Making the Move From CFO to CEO

After serving in the CFO role at several hospitals and healthcare systems, David Cauble decided he wanted, and was prepared for, a much larger role.

David Cauble recently became the CEO at Sky Lakes Medical Center in Klamath Falls, Oregon, a 176-bed teaching hospital, after spending many years as a hospital CFO. Cauble was previously the executive vice president and CFO at Children's Mercy Hospital in Kansas City, Missouri, and held prior CFO positions at St. Vincent's Health System (now Ascension St. Vincent's) in Birmingham, Alabama; at CarolinaEast Health System in New Bern, North Carolina; Trover Health Systems in Madisonville, Kentucky; and The Emory Clinic in the Greater Atlanta area.

HealthLeaders spoke with Cauble about his journey from CFO to CEO, what inspired the move, how his background prepared him for the change, the top challenges for healthcare executives in 2022, and his advice for other CFOs that want to make the jump to CEO.

HealthLeaders: Prior to your current appointment as CEO at Sky Lakes Medical Center, you came from the CFO ranks in your previous roles. When did you decide you wanted a CEO role, and what drove that decision?

David Cauble: My interest in becoming a CEO began many years ago as I started to grow as a leader, and I developed a strong orientation to the mission of serving the health and well-being of communities. 

I have benefited from some great mentors in my career, who invested in me and helped me develop and prepare for the eventual opportunity to become a CEO. I have experience in a variety of organizations, and those opportunities provided a great environment to learn and grow as a leader. 

The broad exposure to new environments and new challenges helped prepare me for a larger role. That led me to conclude that the timing was right to pursue a CEO position, where I could apply all that I have learned and make a positive impact for a new organization.

HealthLeaders: When you set your sights on a CEO role, tell me about the self-assessment you did of your professional skills, personal traits, and career background to identify strengths and growth opportunities.

Cauble: Objectivity is challenging when conducting a self-assessment. That makes the role of a trusted advisor and sponsor critical. 

As I evaluated my personal development and readiness for the CEO role, I was fortunate to have strong advice and counsel from those who I trusted and could help guide me through the growth process. Listening to, and observing, other leaders offered an additional opportunity to learn and better understand where I needed to grow and focus on my development.

HealthLeaders: What did you consider to be your top professional and personal strengths for such a role?

Cauble: Early in my career I developed an open and collaborative leadership style that invites engagement and input from leaders who represent diverse opinions and perspectives. With increased responsibility came the opportunity to expand my network and deepen relationships in areas outside of the traditional scope of a CFO. 

I have always enjoyed learning. That, coupled with a willingness to listen and engage others, has developed into an important strength that I routinely rely upon to gain new insights and inform decisions.    

I have also received positive feedback on my ability to maintain perspective and a sense of calm in most every situation. I have learned the importance of listening first before attempting to respond or solve a problem. Listening and providing a safe space for others to express their concerns or issues helps to create a calm environment. And it provides the opportunity to create clarity and alignment on a chosen course of action.

HealthLeaders: What areas did you identify as growth opportunities for your role, both personally and professionally?

Cauble: Healthcare is complex and it requires a willingness to rely on the strengths of others. The most effective leaders I have known are those who remain curious, are open to new ideas and perspectives, and are willing to seek the help of others. 

Coming from a CFO role, the greatest challenge I have faced is overcoming the perceived limitations of that role and engaging with leaders in areas outside of what is considered the normal scope of work.  Transitioning to a CEO role requires the willingness to seek the help of others. You should surround yourself with leaders who know more and have greater experience in key areas. 

I have successfully surrounded myself with strong leaders, and I invite them to contribute their strengths. That will ultimately make the enterprise stronger and allow me to focus on the areas where I can have the greatest impact.

I can, and have, made incremental improvements in the areas where I have any weakness. But focusing all your energy on improving in a weak area does come at the expense of the time invested in truly developing your strengths and impacting the organization in ways that only you can.

HealthLeaders: What actions did you take to address the growth opportunities that you identified?

Cauble: Mentors and those interested in helping me grow played significant roles in identifying my strengths and weaknesses. In some instances, I used insights from others to proactively invest in my skills and improve in specific areas. 

As an example, learning to listen and address difficult conflicts was a skill that I needed to develop. With intentional effort, and great support from my trusted advisors, my skills improved and the weakness became a strength. 

In other instances, I have intentionally added to my team leaders who possessed skills that were needed to better serve the organization, but which were not among my strengths. This has invariably led to better results than if I had attempted to overcome a weakness on my own. 

HealthLeaders: What do you believe were the most important messages you delivered in your interviews for this CEO role that helped earn you the position?

Cauble: I have a passion for rural health and a commitment to impacting the health and well-being of this community. The board has a shared passion and commitment to this community and finding a leader who was aligned with that vision was important. 

The depth and breadth of my experience as a transformational leader was also important in giving the board confidence that I was fully capable of maintaining the independence and financial health of the system while setting the direction for the future.

HealthLeaders: What mission have you been given in your new role, and how do you think your experiences as CFO have helped prepare you to meet that mission?

Cauble: Sky Lakes is a strong health system that is vital to this region. The board is fully committed to serving this community and maintaining financial independence. There is a great foundation of leadership from the hospital in the region, and a strong commitment to the mission that "strives to reduce the burden of illness, injury and disability, and to improve the health, self-reliance and well-being of the people we serve."

The charge that I have received from the board is to continue serving the mission, while ensuring the system remains independent and well positioned to further the positive impact on the health and well-being of the community. 

My vision for Sky Lakes is well aligned with the board's direction, and my experience has given me a depth of knowledge and resources to sustain the mission and grow the impact on this community.

Editor's note: In the upcoming part two of this article, David Cauble discusses the top issues facing healthcare CEOs in 2022, finding solutions to those challenges, opportunities for CFOs to become CEOs, and his advice on how to be successful in the move.