The Healthcare Manager's Playbook

This is the ninth post in a twelve-part series exploring key lessons I wish I had known before becoming a director for the first time. This series is inspired by a common question I hear from new directors I help onboard: “What do you wish you had known before you became a director?”

In this entry, I want to talk about a reality many new leaders are not fully prepared for: your work relationships will change once you become the boss. When you become a director, you are no longer just part of the team. You are leading it. That shift brings with it an unavoidable change in how others relate to you and how you relate to them.

As a staff therapist, you worked side by side and shared equal footing with your colleagues. As a director, however, you are now in a role of authority. You oversee hiring, disciplinary actions, and job performance evaluations, to name a few. That authority changes the dynamic of relationships, even if your intentions and personality remain the same.

Marc Horstman, author of The Effective Manager, puts it bluntly: “Your team does not laugh at your jokes because they are funny. They laugh because you are the boss.” This quote captures the subtle but important power shift that happens when you step into a leadership role.

This shift can feel awkward or unexpected, particularly if no one has prepared you for it. You may notice that therapists speak or act differently around you. Now that you are responsible for disciplinary actions or employee recognition, people may filter their words and behavior. This does not mean they are being fake. It means they are reacting to your influence on their professional future.

There is a positive side to this dynamic. Your staff also wants to make you proud. Be intentional about noticing their efforts and be willing to provide frequent positive feedback. One way to do this is to work outside of your office. Find ways to work in the gym if possible. Set up a rolling table in the periphery and work through pen and paper tasks. Computer work is not recommended, as it can easily consume your focus. Working in the gym gives you time to see staff in action and provides opportunities to observe your team doing great things for patients.

Relationships also become more complex. If you spend more time with one team member or a small group, others may assume you have favorites. This perception, whether accurate or not, can damage team trust and morale. It may have been acceptable to socialize in cliques as a therapist, but it is no longer how you want to operate as a director. For example, if you always sat at the same table with the same people at lunch, you will now want to rotate and sit at different tables. The goal is to spend equal social time with all members of your team.

To maintain a sense of fairness and team cohesion, it is helpful to spread your presence and support evenly. Make a point to check in with every team member, not just those who are easier to talk to. If you are invited to events or gatherings, consider attending only if the whole team is included. It is best to avoid activities that might unintentionally reinforce cliques or favoritism.

What once felt like natural friendships as a staff therapist may now feel inappropriate or exclusive in your new role. Do not confide in your direct reports. Sharing sensitive information is not fair to them, and it is likely they will share it with others. This will undermine your authority. As a leader, you need to be more aware of how your attention, feedback, and time are distributed.

Everything you say or do as a leader carries weight. A casual comment or offhand joke may be remembered and analyzed long after you have moved on. One director I worked with openly expressed their political preferences during an election year. While it may have seemed harmless to them, it led to discomfort and even resignations among staff who held different views. Leadership requires awareness. You are always setting a tone, whether you realize it or not.

Relationships will change when you step into leadership. That is natural and expected. The key is to enter your new role with intention, humility, and a commitment to fairness. Rather than learning through trial and error, prepare yourself for the shift. The more you anticipate the dynamics that will change, the better positioned you will be to start off on good footing as a new leader.

About the Author: Shane Haas serves as the National Director of Outpatient Services at Ernest Health, a leading provider of inpatient and outpatient rehabilitation. He enjoys learning and sharing leadership and management principles. His backgrounds in Physical Therapy (UF ’96) and Industrial Engineering (TTU ’02) provide a balanced heart and head perspective that shapes the Healthcare Managers’ Playbook.

References:

Horstman, M. (2016). The Effective Manager. John Wiley & Sons.