The Ambiguous and Underappreciated Role of Middle Managers in Healthcare Organizations

Abstract

Balancing strategic awareness with operating experience has become the new mantra for successful high-impact middle managers. Recently, however, the value of middle managers has come under attack. Middle managers are viewed as an expendable commodity that adds complexity and hinders executives’ ability to understand what’s “really going on” at the front line. Evidence suggests that executives increasingly prefer to get closer to their operating core. As a result, some middle managers “slide out” or more extremely become “hypereffective” with considerable loss of discretionary time and feelings of powerlessness. How do healthcare organizations improve if middle managers, responsible for knowledge transfer and innovation implementation, are removed from the decision making process or circumvented? Have middle managers been de-skilled as top executives rationalize resources and capabilities? Are they well regarded and targeted for upward mobility in a succession planning process? In this paper we: (1) Discuss the dynamics associated with traditional and transitional roles of middle managers in healthcare systems; (2) Provide a diagnostic framework to help differentiate and group roles assumed by middle managers in healthcare organizations; (3) Identify where and how middle management in healthcare organizations creates the greatest value; and, (4) Explore ways and offer strategies to avert the potential for leadership failure in healthcare organizations. Implications for management and directions or future research are also provided.