While healthcare leaders are focused on transforming their organizations amid constant change, the nature of their roles has changed quite a bit, particularly in their breadth, complexity and in the importance of supporting empowerment.
All three require skill sets not readily learned in a traditional classroom, and not reliably mastered in the workplace.
Breadth: I was originally hired to work in a hospital. That soon became a hospital plus some outpatient facilities. Then came nursing homes, joint-ventured hospice services and large home-care organizations, as well as a reference lab, multiple ambulatory surgery centers and community indigent-care clinics. Next was a rapidly growing physician enterprise, free-standing emergency departments and a large transport system. Add an accountable care organization, taking on financial risk and a health plan.
About five years ago, a speaker said in the middle of a presentation, “Tim, let's pretend that you are responsible for the healthcare of your entire community. Oh, I guess you are.”
For many of us, we became our community's largest employers. Health system leaders today also provide executive leadership for much of what happens in our communities: the Chamber of Commerce, the United Way, the school system, community not-for-profits. We are sought out on every university board, every not-for-profit board and for every fund-raising effort.
The role we were trained for is not the role that has emerged. And that reality is increasingly the case throughout the entire leadership team, not just at the CEO level. It is also more important than ever to mentor diverse candidates so that senior leadership truly represents our populations served, and so that we can be credible stewards of health throughout our communities.
Complexity: Leaders in the C-suite used to have direct lines of sight. We knew who we reported to, who reported to us, and our span of control. Now, most leaders are in a matrixed role. As CEO, I used to know that I reported to a board, which was quite a challenge. Later, the reporting seemed to flip.
With more employed physicians, I sometimes felt as though I was reporting to them, not vice versa. With acquisitions, I had new communities to learn, new formal and informal “relationships” where I was held accountable. I also felt more accountable to outside entities or interests.
The role of the chief learning officer is a good example of this complexity. This person might have relationships with HR, but also directly with the CEO. The role also may link indirectly to the chief strategy officer, the chief medical officer and others. This executive may be involved as a “change agent” in information technology projects and organization re-engineering, or in leading cultural change efforts, redesign or other systemwide functions.
Culture of empowerment: I don't recall when I first heard the phrase “culture” as it pertains to an organization. However, as I started to take organizational culture seriously, much that I was trying to do as a leader was to create a culture in which people spoke up, leader to leader, staff to leader, all levels of clinicians to all others. I watched new leaders in various parts of my organization create their own micro-cultures.
I became much more aware of the small signals we send that create that culture—the stories we tell, what we reward, where we focus our attention, and the types of people we surround ourselves with. All of this adds (or subtracts) from the culture we want to create. I knew that getting the culture right was critical. As has often been said, culture trumps strategy.
Successfully managing this breadth, complexity, and the need for intentional culture development also means leaders need to do more to position and prepare staff at all levels. We need to tap into the best minds in leadership development to learn, share and collaborate. We all need to recognize the changing nature of leadership and align ourselves with those who are committed to making a difference in our organizations, in our industry and for our patients.