5 Things Nobody Told Me Before I Became CEO

Becker's Hospital Review asked five hospital and health system CEOs from around the country to share a piece of advice that nobody told them before their first day leading a hospital or healthcare system. Respondents offered a variety of answers, ranging from the amount of time they devote to conflict management, to unexpected changes in personal relationships, to waking up at 4 a.m. wondering what they forgot to do earlier in the day. Here are five things these CEOs had to learn on their own.

Richard Afable, President and CEO of Hoag Memorial Hospital Presbyterian in Newport Beach, Calif.: As I think about the elements of my work, I was not prepared for the number and intensity of disputes that need to be resolved, especially between people and factions within the organization. The assumption is that you, as CEO, have all the requisite knowledge, wisdom and skill necessary to resolve every issue, completely and correctly — and that you will do so impartially, much like a judge would do from behind the bench. Well guess what: I didn't go to law school nor do I have the time or intention to watch Court TV sufficiently often such that I could know how exactly to make these interpersonal decisions well and in everyone's best interests.

But yet, it is part of my job. Someone has to judge, someone has to consider all sides, and ultimately, someone has to decide. This commonly comes down to the CEO. Slowly and with experiences (some good and some not so good), this skill develops over time. Soon enough, one can get the gist of an issue pretty [quickly] and most decisions become obvious. But in the beginning, these issues were tough and risky. I wish someone had told me this issue was going to be part of my job. I probably would have watched more daytime TV!

Jim Dague, President and CEO of Indiana University Health Goshen (Ind.).: Planning and visioning should be a CEO's strongest skill, and the way you spend most of your time. As a candidate for CEO positions, you realize you'll be the leader of the organization, but there's a very lonely moment when you sit in the big chair for the first time and that organization is waiting for your vision, your leadership.

This is not a custodial job. There are too many people in these top positions that think they're custodial and can keep things the same. Too much is changing in healthcare to think that way. For example, a hospital's heart program shouldn't be the same as when you walked in the door 10 years ago for your first day. If you're going to be a custodian CEO, and you don't have a vision, please don't accept the job.

Joseph A. Quagliata, President and CEO of South Nassau Communities Hospital in Oceanside, N.Y.:
At the time I was named CEO at South Nassau Communities Hospital, it would have been beneficial to be aware that my professional relationships would change with the people I had been working with for a long time prior to being named CEO.

Barry P. Ronan, President and CEO of Western Maryland Health System in Cumberland, Md.: What still amazes me is the amount of knowledge a CEO needs to have based on the complexity and ever-changing aspects of the healthcare industry. In addition to the day-to-day requirements of running a health system, a CEO needs to be aware of so many other aspects of the industry. From federal requirements to state regulations; from financial planning to strategic planning; from clinical integration to health information technology; previously the CEO could get away as a generalist, but not anymore.

We recently completed the building of a new hospital. I assigned the administrative oversight responsibilities to a vice president. He did an exceptional job, but for the 35-month construction period, even with a dedicated administrative officer, approximately 60 percent of my work day was consumed by some aspect of the building project. I had to become an expert in yet another aspect of this business. It’s still a job that I love doing in an industry that I have been a part of for more than 36 years.

Bill Thompson, President and CEO of SSM Health Care in St. Louis:
Nobody told me that I would routinely wake up at 4:00 a.m. worrying about things that I have absolutely no control over. And remembering the things that I am supposed to have some control over, but forgot about in the crush of all the other things that I’m supposed to remember.

Is there something you wish you knew before you began as CEO? Becker's Hospital Review is seeking hospital or healthcare CEOs to share their response. Please email Molly Gamble at molly@beckersasc.com.

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