"Intellectually, they get it until the day arises and there's no longer a VP of planning sitting next door and they can't develop a program locally," Thompson says. "That's where the intellectual and visceral intersect. But each of them plays a critical role in the success of our organization as a whole. Unless they are delivering the best-quality care within their area, the whole organization will be suboptimized."
Thompson admits the transition, which extends well beyond redefining the local top executive's role or duties, is a learning process.
"We have not done it as well as we could, but we're moving so fast as an organization that more than once in a while, we are not doing a good job communicating the whys and wherefores."
He cites the example of his recent letter to the entire group of local presidents concerning benefit changes about which he received some vocal pushback. On reflection, he realized the letter did nothing to explain why the change was being made.
"We did it because we wanted to reduce variation and try to become more equitable and eliminate the special deals in return for values of fairness and respect," he says.
Such rapid change in roles means SSM runs the risk of losing talented people it wants to retain, says Thompson. Part of the effort to prevent those losses in talent runs directly to his office and is a matter of good talent management.
"One of the things we're learning is we have to do a better job of identifying our top performers and telling them that often, no matter where they are: 'Your job may be changing, but you are a vital contributor to our success, so we want to know where you want to go in the organization. Just because you're doing this job now doesn't mean there won't be future opportunities.' "
Besides, he says, even if the role of hospital president is more limited than in the past, there are systemwide opportunities to chair task forces that give presidents an opportunity to display their capabilities to a larger audience. Slimming down responsibilities in the name of better focus applies to him as well.
"Literally every day, I ask myself what I need to be involved in and what I can pass off to someone else," he says. "More and more, my responsibilities are to the system as a whole."
And responsibilities, while lessened in some areas, are broader in others.
"We're still calibrating this," he says. "But ultimately, because of our triad structure, it's more important to the business unit leader to get the support of other members of the triad than it is to get my approval."
Making the change
The transitions in responsibilities that Ascension, CHI, and SSM are trying to implement at the local leadership level have been less jarring for St. John's Brooks than he anticipated. He realizes that even as a president and CEO, he was never in total control and those who think they are, even at the very top of the organizational chart, are deluding themselves.
"I've never thought of it that way. The stakeholders we have, the constituencies, the complexity, has always led to leadership being a team sport," he says. "The CEO is captain, but should be very team oriented. Frankly, if total control is what you need, these aren't going to be the right roles for you."
On the other hand, if you like to be a leader in a team construct and can work well in a "matrixed" management environment, "you'll find great support in real tough situations," Brooks says.
"There's a tradeoff, absolutely. If you need minimal ambiguity, this won't work, but think of the other side of the coin," he says. "When you're in total control, it's lonely because it always falls to you. But if you want to flourish in an environment that can adapt and move quickly, this transition can be complicated but wonderful."
Today's local leaders have to want to be collaborative.
"Leadership's job is to make improvement. That's the only reason we exist," Brooks says. "If it's about turf, that will all feel very antagonistic. Our role is to create great systems of care. Not great hospitals or great doctor's offices or great home care. It all has to fit together. The joy is you're not just limited to the walls of the acute care model."
This article appears in the May 2014 issue of HealthLeaders magazine.