July 23, 2024 Leadership Ladders: A Framework for Frontline Managers & Their Teams

The “Leadership Ladder” concept 
Leadership Ladders are a development tool that organizes and extends the leadership capability of any frontline manager’s team. Building on each individual employee’s goals and strengths, coupled with defined department standard work, Leadership Ladders can play a central role in transforming culture, improving staff morale, building local leadership teams, creating platforms for delegating and sharing leadership work, and advancing the professional growth of team members.  

A prior article discussed the development of Leadership Ladders at the organization-level. This article builds on those concepts but discusses how individual managers can build them for their own teams. 

Leadership Ladders can serve as a significant staff empowerment tool focused on team engagement, ultimately having a meaningful impact on quality and performance. They provide a path to increasing what managers can effectively delegate to their team members, which both builds mutual trust and reduces the work burden on managers.
The development of such a leadership track or ladder is an informal process intended to meet the unique needs of a department, clinical or otherwise. The approach offers tremendous flexibility to determine what processes require leadership support and what types are needed within any given department. In addition, team members can complete multiple Ladders over the course of a career, perpetually giving them something new to learn and achieve.

Managers can develop informal leadership ladder structures in the absence of, or in parallel with, any existing organization-wide development program. They should in no way compete or conflict with any preexisting leadership program, but rather should serve in a complimentary process.

One manager’s story
Matt Quin, who has led health systems as both a CNO, COO, and President, shared how the Leadership Ladders concept helped him and his team on a transformation journey early in his career. “I joined a highly specialized patient care department as a first-time manager with 125 team members. I quickly saw where we were starting from: a place where outcomes were achieved mainly by heroic individual efforts, where gossip and acting out was the standard method for being heard, and where major attendance issues had been left unaddressed.

But I knew where I wanted to go: a care setting where good communication could thrive, teamwork was the normal state, good people and sound processes were in place, and where people were empowered to create change and do their best work. It took a couple of years to get there, but we did. Building a sense of collective leadership empowerment was a central theme and ‘Leadership Ladders’ was a foundational component.”

Step 1: Identify and define the department’s “Leadership Ladders”

• Define the core areas of the department’s responsibility
  • Find areas that align with the department’s deliverables and Key Performance Indicators (KPIs), e.g., quality and productivity goals.
  • Of these areas, prioritize the ones that meet two criteria:
    • • One, they are areas under the complete supervision of the department manager; in other words, the manager can adjust them as needed without coordinating with external stakeholders
      • Two, they are areas that have shared accountability with staff and leaders in the department. 
      • Core responsibilities that meet the two criteria might include resourcing shifts, managing productivity, managing equipment and supplies, and improving clinical practice.
• Define specific responsibilities for the prioritized areas
  • • For each prioritized area, define specific role responsibilities, accountabilities, workflow processes, and the information/metrics used to support the work and measure progress. 
• Identify training and other resources necessary to support skill development
  • • See the examples in the three Ladders below. Invest particular focus on identifying the right development steps for those in their first year on the Ladder; future years on the Ladder can be co-defined later and will be natural extensions of those steps, including training new team members.
• Communicate the Leadership Ladders and what’s included
  • • Using an approach similar to the three Ladder examples below, share the available Ladders with the entire team and explain what training and opportunities are included in each. This will help encourage team members to sign up and to maintain clarity on the overall project.
    • Create a “Ladder Fair” to share more information with the team.

Three common areas of prioritization in a clinical department described below are: leadership of clinical operations (e.g., formal management track), professional practice/education, and interdepartmental representation. Other possibilities include Ladders for quality and safety, patient experience, accreditation/ compliance, and finance. 

Each of the prioritized areas of responsibility then become Ladders as shown in the examples below. Two examples reflect the type of activities associated in some representative Ladders. 

Leadership Ladder Example 1: Management (focusing on clinical operations)

This Ladder includes staffing, assignment making, break transport facilitation, and patient flow. 

• Attend a “Charge Workshop”
  • • Charge nurses and potential future charge nurses attend a workshop. This is the baseline exposure to all the principles and procedures of the role.   
• Shadow a charge nurse
  • • Participants shadow existing charge nurses for a period and then perform the primary charge responsibilities with 
• Attend the charge nurse Council
  • • These are monthly 4-hour charge nurse committee meetings
• Attend patient throughput huddles
  • • These are daily 15-minute patient throughput huddles with Operating Room, Intensive Care Unit, and step-down unit charge nurses to move patients along the care continuum efficiently. This is a highly structured and formatted huddle with specific patient and capacity data sharing and transfer planning. 
• Participate in RN Leader Rounds with the unit manager/charge nurse
  • • Charge nurses and potential future charge nurses round with their leader and observe operational issues that require leadership probing and attention and how the manager handles them.  Experiencing situated leadership practice is an effective practical role modeling/learning tool that allows future leaders to see how they may effectively handle similar situations that arise while in charge.  

