Along with healthcare organizations themselves, the job of managing them is getting bigger. Many CEOs are coping by hiring a chief of staff.
In a sense, the job of chief of staff at WellStar Health System was made for Andrew Cox.
He was born at a WellStar hospital. His first office there was the back of a landscaping truck as a summer college job. And since he started in human resources after college 15 years ago, he hasn't worked anywhere else.
As director of HR at the 11-hospital health system in Atlanta, he was asked to develop a job description for the new position of chief of staff.
CEO Candice Saunders had him in mind for the job; she just didn't tell him. And he says he didn't have a clue.
If she had told him, he's not sure he would have wanted it anyway, because he loved management and human resources. Researching the position was difficult, even for someone with a background in HR and an MBA degree to boot, says Cox.
He began the process while Saunders was a CEO-in-waiting. Although she had already been named, she was a year away from taking over the CEO role from her predecessor, Reynold Jennings.
If he had known Saunders wanted him in the role, "I think there would have been a lot of anxiety, so I built the job description not realizing I was going to pursue it," says Cox, who is about to celebrate his third anniversary as assistant vice president and chief of staff.
Borrowed from Politics
Long associated with politics, hospitals and health systems are increasingly adding chief of staff to the executive team, says Andrew Chastain, CEO of Witt/Kieffer, an executive search firm. Ironically, it does not currently conduct chief of staff searches for its clients.
One major reason the title has grown more popular is that CEOs need someone to help manage tasks such as community speaking engagements, project management, managing executive searches, or managing the health system's agenda.
That's largely because of the degree of consolidation in healthcare, says Chastain.
"The systems have just gotten much larger, so the constituency group CEOs must deal with is getting so much bigger too," he says. "Having someone who can help navigate the agenda of outside influences for agenda mapping is incredibly complex."
One health system where Chastain helped conduct a recent CEO search had grown to 60,000 employees and multiple constituent groups. No matter how personable they are, it's unrealistic to think CEOs can be accessible to that many people.
"If this position helps facilitate and extend the reach of the CEO, it absolutely validates its existence," Chastain says.
Chief of staff, in the political sense, is someone who controls access to the boss. In the healthcare sense, that person is seen more as a person to help manage the CEO's priorities and to help deliver the CEO's messaging to internal and external audiences, not mention managing projects and the work streams that emanate from strategic projects the CEO doesn't have time or bandwidth to supervise.
It's not a management position, says Chastain. Instead, it helps control and facilitate access to the CEO for those who do manage the health system's huge number of employees.
Strategic Humility
Cox says it takes a certain amount of strategic humility about one's own career to serve as a chief of staff. It's a top leadership position, but unlike other leadership positions, there's no management component, and taking the job ties one inexorably with the CEO personally.
As part of his research on building the chief of staff's job description, Cox visited extensively with every member of the leadership team and individual hospital presidents, finding out how the candidate who was hired for it would ideally interact with them.
"I went to key executives, scheduled one-on-ones with them and asked how they saw this role benefiting the organization," he says.
In addition, in HR role, Cox arranged individual focus groups to help understand how a chief of staff should interact with key co-workers, such as the government relations director, the director of public relations.
After he was named chief of staff, he spent his first few months "going out and reintroducing myself as chief of staff, not as an HR professional," he says. "The biggest challenge is you have to step away the furthest from what you're comfortable at."
Now, his normal routine includes rounding with executive vice presidents as an extension of the CEO.
"Also, there's lots of face time with the CEO, continuing the work of her office and giving her updates, for example, if she's traveling, to keep her looped into the organization, including progress on projects."
He also spends lots of time with Saunders' direct reports, and assisting them where they may need direction in projects. He works closely with the government relations director as well on local and national efforts. He says that based on perceptions of the job thanks to programs such as House of Cards, people are sometimes intimidated by his title. But he tries to focus on being visible and approachable.
"I work very closely with all of them and I do regular rounding," he says. "I try to pop in frequently and I'm working on key projects with them. We're all in the same building and work very closely together even when Candice may not be there. Great working relationships are built over time."
Philip Betbeze is the senior leadership editor at HealthLeaders.