It’s a Matter of Scale for Healthcare System CEOs

By Rodney Reider 

For healthcare CEOs, as the size of the healthcare system grows, so grows their need to balance priorities. By organizational structure, larger system CEOs, including those individuals who are Physician CEOs, often coordinate with multiple individuals reporting to a board of directors. The CEO perhaps has a specific specialty from past experience––finance, legal, medical––with next-level leaders who broaden the operational bandwidth through their specialties. 

In contrast to the stand-alone hospital CEO who are more intimately involved in the daily operations of the rural or individual hospital, large system CEOs find themselves in larger cities with more public points of interactions and more team members among the healthcare staff to whom they must stay connected.

Time is always a factor

Hospitals are 24/7 operations, and large systems have hundreds or thousands of people relying on services at any given time. The large system CEO cannot reasonably be involved in these daily functions and resource needs. This CEO is consistently informed by the people they’ve entrusted with overseeing specific functional areas. The CEO must hire the correct people to provide operational knowledge and support who report back on the needs of the system.

In the meantime, the large-system CEO balances the internal time demands with the duties of external community and coalition building. Regardless of the size of the healthcare facility or system, the CEO experiences the time demands of interaction with the arts, nonprofit organizations, Chambers of Commerce, and government officials at all levels. The difference for large-system CEOs is simply that cities where larger health systems are located have more points of interactions than rural communities.

Regardless of these external time pulls, the CEO must maintain accessibility to internal leaders, physician groups, teams, and patients and their families without micromanaging.

Balancing priorities

Large-system CEOs master the art of balancing priorities on the individual level with their own time and focus, and at the system level to provide leadership and innovation needed to move the system forward. This is accomplished through building your team of trusted leaders, staying forward-focused, and communicating continuity and culture.

Find people you can trust. Move the organization forward by empowering the people you have entrusted with oversight of operational functions. There is value in elevating individuals from within the organization because they have established relationships and they know the culture of the YOU (the CEO). There is value in the continuity of long-time employees. These individuals need the preparation and motivation to rise to the next level, to stretch beyond their current responsibilities.

Conversely, hiring from outside the organization, know the person you are bringing in. Observe their work and sphere of influence. Understand what she or he brings in terms of diversity of ideas. Invite your current team to be part of the hiring process. And, even though it should go without saying, always check references.

Once you build your team, hold them accountable for the work they do. Continually motivate them to succeed for the organization. You aren’t necessarily an expert in their field of responsibility. Ask illuminating questions to encourage them to keep you informed, and share ideas and perspectives.

Stay forward-focused. Anticipate the needs and trends of the system and profession to resist the tendency to live in the realm of reactionism. Be aware of getting caught up in the immediate instead of maintaining the longer-term vision of the system. Micro-details can distract CEOs from anticipating the overarching needs and goals of the organization and allotting the resources to accomplish the desired outcomes. 

Communicate continuity and culture. The large-system CEO must be an attentive, active listener. The Greek philosopher Epictetus said, “We have two ears and one mouth so that we can listen twice as much as we speak.” In reality, the ratio of listening to speaking should be much wider––perhaps as much as 95 percent of your time is spent listening.

The system’s culture should be energetic and optimistic, and the CEO is the keeper of the culture. As the CEO, you set the tone for interactions among team members and between medical personal, staff, and patients. You are the role model from the top of the organization through the front-line employees. 

So, how does a large-system CEO balance the internal and external responsibilities while maintaining a future-focused vision? You’ll find it in the cycle of information you take in and what you do with that information that benefits your healthcare system.

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  • Expand your consumption of information beyond healthcare. Look outside the healthcare industry to learn from the successes and failures in other industries. Seek continual improvement. Remember, people’s lives are in your hands.

  • Embrace diversity of thinking — weave the freedom to express opposing opinions into the system culture.

  • Be creative and embrace innovation. Think like a nimble startup. Look for unusual but productive partnerships––for example, collaborating with payers.

  • Make things happen. Bust your organization out of the traditions of bureaucracy and slow adoption of change.

The greatest challenge for a CEO, especially those in larger health systems, is making things happen. Embrace the differences that exist among facilities of the organization, rather than implementing cookie-cutter programming. Bring the passion and drive of smaller stand-alone organizations into multi-location, multi-state systems. It’s the vision of the CEO who sees amazing things happening, brings that back to the system, and achieves the ultimate shared goal for healthcare: lower costs and better patient experiences delivered through higher-quality healthcare.