The Stage

I remember vividly how “important” I felt as a new front-line manager in a progressive healthcare system adopting “lean practices” in the mid-2000s. I received plenty of attention.

Specifically, the senior leadership team visited me about twice a month. They came to the front line to learn about the lean deployment and the status of our organization’s journey.

There was great pride in our work. I, along with my team, enjoyed sharing our latest improvements and learnings.  After the Senior Leadership Team left, the pride remained, but the real work at the front line continued.

This work was challenging as we lacked experience and tried to work in ways that felt counterintuitive. What I also observed was my “1-up” trying hard to support our team in this new way of leading, but they were not sure how because they were not receiving coaching.

I had external Senseis with great experience come work with me and the internal experts who were also there to support me. Yet, the person I reported to, the person who coached me on my performance and worked with me to set goals, was largely on their own. They were trying to learn about “lean” and support my team and me, but they were working in two worlds:

The old way and the new way.


I share this experience not to point fingers but rather to bring out the importance of “the middle.”

In every healthcare organization I have worked with, I’ve found both very hard-working front-line leaders and dedicated, visionary executive leaders. In addition, I have found middle-level leaders who work equally hard and are equally dedicated, often trying to learn their way into a new way of leading.

In each case, when I have observed a middle-level leader trying to develop on their own, it has been stressful, exhausting, and most often ineffective.

Why is it so difficult for middle-level managers?

The experience I had at the beginning of the lean transformation is very typical, as most organizations begin by teaching concepts and principles to the executive team and front-line teams. I don’t think this is wrong, but I want to express that it is important to provide middle-level managers with training and coaching so they can be successful.

They are being asked to change the way they lead by being less directive and linking their work to the organization’s strategy in ways that they have likely never done.

They are also required to support frontline managers and teams through a large amount of change, which comes with a lot of emotion and struggles – that they are often not equipped to handle.

Many times, they aren’t even sure what the main objectives of their role in the new way of working are.

The role of middle-level managers

Middle-level leaders play a number of vital roles in the journey toward excellence. One, middle-level leaders are the connection between the executive leadership team and the front-line teams in the strategy deployment cascade.

Their role is to understand the strategic direction and align it with front-line capacity and capability. Middle-level managers need to translate strategy into the impact expected at the front line and then help influence strategy based on their knowledge. A middle-level leader who has not lived through a lean transformation may not know how revolutionary the transformation can be and may coach to reduce/minimize the outcome of a strategic plan.

Another responsibility of middle-level leaders is to develop front-line leader capabilities with not just technical but also social elements of change. The change curve is steep in the middle of transformative work, and the front-line leader needs to be knowledgeable of and skilled at change management strategies to keep up with the pace of change during an organizational transformation.

The middle-level leader is a vital support mechanism for the front-line leader, but if they are not well-versed in change management, the whole effort may stall.

How to help middle-level managers

As an executive leader, focus on your behaviors that help develop your direct reports. As examples:

  • Dig deeper in catch-ball conversations during strategy deployment sessions. Try to assess if they truly grasp front-line capacity and capability, challenge their thinking, and how they know what they are telling you.
  • Go with them to observe at the front line and coach them on how they interact.
  • Ask them questions about their scientific thinking and practice; challenge them to take chances and experiment.
  • Encourage them to fail safely to accelerate their learning.
  • Help them lead the vision of the change at hand, not to minimize the work and accept stepping backward to the status quo.

In essence, prepare them to be successful so they can help their teams be successful. Envision the skills you want the front-line leaders to be capable of, and then teach them to your direct reports.

How to know you are on the right track

This “different way” can sound like the management system that has been in vogue for much of the last decade.  I have observed the hypothesis that if a leader has their standard work, meets with their direct reports regularly, and asks humble inquiry questions, then they must be developing their direct reports and doing a great job as a leader. This may be true, but I’ll offer an additional challenge, the only way to know if this is true is on one condition.  

If the development activities (inherent in a management system) are completed in the course of improving the work itself, and through leading differently, there is an increase in the value the customer is seeking, then you’ve successfully developed a direct report. If you only complete the actions, but the customer never experiences greater value, then you’ve been active, not productive. 

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