SKILL 7: Conflict resolver
Change is inevitably accompanied by conflict, and successful leaders in health care must be expert in managing it, says Leonard J. Marcus, founding director of the Program for Health Care Negotiation and Conflict Resolution at the Harvard T.H. Chan School of Public Health.
Marcus advocates a two-part approach to build consensus out of conflict. First is resolving issues as they emerge. “People are concerned about what they may lose — market share, value, income — and some are just resistant to change. It’s in their nature.” Acknowledging and addressing fears with facts helps to keep them from blowing up.
Second is articulating a value proposition in which people want to participate. Identifying ways in which the emerging organization can meet everyone’s common interests — professional, personal and economic — creates an upside that everyone can buy into, Marcus notes. “Resolving conflict is preventing the downside, the upside is creating value.”
Achieving this requires what Marcus calls meta-leadership. “Meta-leaders bring an orientation toward building connectivity across systems so people can see the value of being part of the enterprise, and are able to guide and motivate activity toward being part of that value.”
Developing meta-leadership skills involves three dimensions of practice skills and the person, says Marcus, co-director of the National Preparedness Leadership Initiative, who trains both health care leaders and government officials. The first is based on emotional intelligence. It includes developing self-awareness, self-regulation, empathy, social skills and the ability to engage the emotional intelligence of others. Second is understanding and engaging the contingencies you face. Third is building connectivity of effort, which includes building a strong team reporting to you as well as strong connections with bosses, boards and others to whom you report, as well as to other organizations, including community health, insurers, regulators and government.
This requires specific leadership training. “Often, the people who rise to leadership have great technical skills, but haven’t been trained to lead and don’t orient their work toward leadership,” Marcus says. “The biggest ‘aha’ moment is when you realize you are not born with leadership skills any more than you are born with cardiac surgery skills; you have to develop them.”
SKILL 8: Agile learner
Even more important than specific skills, experience or even general intelligence is learning agility, Giella says. At Korn Ferry, it is considered the leading predictor of success in leadership roles — and critical for leading change.
“Learning agility is the ability to assess a situation quickly and adapt with responses that may not have existed in the prior state,” Giella says. “If you’re trying to get your receivables from 110 days to 50 days, it’s all tactical stuff that you have done before. But when you have employed physicians and you have leakage, figuring out how to get them to admit to your hospital is an entirely new challenge requiring a solution that didn’t exist before.”
Learning agility is especially important for dealing with technology, Giella adds. “With new technology every six months, you need someone who can take a new concept and run with it. Uber didn’t exist five years ago and now every cab company in the world is scared to death of them. Now everyone needs to be very nimble.”
Giella looks for candidates who have experience with startups or turnarounds. “What have they done that is innovative? It is easy to say what your operating margin or market share is, but these are quantitative outcome measures. Better questions are: What programs have you started? How did you do things differently? How did you adapt to new competition? Did you develop new physician relationships or start your own insurance product, or did you stay the course and do nothing? It’s a more holistic assessment of the hows and whys of what you did that goes beyond day-to-day operations to strategic thinking.”
SKILL 9: Strategic visionary
At 94 percent, critical thinking and strategic planning were identified as the top skills needed to lead health systems in the next few years, followed closely by innovative thinking and creativity, and transformational change/change management. The new CEO must be able to articulate a vision of a better organization, and inspire others to accept and work toward it, Giella says. “The CEO is now an integrator of different models of care into a seamless system where patients can access care at the right time and location.”
Scripps’ Van Gorder agrees. “I spend 25 to 30 percent of my time being a teacher,” he says; that includes regular tours of his facilities, conducting Q&A sessions and explaining system strategy. He also emphasizes listening, and personally responds to every email from employees to keep everyone in the loop.
Above all, the new CEO must inspire, Giella says. “We are in uncharted territory and there is a lot of nervousness. We need someone who is incredibly positive –— ‘We can take that hill, guys, follow me.’ ”
Howard Larkin is a contributing writer for H&HN.
Is non-health care experience a plus?
