When Kathy Donovan, MSN, RN, joined Springfield, Ill.-based Hospital Sisters Health System as senior vice president and COO in 2023, she recognized the need for changes to the leadership structure.
Ms. Donovan had already worked in highly matrixed systems. Before coming to HSHS, she served as group COO for Tenet Healthcare's Detroit market as well as president and CEO of the DMC Children's Hospital in Detroit. She also previously served as COO and chief nursing officer at SSM Health Cardinal Glennon Children's Hospital in St. Louis and as COO of HCA Healthcare's Sunrise Children's Hospital in Las Vegas.
And when she joined HSHS, the hospitals reported up through her and, at the time, "we had 15 hospitals, and I was trying to get my arms around all 15," Ms. Donovan told Becker's. "We just seemed like we were a bit disjointed, with each hospital functioning in a silo."
She and other leaders at the system continued to think through the organization's leadership structure. This ultimately led to HSHS' new senior leadership approach, launched in June, which appoints market-level chief executives to manage ministry operations in its three core markets: Central Illinois (Springfield), Southern Illinois (O'Fallon) and Wisconsin (Green Bay).
As part of the approach, the three chief executives will be supported by market-level COOs, chief nursing officers and chief medical officers. HSHS also eliminated the role of president and CEO at Holy Family Hospital in Greenville, Ill.
Kelly Sager, MSN, had served as president and CEO of Holy Family Hospital since March 2019 and is no longer with the organization. HSHS has named Teresa Cornelius, DNP, RN, chief administrative officer for Holy Family Hospital. Dr. Cornelius is also CAO of HSHS St. Joseph's Hospital in Highland, Ill.
HSHS was able to elevate many internal candidates to this new leadership structure as well, including Allison Paul, DNP, RN, chief nursing officer of HSHS St. John's Hospital in Springfield, Ill., who was promoted to CNO of the HSHS Central Illinois Market, and Isabelle Garibaldi, DNP, MSN, RN, who was named as market CNO for HSHS Wisconsin. Both roles were announced this week.
"HSHS has three larger facilities that are flagships, and then smaller ministries encircle the flagships," Ms. Donovan said. "So [the new approach] lended nicely, just from the way each hospital is laid out in the market, to move to these structures."
Even so, she acknowledged there was a lot of preparation involved and time discerning whether the approach was the best option.
"In any big decision you make, you really have to make sure you take the time to work through all the pros and cons of the process," Ms. Donovan said. "That includes pulling in local boards and the board chairs, along with the system board, and also considering key community stakeholders, because we didn't want any of the ministries to lose their identity.
"That can be some of the fear in moving to these market structures. So we wanted to make sure that the local boards, the local leadership teams, and the community were behind us. We discerned whether we should stay with the current model we had or move to a more modernized model. Luckily, I feel very thankful that we have the support we needed to move in this direction."
Ms. Donovan also noted that the system's Green Bay market essentially functioned like the new structure already, so system leaders could talk about successes in that market in the two markets they were looking to incorporate.
A long-term CEO in Green Bay had arranged the market to function in terms of service line leadership and how care was coordinated between the smaller ministries and the large markets.
"They were very successful in Green Bay with what we call our swing bed program, so when the flagship hospitals are full, there's a place to send some of the lower acuity patients. That's one of the major successes we highlighted," Ms. Donovan said.
"It was also a big win for the medical staff because they can care for their patients across the continuum. So we lifted that model and brought it down to Illinois, where our other two markets exist today, and we really engaged the local boards."
She said HSHS also wanted to have one CEO title per market, and the system elevated those titles to market CEO to reflect the scope of what they were currently covering. The system focused on clinical leadership in smaller ministries as well.
"So what we came up with was changing the rollout from CEO to chief administrative officer, which is a very common title for hospitals besides, for example, Holy Family, which has about 10 inpatient beds," Ms. Donovan said.
One of the qualifications to hold the CAO title is to be a nurse, "because we wanted to stand behind the model that we value clinical quality care above all else. So that was our thinking there of promoting nurses into these roles and then reporting up to the market CEOs," she said.
While the new leadership approach is still in its infancy, Ms. Donovan pointed to multiple wins so far. One example is from the Southern Illinois market. She said there is a 7:15 a.m. bed huddle call during which all clinical leaders get on the phone by market. The market chief nurse runs the calls.
"We really talk about every single patient that's on the board for discharge, and we work through the holds at the flagship hospital," she said. "This has maximized the inpatient beds at the small ministries while freeing up St. Elizabeth's Hospital in O'Fallon to take care of the sicker patients that need more resources. It also allows our subspecialists to gather at the ministries, and it makes life for the physicians a little easier."
Additionally, the CAOs have been well received, Ms. Donovan said.
"The proof is in the pudding," she said. "And the way these leaders have stepped up and stepped into these roles, I really feel like the hospitals feel they're being taken care of, the boards feel they're being taken care of, and certainly, the community feels their presence.
"It was really important for me to still have a present leader that's from the community leading these hospitals. … And these were longtime leaders that were already in the community, such as Teresa Cornelius stepping up. So they've been very well received. Everything has been positive feedback, and we're really excited for what this next year brings for us."