January 12, 2024 13% of clinical employees become managers; what about the other 87%?

Employees in clinical departments average only a 13% lifetime likelihood of being promoted to a manager role. Are health systems creating enough leadership opportunities for the other 87%?

Laudio Insights - Lifetime likelihood of a team member being promoted to manager by Inpatient Clinical department type

What the data says

For employees in clinical departments, the overall lifetime likelihood of being promoted to a manager is 13%. The likelihood varies by clinical department with ICUs being the lowest at 4% to Pediatrics the most likely at 26%. (Calculation explanation at end of article.) 

Many clinical team members may not be eligible for the manager role; for example, the total headcount used here includes nurse assistants and technicians. Many other team members are not interested in the manager role. Additional analysis shows that managers are typically promoted to an assistant manager role at a median age of 35; after that, the odds of promotion decline over time. Many employees move between clinical areas in the course of their career: the average likelihood of promotion is still 13%.

What it means

Leadership development needs are different for those who are promoted and those who are not. 

  • For the few who are promoted to a manager role during their careers, they are entering a path that is statistically far less traveled and thus joining a role that is far less documented than the one that they are coming from.
  • For the many that are not promoted to a manager role, they have a need to grow as leaders in non-management ways throughout their careers.

What the implications are for healthcare leaders 

  • Standard work processes are clear for frontline team members; those who are promoted often find the role especially challenging due to it being less-traveled and thus much less documented.
    • Documentation and socialization of Leader Standard Work is critical for the few who lead: it helps them transition effectively from the rigorously standardized role that they have, to this point, spent their careers in.
    • The role of the frontline manager requires many skills and behaviors that new managers are unlikely to be comfortable in; for example, knowing when to trust the team members’ judgments, when to request more information, and when to be more involved in the decision-making processes. It requires the courage to stand up to challenges with clarity of communication while also being able to admit to making mistakes. For a new leader of a large team with more experienced veterans, the more difficult the transition to manager will be.
    • Building formal assistant manager roles, especially into large spans of control teams, not only benefits the manager, but also benefits the team member who is next promoted into the role. As one CNO shared recently: 

“Nurse managers typically start as an assistant nurse manager role so, when they become a manager, they have a good sense of what leadership is. For managers who are promoted directly from a staff position, it is difficult to let go of the staff nurse duties and the friendships and relationships with former peers. It is very important to clarify the relationships they have with the team in their new role; for example, to re-evaluate how they engage on social media.”

  • Executives must build “everyone is a leader” into messaging, storytelling, and performance development programs from the start of employees’ careers.
    • Every clinician is a leader in their role and there are many possibilities for leadership paths:
      • A clinical expert
      • An educator (e.g., as a formal role in professional development)
      • A skills leader (e.g., who organizes new skills / training days)
      • An advanced practice clinician
      • A preceptor of new grads and students
      • A leader in patient experience
      • A leader in team member experience 
      • A charge nurse
      • A quality leader (e.g., coordinating with others in the review and application of new guidelines
      • An assistant manager / supervisor / manager
    • Managers of teams should emphasize employee growth not just by discussing the path to being a manager, but to all forms of leadership. Managers should underscore the sentiment that “everyone on the team is a leader.”
    • The question in quarterly check-ins and annual reviews then becomes less about trying to find the next individual career goal but to ask and make progress on the question: “What kind of leader do you want to be?” and use that to differentiate the individuals’ opportunities.
    • Managers should provide early opportunities for all team members to experience and participate in activities aligned with their own leadership interests, followed by intensive reviews on the chosen path and specific coaching, training, and planning around it.
    • In other words, starting from the beginning of their careers, all frontline employees should be encouraged to become a leader in capacities that best fit their skills and interests. By building this solid foundation early on, exposure to formal leadership roles can be facilitated, thus providing growth opportunities for the vast majority who don’t take a manager-track role as well as providing formal leaders with the greatest exposure across their teams.  
    • As one manager shared recently:

“One of the ways we grow frontline clinicians into excellent leaders is teaching them how to support their team and how to problem solve. Problem solving was one of (and still is) my favorite aspect of leadership; knocking down barriers for my team is so satisfying. Early on in my career as a team leader I learned that once you know how to solve a problem or you identify something that works well, and works well consistently, you need to empower and share that knowledge. Teams should not be paralyzed when their leaders are not present. They should have the tools and independence they need to solve problems and lead.”

Data definition

The calculation assumes a 40-year career. Each department type has an average span of control and an average manager tenure. The average span of control in clinical departments is 41 headcount and the average manager tenure is 7.4 years. Over a 40-year career, 5.4 opportunities to be elevated to the manager role are available, on average (=40/5.4); and of an average span of control of 41, there is an overall average likelihood of promotion of 13% (41/5.4), though all of the values vary by department type.

Written by

Tim Darling

President of Laudio Insights

Tim Darling is a co-founder and President, Laudio Insights.  With over 20 years of experience in healthcare technology, Tim has a real passion for using data and analytics to serve the challenges facing healthcare organizations. Prior to Laudio, Tim was on the leadership team of a healthcare education analytics company and he spent seven years as a consultant at McKinsey & Company.  He has an MBA from Carnegie Mellon and BS degrees in Mathematics and Computer Science from the University of Maryland, College Park.


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