Building Strength From Within: Growing Leaders Who Know The Work

Read about how healthcare leaders strengthen succession, retention, and organizational resilience by intentionally developing leaders who already understand the work from the inside out.

Every healthcare organization feels the constant pull of urgent clinical needs, shifting operational demands, and daily decisions that cannot wait. These pressures fill the calendar so completely that leadership development becomes something everyone acknowledges as essential, yet few manage to protect time for. The result is a familiar cycle. A respected leader announces a departure, the organization enters crisis mode, a short list of familiar names circulates, and attention quickly turns to an external search because no internal candidate seems fully ready.

From our experience supporting healthcare organizations, the team at BHS Connect has seen how this pattern quietly erodes organizational strength. When experienced leaders leave, they take years of knowledge with them, and the culture loses another stabilizing force. Rapid external hires can bring talent, but they often lack the lived understanding of clinical realities, operational rhythms, and informal networks that make the organization function. Over time, reliance on outside solutions grows while confidence in internal development weakens.

Based on what we have learned through our partnerships with leading healthcare organizations and the successful strategies they employ, the BHS Connect team created this article to help leaders build a meaningful leadership bench. 

Promoting from within accomplishes far more than filling an open role.

The Strategic Power Of Promoting From Within

Promoting from within accomplishes far more than filling an open role. It sends a clear message that the organization notices and supports the people who already move the work forward. When someone who has built their career inside the organization steps into a leadership position, they carry a practical understanding of workflows, clinical dynamics, historical tensions, and the unwritten rules that shape daily operations. No external candidate, however capable, arrives with that depth of context.

There is also a powerful effect on retention. High performing clinicians and administrators pay close attention to what advancement looks like. If they conclude that real growth requires leaving, many will eventually do so. When they see colleagues rising through the organization in credible, meaningful ways, they can picture a future in which their ambitions and the organization’s needs move together. 

Internal promotion strengthens collaboration across functions. Imagine a director who once worked as a practice manager. When they take on a major access improvement effort, they already understand how scheduling templates vary across specialties, why front desk staff feel stretched, and how physicians respond when patient flow slows even briefly. They’ve lived the experience, and staff are more likely to trust and follow someone whose capability they have witnessed up close.

Why Emerging Leaders Are Often Overlooked

Many emerging leaders go unnoticed not because executives are uninterested in developing talent, but because daily pressures reward short term reliability far more than long term growth. A supervisor, charge nurse, or operations manager who can walk into any unit and restore stability becomes essential in their current role. When a broader opportunity opens, senior leaders often repeat the same refrain. This individual would excel, yet the organization cannot afford to shift them right now. That reasoning feels practical in the moment, and it can hold a talented person in place for years.

Potential is often interpreted through familiar patterns that leaders may not realize they are relying on. People who exert influence quietly, or who have followed less traditional professional paths, can be missed because they do not resemble an unspoken image of who a leader is supposed to be. Research in healthcare leadership development shows that many promising clinicians and administrators remain under supported not due to lack of ability, but because organizations do not have reliable ways to identify them and help them advance. Developing Leaders in Academic Medicine and Learning Health Systems, presents the same dynamic. High potential individuals often navigate inconsistent encouragement, vague expectations, and uneven access to mentorship and visibility. These conditions create stalled careers and narrow pools of future leaders.

Consider an operations coordinator who regularly diffuses tension between departments, anticipates where workflows will break, and asks questions that reveal a deeper understanding of how the system fits together. They are already operating with a leadership mindset, yet their ability may go unspoken because the organization has no consistent language or process for naming it. Over time, people in this position reach a plateau or eventually leave for places where their contributions are recognized and cultivated.

Talent pipelines rarely fail because of a shortage of capable people. They falter when organizations lack the structures that help leaders notice the talent already in front of them.

In everyday operations, certain patterns signal leadership potential long before someone is formally recognized.

Tools For Recognizing Leadership Potential On Clinical And Administrative Teams

Recognizing leadership potential requires a different lens than evaluating performance. It shifts the focus from questions about who consistently meets their metrics to questions about who reshapes conversations, who notices patterns beyond their immediate responsibilities, and who earns trust across diverse roles. These questions reveal qualities that matter for leadership but often remain invisible in routine performance reviews.

Succession planning research within healthcare offers practical guidance. A policy analysis on nursing leadership succession describes structured methods for spotting future leaders that rely on clear evaluation criteria, multiple sources of information, and alignment with the organization’s long term priorities. The guide, Identifying And Selecting The Next Generation Of Nursing Leaders Through Effective Succession Planning, reinforces an important point. Intuition plays a role, yet it cannot stand on its own. Organizations need deliberate and transparent processes that make talent visible in a consistent and reliable way.

