Fast and Furious – Preventing Flameouts of New Healthcare CEOs

Fast and Furious – Preventing Flameouts of New Healthcare CEOs

The cold truth: The average tenure of a hospital CEO is somewhere around four years.

That’s right, just four years. And the process of replacing a CEO for a health system of any size is no easy feat.

A recent study cited by HealthLeaders* found that half of hospitals and health systems lack a formal CEO succession plan. Knowing that, we’d safely bet that – beyond the obvious introductions – robust CEO onboarding plans are few and far between. Yet without a good executive transition plan, healthcare organizations are at risk for rapid executive turnover. This, in turn, can cause frustration and loss of trust within the organization, lack of continuity in strategic initiatives, and a sucker punch to the bottom line due to transition costs.

What happens when that beloved CEO of 20 – or 3.5 – years retires?

Candidates are vetted, interviews are set and, if the recruiter has done a good job, there is consensus about the best person to take over. Follow up visits are scheduled. Offers are made and negotiated. That’s the easy part.

Then, the real work begins. From the get-go, system leaders, employees, providers and trustees develop (but don’t necessarily communicate) expectations of and for the new CEO. The new leader wants to do right by the organization and its most important stakeholders, but desire isn’t enough. Sadly, in half of these situations, people on all sides of the hiring decision are going to suffer significant disappointment. Board goals aren’t met, system leaders feel disconnected from their new leader, employees don’t feel heard… the list goes on. The result? That shiny, new CEO flames out quickly. According to Lumenis Partners and Harvard Business Review, half of new CEOs turn over within their first 18 months.

Success – or failure – lies within the onboarding process for new leaders.

Too often, onboarding plans are nothing more than a jam-packed itinerary of meetings devoid of meaningful interactions and relationship building. Instead, onboarding “success” is measured by checklists and number of firm-but-friendly handshakes. Process-driven onboarding fails to address a number of critical elements that should inform a new executive’s experience: intent, content and priorities.

How do you set your new leader on a path for success? Good plans include these elements:


Organizational leaders – both executives and trustees – should be able to voice the intent of the onboarding process, both in cultural terms and through the outline of specific goals and milestones. This requires reflection and candor and may change the structure, timing and nature of the onboarding process. Is the emphasis on preparing the new executive to fit into the prevailing culture? Are there opportunities for more than just a ‘getting to know you’ series of meetings? Remember, throughout the selection process, a number of stakeholders have been developing expectations of new leadership.

There’s a reason why ‘early wins’ are on a new executive’s checklist. Early failures are hard to overcome; stakeholders make up their minds about new leadership very quickly. The honeymoon period for highly compensated executives whose arrival has usually been heralded as a new direction for a healthcare system is short, to say the least.


Onboarding plans can be long on structure – typically in the form of stakeholder meetings – and short on content.  Where in the process, for instance, are executives learning about existing and emerging champions or detractors?  Are they fully informed about the system’s strengths and weaknesses, its perception in the community, its relationship to other organizations, both allies and competitors? The content and structure of new leaders’ first critical months should be designed to inform them about the challenges ahead, to identify who can assist in meeting those challenges and to imbue confidence in the organization’s direction under new leadership.  It’s a mistake to assume that these elements have been shared through the recruitment process.


Finally, where are the priorities for the onboarding process developed? This should be outlined in terms of both timing and the amount of time allocated for each element. New leaders should focus the majority of their early months on high-value issues that allow engagement with key stakeholders and focus on ways to create meaningful change that matters to their people. Through structure and leveraging the power that a new leadership role gives to the flow of information, new leaders portray confidence and have the ability to score early wins and make key decisions faster in their tenure.

Healthcare is a high-stakes business, and the stakes are only getting higher. In upcoming blog posts, we’ll explore other key factors to ensure that those crucial first months of a new CEO’s tenure set a course for both personal and organizational success.

Find out how we can help make your executive transition successful:

*American Hospital Association Trustee Services 2019 national healthcare governance survey report as reported in the June 20, 2019 online edition of HealthLeaders.

Special thanks to Erin Beck and Courtney Williams for their contributions to this piece.

Rebecca Climer