Carving Out a New CEO Model

Philip Betbeze, for HealthLeaders Magazine , November 12, 2009
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"So in this case, it will push the hospital leadership to work more collaboratively with physician leadership to form more of a team relationship," he says. "I've really been engaged in this in my first three months and it's time well spent. That's the model of the future and it's how hospitals will succeed."

Philip Betbeze is senior leadership editor with HealthLeaders Media. He can be reached at
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Anyone who has ever applied for a job that's slightly above their comfort level has heard the refrain, "We're just not sure you have the experience needed for this position," or something to that effect.

Never have more aspirants to the CEO's office in healthcare heard it more than they are hearing it now, says executive coach and former hospital CEO Keith Pryor.

"For many very talented non-CEOs, the jump is a tricky one because boards are looking for someone who already has that title next to his name," he says. "They take comfort in those who have a track record at this level."

That's due to a variety of factors, but boards increasingly aren't willing to take a risk with a person who's inexperienced in hospital leadership, even if such a move might ultimately be the most prudent. One reason is consolidation.

"We'll see fewer hospital CEOs as consolidation occurs. You'll have a bunch of No. 2s but there will be fewer top leaders," says Robert C. Garrett, acting president and CEO of Hackensack (NJ) University Medical Center.

Another reason non-CEOs aren't nearly as welcome as CEOs these days is that deals are under increasing scrutiny, and it takes another level of competency to be able to manage in that environment, Pryor asserts.

"Boards today are more conservative about what they're looking for in a CEO," he says. "They tend to look for people who have already done it."

Another reason it's tough to break into the CEO role: simple demographics.

"Unlike what I tend to hear in the general media, I don't think we're on the verge of major turnover at the CEO level," says Pryor. "These are increasingly tough jobs, there's a lot of chatter about how difficult the work is, and there's black humor about early retirement. But the reality is that most of these people still really like their work, and are frustrated more now than they have been in some other years. But their talk of early retirement is moderated by their own financial realties."

Philip Betbeze

Evidence-Based Leadership

CEOs and other hospital leaders are probably sick and tired of hearing about evidence-based medicine. Many of them have bruises on their foreheads from banging their heads against the wall trying to integrate the philosophy into treatment protocols.

But if they believe so strongly in EBM, says Quint Studer, founder of The Studer Group, an international healthcare consulting firm, then they should devote themselves equally to evidence-based leadership. What he means by that is, just like in the practice of medicine, if evidence exists that leaders who practice certain behaviors or use certain tools or techniques will achieve the desired results, it's folly to ignore that evidence.

"We know if we wash our hands, we'll have less infection. Surgery checklists lead to fewer problems in the OR. We even use evidence to show maintenance workers the best way to clean a floor. Yet we have evidence that shows the best way to lead and we don't follow them."

Human nature is the cause, Studer argues. For example, he contends that people strive to become leaders because they want autonomy.

"That way you don't have to buy into all this standardization."

But high performers are working to standardize certain techniques in leaders, which results in better outcomes across the board.

He cites a variety of examples for which he's done the research. For instance, if a patient is visited by nurse leaders while they're in the hospital, that person is more likely to feel good by far compared to others, he says. "They'll be in the 70th percentile on care. When not visited, their perception of care is in the 1st percentile. Shouldn't I make sure my nurse manager is rounding on every patient?"

Another example: "When we call a patient after discharge to see how they're doing, their likelihood of recommending us to others is in the 98th percentile. If not, we're in the 40th percentile, so why shouldn't we standardize this?"

Still more: "If turnover is 12% or lower, the mortality index is lower. If we integrate certain behaviors in the first 90 days of a person's employment, we can reduce turnover by 66%. If I can show you this, and turnover means lower length-of-stay, wouldn't it make sense to incorporate this?"

The highest purpose of a CEO or other chief hospital leader is to make sure the organization integrates behaviors that are known to improve patient and employee perceptions and healthy outcomes, Studer contends.

The choice is stark: "If you're not willing to implement evidence, you're telling me you would rather people die."

Philip Betbeze

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