The Dance Between Authority and Responsibility

By: Dana Jacoby

A wise man once told me, “Never accept responsibility for something unless you have the authority to make it happen.”

Too often, we separate responsibility from authority. We try to hold people responsible for specific tasks that need to be accomplished, but we withhold the power to make the decisions and take the actions necessary for success. We say things like, “It’s your responsibility to keep our patients happy, but before you do anything please get approval from me first.” Sometimes, the separation happens after the fact like when one of our team makes a valiant effort to meet their responsibility, only to be criticized for exceeding their authority.

That is a recipe for both performance problems and morale malaise. As leaders, it is ineffective and unfair to put our teams in that position. Rest assured, the person on our team without authority will quickly learn to shun responsibility.

Certainly, there are hard and fast rules that act as the boundary lines within our organization. But between the sidelines, there is a huge opportunity for our teams to exercise their talents, skills and judgements to win the game. After all, that is precisely why we asked them to join the team in the first place, isn’t it?

The retail clothier Nordstrom is famous for granting to their staff the authority to make the customer happy. Whether it involved a split second decision to make a refund as in the true story of a cashier who refunded a set of tires (Nordstrom took over an Alaska department store that previously sold tires), or a sales associate who helps a harried customer carry an armful of holiday packages to the car, Nordstrom became legendary in their customer service. At the heart of their culture was the intentional dance between authority and responsibility.

On the other side of the equation, we are witnessing a growing number of leaders who are simply weary and looking for ways to change their level of responsibility. Given the current challenges in our economy, the rapid changes in healthcare and the onslaught of the COVID pandemic, responsibility has a weight that feels unbearable to many in the practice of medicine in general and urology specifically.

Sometimes, the reduction in responsibility may take the form merging into a much larger organization or adjusting the sails across the leadership team. In some cases, those decisions may successfully reduce the amount of responsibility on specific leaders. This is because of things like systems and synergies. More can often be achieved when the steps are specialized and systematized.

But the dance between authority and responsibility is still present. Recently, I have spoken with a number of doctors and practice leaders who are discovering that with the reduction of responsibility comes an equal curtailment of authority. No longer do they have the ability to set their own hours, determine their “on-call” or hire their teams. The reduction in responsibility is a relief; the loss of authority is startling.

The difficulty with the dance between responsibility and authority is that there is no perfect balance. Just about the time we think we have achieved the right mix of responsibility and authority, our circumstances change. As in any dance between people, someone moves and we must readjust to find a new balance. Back and forth it goes, because standing still simply isn’t an option.

The important lesson here is not to try to find the perfect balance. The learning is in the recognition of the pattern. Any time there is an assignment of responsibility, there must be a consideration of who has the authority to make it happen. Ideally, the two elements move together. When one side of the equation changes, the other moves in the same direction. And we know that when the balance is lost, the dance becomes difficult. But with careful consideration and a recognition of the relationship, responsibility and authority can be very effective tools in the hands of good leadership.