The role with origins in politics and the military has made its way into some large health systems, and can be clouded with obscurity given its variability and intensity.
"As one former [chief-of-staff] told us, 'It is one of the hardest jobs that you can have,'" according to a partner and consultants with McKinsey.
Leaders at Ascension, Cleveland Clinic, Mass General Brigham, NewYork-Presbyterian and Novant Health — among other health systems — fulfill the reportedly challenging role. Although the ascent to it and duties of it can vary from system to system, the COS essentially acts as the right hand to the CEO, an air traffic controller for the chief executive and the senior leadership team. Some duties are more explicit than others, with CEOs leaning on chiefs of staff as confidants, impartial sounding boards, and strategic thinkers who can see beyond silos and vested interests.
In 2020, an article in Harvard Business Review contained a questionnaire for CEOs to assess their need for a chief of staff. The questions themselves shed light on the job's inherent challenges. Here are just a few:
"As you deliberate on the decisions that only you can make, are you getting the best available information? After you’ve made a call, do you get surprised by new information that you should have known?"
"Do political or cultural factors — such as relationship problems between powerful subordinates or destructive gamesmanship between competing departments — block progress?"
"Are problems identified early enough that action can be taken before they create damage, or is it common for large problems to occur unexpectedly?"
The McKinsey team connected with former chiefs of staff to better understand what they found most demanding about the job. Below are some of their insights, verbatim from McKinsey, for current chiefs of staff to relate or for other executives to better understand their colleague.
1. The job can require reprioritization of interests. As one noted, "Your job is not to make yourself look good but to make your principal look good." Humility, maturity, self-restraint and situational awareness are key attributes for people in this role.
2. Chiefs of staff know high wire acts. They must be part of the broader leadership team while maintaining independence from it. "It's a difficult balance to be a trusted confidant to the principal and a sounding board to their team and then deliver aggregated 'home truths' delicately to the principal as and when needed," a former COS told McKinsey.
3. The role can be lonely. A chief of staff works autonomously. As confidants and impartial sounding boards to the CEO, chiefs of staff may have limited colleagues they can confide in. Some chiefs of staff turn to executive coaches for a neutral perspective and guidance.
4. Chiefs of staff are straightforward with the good and the bad. Chiefs of staff help CEOs avoid surprises, relaying positive and negative information to them about events on the front lines or throughout the enterprise. That said, the role cannot be a human news ticker, either. "You need to have a compass of what you perceive to be the 'right' thing to bring to your CEO's attention," one COS told McKinsey.
5. The goal of the job is to go as deep and broad as possible. Not either/or. Chiefs of staff need comprehensive understanding of the enterprise's operations, initiatives, challenges and objectives but cannot become bogged down in the details of any single one. As one COS told McKinsey, "A COS can be an emissary for change and at the same time must be ready to be a resource for the entire organization."