Corinne Z. Wohl, MHSA, COE; John B. Pinto , 2025-05-02 18:00:00
“When two men ride a horse, one must ride behind.”
– William Shakespeare
“Too many cooks spoil the broth.”
– English proverb
Leadership structure is the backbone of your practice and drives effective functioning of the company. In your practice, it guides decision-making, sets the vision and ensures operational efficiency.
While the idea of co-leadership — having two individuals share a senior leadership responsibility — might seem appealing because it potentially avoids the hurt feelings of voting someone “out,” it often proves problematic. Whether at the managing partner or senior administrator level or in smaller team settings like departments, having co-leaders often leads to inefficiencies, conflicts and diluted accountability.
As a performance baseline, you expect your lay managers will have leadership skills that include decisiveness, clear communication and accountability. These qualities become diluted when two people are at the helm. The traditional unitary leader structure has persisted over the years because of its effectiveness and tendency to reduce conflict.
When one person is in charge, decision-making is more streamlined. There is no ambiguity about who makes the final decision. This management structure has the potential for faster responses and more decisive action.
This is not always the case, though. Ultimate success depends on the management skills of the individual leader. If you have a manager who does not have these skills, the answer is not to add a second leader. Either coach the manager to develop their skills or consider replacement.
Here are some potential pitfalls and other considerations of co-leadership:
1. A single leader can do a better job driving a consistent and cohesive vision, whereas two leaders may have conflicting perspectives. A co-leadership structure can result in sending mixed messages within the organization. Clever staff are famous for pitting two co-leaders against each other and seeking permission from the “easy” half of the comanagement dyad.
2. A significant benefit of the unitary vs. co-leader model occurs when things go wrong. A single leader — and everyone else in the practice — knows who is responsible. In co-leadership structures, accountability can be blurred, leading to a lack of ownership and clear responsibility over failures or missteps. The fallout from these errors can not only erode the working relationship between the co-leaders but also affect the respect of the leadership by staff when they see the co-leaders working out of sync. It is also easier for blame-shifting to occur and more difficult to determine where the corrective action and learning should be applied. For all these reasons, communication and workplace dynamics suffer.
3. In client practices where the board has chosen a co-leadership model for any of the administrator, managing partner or department head roles, it is decision-making paralysis that stands out the most. When two individuals share leadership responsibilities, any disagreement between them can lead to delays in key decisions. Even if both leaders share similar goals and take pains to communicate well, experience shows there can be delays and a lack of boldness because the co-leaders are perpetually walking on eggshells.
4. Differences of opinion between co-administrators lead to their managers and line employees being forced to navigate between competing directives. The result is confusion, inefficiency and a generalized feeling of “unsettledness” in the practice. It is not surprising to see a higher than normal staff turnover when key leadership positions are shared.
5. Authority can sometimes be ambiguous even in the best-run practices. Who has the final say? If two people are responsible for something, then no one is truly responsible. Even if responsibilities are divided and agreed upon in writing, there can be areas of overlap where disagreements or confusion arise. This creates power struggles, whether overt or below the surface, as each leader tries to assert their influence.
6. A common adverse situation is the practice with multiple owners but no singular managing partner. Even a practice with just two owners functions better with one owner designated as the managing partner. Being the managing partner does not mean that the partner has the authority to make all the decisions. The full board of owners gives the managing partner the goals and authority to make limited day-to-day decisions, often within formal financial boundaries. The unitary managing partner’s main responsibility is to lead the management team to execute the goals of the board, be the direct supervisor of the practice administrator and provide organized access to mid-level managers through management committee meetings.
7. When two leaders hold equal authority, they often send conflicting messages to employees. Employees perform best when they have a clear understanding of hierarchy and everyone’s responsibility. Even slight differences in interpretation or emphasis can cause confusion, leading to inefficiencies and frustration. The clarity of directions and assignments can have a significant impact on employee morale and operations efficiency. For example, if one co-manager prioritizes customer satisfaction while the other focuses on cutting costs, employees may struggle to determine which directive has priority. Over time, this lack of alignment can erode morale and productivity.
While the idea of co-leadership may feel like a way to distribute workloads and leverage diverse perspectives, the practical reality is that it often introduces more problems than it solves. Organizations function best when they have a clear leader who can make decisive choices, drive a unified vision and ensure accountability.
There have been some high-profile co-leadership attempts over the years in big industry that have been successful. Those are rare cases. The innovative eyewear company Warby Parker has been well led by co-CEOs Neil Blumenthal and Dave Gilboa since 2010. Their rare, exceptional success at sharing leadership proves the rule that co-leadership often fails.
For more information:
John B. Pinto is president of J. Pinto & Associates, Inc., an ophthalmic practice management consulting firm established in 1979. He is the country’s most published author on ophthalmology management topics, including John Pinto’s Little Green Book of Ophthalmology, Simple: The Inner Game of Ophthalmic Practice Success and Ophthalmic Leadership. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: https://www.pintoinc.com/.
Corinne Z. Wohl, MHSA, COE, is president of C. Wohl & Associates, Inc., a practice management consulting firm. With 35 years’ experience, her firm specializes in leadership, operations enhancement, financial benchmarking, executive and provider coaching, and management team development. Her book, co-authored with Pinto, is UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance and Career Satisfaction. She can be reached at 609-410-2932; email: czwohl@gmail.com.
Sources/Disclosures
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Expert Submission
Disclosures:
Pinto reports being president of J. Pinto & Associates, Inc. Wohl reports being president of C. Wohl & Associates, Inc.
