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For Students -- Success and Succession

Posted Oct 21 2008 12:51am
Wednesday is response-to-students day. EB, below, is not quite a student, but his question is a good one and relevant to those thinking about careers in health care. I include excerpts and then reply.

Being in my early 30s, I have had the opportunity to hold various middle management positions in administration at hospitals in major US cities. My motivation for leaving each of those roles was due to the lack of perceived opportunity to ascend to more progressive levels of responsibility and in time, move to higher positions within the organization. I often found myself questioning why there seemed to be a large gap in age between myself and others in middle management. And then it dawned on me. I found in these 3 separate organizations, there was not much evidence of commitment to leadership succession and growth/development of earlier careerists.

With all the challenges the hospital industry faces in the upcoming years:a) where will the hospital leaders of tomorrow come from?b) How can hospital attract a qualified entry level and middle management workforce when other industries (banking, finance, law) offer more competitive salaries/benefits?

How are you thinking about addressing the situation that some mid-level managers in hospitals perhaps face, as I did, and future succession planning efforts such as those I mention above?


One job of all senior level managers is to prepare to make themselves dispensable by ensuring a good succession plan. EB is correct that this is often neglected in large organizations, and health care is no exception. This is a shame because an organization spends a lot of time and money hiring, training, and grooming mid-level executives, and if you give them no sense that there is a career path in your own organization, they will eventually leave for another.

We recently created a program for several of our mid-level top performers, people we view as having the potential to run the hospital in the next few years. We call them Sloane Fellows in honor of our previous Board chair, Carl Sloane, one of the country's preeminent management experts, who was kind enough, too, to help us design the program. We sought nominations from our senior-level folks for this program and choose 19 -- out of 50 very good nominations. These folks have just completed an 18-month program of intense individual and team development. Perhaps some of them will want to add comments to this post to talk about their experiences.

I offer this as just one example. There are more subtle things we do, too, to prepare people for succession. In addition, we always attempt to promote from within the organization to reward successful managers with further career opportunities. Nonetheless, this is an area that needs continued work.

Meanwhile, on the clinical side, I would have to say that the academic departments generally do a very poor job with succession planning. This shows up in the following way: When a chief of service resigns, the likelihood that his or her successor will rise from that same department is small. With a few exceptions, department chiefs do not do a very good job grooming their division chiefs and other prominent faculty to be their successors. I am starting to see some changes on this front, but this is an area that needs more attention.
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