Leadership Ladder Example 2: Education

This Ladder includes processes related to evidence-based practice, staff competency, quality, and safety.

• Attend RN Practice Councils
  
  • • Serve as a member of a practice council. 
    • Each member is responsible for identifying best practices from the meetings and sharing it back across all team members in their respective shifts.
• Review and share best practices
  • • Conduct literature reviews to identify best practices that can be distilled down to simpler bedside training sessions.
• Track quality and safety data
  • • Review quality and safety metrics regularly.
    • Help develop/improve care improvement plans. 
    • These are designed for all staff to address any opportunities identified in the metrics.
• Track competencies
  • • Identify ways to build/improve processes for competency tracking.
    • Support the rollout of plans for educational/practice implementations to share what is coming and what is expected with all staff. 

Step 2: Identify, initiate, and advance existing/future leaders into the Leadership Ladders and empower them to lead

• Identify and engage team members for the Ladders
  • • Engage team members early and often about their leadership interests and their potential. Ask them what they’re interested in and guide them towards a Ladder that would be a best fit.
    • Identify team members that demonstrate skill or interest in a specific Ladder. 
    • Measure processes with which staff were identified for the Ladders and how they were encouraged and supported to participate.
      • • As part of new team member onboarding, assess a new hire’s interests and begin aligning them into the appropriate Ladder. Understand and sort into “ready now” and “future potential.” 
        • Engage team members who may not see themselves as leaders beyond the core frontline role and paint the possibility of leadership for them.   
• Initiate and support team members as they take their first step on a Ladder
  • • Create shadowing opportunities with leaders aligned with their interests,such as management, education, quality and safety, etc. to provide the team with a broad picture of the work. 
    • Involve team members in the department-based work by matching candidates with an existing Ladder leader to gain exposure to the leadership work. 
    • Delegate small tasks associated with the role so they can contribute to the work. This enhances staff engagement and builds confidence in future leaders.
• Act to support and train team members as they climb to higher rungs    
  Leverage understood methods of learning that support lasting behavior and culture change, such as William Halstad’s “see one, do one, teach one” method, widely understood in healthcare settings.
  • • First rungs/“See”: Engage team members in discussion about leadership potential and provide exposure to the leadership Ladder/committee work of interest
    • Middle rungs/“Do”: Begin more formal orientation; add progressive responsibility through training. Start to take on delegated tasks, especially simple repetitive ones, from a peer or the department manager. 
    • Middle rungs/“Do”: Assume accountability for complete projects, processes, and outcomes metrics.
    • Higher rungs/“Teach”: Train new candidates entering the leadership track. Support updating the Ladders based on their own experience to improve the path for the next round of leaders.

Matt adds that based on his experiences, “Some people we approached, especially newer staff, didn’t necessarily view themselves as leaders in the department. The interactions I had with them about the Ladders began to shift their thinking. The end result was having staff actively engaged in the leadership work and playing a role in the department’s improvement projects.”


Step 3: Create a strong communication process  

Throughout this process, it is critical to ensure bi-directional communication about the Leadership Ladders including the roles and responsibilities, work plan, and progress updates. Communication from the manager is essential but it is also helpful to have peer-to-peer interactions so team members can hear directly from colleagues as they are shaping the department’s work. 

A number of communication tools can be used, including updates in leadership committees and monthly/quarterly newsletters. Opportunities for Ladder or committee members to present updates to staff in huddles or staff meetings should be encouraged, allowing for further leadership growth and development. 

Finally, it is valuable to create mechanisms for feedback throughout the Leadership Ladder design and implementation process. Consider including a request for feedback about Ladder work and committee updates as a standing monthly staff meeting agenda item. Feedback should be welcomed and received, clarifications should be provided as questions arise, and any mistakes should be acknowledged.

Leadership Ladders are a powerful development tool that individual managers can deploy to support their teams, even in the absence of centralized support for them at an organization level. By creating such ladders, managers can help cultivate the next generation of leaders at their organization while providing valuable opportunities for those team members to learn, grow, and start paving a path to future formal leadership roles. 

Hear directly from co-authors, Matthew Quin and Tim Darling: