10 Critical Considerations for Filling Interim Management Positions at Your Hospital

The healthcare industry today is more complex and competitive than ever. The demand for efficiency and consistent positive results has never been greater. At the same time, the industry is facing an aging workforce, and experienced healthcare leaders in nursing and other clinical areas are reaching retirement at a rapid pace. This has led to growth in the area of interim management for hospitals. Interim leaders can provide support to an organization for a period of time while a permanent replacement is identified and vetted for the position.  

Where does a healthcare organization go to find interim leaders and support? There are several ways, but the recent trend is to either utilize a healthcare management consulting firm that provides support in the form of interim management, or to enlist the aid of a recruiter (i.e., a permanent management recruiter) that also places interims.  

Both options provide a variety of benefits depending on the situation.

A consulting firm, often staffed with experienced professionals coming from a clinical background, can assist in selecting and supporting the interim staff at your facility (support may have an additional cost) to ensure a smooth transition.

A recruiter or executive placement firm may or may not have staff with a clinical background, but has the capability of offering a wide variety of potential applicants and supports many of the HR-related functions of your search. Some executive placement firms specialize in industries, while others offer more general search assistance. In addition, these companies often provide extensive support in the area of job search functionality. If you have a position to fill quickly and feel your department is running optimally, then using a recruiter can be incredibly cost effective.

The question becomes, "Which should you use for your interim management needs? The short answer to this question is "it depends."

Below are some questions and answers to help you make that decision.

1. How well is the department currently running?

If your financial performance indicators are near or meeting their targets and you have a quality program in place with minimal errors, then utilizing an interim from a recruiter is often the best solution. However, if this area is an ongoing challenge to your organization, a management consulting firm backing an interim may provide you with a solution to the problem.  

If there is business growth within the area, and there is already a structure in place to ensure a smooth assimilation of the new business, you may want to take advantage of the services of a recruiter to fill your interim management needs. If the area lacks such structure, this may be a time to consider additional support during the interim period, and often a HCMCF will have the expertise for this type of transitional project.

2. Are the patients satisfied with the service provided?

If your patients and physicians are happy, then you may not even need an interim. If you want to ensure that someone is minding the department while the search is underway, using a recruiter to provide an interim to maintain satisfaction makes sense.  

If your service levels are not meeting the expectations of your end users, an experienced management consultant could provide you with a rapid assessment of the area along with the interim leader so that a plan of correction can be developed and implemented during the interim's tenure.

How can you determine this? Ask yourself these questions:
  • How have you scored on your most recent HCAPS survey?
  • Are your patients satisfied with the service that is provided?
  • What about your physicians? Are they satisfied with the care that their patients receive?  Are they happy with the service provided by the affected department(s)?

3. Is the department staff satisfied?

Are the employees in the affected area(s) motivated and professional? Has there been sufficient professional development? Are their competencies and evaluations up to date? Do they have the maturity to stay focused on their work while waiting for a new leader? Today there are so many mandatory education requirements that it is sometimes a challenge to ensure that the departmental education and competencies are current and documented. A recent client faced rapid turnover in a leadership position that left a gaping hole in the staff competency documentation. Our firm was able to bring in a "swat team" to review all of the staff files and identify what was lacking in each file and develop a plan to get everyone into compliance.  This type of additional support, provided by a management consulting firm, is typically not available to an interim provided by a recruitment firm.

If the department is running smoothly and all indications are that the interim placement is straightforward, then utilizing the expertise of a recruiting firm is the right choice in most cases.

4. Are you planning any politically sensitive changes to the area?

Is the leadership or staff turnover in the affected areas greater than the average turnover for the hospital? This could be an indication that you have a real problem in the area. It could mean that there is lateral violence among the staff or unreported disruptive behavior occurring. This can be a very politically sensitive area to be addressed and it must be done with the utmost skill and attention.  

If you have a strong human resources department ready and able to assist a solo practitioner coming in through a recruitment firm, be certain that both your interim and HR department are prepared to address the challenge. Because these politically charged situations require a balanced and experienced approach, sometimes the additional support from a management consulting firm can diffuse and disengage explosive situations that were previously unmanageable.

In the same vein, you should consider whether there are personnel or program changes that need to be made and could impact the department politically. If there are sensitive changes in the offering, it may be better to have a resource team available to address additional, unanticipated needs that may arise.  Make sure that the recruitment firm or management consultant is aware of this and make sure they have the skill set and/or additional resources if the need does arise.  

