"I used to think you had to be a masochist to want to run a hospital," a longtime CEO of a medical center in the Northwest told me last spring at a health care conference in Washington, D.C. "Now I know it."

The comment, obviously made in jest, was imbued with genuine angst. It's the kind of black humor I've heard hospital executives express any number of times over the past several years, and no wonder. From our lingering economic malaise to the fundamental transformation now under way in how health care is delivered, to the shift from the fee-for-service payment system to a value-based system, leading a hospital today ain't for the faint of heart. A recent report by consulting firm Towers Watson reveals that hospital leaders "demonstrate a consistent push-pull between a business-as-usual mindset and the need for fresh thinking and approaches to delivering care efficiently and effectively."

Freshness of thinking and the nimbleness to react quickly to challenges are attributes every person on the leadership team needs, not just the one at the top. Besides the core competencies required of their individual jobs, C-suite members must develop the vision to understand how what they do links to and impacts everything else in the organization. It's a skill central to process improvement methodologies like Six Sigma and Lean. H&HN's ongoing Fiscal Fitness series includes profiles of hospitals that have embraced those techniques, and have improved quality of care while benefiting their bottom lines. For more, go to www.hhnmag.com/fiscalfitness.

The scope of the challenges leaders face is documented in "Hospitals and Care Systems of the Future," a report from the American Hospital Association's Committee on Performance Improve-ment. It lays out 10 must-do strategies and seven core competencies "organizations should establish to remain successful in this time of sweeping change." Among the strategies: Educate and engage employees and physicians to create leaders. Among the core competencies: Engage full employee potential.

In other words, your success as a leader depends on the people working for you. Hire smart, keep a sharp eye out for staff with leadership potential and give them the tools and culture to grow. "Leadership competencies needed for the future will be very different, and savvy hospitals will need to start the process now of defining the leadership profile of the future," Towers Watson declares.

At many hospitals, leadership roles already have changed dramatically. In January, we launched our bimonthly Focus on the C-Suite series; each installment spotlights a particular position within senior management. Last month, four chief operating officers described how their jobs have morphed beyond the traditional description to embrace information technology, data analysis, accountable care and other imperatives. Next month, we'll focus on chief medical officers.

And, as Haydn Bush noted in H&HN Daily on Jan. 18 (www.hhnmag.com/hhndaily), some hospitals are reorganizing their teams to create new titles, such as ACO president or president of an employed physician group, to reflect these new realities.

— Let me know what you think. You can reach me at bsantamour@healthforum.com.