don’t show favorites and don’t change the rules for different individuals.
be honest and trustworthy; broken trust may not be repairable.
communicate; be clear with what you need and expect; remember, information needs to flow both ways.
share your vision; you can’t achieve it alone.
plan for tomorrow; where do you see your department in 5 years and how will you get there?

Staffing a Sleep Center

A sleep center’s ability to grow and stay on top depends largely on the quality of the people working in it. That is because the most important asset of any business is the people. Finding and keeping those quality people is challenging. Turnover costs are high. Getting a reputation for high turnover in a sleep center can have the unwanted result of no one of quality wanting to work there.

HR management is necessary in any business because it is all about people. HR management encompasses federal, state, and local regulatory issues, compensation and benefits, recruiting, interviewing, staffing, retention, job descriptions, policies and procedures, personnel files, team building, training and staff development, creating a safe, healthy, and productive environment, performance evaluation, and discipline.

The type of sleep center determines who is responsible for HR management. A hospital-based sleep center will have an HR department to handle many of these functions for all of its employees. A medium-sized sleep center or a sleep business of multiple centers may have one or two people devoted to HR management. A small freestanding sleep center may have only a manager or supervisor who is responsible for HR management.

Recruiting, Interviewing, and Hiring the People You Need

The hiring process has one purpose, namely, to exchange enough information so that the parties involved can make an informed decision about whether or not to enter into an employment relationship. The usual steps in the hiring process are developing job descriptions, advertising the opening(s), recruiting candidates, reviewing job applications and résumés, interviewing, performing pre-employment checks, and extending an offer.

Job Descriptions

Before any recruiting is done, job descriptions must be in place. A job description defines the employment relationship. It includes the following:

the position title,
the essential duties of the job,
the necessary job experience,
the educational requirements and/or special skills necessary to perform the job,
licensure, registry, or certification requirements,
physical requirements such as the demands of the job, the length of the shift, weekend work, rotating shifts, frequent overtime, and exposure to particular conditions (e.g., chemicals and hostile clients),
special attendance requirements,
a statement that the employee may be asked to perform other duties as needed,
satisfactory performance measures,
the employee’s supervisor, and
the date of the most recent update of the job description.

In a sleep center, job descriptions for the technical staff may include trainee, sleep technician, and sleep technologist. The descriptions vary based on the difference in the scopes of practice (2). A trainee is someone who is learning the basic competencies of sleep technology under the direction of a sleep technician or a sleep technologist. A sleep technician is someone who knows the competencies of sleep technology but is not yet credentialed. A sleep technologist is someone credentialed by a board indicating skill mastery. Thus, a sleep technologist should be able to perform all the scope of practice of the sleep technology profession and may provide oversight or training of noncredentialed technical staff. As the role of the sleep technologist expands to include more clinical roles, and technologists seek advanced credentials, higher-level job descriptions may be required to outline the duties of a clinical sleep health educator, patient care coordinator, or shift supervisor.

Administrative assistant job descriptions are developed according to the needs of the individual sleep center, its location, organizational structure, staff size, and amount of business. The administrative staff work closely with the medical director to ensure that sleep center operations comply with federal, state, and local regulations and with other governing bodies such as the American Academy of Sleep Medicine (AASM) and the Joint Commission. In a small sleep center, one person could wear many hats. A manager may have responsibility for day-today operations, technical operations, and staffing. As the business grows, with an increasing patient load and increasing staff size, the size of the administrative staff generally increases and the responsibilities diversify. It is the administrative assistant position that usually maintains contact with the technical staff, the medical staff, the insurance industry, and the public. Administrative assistant positions are public relations positions.

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