In everyday operations, certain patterns signal leadership potential long before someone is formally recognized. A clinical team member who routinely connects disciplines, clarifies miscommunication between physicians and nursing staff, and anticipates how a policy change will ripple across units is already building leadership muscle. A frontline supervisor who can articulate the needs of their team while also acknowledging organizational constraints, without drifting into cynicism, is demonstrating the emotional steadiness required for larger roles.

To identify these individuals more consistently, many organizations rely on a mix of methods. Leaders hold talent review discussions that separate performance from potential, invite peers into nominating conversations, and gather brief multi-rater feedback that focuses on influence, judgment, and the ability to move work across boundaries. 

Creating Growth Paths That Are Both Ambitious And Realistic

Once emerging leaders are visible, the next challenge is designing growth experiences that stretch their abilities while keeping daily operations steady. Healthcare organizations feel this tension more acutely than most. Pulling a strong clinician or manager away from their usual workload, even partially, can create discomfort in the short term. Yet that temporary strain is often the very investment that allows the organization to benefit from stronger leadership in the years ahead.

Insight from broader corporate research can provide useful direction. McKinsey’s article, The Art Of 21st Century Leadership: From Succession Planning To Building A Leadership Factory, recommends approaching leadership development as a structured system rather than a series of isolated opportunities. This systematic approach is often formalized using the 70-20-10 Model, which dictates that development should be weighted heavily toward Experiential Learning (70%), followed by Social Learning (20%) (coaching and mentoring), and finally Formal Learning (10%) (courses and reading). In this framing, leaders advance through a sequence of experiences that increase in complexity and scope. Healthcare settings lend themselves well to this idea because the work naturally contains projects and initiatives that vary in scale and risk.

The essential point is that development must involve real ownership. Emerging leaders need responsibility for decisions that carry weight, even when a senior sponsor is nearby to provide guidance. At the same time, their current workload must be thoughtfully adjusted. When development is added on top of full responsibilities, it becomes unsustainable, and the implied message is that leadership is an extra burden rather than an integral part of their role. Organizations that excel in this area deliberately rebalance assignments, shift routine duties, or add support so that the individual has genuine space to learn, practice, and lead.

Another important design element is the use of time bound leadership roles. An assistant medical director, for example, might lead a major care redesign effort for twelve months with a defined beginning and end, access to a coach, and a structured debrief at the conclusion. This creates a clear arc of development, builds confidence through achievement, and gives the organization a more accurate picture of how the individual performs when operating at a broader scale.

Formal mentoring programs are common, yet many lose momentum once the initial excitement fades.

Embedding Mentorship In The Daily Rhythm Of The Organization

Formal mentoring programs are common, yet many lose momentum once the initial excitement fades. Meetings become infrequent, conversations stay polite but superficial, and both participants eventually return to their routines. These programs often falter when they are detached from real work and lack clear expectations or meaningful support.

Healthcare organizations can avoid this pattern by treating mentorship as a way of working rather than a separate initiative. The most reliable approach is to anchor mentorship in concrete responsibilities. If a physician leader is mentoring an emerging practice leader, the relationship should revolve around a shared piece of work such as co-leading a patient experience initiative or developing a service line expansion. This gives the mentor opportunities to coach through actual decisions, stakeholder dynamics, and tradeoffs rather than offering abstract career guidance.

Short, focused mentoring interactions also reinforce learning in ways that long formal sessions rarely do. A senior administrator can invite an emerging leader to sit in on a contract negotiation, then spend fifteen minutes afterward walking through the tactics and reasoning behind each move. A chief medical officer can ask a potential successor to draft talking points for a town hall, then refine them together and explain how tone, timing, and framing shape the message. When these small episodes accumulate, they create a continuous learning environment that is fully integrated into daily operations.

There is no training like participating in the real thing. 

Development Plans That Are Grounded In Real Work

Many organizations require individual development plans, yet those plans often sit in human resources systems rather than influencing the daily work of the organization. They list courses to attend or books to read, but they rarely translate into concrete responsibilities or leadership experiences. In the fast pace of healthcare, development framed in this way remains aspirational. It cannot withstand the pressures of nonstop clinics, staffing challenges, and operational fires.

A more practical approach comes from the concept of learning in the flow of work, described in A New Paradigm For Corporate Training: Learning In The Flow of Work. Instead of asking people to step away from their roles to grow, leaders bring development opportunities into the work itself. For healthcare organizations, this means aligning development plans with active strategic initiatives where learning and contribution reinforce each other.

Imagine how this might unfold for an emerging leader being prepared for a director level role. Rather than listing broad leadership courses, the development plan might specify that they will lead a multi month redesign of referral management. Their responsibilities would include mapping current state processes across sites, testing new workflows, helping physicians align around changes, and presenting outcomes to the executive team. The development objectives would be tied directly to the work, such as influencing without formal authority, integrating clinical and financial considerations, and managing conflict across disciplines.

