What's it take to lead a hospital today when health care is changing in such a multitude of ways?

Six CEOs from hospitals and health systems around the country say it's a balancing act. First you must acknowledge to everyone involved — board members, the executive team, clinicians and nonclinical staff — that the business model is being turned on its head and will never be the same again. Then, you must assure them that however it all turns out, everything will somehow be OK.

"You have to be paranoid to some degree, but you also have to give hope," says J. Thomas Jones, president and CEO of West Virginia United Health System.

Kathryn Raethel, R.N., president and CEO of Castle Medical Center in Kailua, Hawaii, echoes that sentiment. "We have a responsibility to set the tone and to be inspirational, to see a positive future." Though that, she admits, "takes some perserverance."

At the invitation of Hospitals & Health Networks, Jones, Raethel and four other CEOs sat down together this summer in San Francisco to discuss how the roles of hospital leaders are changing as the transformation of American health care charges full-steam ahead. The discussion was fascinating and wide-ranging, touching on the new competencies executives will need, how to develop physician leaders, what a CEO's relationship with board members should look like now, and how to identify and mentor the next generation of leaders from an age group with much different expectations from their own.

The entire Executive Dialogue, which we call "The Evolution of Leadership," can be read here. This is just a small sample of the many choice observations:

Jones on rethinking the CEO role: "After everything is said and done, we have to recognize that some of the things we've done for years, such as analyzing financial statements, can be done by somebody else. We need to be more visionary and strategic and, quite frankly, spend our time more appropriately."

Mary Starmann-Harrison, president and CEO of Hospital Sisters Health System in Springfield, Ill., on easing staff worries: "Communication … is even more important today. Everyone has to know the 'why,' not just the 'what.' In the past we probably haven't given enough information. We need to provide more information so people understand why we're taking the steps we're taking, and the direction we are going is really key."

Carol Dozier, R.N., CEO of Ivinson Memorial Hospital in Laramie, Wyo., on helping sort it all out: "We need to be educators. Board members, physicians and members of the community keep asking, "What's going on?" I have to keep up with as much as I can and take it back to them. They don't have the time and the resources to do it themselves."

Adds Jones: "The message we have to deliver is overwhelming, but if we break it down, it becomes more manageable. For example, instead of talking about cuts, talk about savings that can be accomplished through reductions in length of stay and the standardization of physician preference items. That's one of the things we have to do — give them hope but also a dose of reality."

Britt Berrett, CEO of Texas Presbyterian Hospital in Dallas, on inspiring colleagues: "There is purpose behind what we do. We need to communicate that and reignite the fire that brought us into this profession. So the message may be that we need to reduce costs by a significant amount, but we do it to bless the lives of our patients and we do it for no other reason."

John Brennan, M.D., president and CEO of Newark (N.J.) Beth Israel Medical Center, on whether executives must acquire a better understanding of clinical issues: "Senior leaders won't need to have the skills to remove an appendix. But they will need to be better able to speak the language … We sent our senior management team on rounds with the risk manager. My CFO said it was a great experience for him."

Berrett concurs: "It's important for all of the senior leadership team to expand its clinical knowledge. The chief information officer has to understand clinical processes … to know not only key performance indicators, but also how to use them."

Despite all the angst around the future of health care, it's not all gloom and doom, according to Doug Smith, president and CEO of executive recruiting firm B.E. Smith, which sponsored the roundtable. "I see a growing level of excitement among today's leaders," he says. "The game is a lot more fun today."

Do you agree?