Moving health care from providing discrete services to fostering overall population health requires new and diverse skills. Customer service, insurance operations, process improvement, information technology and human resources are just a few. And more health care organizations are hiring from outside the industry to get them.
But what about the CEO?
Executives with a lot of health care experience, particularly building physician networks and multidisciplinary management teams, are still the best candidates, says Phil Dalton, senior vice president, physician strategies at VHA Inc. Other critical skills include understanding payer relations and health care market strategy.
“It is really hard to take someone who is non-health care and put them in the health care CEO role. You may be looking for innovation, but a fairly heavy background in health care has to be a qualifier,” says Dalton, who has extensive experience developing health system strategy and leadership.
Michael Rowan, president for health system delivery and chief operating officer at Catholic Health Initiatives, agrees. “Fundamentally, we have to have the skill set required to do the job.” For a regional market CEO or hospital president, that includes significant health facility management experience.
CHI tries to hire internally, Rowan says. The system, which currently includes 110 hospitals in 45 markets, also systematically evaluates employees at the vice president level and above to determine what skills they need to develop to move up, and provides training and experience to groom future leaders.
Still, sometimes it must go outside for the skills it needs. In particular, CHI is bringing in people with experience in strategic planning and leading complex organizations — retail executives who can help with customer engagement, data analysts and health plan professionals with experience in managing risk and contracting.
Tom Giella, who heads health care services for executive recruiter Korn Ferry, also says that most top leaders still come from health care. But he is seeing more and more outsiders in other roles. “At the CEO level, we are not seeing it yet, but the last four HR people have come from outside health care,” Giella notes. Organizations with dozens of locations, tens of thousands of employees, and complex training and succession planning needs require more sophisticated human resource talent than can be developed at a 300-bed hospital, he explains.
As the health business model moves toward population health management, Giella believes more CEOs could come from other backgrounds. “We are still primarily hospital systems, so we are going to get hospital executives. Hospitals still have the biggest budget and dominate the system. But as we move toward a health system, hospitals will be a cost center, and insurance, wellness, outpatient services, pharmacy, home health and physicians will gain importance. When you have a system that employs 1,000 physicians and has a big insurance arm and wellness operations, you may need different leadership.” — Howard Larkin
Advice for Aspiring CEOs
• Get a graduate degree
Health care is a very credential-driven industry,” says Korn Ferry recruiter Tom Giella. An MBA or MHA is good, as are medical or nursing degrees. But clinicians also need business training. “If they only worked in quality and never strategy or finance, they are not really prepared to run a $2 billion system.”
• Attend internal development programs
“At CHI, we do our best to hire internally,” says Michael Rowan, president for health system delivery and COO at Catholic Health Initiatives, a 110-hospital system. “We look at everyone from the VP level or above to understand their development needs and what the next step should be to pick up needed skills.”
• Learn leadership skills
The new health care environment requires constant adaptation and the ability to lead others in creating a new delivery system, says Leonard J. Marcus, director of the Program for Health Care Negotiation and Conflict Resolution at the Harvard T.H. Chan School of Public Health and co-director of the National Preparedness Leadership Initiative. “The people more able to adapt are those who are committed to leadership itself as best practices and personal development.”
• Engage your team
“Once you make a commitment to leadership, make sure you have training and commitment, and encourage the same development among team members. Encourage those people to think about how the organization can adapt and change, and link with and leverage all the resources they have,” Marcus says.
• Get in the game
“If you are in a community hospital and are thinking about a physician alignment strategy or ACO, roll up your sleeves and jump in,” advises Phil Dalton, senior vice president, physician strategies at VHA Inc. The experience of taking risk, organizing a network and working with payers is invaluable.
• Get strategic & operational experience
“A senior VP of planning and strategy most likely has been at the table with the CEO making alliances and understands the art of the deal, strategy, marketing and closing. If they had a service line management role along the way, they might be a candidate for CEO,” says executive recruiter Peter Rabinowitz of P•A•R Associates, Boston.
• Find a role model and mentor
“Who are the best CEOs you know? What is it that makes them so? Find a way to work for them or study them at management school. To be an effective CEO, you may need to develop new skills,” Rabinowitz says.