Wednesday, May 16, 2007

For Students -- Success and Succession

Wednesday is response-to-students day. EB, below, is not quite a student, but his question is a good one and relevant to those thinking about careers in health care. I include excerpts and then reply.

Being in my early 30s, I have had the opportunity to hold various middle management positions in administration at hospitals in major US cities. My motivation for leaving each of those roles was due to the lack of perceived opportunity to ascend to more progressive levels of responsibility and in time, move to higher positions within the organization. I often found myself questioning why there seemed to be a large gap in age between myself and others in middle management. And then it dawned on me. I found in these 3 separate organizations, there was not much evidence of commitment to leadership succession and growth/development of earlier careerists.

With all the challenges the hospital industry faces in the upcoming years:a) where will the hospital leaders of tomorrow come from?b) How can hospital attract a qualified entry level and middle management workforce when other industries (banking, finance, law) offer more competitive salaries/benefits?

How are you thinking about addressing the situation that some mid-level managers in hospitals perhaps face, as I did, and future succession planning efforts such as those I mention above?

One job of all senior level managers is to prepare to make themselves dispensable by ensuring a good succession plan. EB is correct that this is often neglected in large organizations, and health care is no exception. This is a shame because an organization spends a lot of time and money hiring, training, and grooming mid-level executives, and if you give them no sense that there is a career path in your own organization, they will eventually leave for another.

We recently created a program for several of our mid-level top performers, people we view as having the potential to run the hospital in the next few years. We call them Sloane Fellows in honor of our previous Board chair, Carl Sloane, one of the country's preeminent management experts, who was kind enough, too, to help us design the program. We sought nominations from our senior-level folks for this program and choose 19 -- out of 50 very good nominations. These folks have just completed an 18-month program of intense individual and team development. Perhaps some of them will want to add comments to this post to talk about their experiences.

I offer this as just one example. There are more subtle things we do, too, to prepare people for succession. In addition, we always attempt to promote from within the organization to reward successful managers with further career opportunities. Nonetheless, this is an area that needs continued work.

Meanwhile, on the clinical side, I would have to say that the academic departments generally do a very poor job with succession planning. This shows up in the following way: When a chief of service resigns, the likelihood that his or her successor will rise from that same department is small. With a few exceptions, department chiefs do not do a very good job grooming their division chiefs and other prominent faculty to be their successors. I am starting to see some changes on this front, but this is an area that needs more attention.


Anonymous said...

Hang in there. I'm 39 and stuck in middle management too. What I've come to realize is that many of the positions above me are occupied by baby boomers. It used to frustrate me, however, I now look at these circumstances as an opportunity. An opportunity to enjoy life. As my calendar said yesterday, life is a journey, not a race.

Rob said...

This is true in every business. Because we broke the unspoken social contract, back in the '80s and '90s, there's no sense that there even OUGHT to be continuity, nor that running a business is more than crunching numbers. We've become number-blind and have forgotten the lesson that an institution is the sum of its assets, both monetary and human, and that its philosophy, its memory, and its motivation lie in the latter.

It's something that ought to be natural, but has to be planned. It is, in the end, a matter of leadership at all levels. That's the rub. Who wants to lead if it means some day you get laid off anyway? It's a shame.

Marsha said...

I am one of the Sloane Fellows Paul refers to in his post. The Sloane Fellowship program has been an incredible experience. The program has included MBTI, 360 evals, individual coaching, educational sessions with Harvard Business School professors, intensive training in presentation skills, and "stretch" projects, typically outside our areas of daily line accountability. It's clearly an example of an organization investing in growing it's leadership internally. And it works, I use my learning every day.

I would add also, as a nursing leader dealing with an aging nursing workforce, that I am always on the lookout for talent among our junior nursing staff. It's important for me to notice those folks, make time to meet with them for conversation about their career goals, identify projects and responsibilities that can excite and stretch them, support their return to school and participation in professional associations and so on. I honestly can't imagine working in an environment where "continual learning" wasn't the culture. It keeps people engaged and motivated, and it's fun!

Anonymous said...

I'd also like to see more investment in formal graduate programs with focuses in healthcare administration. Speaking personally, I have an MBA with a focus in healthcare from a well-known college and there were only 2, sometimes 3 people in my healthcare classes. While I'm sure the Boston colleges and universities have more robust graduate healthcare programs, I'd like to see more investment in some of the other area colleges and universities across this state to foster the future 'class' of healthcare leadership. Perhaps insurers and hospital / healthcare networks should look into such investments with an eye towards grooming their own future workforce. In most cases, an entry level position in healthcare is less attractive, certainly financially, than its counter part in the financial sector. Create incentives for people to enter into the healthcare arena through scholarships or other incentives to provide long-term returns for both the employer and employee.

I can relate to EB, in that most of my fellow managers are 15, sometimes 30 years older than me (i'm a few months shy of 30 myself) and do notice that in my various meetings outside of the organization, I experience the same dymanic nearly 100% of the time. I believe that age is just a number in most cases, but in terms of the 'next crop' of leaders, I don't see many people my age nipping at the heels of their higher ranking counterparts.

