Roles in which executives who already lead a region or facility take a second, dual position within the enterprise continue to make their way into hospital and health system C-suites, and these roles vary depending on factors such as the organization's size and the individual's skill set.
"What I can absolutely say is that because of the current state and the financial stresses and the operational priorities [of health systems is] that without question, operational priorities and goals are an increased aspect of all C-suite level roles, regardless of whether they have a dual title," according to Paul Bohne, managing partner in the healthcare practice at executive search and advisory firm WittKieffer.
Leaders at Milwaukee-based Aurora Health Care, Kansas City, Mo.-based Saint Luke's Health System, Renton, Wash.-based Providence, Little Rock, Ark.-based CHI St. Vincent Infirmary and Traverse City, Mich.-based Munson Healthcare — among other hospitals and health systems — fulfill these dual roles. There is no one-size-fits-all in terms of what a dual role looks like at organizations, but these roles span many parts of the senior leadership team, including operational, clinical and legal functions.
Mr. Bohne told Becker's that WittKieffer's data does not identify a clear, specific trend related to prevalence of dual hospital and health system executive roles. However, the data does point to clear examples.
WittKieffer identified the following pairings as the most common, based on the firm's database:
Note: This list does not include more obvious overlapping pairings such as chief medical officer and chief medical informatics officer.
- Chief quality officer-chief compliance officer
- Chief nursing officer-COO
- General counsel or chief legal officer-chief compliance officer
- Chief medical officer-chief quality officer
That is not to say these are the only pairings. For example, Nkem Iroegbu, MD, serves as president of St. Luke's South Shore hospital in Cudahy, Wis., in addition to his role as president of Milwaukee-based Aurora Sinai Medical Center. Also, Brian Helleland was selected as chief executive of Providence St. Joseph Hospital Orange (Calif.) and chief executive for the Orange County/High Desert service area, part of Renton, Wash.-based Providence's recently reorganized California South division.
Mr. Helleland told Becker's dual roles are nothing new in healthcare, but he sees their value in today's industry environment.
"By creating this structure, it's really allowing me to have a closer working relationship [with other chief executives]," he said. "Still focus on my own local hospital, but also really facilitate the right decision-making, the right leadership structures that align thinking instead of thinking as one hospital.
"How do I truly get those other ministry executives to think about what's in the best interest of the rest of Orange County or the High Desert? So the big change is stretching the thinking and the delivery to a broader scope."
Mr. Bohne said he sees dual roles, particularly CFO-COO or CNO-COO, often at smaller organizations that may not have advantage of scale and where executives are required to often wear multiple hats. One example is Cristen Brandsma, BSN, RN, was named COO and CNO of two hospitals belonging to Munson Healthcare.
Mr. Bohne also attributed dual roles to the fact that organizations of various sizes are looking at efficiencies and leveraging skills of people on their team to create some of these roles. He has observed some chief quality officers also taking on compliance functions, particularly in which the chief quality officer reports to a CEO. Although less common, he also has seen examples of a chief legal officer-chief human resources officer.
"Organizations are trying to gain efficiencies, and there's no question that with having people wear multiple hats, there's also the increased complexity and capacity of people," he said.
Additionally, sometimes dual roles may be a component of longer-term succession goals, Mr. Bohne said.
No matter the reasoning, optimization, streamlining and efficiency appear to be consistent factors in establishing dual roles.
Mr. Helleland began his dual role Nov. 28 after serving as interim chief executive of Providence St. Joseph Hospital Orange.
St. Joseph is a 463-bed hospital with 3,100 caregivers and 1,100 provider medical staff. Providence's Orange County/High Desert service area includes St. Joseph, Providence Mission Hospital in Mission Viejo, Providence St. Jude Medical Center in Fullerton, and Providence St. Mary Medical Center in Apple Valley.
With his new dual role, he went from overseeing 17 hospitals to five.
"How I typically share it even with the team here is that we want our sister hospitals to make us better," Mr. Helleland said. "We don't want to be first at their expense just because they may have dropped in a particular metric and it made us leap to No. 1. That's not how we want to be. We want to be No. 1 because our sister ministries improved, got better, and they challenge us to get better ourselves."