The Untrained Leader Problem: Why Healthcare Promotes Brilliantly and Develops Terribly

I want to start with a question I think most healthcare leaders have never been asked out loud.

How did you actually learn to lead?

Not how did you learn to do your clinical work. Not how did you learn the regulatory environment. Not how did you learn to read a P&L or run a meeting or interpret a productivity report.

How did you learn to lead?

Most of the leaders I work with - and I've coached and mentored close to 250 healthcare professionals over the years, across community health centers, private practices, pharmacies, dental departments, primary care, behavioral health, and public health - most of them, when I ask that question, they pause.

They get a little quiet. And then they say something like, "I figured it out. I watched my old boss. I read a couple of books. I made a lot of mistakes."

And here's what I want to say to every leader who has answered that question that way.

That is not your fault. But it is a problem that needs to be solved. And until we name it for what it is, healthcare is going to keep promoting brilliantly and developing terribly — and we are all going to keep paying the price for it.

The Pattern I See Over and Over Again

Healthcare is one of the only industries I can think of that consistently promotes people into leadership positions based on their technical skills, but not necessarily their leadership skills.

The Chief Medical Officer is the doctor who has been with the health center the longest. The Clinic Director is the nurse who patients ask for by name. The Dental Director is the dentist who has built the strongest patient panel. The Pharmacy Director is the pharmacist who keeps everything running smoothly.

These are exceptional clinicians. They are valued for their technical mastery. And then one day, we promote them.

The title changes. The pay changes — maybe a little. The responsibilities multiply.

But here's what doesn't change.

Nobody teaches them how to do this new job.

Nobody hands them a leadership curriculum. Nobody walks them through how to give difficult feedback to a provider who used to be their peer. Nobody shows them how to design a team that doesn't depend entirely on them being in the building. Nobody helps them understand that the skills that made them a great clinician — solving problems themselves, taking personal responsibility for outcomes, working harder when things go wrong — are actually some of the worst possible habits for a leader.

They're just expected to figure it out.

And so they do what high-achieving humans do when they're thrown into something they weren't trained for. They work harder. They stay later. They take work home. They try to be a full-time clinician AND a full-time manager. They get tired. Their team gets confused. The people they loved working with start to leave. And eventually, they start wondering if they were ever cut out for leadership at all.

That is the untrained leader problem. And I would argue it is the single biggest unaddressed crisis in healthcare workforce sustainability right now.

The Numbers Tell the Same Story

The most quoted statistic in leadership development comes from DDI, a global leadership research firm. Their research found that 57% of employees have left a job specifically because of their manager. Not because of pay. Not because of benefits. Not because of the work. Because of the person they reported to.

In a 2025 study by BambooHR, 58% of employees cited their manager's management style as the primary reason they quit a job — up from 37% just eight years earlier. That number is climbing fast. And 90% of employees said their boss influenced their decision to leave their last job.

Ninety percent.

Gallup has been studying this for decades. In one of their largest studies — over 7,000 adults — 50% of employees had left a job at some point in their career, in their words, "to get away from their manager to improve their overall life."

Half. Half of the working population has, at some point, quit a job to escape a leader.

And here's the one that hits hardest in healthcare specifically.

According to the 2026 NSI National Health Care Retention Report, the average cost to replace a single staff registered nurse is now $60,000. Hospitals are losing an average of $5.2 million per year to nurse turnover alone. The national RN turnover rate is 17.6%, and in some specialties like behavioral health, it's over 22%.

Now think about that.

We have an industry where workers leave their jobs primarily because of their managers. We have a workforce shortage so acute that replacing a single nurse costs $60,000. And our solution to leadership in this industry is to promote our best clinicians and hope they figure it out.

If you ran the math like that on any other system in healthcare — if you saw a $60,000-per-incident error rate that was preventable through training — you would not tolerate it for ten minutes. You would invest in training tomorrow. You would build the systems. You would write the policies. You would mandate the education.

But because the cost shows up as turnover, and burnout, and quiet quitting, and people slowly leaving the profession altogether — it gets normalized. It becomes "the way healthcare is right now."

It doesn't have to be the way healthcare is.

One Leader's Story

Let me tell you about a leader I worked with. I'm keeping her anonymous, but this story is so common I could be describing any one of dozens of my private coaching clients.

She is a nurse. She has been with her health center for over a decade. She is clinically excellent. Her patients ask for her by name. The providers all want her to be their nurse. The staff respects her. She knows the systems, the patients, the community.

So when the Clinic Director role opened up, the leadership team did what most leadership teams do. They promoted her. Of course they did. She was the obvious choice.

