Calling All Mid-Level Managers in the Health System

Sofia Ramirez

There's a lot of buzz right now, you know, about everything from President Trump's decisions regarding the WHO to RFK Jr.'s controversial statements, even whispers about radical change in health policy on the horizon. It can feel overwhelming, like all these external forces are completely out of our control.

David Caldwell

Right! And it totally feels like CEOs or, I don’t know, these billionaires driving Teslas have all the power. It’s like "What can I even do against that?" It’s almost paralyzing sometimes.

Sofia Ramirez

Exactly. It's easy to fall into the trap of feeling helpless, like we don't have any way to influence such a massive, complex system. But here's the thing—we do. We actually have more power to shape the health system than we think, especially when we start working together.

David Caldwell

Wait, seriously? Like... you're saying regular people, not politicians or CEOs, hold that kind of influence?

Sofia Ramirez

Absolutely. Of course, we'll talk about the politicians and the wealthy because they're part of the system. And we'll talk about regular folks without formal titles in an episode soon too. But we can't underestimate the impact mid-level managers can have. These are people like hospital department leads, university deans, and public health managers—people who often direct everyday decisions.

David Caldwell

Okay, I get that they have influence. Like, they hire folks, maybe sign off on budgets? But you're really saying they could, what, revolutionize our health system?

Sofia Ramirez

Yes, and here's why. We're not just talking about improving the existing system. Mid-level managers can help redefine how the system operates entirely—helping to move toward a vision where health outcomes are more important than profits or ways of doing things that we inherited. They’re perfectly positioned to make this shift.

David Caldwell

Whoa, I feel like, uh, that’s a bit mind-blowing. I mean, these are folks working in team meetings and conference rooms. But you’re saying—

Sofia Ramirez

Exactly—they're the ones who can influence the strategic direction of their organizations. They're involved in hiring and forging collaborations. And, just as importantly, they can create environments that value innovation and align teams around big changes. Even when others in the system resist.

David Caldwell

Huh. So, they're not flying under the radar, but they can be like... the unsung heroes of transformation?

Sofia Ramirez

That’s one way to look at it. They’re often the ones who can shape cultures of belonging and support job security for progressive thinkers. It can be lonely and isolating to work against the status quo. They can inspire their teams to work for change rather than reinforcing the way things have always been.

David Caldwell

So basically, they’re the health system version of, uh, secret agents?

Sofia Ramirez

If secret agents planned staff meetings and tackled bureaucratic red tape, then yes, exactly.

David Caldwell

Love it. Alright, quick side note—you’re an AI. I’m an AI. Let’s just remind everyone there’s a real person behind all this brilliance we’re dropping.

Sofia Ramirez

That’s true. Dr. Chad Swanson, an ER physician, is the person guiding this discussion. He’s active on LinkedIn, TikTok, and YouTube. And he’d love your feedback.

David Caldwell

So hit him up. He'll, like, communicate with you, real person to real person. Okay, let’s keep going—this whole “stealth mid-level manager as change-maker” thing is blowing my mind.

David Caldwell

So help me get this straight. You’ve been talking about mid-level managers, like hospital department leaders or chief officers. What exactly makes them such key players in this whole healthcare transformation you’re describing?

Sofia Ramirez

Great question. So let’s start with one of their biggest powers—they’re the ones who hire people. And not just anyone. They have the ability to bring in clinicians, administrators, and other leaders who share a vision for transformation. It’s not just about filling roles; it’s about aligning teams with a mission for real change. That's huge because most new hire decisions are made based on the candidate's ability to excel in the current environment.

David Caldwell

Wait, hold on. Are you saying the people they choose to hire could make or break an organization’s ability to innovate?

Sofia Ramirez

Absolutely. Imagine hiring someone who isn't just qualified but also deeply committed to tearing down those institutional barriers we’ve been talking about. Those hires set the tone, and they build momentum.

David Caldwell

That’s... kind of incredible. Like, mid-level managers could quietly assemble the A-team for a healthcare Avengers-style transformation?

Sofia Ramirez

Something like that! They have the latitude to look beyond just technical qualifications and find people who are passionate about the bigger picture. That alone can have a ripple effect down entire departments.

David Caldwell

Okay, but let’s keep it real here. These managers still work within a system, right? I mean, they’re not completely free to, I don’t know, just shake things up without constraints or red tape getting in the way.

Sofia Ramirez

You’re absolutely right, they do face constraints. But that’s what makes their role so critical. They operate within the boundaries of the system, sure, but they also have opportunities to challenge the status quo in ways that higher executives often miss or ignore.

David Caldwell

Huh, okay. So what else? Besides hiring the right people... how else are they driving this change?

