Jennifer Tomasik, FACHE, vice president and principal with CFAR Inc., a management consulting firm, agrees. “The stakes are higher now,” she says of leaders’ efforts to recruit for their executive teams. In her role, Tomasik is seeing a “hangover” in the healthcare industry, creating a sort of organizational languishing borne out of the intense effort and focus that was required of hospital and health system personnel during the COVID-19 pandemic.
Now, as healthcare organizations grapple with financial pressures, exhaustion and employee “churn,” leaders are recruiting smaller teams of executives and deploying different strategies to do so. “They’re reconfiguring roles and asking people to take on multiple responsibilities,” says Tomasik, “and moving toward a much tighter, more nimble, more resilient team that really trusts each other.”
In this feature, we explore the strategies healthcare leaders are using to build executive teams that can succeed both today and tomorrow, as well as trends in how leaders are building their teams. Conversations with experts and providers alike revealed whether leaders are recruiting from outside their organizations or focusing more so on developing leaders internally, what leaders are looking for in the executives they hire, and the backgrounds and career pathways of the candidates who are surfacing to the top of their searches.
Searching Within
Tomasik, who is accustomed to seeing organizations use a search firm when leadership spots open up, says the process now begins with assessing their own ranks first. “They are taking that initial search with their own people who they’ve had experience with or they’ve heard of through their networks who might be the right fit, not just from a technical standpoint but also really from more of a values and a cultural standpoint.”
From a strategic point of view, Dennis Kain, FACHE, senior vice president with executive search firm Kirby Bates Associates, says organizations are looking both inside and outside when hiring. But, he points out that having a succession planning process “that reaches into the organization to keep a current inventory of available talent” can help. Even if an internal candidate’s resume isn’t an exact fit, the organization knows that person’s qualities and strengths, which it can buttress with executive coaching, for example. “As we’re all moving to have a more diverse leadership team and one that represents the communities we serve, it’s also an opportunity to give people the opportunity to grow their careers,” Kain says.
When external candidates are recruited, organizations typically seek successful leaders with diverse backgrounds, according to Kain, who has seen a rise in leaders wanting to measure internal candidates against external options. “They’ll have candidates go through the interview process to measure them side by side and validate whether to promote from within or hire externally.”
Fernandez, who assumed the role of president and CEO of Lifespan and interim president of Rhode Island Hospital in early 2023, has been rebuilding and reorganizing his team across the integrated, not-for-profit, academic health system. In doing so, he has relied on a mix of recruiting people from outside the organization and promoting people from within.
Right away, Fernandez had to find replacements for the recently vacated positions of CFO and head of human resources. He hired two individuals with whom he had worked previously—one to handle the areas of finance and administration, and that of senior vice president of strategy and planning—a new position at Lifespan that he felt was needed to “plan for a future and a lot of fixes.”
Soon after Fernandez started, the health system announced the reorganization of some of the senior management team. This involved recasting two existing clinical positions into new roles, for which he is still recruiting, and streamlining the number of his direct reports down to six. “Sometimes having fewer people who are in decision-making roles can help the organization move faster because there’s just fewer committees and people to deal with,” he says.
Finding the Right Fit
As teams shrink, finding candidates who are a great fit has only grown in importance. “You always hear the word ‘trust’ in teams and how essential it is, but it takes time to create that,” says Tomasik. Now more than ever, leaders are searching for candidates who “can hit the ground running and really accelerate up that trust curve in a way that enables the full team to get better jelled and improve their performance.”
During the last several years, one of the main criteria in Fernandez’s search for candidates is kindness. Ensuring that the people he hires are kind “doesn’t mean they’re super sweet” but that “deep down in their soul, they’re kind and care about our patients and our mission and other people. After that, if they can do some finance or operations, that would be good.”
Amy B. Mansue, president and CEO, Inspira Health, a charitable nonprofit healthcare organization that includes four hospitals, two comprehensive cancer centers and several multispecialty health centers throughout Southern
New Jersey, says she is looking for leaders who are great communicators, experts in their skill sets and who possess high emotional intelligence.
Also high on her list of values in candidates is agility and the ability to manage change. “We’re making sure that people who are coming to the table have an understanding that if you’re looking for static, the same thing every day, this is probably not the field you want to be in right now.”
Mansue indicated that the past few years have signaled significant changes and challenges in the healthcare landscape, with 2020 being the catalyst for much of what health systems, including Inspira Health, continue to face three years later.
Candidates with a successful track record of implementation are also in high demand, according to Kain; however, the measure of successful implementation is transitioning away from a basis of revenue growth toward managing costs and doing more with less while at the same time continuing to maintain quality. “That’s a unique skill set these days. Right now, we’re at a crucial moment. With a ‘COVID echo,’ we need to be nimble, and we need to be able to make tough decisions regarding services that we offer,” he says.
Making that determination can be difficult with respect to licensure issues. “In order for hospitals to open their doors, accept patients, receive CMS reimbursement and maintain their license, they have to treat any patient who comes into their emergency department. This creates a very high demand on hospital services and costs,” Kain says, adding that the requirements for not-for-profit hospitals is very high. “To continue providing quality care under such pressure, more organizations have pivoted toward ambulatory/physician practice leadership and moving patients to lower cost of care settings.”
