Definitions of a "great workplace" can vary depending on who you ask. But according to Quint Studer, founder of Gulf Breeze, Fla.-based Studer Group, most hospitals and health systems that pride themselves on excellent workplace cultures and performance do one simple thing well: They cultivate and nurture a strong middle management team.
"One of the big myths of organizational science is that engagement efforts should be focused on hourly and front-line employees," says Mr. Studer. "Of course, front-line people are deeply important to an organization's success, but engaging them happens through their managers. That's where organizations need to place their focus." 
In 2008, Studer Group conducted a study on work-life balance among women in the healthcare industry. Among other findings, it showed the number one factor in determining employee satisfaction is the supervisor relationship. Mr. Studer says most people don't leave their jobs. They leave their bosses.
"The number one priority for any organization striving for workplace excellence is to ensure people are working for well-trained and developed leaders and managers," he says.
In other words, organizations need to focus their engagement efforts on meeting this priority — and not on "window dressing" like recreational outings and unique perks.
Here are four ways hospital leadership can help their middle managers and, through them, help their organizations become better and greater places to work.
First, reduce variation among leadership. Physicians, nurses and staff have long understood the need to reduce clinical variation, yet so much variation persists among hospital management. Leadership styles and techniques can vary wildly across an organization. This is especially concerning as health systems continue to consolidate and grow larger, resulting in more complex leadership structures.
The results of leader inconsistency can trickle down throughout the organization, leaving employees frustrated and dissatisfied. That's why, to create a high-performing organizational culture, senior leaders must invest in training for managers.
"You can't standardize managers themselves, but you can standardize the training they receive to create consistency in their behaviors," says Mr. Studer.
For example, organizations need to have a unified hiring process. Every manager needs to follow the same hiring guidelines. Every manager needs to know how to run an effective meeting. Every manager needs to know how to manage financial resources — if an employee has a question about spending on advertisements, for instance, the employee should get the same response no matter who they ask.
The challenge is two-fold: Many organizations don't even realize they are providing an inconsistent leadership experience, and even if they do realize it, they feel they can't afford the training that enables managers to maintain the needed consistency.
"As a result, many organizations have created management teams with uneven skill sets," says Mr. Studer. "While employees in one department may have an excellent leader, those in the department right down the hall may not. That's too bad, because the inconsistency has a huge impact on overall engagement."
Be generous and fair with professional development. For some, leadership abilities come naturally. For many others, it takes formal training and lots of practice. This holds true in any workplace or industry — even on the golf course. Bubba Watson is called a "creative golf genius" because he is self-taught and has won six PGA Tours. He's the only professional golfer who can say that. It would be unreasonable to expect the same outcome from other golfers, yet many organizations do this to their managers.
Leaders see one manager excel at his or her job without training, and they expect the same aptitude from others. What they don't realize is that only about three out of 10 people "get it on their own and are natural leaders," says Mr. Studer. The other 70 percent have potential, but they need some help in developing their leadership capabilities.
Leaders must identify where middle managers are in their skill development and provide them with the proper training to be successful. They need to ask themselves: How can I better equip my managers to understand the external environment of healthcare? How can I make sure they are ready to explain these concepts to staff?
Those questions are especially imperative when hospital and health systems face tighter budgets, says Mr. Studer.
"Managers have to say 'no' to more requests than 'yes,' so how do they explain why they are saying no or why the organization is doing what it's doing?" he says. "That's really hard for a manager — and it's an important part of the training they need."
Spell out priorities. Time management isn't a new challenge to anyone. Many people struggle with accomplishing all they need or want to do in one day, but middle managers have an exceptionally hard time, says Mr. Studer. It goes beyond time management or organizational skills: Many managers do not have a sense of which tasks matter most.
"Middle managers have like 20 priorities," says Mr. Studer. "It's too much. Many managers are left feeling all tasks are created equal, and it's causing a lot of stress and dissatisfaction that will inevitably rub off on employees and patients."
In fact, in a survey conducted by Studer Group, middle managers identified the following as the three biggest roadblocks they face at work: (1) There is too much on my plate, (2) I don't know what my priorities are, and (3) I am not getting the skill development I believe is necessary to succeed in this changing environment.
There isn't a shortcut to solve these problems. Senior leaders really have to sit down with each manager in their organization and identify the five key goals they need to accomplish. If the number of goals exceeds seven, that will leave the manager frazzled and overwhelmed.
Rather than numbering the five goals — since everything will inevitably seem like a No. 1 — Mr. Studer recommends assigning goals portions of time. This is where the time management kicks in. "Say, 'Here's 100 percent of your time. We want 30 percent spent on this, another 30 percent goes here,' and so on," says Mr. Studer.
Performance evaluations should also include weights for these priorities. Weights can help reduce anxiety and clarify what leaders should focus on. For example, one organization might have too many cases of hospital-acquired pneumonia. If 30 percent of the CNO's performance evaluation is based on reducing hospital-acquired pneumonia by a certain percentage point, the CNO will understand the urgency of the problem.
Meet with managers regularly. When Mr. Studer asked a group of healthcare managers if they have regularly scheduled meetings with their leaders, only half of their hands went up. Many said they have meetings, but they are not scheduled nor supervised. This haphazard approach needs to change, he says. In fact, leaders need to hold meetings at least once a month at a scheduled time — even when all is going well.
"I think leaders have to look at these meetings with middle managers as more than supervisory," says Mr. Studer. "They should involve more planning and development. Leaders should ask managers questions like: 'What can I do to help you? What barriers are you facing?' This shows a boss is engaged with employees and values one-on-one communication."
Conclusion
It's called "middle management" for a reason, and managers today are feeling the squeeze more than ever. Organizations should remember how much of their success rests on their managers — how prepared they are to lead, how valued they feel within an organization and how well they understand their priorities.
"Once hospitals and health systems establish this consistency and strength in the middle — the core of their organization — they are better positioned to see the benefits among the broader employee base and, most importantly, patients," says Mr. Studer.
More Articles on Employee Engagement and Managers:
The Google Approach: How Hospitals Can Create Cultures That Drive Employee Engagement, Satisfaction
Employee Engagement No Longer a "Soft" Science: 3 Steps to Cultivate More Committed Employees
The Ladder of Employee Engagement: 5 Can't-Miss Steps for Hospital Leaders