Amid the rumbling shifts of healthcare reform is another change taking place within America's hospitals: the graying of the C-suite. The departure of longtime CEOs is signaling an influx of first-time leaders — a recent Witt/Kieffer survey found 41 percent of recent healthcare CEO placements had never held a CEO role before. Just as today's college freshman have no memory of George H. W. Bush as president, first-time hospital leaders named from March 2010 onward know no other healthcare environment but one in reform. The following professional trends and workplace issues are likely to affect the emergence, and success, of first-time hospital CEOs.
Healthcare leadership is "wide open"
Coinciding with the departure of longtime CEOs is a complementary trend: the emergence of hospital chiefs with unlikely backgrounds. Kim Smith, a former hospital CEO and current partner with executive search firm Witt/Kieffer, has seen this firsthand.
"There are more candidates coming from backgrounds we wouldn't have seen 10 years ago," says Ms. Smith. "There are more clinical folks, more finance backgrounds and more physician candidates." Only a few years ago, the path to the hospital C-suite was more structured and regimented. For example, a professional might have often completed an administrative residency, worked as a vice president and held the COO position before assuming the CEO title.
Now the process is much more flexible. Hospital boards are increasingly paying attention to how a CEO can help a hospital's unique strategy when making their selection. "I think healthcare leadership is wide open right now," says Ms. Smith. "It's a time when lots of different people will rise to the top of organizations."
Different leadership traits see higher demand
The entire healthcare industry is undergoing revisions to its philosophy with a newfound focus on collaboration. The emphasis on cooperative attitudes means a CEO's ability to work out of hierarchal bounds — and abandon a divide-and-conquer mindset — is crucial to the hospital's success. This ability is partially generational but also something people can develop professionally. "I think some of this change is the most difficult for traditionally-trained leaders to adapt to," says Ms. Smith. "It's not about who owns the power anymore. It's about managing the relationship."
For instance, hospital-physician relationships today are not as black and white as before, and leaders who can negotiate in these gray terms may see much more success. This is particularly true in terms of accountable care organizations, physician network expansion and patient-centered medical homes. "Today's leaders are approaching physicians as, 'What does this physician need from me, what do I need from him or her, and how can we both come out winning?'" says Ms. Smith.
When friends become direct reports
Compared to seasoned leaders, first-time CEOs are bound to experience cultural challenges within their first year on the job. Interpersonal relationships are often one of the largest sources of stress. "Most first-time CEOs are coming out of a senior leadership team where they've had peer relationships. As CEO, it can still be tempting to look at those people — who are now your direct reports — and fall back into those peer relationships," says Ms. Smith. This is likely to result in dysfunction, and the CEO should adopt a new approach to those relationships — something much easier said than done.
Behind-the-scenes duties
First-time CEOs will need to accept major changes to their personal schedule — even down to how much they visit the local gym. Professional dinners three to four times a week may present an unexpected shift in their work-life balance, as well as the scale. Regular meetings with philanthropists, system leaders, physicians and community stakeholders will also take a large portion of their time, as a "community-focus" is a keyword in their new job description.
Even CEO candidates who kept an eye on their predecessor's workload may be surprised with the amount of behind-the-scenes work. "Most people have watched CEOs, but the job is more demanding. You're not there from 7 a.m. to 7 p.m. That's your day job," says Ms. Smith.
First-timers' feelings of isolation
There are often bouts of loneliness and alienation in the C-suite, especially if it's the leader's first time at the reigns. Hospital leaders in today's competitive markets are most likely to feel isolated, according to Ms. Smith. "It is especially difficult in highly competitive markets because you can't pick up the phone and talk to your arch rival across the river. You can't talk about your bad day in the same way you could talk to a peer when you both reported to the CEO," she says.
Instead, some leaders are able to rely upon group purchasing organizations or other professional associations to talk with colleagues who are not in direct competition. This can prevent missteps — or reinforce their brilliance — when it comes time to present a groundbreaking idea to the hospital board.
How senior leadership can help
Members of the hospital's senior management team can certainly help these first-time CEOs without overstepping professional bounds. "Preparing that group before the new hire starts is critical," says Ms. Smith. "There will need to be key traits complemented by the team, so that will reassure them that they all still have a place." Seniors leaders might be nervous about these transitional changes. Adopting the mindset of group success — or pairing their success to that of the new CEO — can help reduce anxiety.
