Rain can begin falling from a cloud and evaporate before it ever reaches the ground. Meteorologists call it virga. In healthcare organizations, something remarkably similar can happen to change.
In this reflection on Episode 30 of Viral Healthcare, Dr. Bruce Spurlock returns to the overlooked role of middle managers and asks why strategies that seem clear at the executive level sometimes disappear before they ever become part of frontline practice.
The problem usually isn't sabotage or resistance. Middle managers are balancing demands from both directions: senior leaders asking for greater efficiency and new initiatives while frontline teams are asking for more time, staffing, resources, and support. Add another priority without removing anything, and even a good idea can quietly get deprioritized.
Bruce also examines another overlooked problem: many middle managers are promoted because they're strong clinicians, operators, or leaders—but are never actually taught how to lead change, implement new practices, or use quality improvement methods.
If healthcare organizations expect middle managers to turn strategy into practice, they have to give them more than another directive. They need clarity, capacity, training, and a voice in deciding what comes off the table.
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