Printer Friendly

Leadership lessons learned from middle management.

About a year ago, my boss (our hospital's chief medical officer) came by the office that I share with two other physicians and looking at one of the desks, asked, "Whose desk is that mess?"


I commented that it was mine and that the reason it looked like a mess with lots of folders and other papers stacked all over it, is what I call the "upper management clean desk phenomenon."

I explained that the reason that his desk and office, as well as the offices of most leaders that I have been in, are so neat and tidy (besides the services of a secretary that most middle management may not have--at least in health care) is that they decide what needs to be done and send it to middle management to get done.

As a result, much of what the CMO didn't throw away but decided needed action, ended up on my desk or ones like it within the organization. And since I don't have anyone to pass it on to, my desk stays cluttered until the work is done.

Most articles today about leadership are written from the perspective of successful leaders, or those who either teach people how to be successful leaders and write about traits of successful leaders.

Jim Collins in his book, Good to Great, talks about such skills as building relationships, personal humility, creating a climate where truth is heard and adhering to the core values of the organization they work for.

Five additional lessons

I believe that from my experience in middle management over the last 13 years (despite my other career as a practicing pediatrician for the last 20 years)--and having worked in two very different organizations under a multitude of various CEOs, COOs, CFOs, CMOs and VPs--that I have learned five additional lessons that may help any leader to be more effective.

First, I would urge all leaders to realize that first impressions may be deceiving in that a messy desk does not mean an inefficient desk.

Second, willing something to be done doesn't make it happen--your desk is clean because mine is cluttered.

Another essential lesson that all middle managers wish their leaders would learn is the importance of communication. Leaders typically don't need to get a lot of communication since, by definition, they are in the "loop" of what is happening within their organization.

On the other hand, middle management depends on receiving information by one of two methods.

The first and most common, though not terribly effective, is the rumor mill. I had been with my previous organization for about a year when I went to my site chief (satellite clinic lead physician) to ask about a rumor. He wisely taught me to ignore rumors until they became fact, a policy I have tried to stick to ever since. However, without any information to the contrary, rumors often take on a life of their own.

The second method is accurate and timely communication. I am a firm believer that there is no such thing as too much information and have only rarely in my career complained about receiving it.

On the other hand, I cannot begin to count the number of times I have pleaded with leaders to get information out to me or others in order to allow the organization to move forward in a positive manner.

Obviously, some leaders may argue that they are getting out just what is needed, but from where I sit they often miss the boat. Clearly there is a fine line between overloading people with too much information and not providing enough, but I would tend to err on the side of giving more, rather than less.

Invisible leaders

The invisible leader is a common problem to all large organizations. Many employees may know who the leaders are, what they look like and even where their offices are. Unfortunately, they are often invisible to the organization because they never visit different sites within the organization.

Granted, in large organizations with many sites and numerous departments, visiting each one on a regular basis would be impractical. However, visiting many of them on a rotating basis, even once a year, should never be out of reach. And meeting with people at a mass meeting (e.g. annual meeting or quarterly directors meetings) should never substitute for going to individual units.

One day I was approached by our CFO who wanted to know how we were using our electronic medical record. I offered to show him on his office computer but he said he preferred to come up to the clinic. He spent an hour with me at my work space and not only did he enjoy being in the clinic, but it was remarkable the number of staff who came up to either meet him or say how nice it was to have him visit the clinic.

I cannot say enough about how important it is for leaders to let themselves be seen in the workplace and this is my fourth lesson for effective leadership.

Finally, to be an effective manager, you need to have the ability to make decisions and implement changes within your reporting unit. Asking managers to solve problems but not giving them the authority to actually carry that out will not only result in inefficiency, but also disgruntlement on the part of the middle managers.

Likewise, micro-management is an inefficient way to lead, since it both gives the message that the manager can't do the job in an effective manner and also leads to duplication of effort by both the manager and the leader.

In the past, I have struggled with personnel issues where I was supposed to solve some problems with personnel that were not performing as expected, but yet I didn't have the authority to make the changes needed. As a result, I constantly had to turn to my supervisor to ask him to do what I felt was necessary, rather than doing them myself.

This then is my final lesson and one that many others have also written about. Leaders should pick the right people to manage and then let them do that.

I would be the last to imply that middle management doesn't have a lot to learn from upper management. However, there are also things that leaders can learn from those they are supposed to lead, if they are willing to ask and listen.

Sheldon Berkowitz, MD, FAAP is medical director of Minneapolis Children's Clinic in Minneapolis, Minn. He can be reached at 612-813-6077 or


By Sheldon Berkowitz, MD, FAAP
COPYRIGHT 2005 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2005, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

Article Details
Printer friendly Cite/link Email Feedback
Author:Berkowitz, Sheldon
Publication:Physician Executive
Article Type:Column
Geographic Code:1USA
Date:Jul 1, 2005
Previous Article:Impact of formulary restrictions on patient safety.
Next Article:Management in residency training.

Related Articles
Senge, Covey, and Peters on leadership lessons.
Competence and character: developing leaders in the LAPD.
"Never walk past a mistake." (interview with America's Promise Chairman General Colin L. Powell)(Interview)
What's on the Web.
The Origins of Change.
Regarding aesthetics and quickies. (Let's Discuss It ... in One Hundred Words or Less!).
Using technology in the classroom to foster student learning. (ERIC/EECE Report).
Formative evaluation of a CSCLIP lesson.
Teachers blossom into new leadership roles.
Teaching leadership as creative problem-solving.

Terms of use | Privacy policy | Copyright © 2020 Farlex, Inc. | Feedback | For webmasters