For all the literature, studies and allegories that circulate in the business world about teams — and what makes great ones — one obvious factor often goes unsung: how long they've been together.
At Houston Methodist, CEO Marc Boom, MD, is surrounded by an executive team that shares more than 150 years of experience with the health system. At Northwell Health, Michael Dowling is surrounded by senior leaders who have been with the New Hyde Park, N.Y.-based system for anywhere from a decade to nearly 30 years.
"We don't have to spend a lot of time explaining things to one another," says Mr. Dowling, who has been with Northwell for 20 years himself. When outside parties come into Northwell for a meeting with senior leaders, the team doesn't spend time preparing remarks about their own organization. Mr. Dowling said he can ask any member of the senior leadership team to speak about where the health system is and where it is going, and the message and strategy will be the same.
"I've had a very consistent team for a long time," says Mr. Dowling. "That continuity of people provides continuity of purpose, vision, strategy and relationships. You don't have to prepare when the people around you know the culture, mission, strategy and what's important."
Dr. Boom, who marked his 26th anniversary with Houston Methodist this spring, can send the briefest text message to his senior team and they quickly pick up what he is putting down.
"These folks know me inside-out, I know them inside-out, and I can't tell you how useful that is," he says. "Obviously during times of crisis, it's particularly valuable to know each other so well that we can have a six-word text or one-minute conversation and I know you are on the same page, know what the judgments are, and know the things I need to be involved in and the things that are just 'go' and I'll learn them later."
Steady hands in a turbulent world
In most, if not all, realms of life, Americans are resistant to aging and hellbent on preserving youth. But the age of an executive team, or number of years they collectively share in working together, is one thing you likely want to be higher in health systems.
The latest figures available from the American College of Healthcare Executives have the average hospital CEO tenure at a little more than five years. In February, hospitals saw 18 CEO exits, a 29 percent increase from the 14 recorded in February 2022. In the first two months of the year, hospitals saw 41 CEO exits, up about 58 percent from the same timeframe last year.
Long tenures and low turnover rates aren't necessarily a good thing. Sometimes poorly performing leaders need to go, and long tenures run the risk of complacency and becoming good ol' boys clubs. But as a general rule, it's harder to accomplish much of anything in healthcare if there is change or unfamiliarity at the top.
"When a CEO changes, everybody around him or her does too," says Dr. Boom. "That's a disruptive time for an institution."
Another dynamic can occur when a new leader recasts the senior team or a few key positions undergo periods of high turnover — the executive team begins to feel more like a presidential administration. Cue the consolation people turn to when unhappy with an election outcome: It's only four years. Opportunities for innovation and improvement go unacted upon when employees see the C-suite as a big revolving door.
"Physicians will practice most of their career in hospitals and may see six to eight administrative teams come and go in their time there," says Dr. Boom. "Then you have negative dynamics both ways. The team cannot understand the physicians and their needs and be the servant leaders they should be, and the physician thinks, 'I just have to last a couple more years and there will be a brand new team.'"
Mr. Dowling points out that the magic of leadership tenure isn't simply a matter of who endures and for how long. Before recognizing the benefits of a seasoned, trusted and familiar team, he'll first tell you how much time and judgment it took to find them. Ninety-nine percent of the people who ran any part of Northwell 15 years ago are no longer with the organization.
"There's been lots of change," says Mr. Dowling. "The success of the organization is so dependent on the people and leadership you have. You have to make sure you take the time to pick the right people you want to be around for the long haul. It's about getting the people in place who you are comfortable with, who are team players and define success not as success for them, but for the organization."
At Northwell, even if appointed to a leadership role after earning a great deal of trust, no status precludes consequences for high ego or bad behavior. There's no back-biting or tolerance for disrespect. ("With the wrong people who have the wrong attitude, long-term consistency can be deadly," says Mr. Dowling.)
There's also no tolerance for the status quo. Complacency can be a risk that comes with familiarity.
"That is a real danger, but leadership has to make sure you are continually evolving and innovating," Mr. Dowling says. "You can't have consistency over a long period of time and get comfortable with the status quo. You have to have people who are relatively uncomfortable with what is because they want to make it better all the time. The right people who have entrepreneurial spirit, mission and work in a collaborative way — long-term consistency can be unbelievably beneficial."
People want to know who is going to show up every day
There is a scene in the movie Apollo 13 in which Tom Hanks' character, mission commander Jim Lovell, learns that NASA administrators need to make a personnel change with his crew due to one astronaut's exposure to the measles.
"You want to break up my crew two days before the launch," he says, brow furrowed. "When we can predict each other's moves. We can read the tone of each other's voices."
The scene comes to mind as Dr. Boom and Mr. Dowling discuss the dynamics of their leadership teams. These are stories and snippets that can't be tracked in an Excel spreadsheet, aren't advertised on the health system website, and aren't ranked or rated by any third party. But they are valuable glimpses into what makes teams of people in high-pressured positions and situations really work.
These seasoned teams share the benefit of the doubt, a game-changer for relationships. The more you know someone, the less room there is to interpret their actions as malicious. "When there is trust, you don't fill in an unknown void with negativity or attribution of negative motivation," Dr. Boom says. "Instead you think, 'That doesn't sound like him, that doesn't sound quite right. Let me pick up the phone and call — oh yeah, there's a misunderstanding here.'"
Humor and storytelling is key. "We just came out of a difficult meeting, and we were all laughing as we came out," Mr. Dowling says. The positive relationship between trust and humor is long-studied and evidenced, as are laughter's health benefits. Humor shared among competent people who do good work makes for a distinct sense of resilience. Just as families share their own sense of humor from their shared environment, so too do long-standing executive teams.
There's a level of predictability to their working relationships. This does not equal monotony. Reasonable anticipation of how leadership will act is key for employees. They are better if they get the rhythm of their leaders' values and judgment. "They're going to make good decisions, decisions that are consistent with our culture, decisions that are good for patients," Dr. Boom says. "I do believe there is a trust level that comes from some predictability and relationships. It's not a new flavor du jour."
And most importantly, Dr. Boom and Mr. Dowling know the stories of Houston Methodist and Northwell do not stop with them or their current executive group. Each emphasized the importance of succession planning and building up leaders behind the leaders.
"All people in our senior team have succession behind them," says Mr. Dowling. "Now we are building the people coming up behind to continue and improve what we did. It's like the relay race — you run as fast as you can and try to get the lead, then hand off the baton to the next leader who will run faster than you did so you win the race."