It's a dirty job, but somebody's got to make surgeons who outrank and outearn them do their cases economically and efficiently. And somebody's got to be part den mother and part mother hen to nurses, techs and clerical staff. That somebody would be you, dear administrator.

Of the many bullets and verbs in a surgical administrator's job description, managing and motivating surgeons and staff have always struck me as particularly daunting responsibilities. It takes a pretty cool customer to influence those who are more powerful as well as those who answer to you - and not feel out of your element.

I've seen several good managers in action. They're firm but fair, calm in the eye of the storm and rule with an iron hand inside a velvet glove. They all manage by seven simple words: People do what's inspected, not what's expected. Which is another of way of saying that, if it doesn't get measured, it doesn't get done.

The truly good ones long ago stopped trying to make surgeons and staff serve at their pleasure once they figured out that people (MDs, RNs and part-time schedulers alike) are slaves to what they measure - and post on the bulletin board for all to see. Yes, a bar chart can be a very powerful motivator, especially when it plots surgeons' case costs, procedure times, on-time starts and infection rates ... or staff's caseload, turnover times, patient satisfaction rates and safety record.

Want something done? Measure it.

Want something repeated? Recognize it.

You can apply this beyond your ORs to every corner of your facility - from how claims are collected to how cases are coded to how supplies are ordered to how instruments are reprocessed. Set goals. Measure performance. Give rewards.

What do people do? What's inspected, not what's expected. I expect my 6-year-old son, Danny, to make his bed every morning, but it wasn't until I began inspecting the job that the bed got made.

Still not convinced? How else do you explain your obsession with benchmarking or with the items on the accreditor's checklist or with the targets on your incentive plan? The same forces that motivate you, motivate surgeons and staff.

You may have heard of the Hawthorne Effect (or the "somebody upstairs cares" syndrome). It's a term used in research to describe changes in the subjects' behavior caused by the researcher's presence or by the subjects' awareness of being studied. It has been described as the rewards you reap when you pay attention to people. The mere act of showing people that you're concerned about them usually spurs them to better job performance.

It means that when you change the way you look at things, the things you look at change.