Joe said...

I’m also one of the Sloane Fellows and have several comments. To give you some perspective, I’m 52, male and like yourself have had the good fortune to have worked in a wide variety of venues and locations including NYC and several years in Canada before landing here in Boston and BIDMC nearly five years ago. In my mid- thirties I, like yourself, was much more focused on ascending the ladder and the trappings of success than I believe I am today, but today I have the great good fortune to have landed in a terrific environment that is challenging, exciting, nurturing, and to echo Marsha’s thoughts, fun! Every Day!

Today, my thoughts are more along the lines of finding ways to make more important and strategic contributions to the success of the organization than worrying about whether I’ll become a CXO, VP or whatever. Another thought is that maybe some of these opportunities are eluding you because those who would grant them have looked at your CV (which I haven’t), seen a lot of motion (which I sense), and wonder if you have the patience and stick-to-it-iveness to prevail. At the risk of sounding my age, I see an awful lot of younger, self-entitled individuals without a lot of real horsepower or business sense and sensibility but with great expectations. Be patient. Your life expectancy demands it.

Anonymous said...


I am fortunate to be one of the Sloane Fellows at BIDMC. I have worked here for the past 25 years and my role is as Director of Professional Practice Development for Patient Care Services. In this role I work toward improving the quality and safety of our patient care practices.

It thought that your readers might like to hear what we have been doing in the last 18 months! First, it all began with an intensive assessment including a 360 and a debrief with an executive coach. At that point, an individualized development plan was collaboratively formulated by me, my coach and my Sr VP sponsor. This was a great way to get feedback on my leadership style, my communication skills, organizational skills, ability to lead change etc. Let me tell you - this was intense!

Over the course of the next year,each fellow was challenged with a project that took us out of our comfort zone. We worked with other departments and VP's and did work on programs that we really didn't know much about. We really learned about leading change! This was reinforced by several full day sessions with HBS professors who used business case studies to reinforce concepts around leading individuals, leading teams, and leading organizations. These were fabulous!

The final continuous aspect of the Sloane program was access to an internal executive coach who met with me at least once per month - sometimes more. This was an intensive opportunity for introspection and strategic planning around my own leadership goals.

The Sloane Fellowship was a great opportunity for challenge and assessment - coupled with the right amount of support to keep me on target with my goals. I feel very fortunate to have been a part of this great group. I now have 18 fellow - fellows that I can call on anytime! I also have a clear idea of my strengths and "growing edges'!

Thank you Carl Sloane for your wisdom in helping to design this program. If more hospitals developed programs like this - the succession planning for the leaders of the future might not be such a worry.

Qiang said...

I’m an IS manager of the Beth Israel Deaconess Medical Center and have been in this capacity for over two years. I was fortunate to be chosen to participate in the Sloane Follows program Paul refers to in his blog. Being a Sloane Fellow has been an incredible learning experience for me. It has inspired my greater interest in leadership, boosted my confidence in leadership ability, motivated me to further develop self-awareness and helped accelerate my individual development. I believe this type of leadership development programs will let more people emerge as senior leaders. Viewing this type of leadership development program as an early step in leadership succession planning, I’ve been pondering on what might be the next step to extend its success. I think one possible approach might be for senior leaders to create opportunities for middle-level leaders to try out and experience a more senior leadership role. This step will not only provide recognition for their leadership ability but also better prepare them to take over a more senior leadership role in the future.

Anonymous said...

Qiang has an interesting idea. I have seen this done at a large botanical garden where I volunteer; they have had two temporary directors mentored by the permanent director. I believe the time period is several months long, not just a token "leader for a day".
And lest you think a botanical garden does not translate to a hospital, as a retired M.D. I have learned otherwise, especially in the financial, customer satisfaction and prima dona scientist areas! (:
An idea to consider, Paul.

vkrn said...

In the 17 May issue of the NYTimes, the article "In Bid for Better Care, Surgery With a Warranty" discussed the tremendous successes Geisinger has experienced with their new ProvenCare program. Geisinger uses a step-based system to ensure all surgical patients get high-quality, standardized care that adheres to professional guidelines. ProvenCare was created in conjunction with Geisinger's surgeons, and allows them to modify steps to fit unique patient circumstances.

Does BIDMC have a version of ProvenCare now, and if not, do you see BIDMC incorporating this in the future?

Importantly, what procedural steps would BIDMC have to take to institute a version of ProvenCare?

Thanks for being open to our questions.

(I'm an incoming BIDMC preliminary IM intern, and have posted here before. I love your blog, and am taking you up on your invitation to pose questions for you.)

Elaine said...

