Midlevel Managers

In our January 2015 Industry Survey, 71% of respondents describe their leadership team as strong or very strong, while just 50% can say that about their midlevel managers. HealthLeaders Media Council members discuss the imbalance.

This article first appeared in the July/August 2015 issue of HealthLeaders magazine.

Tom Dandridge
President and CEO
The Regional Medical Center of Orangeburg and Calhoun Counties
Orangeburg, SC

This imbalance is rooted more in the change in expectations we have of midlevel managers than anything else. When I first started in this business 40 years ago, managers just counted noses and made sure we had enough people to work. But now we expect a lot more from them.

The challenge has been to further develop managers as the environment has changed, and I think that's really the reason some of us feel that our midlevel managers are not as strong as we would like to see them be. But it's really important to figure out for ourselves that it's possible we're not developing them as well as we should be.

It's human nature that we senior leaders can be blinded to our own perspective, but we've got to spend more time talking to our managers. To empower them, we need to ask them questions. Do they understand management concepts? Do they understand what effect they have on their units? Do they understand how they must behave differently than they did before to accommodate and establish change?

In the C-suite, not only do we have to develop our managers, but we must recognize that the midlevel is where the rubber hits the road. I could talk all I want to about cost efficiency, but unless a midlevel manager implements cost-efficient measures, they're not going to happen. It's the midlevel managers that bring plans to life.

Steve Long
President and CEO
Hancock Regional Hospital
Greenfield, IN

In our larger metro area, there's lots of opportunity, and in a small to midsize hospital like ours, the organization structure is pretty flat, without many layers of leadership. So, when really good potential midlevel managers are looking at available positions, they kind of realize that when they come to a place like this, the opportunities for advancement are fairly few and far between.

Attracting talent is different for different organizations. A very large organization in a metro area where there is lots of opportunity for advancement will likely have more candidates to choose from.

Now, all that said, midlevel managers are not usually, especially in smaller organizations, brought in from the outside. They are usually selected from frontline technicians who are already working there. We, as an industry, take the very best technician we've got and say, "Wow, they would be a great manager," and plop them into the management role—and rarely does anyone invest in leadership education or training. We just drop them in there and tell them, "Good luck with that." And when they fail, we're surprised, because they were so good at being a technician. We are blessed at Hancock Regional Hospital to have exceptional midlevel managers and have understood that continuing leadership development is vital to the future of our organization.

Bruce Elegant
President and CEO
Rush Oak Park (IL) Hospital

On the move from middle management to C-suite: Frequently, we will get a strong midlevel manager, and they will become so good at their role that when other opportunities in the organization present themselves, we're hesitant to promote them because we'll lose them for the role that they're already doing exceptionally.

We do have a preference—and make it a priority—to promote from within, but it's not always possible. Unless you have an obvious "next-in-line" employee who is particularly strong and ready to go, you reluctantly sometimes go outside the organization to fill the position.

On training midlevel managers for the C-suite: Over the past year, the Rush healthcare system started a leadership academy. We're identifying midlevel leaders with high potential and carving time out for them to enroll in some continuing education with regard to how to become a more effective leader.

The training really puts potential leaders in a position where they're networking and learning from others. We have some team members in the human resources area who are teaching them skills such as time management, how to evaluate employees in a more effective manner, and, if they require remediation in anything like financial analysis, then we focus on those skills. Some of the training is academic, but a lot of it is networking and getting feedback from your peers and current leaders.

Michael Wiechart
President and CEO
Capella Healthcare
Franklin, TN

I was quite surprised to hear these statistics, because I think that if we were to poll our organization, we would probably find that we have equal confidence in our midlevel managers as we do in our leadership team.

Our strategy for securing and maintaining top talent has been something that is very important to our company's culture over the years, and something that we have invested heavily in. In order to attract strong managers at every level, it's vital to provide a workplace where people are proud to serve. This means having a commitment to providing the highest quality of care first and foremost, and frankly, fair compensation second.

To keep strong managers at all levels, including midlevel management, it's important to have a culture in which people are held accountable. If poor performers are allowed to remain in the workforce, it is demotivating to everyone, and it's completely defeating to those managers who have the ability to be outstanding.

When we recruit or attempt to retain talent, candidates understand that they have to share our top priority. If the conversation starts there, whether you're talking about the leadership team or the midlevel managerial level, it only strengthens or edifies our relationship with our leaders and ensures that the right engagement is in place.