Middle managers provide core strength to your practice. They are deep in the middle of the day-to-day routines that make or break the day. Although they usually report to the administrator or doctor-owner, they serve as a base of support to everyone, up and down the ranks, all day long.
It is common for many middle managers to have been promoted because they were excellent or loyal employees. This approach makes sense, as they bring practical knowledge of the organization and can hit the ground running. But it can be a disservice to them if they are not well-prepared for the position. Sometimes, their gaps in knowledge are not obvious until after they are in the new role.
Many of newly promoted managers are hesitant to speak up when they’re struggling. They often feel they “should know” what to do—when in reality, they may be unsure how to handle entirely new responsibilities: supervising former peers, managing conflict, or analyzing departmental metrics.
It is never too late to help these managers grow in their role. Depending on the size and scope of the practice, the following 10 suggestions can be applied by the practice owner, an office manager, or an administrator.
10 Action Steps
1. Meet with each manager to create a management skills development plan.
Discover their strengths and weaknesses together. Find out what will motivate them to improve, and include that in the plan along with goals and deadlines.
This meeting sets the tone. It tells them their growth is a shared priority. Consider identifying 2 or 3 focus areas, such as staff development, time management, or financial awareness. Develop the plan together so that it also reflects their professional goals, not just organizational ones.
2. Meet monthly to review progress and obstacles.
If you prioritize this management skills plan, they will, too. Interest will wane for both of you if regular follow- up becomes too casual. To get the most out of the management plan, a formal and pre-planned follow-up is required.
Use these check-ins to ask what’s working, what’s been tough, and how they’re feeling about their progress. It’s a good opportunity to provide feedback and reinforce your commitment to their development. A brief written summary after each meeting can help keep both of you accountable.
3. Send them to conferences for continuing education.
It doesn’t have to be a national meeting (which is more expensive, and perhaps not exactly applicable.) There are often local education opportunities to learn your state’s human resources laws or how to handle difficult employees—subjects that newer managers typically find helpful.
Online seminars, leadership podcasts, or certificate programs (many are free or low-cost) can also be excellent tools for development. Some practices even designate an annual education fund to support staff training. Encourage your manager to share what they learned with the team afterward—it reinforces their leadership and extends the benefit to others.
4. Select a project and work alongside them.
Serve as both a guide and a support, depending on the manager’s expertise and areas where they need help.
This could involve launching a new patient recall initiative, revamping the front desk workflow, or introducing new practice management software. Use the project to model how to develop goals, create timelines, assign responsibilities, and measure success. This process can help managers feel more confident handling larger responsibilities independently in the future.
5. Have them collaborate with a doctor-advisor.
Set goals together. This can help close the gap between operations and clinical care. Managers often gain valuable insight when they hear a physician’s perspective. Likewise, the doctor may gain a deeper understanding of what the manager is navigating day-to-day.
6. Give them a modern business reference text or periodical and challenge them to identify an idea to apply at the practice.
You can choose books on leadership, teamwork, communication, or productivity. This approach makes their subsequent learning practical and encourages them to look for new ideas that help your practice in everyday life. Have them briefly present the concept they chose at a team meeting or in a follow-up meeting with you. Whenever possible, approve and implement their ideas.
7. Ask them to make a presentation to their fellow managers, to the board, or at an all-staff meeting.
Many managers are competent but hesitant when asked to speak to a group. Encouraging them to share updates about new developments or goals that have been accomplished in their department builds both confidence and presence. The more comfortable they become speaking in front of others, the more effective they’ll be in team meetings, conflict resolution, and setting a professional tone.
8. If they are reaching their management skills limit because of weak math skills, teach them benchmarks germane to their department and task them with graphing these monthly over time.
This builds analytical skills and accountability.
You might start with just 2 to 3 metrics—for example, tech work-up time, patient throughput, or staff overtime hours. Help them create simple visuals (line or bar graphs) and ask them to report on trends at monthly meetings. Over time, this strengthens their ability to speak the language of numbers with more confidence.
9. If they are poor at confrontation, assign them reading and engage them in role-playing conversations.
Fear of confrontation is a common and frustrating limitation. Have managers start by reading Crucial Accountability (formerly titled Crucial Conversations)by Patterson et al, then coach them step-by-step in how to deal with a specific difficult employee.
Role-playing conversations can be surprisingly effective. Help them script the discussion, anticipate the employee’s reaction, and choose calm but firm language. Offer to sit in or debrief afterward. Conflict avoidance is one of the biggest hurdles new managers face—but once they gain confidence in this area, their leadership expands significantly.
10. Encourage and motivate all mid-level managers.
The role of a middle manager can be especially tough within the organization. One minute they are the leader with their staff, the next they are the follower to doctors and administrators. It is a pressure-filled position, so it is important to recognize the need to encourage and support this role.
A thank-you note, a coffee chat, or public recognition of their efforts can go a long way. Remind them that their contributions are noticed and that what they do matters. Retention, morale, and productivity often hinge on how valued your middle managers feel.
The Practice Wins
Middle managers often operate behind the scenes, but their influence on staff morale, team performance, and patient experience is enormous. By helping them grow beyond their current ceiling, you’re not just developing individual leaders—you’re building long-term stability, trust, and excellence within your practice. OM