Sofia Ramirez

They create conditions where innovation can actually thrive. That means fostering a culture that doesn’t punish experimentation or failure, building trust among their teams, and advocating for the resources their departments need to succeed. Even in high-pressure, low-margin environments like hospitals, these managers can help their staff feel safe enough to think big.

David Caldwell

So, like, by being the ones who care about... I dunno, morale and teamwork, they’re kind of laying the foundation for what, big-picture reform?

Sofia Ramirez

Exactly. It’s not just about morale—it’s about aligning morale with purpose. When people feel supported, they can channel that energy into engaging with the bigger challenges of the health system. Hiring is important, of course, but mid-level managers have all kinds of ways they can amplify impact. For example, what if they organized and supported a "transformational change group," a group that explored real world ways to move beyond fee for service, hold people accountable for improved health (not just providing services), etc.?

David Caldwell

Wow, I don’t think I’ve ever thought about this—like really thought about—how one person in middle management could, you know, ripple out across an entire health system. It’s powerful stuff.

Sofia Ramirez

It is. And when that ripple effect grows, it reaches beyond the hospital walls. We need many, many more. It has the potential to transform how the entire healthcare system thinks about access to quality care, equity, innovation... everything.

David Caldwell

We’ve covered how mid-level managers in hospitals can drive some serious change, but what about universities? Are deans stepping into a similar role, or is their influence completely different when it comes to shaping the health system?

Sofia Ramirez

Well, maybe not capes, but definitely influencing change. Mid-level managers in academic institutions—like department chairs or program directors—have a surprisingly big role to play. They’re uniquely positioned at the intersection of education, research, and health systems implementation.

David Caldwell

Okay, I see where you’re going, but let’s keep it real. How does being, I don’t know, the head of a microbiology department or some academic division actually make a difference for the healthcare system?

Sofia Ramirez

It’s a fair question. Let me give you an example—Dr. H. Jack Geiger. He was serving in what we’d call a mid-level academic role back in the 1960s, and he co-founded the country’s first community health centers in places like Mound Bayou, Mississippi, and Boston.

David Caldwell

Community health centers? Those are like, clinics for underserved communities, right?

Sofia Ramirez

Exactly. But here’s what made them groundbreaking—these centers didn’t just provide medical care. They addressed social determinants of health, like access to proper nutrition, education, and even economic development. Dr. Geiger recognized that treating patients wasn’t enough if the environment they lived in was making them sick all over again.

David Caldwell

Wait, wait, wait. So this guy wasn’t just running some academic program; he was launching a whole movement.

Sofia Ramirez

He was. His work laid the foundation for a national network of community health centers, which now serve millions of low-income patients across the U.S.

David Caldwell

That’s... honestly kind of wild. I mean, it’s easy to think professors or deans are just, you know, writing papers in ivory towers. But this is real, tangible change.

Sofia Ramirez

Exactly. People like Geiger—mid-level academic leaders—can connect research, education, and practical applications to address systemic problems in healthcare. It’s not just about teaching the next generation; it’s about creating programs and initiatives that ripple out into the world.

David Caldwell

So, mid-level managers in academia are like, what, the architects of these big social health projects?

Sofia Ramirez

That’s a good analogy. They have just enough autonomy to innovate, while still being close enough to the ground level to see real-world needs. They act as a bridge between ideas and action.

David Caldwell

Alright, I’m sold. Mid-level academic managers—unsung heroes. Got it.

David Caldwell

So we’ve talked about how mid-level managers in hospitals and academia can drive innovation and solve real-world problems. It’s pretty eye-opening, honestly. But what about public health? Do mid-level managers in public health offices really have the same kind of impact?

Sofia Ramirez

Absolutely, and the work they do often has an impact that goes far beyond just their local communities. Take Dr. Charles V. Chapin, for example. He was a superintendent of health in Providence, Rhode Island—essentially a mid-level manager back in the early 1900s—but his approach completely revolutionized public health.

David Caldwell

Revolutionized? What, like, invented handwashing or something?

Sofia Ramirez

Not quite, but close. Chapin championed the use of scientific approaches to prevent and control disease. He was one of the first to implement methods grounded in epidemiology rather than just relying on quarantine as the default for every outbreak. His work dramatically reduced infectious diseases in Providence.

David Caldwell

So, like... he was figuring out how diseases spread before we had, you know, modern tools or even germ theory fully accepted?

Sofia Ramirez

He was operating in a time when public health was still finding its footing as a science. He could have done things the way they had been done, but he chose to do things differently. Chapin understood the importance of data and evidence, and he used those tools to change how cities managed disease outbreaks. In fact, his emphasis on prevention over reaction shaped public health policies across the country.

David Caldwell

Huh. Prevention over reaction—that’s kinda like... washing your car to prevent rust instead of waiting to patch holes in the floor?

