Cath Lab Management

Advice: Good Management

Marshall W. Ritchey, MS, MBA, RCIS, CPFT, CET

Marshall W. Ritchey, MS, MBA, RCIS, CPFT, CET

Dear Friend, 

Greetings and Salutations! I hope this e-mail finds both you and your family happy and healthy.

We are friends.  I have been gone for a while and I haven’t heard from you. I have heard from others at [x] and they relate that things are not going well in their relationship with you. You and I have had long discussions on working relationships and bringing out the best in people.  

To continue the discussion and hopefully provide you with tools in dealing with these relationships, here are some thoughts.  There are many different points of view.  I don’t have all the answers.

I can tell you that currently your work interactions are not going well. There is resentment towards you. There is a lack of trust. There is the thought that you misrepresent the truth. So, what is going on?

General (then President) Dwight D. Eisenhower is quoted as saying “Pull the string, and it will follow you wherever you go. Push the string and it will go nowhere.” 

Also, “When you find a man who knows his job and is willing to take responsibility, keep out of his way and don’t bother him with unnecessary supervision.” (Thomas Dreier)

“Managers, your unnecessary supervision can easily become interference.” (Brian K. Rice)

Most staff know what to do. Our job, as management, is to lead, delegate and provide the tools to get the job done. We are to set the standards high and help our staff achieve these lofty goals. Pushing people usually is met with resistance, as General Eisenhower noted: “Push the string and it will go nowhere.” Anger multiplies the emotion of resistance to resentment on both sides.  

My thinking is, stay away from micro-management — unless you are going to do the whole job yourself. Admittedly, this is the best control. When you do the job, you know the quality and quantity of the work, but because you alone are doing the work, the outcome is limited, because it is only you. There are only 24 hours in a day and you can only do so much in a work day. 

Control? Leadership is usually referred to as “management.”

The greatest challenge for managers is time management. That’s because most managers have more tasks than time available (unless they want no personal or family life, which is a higher priority). Now ask yourself, what are the 20% of things that get you 80% of your results in terms of quality and productivity? Always make those tasks or activities come first. 

The other 80% are where you have to make the most important decisions: delegate, set as lower priorities, or just say “no.” Knowing when to say no is the best thing to know.           

Ask yourself the following*:

  1. Does anyone have to do this task at all?  Will it make a difference in a year?
  2. Do I have to do it or could someone else get it done? For instance, do I really need to go to all of those meetings, or can someone else go and brief me later?
  3. Do I have to do it now or can it wait? Timing is everything. Don’t wait until the last minute, but some projects are never done. They are a work in progress that eat up hours and the quality does not increase proportionally with the effort.
  4. Are my standards too high? Am I driving myself crazy? Can I make decisions more rapidly and with the information available? Am I nagging or irritating staff without improving patient safety or patient satisfaction because I want things my way?
  5. For greater efficiency, can I set aside specific time to group certain tasks and be more efficient (like setting aside an hour-long block for people to ask questions, rather than having a constant interruptions — excepting TRUE emergencies, of course)?
  6. For which tasks do I need to set boundaries or negotiate with someone to let them know that I can either do those tasks or another set of tasks, but don’t have the time to do both? Are there some tasks that aren’t your responsibility?  
  7. On which tasks can I be more efficient, for instance, by scanning journal articles rather than saving and trying to read the entire journal? Having staff tell me where schedule conflicts are, as opposed to looking for the rough spots?

Time management is always tough. You spend half your time working with the staff, the other half going to meeting, and the other half doing paperwork. Try to schedule your day more efficiently and proactively. For instance, set aside schedule blocks where you are walking around, where your office is open for questions, where you are delegating more tasks to others, and where you are in closed-door work doing admin things. (Then make sure you schedule time for family.)

Best wishes to you and the rest of the crew. Remember, these are the good old days. At least twenty years from now, they will be. I hope I provided some helpful ideas or thoughts. I don’t have all the answers.  I always enjoyed our talks and friendship.

Keep up the good work!

Respectfully yours,

Marshall W. Ritchey 

*More questions managers can ask themselves:

  1. Are there any patient safety issues on the unit?
  2. Where are we in regard to budget this week?
  3. How are supplies? Are we within budget? Are any supplies at risk of being expired? Are par levels appropriate? Are supplies organized and accounted for?
  4.  Have you completed performance evaluations for all of your staff on the unit?
  5.  What is happening during the afternoon and night shifts?
  6.  Which patients are ready for discharge, and which are having issues that will lead to a longer-than-anticipated stay?
  7.  What beds will be available today, and approximately at what time?
  8.  Is every staff member on the unit safe, competent, loyal, committed, and proud of the results on the unit?
  9. How have you interacted with the medical staff today? Are there any issues, complaints, or suggestions from the medical staff we should be considering?
  10. Are there any issues with staff that could lead to grievances or that are causing a competent staff member to be a “flight risk”?

Read more from Marshall Ritchey, MS, MBA, RCIS, CPFT, CET:

Ritchey MW. Trick question! Cath Lab Digest. 2016 May; 24(5). Available online at

Ritchey MW, Hartsoe L, Rentner R. Where is my stent?! Cath Lab Digest. 2016 March; 24(3). Available online at

Ritchey MW. They call it a “huddle” or leitungsbesprechung! Cath Lab Digest. 2015 Sept; 23(9). Available online at

Ritchey MW. On-call scheduling – trying for equity. Cath Lab Digest. 2013 February; 21(2). Available online at

Read more from Cath Lab Digest on management in the cath lab:

Kern M. Dynamic leadership in the cath lab: balancing taking charge and being part of the team. Cath Lab Digest. 2010 Jan; 18(1). Available online at

Doucette JN. Improving communication amidst conflict: The cath lab manager’s guide. Cath Lab Digest. 2010 March; 18(3). Available online at 

Marshall W. Ritchey, MS, MBA, RCIS, CPFT, CET is an independent contracted cardiology consultant. He has over thirty years of chief technologist, manager, director, and executive director experience in over seven healthcare systems. He can be contacted at