Why I find Rural/Small/Stand-Alone-Hospital CEOs so Impressive.
By Rodney Reider
“Stand alone” hospital presidents provide a great deal to admire.
I was the lead in a recent strategic retreat and the CEO was incredibly impressive as I watched her interact with her board, her physician leadership and her administrative team. Once again it rekindled my awareness of how small hospital CEOs have to do it all. They are the engaged in the community, lead in the facility, influence the physicians, head Human Resources, know all the staff by name and can even be involved in the revenue cycle, IT and compliance departments. There is very little this CEO isn’t aware of from governmental changes to the one physician or nurse who leaves unexpectedly. There is no cushion. There is no room for error. It is a pure survivability issue. They must know everything and be involved in everything. As they look around them, there are few, if any, people to delegate to within the organization. They have the community depending on them as one of the key employers if not the largest of their city. System CEOs on the other hand have delegation capabilities and can look to corporate for support and capital. While a smaller hospital CEO bears the brunt of this responsibility.
It is not a complete isolation issue. They do have a team, just no “extended family” in the form of a corporate system structure. They often have a CNO and CFO, but the systems and support beyond are non-existent. Where can they turn as the squeeze of reduced reimbursement has its negative impact? In a larger system, the higher performing hospitals can supplement the lesser hospitals to possibly garner the needed capital for necessary renovation or the equipment purchase to enhance competitiveness. In some instances, marketing or even the new physician recruitment can be supported through corporate system funds. They of the stand alone hospitals, truly do stand alone. If there is capital to be had they must be reliant on their own diligence and ingenuity. If it is a physician they need, the hospital performance and quality of life and the interaction on the visit must be the draw.
While the system CEO will say, “I must survive solo”; however, in reality, IT and the Revenue Cycle are predominately being performed under the watchful eye of the corporate and direct report at home office. In addition, monthly and “in real time” reviews by corporate provide for an enhanced and frequent view of corporate delegated accountability and pressure. Conversely, the pressure of the rural CEOs and all the necessary corresponding accountability is all self-imposed. Well, as self imposed as everyone in a small community can be when all eyes are aware of your every move and interaction. This ranges from your favorite bagel, your time of arrival each morning to even what person you smiled at or didn’t that day – all of which may influence an employee who knows someone who is related to someone on the board directors. Small can be beautiful, but also challenging in any environment. In addition to self-imposed day-to-day pressure of the smaller hospital CEO, there’s the added responsibility of being expected to listen to not only every member of the medical staff community, but also their family members and the general public. There is no off switch for these CEOs. The large hospital can allow some committees to function without their presence, the events can proceed minus 100% attendance, not so for the stand alone. Everyone wants to know prior to attendance will the CEO be there too? And if no, why not?
In addition, there is no operational function not truly known by the small hospital CEO. There is not the time or money available to study the issue when the physician grabs you in the hallway. There is no place to hide…one must take action even more quickly then in a larger system-run facility. It is known there is no cushion when the census drops down “below” at a small facility. It’s for all of these reasons and more not even mentioned, that my hat goes off to the stand-alone hospital CEO. Keep up the good work.