And then, predictably, the wheels started coming off.

Not because she's not capable. She is enormously capable. But because the job she was promoted to is fundamentally different from the job she was excellent at - and nobody had ever explained that to her.

When I started working with her, here is what was happening.

She was working sixty hours a week. She was answering emails at ten and eleven o'clock at night. She was the first call for every clinical question, every staff conflict, every operational hiccup. Two of her medical assistants had recently given notice, both telling HR on the way out that they didn't feel supported. She had a provider who hadn't been giving direct reports any feedback in months because she didn't know how to have the conversation. She was, in her own words, drowning.

And she was starting to believe she was just not cut out for leadership. She was actually thinking about going back to being a staff nurse.

That part broke my heart every time she said it. Because she absolutely IS cut out for leadership. She has every quality I look for in a great leader. She had just never been taught the actual skills of leading. The frameworks. The scripts. The systems. The mental models. The boundary-setting practices. The succession planning. The team architecture.

She had been promoted into a role and handed a title - but never handed the education to go along with it.

What We Did Over Six Months

Here is what we worked on together, over about six months.

The Identity Shift. This was where we started. I helped her understand that her job had fundamentally changed. She was no longer paid to do the clinical work. She was paid to make the clinical work happen through other people. That sounds simple, but for clinicians turned leaders, it is one of the hardest mental shifts to make. Every instinct says, "I'll just fix it myself. I'll jump into the room. I'll do the vitals. I'll room the patient." Leadership requires unlearning that instinct.

Candid Conversations. We built scripts for the conversations she had been avoiding for months. And then she started having them. She told the provider directly what she needed. She gave a long-tenured staff member real feedback for the first time. She started running her one-on-ones with structure instead of just asking "how's it going?"

Time Management and Delegation. This is something I find most leaders struggle with the most, and it is why they burn out. She started protecting two hours of her week for actual leadership work - strategic thinking, system-building - instead of just putting out fires.

Team Design and Recruitment. She started building the team architecture that didn't require her to be the bottleneck for every decision.

Sustainability. Because the most overlooked leadership skill in healthcare is the skill of staying. Of not burning out. Of taking your vacation and actually being on vacation. Of building the systems that allow you to step away without your team falling apart.

Six months in, here is what changed.

Her hours were back down to around forty-five a week. Her clinic had hired two new medical assistants, both of whom were still there a year later. She had not lost a single staff member in eight months. Her provider's productivity was up. Her patient satisfaction scores were up. And - this is the part I think matters most - she was no longer wondering if she was cut out for the job. She knew she was. She just finally had the tools.

That is what trained leadership looks like.

And that transformation is replicable. It is not magic. It is not personality. It is not "having it" or "not having it."

It is a skill set that can be taught. But only if we actually decide to teach it.

Why This Matters More in Healthcare

Here is why I think this matters more in healthcare than in almost any other industry.

In healthcare, when a leader struggles, the cost doesn't stop at the leader. It cascades — and it cascades fast.

A struggling clinical leader means a struggling team. A struggling team means struggling retention. Struggling retention means more travel nurses, more agency staff, more onboarding costs, more inconsistency in patient care. Inconsistent patient care means worse outcomes, lower satisfaction scores, more complaints, more medication errors, more patient falls.

The research bears this out. Hospitals with high nurse turnover see a 7% increase in patient falls, a 12% rise in medication errors, and a 15% decline in patient satisfaction scores. That is not just an HR problem. That is a clinical quality problem. That is a patient safety problem.

And the leaders themselves? They are not okay either. Between 35% and 54% of the US nursing and physician workforce reports symptoms of burnout. The leaders carrying those teams are even worse off than the teams themselves.

So when we don't develop our leaders - when we just promote them and hope — we are not just being unfair to them. We are not just being inefficient as organizations. We are actually compromising the quality of care our patients receive.

This is a mission issue. For Federally Qualified Health Centers, for safety-net providers, for any mission-driven healthcare organization - investing in leadership development is not separate from the mission. It IS the mission, expressed in how you treat the people who treat your patients.

If we are serious about the dignity and worth of every patient we serve - and most of us are - then we have to be just as serious about the dignity and worth of every leader we promote. That means giving them what they need to succeed. Not just the title. Not just the pay bump. The training.

Four Things Every Health Center Should Do

Here is what actually works. I have spent the last several years building and refining what I think makes the difference, and there are four things I want every health center leader, every CEO, every board member to consider.

