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For many years — decades, really — the way U.S. health care worked from a business standpoint barely changed. Medicare came along a half- century ago, a monumental shift, but from then on, any talk about how we needed to fix the American health care system so it could become, in fact, a true system — organized, interconnected, efficient, with a disciplined process to develop evidence-based best practices in both the clinical and business areas and spread their adoption quickly across the nation — amounted to little more than just that, talk.

For sure, amazing innovations appeared on a regular basis — in treatments, in pharmaceuticals, in medical devices, in technology, in facility design and operations. Many were quite expensive, and most were incorporated in such an un-uniform, catch-as-catch-can way that the beneficial impact on outcomes and costs varied widely from one physician to another, from one hospital to another, from one region to another.

Then came health care reform — transformation, if you prefer, or, more ominously, disruption. From electronic health records to population health to accountable care to value-based payments, what's going on in our world at this moment virtually defines the word disruption. It ain't your father's health care anymore.

Except, it kind of is.

The majority of people leading health care organizations today are in their 50s and 60s. There are plenty of fathers among them — not to mention mothers, grandmothers and grandfathers. Most of these veteran execs find themselves understandably daunted but, nevertheless, invigorated by the prospect of rethinking nearly everything they and their organizations have been up to lo these many moons.

But in the commotion enveloping health care, a rather stark fact seems to have eluded many a baby boomer's radar: Their careers are winding down. They're now in that weird phase of professional life in which the job is to build and fortify an organization that, rather than lead, they will leave behind. However heroically they navigate health care's turbulent seas over the next five years or so, their success will be judged largely on how well the organization survives without them — Wwhich is why it's disconcerting that so many of today's hospital executives are failing to identify up-and-comers already on their staffs who have the potential to guard and even build upon their legacies.

In this issue's "Generations in the Workplace" article on Page 34, Jim Diegel warns of a "huge chasm" in leadership looming for hospitals. Diegel, who is president and CEO of St. Charles Health System in Oregon and chairs the American Hospital Association's Committee on Performance Improvement, notes that as baby boom execs "exit at a pretty rapid rate … there's not enough tenured and experienced talent in the pipeline." The article describes a variety of tactics pro-active hospitals are employing to fill that pipeline, and not- so- proactive hospitals ought to consider.

Succession planning may not be as exciting as other aspects of health care transformation, but it is essential. Failing to prepare the leaders of tomorrow would represent a lapse in leadership today.

— You can reach me at bsantamour@healthforum.com.