Does Your Healthcare Practice Need Another Manager?
Hiring a manager at the right time is critical in healthcare.
As a CEO or practice administrator in a growing healthcare business, you've likely faced a critical question: When is it time to hire a manager (or another manager)? It's a strategic decision that weighs heavily on your mind, and for good reason. Managers cost more than non-managers, a bad hire can ripple negatively through your culture, and too many "chefs" can quickly lead to an overcooked mess of bureaucracy and inefficiency.
These are all valid reasons to hesitate. In general, I often recommend waiting until the last feasible moment to add more managers or executive leaders. Why? Because it can undeniably add bloat to your operational costs and introduce more layers of discussion and bureaucracy.
But when is that “last feasible moment?” That’s the critical question. My answer might be different from the answer given by a penny-pinching CFO or a fearful healthcare business owner.
This is because failing to hire management at the right time can be an even greater strategic misstep. It's a delicate balance, and finding that sweet spot is crucial for sustainable growth and a thriving team.
The Hidden Costs of Under-Management in Healthcare
While the financial cost of a new manager is clear, the indirect costs of not hiring one often go unnoticed until they become systemic problems. When your current managers are stretched too thin, supervising too many direct reports, it creates a cascade of negative effects that directly impact your healthcare staff retention and overall clinic productivity.
Here's what happens when your management structure can't keep pace with your growth:
Employee Disengagement & Turnover: When employees feel unsupported, unheard, or unable to get timely answers, their engagement plummets. They feel like they're "being hung out to dry" and are far more likely to seek opportunities elsewhere, driving up your healthcare turnover rate.
Manager Burnout & Leadership Turnover: Your existing managers, constantly juggling an unmanageable workload, will inevitably experience stress and burnout. This not only affects their performance but also puts your vital leadership at risk of leaving.
Reduced Productivity & Training Deficiencies: With managers spread thin, new hires won't receive adequate training or support, slowing their ramp-up time and impacting overall clinic efficiency. Existing employees may also be less productive as they lack consistent guidance.
Erosion of Trust and Culture: A direct human touchpoint with a supportive manager is critical for building trust and a positive work culture. When managers don't have time for their team, trust erodes, impacting everything from team cohesion to patient care.
For all of these reasons, and because these factors are tied to hidden costs that multiply much faster than the cost of a new manager themselves, I would err on the side of hiring a manager if you are truly on the fence. But read on for more tips to keep in mind.
Beyond the Balance Sheet: The Strategic Benefits of New Leadership
While the challenges of under-management are clear, it's also important to recognize the significant benefits that a new manager can bring:
Fresh Ideas and New Energy: A new manager, whether external or promoted from within, can infuse your practice with fresh perspectives, innovative strategies, and renewed energy. They can identify bottlenecks, streamline processes, and introduce best practices that boost efficiency and employee engagement in clinics.
Enhanced Employee Support: A lower manager-to-employee ratio means more individualized attention. Employees get their questions answered faster, receive more frequent and meaningful feedback, and feel more supported in their roles. This directly improves job satisfaction and staff retention in healthcare.
Clearer Growth Pathways: Promoting a new manager from within demonstrates a commitment to employee growth and creates a tangible example of career progression within your organization. This inspires your team, showing them there's a ladder to climb, not just a flat structure.
Improved Hiring and Onboarding: With dedicated managerial capacity, the quality of your hiring and onboarding processes can vastly improve. Better selection, more thorough training, and consistent follow-up lead to more productive and satisfied new hires from day one.
The Crucial Tipping Point: When Is It Time to Hire Another Manager?
So, how do you know when you've reached that critical juncture where the benefits of hiring a new manager outweigh the costs and potential for bloat? There's no single magic number, but here are key indicators and questions to consider:
Manager-to-Employee Ratio: A general guideline in a clinical healthcare environment is to evaluate when any one manager is consistently supervising over 10-15 direct reports. Beyond this number, it becomes increasingly difficult for a manager to provide adequate support, conduct meaningful one-on-ones, and handle their own operational duties effectively.
Actionable Tip: Calculate the current direct reports for each of your managers. Is anyone consistently above this range?
Team Experience and Autonomy: How experienced is the team being supervised? Highly experienced and autonomous teams might require less direct supervision. Conversely, a team with many new hires or less experienced staff will demand significantly more managerial time and oversight.
Actionable Tip: Assess the skill level of the employees under each manager. Adjust your expectations for management capacity accordingly.
Feedback from the Front Lines: What are you hearing from both your managers and employees about the current organizational structure? Are employees reporting that they can't get timely help or feedback from their managers? Are your current managers expressing feelings of burnout, being overwhelmed, or struggling to complete their responsibilities?
Actionable Tip: Implement regular, confidential feedback mechanisms (e.g., anonymous surveys, skip-level meetings) to gauge employee and manager sentiment regarding workload and support. Do employees say they can “never find a manager” or they’re“feeling unsupported?”
Time for Core Management Functions: Do your current managers have enough time to meet with employees regularly (e.g., weekly or bi-weekly), provide meaningful performance feedback, dedicate quality time to interviewing and onboarding new staff, and engage in their own professional development? Do you have HR, finance, marketing, and IT covered by true professionals (either fractional or full time)? If the answer is no to any of these questions, then your manager is being pulled in too many directions or being asked to wear too many hats and this WILL impact your business negatively.
Actionable Tip: Ask your managers to track how they spend their time for a week. Identify where the bottlenecks are and if essential leadership tasks are being neglected.
Your Practice's Turnover Rate: Is your employee turnover consistently high? Higher turnover rates demand significantly more managerial supervision due to the constant need to recruit, interview, onboard, train, and offboard employees. New hires, in particular, consume substantial managerial time. Anything over 30% turnover is cause for concern.
Actionable Tip: Analyze your turnover data. A consistently high rate, especially among new hires, often points to a lack of effective management and support during critical early stages.
If you want a professional to help you make these assessments, reach out to me. An HR assessment will cover this topic and much much more to help give you confidence in your people leadership programs.
Smart Solutions Before You Hire: Creative Management Structures
Before you jump straight to hiring another full-time manager, consider if there are interim solutions or structural adjustments you can make:
Empower Team Leaders: Push as much work as possible to a "team leader" role. You may need to formally create this job title and provide training on basic leadership skills. This not only offloads some burden from managers but also cultivates your next generation of leaders from within. When you are ready to hire a manager, these team leads often become your best candidates.
Dedicated Trainer Role: Can you designate or hire a dedicated trainer, even on a part-time basis, to help with interviewing, onboarding, and initial training for new hires? This frees up managers to focus on ongoing development and performance, while ensuring new team members get a strong start.
Fractional Help: If you aren’t big enough for a full time Finance, HR, IT, or Marketing Director, consider hiring a fractional leader for these functions. These professionals can offload a huge amount of work from your existing operational leadership and they’ll bring a host of benefits like financial clarity, business growth opportunities, better employee retention, and reduced risks.
If you’ve done and/or considered all of these options, but the other signals indicate a need for more leadership, then it’s probably time to hire another operational leader in the business.
What Now?
If it’s time to hire another operational leader, then you’re about to make a HUGE decision in your business. Having help from a seasoned professional can mean the difference from an awesome hire that saves you time to a time-sucking culture crushing hire that hurts your clinical operations. Reach out to me if you’re curious about how I could help.
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