By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer
“The best management is a true science, resting upon
clearly defined laws, rules, and principles.”– Frederick Winslow Taylor, American mechanical engineer
In medicine, we tend to measure what we can see: labs, vitals, outcomes. When Google, one of the world’s most data-driven organizations, applied the same rigor to management, the results revealed worthwhile lessons. Project Oxygen may have originated in Silicon Valley, but its findings translate with striking clarity to the halls of a hospital or a busy primary care practice.
In the early 2000s, Google’s founders held a view common among tech-minded leaders: managers were, at best, a necessary inconvenience. The hypothesis was that talented engineers performed better when left alone and that hierarchy got in the way. In 2002, Google tested this by briefly eliminating all manager roles. The experiment failed quickly. Without management, communication broke down, priorities blurred, and staff were left without support or direction.
This failure planted a serious question: not just whether managers matter, but what specifically makes a manager effective. In 2008, Google’s People Innovation Lab launched Project Oxygen to find out, beginning with the goal of proving management quality had no impact on team performance. Instead, the data proved exactly the opposite.
The methodology behind Project Oxygen was rigorous and multi-modal. Researchers analyzed over 10,000 data points drawn from performance reviews, employee engagement surveys, and nominations for Google’s internal Great Manager Award. They also conducted hundreds of hours of structured interviews with employees across the organization. Statisticians were brought in to evaluate the differences between the highest and lowest-rated managers, looking for patterns, not anecdotes.
The findings were unambiguous: teams with highly effective managers consistently outperformed those with poor managers. They had lower turnover, higher satisfaction scores, and stronger overall results. The research identified eight core behaviors initially, which were refined and expanded (following an updated employee survey in 2018) to the ten behaviors recognized today. Crucially, the updated list of ten was even more predictive of team outcomes than the original eight.
For clinician leaders in primary care and hospital settings, there is an important parallel here. Just as evidence-based medicine replaced intuition with data, Project Oxygen replaced assumptions about leadership with proof. The behaviors that emerged aren’t soft, unmeasurable ideals; they are specific, observable, and trainable.
Google has a proprietary process for assessing their managers for weaknesses and specific trainings for addressing these. See this 2013 Harvard Business Review case study for details. As a non-proprietary shortcut, we can do an honest self-assessment of each, or ask a trusted colleague reporting to you to rate you on each of these.
Every one of us has something from this list that we can work on; start with just a few.
Here are the 10 behaviors, with a brief description of each:
1. Is a Good Coach — Ask before you answer.
Great coaches resist the urge to solve problems immediately. Instead, they use challenges as teachable moments: asking questions, drawing out the team’s own thinking, and building long-term problem-solving capacity. In clinical settings, this looks like a charge nurse who asks, “What do you think we should do?” rather than issuing orders at every turn.
2. Empowers Team — Does Not Micromanage — Delegate authority, not just tasks.
Effective managers grant autonomy that matches the skill level of their team. They distinguish between someone who needs direction and someone who simply needs support. For a primary care group, this means trusting clinicians to manage their patient panels without constant oversight, while remaining available when needed.
3. Creates an Inclusive Team Environment — Safety before solutions.
Google’s research confirmed that psychological safety, the belief that one can speak up without fear of embarrassment or retaliation, is essential to team effectiveness. In healthcare, where hierarchy runs deep, this behavior directly impacts error reporting, care quality, and staff retention. Inclusive leaders actively invite quieter voices into the conversation.
Interestingly, in follow-up research, Google’s Project Aristotle identified psychological safety as the most important trait of high functioning teams.
4. Is Productive and Results-Oriented — Focus on outcomes, not activity.
High-performing managers prioritize ruthlessly and keep their teams oriented toward meaningful outcomes. In clinical leadership, this means distinguishing between metrics that matter (patient experience scores, readmission rates, staff turnover) and the noise of administrative busywork. They model urgency without generating chaos.
5. Is a Good Communicator — Listens and Shares Information — Information is oxygen for your team.
Great managers are conduits, not gatekeepers. They share context, explain the ‘why’ behind decisions, and actively listen in return. For clinician leaders navigating organizational change (e.g. new EHR systems, staffing shifts, policy updates) keeping communication flowing prevents the rumor-driven anxiety that derails teams.
6. Supports Career Development and Discusses Performance — Grow your people or watch them leave.
Effective managers invest in the futures of their direct reports, not just their current performance. They hold regular one-on-ones, set clear expectations, and address problems early and honestly. In healthcare, where burnout and workforce shortages are systemic issues, career investment is also a retention strategy.
7. Has a Clear Vision and Strategy for the Team — If you don’t name the destination, no one can get there.
Teams perform better when they understand where they’re headed and why their work matters. Clinician leaders who articulate a compelling vision, even for a small primary care panel, give their team a shared purpose that transcends the daily grind of a busy schedule. Usually this vision is linked to the organizational mission and vision.
8. Has Key Technical Skills — Clinical credibility still matters.
Google’s data showed that managers don’t need to be the most technically skilled person on the team, but they do need enough fluency to be taken seriously and to provide meaningful guidance. For clinician leaders, this means staying current enough in your clinical domain to support your team, even if your primary role has shifted toward administration.
9. Collaborates Across the Organization — Leadership stops at your team’s edge, unless you build bridges.
This behavior reflects the growing complexity of organizational work. Cross-functional collaboration (between primary care and specialty teams, between clinical and administrative leaders, between departments) is now a core leadership competency, not an optional soft skill.
10. Is a Strong Decision-Maker — Decide with confidence, revisit with humility.
This behavior recognizes that indecision is itself a decision, and often a costly one. Strong managers gather relevant input, make timely calls, communicate the rationale, and remain open to adjusting course with new information. In fast-paced clinical environments, decisiveness paired with transparency builds deep team trust.
Final thoughts
Project Oxygen’s deepest finding — the qualities defining great management are primarily relational, not technical — should resonate with anyone trained in patient-centered care. The skills making a physician or nurse practitioner effective with patients (listening, coaching, clear communication, trust[1]building) are the same skills making them effective leaders of teams.
The 10 behaviors are not a checklist, they are a continuous practice, best approached the way we approach clinical quality improvement: with honest assessment, iterative refinement, and the willingness to be accountable to evidence. Managerial excellence, like clinical excellence, is always a work in progress.
For the past decade, I have posted a list of the core behaviors near my desk, where I can ponder them from time to time. (If you look closely, you will see Google combined some behaviors together to keep the list to a manageable number of 10.)
In case you also want to print these out and post them, here is the adapted version I use:
Ten Behaviors of High Functioning Managers
- Be a Good Coach
- Empower the Team; Do Not Micromanage
- Create an Inclusive Team Environment
- Be Productive and Results-Oriented
- Be a Good Communicator: Listen and Share Information
- Support Career Development and Discuss Performance
- Have a Clear Vision and Strategy for the Team
- Maintain Key Technical Skills
- Collaborate Across the Organization
- Be a Strong Decision-Maker