Can hospitals save middle management? How 1 president strives to

Between the demands of the C-suite and the realities of the front lines, middle managers are relentlessly squeezed. 

The challenges of leadership are "probably the highest they've ever been," M. Shafeeq Ahmed, MD, president of Columbia, Md.-based Johns Hopkins Howard County Medical Center and an assistant professor at Baltimore-based Johns Hopkins School of Medicine, told Becker's

"I think people look at [middle management] as such a challenging job that they may question why they, themselves, would want to become leaders. Why wouldn't they just stay where they are? Why would they take on the additional stress?" Dr. Ahmed said. "That's a problem, because you're not exactly going to attract the best to that role. Something that I'm beginning to sense is that not everybody who really would be great at this wants to step up and do it. I don't know if it seems as attractive as it may have in the past." 

Recent data supports his observations; a fall Gallup poll found that only 31% of managers are engaged at work, and 55% are actively seeking a new position. Their lack of satisfaction might stem from heightening demands placed upon them, compounded by the lack of autonomy to make lasting change, according to Dr. Ahmed. 

"The focus on finance is very important for these organizations, so [middle managers] don't necessarily have the ability to spend unlimited amounts of money," Dr. Ahmed said. "Recruiting is very difficult and trying to get out of agency-type staffing is very important. So how do you entice people to not be agency, to want to stay with you? How do you manage to recruit for people who are coming to stay and work with you? That is very much incumbent on a front-line leader, because of the relationship that they establish with these folks. So there's that level of pressure." 

Generational shifts also place middle managers in uncharted territory, he said. 

"Then there's the pressure of people coming into the workforce for clinical areas that don't have as much practical experience," Dr. Ahmed said. "They may be newer graduates. So how do you continue to support them and make sure that they are learning while actually working?" 

The cherry on top: many managers are new to leadership and might struggle to make progress towards patient safety goals and quality efforts. People are frequently promoted with content expertise in certain areas, but not leadership specifically, according to Dr. Ahmed. That's why Johns Hopkins Howard County is leaning into leadership development for entry-level leaders — giving them the support they need to effectively support others. 

An internal leadership development program at the hospital leads discussions about basic leadership challenges and teaches new managers how to navigate crucial conversations. It has become increasingly challenging to recruit for middle management positions, but by ensuring leaders have an outlet for frustrations and a place to hone their skills, Johns Hopkins can "build a link to the future," Dr. Ahmed said. There are still people who will step up to the plate. 

"It's not just about work ethic, it's about your moral compass and what is driving you to do what you do," Dr. Ahmed said. "That ultimately tells what you're willing to do and how much you're willing to grow as a leader and undertake those responsibilities." 

"It's the inner drive to want to make things better," he continued. "And if I were to try to identify people [who are suited for middle management], I would seek out people who have more of an interest in that and less of a transactional view. I'd really love to see folks that are trying to make a difference."

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