March 7, 2024 The next rung up: Building organization-wide “Leadership Ladders”

Greta Rosler, MSN, RN, NEA-BC, CPXP
Tim Darling

The Leadership Ladder concept 

Health systems have formalized professional development programs to give employees opportunities to grow in their roles. Given the current large spans of control, there are few opportunities for most employees in a team to be promoted to a manager/assistant manager role. 

Clinical Ladders exist in some form today in many health systems. These programs allow team members to advance with formal recognition of their growth while staying in the same frontline role for much of their careers. In many organizations, compensation rises as employees climb steps on the ladder, providing an additional incentive for team members to advance.

The rationale for “Leadership Ladders” results from a gap in this standard professional development structure within healthcare organizations. Such ladders are similar in spirit to Clinical Ladders, yet emphasize the development of individuals specifically interested in leadership and from any discipline, not just nursing.

The intended outcomes of Leadership Ladders for organizations are to demonstrate a commitment to quality, show an investment in employee professional growth, and improve employee retention by providing compelling career advancement opportunities.

Two questions serve as litmus tests for whether an organization is running exemplary leadership development programs for frontline team members: 

1. Is the organization consistently filling open leadership roles by drawing on a pool of internal candidates who have progressed through established professional development programs/ladders?  
2. Is there enough transparency and communication within the organization so that individuals interested in any form of leadership can articulate a clear, objective process for advancement?
   
   

Main Challenges with current development programs

1. There are not enough meaningful variations of these development programs
   • Some employees want to be people leaders; some want to become experts in particular aspects of their roles; others want to develop on a path to train their colleagues.
     
     
2. Employees often do not gain practical competencies to prepare them to lead effectively
   • Professional development programs are often focused on progressive involvement in hospital affairs and advancement of degrees or qualifications. While these activities are valuable to the individuals and their organizations, they tend to overshadow the development of practical skills, such as how to best conduct daily employee or patient rounds, or how to have an accountability conversation.
   • While the financial reward for progressing should be an incentive, the perceived value of practical skill development should be just as compelling, if not more. In a recent review of one representative organization, 79% of participants in a clinical ladder pursued the opportunity for advancement because of the financial incentive.
   • In clinical departments, many new nurse leaders share that they feel unprepared for their roles as leaders, despite having advanced degrees, certifications, and prior involvement in development ladders.
     
     
3. The programs are too tedious
   • Though some formal professional development programs offer financial incentives and the reward of gaining expertise, the burden of figuring out the ladder or the toll of the requirements to complete it often outweigh the reward.  
     
     
4. It is difficult for frontline team members to determine if and how the programs will support them and their own goals
   • Even where programs exist, meaningful self-assessments of learning goals and needs are rarely built into the programs - a step that allows team members to self-assess their own goals and visualize how the program will further them on their leadership journey.
     
     

What executives can do to take the “next rung up”

1. Develop Leadership Ladders to support the types of leaders the organization needs to meet its future objectives
   • Define the objectives for each service area/role that the programs should aim to support. For example, the desired outcomes could be:
     1. Management track: develops team members to be responsible for specific leadership roles and activities on the unit/department; transparently develops manager succession candidates in the unit.
     2. Education track: develops team members to be preceptors and educators who lead peer-to-peer sharing of skills and education, teach and support team members on policies, achieve advanced degrees and certifications; creates a recruitment pipeline for clinical educator and professional development roles.
     3. Specialist skill track: develops team members to achieve advanced knowledge and skills needed to play specific roles on the team; creates team members who are certified on specific equipment or who can lead the development of team policies in specific areas, such as allergy processes in food preparation.
        
        
2. Build the programs with a focus on developing practical competencies
   • For each specialty track and participant in a Leadership Ladder program, it is essential to offer routine feedback and coaching if the intent is true competency development versus just higher pay. This should include feedback conversations with a leader or coach skilled in this type of dialogue to ensure that the participant is defining specific goals and receiving specific feedback about the practical competencies they are developing, such as:  
     1. For the Management track: leader rounding, feedback conversations, recognition, creating buy-in, quality improvement work and documentation, staffing, fiscal management (including budgeting), meeting management
     2. For the Education track: mentoring skills, feedback conversations, adult learning practices, establishing influence, meeting management
     3. For the Specialist skill track: policy development, equipment/supply procurement, meeting management
        
        
3. Keep the steps to navigate the programs clear and simple; get creative with how to make the Leadership Ladders meaningful
   • Though ladder programs often emphasize nonproductive time spent in committee meetings or education, consider including achievable milestones that create impact and can occur during routine work, such as:  providing peer feedback, initiating a departmental task or project during downtime, or creatively solving a scheduling or staffing issue.
   • Consider integrating the ladder with job descriptions to reduce the burden of managing it as a separate program.
   • Ensure movement up the ladder represents meaningful growth in skills and competencies (as listed above) and not just completion of tasks, attainment of degrees or certifications, or attendance at events.
   • Consider adding more rungs to ladders to allow younger team members to realize a sense of meaningful upward movement earlier on in their careers. For example, consider adding preliminary steps to enter the ladder for new graduates.
     
     
4. Ensure that a meaningful self-assessment of learning goals and needs (as well as reflection and personal awareness) are integral parts of any ladder
   • Leaders should prioritize self-assessment activities to ensure that individual objectives for a ladder program are aligned with their aptitude and professional goals as well as the needs of the organization.
   • Utilize consistent approaches with skilled mentors, leaders, and ladder facilitators to enable applicants to self-assess where they are, what they hope to learn, how they hope to grow, and how others perceive their growth.