Navigating the Pressures and Successes of Middle Management in Healthcare

Middle managers in healthcare organizations often find themselves squeezed between demands from above and needs from below—navigating constant pressures sometimes without the authority of senior leadership or the voice of front-line staff. This conversation is especially urgent now, as healthcare systems continue to face staffing shortages, change fatigue and increasing complexity. Middle managers are essential to organizational health and effectiveness but “the middle” is not a single role and instead a complex, multilayered set of positions within healthcare systems. Many arrive in the middle not by design but by progression—moving from individual contributor roles into management without a clear roadmap for what leadership in the middle actually demands. It includes early careerists stepping into leadership for the first time, experienced managers who have been overseeing teams for decades and those at various points in between. What unites them is the need to navigate competing expectations from above and below while keeping teams aligned and work moving forward.

This session will explore the lived experience of being in the middle and the skills required to thrive in this role, drawing lightly on Barry Oshry’s organizational systems thinking to illuminate the structural dynamics at play. Panelists will reflect on the systemic forces that shape middle management, the tensions they experience in aligning competing priorities and advocating for their teams, how they’ve succeeded in the face of these challenges, and the leadership capabilities they’ve developed to be effective in this often-overlooked but crucial space. They will reflect on how to manage up and down simultaneously, how to communicate when messages get distorted or lost in translation, and how to expand their networks and voice to increase impact. Drawing from real experiences and interactive audience engagement, this session will help you reframe individual challenges as predictable dynamics in complex systems—and identify new ways to lead from the middle with clarity, resilience and impact. By connecting personal experiences to broader organizational patterns, you will explore how influence and authority can be exercised across different levels of the system, even without formal power.