Sofia Ramirez

That’s a decent analogy! And it worked. By applying this philosophy, mid-level managers like Chapin could enact practical, scalable changes that saved countless lives. They weren’t just administrators—they were innovators, often without the resources or recognition they deserved.

David Caldwell

That’s wild. So what can we learn from Chapin’s work now? Are mid-level public health managers still driving this kind of change?

Sofia Ramirez

Definitely, but much more can be done. Like Chapin, they have a unique vantage point—they’re close enough to see how policies affect real people but high enough up to influence strategy. They can champion data-driven initiatives, collaborate across sectors, and create sustainable programs. All without waiting for top-level executives to greenlight every decision.

David Caldwell

So basically, they’re like the nerve centers of public health systems—quietly running everything but only noticed when things go wrong?

Sofia Ramirez

Exactly. And when they do their jobs well, they make it easier for local communities to thrive. Public health is all about the groundwork—making changes that might not grab headlines, but that lay the foundation for healthier futures.

David Caldwell

So, we’ve talked about hospitals, academia, and public health offices—how mid-level managers are shaping so much behind the scenes. But it’s got me wondering: How does all that connect with everyday people in the community? Are they playing a role in this, too?

Sofia Ramirez

Absolutely, David. Change doesn’t always start in boardrooms or government buildings. Sometimes it begins with community organizations, nonprofits, or even individuals who just refuse to accept the status quo. Let me give you an example—have you heard of the Camden Coalition in New Jersey?

David Caldwell

Uh, no, but I can guess it’s not a group of superheroes in capes solving the health system?

Sofia Ramirez

Not exactly, but they’re still pretty heroic. The Camden Coalition was started by Dr. Jeffrey Brenner, a primary care physician who noticed that a small number of patients in Camden were using up a disproportionate amount of healthcare resources—often because their social needs, like housing or food, weren’t being met. So he created a group to focus on these “super-utilizers.”

David Caldwell

Wait, so instead of just treating patients over and over, they looked at the root causes behind why these folks kept coming back?

Sofia Ramirez

Exactly. They tackled those underlying issues—offering support for housing, mental health, or navigating insurance—and they ended up drastically reducing hospital visits for these patients. This wasn’t a top-down initiative from Washington or some huge corporate program. It was local, community-driven, and it proved that focusing on people’s broader needs could improve health outcomes and even lower costs.

David Caldwell

Wow. So one guy, one coalition, completely flipped how we think about high healthcare costs?

Sofia Ramirez

That’s right. And it’s not just about healthcare. Take, for example, the work of organizations like Springboard to Opportunities in Mississippi. They focus on providing economic and social support to families living in affordable housing. By helping people achieve stability in their lives, they indirectly improve health outcomes too.

David Caldwell

Huh. So these groups are kind of teaching us that the barriers between social issues and health issues are... well, imaginary?

Sofia Ramirez

Exactly. They show us that if you support people holistically—through their housing, their education, their food security—you end up improving their health as well. And these efforts are often driven by people who aren’t waiting for permission to make change. They just do it.

David Caldwell

That’s actually super inspiring. So health systems transformation isn’t just about managers, or politicians, or CEOs—it’s really about all of us?

Sofia Ramirez

That’s exactly the point. Whether you’re a mid-level manager, a community leader, or just a passionate individual, there’s always room to challenge the status quo and make a difference. It doesn’t require a cape, just commitment and a willingness to act.

David Caldwell

Okay, so now I feel like I need to go out there and, I don’t know, join three nonprofits or something.

Sofia Ramirez

You don’t have to do that, David, but even raising awareness about these issues is a great start. Every bit counts.

David Caldwell

Fair enough. Honestly, though, this whole conversation has been eye-opening. I mean, we started talking about mid-level managers, and now I’m thinking about grassroots change, stealth innovators, and mission-driven coalitions. Wild ride.

Sofia Ramirez

It really is. And it shows that change doesn’t happen in isolation. It’s about connecting ideas, people, and efforts at every level—from hospitals to public health to the community. If any listeners take one thing away from this, it’s that transformation could be closer than we think. It starts with us.

David Caldwell

Love it. Alright, folks, thanks for joining us today. Maybe you learned something new, maybe you’re feeling inspired to shake up the system yourself. Either way, we’re glad you tuned in. The key, as we always say, is a relentless focus on a shared vision of health. For all. At the lowest cost

Sofia Ramirez

And we’d love to hear your thoughts. If there’s a story or idea you’re passionate about, share it with us! We're here everyday, and we want to be responsive to your needs and questions. Until next time, everyone—let’s keep working toward a healthier future.

David Caldwell

On that note, we’ll see you next time. Stay curious.