Much of this comes from the idea of developing a sense of "systemness"—that local CEOs are no longer free to run their organizations as though they are independent franchises.
As CEO of a hospital in such an organization, you may not be able to go off the reservation and use your own consultants or implement your own patient management system, or even hire your own chief nursing officer. You'll need to work much more closely with your peers and with corporate on local strategies.
And you might not even be called the CEO anymore. After all, it's confusing to outsiders if the corporate head shares your title. How's that for a shocker?
Couple the continuing development of systemness with the expected shrinkage of hospitals in general, and independent hospitals specifically, and you have the recipe for a diminished market for hospital and health system CEOs, at least CEOs as we're used to defining the job. The problem is that much of the data needed to confirm trends—outside of anecdotal evidence—is four to five years old, says Deborah Bowen, president of the American College of Healthcare Executives.
"There isn't a lot of good data about this, so what we've got right now are frankly a lot of assumptions and perspectives that may or may not be true," she says.
Still, some trends among executive leadership seem locked in, at least for now.