For this approach to succeed, leaders need to adjust structures around the individual. Some existing tasks must be reassigned or paused so the development assignment does not become a second job layered onto an already full workload. This adjustment isn’t a simple reduction in volume; it’s a strategic prioritization exercise. It requires leaders to identify and prune 'low-value' work such as redundant administrative reporting, non-essential committee participation, or legacy meetings to create the necessary capacity for high-value leadership activities that drive the organization forward. Regular check-ins should cover both the operational progress of the project and the individual’s growth in leadership behaviors. The sponsoring executive plays a crucial role by helping the emerging leader frame difficult choices, anticipate resistance, and reflect on their own impact as the work evolves.

Strong development plans also make expectations clear. The emerging leader should understand what success looks like, not only for the project but for their own advancement. A plan might specify that by year end the individual will have led a cross-functional team through several major decision points, navigated a difficult stakeholder conversation with limited intervention, and delivered a coherent narrative about project outcomes to the board’s quality committee. These kinds of expectations give structure to coaching and ensure that growth is visible and measurable.

For a deeper view into formalizing these transitions, the Center for Creative Leadership’s guide, Putting Experience at the Center of Talent Management, provides a research-backed framework for turning high-stakes projects into sustainable development pathways. It offers a practical blueprint for shifting from static training checklists to a culture that treats real-world work as the ultimate leadership laboratory.

Even the strongest processes will falter if the broader culture treats leadership development as a rare privilege or an activity that can be paused whenever pressure mounts.

Sustaining A Culture Where Leadership Growth Is Expected, Not Exceptional

Even the strongest processes will falter if the broader culture treats leadership development as a rare privilege or an activity that can be paused whenever pressure mounts. To build a reliable leadership bench, development must be understood as a normal part of organizational life. It should be something leaders are expected to cultivate and something the system is designed to support.

Industry analyses, including the AMN Healthcare and B E Smith white paper, point out that healthcare leaders continue to face unrelenting pressure from financial strain, workforce shortages, and shifts in patient expectations. These analyses also note that succession risk is increasing, with many executives considering earlier departures. In this environment, treating leadership development as optional introduces a level of strategic vulnerability that few organizations can afford.

Culturally, senior leaders have powerful ways to shift expectations. They can talk about talent development alongside financial performance and quality outcomes rather than treating it as a sidebar for annual planning sessions. They can ask, in every major initiative, who is the emerging leader gaining a stretch opportunity, and then hold themselves accountable for acting on that commitment. They can be open about their own succession planning by naming how they are preparing possible successors and encouraging their peers to adopt the same discipline.

Routine practices reinforce these cultural signals. Some organizations conduct quarterly talent reviews that are directly connected to real opportunities. Each director arrives with a short list of individuals who show potential for future roles, along with specific next steps that would move their development forward. The group then looks across departments to coordinate opportunities and reduce the common pattern in which one executive keeps promising people close because they are helpful in the current role.

Another important cultural lever is how the organization responds when development experiences fall short of perfection. If a stretch assignment is treated as a single high pressure test, and any sign of struggle becomes a permanent mark against the individual, leaders will quickly become reluctant to offer these opportunities. If, instead, the organization treats stretch assignments as genuine learning experiences with built-in support and reflection, people will step into them more readily. This approach does not mean accepting poor performance without limit. It means recognizing that short term imperfection is part of growth rather than evidence that someone should never be considered for leadership again.

When this mindset takes hold, staff begin to assume that leadership development is part of the everyday rhythm of the organization. New managers anticipate coaching. Experienced clinicians understand that mentoring is part of their role. Emerging leaders expect to take on challenging and meaningful work, not just tasks that are safe and predictable. Over time, the conversation at the executive table shifts from asking who might possibly fill a role to choosing among several prepared colleagues who could succeed in it for different reasons. That shift is one of the clearest signs that a true leadership bench has been built.

Final Thoughts

Healthcare organizations pour extraordinary effort into staying operationally steady in an environment that shifts from hour to hour. In this constant state of urgency, leadership development often becomes the shared belief that never quite becomes a shared practice. The cost of that choice reveals itself gradually, then suddenly, in fragile succession plans, rising turnover among high potential staff, and leadership gaps that grow widest at the very moment the organization needs consistency and judgment.

Building a leadership bench is not the result of a single program or a brief burst of attention. It is a continuing discipline that shows up in daily decisions. It involves promoting from within when the opportunity exists, making emerging leaders visible long before a role opens, and recognizing potential with the same rigor used to judge performance. It involves designing growth experiences that mirror real organizational work, embedding mentorship into everyday interactions, and treating development plans as living agreements about responsibility and learning rather than compliance documents. It is also cultural work. It requires leaders to insist that growing talent is part of their job, not an optional activity reserved for a select few.

BHS partners with leading healthcare organizations to provide a full range of no-cost Release of Information (ROI) services supporting Medical Records and Health Information Management teams.

If someone on your team would like to explore how we can support your facility, please feel free to reach out. We’d be happy to share more details and answer any questions.