The shared leadership arrangement at 147-bed New Island Hospital, Bethpage, N.Y., lasted nearly a year before the governing board chose the physician over the administrator as chief executive.
On Nov. 16, the board announced that Aaron Glatt, M.D., president and chief medical officer, had won the CEO position over Giovanni Distefano, the hospital’s long-time chief operating officer.
“It is tremendous,” Glatt says. “I hope to do the best job possible.”
Because of questions about overlapping authorities and resulting decisionmaking delays, Jack Howlett, the board’s chairman, told Modern Physician that the two executives asked the board in October to decide on a single president and CEO to lead the community hospital, which is located 25 miles east of Manhattan.
“We worked together as well as we could, but we reached the limit where we needed to really have one person make the decisions,” Glatt says. “Each of us had a slightly different vision on how it should go.”
Howlett says the board decided to go with the traditional president and CEO approach because “there were some gray areas that created some employee-based concerns. We consciously made the decision to elevate Aaron as president and CEO.”
Distefano will remain COO, and the hospital will hire a new CMO, Howlett says.
“Both Gio and Aaron were uncomfortable about those gray areas where they both had the authority to make decisions,” Howlett says. “In some instances, when it came to clinical services and regulations, they were stepping on each other’s toes.”
Howlett says the dual leadership arrangement also affected the chain of command within the management staff. “The subordinates, the vice presidents, were having some difficulty in knowing who to report to and go to for decisions,” he says.
In his shared leadership role, Glatt, as president and CMO, primarily oversaw clinical programs, quality improvement, developing new services and is liaison to the medical staff, community and professional organizations. Distefano, who was the hospital’s CEO and COO, was in charge of operations, labor relations, maintenance and physical-plant improvement.
In October, Howlett told Modern Physician that the shared leadership arrangement could have “been a recipe for disaster.” But Howlett felt the two executives had put their egos aside and worked well together to improve the hospital’s quality and operations.
“We each have different backgrounds, skill sets and responsibilities,” Glatt said at the time. “I am a physician. He has been in operations at hospitals for years. It is a wonderful mix. The skills I have mesh well with his.”
Glatt added: “When we have disagreements on approaches, we sit down and talk about it.”
However, over the past few months, Glatt and Howlett say the shared leadership approach ran into difficulties.
For example, when Glatt wanted to create a partnership with physicians to develop an MRI, Distefano cautioned against moving too fast.
“I talked with the doctors and they were real excited. I wanted to do it right away, but Gio says you need to do a (certificate of need) and that takes 90 days. I told him, OK, let’s get it done in 91,” Glatt says.
When it comes to getting projects accomplished, Glatt says that he usually has a quicker turnaround in mind than Distefano. “I am a physician. When I prescribe something, I want to give it now,” he says.
Howlett says this is one example where the power-sharing arrangement fell short. “Clinical services and regulations was one issue of overlap where there was some confusion,” Howlett says.
Glatt also wanted to immediately open rooms near the emergency department to take on additional capacity. Distefano wanted to take more time because the move required CON approval.
“It became difficult when we had different opinions on how to proceed,” Glatt says. Subordinates “needed both of us in the same room together. They were unsure of what to do.”
But Howlett says the fact that Glatt was a physician and Distefano a lay administrator had no effect on the decision to go with one or the other.
Glatt “is a very good leader, very aggressive, with foresight and vision,” says Howlett, adding that Glatt is more of a “point person” who is more at ease in the public eye.
Distefano “has been there 11 years and is very familiar with regulations. His talent is on the administrative side,” Howlett says.
Until the shared leadership arrangement started, Howlett says, tensions existed for more than 10 years between the medical staff and management. But the physician-management relationship vastly improved over the past year, he says.
“Doctors are very pleased, very happy with my selection,” Glatt says.
In October, Howlett said that the shared leadership arrangement could work at other hospitals if there is open daily communication. Glatt said success is totally dependent on the individuals, but that it should not be a long-term solution.
“It depends on the personalities involved,” Glatt says. “You have to have people in those positions who do not want to be sitting in the driver’s position all the time.”
But now Howlett says he would recommend against other hospitals adopting the shared leadership model.
“Over the last few meetings it became clear that it slows down the process and causes confusion among managers on whom to report to,” Howlett says. “As board members we asked, ‘Why aren’t things getting done as quickly as we thought?’”
In the past year, New Island Hospital has improved clinically and financially, says Glatt, who also is professor of clinical medicine at New York Medical College. “We have made tremendous progress on improving our quality core measures,” including pneumonia, surgical infection prevention, congestive heart failure and acute myocardial infarction, he adds.
From 2004 to 2006, the hospital lost $15 million. “It is unclear whether we will break even this year. We had a rough summer,” Glatt says.
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Jay Greene is a former Modern Physician reporter and now a freelance healthcare writer based in St. Paul, Minn. Contact Greene at [email protected]