Strong communications and interpersonal skills are two traits that stand out for Tomasik in recent executive searches. The “ability to know how to engage people at different levels” is an especially important skill, “especially in a world where you really need to motivate and inspire people,” she says.
Though background, technical skill and education are all important factors to consider in hiring an executive candidate, determining whether someone is the right candidate often comes down to whether they can be seen as a leader, Kain says. More often, he sees leadership teams hire executive advisors to be part of the evaluation process and to assist newly appointed external candidates to fit well within an existing team.
Restructuring for Safety and Other Challenges
When Inspira’s Mansue started her role three years ago, she prioritized creating a sense of community.
To do this, Mansue conducted an internal engagement survey and evaluated the strategic plan against the backdrop of the pandemic. What she discovered was employees who felt concerned for their safety because of the pandemic and the increase of incidences of violence toward staff.
In response, the health system took a clear approach to establishing a culture that focuses “very specifically on the safety of our employees and on the reminder that none of us are alone,” says Mansue. Part of the organization’s renewed focus on safety included creating a culture where employees could feel comfortable speaking up and demonstrating their feedback in action.
At the same time, Mansue believed the leadership team needed to be restructured so that certain positions could better support driving the dual focus of quality and safety. “It was about creating the structure first and then finding the people who fit into that structure.” With the right structure and people in place, Mansue’s leadership team could lead for safety, reinforcing to staff the importance they play in that work.
In addition, Inspira has invested in technology and expertise around workplace violence. For instance, an on-staff expert provides training to ensure all employees use a common language about how to relate to patients who need to be de-escalated, and to also manage crisis situations.
Beyond the hands-on training and resources, Inspira has also invested in numerous technological resources employees can use for keeping both patients and staff safe, including Strongline Staff Safety System, a GPS-enabled badge that serves as an easy and discreet way for staff to instantly summon help if they feel threatened.
In addition, psychiatric advanced practice nurses are now in the ED, and the system has expanded its behavioral health assessment team to support the medical staff until they can get patients to the right behavioral health units and services. Bringing these changes to life required the feedback from employees and the right leaders at the helm to activate it effectively.
As to the size of her team, Mansue says it’s about the same as previously, but there are now “new voices at the table.” For example, the health system added a chief of innovation and information technology to help link those two areas. “We’re just trying to reorganize things for the current environment, and then we’re also trying to create that systemness,” she says. To that end, Inspira Health is sharing lessons learned throughout the facilities that comprise the system.
“That then falls into the whole issue around transparency and safety. Are we reporting out? We’re sharing our best practices and areas of improvement.”
Inspira has also adopted an operating model it calls “operational advantage,” in which the health system shares its goals on a regular basis with the workforce and demonstrates whether it’s on track to meet those goals. “I think that’s a much more transparent process to ensure that everybody’s involved and understands how decisions made at the system level impact each staff member.” To do that requires leaders who “understand in a deep way that we’re going to continually change until we get to the right structure to best serve our patients and employees,” she says.
For Fernandez, preparing for future challenges means having a “very clear” multiyear or strategic plan “so we all know what direction we’re headed.” On the softer side, he plans to do intentional team building and formal leadership assessments to determine how to build the organization’s bench strength over time. The health system also recently implemented a training program called “Leading at Lifespan,” which provides one-on-one management training designed to build a cohesive leadership culture across the organization.
Leadership Development and Succession Planning
Tomasik is hearing a desire from her clients for more leadership development, not just at the senior level but across the organization; however, budgets aren’t necessarily there to support that, she says. “On the one hand, you can’t afford not to do it, but on the other hand, in a world where you have limited resources, where do you put those resources?”
She advises clients to try to layer leadership development into the work that organizations are already doing when shaping a strategy or advancing an initiative. By providing more intentional strategies for leadership development that people can apply to the work they’re already doing, Tomasik says it feels less like a “big, separate, expensive thing to do.” She describes it as, “do the work, build the team.” However, it does take time, attention and intentionality, she cautions.
Additionally, strong leaders can model and cascade their skills down to their teams, Tomasik says. “The significance of a strong leader on organizational performance cannot be overstated.”
Kain finds that leaders are very sensitive now to the idea of promoting from within, as it leads to greater morale and can be seen as a recruitment advantage that says, “if you join this organization, there are pathways to grow your career.” He expects to see more of an emphasis of internal hiring, “particularly as we’re trying to go down the path with DEI to purposefully identify potential leaders.”
Inspira is offering advancement opportunities to its full-time employees by reimbursing tuition for classes taken at Rowan College of South Jersey. In addition, Inspira has partnered with the college to create training programs for areas in need of staff. “Our vision is that you come in one role and we’re going to support you all the way through to get the education you want and need to be anything you want,” Mansue says.
As for succession planning, Inspira incorporates it into its annual review process, identifying candidates who have high potential within the organization who may benefit from additional training. “All of that is just part of the continuum and making sure we can grow our leaders from within,” Mansue says.
Lea E. Radick is a healthcare writer in Chicago.
Improving Onboarding and Transitioning New Team Members
As a management consultant, Jennifer Tomasik, FACHE, vice president and principal with CFAR Inc., sees opportunity in how organizations support leadership transitions. “There’s usually a big focus on identifying the right person for the role, and much less attention given to ‘how are we going to help this person succeed once they arrive?’”