Working to the Top of Your Title

In healthcare, successful leadership is both independent and collaborative. Effective leaders understand the importance of their unique role, but rely on the input and contributions of others to truly excel. Knowing the responsibilities associated with a specific management title or position distinguishes workload distribution and controls expectations. It is equally critical that staff are fully aware of “who is their leader and what do they do.” This eliminates any confusion surrounding “chain of command” and identifies the most appropriate individual(s) to address specific questions, handle certain situations, or provide the help required.

Here is a bottom-up breakdown of some of the most common leadership roles in healthcare:

  • Supervisor: a person who is in charge of others within a department. The supervisor’s overall role is to communicate organizational needs, oversee employees’ performance, provide guidance, support, identify development needs, and manage the reciprocal relationship between staff and administration
    • Often considered a “Lead” position and work within staffing 100% of their time
  • Manager: responsible for supervising and motivating employees and for directing the operations of a department(s)
    • Often synonymous with the Director role, but in larger organizations a department Manager reports up to the Director
    • The Manager oversees day-to-day operations, designs strategy, sets goals for growth, maintains budgets, optimizes expenses, establishes policies and processes, ensures employees work productively and develop professionally, and oversees recruitment and training of new employees
    • In most organizations, Managers are a “working” leader and are in staffing about 50% of their time or more
  • Director: departmental or service line administrator who commonly manages multiple cost centers, sometimes unrelated in operations, within a hospital or health system. They are responsible for developing short/long-term operational strategies and overseeing implementation
    • Directly manage personnel, service delivery, supplies, schedules, customer services, finances, etc. and routinely interface with other administrators/providers
    • In most healthcare organizations, Directors are working administrators and provide hand-on support about 20% of their time
    • Reports up through a Vice President or directly to the C-suite executives in smaller organizations
  • VP (Vice President): the administrator that manages and coordinates the operations of several departments/service lines to ensure proper execution and effective delivery. Responsible for defining and enforcing departmental/service line policies and procedures
    • Reports up to an EVP where appropriate and/or C-suite executives
  • DON (Director of Nursing): responsible for leading and supervising nursing units within a hospital or health system. This position is ultimately responsible, and accountable, for the nursing care received by patients
    • The DON report to the CNO and has administrative and supervisory roles
    • In some organizations, the CNO and DON are synonymous with only one designated nursing executive
  • C-Suite Executives
    • CNO (Chief Nursing Officer): an experienced nurse who provides leadership to the nursing team and helps manage finances, enforce policies, and connect patients with the care they need
      • The CNO fulfills a wide variety of regulatory duties, implements treatment plans, integrates new medical technologies, assigns schedules, and onboards new nurses in addition to overseeing patient care
      • In smaller healthcare organizations, the CNO may also step-in to provide direct patient care
    • COO (Chief Operating Officer): the senior executive tasked with overseeing the day-to-day administrative and operational functions of a hospital or health system
      • The COO typically reports directly to the CEO and is considered to be second in the chain of command
      • Smaller healthcare organizations tend to not have a defined COO role with these responsibilities shared among the other designated executives
    • CFO (Chief Financial Officer): the senior executive with responsibility for the financial affairs of a hospital or health system
      • The CFO only oversees the financial operations and reports to the CEO, not to the board of directors
      • Often supported by the Controller, a higher-level finance position that takes the responsibility over the financial reporting process to deliver internal and external statements
    • CEO (Chief Executive Officer): the highest-ranking person in a hospital or health system; the executive with the greatest decision-making authority
      • The CEO typically outranks the President, the second highest-ranking officer, but in some organizations both roles may be held by the same individual
      • The CEO is typically appointed by the board of directors and is the person in charge of the overall day-to-day management.
        • Conversely, the Owner, as a job title, is the sole proprietor who has total ownership of the business, but does not have to be in charge of company management

Contrary to popular belief, leadership is not “untouchable!” and only truly thrives through partnership with one another and those they are tasked with supporting. Strong leaders at every level should be visible and approachable. That said, it is also essential that the boundaries defined by each title be understood and respected. This creates a distinct career path and promotes a healthy work environment.

ALTIUS works closely with all layers of client management, providing the education, data, and tools necessary for them to enhance their skills and work to the top of their titles.  To learn more about our services and partner with us, reach out directly at [email protected] or visit our website at

Leave a Reply

Your email address will not be published. Required fields are marked *