Middle management's shaky future

Middle managers are increasingly on the chopping block, Bloomberg reported March 15. 

In 2023, 31.5% of layoffs affected middle managers — nearly a 12 percentage-point increase from 2018, according to an analysis for Bloomberg News from Live Data Technologies. 

The trend has been reflected in healthcare. At least two health systems have eliminated management and supervisor roles since January, including Chicago-based Rush University System for Health and Oakdale, Calif.-based Oak Valley Hospital District. In 2023, several hospitals and health systems slimmed down their management teams, many citing financial headwinds. 

Another reason companies are slashing middle management jobs is to improve "efficiency," according to Bloomberg. In healthcare, that sometimes translates to "integration," as large systems aim to narrow the gap between their individual entities and the capital-B "Brand." At some organizations, like Atlanta-based Emory Healthcare, the desire to improve integration has led to the elimination of CEOs at hospital campuses. The fewer layers between the C-suite and those with boots on the ground, the easier it is to communicate a shared mission, Joon Lee, MD, Emory's CEO, told Becker's in January. 

But health systems shouldn't be quick to write off middle management's value. Last year, an analysis from McKinsey & Co. found that "organizations with top-performing managers yield multiple times the total shareholder returns of those with average or below-average managers over a period of five years."

Middle managers can also serve as valuable mentors for new recruits, especially in overwhelming roles like nursing. A strong, hierarchical mentoring relationship can improve first-year retention in tough-to-fill positions. 

When 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 — spoke to Becker's in January, he said middle management roles are valuable, but have been increasingly tough to fill. 

"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." 

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