Hospitals are seeing increasing amounts of management turnover, especially in the C-Suite. Skilled and experienced healthcare executives are in short supply mostly due to an industry-wide talent drain, lack of mentoring, and minimal succession planning.
Realistically, filling executive positions takes time, even with the assistance of search firms. Meanwhile, management voids can be damaging: communications suffer, initiatives lose pace, and disruptions occur. Even during a brief transition, some organizations cannot afford vacant leadership positions.
Is interim management a viable option to the risk of absent leaders? Is it better to hire quickly to avoid a vacant role? Many organizations consider interim management solutions as a transitional step to permanent replacement of vacant positions, often in conjunction with the use of a search firm. Others may see the talent and skills within and be able to move quickly. Still, others may hire hastily and lose valuable time in the long run to identify the best candidate.
What tact should your organization take when leadership vacancies occur?
ADVANTAGES OF INTERIM MANAGEMENT
When openings occur in the senior leadership structure, interim management offers advantages over traditional alternatives.
1. Prevents work overloads. Spreading assignments among others causes work overloads. Temporary assignments add extra responsibilities to an incumbent's already "full plate," which can lead to work overload and compromised performance. However, a capable interim executive can devote full time and attention to the responsibilities of the vacant management role. A temporary appointment is a welcomed contrast to assigning extra responsibilities to incumbents when a resignation occurs.
2. Adds objectivity. A new set of eyes is beneficial to organizations in transition. Interim leaders usually are less affected by the internal politics of an organization, especially those related to a promotion or a permanent placement into the vacant role. By removing the "vested interest" from the leadership paradigm, the interim executive holds a unique perspective often unavailable to others within the organization. Simply, the temporary status allows the interim position-holder to make decisions unencumbered by career-driven aspirations.
3. Enthusiasm generates optimism. Seasoned healthcare leaders enjoy serving as interim executives and they bring their gratification to the assignment. Their extensive experience and relevant knowledge enables the interim manager to serve as a short- or medium-term replacement for a vacant position as well as a valuable consultant. The organization benefits from the interim's experience and ability to address the ongoing challenges. When a national search to fill the position is concurrent with an interim assignment, the interim leader and the search consultant can work together to identify a candidate with the right cultural fit. Nuances unique to the operation, culture, and strategic initiatives otherwise unnoted are minimized as the two executives work in tandem.
DISADVANTAGES OF INTERIM SOLUTIONS
An interim management solution may not be the best option for every organization or with every vacancy. Quickly hiring and filling the position may be more expedient, especially if an internal candidate with the necessary skill set and personal attributes to succeed is available. Interim solutions may convey misconceptions among the senior managers.
1. Delay may cause unrest. Concerns about a delay should not lead to rushing to a decision or hurriedly identifying an individual to fill the vacated position. Other leaders and managers throughout the healthcare organization may become disillusioned when a vacancy is filled hastily with an internal interim solution.
2. Management perceived as indecisive. By engaging in a temporary solution, senior management may be perceived as indecisive and willing to "float along" for a period while the entity secures the right person with particular skills.
GUIDELINES FOR INTERIM MANAGEMENT
If you decide to engage an interim executive, follow proven guidelines to achieve success and to provide your organization with a value-added service beyond supplying a temporary workforce.
1. Use a reputable and qualified placement firm. Engage a reputable executive search firm to identify and vet candidates before placement. Using qualified professionals to fill interim assignments allows you to off-load the time-consuming, and often expensive, recruitment and screening process. Some firms have both a capable short-term bench and the capacity to conduct the search for the permanent placement. As a subject matter expert, the interim executive can collaborate with the search professional to produce the desired results.
2. Inform candidates of expectations. The candidates should be aware of the expectations that both the hiring organization and the placement firm will have for them. The acting executive needs to understand that their primary focus and allegiance is to the assigned organization. He or she should consider the provisional assignment as a full-time role and not just act as a placeholder. This ownership of the job responsibilities at hand will be a critical success factor for the interim executive. The placement firm should provide oversight to ensure the interim executive approaches the work in this manner, focusing on results. Other leaders within the organization must not perceive the interim as temporary, rather a part of their team.
3. Engage a multi-service search firm. The organization may be well-served by using executive search companies that have the bench strength to fill both short-term and permanent vacancies, as well as the resources to evaluate and even train interim executives in the leadership skills necessary to their new roles. Executive coaching of this type can be especially valuable with physician executives who may lack the management training and experience to succeed in their new non-clinical areas of responsibility.
4. Focus on alignment and avoid conflicts of interest. The organization and the placement firm should be transparent and focused on alignment to assure that the interim executive succeeds. They should identify any potential conflicts of interest and make all efforts to resolve these without involving the interim executive. The executive should be able to commit his or her full loyalty and attention to the hiring organization. He or she should not be in a position of having to choose between fidelity to the interim employer or their direct employer, i.e., the placement firm.
5. Compensate fairly. Executive search firms that know the market rate for high-level managers in healthcare organizations are best suited to handle interim placements. An acting role may demand a premium payment for travel expenses, dislocation of the candidate from his or her family, relocation to a geographically isolated facility or overseas location, and placement into an often chaotic and dysfunctional environment. However, the fees for the interim manager should be valued fairly, not exceeding the boundaries of fair-market-value or commercial reasonableness. This test is especially important when hiring physician executives into these roles, as Stark and anti-kickback laws may apply, especially if the physician continues to practice clinically.
CASE STUDY
In 2014, a large multi-specialty healthcare system engaged Coker Group to assist with the interim management of their Chief Financial Officer position. The assignment also included conducting a national search for filling the position permanently. Coker vetted several candidates and then agreed to place into the role a full-time Coker employee with extensive experience as a CFO and CEO of several healthcare organizations.
The interim CFO assignment was filled within a week of the discussions. The acting executive immediately faced several issues: declining revenues in several important service lines, and languishing growth and business development initiatives in critical service areas (cardiac services and orthopedics).
Over the next four months, the interim CFO was able to advance many of the stalled initiatives. By performing successfully as CFO, he was asked to assume the role of interim CEO for the system's flagship hospital, upon the resignation of its CEO. Now, with the CFO position vacant, Coker provided another experienced interim candidate as CFO, again within a week.
Utilizing the skill set from many previous CFO and CEO assignments, the interim candidates quickly aligned with other members of the health system's senior management team. They expeditiously identified and prioritized opportunities to align costs, increase reimbursement, challenge charge master assumptions, and analyze service line margin contributions. This engagement provided an example of collaboration to the other C-Suite members, as previously they had not worked with their peers and subordinates, creating a silo mentality regarding routine tasks and operational responsibilities.
This case denotes how interim executives can enter into an organization and guide it successfully through uncertain times. It also demonstrates how the right interim leader can take ownership of an acting role and consider it his or her full-time position. The successful leader is versatile and can work at many positions, often assuming greater responsibilities. Ultimately, the CFO and CEO positions were filled permanently as a result of the executive search, and the organization lost no momentum during its conduct.
CONCLUSION
Immediate replacement versus interim management is a consideration for every board and executive team that must fill a vacancy in its executive positions, with advantages and disadvantages for both options. Each vacancy in healthcare leadership offers a unique challenge. Consider the options, reflect on the personalities of the existing executive management, the political climate of the organization, and the skills and expertise needed before making a decision.
(For more information about permanent placements or interim executive assignments, contact Ellis M. Knight at mknight@cokergroup.com, Rick Langosch, rlangosch@cokergroup.com, or Chip Nagle, cnagle@cokergroup.com.)
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