CAOs: A growing C-suite fixture

The role of the chief administrative officer has increasingly made its way into hospital and health system C-suites, and it can look different depending on how the position aligns with the organization's structure. 

"The biggest challenge with these roles is their evolving nature and that many of them are newly established within their system. Many of these positions have evolved from leaders who began in strategy, human resources, and/or general counsel roles," according to Donna Padilla, executive partner and market leader for healthcare at executive search and advisory firm WittKieffer. 

Leaders at University of Maryland Medical Center Midtown Campus, CommonSpirit Health, UAMS Health, Beth Israel Lahey Health and SSM Health — among other hospitals and health systems — fulfill the reportedly varying role. There is no one-size-fits-all in terms of what the position looks like at organizations, but the CAO is a key part of the senior leadership team. Duties are more expansive at some systems than others.

For example, Rebecca Altman, RN, was selected this year as senior vice president and chief administrative officer for University of Maryland Medical Center's Midtown Campus in West Baltimore. In this inaugural role, among her top priorities are "build[ing] on the operational, clinical and functional integration between UMMC's downtown and midtown campuses, enhancing the medical center's community health initiatives and improving efficiency of its ambulatory services," according to an October hospital news release.

John Nguyen, formerly chief strategy officer of St. Louis-based SSM Health,  also moved to the newly mintly role of chief administrative officer. He will have accountability for advocacy, governance, marketing and communications and philanthropy efforts. 

Chicago-based CommonSpirit Health's new CAO, Michelle Johnson Tidjani, will have oversight of "the national budget, ensuring resource optimization across the organization, and implementing the healthcare ministry's new operating model."

At some organizations, the CAO can be an alternative to a president or CEO title at a specific hospital, Ms. Padilla told Becker's. As systems continue to identify one CEO or president for the system, they are looking to differentiate the titles across the system to align with responsibilities or underline the operational responsibility of the role. The CAO title, for example, used at Marshfield (Wis.) Clinic Health System denotes the leader at each of their hospitals and regions, said Ms. Padilla.  

Although it looks different across organizations, the role appears to be growing in prevalence. Eighty-five health systems submitted data on CAOs for 2023 — up from 69 in 2019 — according to the 2023 Health Care Management and Executive Compensation Survey conducted by Chicago-based consulting firm SullivanCotter.

"The use of a chief administrative officer position in leading healthcare organizations has increased in recent years," Bruce Greenblatt, executive workforce practice leader with SullivanCotter, told Becker's. "This is being driven by the greater complexity of operations and the need to 'do more with less' by expanding the span of control of senior leadership positions to oversee multiple areas."

Across payers, higher education, life sciences, hospitals and other organizations, WittKieffer's database had about 100 organizations list a CAO in 2020. Now there are 240 of those titles in the database. In healthcare, the firm has seen the number of CAOs triple in the last three years. 

"We're clearly seeing more of these positions created throughout the industry," Ms. Padilla said. She attributed this, in part, to the ability for organizations to consolidate and create more streamlined C-suites. Hospital C-suites face tough decisions as they focus on key areas such as quality, growth and strategy to ensure long-term success. These decisions range from service cuts to streamlining leadership structures. And while it remains to be seen how many hospitals and health systems will bring on chief administrative officers in 2023, streamlining at the leadership level is sure to continue. 

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