By: Allison McCarthy, MBA | amccarthy@barlowmccarthy.com
My client had served as a Senior Director of Ambulatory Operations for a large health system. Sitting squarely in the middle of leadership, this leader was responsible for bridging strategy from the top, aligning peers across functions, and ensuring operational clarity for hundreds of frontline staff.
The pressures were constant: balancing executive’s expectations, navigating organizational re-structures, and managing the churn of healthcare change while trying to keep teams engaged and focused.
The Challenge of the Middle
Mid-level leaders frequently feel “squeezed.”
Senior leaders demand quick results in a shifting healthcare landscape. Peers compete for resources and visibility. Teams need clarity in the midst of constant reorganization.
Leadership at this level is about influence, presence, and clarity. These are all skills that determine whether work accelerates… or stalls.
Issues on the Table
When the client began coaching with me, they were navigating several challenges:
- Difficulty managing up to senior leaders amid shifting strategies and frequent leadership turnover.
- Struggles with peer collaboration, especially when priorities conflicted.
- Communication breakdowns with teams, leading to siloed work and disengagement.
- A sense of being reactive instead of proactive in high-pressure leadership moments.
- Concerns about personal wellness: stress, exhaustion, and the toll of balancing career demands with personal commitments.
Coaching in Action
Through our coaching sessions, my client and I worked systematically across six core areas:
- Gravitas: Building presence under pressure by regulating emotions, projecting steadiness, and practicing decisiveness in uncertain situations.
- Communication: Developing tools for reframing messages, using active listening, and adapting style for senior executives, peers, and frontline staff.
- Influence: Shifting from waiting for executives to make the necessary changes to proactively leading it themselves.
- Relationships: Mapping key stakeholders and creating a “relationship agenda” to intentionally strengthen alliances with senior leaders, peers, and cross-functional partners.
- Adaptive Leadership: Learning to step onto the “balcony” to see patterns and anticipate challenges, while translating strategy into actionable steps for teams.
- Personal Wellness: Establishing routines for balance and resilience so the leader could show up with energy and clarity in demanding situations.
Together, these six areas created a foundation for leading with influence rather than relying on position.
The client learned to see pressure moments as opportunities to project steadiness, and everyday interactions as chances to build trust. Most importantly, the work gave them a repeatable framework, one they could return to whenever the demands of mid-level leadership began to feel overwhelming.
Presence and Influence
This client discovered that influence wasn’t tied to position, but to presence and credibility. Coaching emphasized small but powerful shifts: speaking with steadiness in pressure moments, clarifying decision rights, and showing confidence in delegation.
As the client reflected:
“It’s not that I necessarily needed the title or the money, it was more about having a role where I felt my skills were valued and respected.”
For this leader, the real turning point was realizing that leadership wasn’t only about chasing titles or paychecks, but about ensuring their skills were recognized and put to use.
That shift made presence less about outward performance and more about inward alignment: showing up with clarity, steadiness, and conviction because the work itself mattered. In their words, being valued and respected became the true measure of influence.
Personal Wellness and Boundaries
Another key breakthrough was learning to balance ambition with sustainability. This leader had always been driven, often putting work ahead of everything else.
Coaching created space to step back, define priorities, and protect personal energy.
“I’ve always been head down, get the work done, do a really good job. But that doesn’t always get you anywhere. Coaching helped me see that lack of responses wasn’t rejection, it’s just people having a lot on their plate.”
“I have to have some boundaries for myself. I realized it wasn’t about chasing a title. It was about finding a role that valued my skills, while giving me the flexibility I need right now.”
These reflections marked a significant shift: success was no longer defined by constant overwork, but by alignment between values, energy, and goals.
By creating boundaries and adjusting communication approaches, this leader found a more sustainable way to grow. In the end, personal wellness wasn’t a distraction from leadership, it was the foundation that allowed them to show up with clarity and resilience in every direction.
The Shift Forward
Over time, the client’s mindset evolved:
- From feeling “stuck in the middle” to leading in all directions— up, down, and across.
- Clarity on decision rights and confidence in delegation.
- Stronger peer and upward influence, ensuring their voice carried weight in strategic conversations.
The client began to see mid-level leadership not as a holding pattern, but as a launchpad for broader impact.
Results
The results were tangible:
- Improved team alignment and morale, with clearer communication and direction.
- Recognition from senior leaders for bringing clarity to complex initiatives.
- Greater confidence in navigating tough conversations and high-stakes moments.
- Renewed energy and focus, balancing long-term goals with personal wellness.
This case study reinforces my central message: mid-level leadership is not a holding pattern. It is the place where true influence is forged.
A Takeaway for You
If you see yourself in this story, know that these shifts are possible for you too. Coaching can help you strengthen your influence, presence, and clarity no matter where you sit in the organization.
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Want to learn more about building influence from the middle? Start with downloading my free guide: Leading Up, Down, and Across from the Middle: Grow Where You Are, Then Grow Beyond
You can also schedule a free discovery call with me here.