Peter Banko wrote a book about firing people. He will be the first to tell you it isn’t really about that.
The subject that drove the president and CEO of Springfield, Mass.-based Baystate Health to sit down in 2024 and finish a manuscript in four months is a workforce and leadership crisis that has been quietly worsening for more than a decade. Four out of five American workers are disengaged, according to Gallop’s “State of the Global Workplace 2026” report; one in five describe their work experience as miserable and engagement in the U.S. workforce has dropped to its lowest level in a decade.
“People don’t quit organizations. They quit their leader and their team,” Mr. Banko said in a recent episode of the “Becker’s Healthcare Podcast.” “Bad leadership, dysfunctional teams is why people are miserable at work. We’ve got to do something about that and make sure we’ve got the right people in the right seats on the team.”
The observation animates his new book, The Necessary Goodbye: How Great Leaders Fire with Clarity, Confidence, and Compassion, though he is clear the title is a vehicle, not the destination.
The book’s argument, in the end, is not about firing. It is about the full arc of leadership: who you hire, how you develop them, whether you show up in a way that makes people want to stay and when all of that fails, the courage to act without equivocating.
“Leadership’s not a popularity contest,” he said. “You lean into doing it with compassion, clarity and confidence.”
Baystate has four hospitals, with a fifth opening in November, a large integrated physician group of more than 1,300 providers, and a health plan spanning commercial, Medicare and Medicaid lines. It is the academic health system and the safety net in Western Massachusetts, the largest employer in the region and it doesn’t have a fallback.
That context gives the leadership crisis concrete stakes. A B.E. Smith leadership trend survey found that nearly two in three healthcare executives are considering leaving their jobs, with one in three indicating they may do so within the next 12 months. The organizational cost of that attrition, including institutional knowledge, culture continuity and the downstream effect on teams, compounds a financial environment already under pressure.
Mr. Banko said there are too many leaders in the wrong seats, and too few doing the daily, deliberate work of showing up well. The philosophical framework he returns to is the capacity to hold opposing truths simultaneously — a concept he traces to F. Scott Fitzgerald, who in a 1936 essay wrote that the test of first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.
“Yes, our environment’s challenging. Yes, it’s tough at work. You’re going to have to fight a fire today,” he said. “But at the same time, there’s so many opportunities in healthcare and in every other organization in the United States. You can hold the challenges and opportunities in equal measure and truth, and choose to embrace the opportunities during the course of the day and not get thrown by the challenges. Just get comfortable with being uncomfortable. That’s the leader’s job. That’s the CEO’s job.”
The commitment to greatness in healthcare delivery despite the mounting challenges and shifting industry dynamics starts at the top. Mr. Banko takes his role within the organization seriously and understands the ramifications of accepting mediocre work.
“As a CEO, I view myself as the chief mission officer and the chief culture officer, the chief spirit officer,” he said. “If you’re not talking things up and you’re not talking the organization up, who else will?”
That does not mean performing optimism. Authenticity requires naming what is hard. But it means refusing to let the difficulties of the day become the organization’s operating premise. For leaders who struggle with that balance — and he is candid that no one navigates it perfectly — he advises creating time for heads-up thinking, stepping away from the schedule, leaning on your network and finding a coach. He has worked with an executive coach on and off for 19 years.
“They’re a good sounding board to say, ‘You’ve got to get back in the game. You’re not at your best self’,” said Mr. Banko. “You’ve got to have people around you that can tell you the truth when your behavior is not where it needs to be. You need to pivot and get back on the horse and ride again.
The leadership act the book is nominally built around, the termination, is less an act of cruelty than one of clarity. Mr. Banko draws on Brené Brown’s formulation: clear is kind, unclear is unkind. A termination done right shouldn’t be a surprise. Instead, it should follow multiple prior conversations and genuine attempts to help the person succeed. It should treat the departing employee with enough dignity to protect what matters most in their life.
“You don’t want someone to lose their house or their car or their marriage or their family over this decision,” he said. “Take care of them on the way out.”
Mr. Banko has the experience to support his thesis. Early in his career, he worked with a young and talented executive who wasn’t the right fit for the organization he headed. The two parted ways and the termination weighed on Mr. Banko. Years later, that same man was running hospitals across multiple states and said the experience of being fired helped free him to pursue things he never thought were possible.
Mr. Banko is also acutely focused on going upstream to the hiring decisions. Research suggests up to 50% of new hires prove to be mistakes within 18 months, and he believes the culprit is a process too often optimized for speed over fit.
“I don’t view it as the end for the person,” Mr. Banko said. “It’s a new beginning. It just didn’t work out. You’ve got to help them find that new beginning.”
At Becker's 4th Annual CEO + CFO Roundtable, taking place November 2–5 in Chicago, more than 1,500 hospital and health system executives tackle decisions that determine whether organizations thrive or merely survive: protecting margins under cost pressure, choosing where to grow, renegotiating payer relationships, stabilizing the workforce and proving real ROI on technology. This is where leaders work through them together, face-to-face. Apply for complimentary registration now.