1. Stop assuming clinical excellence translates to leadership ability.

It doesn't. They are two different skill sets. When you promote a clinician into leadership without leadership training, you are setting them up to fail in slow motion. Recognize the gap, and commit to closing it.

2. Make leadership development a budgeted, predictable line item - not an emergency response.

Most health centers respond to leadership struggles reactively. A leader is in crisis, so we bring in a coach. A team falls apart, so we hire a consultant. By the time we get there, the cost has already been paid - in turnover, in patient experience, in lost goodwill. Build the development into the system before the crisis.

3. Develop your leaders as a team, not just as individuals.

This is the piece almost nobody does, and it is where I have seen the biggest organizational impact. When you send one leader to a conference, they come back with ideas - but they are alone in trying to implement them. When you develop your entire leadership team together, with shared frameworks and shared language, the whole culture shifts. People stop reinventing wheels. Departments stop operating in silos. Difficult conversations get easier because everyone has been trained in the same approach.

4. Invest in the skills your leaders actually need.

The corporate world has flooded the leadership development market with content that sounds great in a TED talk but lands awkwardly in a community health center. We don't need our medical directors to learn the leadership principles of a tech CEO. We need them to learn how to have a hard conversation with a provider who is burning out. How to manage up to an executive director who doesn't understand clinical reality. How to design a clinic that runs itself when they are on vacation. How to retain a medical assistant in a market where every other clinic is also hiring.

That is the content that moves the needle. And that is the content I have spent my career building.

The Work I Do

If something in this is landing - if you are recognizing your organization, your leaders, or yourself in what I am describing - I want to gently let you know that this is the work I do.

I run leadership development programs for health centers and clinical organizations. I work with CEOs, executive teams, and entire leadership cohorts to build the skills that aren't being built anywhere else. My Leadership Academy curriculum covers everything from the identity shift to candid conversations to succession planning, and it has been tested by hundreds of healthcare leaders across community health centers, FQHCs, private practices, and specialty clinics.

What's been most exciting lately is the work I have been doing with full leadership teams at health centers. I recently designed a ten-month program for a large FQHC where I come in once a month to teach a live masterclass to their entire leadership team, plus twice-monthly group coaching calls, plus dedicated one-on-one coaching for individual leaders. We start with the identity shift. We end with the operational systems that let a clinic run itself. And in between, we build every leadership skill that should have been taught when they were promoted - but wasn't.

The leaders who go through this work don't just become better leaders. They become sustainable leaders. They stop drowning. They start sleeping. They take their vacations. They keep their best staff. They actually start to enjoy the leadership role they once secretly resented.

One Last Thought

I want to leave you with one last thought.

The leaders in your organization right now - the ones running your clinics, your departments, your service lines - they did not get to where they are by accident. Someone saw something in them. That was probably you. Someone trusted them with this responsibility.

The question is whether we are going to keep trusting them to figure it out on their own, or whether we are going to give them what they actually need to succeed.

Because here is what I know after a lot of years of doing this work.

People don't quit healthcare because the work is hard. The work has always been hard.

People quit healthcare because the leadership is hard, and lonely, and unsupported, and they finally decide they can't do it alone anymore.

We can change that. We have changed it, organization by organization, leader by leader. And every time we do - every time we take a brilliant clinician who was thrown into leadership and we give them the training they deserved from day one - something beautiful happens.

They stay. Their team stays. Their patients are better cared for. And the mission that brought all of us into this work gets a little bit stronger.

That is worth investing in.

Ready to Talk?

If you are a CEO, executive director, or board member who has been watching your leaders struggle - or worse, watching them quietly look for the door - I would love to have a real conversation about what you are seeing in your organization.

I am taking on a small number of new health centers this year for full leadership team development, and these conversations are how we figure out together if it is a fit. There is no pitch, no pressure - just an honest conversation about your leaders, your team, and what the right next step might be.

👉 Schedule a conversation with me

🎙️ Listen to Episode #27

Your leaders deserve more than a title. They deserve the training that should have come with it.

Connect with Jill:

• Website: www.jillsteeley.com
• Leadership Masterclasses: www.jillsteeley.com/leadership
• Schedule a conversation (link to Jill’s calendar)
• Email: [email protected]

Jill Steeley is a leadership coach and healthcare consultant who has spent her career helping mission-driven healthcare organizations develop the leaders they need to thrive. Her work spans CEO-level strategic coaching, executive team development, and leadership academies for clinical and operational leaders across Federally Qualified Health Centers, community health organizations, and private practices. She is the host of the Community Health Collective Podcast and the co-leader of the CEO Connect Bootcamp with Steve Weinman.