Last week in this space, I explored the idea that the pressures hospital CEOs are now facing — from reimbursement challenges to care delivery transformation and labor issues — are convincing a fair number of leaders to call it quits. A recent study by the American College of Healthcare Executives suggests CEO turnover is trending upward, and I'll be exploring this issue in depth in an upcoming edition of H&HN.

Following that column, I spoke with Steve Valentine, president of the health care management consulting firm the Camden Group, who believes that the increasing pressures on the hospital C-suite may be making some leaders reconsider their commitment to their roles. And in some instances, Valentine says, their institutions may be asking them to step aside.

"Things are a lot tougher in this environment," Valentine says. "Some people who were able to exist in a more cordial marketplace are seeing this change coming. They see the angst of doctors, and maybe some board members who want to exert more influence and are asking tougher questions. And CEOs are saying, 'I'm fully vested, or maybe I've got a couple of years left.' "

Succession planning, of course, is usually the first thing that comes to mind when the discussion of CEO turnover is brought up, and Valentine says more hospitals are creating or updating formalized succession plans. But I also asked Valentine what hospitals can do to avoid turnover and retain top leadership — a tough task, he says, since many organizations have already thinned out their nonclinical staff in recent years.

Proactively, Valentine says he's seeing hospitals rebuilding their leadership team to add the appropriate depth to deal with the impending challenges. For instance, he's hearing of hospitals that are responding to trends in physician alignment and quality improvement by hiring more physicians, as well as executives with a stronger clinical background.

"They're adding more of the clinical piece," he says.

Once those new leaders are in place, Valentine says, hospitals are reorganizing their teams to create formalized positions reflecting the new realities. Depending on the structure of a particular institution, it might make sense to have an ACO president or president of an employed physician group, Valentine says. Other institutions may be adding more focused service-line management responsibilities. Together, CEOs who add leadership staff with a clinical background can both delegate critical responsibilities and relieve some of their own pressure, Valentine says.

Have a story about how hospitals are coping with CEO burnout or rethinking their leadership teams to compete in the changing health care system? Contact me at hbush@healthforum.com.