What the data says
The black curve represents the historical average tenure distribution for clinical managers. It decays over time with the steepest turnover in the first couple of years after their promotion to manager. For those with a current tenure beyond ~4 years, turnover rates remain at historical levels.
The bar chart distribution is as of November 2023 and represents the current tenure distribution for managers in Med Surg, ICU, CCU, and ED departments. It shows that those who were promoted to the role 2.5 to 4 years ago have had lower retention rates than the historical average. In other words, managers who were new to their role as of late 2019 through early 2021 have not persisted as well as the historical average.
The gap between the actual distribution and the historical average distribution adds up to a loss of 6% of the total manager workforce under 5-year tenure. (Viewing the same chart from two years ago confirms that the number of new managers during that time was similar to the historical average.)
For a typical 500-bed hospital, this could add up to three to four managers, leaving a large part of a “generation” of managers who will be missing from leadership going forward.
In addition, there are more very junior managers now than is typical; they are the additional new managers filling in the gaps (the bars on the far left of the chart are higher than the historical distribution).
What it means
1 - Health systems are missing many mid-tenure managers and have more lower-tenure managers; this unfamiliar imbalance in the distribution of leader experience will persist for years.
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- There is a well-repeated adage that it takes managers two years to independently be able to lead their teams on all of the outcomes they are the first line of responsibility for, such as employee retention, employee engagement, patient experience, and quality and safety. Today, health systems have more managers who have not reached this threshold.
- Health systems are also missing a large segment of peers to the lower-tenured managers who are often best able to counsel them through the first few years based on their own recent experiences.
2 - Early-tenure managers today have had most of their leadership experience limited to a command-and- control and crisis environment and, thus, have not been able to develop the skills to lead independently.
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- As one Associate CNO of an academic medical center shared:
“We now have a whole group of managers who have only managed during the pandemic. They didn't learn how to lead independently. These managers are often paralyzed in making decisions because they had so many decisions handed to them during the pandemic. They are paralyzed because they lack experience in determining what they should escalate to senior leaders, what they should act with informing and coordination, and what they should just act on.”
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- The managers who were promoted during the pandemic were new to the role when it was at its most intractable. Specific challenges included:
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- Essential areas of training for new leaders, such as mentoring and financial management, were often bypassed;
- Staffing was at historically difficult levels with a lot of cross-department floating and reliance on travelers;
- Loyal staff were frustrated by the lofty salaries earned by those who converted to being travelers and felt that their loyalty was not being recognized;
- Command center and executive leadership was far more explicit than usual, thus removing a chance for new managers to develop aspects of their own leadership;
- Policy changes came in rapid succession, such as safe infection control and visitor management practices, and supply chains were operating at critical levels.
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- All managers experienced these challenges, but for new managers, they were often overwhelming. As one manager who was new during this time explained about the staffing challenges,
“I was wary of disciplining any team member knowing that I would not have a replacement if they left.”
What the implications are for healthcare leaders
1 - Given less mid-tenure managers and more lower-tenure managers, organizations should consider formalizing manager mentorship programs and encouraging cross-disciplinary relationships.
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- New managers often look to their closest peers to support them through the first few years, and there is an imbalance of more very new leaders and fewer mid-tenure managers today. In addition, the mid-tenure managers have had limited experience leading independently. Health systems should consider with some urgency building formal mentorship programs to connect new and mid-level managers to more senior managers.
- Health systems should also consider creating forums for interdisciplinary relationships to develop. Executives and frontline leaders should look for opportunities to build connections amongst all frontline leaders, especially those that cross clinical, ancillary, and supportive service lines; there is outsized value in managers learning from and supporting each other, especially when their teams work together.
2 - Given new managers' constraints to develop the skills to lead independently, health systems should invest in leadership development programs and fill in the gaps for current managers.
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- Executives should ensure their organization has a complete manager transition program that is deployed to all manager roles (clinical and non-clinical) to build the competencies for new managers. Lessons learned over the past few years demonstrate the value of new manager competency building, support, and leadership development initiatives; they show how taxing the frontline manager role can be when their work is not well articulated – as it generally cannot be during times of crisis.
- Executives and service line leaders should ensure that all managers are given new opportunities now to rebuild any foundations they missed, particularly those where the miss was due to the pandemic, for example, by re-enrolling them in a manager development program.
Any manager who led their team during this period has outsized value for their organization and is worth continual investment. These leaders will be sources of strength and experience when the next crisis hits, whether it be global or local, long-term or momentary.
Data definition
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- Managers’ tenure as a manager: For all current active managers, the number of years since they were first promoted to a manager role in their current organization.
- ICU = any intensive care department, including specialty ICUs such as Neonatal Intensive Care (NICU) and Cardiovascular Intensive Care (CVICU)
- CCU = Critical Care Unit or Cardiac Care unit