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Life before and after becoming a hospital’s CEO.

EDITOR’S NOTE: This is the first in an occasional series by Elizabeth Lamkin.

Everyone is a product of their unique experiences and personality, shaping the lens through which they view the world. This article is simply my lens on what being a hospital CEO means. Granted, I have been around for an eternity, and things are constantly changing, which is a topic for another day, but this is my experience.

First I will share my perceptions “before” becoming a CEO and “after.”

As a young VP in a large teaching hospital, my goal was to be a hospital CEO. It was common for me to declare, “When I get to be a CEO, I will eliminate all bureaucracy and get things done!” This attitude was born from youthful impatience bumping up against a complex hospital system that was very layered and diverse, with the requisite bureaucracy. My CEO at that time, who later became a good friend, would tell me “Patience, my dear, is a virtue.” Needless to say, I was not ready to hear that!

Maybe it was time to take the next step and explore what the outside world had to offer. I felt ready. After all, I was one of 16 VPs, with only so many open spots into which to advance. Back then we were managing by multidisciplinary service lines, such as a heart hospital, cancer hospital, women’s hospital, etc. This gave us the chance to manage across many departments. So, hey, I knew it all, right?

From my vantage point, it seemed that the system president was all-powerful and could simply command things get done. Why wasn’t he flexing his power to fulfill all our requests?

Why did projects that clearly made sense take moving a mountain to get approved? And what did or did not get approved made no sense, through my siloed lens.

Well, fast forward to my first freestanding hospital CEO job. The job was outside the safety of the large, well-established hospital system. In fact, as I am prone to do, I decided to really leap forward and go work for a national healthcare provider, and take on the opening of a brand-new hospital, including the construction. I will spare you the many surprises I encountered in this new environment, both good and bad, as this is about the CEO role, not types of healthcare systems.

The newly minted CEO role was a very exciting experience for me, as it was sink-or-swim time. The first year was planning and building, so not much grey area. Then the real work began in the first year of operations (year two of the CEO role), with humans now in tow. Let’s just say I was not quite swimming, but rather, dog-paddling, while managing to stay afloat.

True to my young boast, I was so proud of allowing leaders direct access to me for decisions, and for the leaders to act somewhat independently within budgets, and with physician input. Hey, you must keep the physicians happy! In other words, there was minimal bureaucracy.

However, it became painfully clear after that first year of operations that my and others’ individual decisions may have been less than optimal. The team was very bright and talented, so there were no major disasters. But there was a lot of after-decision clean-up, with smoothing over of the toes that got stepped on. For example, was IT consulted because the new shiny ball requires much support from IT? Was IT properly staffed? There was a scramble to fix that. Was the physician granted privileges for the new equipment you just approved? Another scramble to fix that. The medical record changed to make nursing more efficient, but now it doesn’t work for respiratory therapy or case management. Scramble to fix that!

There had to be a unifying system. Yes, you heard me, more bureaucracy, to go beyond dog-paddling to actually swimming.

From my first year of CEO experience, I got firsthand knowledge of what people need to know. Information flow became paramount. Everyone needs a playbook to follow, with each role defined. The process of decision-making had to be inclusive, effective, and time appropriate. A tall order.

I will confess, I drew on the lessons I learned from my previous organization. And yes, my previous CEO looked a lot smarter now! Patience is indeed a virtue. Spend the time up front to get it right across the stakeholders and save the back-end fire drill.

As our new team developed systems, the goal was a clear process map that protected everyone from arbitrary decisions. Communication included the mission statement, hospital plans, and annual goals, which were critical success factors to guide actions.  This was opposed to each silo acting on its functions’ needs without a review of how it will affect others. I will spare you the details on the forms that were required to get assurance that every stakeholder had a chance to give input; just suffice it say that now the VPs complained about all the paperwork. I nodded my head and said, “patience is a virtue.”

It was not a sudden “eureka” moment that my lens changed on what a CEO is. It was with the luxury of retrospection, as my precious self did not fully grasp the subtleties and complexity of the CEO role. The real CEO is a constant communicator, leader, consensus builder, system developer, and people builder, aiming to achieve goals in an orderly way. And yes, also a lightning rod for complaints that must be handled gracefully.

This first CEO job became the basis for all the CEO jobs to follow. The structure, process, and people systems went with me everywhere, and they evolved and molded to work in every setting.

The CEO will always be seen as the most powerful position. And everyone will still want to meet with the perceived all-powerful CEO to explain why something is needed, and physicians are still frustrated that administration can’t just make a decision. But a wise CEO takes that in stride, knowing that one person doesn’t have all the information to make all the decisions.

This is not to say there aren’t perks to being the CEO. When it began to feel too stifling and my continued battle with patience was lost, it was time to make rounds in the hospital departments. That is where instant gratification lived; rounds always yielded insight into the barriers that blocked staff and physicians from doing their jobs. Maybe the med-surg nurses are down to one operating BP machine. That is something that can get fixed quickly with a CEO push. Afterwards, a performance team may be formed to put in a permanent fix to the root problem, but for the nurses and patients in need today, some problems can be solved with no bureaucracy.

The next time you, your team, or your best physician complains about the CEO (or in today’s larger organizations, the COO) being slow to make a decision, adjust the lens a little, and have patience.

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