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The two hospitals are divided by the Fox River, with St. Vincent's to the east and St. Mary's to the west and about 150,000 residents on each side. Although they are part of the same system, they once operated separately and competed for the highest-cost services like cardiology, oncology and women's health.

Both hospitals were independently successful, but they wasted resources by duplicating services and operations, Coller says. Hospital Sisters senior management decided it would be more efficient to integrate the two facilities under Coller's management. Coller appointed COOs (also longtime Hospital Sisters employees) to manage the daily operations at each hospital while he focused on integrating the two hospitals. The hospitals merged their information technology, materials management, and billing and collections systems. They share staff and supplies while remaining separate hospitals with separate boards (albeit made up of the same people). By eliminating duplicate services, they maintain separate identities. With 106 staffed beds, St. Mary's provides community-based ambulatory services; St. Vincent's, with 279 staffed beds, provides more inpatient, intensive care.

Perhaps most important, the two hospitals consolidated their financials so that they are looked at as one. Formerly, if the hospitals wanted to switch services around for the betterment of the community, thereby improving one hospital's bottom line but hurting the other, they couldn't because each hospital's financials were reviewed independently from the other's. Now, Hospital Sisters only looks at the combined bottom line.

Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at mrowe@healthleadersmedia.com.

COO for a day

The morning begins at 7:30 with e-mail: a personnel issue, a supply chain problem, the outcome of a patient safety incident. After e-mail, it's a meeting to review the latest financial projections, then another meeting--this one tense--with a high-profile physician who has received complaints for being rude to nurses. Over lunch, there's a phone interview with a reporter, and, finally, in the afternoon, a chance to be strategic: a meeting with other senior leaders to discuss upcoming quality initiatives.

Sound like a typical day at the office? It is, but it's all make-believe--a simulated day-in-the-life of a chief operating officer. A year ago, Hamot Health Foundation in Erie, PA, used a simulation like this to select its next COO. With the help of Development Dimensions International, a human resources consulting firm in Bridgeville, PA, Hamot put more than 35 employees through an assessment process to determine which, if any, had leadership potential and what skills were needed to groom the group for future senior-level positions. The simple leadership training exercise became an all-out recruitment effort when, in the midst of the assessment, Hamot's then-COO announced plans to retire.

The group of 35 was pared down to five potential candidates who undertook several hours of background work, learning about a fictional hospital's history, location and key players. They put in a 10-hour day as hospital COO, responding to e-mails, meetings, phone calls, and voicemails about the fictitious hospital. The simulation was videotaped and reviewed by DDI's team, which assessed each person's strengths and weaknesses.

The assessment looked at how each candidate handled different leadership scenarios, looking specifically at personality variables such as social ability, ambition and conscientiousness. The process also looked for signs of being arrogant or imperceptive--traits that can derail a leader, says DDI Executive Consultant Eric Hanson. The simulation and assessment process reinforced Hamot's first choice for COO.

"We had in mind who we thought might be the best candidate, but this process confirmed that and provided the individual with a development plan," says Hamot Senior Vice President Donald Inderlied.

Each participant was given a plan to improve his leadership skills, especially weaker areas, and two candidates were given expanded responsibilities based on their performance in the simulation. Hamot plans to expand the simulation and assessment process to the top 50 people in the organization over the next two years.

Hamot's new COO took over in July, after nearly a year of mentoring with the retiring COO. "Typically in healthcare, it's 'you're in' and 'you're out.' There's not a lot of transition. In our case, we had the smoothest transition of executive leadership in the history of the organization," Inderlied says.

-Molly Rowe

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