As the senior leader responsible for day-to-day operations, the COO advances strategic priorities by delivering high-quality care and driving efficiencies and operational excellence. This appointment can define one’s career or be a final step toward a hospital CEO or president role.
However, vertical career advancement has expanded due to mergers and acquisitions of hospitals and healthcare systems. For example, market or regional COO roles are now commonplace. These roles oversee a geographical market (often involving several hospitals and sites of care) and therefore require greater responsibility than a single entity. In these instances, the hospital CEO or president usually reports to the market COO or healthcare system COO.
Becoming a COO requires significant practical experience and power skills, including attributes such as a growth mindset, a transformational leadership style, practical multimodal communication skills, an ability to cultivate followership and demonstrated intellectual curiosity, which can sharply differentiate a COO from the rest of the field.
Relevant Professional Experience
Most aspiring and newly appointed hospital COOs have extensive experience leading numerous ancillary (non-nursing) departments. For example, an aspiring COO can gain relevant experience by volunteering to lead or assist with hospital-wide initiatives such as improving patient safety, reducing readmission rates or optimizing staffing schedules.
As another example, gaining hands-on experience in managing specific operational functions—supply chain management, patient flow optimization, facilities, environmental services, laboratory services, security or transportation—can help further develop an appreciation for hospital efficiency.
Executive Operational Competencies
The heart of the COO’s responsibilities is overseeing the hospital’s daily operations, ensuring services are delivered efficiently and effectively. Senior operational leadership requires balancing competing priorities, including growing service lines, maintaining operational costs, and managing licensed and non-licensed staff members.
The most effective COOs demonstrate expertise in many wide-ranging competencies. However, the following competencies, or “hard skills,” are necessary for success.
Stakeholder engagement. The COO works closely and collaboratively with other C-suite leaders, the hospital board, the medical staff and external partners to develop and execute strategic plans. Reporting to the hospital CEO requires an unflappable presence, effective multimodal (public speaking, email, telephone, text) communication and professional dependability.
In practice, the COO hosts regular discussions with senior leaders, department heads, physicians and front-line staff to gather feedback on operational challenges and collaboratively develop solutions, ensuring all voices are heard and valued in decision-making. Despite managing complexity and dealing with ongoing pressure, the COO provides reliable and data-driven recommendations to the CEO.
Capital and expense management. COOs are clear-eyed about where spending can be reduced without compromising quality. This might involve negotiating better contracts with external vendors, optimizing staffing schedules, reducing contract labor, growing procedure and surgical volume, increasing operational capacity, and reducing unwarranted lengths of stay.
Here, the COO evaluates and prioritizes major equipment purchases, such as imaging equipment, a fleet of hospital beds or surgical robots—based on ROI, patient demand and long-term strategic goals—ensuring hospital capital is invested wisely.
Quality improvement programs. COOs may lead or support quality improvement initiatives such as reducing hospital-acquired infections, minimizing medical errors, preparing for Joint Commission surveys, elevating patient experience scores and improving patient safety. Therefore, the COO needs to master the application of performance improvement science and use that knowledge to improve outcomes.
In this competency, the COO leads a multidisciplinary team to analyze patient discharge delays, identify bottlenecks and implement a new streamlined discharge protocol that reduces length of stay and improves patient satisfaction.
Technology adoption and innovation. COOs are fervent sponsors of innovation; however, they adopt technology through a data-driven and cost-efficiency lens. Adopting cost-effective and empirically proven technologies can position the hospital for long-term growth and market differentiation.
On the ground, the COO champions technology, such as asset tagging systems, wearable devices for patient monitoring, robotics, touchless security systems and AI-powered predictive analytics tools to optimize patient flow, reduce wait times and improve operational efficiency.
Process optimization: A COO improves hospital-wide operations by identifying inefficient workflows and interdependent processes that impact patient care. The COO must be willing to walk throughout the hospital, across campus grounds and parking locations designated for patients and visitors. By reengineering workflows and processes, COOs can significantly enhance the efficiency of clinical, operational and administrative functions, ultimately improving outcomes and reducing costs.
In this case, the COO champions cross-functional collaboration through structured huddles or rapid improvement events (e.g., Lean Six Sigma) to identify pain points and implement workflow solutions driven by the front line.
Grit: The Singular Competency That Can Set You Apart
If most workdays overwhelmingly involve virtual and in-person committee meetings, then a COO is simply “working” the ranch, not “running” the ranch. COOs are change agents. It takes grit and tenacity to run day-to-day operations in a highly complex organization effectively.
There will be times when the COO fails in the short term. Despite such setbacks, COOs must be resilient, leave the safe confines of their executive offices and accept the gifts of being scrutinized and judged. The COO must reevaluate or pivot in their approach to a problem only after visiting and conversing with managers and front-line staff. Being visible and accessible require time and energy. This type of grit separates effective leaders from mediocre leaders.
The practice applies when faced with a significant staffing shortage. For instance, the COO works long hours alongside department heads to reassign resources, recruit temporary staff and implement retention strategies, refusing to give up until patient care standards are stabilized.
Power (or Soft) Skills
The practical application of power skills is equally as important as professional experience. For example, be kind and patient, actively listen and seek understanding.
Many also refer to these skills as soft skills, which can be refined by engaging and leading cross-functional employees. Make it a point to conduct your leadership rounds to connect rather than inspect. Show and explain, rather than direct, by sharing stories that illustrate organizational priorities. As a meeting facilitator, allow people to bring their perspectives forward. Ask open-ended questions.
How you show up for work determines how your colleagues and team members perceive you. Accordingly, self-regulation and self-awareness (emotional intelligence) are perhaps the most advanced power skills. Some examples include:
- Listen carefully during a tense one-on-one meeting rather than interrupting.
- Praise employees after noticing their effort and improvement.
- Set a steady example with composure during a crisis.
- Be aware when a colleague is overwhelmed, and offer support and goodwill.
- Use professional body language when exposed to adverse interpretations and misinformation.
Finally, remember your purpose—your why—and carry it with you. Employees and patients are your essential and most vulnerable stakeholders. Treat them well and nurture them. There is no better work than leading human beings, running day-to-day operations and making it easier for providers to deliver exceptional care. Your community is counting on you.
Kofi A. Cash, DSc, FACHE, is a seasoned hospital operator and executive director of operations in the Greater Boston area.