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Strategies for Hospital C-suite Organization

Philip Betbeze, for HealthLeaders Media, September 14, 2010
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"I was blessed with a group that, for the most part, had between 15 and 20 years of experience each," he says. The only exception was a vacancy in the chief human resources officer's office, "but there was a guy who had been here more than 10 years who was ready to assume that role."

Laney's direct reports include the chief operating officer, the chief financial officer, the chief of human resources, the chief brand officer, the chief information officer, and the chief of strategic planning, mirroring many CEOs with whom we talked. But at Heartland, for example, the top administrator of the medical practice actually reports to the COO, on whom Laney leans heavily, perhaps making that title first among equals, as the saying goes.

"I really like to know what's going on at a high level but I don't have time to manage the daily operations, so it's kind of a balance between oversight and not getting stuck in the day-to-day," Laney says.

Laney's inner circle is a time-tested one, but many presidents and CEOs are experimenting with new ways to integrate important new initiatives by appointing a new position of influence. Michael Riordan, president and CEO of Greenville (SC) Hospital System, which has five hospital-anchored medical campuses, pulled that sort of switch with his senior executive team.

"We had to have a strong COO, because I noticed in my previous experience that if the COO and chief nursing officer are equal, it got a little tough to make a decision," he says of a particularly dicey transition. "The COO who was here had been in the system for a long time, so there was no problem with his credibility, but the toughest thing was to make sure I was sending the right message to nursing."

 Riordan did, indeed, make the COO the final arbiter of operational decisions, but he also promoted the CNO to a new title of campus president of the flagship hospital, Greenville Hospital.

"That was a good nod," he says. "She became the only woman president of the five-hospital system, and we protected nursing from feeling they had been marginalized."

Do titles matter?
Titles don't matter, until they do, say most CEOs. There's a veritable alphabet soup of senior executives in healthcare, and it seems as though a new, hot, vice president-level title gets conferred just about every year; but, generally, titles in the C-suite reflect the relative importance an organization places on the responsibilities each person oversees, and the CEO controls that.

"Being a collaborative person is extraordinarily important," says Beth Israel's Nagler, regarding who makes up the inner circle. "The individual approach is doomed to fail. The monolithic answer is probably the wrong answer. Being autocratic is not going to get the organization where it needs to go."

With quality of care gaining so much emphasis recently, Nagler stresses responsibilities that span all leadership titles. One relatively new title at Beth Israel and other hospitals and health systems is the chief medical information officer, sometimes called the chief medical informatics officer. This person helps integrate technology and medical applications so that quality data and evidence-based medicine guidelines can efficiently be integrated into physicians' practice patterns. Overall, he stresses collaboration among the C-suite.

"One of our catchphrases is 'We're here to help,'" he says. "We're here to help each other. These new titles don't have a reason to exist without helping someone else achieve their goals."

Restructuring without preconceptions
In organizing his team, Heartland's Laney seeks to ensure that each of the roles' responsibilities are clearly defined.

"I continue to be surprised by the lack of clarity that people have about their roles," he says about C-suites generally. "That could be whether it's a board member or an officer, it's critically important for the CEO to define very clearly what each person's responsibilities are and the expectations. A lot of CEOs assume people know."

So that particular failure is more with the CEO than the lieutenant. Laney takes time to be direct with members of his C-suite about their essential responsibilities, even if some might fall outside the traditional job description. Further, he says, a follow-up mistake that CEOs often make is that they don't hold their team members accountable.

"If you don't do both, you haven't done your job," he says. When you do those things with talented individuals, they will rise to the occasion and exceed your expectations." He says simplicity is important in defining goals. "I tell them that by the end of 12 months, for example, here's what I need you to accomplish." He meets with them individually every two weeks for 15 minutes to an hour to monitor progress on those goals, and meets with the entire group every week for two hours.

As the CEO of a stand-alone hospital, Crouse's Kronenberg has a somewhat different organizational structure for his team. 

"We don't have the formality of most organizations," he says. "We have chiefs and VPs, and don't ask me why some are chiefs and some are VPs, but it was historical. I call them my senior leadership team and we sit around the same table. I use a matrix model of leadership, where there's a lot of collaboration between the different components."

That said, he does have the traditional titles, with a CFO, CNO, CMO, CIO, and vice president of communications on the senior leadership team. But he also has a vice president of strategic planning. His chief quality officer, given the absence of a traditional COO, has many operational responsibilities, including human resources, which links to quality, security, and patient safety. Finally, he has a vice president for support services, which includes pharmacy, lab, food services, radiology, and cardiac services. The director of the hospital's foundation also sits in the C-suite.

Kronenberg didn't hire a COO, he says, after a previous COO left the hospital. The responsibilities and functions were reassigned to other executives. 

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