Traditionally, individuals became leaders of healthcare organizations due to seniority, loyalty, clinical competence. Many made fine leaders over time and many did not.
The assumption was made that if you good in one job, you can do another. Today, that assumption is being questioned as many challenge whether success in one job will necessarily predict success in another job that requires different skills (both innate and acquired) and even a different temperament.
For instance, because someone is an excellent surgeon with above average acumen in managing complex surgical cases and directing surgical care, does it follow that this individual will be equally adept at managing systemic problems, writing a budget, working harmoniously in managerial teams, or dealing with behavioral and other sensitive human resource issues?
If someone is an excellent clinical nurse, will that individual be able to manage his/her coworkers, write a budget, and manage the operations and financial performance of his/her unit?
Organizations throughout the country are increasingly looking at leadership succession planning as a more rational and predictive approach to: defining the criteria for, recruiting, screening, preparing, supporting and retaining qualified leaders. The following is a brief outline of how such a plan works:
1. Defining Leadership Roles and Responsibilities
The first step in any leadership succession plan is to define the number and kind of leadership positions necessary to achieve the goals and objectives of the organization. This seems like a simple process; however, it requires thoughtful reflection of the nature of organizational structure and processes.
For example, many medical staffs and management teams are replacing voluntary department chairs with brief rotating terms of office with paid medical directors who are accountable both to management and to the medical staff with long term length, leadership training/development and accountability for key organizational goals/objectives.
Many organizations also are replacing the lone nurse department manager with a dyad of nurse and physician managers, overseeing clinical care and operations together. Reflecting on the key leadership roles, their functions, expectations and accountabilities are an essential first step.
In human resource vernacular, this is called creating a job analysis (defining the organizational needs of a job) and a job description (defining the requirements of the job in terms of preparation, training, requirements, skills and risks). In addition, formal criteria for eligibility to apply for the job should be established to aid in the recruitment, screening and performance management process.
2. Recruiting Qualified Leaders
Once the leadership position and its criteria are defined and established, the next step is to recruit current and future applicants who meet the eligibility requirements and will likely succeed in the position. This requires skill and tact, as individuals with the greatest seniority or who voluntarily apply for a position may not be the best qualified.
Some individuals with great potential step forward and others must be actively recruited and encouraged. This requires a process to identify current and future leadership applicants who possess the emotional, psychological and intellectual temperament to serve in leadership roles.
Does the individual have the ability to: work within an organizational structure, facilitate teams, deal with sensitive personnel issues, enforce policies and legal obligations, influence others to do things that may not want to do and drive an organizational agenda?
These are not skills that everyone possesses and success in a clinical area may or may not predict success in management.
3. Screening Potential Leaders Against Criteria
The screening process has important two objectives: to convince the organization that an individual will be successful in a leadership role and to convince an individual that pursuing leadership is the right thing from him/her to do.
Many individuals appear to be leaders in their clinical roles; however, when you sit down with them and discuss the quantity and quality of work required, it may or may not be in their heart to pursue such a career path. Typically, compensation for these roles is not as high as commensurate clinical work. And the requirement to build consensus, attend meetings, work with groups and support organizational policies may not agree with an individual's temperament and skills.
This is the time to identify incompatibilities or personal conflicts that may lead to leadership challenges, as well as manage personal or professional conflicts that may arise in a leadership role.
Finally, it is important for a potential leader to have a realistic understanding of the commitment required to succeed in the position and what s/he can realistically expect in terms of the time needed to grow into a competent and skilled leader.
4. Preparing Leaders
Leadership skills are both innate and acquired and thus, new leaders should be trained prior to and during their leadership tenure. Traditionally, we enabled individuals to "learn on the job" and assumed that experience would be the best teacher. Unfortunately, Confucius declared almost 5,000 years ago, "Experience is a hard teacher; she gives the test and then the lesson."
Thus, enabling a new leader to learn based upon experience alone enables the individual to potentially fail at first through lack of preparation, and destines an individual to learn through the arduous course of trial and error. Nothing can replace practical experience; however, the learning curve is far more efficient and forgiving with solid preparation in advance.
Good leadership training includes the following general areas:
- Roles and responsibilities
- Organizational structure
- Fundamental leadership skills (running a meeting, building a consensus, managing change)
- Operations (writing and managing a budget, creating an operations plan)
- Human resources (federal and state requirements, bylaws/HR requirements, managing personnel challenges)
- Finance (how to read a financial statement or statement of operations)
- Performance management (establishing performance expectations, measuring performance, providing feedback and guiding improvement)
- Legal, regulatory and accreditation requirements
- Implementing strategic goals and objectives
- Quality, safety and service
Providing a solid knowledge base prior to assuming a leadership role makes a smoother and less costly transition that best serves the new leader and the organization.
5. Supporting Leaders
Once a leader assumes his/her position, on-the-job training and coaching is invaluable to helping the individual succeed. There is far too much information to impart in orientation, and some knowledge only makes sense in the context of practical experience. Navigating political conflicts and culture can be tricky for the most experienced leaders and new leaders require additional guidance and support to understand the importance of collegial and constructive relationships.
In addition, many new leaders will demonstrate an early aptitude for certain areas and it is in the organization's interest to further develop a leader's talents to provide optimum value to the organization.
Fair compensation, recognition, and protected time are other ways to support the success of a new leader to ensure that s/he can contribute the necessary time and commitment to perform his/her leadership functions. Finally, it is important for management to positively position new leaders so that a smooth transition of their organizational identity may be made and others will recognize and respect the leadership roles these individuals serve.
6. Retaining Leaders
Good leaders are not as common as we would like. Once an individual is found who possesses both the innate and acquired skills necessary, it is important for the organization to actively keep that individual in his/her leadership role. Each leader is different, and what s/he requires for retention may vary and may include:
- Continued leadership development and potential advancement opportunities
- Protected time with the ability to balance professional and personal obligations/interests
- Incrementally increasing influence and responsibility in desired management or governance areas
- Advanced or specialized training in areas of interest/expertise
- Administrative support (personnel, supplies, space, equipment) to ensure a good working environment
Providing resources sends an important message to the leader and the organization that his/her services are valued and respected, which positions both the individual and his/her leadership role well.
Good leadership is not an accident; it is the result of careful planning and the creation of a leadership succession planning process that identifies potential leaders, screens and optimally develops, supports, and retains them, and creates an environment and culture that supports optimal leadership performance.
Cutting leadership programs due to budgetary constraints is self-defeating as the cost of creating poorly prepared and supported leaders is far too high and directly correlates with declining organizational performance. Leadership succession planning is an investment in the organization's future and will ensure that leaders can successfully implement and manage the organization's strategic vision.
Jonathan H. Burroughs, MD, MBA, FACHE, FACPE is a certified physician executive and a fellow of the American College of Physician Executives. He is president and CEO of The Burroughs Healthcare Consulting Network and works with some of the nation's top healthcare consulting organizations to provide "best practice" solutions and training to healthcare organizations.