Leadership: The Challenge of Planning

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For more analysis and a look at the complete survey results from all sectors, please visit our HealthLeaders Media Industry Survey 2009 Web page, which features downloadable reports covering CEOs, finance, technology, quality, marketing, health plan, physician, and community and rural leaders.

A CEO is supposed to be the "visionary" of an organization—and apparently, most CEOs are adept at portraying that image. Forty-eight percent of the senior leaders across all pillars of our survey described their CEO as a visionary, and 42% described the CEO as a competent administrator. So it was interesting that CEOs along with other respondents in the leadership pillar of the survey didn't rate their long-term planning—a job that is presumably one of their main areas of focus—so well. Only 40% of CEOs rated their long-term planning as slightly strong, and just 15.7% rated it as very strong.

"We tend to rate long-term planning a bit lower because it is so hard to do with any degree of accuracy," says Cheryl Herbert, president of 94-staffed-bed Dublin (OH) Methodist Hospital.

CEOs are trying to please multiple stakeholders and respond to outside forces—reimbursement, regulations, and the economy, she explains. "It is difficult to set a plan that holds up in the longer term."

Nancy Newby, president and CEO of Washington County Hospital in Nashville, IL, agrees, saying that CEOs can no longer do long-range planning because the economics of healthcare change on a quarterly basis. "I could spend days and a large consultant bill on creating a great five-year long-range plan, but if I lose a doctor or Medicaid extends its payment cycle to 400 days instead of 250—all bets are off," she says. Even if hospitals wanted to devote time to planning, many small and midsize facilities don't have the resources in house to do so, adds Robert G. Kiely, president and CEO of Middlesex Hospital in Middletown, CT.

So where is the focus of CEOs? Quality and patient safety was cited by chief executives as the top priority during the next three years. Coming in second was physician recruitment and retention followed by reimbursement. The lowest priority was transparency, which received a handful of second- and third-place votes. Also not high on the priority list: technology and equipment, and employee satisfaction, which were ranked No. 1 by just three and two chief executives, respectively.

Given the list, CEOs weren't too surprised by the ranking. "Quality and finances are survival for the CEO. Transparency is simply putting the quality and financial results in the public's eye," says Newby, adding that many CEOs already publicize their data. "Our more important focus is on the physician issues which directly impact the financial picture," she says.

Looking ahead, 74% of CEOs plan to retire in the next 10 years, which may not be too surprising considering that 80.7% of CEOs are 46 years old or older. Still, Kiely worries about a developing talent pool void. "I wish that mentoring of early and mid-career executives was stronger," he says.

It appears that Kiely is not alone. While the No. 1 personnel issue that needs improvement, according to CEOs, was eliminating low performers, mentoring future managers was second on the list, with succession planning for senior-level staff coming in fifth of 10 concerns listed. But while they recognize the problem, CEOs do not rank it as a significant priority among the challenges they face. Indeed, leadership development ranked next to last, less important than everything but transparency.

For the next HealthLeaders magazine story in this package, visit www.healthleadersmedia.com/industry_survey/technology. For complete, detailed survey results, visit www.healthleadersmedia.com/industry_survey.

Carrie Vaughan

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