The CSO most often reports directly to the CEO, but in some larger organizations, he or she might report to the COO, Willig says.
From nice to have to critical
Strategy is a small piece of what the CEO does on a daily basis, so adding a CSO should be a critical priority for helping the organization step out of the day-to-day margin issues and tight battles with operational efficiencies and instead look ahead. What's unusual, says Willig, is that salaries for CSOs, despite their range of responsibilities, still aren't commensurate with traditional C-suite salaries.
"That's a generality," she says, "but think back to about five years ago when the market started tanking, this then-new position was one of the first few to be let go."
After all, you can't focus on strategy, marketing, and clinical integration when you need to make the weekly payroll, but since the financial crisis and recession, Willig thinks CSOs are becoming more valued than ever. In most organizations where the CSO title still exists, it's not a glorified marketing position. Those jobs got washed away.
"Organizations are coming around to the fact that this is a need-to-have role now," she says. "It's the fact that we're operating in a competitive marketplace with much thinner margins than before. That's forcing everyone to take a much more aggressive and progressive view of what businesses they're in and what businesses they need to be in. You can't be everything to everyone; the market is changing so fast that organizations are realizing they need someone whose job is to focus on the future."
That future focus is one reason Julie Carmichael is aboard as the CSO at St. Vincent Health in Indianapolis. Part of Ascension Health, St. Vincent has 22 hospitals in Indiana, including several joint ventures. The organization's fourth CSO in 12 years, Carmichael has a 25-year background in healthcare, starting at the state hospital association in policy and moving on to run an organization that represented 20 suburban health organizations before joining St. Vincent about a year ago. She laughs as she notes that she has never worked in a hospital. That may be a positive, as a big part of her role is helping the organization grow beyond hospital care.
"We're really trying to figure out what our business model of the future needs to look like," she says. "We're trying to evolve our business into a more sustainable model for the long term, so we're moving toward a population health model."