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Human Resources: HCA's Next Leaders Are in the Pipeline

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The COO Development Program pairs young talent with a CEO who serves as a mentor and boss.

With a generation of baby boomers nearing retirement, the rush is on across most business sectors to find America's next generation of leaders.

Where will we find the next executives who'll someday run the nation's hospitals? HCA Inc.—a Nashville-based system of 163 hospitals and 120 outpatient centers in the U.S. and England—has been preparing for that inevitability since 2001, when the nation's largest hospital company established its COO Development Program. "We got to looking at the management teams in the hospitals and, just like the general population, our management teams were getting older," says Lee Nelson, director of the program.

"We were anticipating retirements but hoping not. The reality is that is going to happen. We started looking in the pipeline and that was OK, but we were looking for a structured development program that would continue to feed that pipeline," he says.

Since the COO program's inception eight years ago, about 60 "associate administrators"—40% of whom are minorities and/or women—have graduated and taken jobs as COOs at HCA's hospitals across the nation. Of those graduates, five have already been promoted to CEO.

The candidates are found in-house, at the nation's leading business schools, and through professional business organizations like the National Black MBA Association.

Unlike some executive development programs that supplement regular duties with leadership training and special projects, HCA's associate administrators are hired to participate solely in the program. Once accepted, administrators are assigned to hospitals, where the CEOs serve as a mentor and a boss. The specific job responsibilities of the administrators are determined by the CEO and the hospital's leadership team in consultation with HCA's COO Development team.

Depending upon an administrator's progress, the program can last between two and four years. "We don't guarantee a job when they complete the program, but once they get to the point where they are deemed promotable they become a candidate for openings," Nelson says.

The program has become more selective than an Ivy League school. The most recent COO development class attracted more than 1,200 applicants for 14 spots, an acceptance rate of about 1 in 85. Harvard University received a record 29,000 applications for 1,660 spots in the Class of 2013, an acceptance rate of about 1 in 17. "The first year there were probably about 150 applicants," Nelson says. "It started out mostly as an internal program, so it took a couple of years to get the word out, but after that the number of applicants has gone up to where now we are getting 1,000-plus."

In addition to the daily mentoring, every quarter HCA gathers the associate administrators, currently 35, in the program at corporate headquarters in Nashville for seminars. The topics include budgeting, strategic planning, capital asset management, patient safety, and physician relations. There is an emphasis on leadership training, and the associates are required to attend the American College of Healthcare Executives annual meeting.

Nelson says the curriculum provides a formal course on corporate operations for the associates that augments the less-structured personal development in the mentoring program.

Shana Sappington Crittenden, a graduate of the program who is now a COO at Plantation (FL) General Hospital, says the quarterly meetings create loyalty to the company and a strong bond among the associates.

"It's really important who you know," she says. "This program gives you an immediate constituency of classmates. I knew 30 people across the country in HCA facilities who I could call and who were all on the same level and we could bounce ideas. Most of us are COOs now. We are all still in touch. We go to each other's weddings and celebrate birthdays and things like that."

John Commins

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