Is your hospital's leadership team full of dinosaurs, content to coast into retirement without evolving from the Cretaceous period?

I recently took a few minutes on the phone to speak with Tim Morgan, chief operating officer of B.E. Smith and a former hospital CEO, for an upcoming feature on restructuring leadership for a value-driven model. Morgan tells me that some key "red flags" will pop up to signal whether or not executives are willing to refine their skills. Phrases like "that's not the way we do it" or "this will pass" or "we just have to get through it" should raise eyebrows.

"The most difficult cultural change is made in a team or with certain individuals who don't have the drive to change and are stuck in their ways because that's the way they've always done it," Morgan says. "Leaders should lead. Part of being a leader is to understand that change is inevitable, and that we're going through dramatic change in health care today. Those teams or individuals who can't get that are going to be the ones who are dragging their feet."

But what if the obvious red flags don't pop up? Morgan tells me that he usually advises hospital leaders to do some sort of cultural assessment to try to gauge their staff and pinpoint any outliers. But the positive signals should be obvious: a cohesive team with competency, character and consistency, along with a willingness to learn and strive to understand today's health care environment.

Most leaders should be willing to get on board, Morgan says, and hospitals should find ways to get them up to speed and take control of the process. The first step is always training and educating leaders who are lagging on what they need to reorient themselves toward the value-based future. Also helpful is some sort of coach or other support mechanism to advise them on the challenges ahead and ways to strategically plan for them. Trustees, too, should be as educated as anyone in the C-suite to be able to hold leadership accountable to meeting quality metrics in the future.

Another challenge that lies ahead for hospitals, given the age demographics of today's health care chiefs, is a gap in leadership talent, and a need to grow the next generation of executives, Morgan says. Many at the top may opt to retire rather than try to change their whole mindset, and hospitals need to have young guns ready to step in and take their place. Some providers are grooming physicians — who have more clinical knowledge than CEOs from other backgrounds, and can navigate through all issues of doctor employment — for top spots.

"We've got to be able to fill positions with talent that is contemporary and understands the new world of health care, and that's a big challenge for leadership," Morgan says.

CFO is likely the position that needs the most reorientation because financial people of the future will need to be able to master the balance sheet, while also staying aware of the hospital's clinical outcomes and strategies that will affect reimbursement. Morgan cautions providers not to get too caught up in the latest trend of creating new C-level positions that sound nice, but don't do much to bring the organization forward.

"That poses a real question about who is responsible for what, and the more fragmented your leadership team gets, the more confusing it gets," Morgan says. "I always caution our clients to be very careful about the newest fad position that is being recommended."

What is your hospital doing to restructure its leadership for value-based care? Email at or give me a ring at 312-422-2605.