One constructive suggestion that we offer: hire a chief of staff.

Chiefs of staff are common in the corporate and political worlds, and they can play a critical role in health systems as well. CEOs may need someone who can manage the executive suite, consult on essentially all matters and occasionally serve as a surrogate.

Two examples

One major health system we know that is creating such a role is doing so with three primary responsibilities in mind: a full-time adviser and counselor to the CEO; an operational and strategic manager for the executive suite; and an integrator who oversees cross-functional planning on major initiatives. This same employer lists more than a dozen essential functions for the role as well as “other duties as assigned.” Functions include:

  • Overseeing the operations, staff and budget of the executive office.
  • Preparing and facilitating communi­cation to and from the executive office.
  • Overseeing procedural and deci­sion-making protocols.
  • Acting as the CEO’s ambassador and spokesperson to external constituents.
  • Supporting the chief operating officer in process improvement initiatives.
  • Facilitating coordination with functional experts, including those from finance, legal, human resources, information systems and clinical services.

The breadth of potential responsibilities means that the chief of staff position must be defined by leaders in each organization — the CEO, board and other executives — with suggestions for tweaking coming from the individual fulfilling duties of the position.

A few years ago, as WellStar Health System had grown to 11 hospitals and some 20,000 employees, its leaders saw a clear need for a chief of staff. The decision was made by then-COO and current CEO Candice Saunders to create the role as a means to support and sustain her transition. In the position profile, WellStar stipulated that the chief of staff would be a key member of the executive staff, “responsible for the central coordination of activities (operations and planning) and ensuring timely flow of information to and from the executive office.”

Stated job requirements at the time included (and now include, with Andrew Cox in the role):

  • The ability to “interact and influence at the most senior levels of the organization.”
  • Exceptional interpersonal skills.
  • Strong managerial ability.
  • The ability to work collaboratively across functions and departments and with physicians, system leadership and hospital leadership teams.

What makes a good chief of staff?

In addition, general prerequisites that we recommend for a chief of staff include:

  • Ten or more years of executive management experience in a large, complex organization (preferably in health care).
  • Experience in human resources, marketing and communications, and preferably other functional areas.
  • An advanced degree in business or the equivalent combination of education and/or business experience.
  • Experience leading and managing a high-performing team of executives and professionals.

Beyond the prerequisites are special personal qualities. “A good chief of staff is a leader who is loyal to the mission of the organization,” says Saunders. “This individual must understand that our purpose in health care is to provide the highest quality care to our patients and that all business strategies and decisions ultimately must have a positive impact on the patient and the community.” In other words, one must have the ethos for the health care chief of staff role in addition to the skills — both “character and competence,” Saunders says.

The CEO and chief of staff need to be like-minded and compatible — there has to be considerable trust between the two, notes Saunders, particularly because of the surrogate capacity that the chief of staff often fulfills.

Hiring considerations

In a recent article for Trustee magazine, we provided rules of thumb for CEOs and boards considering hiring a chief of staff:

  • Shape the position around the CEO. A chief of staff who doesn’t get along with the CEO is not likely to succeed.
  • Consider hiring an insider. It helps tremendously if the person already knows the organization and its culture. 
  • Seize an opportunity to support a CEO transition. A chief of staff can start as a new CEO is hired, helping to familiarize the new executive with the organization. (This is the case in two recent situations we are aware of — with chiefs of staff Debra Plousha Moore at Carolinas HealthCare System and Nancy Ban at Central Maine Healthcare.)
  • Consider candidates from different professional backgrounds. There is no blueprint for a good chief of staff.

The chief of staff role in health care is still taking shape. Each organization must define the role within its operational and strategic needs, then hire an executive who can do a little bit of everything as well as form a tight bond with the CEO.

More from Candice Saunders

In a Q&A, WellStar Health System CEO Candice Saunders elaborated on the chief of staff position and the importance of rooting the role in trust.

What were your main criteria for initially hiring a chief of staff?

Saunders: There were a number of criteria discussed in the initial planning stages, but in the end we stayed true to our principle for all leadership positions, which was to hire a leader who possessed both character and competence. I fully understood this was a new role for the system and there would be a time period for the chief of staff and the organization to adapt. I felt that the person who would fill the role would need to possess the skills to create and sustain productive and honest relationships with the executives, physicians, leaders and team members across the organization and in the communities we serve.

How dependent is the success of a chief of staff on his or her relationship with the CEO?

Saunders: The relationship between the CEO and the chief of staff must be rooted in trust and vision, not based on individual pursuits but based on organizational goals. This trust is particularly important because the chief of staff often acts as a surrogate or representative of the CEO. In these situations, the chief of staff is an extension of the CEO and the organization as a whole and has the responsibility to represent the CEO and organization to the best of his or her ability. I benefited from hiring a chief of staff who had been with the organization for a number of years and whom I personally worked with in a previous role. I knew the character and the work ethic of my chief of staff, which accelerated the pace for us to build our new relationship as president and CEO and chief of staff.

Do you see your counterparts at other systems wanting and needing this type of role to support their work?

Saunders: This is a role I would recommend for larger health care organizations and my fellow CEOs. Similar to political structures or social structures, larger health systems are large social systems that feature a number of communities, hospitals, care sites, physicians, leaders and team members. In large organizations, communication is essential, and the chief of staff acts as a connector between the CEO and every aspect of the organization.

Do you see a need for more formalization of the chief of staff role across the industry?

Saunders: I think the need for a chief of staff role is unique to each health care organization, and the need to formalize the role is more an organizational question then an industry question. I would say that there are benefits in connecting chiefs of staff between organizations as it enhances and accelerates communications between organizations since the chiefs of staff are extensions of the CEOs. Today, I would say that the concept of the chief of staff role might be more familiar in academic health care settings than community‐based health care settings. As the role grows and becomes more established, I see an opportunity to create a formal network through hospital associations or advisory groups to establish a platform for dialogue and best practices.

Andrew Cox is chief of staff at WellStar Health System, headquartered in Marietta, Ga. Andrew Chastain is managing partner and chair of the health care practice at the executive search firm Witt/Kieffer. He is based in Atlanta.

The opinions expressed by the authors do not necessarily reflect the policy of the American Hospital Association.