A hospital's continual advancement of strategic goals just won't happen in a rigid top-down leadership structure. I talked with a new CEO who was in the midst of dealing with an organizational culture that sucked him into just about all hospital decisions—the strategic, the operational, and the mundane.
This organization might have ambitions to become a world-class international hospital, but the CEO knows it won't happen if he doesn't have empowered leaders among his clinical and administrative staff. For now, he's prepared himself for a long journey to bring the hospital out of the paralysis of group think.
It's probably little comfort to this CEO that he's not alone. I've heard this complaint from other hospital leaders. It's usually an incoming administrator who discovers the job is less about stewardship of a strategic plan than it is about sitting in meetings with folks in suits, white coats, and sometimes hardhats; they offer only questions and vapid stares, waiting for the CEO to make up his mind. There's good reason why the top healthcare organizations have multifaceted leadership models, and the best reevaluate the effectiveness of their leadership structure as the organization evolves.
As an example, Bangkok Hospital Medical Center is the leading healthcare system in Thailand. The 500-bed four-hospital system caters to regional and international patients, with state-of-the-art medical facilities that received JCI accreditation last year. I recently had an e-mail dialogue with a couple members of Bangkok's leadership team about the roles and responsibilities of the C-suite staff.
Chief Medical Officer Trin Charumilind, MD, told me about the leadership model that works for this complex system. To put it simply, the CEO of the system sets the targets and direction for the leadership team, but hospital directors and department managers have full authority over their assigned areas. Charumilind also points out how vital it is for the entire leadership team to be able to interact with one another. They have common areas in which to network and make decisions as a team, he says. "But strategic decisions about each hospital is the sole responsibility of the hospital director," he notes.
And the targets set by the CEO are not without careful discussion and feedback from the senior leadership team, adds Somchai Chansawang, MD, director of Bangkok Hospital, the system's flagship facility. "Decisions made by the CEO will affect the whole team, which makes us responsible to provide feedback," he says. "Our CEO encourages this behavior because he has altered plans and decisions many times over recent years due to feedback from the leadership team."
This kind of feedback won't happen unless the CEO gives access to each member of the leadership team, and Chansawang says BMC's CEO, Chatree Duangnet, MD, makes the effort to interact informally with executives so that he appears approachable to receive advice.
The ability for BMC's leadership team to plan and implement strategy has been critical to its growth, but the team is starting to worry about succession planning. Chansawang says employers in Asia face a severe shortage of management talent. "A company's growth trajectory depends largely on the quality of the leadership pipeline …. This is not replacement planning, but a commitment to build great leaders by alignment between individual career goals and organizational needs," he says.
So even a system with a strong management model has serious concerns about maintaining it. Perhaps that underlying sense of urgency is why leaders at BMC interact so well in the first place.
Rick Johnson is senior online editor of HealthLeaders Media. He may be reached at rjohnson@healthleadersmedia.com.
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