Sometimes the smallest things can help the CEO feel more comfortable, such as letting them know the best restaurants, car mechanics or dry cleaners in town. "Some of the things that unhinge leaders can be really simple," says Ms. Smith. She recommends hospital senior management help fill in the CEO on all the bits and pieces of knowledge they have acquired throughout their tenure at the hospital.
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Healthcare leadership is "wide open"
Coinciding with the departure of longtime CEOs is a complementary trend: the emergence of hospital chiefs with unlikely backgrounds. Kim Smith, a former hospital CEO and current partner with executive search firm Witt/Kieffer, has seen this firsthand.
"There are more candidates coming from backgrounds we wouldn't have seen 10 years ago," says Ms. Smith. "There are more clinical folks, more finance backgrounds and more physician candidates." Only a few years ago, the path to the hospital C-suite was more structured and regimented. For example, a professional might have often completed an administrative residency, worked as a vice president and held the COO position before assuming the CEO title.
Now the process is much more flexible. Hospital boards are increasingly paying attention to how a CEO can help a hospital's unique strategy when making their selection. "I think healthcare leadership is wide open right now," says Ms. Smith. "It's a time when lots of different people will rise to the top of organizations."
Different leadership traits see higher demand
The entire healthcare industry is undergoing revisions to its philosophy with a newfound focus on collaboration. The emphasis on cooperative attitudes means a CEO's ability to work out of hierarchal bounds — and abandon a divide-and-conquer mindset — is crucial to the hospital's success. This ability is partially generational but also something people can develop professionally. "I think some of this change is the most difficult for traditionally-trained leaders to adapt to," says Ms. Smith. "It's not about who owns the power anymore. It's about managing the relationship."
For instance, hospital-physician relationships today are not as black and white as before, and leaders who can negotiate in these gray terms may see much more success. This is particularly true in terms of accountable care organizations, physician network expansion and patient-centered medical homes. "Today's leaders are approaching physicians as, 'What does this physician need from me, what do I need from him or her, and how can we both come out winning?'" says Ms. Smith.
When friends become direct reports
Compared to seasoned leaders, first-time CEOs are bound to experience cultural challenges within their first year on the job. Interpersonal relationships are often one of the largest sources of stress. "Most first-time CEOs are coming out of a senior leadership team where they've had peer relationships. As CEO, it can still be tempting to look at those people — who are now your direct reports — and fall back into those peer relationships," says Ms. Smith. This is likely to result in dysfunction, and the CEO should adopt a new approach to those relationships — something much easier said than done.
Behind-the-scenes duties
First-time CEOs will need to accept major changes to their personal schedule — even down to how much they visit the local gym. Professional dinners three to four times a week may present an unexpected shift in their work-life balance, as well as the scale. Regular meetings with philanthropists, system leaders, physicians and community stakeholders will also take a large portion of their time, as a "community-focus" is a keyword in their new job description.
Even CEO candidates who kept an eye on their predecessor's workload may be surprised with the amount of behind-the-scenes work. "Most people have watched CEOs, but the job is more demanding. You're not there from 7 a.m. to 7 p.m. That's your day job," says Ms. Smith.
First-timers' feelings of isolation
There are often bouts of loneliness and alienation in the C-suite, especially if it's the leader's first time at the reigns. Hospital leaders in today's competitive markets are most likely to feel isolated, according to Ms. Smith. "It is especially difficult in highly competitive markets because you can't pick up the phone and talk to your arch rival across the river. You can't talk about your bad day in the same way you could talk to a peer when you both reported to the CEO," she says.
Instead, some leaders are able to rely upon group purchasing organizations or other professional associations to talk with colleagues who are not in direct competition. This can prevent missteps — or reinforce their brilliance — when it comes time to present a groundbreaking idea to the hospital board.
How senior leadership can help
Members of the hospital's senior management team can certainly help these first-time CEOs without overstepping professional bounds. "Preparing that group before the new hire starts is critical," says Ms. Smith. "There will need to be key traits complemented by the team, so that will reassure them that they all still have a place." Seniors leaders might be nervous about these transitional changes. Adopting the mindset of group success — or pairing their success to that of the new CEO — can help reduce anxiety.
Sometimes the smallest things can help the CEO feel more comfortable, such as letting them know the best restaurants, car mechanics or dry cleaners in town. "Some of the things that unhinge leaders can be really simple," says Ms. Smith. She recommends hospital senior management help fill in the CEO on all the bits and pieces of knowledge they have acquired throughout their tenure at the hospital.
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