I am one of the Sloane Fellows Paul refers to, working in network/business development for almost 5 years at the medical center. I joined the BIDMC organization just after one of the lowest periods in its history. The leadership provided by Paul and others on the senior team over the last five years enabled the organization to not only recover but thrive in an extremely competitive environment. With the support of our past Board Chairman, the Sloane program was created during this time and it seems to me that the wisdom of an organization lies in its leaders who have vision, not only for articulating where the organization needs to go and how it will get there, but also just as importantly for helping to nurture and mentor those who will help make that vision a reality. We get to work in a supportive, creative and enjoyable learning environment because of this vision! This program really is a unique model and has been a great opportunity not only for professional growth but also personal growth. Having had the benefit of "sitting" in roles close to the the top (i.e. reporting to a senior VP or CEO at both small and large organizations, I've seen some incredibly poor succession planning (in another organization) as well as lack of opportunity for growth at the mid manager/director level. One of the best things I think we can all do - and I've seen people inside and outside organizations do this -is to help each other in our chosen areas/fields and to use our own experiences to influence our organizations to create those opportunities for growth.

Anonymous said...

I'd like to make a comment on the clinical side of succession planning. Based on observations that I've seen through my years as a medical student, then resident, early on I noticed that depertment chairs were usually not hired internally as well. My understanding is (based on what senior faculty have told me) is that many times, the department PREFERS to have an outside person hired to become the new department chair. This helps keep the department from becoming stagnant. With new ideas and programs implemented by a new department chair arriving from another hospital, changes (hopefully positive) are usually made after this person starts their new post. I find that the academic appointment of department chair works like this- division chair from one hospital who has done a great job managing his/her division, will be hired to become the department chair of another hospital once a spot opens up. Many times, department chairs may even swap from one hospital to another hospital because they are highly recruited for their talents. Many of the hospitals seem to swap personnel in academic medicine for these esteemed positions.

Anonymous said...

Very true. Good point.

Unfortunately, whether stay or move, those division chiefs often have not received good training in the management aspects of their jobs, so their is a lot of on-the-job training in their new positions as chiefs.

kelly said...

I too am a Sloane Fellow. I echo the sentiments of my collegues as it relates to the tremendous experience & opportunity I was given during this program. I am a better leader & communicator as a result of the program. I have been at the medical center for over 10 years. Currently I am a Director in the Ambulatory Services Division and have responsibility for four service areas, including an off-site program which is located off of the main academic campus in a nearby community. I feel connected to the organization in a way that was not present before the start of this program and feel very valued. The resources available to the Sloane Fellows were amazing. Our organization runs on a very tight margin and allocation of resources is precious.

I think that succsession planning is challenging for many reasons. It is imperative that senior leaders are actively engaged and committed to this important endeavor. It starts from the top! Fortunately at BIDMC, both the board and senior leadership group have shown their commitment to this business planning activity. This type of formal program is one component of a succession planning strategy. Another key factor is the willingness for current senior leaders to promote & cultivate their cadre of talented mid-managers. I am lucky to work for a Senior Vice President that is known for mixing it up! Over the past five years my reportoire of areas has changed. She is very congizant of assessing someone's stength's and opportunities for growth. She uses these formulations to place people in roles that offer challenges and possiblities to increase skill sets & learn.

As everyone knows there are not enough hours in the day, so it is understandable how these important activities that are necessary for successful succession planning as mentoring, training and job rotation can fall off the radar. These activities are critical because it can takes years of preparing and grooming to develop mid-managers for senior roles.

EB said...

Mr. Levy,

I appreciate your response to my initial inquiry. It sounds from your description and that of the current Sloane fellows that the program is an excellent tool for not only educating but motivating as well (which I "heard" in the posted responses). How I would have enjoyed working for a hospital with a program such as this!

While it is important to have patience while waiting for upward mobility, I believe there is a threshold that should exist too where one stops waiting, particularly if another position presents with that opportunity. I think many managers would keep staff around forever, if they were productive, as opposed to encouraging them to seek other opportunities.

Truly, work is about having fun, learning, being challenged, and taking a sense of pride in the results of your efforts and not just about a paycheck, title or office size. And a program like the Sloane fellowship seems like a great program for encouraging mid level managers to stick around.

I hope more hospitals consider adopting a similar strategy or tactic for future succession efforts, because the company that promotes the person "who has been there the longest" won't help the hospital industry survive the 21st century.

Appreciate everyone's feedback on this topic.

Christina said...

Hi Paul,

I'm a social work intern at DFCI working with their patient and family advisory councils, a partnership between patients and families and senior-level administrators. I was wondering if you had thoughts on this topic and if this practice was something that BIDMC was considering adopting.

Andrew said...

Hi Paul,

A new comment/question on an old post..

After reading the comments from some of the Sloane fellows, it seems that there are a lot of positive things about that fellowship program. Have you considered starting an administrative fellowship program for those who are beginning careers as administrators? Currently, I'm applying for fellowships in hospital administration, and I (and many other students, I'm sure) would be very interested to hear about an opportunity like that at BID.


Anonymous said...

Hi Andrew,

We haven't really created a program for that, but occasionally someone really good comes along whom we recruit and hire, with the idea of moving him/her along through various positions over the course of a couple years -- in essence creating a personalized program.