Hospital and health system CEOs have described middle managers as integral to their organizations’ success. As this tier of leadership takes on growing responsibility, health system CEOs are focusing on how to best support, develop and retain these leaders.
Execution in “the middle space” — where strategy meets operations — is central to St. Cloud, Minn.-based CentraCare’s human resources philosophy, President and CEO Ken Holmen, MD, told Becker’s.
“It’s important for senior executives to understand that the truly meaningful work isn’t done by us,” Dr. Holmen said. “It’s done by our team members, the people who connect directly with our patients and customers every day.”
He added that often, individuals in front-line and middle management roles have not had access to the training, coaching or development opportunities that would help them thrive. CentraCare offers educational and team-building activities aimed at this development.
“Becoming a high-reliability organization is about everyone striving to do better,” he said. “From environmental services to nurse leaders, directors and managers, to our remote team members who are virtually engaged with us. We have many priorities, but one of our top jobs is to continually strengthen the capability of our team members — because safety and reliability start with them.”
Development at every level
Leadership development plays a key role in how CEOs support and retain leaders — particularly in transferring knowledge and enhancing communication, according to Colleen Chapp, MSN, RN, executive vice president of interim leadership at Kirby Bates Associates.
“CEO and executive leadership rounding, truly connecting through active listening and follow up, are important to establishing a more authentic relationship leading to meaningful middle management, and workforce engagement and retention,” Ms. Chapp told Becker’s. “The CEO connection is an opportunity for the CEO to understand what is important to the middle managers, offer encouragement, share words of wisdom and express appreciation.”
Middle managers are “integral leaders” at Helena, Mont.-based St. Peter’s Health, CEO Wade Johnson told Becker’s.
“One of our core values is to empower and invest in our people, and we put this into action by providing continuous leadership development for individuals in these roles,” Mr. Johnson said.
“One example of this is by hosting quarterly offsite leadership summits, bringing together about 80 leaders from across the organization to focus on strategic leadership, team building, and work culture.”
Initiatives include the aforementioned leadership summits, and monthly development meetings. Employees also participate in professional Enneagram assessment to sharpen their leadership skills.
“By prioritizing their growth, we’re not only enhancing leadership quality and effectiveness, but also cultivating a strong, sustainable leadership pipeline that supports both the long-term success of our organization and the health of our community,” Mr. Johnson said.
Snoqualmie (Wash.) Valley Health also emphasizes intentional investment in leadership, CEO Renée Jensen told Becker’s.
The organization created a director of organizational culture role to strengthen engagement and communication and launched its “Lead Boldly. Lead Well.” initiative focused on self-awareness, coaching, accountability and cross-department collaboration. Its BOLD framework centers on building trust, obsessing over excellence, leading innovation and deepening connection.
“When leaders feel supported and recognized, they show up stronger for their teams and see a future here worth investing in,” Ms. Jensen said.
There is a growing push within health systems to build “career architecture” to strengthen the internal bench, Greg Button, president of Global Healthcare Services at Korn Ferry based in the firm’s Philadelphia office, told Becker’s. The biggest shift is in creating more awareness and access for employees to manage their own careers through different programs or e-learning resources.
“A big trend we’re seeing is the focus on building internal talent, whether through reskilling or lateral moves,” he said. “But to do that, systems need baseline tools to assess qualifications, track development needs and analyze data. It sounds complex, but every system is working on some iteration of how to manage and develop their workforce differently than before.”
Financial pressures and the evolving manager role
As hospitals and health systems across the U.S. cut jobs, some are downsizing middle management ranks. At least 87 organizations have made workforce reductions in 2025, including some leadership roles.
Ms. Chapp said she is seeing more blended roles, such as combining director and manager responsibilities.
“Titles may not change; however, stretching with responsibility is really at every sphere of leadership,” she said, adding that CEOs are continuing to weigh how to support leadership development in a cost-effective way.
Investing in growth, she said, helps with engagement and retention.
“Providing and equipping the leaders with the skills and the knowledge to be able to do the best job that they can helps make them feel more engaged,” Ms. Chapp said. “And knowing there has been a significant investment to help support them also helps the retention rate, too. It also prepares leaders for potential career progression in the future, and it’s an investment in people, which is important, especially in healthcare.”
Mr. Button added that while healthcare organizations are examining management layers, mass cuts are unlikely.
“Systems don’t want to eliminate manager positions randomly — they want to use technology efficiently to reduce costs,” he said. “That might mean some positions are cut, but it could also create new roles in digital and tech areas. … I see it as a moderate, gradual transformation, not a sweeping elimination of management.”
