The "medical home" model of care is emerging in Illinois and across the country. In its ideal form, a doctor oversees a team of nurses, physicians' assistants, and health coaches who ensure patients get needed care, support, and education. That frees the doctor to focus on compelling medical issues. Illinois' largest insurer is launching a pilot program featuring the medical home model, and last month Medicare announced a similar initiative. And health reform plans being debated by Congress contain changes designed to foster medical homes.

For a time, I believed the boss from hell was best personified by Miranda Priestly, the omnipotent, dictatorial fashion magazine editor played by Meryl Streep in the movie The Devil Wears Prada. A new study out of California, however, suggests that a better role model might be Michael Scott, the insecure and aggressively incompetent bully boss played by Steve Carell in the TV show The Office.

The study, When the Boss Feels Inadequate: Power, Incompetence and Aggression, is actually a composite of four separate studies conducted by the University of California, Berkeley, and the University of Southern California. It was published in the November issue of the journal Psychological Science.

Based on responses generated from role-playing games, the study found that insecure bosses are more likely to project their self-perceived incompetence onto subordinates through abusive behavior in the form of yelling, belittling or embarrassing remarks, unwarranted disciplinary action, and other undeserved punishment.

In one role-playing test, study participants who felt insecure went so far as to sabotage a subordinate's chances of winning money. In another test, insecure participants would request that a subordinate who gave a wrong answer to a test be notified by a loud obnoxious horn, even though they had the option of choosing silence or a quiet sound.

"Incompetence alone doesn't lead to aggression," says Serena Chen, associate professor of psychology at UC Berkeley and co-author of the study. "It's the combination of having a high-power role and fearing that one is not up to the task that causes power holders to lash out. And our data suggest it's ultimately about self-worth."

Participants who scored high in a leadership aptitude test or who recalled an incident or principle that made them feel good about themselves did not react with aggression, the study found.

I've always found that cheap and completely insincere flattery is a good way to placate an overbearing boss, however temporary the fix. My favorites include: "Looking good chief! Have you been working out?" "You are absolutely right!" and the ever popular "Great idea, boss!"

The study suggests, however, that such shameless toadying might backfire. "It is both interesting and ironic to note that such flattery, although perhaps affirming to the ego, may contribute to the incompetent power holder's ultimate demise — by causing the power holder to lose touch with reality," the study concludes.

So what can you do to screen out would-be bosses from hell in the hiring process, or to mitigate their soul-crushing behavior with underlings? Nathan J. Fast, an assistant professor at the Department of Management and Organization, University of Southern California, and a co-author of the study, has a few suggestions.

"You can't just look at what they look like on paper," Fast tells HealthLeaders Media. "You definitely need to make sure that in an interpersonal setting they can convey a sense of competence and that they seem to have a sense of self worth and confidence that will serve them well on the job."

"Secondly, companies can ease people into positions of leadership so they feel prepared and they aren't just thrown into it in one shot," Fast says.

"Third, make sure that managers know that it's normal to feel inadequate from time to time. It's part of the job and comes with the territory. If it is normalized in that way then perhaps they won't be so threatening to them when they feel inadequate," he says.

"Finally, assigning mentors would be a great idea and a lot of companies to this. They have new managers paired with senior managers so they can go to them for help and advice and they don't feel like they are alone in their new role," Fast says.

It is easy to inject humor in a topic like this, because everybody at some point in their lives (if they're lucky only one point!) has had a boss from hell. But the underlying issue is all too serious. Bad bosses invariably create a bunker mentality at the workplace that robs subordinates of any sense of initiative and enthusiasm. The workplace attitude becomes: Why strive to improve when your successes won't be acknowledged and your failures will be broadcast, and never forgotten? The motivation becomes: How do I get out of here?

Healthcare has enough problems finding adequate, competent staff for vitally important work. Their jobs shouldn't have to be made any more difficult with a bully boss.

Note: You can sign up to receive HealthLeaders Media HR, a free weekly e-newsletter that provides up-to-date information on effective HR strategies, recruitment and compensation, physician staffing, and ongoing organizational development.

Holly Benson, secretary of Florida's Agency for Health Care Administration, is resigning effective Oct. 28. An interim leader of the state's chief health policy and planning entity has not yet been named. The agency oversees the state's $16 billion Medicaid program, the licensure of the state's 36,000 healthcare facilities, and the sharing of healthcare data through the Florida Center for Health Information and Policy Analysis. In a resignation letter to Gov. Charlie Crist on Oct. 14, Benson said the new direction she is heading in requires her departure from the agency. She did not specifically indicate her future plans. Benson was appointed by Crist to lead the health policy agency in February 2008. Prior to that, she served as secretary of the Department of Business and Professional Regulation.