A Dangerous Position: The Health Director’s Job
A health director has a few basic responsibilities: management, including supervision of key medical staff and of non-medical staff; the budget; policy analysis; building effective partnerships; and compliance with Tribal, federal, and state law. Each is manageable on its own. Together they make the position a dangerous one.
The elements of success
- Manage finances.
- Manage people.
- Manage the relationship to Tribal authority: the Council and Tribal administration.
- Manage outside partnerships.
- Manage contractors.
Common pitfalls
- Poor oversight of spending or the revenue cycle.
- Poor organizational structure, which leads to neglect of staff: neglect in support, and neglect in supervision of compliance with job descriptions and professional standards.
- Failure to “crack the code” of performance improvement.
- Failure to develop a respectful relationship with Tribal Council.
- Failure to select quality contractors with clear objectives.
- Allowing indecision about the means to leave critical tasks undone.
- Neglecting outside changes in the health policy environment.
- The reverse: letting attention to the outside environment lead to neglect of management.
- Underestimating difficult staff, who benefit from turnover in management and will work to undermine it.
- Failing to use the options that exist when removing a Tribal member from a position is not an option, such as leave without pay. Not using them rewards bad behavior.
Why so few directors stay
Most newly hired health directors seldom serve longer than two years. In Alaska the saying is that if key staff last three years, they will stay. It is those first three years that are critical.
The search for the perfect director, one who can be and do all things, is a fool’s pursuit. Criticism of one or more aspects of a director’s performance can lead to his or her demise. Just as foolish as hoping for the perfect director is refusing to allow a director to shore up weaknesses and make use of strengths.
Who has your back?
Success in a new position depends on someone who is invested in your success and willing to back you up when the inevitable issues arise. That support can come from Tribal leaders, state and federal partners, colleagues, and Indian organizations. A new director should know early who those people are.
Adapted from Management & Policy Analysis for Indian Health (2017–2023): pages “Health Directors,” “A Dangerous Position,” and “Job Seekers.”