- June 24, 2026
The performance conversation most practice managers are avoiding
NEAS
Most practice managers were never taught how to lead. They were promoted because they were good at the job before this one. Sound familiar?
There is a particular kind of manager who is excellent at almost everything their role requires — the rostering, the compliance, the patient flow, the operational problem-solving — and who quietly dreads one thing above all others: sitting down with a staff member and telling them something isn’t working.
In healthcare practice management, this person is everywhere. And it makes complete sense.
Most practice managers arrived in their role through competence, not through a management pathway. They were the best administrator, the most capable nurse, the most reliable coordinator. At some point, the job grew to include people — and with people came a whole set of challenges that no one had prepared them for. Not because the organisation didn’t care, but because in healthcare settings, formal leadership development is rarely built into the journey.
So the performance conversation gets deferred. Another week, another month. The staff member continues. The team notices. The practice manager carries it.
Why the conversation doesn’t happen
It is rarely avoidance in the way people assume. Most practice managers are not conflict-averse by nature — they deal with difficult situations every day. What makes performance conversations different is the absence of a clear framework for having them.
Without that framework, a few things tend to happen. The manager waits until the situation is serious enough to justify the discomfort, which means minor issues compound into major ones. Or they have the conversation, but it is vague enough that nothing changes — the staff member walks away uncertain about what was actually expected of them. Or the conversation happens once and isn’t followed through, which teaches the team that expectations aren’t really enforced.
None of this is a character failing. It is what happens when capable people are asked to manage other people without being given the tools to do it well.
What the conversation actually requires
A good performance conversation is not a confrontation. It is a clear, specific, and respectful exchange about what is expected, what is happening, and what needs to change. It requires the manager to be precise about the behaviour or outcome in question — not “your attitude has been difficult lately” but “in the last three team meetings you’ve spoken over two colleagues, and I want to talk about that.” It requires the ability to listen to the staff member’s perspective without abandoning the point. And it requires follow-through: a clear agreement about what changes, and a plan to check in on it.
These are learnable skills. They are not personality traits that some managers have and others don’t.
The environment makes it harder
Healthcare practice management adds a layer of complexity that is worth naming. In most practices, managers are leading teams that include people who are more clinically qualified than they are. The power dynamics are unusual. A practice manager might be responsible for the performance of a senior nurse or specialist coordinator who has twenty years of clinical experience and views administrative oversight with some scepticism.
This requires a particular kind of confidence — not clinical authority, but the legitimate authority that comes from being clear about your role, your responsibilities, and the standards the practice is held to. That confidence, again, is something that can be developed. But it tends not to develop on its own, under pressure, between patients.
What changes when managers get the framework
The practices that invest in leadership development for their management team tend to see the same things: clearer expectations across the team, fewer long-running performance issues, and a marked reduction in the quiet resentment that builds when underperformance goes unaddressed. The performance conversation, it turns out, is not just about the individual involved. It is about what the whole team considers acceptable.
The practice managers who have worked through this systematically — who have a clear approach to setting expectations, giving feedback, and having difficult conversations — also report something less obvious: it gets easier. Not because the conversations become comfortable, but because they become familiar. The framework becomes instinct.
That is what structured leadership development offers. Not a personality transplant. Not a management degree. Just a clear, practical set of tools for the part of the job that most practice managers were handed without instructions.
NEAS Education & Advisory Services works with supervisors, managers, and team leaders across professional and technical environments. Our Leading Teams & Managing Performance program runs virtually for 2.5 hours each week for eight weeks and is designed for managers who cannot step away from their workplace to attend training. The next cohort commences 10 August 2026.