Relationships Matter: Lessons for Teachers, Managers, and Clinicians

by Joey Mattingly, PharmD, MBA, Assistant Professor, University of Maryland School of Pharmacy

Teacher quality is often cited as one of the most important variables in student achievement and this quality varies significantly.^1,2  Are we stuck with a predetermined stratification of teacher talent, or is it possible to dig deeper and identify ways to improve organizational environments to achieve gains in teacher quality?  This post attempts to break down an important variable in education, the teacher-student relationship, and identify strategies for individuals and institutions to create environments that improve this exchange.

Figure 1

From a process analysis perspective, learning is an exchange between teacher and student(s) that takes place through a dyadic relationship (See Figure 1).  Since the student (member) essentially reports to the teacher (leader), this dynamic reflects organization reporting structures described in business literature.  The Vertical Dyad Linkage (VDL) and Leader-Member Exchange (LMX) theories were created to examine the impact of these relationships on important business outcomes such as efficiency, profitability, employee turnover, and job satisfaction.^3,4  In the clinical setting, we see research on the patient-doctor relationship (PDR) model and impact on healthcare outcomes and patient satisfaction.^5,6  While all of these theoretical models are being studied by researchers in various fields, there are a few common threads that we can all learn from (See Figure 2). 

Figure 2

Empathy

John Maxwell simplified the importance of empathy in his book The 21 Irrefutable Laws of Leadership through a quote he often shared with his employees, “People don’t care how much you know until they know how much you care.”⁷  A physician may be brilliant and considered a leader by peers, but a patient’s decision to continue the patient-doctor relationship is significantly influenced by whether or not the patient perceives that the physician actually cares.⁸  An educator who displays empathy toward students is able to build a positive classroom climate, stimulate growth, and cultivate more productive learners.⁹ 

Respect

Multiple studies have demonstrated the importance of respect and the relationship between teacher-student.^10-12  Teachers that respect their students, managers that respect their employees, and healthcare professionals that respect their patients are able to build stronger relationships.  Listening is a great way to demonstrate respect.  Students’ perceptions of their professor’s respectfulness are also associated with stronger student self-confidence and motivation.¹²

Accessibility

Top-down accessibility and availability has been cited as an important variable in the dyadic relationship.  One of the components of the VDL and LMX theories within management is the “high quality” and “low quality” relationships that develop between supervisor and subordinate(s).  Dansereau, Graen, and Haga described this phenomenon as employees being divided into the “in group” or the “out group” in terms of relationship quality.  They found that leaders devoted more time, attention, and support to subordinates within the “in group” even though employees in the “out group” needed more support.³  Building strong relationships with students, employees, or patients requires time and making oneself available.

A Leader’s Dilemma

While evidence supports the need for leaders to incorporate empathy, respect, and accessibility into interactions with subordinates, profit- and efficiency-maximizing strategies are often not conducive to relationships building.  An organization wishing to gain economies of scale through growth will increase the number of members reporting to each leader in the organization.  Similarly, a teacher may see class size grow from year to year or a physician may be required to see more patients in order to increase revenues (aka “Do more with less”).

On the flip side, a 1:1 student-teacher ratio would not be practical (and too costly) to implement in most cases even though it would definitely allow the teacher to focus all efforts on one subordinate.  So what is the answer?  Is there a magic number of subordinates that would allow teacher, manager, and physician to build strong relationships with the members they serve? 

The Right Span

If we want to improve the quality of our teachers, managers, and physicians, then we need to consider ways to build an optimal span of control.  Dr. Harold Koontz identified several underlying factors for leaders to consider.¹³  For example, employees require different levels of training based on abilities and experiences.  A manager of a new location of a retail franchise with a high percentage of recently hired employees may be unable to adequately supervise 10 direct reports while a manager of a more established location with more experienced employees may be able to manage 15 people.  When applied to education, a professor leading an undergraduate course on basic microeconomic principles may have an easier time managing 100 students in a large lecture hall as compared to a professor managing a doctorate level course focused on an in-depth analysis of the Nash Equilibrium and other non-cooperative game strategies in economics.  A doctorate level student actually has more training to do the “job” of learning and one would expect a graduate school professor would be able to “manage” more students, but the complexity and intensity of training actually requires more instructional effort and thus limiting the professor’s span of control.  Understanding the variables that influence a leader’s span of control may help determine the right number of subordinates for each teacher, manager, or physician.

Reducing class size or number of patient visits may be difficult from a business perspective, but that doesn’t mean our hands are completely tied.  Knowing how Koontz’s factors influence a teacher’s span of control can help them improve educational outcomes, whether through advocating for appropriate class size changes or applying techniques to improve information exchange.  Improving the quality of communication and the clarity of plans helps simplify the instructions for each subordinate and reduces the amount of time the teacher needs to spend communicating.  Utilizing technology may also help leaders gain efficiencies to tackle their workload.

Identifying strategies to improve the different vertical relationships within organizations should be a top priority.  Developing stronger connections based on a foundation of empathy, respect, and accessibility could help schools, businesses, and health-systems reach desired outcomes. 

For more posts written by Dr. Joey Mattingly, please visit Leading Over The Counter, a blog dedicated to leadership and management topics for pharmacists and other health professionals.

References:

1. Riley RW. Our teachers should be excellent, and they should look like America. Education and Urban Society. 1998; 31:18-29.
2. Slater H, Davies NM, Burgess S. Do teachers matter? Measuring the variation in teacher effectiveness in England. Oxford Bulletin of Economics and Statistics. 2012; 74:629-645.
3. Dansereau F, Graen G, Haga WJ. A vertical dyad linkage approach to leadership within formal organizations: a longitudinal investigation of the role making process. Organizational Behavior and Human Performance. 1975;13:46-78.
4. Thomas CH, Lankau ML. Preventing burnout: the effects of LMX and mentoring on socialization, role stress, and burnout. Human Resource Management. 2009;48:417-432.
5. Mikesell L. Medicinal relationships: caring conversation. Medical Education. 2013; 47:443-452.
6. Weng HC. Does the physician’s emotional intelligence matter? Impacts of the physician’s emotional intelligence on the trust, patient-physician relationship, and satisfaction. Health Care Manage Rev. 2008; 33:280-288.
7. Maxwell J. The 21 Irrefutable Laws of Leadership. Nashville, TN: Thomas Nelson; 2007.
8. DiMatteo RM, Prince IM, Taranta A. Patient’s perceptions of physicians’ behavior: determinants of patient commitment to the therapeutic relationship. J Community Health. 1979; 4:280-90.
9. O’Brien LM. Caring in the ivory tower. Teaching in Higher Education. 2010; 15:109-15.
10. Lammers WJ, Smith SM. Learning factors in the university classroom: faculty and student perspectives. Teaching of Psychology. 2008; 35:61-70.
11. Micari M, Pazos P. Connecting to the professor: impact of the student-faculty relationship in a highly challenging course. College Teaching. 2012; 60:41-47.
12. Komarraju M, Musulkin S, Bhattacharya G. Role of student-faculty interactions in developing college students’ academic self-concept, motivation, and achievement. J of College Student Development. 2010; 51:332-42.
13. Koontz H. Making theory operational: the span of management. J of Management Studies. 1966; 3:229-43.