Hospital director and department head: who looks out for the whole hospital?

Loyalty to the team as a starting point

A department head has good reason to defend their team’s working conditions: they are responsible for the patients admitted to the department and the people working its shifts. Interviews with 24 clinical managers in three regions of Sweden described how strongly managers identified with their own staff. This could reinforce boundaries between parts of the organisation. These are qualitative findings about tensions and limited authority, not a measure of how common the phenomenon is in Poland. The hospital director can therefore start by acknowledging the department head’s responsibility rather than accusing them of not caring about the hospital. They should then ask which patients the additional staffing would protect and examine what allocating it would mean for other shifts.

Where the cost of a local success falls

A benefit to one department does not stop at its door. If moving staff shortens the queue there, it is worth tracing whether it also lengthens waits in the emergency department or adds work for the team taking on the next task. The costs may include extra phone calls, explanations and time patients spend between stages of care. Rather than comparing broad assessments of departments, the director and department head can trace one specific patient journey together. They should record what changes for the department benefiting from the decision and what changes for the unit giving up staff or taking on more work. Only then can they assess the proposal from the perspective of the whole hospital.

A shared goal needs clear authority

A shared goal will do little good if no one has the authority to resolve a problem spanning several departments. A qualitative study of Swedish managers described difficulties coordinating work when mandates were unclear or too narrow. A meta-analysis, meanwhile, found an association between role ambiguity and poorer job performance that was stronger than the association between role conflict and performance. This does not prove that clarifying authority alone will resolve a hospital dispute. It does suggest asking, alongside questions about differences of opinion, where the department head’s authority ends and who can make a decision across departments. The criterion for that decision should be the needs of the whole hospital, such as its capacity to admit urgent cases, rather than the sum of individual departments’ requests.

How to describe a shift in workload

A shift in workload is easier to discuss when the conversation focuses on how work flows, not on presumed intentions. The director can name the decision, identify its benefit to the department head’s team and describe a specific consequence for the next team. Before judging the decision, they should ask the department head to check the facts: is this how the patient journey works, and have any important staffing constraints been missed? It is worth inviting a representative of the unit bearing the cost to help find an alternative. Together, they can establish what work is being passed to that unit, who will first notice a growing burden and what would show that the team’s capacity has been exceeded. This leaves room to correct the account without avoiding the difficult issue.

Debating criteria instead of labelling people

Labels such as “selfish department head,” “demanding department” or “management versus doctors” quickly shift the conversation from decisions to judgments about people. A meta-analysis indicates that relationship conflict is, on average, associated with poorer team performance and satisfaction. This does not mean every disagreement over staffing is harmful; it is worth avoiding a dispute about the character of those involved. The director can ask the department head to explain three things: the benefit to their department, the cost to other units and the effect on the entire patient journey. Both sides can then compare options in terms of patients’ time, risk, patients’ needs, staffing constraints and the hospital’s total workload, describing specific actions rather than labelling teams.

When the director should make the call

Not every difference between departments can be resolved through further negotiation. The director should clarify in advance which matters teams can settle between themselves and which require a decision by someone with broader authority. When teams cannot agree on how to divide staff or equipment, the decision should not sound like a victory for one side. It is worth explaining which criterion carried the most weight, why that option was chosen and who will bear the additional cost. The director then takes responsibility for a hospital-wide compromise rather than leaving it to the department heads in dispute. They should also name someone responsible for implementing the decision and set a date to review its effects, so the team taking on the burden knows when its situation will be assessed.

How to assess effects beyond one department

After a staffing change, a shorter queue in the department that received support is easy to see. But that alone is not enough to conclude that the decision was good for the hospital. At the agreed time, the director and the teams involved should revisit data from both units and the patient journey: is the unit that gave up staff or equipment managing its tasks, and have new delays emerged? They should also look for workarounds, extra phone calls and work done outside the original plan. If a local measure has improved at the expense of a worse outcome across the whole pathway, the arrangement needs to change. The purpose of this review is not to find fault but to check whether the chosen criterion really protects the interests of the whole hospital.

A department head’s loyalty to their team matters, but when allocating resources, the hospital director must also consider the effects on other departments, the emergency department and patients.

Empatyzer in conversations between a department head and hospital director

When preparing to discuss how staff time is divided between departments, the director can start with the “You and a specific person” comparison. A view of the relationship with that person helps them tailor how they present different perspectives to the department head and their way of making decisions. The director can then discuss with Em questions about how the proposed allocation would affect other teams: who will take on the work, how will shifts change and what will happen to the patient journey? Talking with Em about themselves can help the director articulate a shared criterion for allocating resources before both sides begin defending their preferred options. Group insight helps account for departments’ differing expectations, while working with Em in team mode can support the development of shared language for the criteria. The director can also rehearse wording that both acknowledges the department head’s responsibility for their patients and clearly identifies the decision’s cost to the whole hospital. The tool helps prepare for the conversation; it does not replace clarifying authority, checking the data or the director’s decision.