Medicaid leaders have significant opportunities to impact the health and well-being of millions but must balance a myriad of federal and state priorities related to fiscal stewardship, quality assurance, program integrity, and more. The to-do list in a Medicaid agency is long, and there are numerous competing priorities and external stakeholders — the Governor’s office, legislature, providers, consumers, among others — who influence the agency’s strategic agenda.

There’s no shortage of work, yet Medicaid agencies have limited human and financial resources to draw on to get the work done. Agencies lament the need for more positions, the desire for more staff who feel ready and able to take on more responsibility, and nagging decision bottlenecks that slow work down. Frequently, the core group of doers in an agency is at risk for professional burnout and/or are highly sought after by other state agencies and external partners, like health plans. An emphasis on developing staff and increasing delegation strategies can help address these challenges, build institutional knowledge, and foster opportunities to identify and cultivate the next generation of senior Medicaid leaders. Through our work with Medicaid senior managers across the country in the Medicaid Leadership Institute and Medicaid Academies, we are increasingly focusing on strategies for effective delegation. Following are lessons for enhancing delegation drawing from our work.

Strategies for Avoiding Common Delegation Pitfalls

While almost every manager wants to delegate more, there are a few common challenges that can prevent or dilute effective delegation. Even after coaching someone on a new task and decreasing your level of support as they increase their independence, there are still some potential pitfalls to consider.

  • Foster trust. Trust is central to effective delegation. A trusting relationship ensures information is successfully shared between you and the person you’re delegating the work to. Further, trust creates an opportunity to constructively share feedback and provide input where appropriate. Without trust, the individual to whom you’re delegating can interpret the delegation as you “pushing off your work” onto others and feedback can be interpreted as mistrust of their ability to carry out the delegated assignment.
  • Define the task with clarity and coherence. Something you’ve done repeatedly may feel like second nature. You know exactly what it is because you’ve done it so many times. You understand how it connects to the broader context (e.g., political, relationships with stakeholders, etc.) and who needs to be involved. When delegating, it’s important to be clear about what the work involves and connect it to the broader context and the agency’s strategic priorities. Further, connect the task to the individual’s development goals. The more someone understands how a new task can support their growth, the more connected they will feel, and their confidence and commitment will grow.
  • Identify the expectations and feedback loop. Similar to providing the broader context, the more you can be clear about your expectations — for example, the timeline and their level of decision-making authority — the more you set up the delegation opportunity for success. An effective strategy can be reiterating the task and expectations at the end of the meeting or following up by email afterward. Additionally, an unclear feedback loop can lead to miscommunications and you feeling disconnected from the progress and any challenges that have arisen. Preparing legislative reports, for example, is a common Medicaid agency task that may be delegated. If the feedback loop is unclear — e.g., the report may need to be reviewed by the agency’s public affairs or communications team before going to legislators or legislative staff — there’s a risk that a key step will get missed and the report will be externally released before the agency is ready.
  • Don’t forget to FYI. It’s critical to inform other staff and key partners about the task you are delegating and to whom. Otherwise, you still get those meeting invitations and copied on emails related to the task. It is hard for someone else to pick up the task if others perceive it is still yours. The more partners are clear on who is leading the task, the less likely they’ll continue to come to you for information and decisions. Medicaid agencies, for example, are responsible for a substantial amount of internal and external stakeholder engagement. You might delegate responsibilities to someone on your team to manage a specific stakeholder group. If there isn’t clear communication about the transition of roles, however, the stakeholders may continue to come to you with questions or stall key decisions because you’re not in the room.
  • Stairstep to full delegation. Overloaded to-do lists and access to an individual who has demonstrated high levels of success on other tasks can be impetuses for delegating yet another new task to them. However, it’s important to remember where they are in their individual development. If they’re not meeting expectations on the delegated task, you may need to assess whether you need to increase your level of support or even step in more to provide hands-on coaching before the individual can take on full delegation responsibilities.
  • Create time and space for delegation. There are lots of reasons to avoid delegation, most commonly: you like doing the task; it feels quicker if you just do it yourself; no one has time to take on the task you want to delegate. These rationalizations can be a disservice and often perpetuate the status quo. Effective delegation requires some upfront time investment, but the long-term impact can be worth it. For example, testifying in front of the legislature is a common expectation of Medicaid agencies, which can sometimes be stressful and/or require substantial advance preparation. Legislative testimony can be delegated to individuals on your team, particularly those with strong subject matter expertise on the topic at hand. The key is to coach and support them through the process. If you continue to handle all the legislative testimony, it will always be on your plate and you won’t have a cadre of leaders who can also take on this task.

Delegation in the Long Run

Almost every Medicaid leader has the desire to delegate more, but there are some common pitfalls that can make delegation less effective or create frustrating roadblocks. Building awareness about these potential challenges can help leaders more intentionally navigate delegation and support the development of future Medicaid leaders.

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