You hired the operations lead, or you promoted the clinic director. Either way you have a new manager now, and you did it to get the day-to-day off your desk, because you were the one deciding whether to hold an eval slot for a physician referral, whether the therapist who called out gets covered or the patients get moved, and whether to keep treating while an authorization is still pending.
Then your practice administrator, who has been with you since the clinic was six people, comes to your office about the new authorization tracking that your operations lead put in place. They don’t schedule it. They stop in the doorway on the way past, the way they have for years, and they tell you the new way is too much and the front desk doesn’t like it.
You have a moment to answer, and whatever you say teaches your team who decides this.
Many owners answer the question. Partly it’s that answering takes ten seconds and sending them away feels like a brush-off, and partly it’s that being the person your team comes to feels good, and giving that up is harder than most owners will admit. So they explain the reasoning, or they agree that the new process has a rough edge, or they say they’ll look into it. Every one of those is a reasonable thing to say, and every one of them teaches the person that coming to you still works.
This usually isn’t insubordination
The person walking past your manager probably isn’t undermining anybody. They’ve been bringing you things for years. That’s the relationship. They haven’t necessarily been shown a different way to do it, so they’re doing what has worked every other time, and they’d be surprised to hear it described as going around somebody.
Often the new manager is in the same position from the other side. They were handed authority in a meeting. They have no idea yet whether it’s the kind that holds up, because every time it’s been tested so far, the answer came from your office.
So you have two people, both acting in good faith, both waiting to find out how this works now. What they end up believing isn’t what you announced in the staff meeting. It’s what they watch you do the first few times somebody comes to you anyway.
Ask them whether they’ve talked to their manager
When your administrator brings you the authorization complaint, you ask a question. Have you spoken to the operations lead about this? Or use their name. Did you ask Bob what to do about this? Same question when a clinician tells you the new documentation deadline is unrealistic, and same question when the front desk wants an exception to the cancellation policy.
Then don’t offer an opinion. That’s the part owners skip, and it’s the part that does the work. The moment you say what you’d have done, you’ve answered it after all, and both of you know it.
That’s all you have to say. You don’t need to explain the org chart, you don’t need to defend the new process, and you don’t need to soften it with a long preamble about how much you value their input.
Asking shows the person where the line is now, which they may not know. And it tells your manager that the authority you handed over is the kind that holds, which they may not know either.
Then comes the part that decides it. They go and ask, they don’t like the answer, and they come back to you. That’s the moment, and the answer is that the call stands. You can tell them you’ll talk it over with your manager, and then go do that privately, but you don’t change the decision standing in front of the person who came to get it changed. If you overrule once, your team learns that going around you still works. It just takes two steps now instead of one.
Many owners think this is going to be a hard conversation. It usually isn’t, because you aren’t deciding anything. The hard version is the one you get later, if you keep answering, when your manager has stopped acting like a manager and you can’t tell when that started.
You’ll have to do it more than once, and most of all with whoever has been there longest. They knew you before there was an operations lead, and that history is going to feel more true to them than a new reporting line. It’s worth remembering that this is uncomfortable for them too. Being sent to somebody else’s office after years of walking into yours feels like a demotion, even when nothing about their job changed.
Why hiring a new manager didn’t take anything off your plate
Owners come to me confused about this one, and usually a little embarrassed. They made the hire, the hire is competent, the money is going out, and their week looks about the same as it did before. So they start wondering, privately, whether they picked the wrong person.
Usually the new manager isn’t the problem. What happened is that the work moved over and the habits didn’t. Your team still brings you the things they used to bring you.
Your manager got the schedule template, the documentation deadlines, the huddles and the callout coverage. You kept the disagreements, the exceptions and the complaints. The therapist who wants their Tuesday template changed, the front desk person who wants to waive a copay for somebody they like, the clinician who is sure the new eval slot rule will cost them patients. Those still come to you, because routing is a habit and the habit didn’t change.
The decisions you’re still getting pulled into are the expensive part. Handing over the task saves you a few minutes. Handing over the arguments saves you the part you’re still thinking about at dinner.
I had to learn this one myself. When I first started letting somebody else lead the meetings in my own company, I’d sit there thinking I wouldn’t have said it like that. And the temptation, every single time, was to jump in and add something. Well, actually, here’s how I’d put it. I had to come to terms with the fact that they weren’t going to say things the way I would, and that there had to be some space for them to be themselves, as long as they were doing what the business needed. Every time I gave in to that temptation I undermined the person I had just put in charge, in front of the team, and then wondered why they checked with me before the next one.
Your new manager may not know they have it
Most new managers are careful with their authority. They don’t want to overstep, and they’re worried about looking like they’re throwing their weight around in a place where the whole team has known each other for years. So they watch what you do, and they learn from it. If the first complaint about their authorization process gets settled in your office, they learn that their decisions are provisional. So the next time a therapist pushes back on a documentation deadline, they bring it to you rather than settle it themselves, to be safe. Now you have somebody bringing you decisions instead of handling them, which is an extra step in the same pattern you hired them to end.
So tell them, plainly, that you’re going to send people back to them, and that you’ll back their call even when you’d have made a different one. Then do it, in front of people, the first time it comes up. Backing a decision you disagree with, once, in public, does more than telling them they have your support.
If you would have decided differently, that’s a conversation to have with them afterward, in private. You need both halves. Backing them publicly and coaching them privately is how somebody grows into the job. Correcting them in front of the team is how you get somebody who checks with you before every call.
Decide where the line goes
None of this works if you haven’t decided what your manager owns.
If your manager doesn’t know which decisions belong to them, they’ll keep checking with you, and your team can’t be expected to know either.
Sit down with your manager and get specific about the things that come up every week. Who decides whether to treat while an authorization is pending. Who approves a schedule template change. Who handles a clinician running late on documentation, and at what point it stops being a reminder and becomes a conversation. Who decides a coverage plan when somebody calls out on a full day. Which of those they do alone, which they do and tell you about afterward, and which genuinely need you first. There should be very few in that last group.
Write it down and give a version of it to the team, so the routing isn’t a secret between the two of you. If people don’t know who owns a decision, they’ll keep bringing it to the person who has answered it before.
Then hold it. The announcement doesn’t do the work, no matter how well you explain it.
Before you decide the hire isn’t working, check these
- When somebody brought you a problem your manager owns, what did you say, and what did that teach them?
- Can you name the decisions your manager makes without you, in a sentence they’d recognize?
- Does your team know that list, or is it something only you and your manager have discussed?
- Who is your longest-tenured person, and does the routing hold with them the way it holds with the rest of the team?
- Has your manager seen you back a call of theirs in public, including one you’d have made differently?
- When you disagreed with a decision they made, did you raise it with them afterward or fix it in the moment?
- Are the questions coming to you now different from the ones you were getting before the hire, or the same ones from a different chair?
I’m a business coach for PT, OT, and SLP clinic owners. I work one-to-one with owners doing $1M to $5M in revenue and run monthly mastermind groups of four owners using a hot-seat format. If you want help handing real authority to the people you put in charge, get in touch.