As a high schooler, Stephen Williams was hired to be an orderly at Livingston County Hospital, Salem, Ky. At 22, he was named administrator. After that, he was hired as an assistant to the executive vice president of Norton Healthcare, where he has stayed for 38 years. Since 1993, he has served as president and CEO of the five-hospital system based in Louisville, Ky.

This type of bootstrap leadership development, which elevated Williams and so many others of his generation to executive positions, may no longer be applicable in today’s hypercompetitive environment. So the question facing executives and boards is: How do you cultivate the skills needed to lead organizations into the next phase of health care delivery?

A collaborative of like-minded employers, convened by the National Fund for Workforce Solutions, is looking for answers. Started in 2011, the CareerSTAT initiative has brought together dozens of health care leaders to coalesce around ways to invest in career development of front-line health care workers.

There is a multitude of factors flying at hospital leaders today, from aging baby boomers who need more care to service delivery gaps around the patient experience.

Investment is the best way to prepare for the changes to come, says Jan Hunter, director of the effort. “It’s kind of a perfect storm and CareerSTAT really believes — and it’s been proven true through all the research we’ve done in the last year — that interventions and front-line training really do work and they pay off for hospitals,” Hunter says.

Members of CareerSTAT, such as Norton, have placed added emphasis on in-house training of front-line workers who want to ascend into leadership roles. Not everyone in health care chooses the back-to-school route, notes C. Anthony Bohn, chief human resources officer at Norton. So, the system has worked to provide everything from mentoring, internships, career management coaches and forecasting tools to predict hot jobs in the field. Key management skills Norton is seeking for its organization, Bohn says, range from adaptability to trust, analytical thinking, and proficiency in working on teams and engaging other employees.

Determining the management skills of the future also is a key topic of interest for the American Society for Healthcare Human Resources Administration, says Dawn Rose, executive director. The ability to communicate between cross-functional teams and engage health care users in a comprehensive approach to care are both skills ASHHRA already has found to be essential in this changing environment.

With health care constantly shifting because of new laws, technology and research emerging every six to 12 months, proficiency in change management is also crucial. Health care sometimes struggles in responding quickly to change, and some institutions are being forced to tap outside industries, such as technology or consulting, for such leaders, Rose says.

“Health care hasn’t always been known as a nimble industry,” she says. “Change sometimes happens slowly, and for good reasons at times, and with the inherent pace of change that is common throughout our society right now, health care is one of the industries that is still struggling to catch up.”

Norton, too, occasionally has to look outside, but prefers to find its leaders from within when possible.

“We have the infrastructure in place to ensure that if someone wants to be a leader, we can do everything possible to help [him or her] get there. We would prefer to always promote from within,” Bohn says. “There are times, if you need a certain skill set or level of expertise that we don’t have in house, then that’s when we go outside,” he says.

“But I would say, depending on the culture that you build in your organization, to show people that they can grow and prosper and learn to be leaders, that’s the best way to do it.”