CEO Roundtable: The Evolution of the C-Suite

Strategic planning can make or break a hospital or health system's ability to adapt to changing times, best serve patient populations and preserve fragile margins. Each hospital has a slightly different way of navigating these murky waters. Here, four CEOs share their processes for building organizational strategy, including who plans, when planning occurs and what the biggest surprises have been.

Question: Who, exactly, is in the C-suite these days? Which executive positions does your hospital or health system employ, and why?

Barry Arbuckle, PhD, CEO of MemorialCare Health System (Fountain Valley, Calif.): We have what you might consider traditional positions: CEO, COO for the health system, to whom hospital CEOs report, CFO and CIO. We recently made a few changes in the health system positions to reflect the changing environment and to transition from a hospital system to an integrated health care delivery system. I recently split the CFO and treasurer positions, because of the complexity of issues related to the balance sheet. The CFO is focused on system operations and responsible for all CFOs, and the treasurer is a chief investment officer. The chief transformation officer is new to us, to others and is something we'll see more of. Also, we have a new vice president for population health, vice president of business integration and vice president of real estate. For us, these new positions are reflective of where we're going; we're interested in making sure every aspect of our system is wholly integrated.

Paul Bengtson, Northeastern Vermont Regional Hospital (St. Johnsbury, Vt.): We've had the same positions for a number of years. We have a CEO, the vice president for professional services (CNO), a vice president for finance, a vice president of quality services, a vice president for information services and a vice president of human resources. We also have a vice president for marketing and community health improvement. I've always felt strongly we need to be focusing on the health of populations where we reside, and as a critical access hospital, we do that with the many physician practices we own and manage.

Toby Cosgrove, MD, CEO of Cleveland Clinic: Our C-suite consists of clinical and non-clinical leadership that run the business side of the health system (vs. the clinical areas individually). This area includes our CEO, chief of staff, chief of clinical operations, CSO, CIO, chief legal officer, CFO, chief of human resources, chief patient experience officer, CNO, chief marketing officer, chief of quality and patient safety, chief compliance officer and others.

Catherine Jacobson, CEO of Froedtert Health System (Milwaukee, Wis.): Our C-Suite includes a CEO, COO, CFO, CMO, CSO, chief legal counsel, a human resources executive, and the president of our medical group. We will soon be bringing on a health IT. I think nowadays the CMO plays a bigger role than ever before, because redesigning the care model touches on everything any hospital or health system does. Essentially, what the CMO does is a big part of where you're going to be.

 

Question: How often does your C-Suite strategic plan, and with whom? On which areas do you focus?

Dr. Arbuckle: We follow a structured, disciplined process in terms of who is involved and the timing of planning. Planning begins with a strategic retreat with our parent board of directors and heads of strategy committees for each of our entities. The committee annual retreat is in November for the fiscal year that begins 7 months later. Sometimes we'll bring outside speakers with expertise or perspectives on strategy. Then the C-suite has an annual meeting in January to queue up the planning process, in which we go over what needs to be done, when, and by whom. We are all very involved in setting the plan and tactics for the health system. We plan for the next year, for three years and five years out. In late February the plan is distributed to all entities, whose task is to develop their own strategic plan that fits into umbrella of the system plan. A key component of our planning process involves communicating with every manager and every employee so they understand their role in where the organization is heading — how their job fits into that picture.

Mr. Bengtson: We have a written strategic plan, but we keep it summarized as a one-page matrix with mission, vision and values. Every single thing we do in our monthly working committee meetings has to relate to that planning matrix. We officially update our strategic plan once a year, but I like to think we're continuously planning. We also are connected through the New England Alliance for Health to the Dartmouth-Hitchcock Medical Center, which is our main referral center in the area. We strategically plan once a month with them with them as well.

Dr. Cosgrove: Cleveland Clinic has a strategic plan that is developed and driven by the CEO, the chief strategy officer and with great input and involvement from the leaders across the organization and its physician leaders. We have used input from consultants, but the primary responsibility is with the key leadership. We have a focus on seven key areas such as, but not limited to: safety and quality initiatives, enhancing patient experience, strategic growth, continuous improvement and efficiency, cost reduction to drive affordability, regulatory requirements, value-based care and more. It’s an ongoing, near and long-term process.

Ms. Jacobson: During strategic planning, a five-year horizon is typically what we look at, but we do an annual update and ask if we need to change anything. We might introduce a new initiative then or take a broad step back and look at where we're going. It's more about where we're going than how we're going to get there. We don't typically engage external consultants. We have a strategic retreat every year, and we do we bring in an outside speaker then, who is usually someone from another health system who has been successful with some aspects of a plan we'd like to implement.

 

Question: In your opinion, what has been the biggest change or surprise in strategic planning in the last five years?

Dr. Arbuckle : : What I thought years ago was a very complicated business to run has become even more complicated. It's in part because we've diversified that we now have hospitals as well as physicians and more than 200 care sites that need to maintain similar cultures across the system. Because of this diversity in stakeholders and care settings, it is not unusual to have diversity of thoughts and directions we should be going. [Hospitals and health systems] that will succeed in this environment are those that trust one another and have been working together for a good period of time. It makes a world of difference.

Mr. Bengtson: Probably the industry interest in ACOs and in the management of the health of populations across institutions. I'm thrilled at the kinds of conversations we're having. In many ways, they're forcing us to do things that are very difficult to get done, in terms of information flow and patient safety. It's something we weren't hearing a whole lot about five years ago.

Dr. Cosgrove: Personally […], more efficient meetings. As a heart surgeon, it’s in my nature to have focus and be productive. We have a great deal of work on our plates and must be able to lead movement, change, improvements and the like. At the same time, major projects require careful attention and thoughtful discussion. It’s knowing how to balance those that makes most sense to me.

Ms. Jacobson: We've moved away from routine performance reports. Five years ago all anyone was concerned about was patient satisfaction and quality scores, and maybe some growth initiatives. Those things are still important, but now the focus is on where we are on implementing medical homes and shared savings contracts. It's much more about the doing than the reporting.


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