5. Are the costs of operating the unit under control?

The costs of many units within the hospital are largely based on labor. There are a few (for example, the surgery and cardiac catheterization lab) that are both labor intensive and supply intensive. If you have an issue with keeping labor costs under control, it may make sense to have a leader that has productivity experience to implement necessary changes before the permanent director or manager joins the organization. Some interim directors do not have substantial expertise in productivity development or adjustment. In this case it would be very important to specify the need for this experience during the interim hiring process whether using a placement firm or management consulting firm. A supply chain expert, or a seasoned director with supply chain experience would be able to identify and address supply cost issues.  

6. Are you anticipating the implementation of any new initiatives or product lines in the near future?

If the affected department has a new product line that is under development or is about to be rolled out, a support system beyond an interim provided by a recruiter should be considered.   For example, a recent client purchased a $2 million surgical robot right as the director resigned.  Can you afford to let a $2 million investment sit idly by while waiting for someone new to join the organization before you initiate a program? When something like this happens, it may require multiple resources to address the situation in a rapid fashion and get the department back on track.

7. Is there an imminent regulatory review?

Are you confident that all of the regulatory requirements for the area are in place? Does the staff in the area know what is expected of them during a survey? Has the area been free of any sentinel events during the last survey cycle? If you are confident that the department is well prepared for survey, an experienced director providing interim service from a recruiter would be a good choice. If you are not confident that the department is well prepared, a management consulting firm could provide additional resources at the beginning of the engagement to improve chances that you are in compliance by the time the surveyors enter your facility.

For example, a recent client had a short time frame before their triennial survey when their perioperative director resigned. Not only were we able to provide an interim director, we were able to assess the department's preparedness for the survey. Potential issues were identified quickly by the team so that resources could be allocated correctly and the interim could focus on the management of the department. While a director from a recruitment firm would most likely identify the same issues, it may have taken longer for them to surface.

8.  How do you want to structure the interim staffing agreement?

Generally there are two ways to structure an interim agreement. You can "hire" the interim leader on a temporary basis and pay a recruitment fee, or you can contract with the agency for services provided and pay an agreed-upon fee for the service. The first arrangement can put the hospital at risk if the interim does not work out and has to be terminated; the second arrangement puts the risk with the agency. Make sure that your agency has the insurance required for this type of contractual arrangement.

9.  How long do you anticipate the need for the interim staff member to be engaged?

Do you believe that you will be able to attract a strong candidate for the position within a 1 to 3 month period of time? Have recruiters told you there is a large pool of candidates for the affected area that are available?  Are you using the same recruiter for both permanent and interim placement at your organization? How are they addressing the fundamental conflict of interest that exists? What is the incentive to fill the position quickly if they are making a profit from the interim leader?  If you are confident that the recruiter will find you a leader your unfilled need quickly, then a recruiter may be fine. If not, at a minimum use separate firms for interim and permanent placement.

10. Are there any internal candidates capable of taking on the role?

Have you identified anyone within the department with the potential to take on the position permanently if mentoring is provided? Do you have someone within the organization that can provide the mentoring on an ongoing basis after the initial advancement and training? A management consulting firm can assist with mentoring an individual into a management role and assist them in the transition for a number of months, both on site and remotely. Typically, the relationship will end with an interim placed by a recruiter once they leave the premises.

While any one of these issues may be enough for you to decide to use a consulting firm versus a recruiter, there may be other factors to consider. For example, is the area "high profile" within the organization and what financial impact does the area have on the overall performance on the organization? In those instances, a management consulting that has additional resources available may be the more appropriate answer.

The decision to utilize a recruitment firm versus a healthcare management consultant firm for interim staffing needs is a critical one that can have a tremendous and long-lasting effect on a hospital's bottom line — at financial, administrative and HR levels. Regardless of the direction you go, make sure you ask yourself —  and the firm — all the right questions.

Paul Wafer is a 34-year healthcare veteran and founder of Manhattan Beach, Calif.-based Alpha Consulting Group, which provides perioperative professional support and advisory services for hospitals and surgery centers with a need to improve efficiencies, lower costs, address immediate staffing issues, demystify IT system and undertake a myriad of other issues that often plague management. Mr. Wafer built Alpha Consulting Group with the goal of helping healthcare facilities achieve clinical excellence and profitability by providing assistance in what he identified as key areas that impact the operating room.

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