Are You the Roadblock?
A team member stops you in the hallway to explain a problem. Pressed for time, you promise to think about it and get back to them later. With that, the monkey leaps from their back to yours. From then on, they become your supervisor, following up regularly with, “How’s it coming?”
Sound familiar? Congratulations, you’ve just adopted another monkey.
In The One Minute Manager Meets the Monkey, Ken Blanchard and William Oncken describe how managers can become a bottleneck to improvement. In the book, a “monkey” is defined as the next move that needs to be taken for any task or problem.
The core insight is brilliantly simple: in many workplace interactions, busy managers unwittingly collect other people’s monkeys, carrying an ever-growing zoo of responsibilities on their shoulders until they’re completely overwhelmed.
In general practice, team members are often waiting for decisions by practice managers or senior GPs before progressing an issue.
As practice managers and senior GPs, we often find ourselves working later than everyone else, responding to emails on weekends, and wondering how our to-do lists keep expanding despite our best efforts.
This article explores how to recognize when you’re the roadblock and how to delegate effectively without losing control.
How Monkeys Overrun General Practice
You might have a monkey management problem if:
- You’re consistently the last person to leave the practice
- Team members seem unable to solve problems without your input
- Your clinical documentation is perpetually behind
- You handle most administrative escalations personally
- You are the only person approving every purchase, leave request, or patient policy change.
- You are the default IT troubleshooter instead of setting up a system for staff to handle minor tech issues.
- Your inbox never seems to get below 50 messages
- Team members wait outside your door for “quick questions”
- You feel more like a firefighter than a physician or manager
The Four Rules of Monkey Management for General Practice
Rule 1: Describe the Monkey
When someone brings you a problem, resist the urge to take immediate ownership.
Instead, clarify what is the Next Move?
“The dialogue must not end until appropriate “next moves” have been identified and specified.”
When someone presents a problem, don’t solve it—clarify the next move.
Example: A receptionist says DNAs are a problem. Instead of owning it, define the first step: “Let’s tally missed appointments and see if they’re causing gaps in the schedule. Track this and get back to me please”
This forces staff to think critically before escalating problems.
Rule 2: Assign the Monkey
The fundamental rule: the monkey should leave the encounter on the back of the most appropriate person—rarely the practice manager or senior GP.
“All monkeys shall be owned and handled at the lowest organisational level consistent with the monkey’s welfare.”
So, in our example, the ‘next move’ of tallying the extent to which the DNA is a problem should belong to the reception team, via the receptionist who raised the issue.
Sarah, a practice manager, found herself working late every night because staff kept coming to her with problems. She handled rostering, IT issues, patient complaints—everything. After learning about The One Minute Manager, she made a shift:
- She stopped solving issues immediately and instead asked, “What do you think should be done?”
- She empowered team leads to handle common problems.
- She scheduled weekly check-ins instead of daily firefighting.
The result? Sarah regained control of her workload, and her team stepped up. Staff engagement increased because they felt trusted to solve problems.
Rule 3: Ensure the monkey is cared for.
The conversation should not end until it is established what action is expected of the person who has ‘the next move’.
“Every monkey leaving your presence on the back of one of your people must be covered by one of two insurance policies:
- Recommend, Then Act
- The team member is to report back to you with their plan before acting (Level 1 authority)
- Act, then Advise
- The team member should develop a plan and then take action, subsequently informing you of the result (Level 2 authority)
For practice managers:
- Recommend, then act – “Track DNAs and suggest a solution before we act.”
- Act, then inform – “Handle patient complaints per protocol, then update me.”
For GPs:
- Recommend, then act – To the registrar “Draft a management plan before we finalise it together.”
- Act, then inform – To the practice nurse “Review the diabetic recall list, decide which patients need priority follow-up, and proceed with contacting them.”
This framework gives team members appropriate autonomy while maintaining necessary oversight.
Rule 4: Check on the Monkey
“Healthy monkeys need regular check-ups.” Set predictable check-ins:
- Daily 15-minute stand-ups.
- Weekly team leader meetings.
- Monthly performance reviews.
The key is creating predictable touch points that respect everyone’s time while ensuring nothing falls through the cracks.
Monkeys can be passed up but also passed down
Practice Managers often cannot avoid monkeys that are passed down from Practice Owners. But in the process, they should remember the 4 rules:
- Have clarity about the outcome that is desired, and what is the next move
- Be clear whether the next move is to be taken by the practice owner or the practice manager
- Understand what level of authority they have to take action on the issue – ‘Recommend then Act’, or ‘Act then Inform’
- Arrange the follow up time with the Practice Manager to check on progress.
Practical Applications for General Practice
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Institute a “solutions-focused” approach
Require team members to bring at least one potential solution with each problem.
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Create clear responsibility matrices
Establish guidelines for what decisions different team members can make independently. Define who handles which types of issues, from Medicare claims to equipment maintenance.
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Implement “office hours”
Set specific times when you’re available for monkey discussions, protecting the rest of your day for strategic work.
- Create standard operating procedures (SOPs)
- Create decision trees for common problems. Document routine processes so staff can handle them independently.
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Implement a “monkey log”
Track recurring issues to identify system problems rather than repeatedly solving the same problems.
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Set up peer problem-solving
Encourage team members to consult colleagues before bringing issues to you. Establish a “buddy system” where staff members pair up to help each other resolve issues before escalating. Recognize teams that effectively solve problems together.
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Train monkey management skills
Explicitly teach staff how to manage their own monkeys effectively.
The Rewards of Proper Monkey Management
When you successfully implement these principles, the benefits are profound:
- Team members develop greater problem-solving abilities
- You reclaim time for strategic thinking and personal wellbeing
- Patient care improves as staff operate at their highest capacity
- The entire practice becomes more resilient and adaptable
- The practice becomes less dependent on any single person
Remember, the goal isn’t to avoid responsibility but to ensure responsibilities reside with the most appropriate person. As practice leaders, our job isn’t to carry all the monkeys ourselves but to create systems where monkeys are properly cared for by a capable, empowered team.
Leadership isn’t about carrying all the monkeys—it’s about ensuring responsibilities sit with the right people. It’s about creating a team that functions well without you having to be involved in every detail. As Ken Blanchard and William Oncken explain in The One Minute Manager:
“The best minute I spend is the one I invest in people.”
Let’s spend our minutes wisely.
This article was inspired by “The One Minute Manager Meets the Monkey” by Ken Blanchard, William Oncken Jr., and Hal Burrows.