Leadership turnover has become one of the few constants in healthcare, as executives change roles amid consolidation, retirements and mounting operational pressure. The risk isn’t only the vacancy itself but what can leave with it — institutional knowledge, hard-won relationships and a sense of direction that took years to establish.
In this Becker’s Healthcare Leadership Council column, health system leaders make a shared case: that continuity is not something to switch on when a role opens, but something built daily through how organizations develop people, share knowledge and ready a deeper bench to lead.
Question: Leadership transitions have become a constant across healthcare. How are you approaching continuity as a deliberate strategy — spotting successors, preserving institutional knowledge and building a deep bench of talent — so your organization holds its direction through change at the top?
Amy Perry, President & CEO, Banner Health (Phoenix)
At Banner, strategic talent planning is about far more than filling leadership vacancies. It is an investment in organizational resilience, ensuring continuity of care, preserving institutional knowledge and preparing leaders to navigate an increasingly complex healthcare environment.
Succession planning is embedded in our leadership culture — not treated as a periodic exercise. Through an integrated talent review process aligned with performance and development conversations, we identify high-potential leaders, assess succession readiness for critical roles and proactively address leadership risk. Quarterly talent reviews with senior leaders help ensure we proactively address retention and develop the right talent at the right time.
Equally important is preserving the knowledge and experience that have shaped our organization. We foster open career conversations across the workforce and have implemented innovative approaches, including incentives that encourage leaders to provide early notice of retirement. This creates meaningful opportunities for knowledge transfer, successor development and seamless leadership transitions while honoring years of service.
Building a strong leadership bench requires both investing in internal talent and welcoming external leaders who bring specialized expertise and diverse perspectives. Our leadership development portfolio spans every career stage, offering coaching, mentorship, networking and tailored programs for current and emerging leaders, including clinicians transitioning into leadership roles.
The healthcare organizations best positioned for the future will be those that intentionally cultivate talent long before leadership transitions occur. Strategic workforce planning is a business strategy that strengthens culture, advances organizational performance and ultimately supports exceptional care for the communities we serve.
Brad Haws, CEO, Clinical Enterprise, UI Health Care (Iowa City)
As our organization continues to grow and evolve, particularly during periods of transition and change at the executive level, it becomes increasingly important to have a deliberate and well-defined strategic vision. A clear direction in an uncertain, ever-changing world provides stability and continuity, ensuring that our priorities and decisions remain aligned regardless of changes in leadership or organizational structure. Rather than our direction being driven solely from the top down or from the bottom up, a strong strategic vision serves as a shared roadmap that guides everyone toward common goals.
As a complex organization, we rely on collaboration across multiple systems, departments and stakeholders. Because of this complexity, effective communication is critical to our success. Consistent messaging, transparency and alignment across teams help ensure that everyone understands organizational priorities and how their work contributes to broader objectives. Local leadership plays a particularly important role in this process by setting the tone, reinforcing key priorities and helping employees connect their individual responsibilities to the organization’s larger mission and vision.
Ultimately, our greatest strength lies in our people. Processes, systems and strategies are only as effective as those responsible for carrying them out. We are fortunate to have a workforce that is deeply committed to our mission and dedicated to serving those who come to us. By continuing to invest in communication, strategic alignment and employee engagement, we can build on that strength and position our organization for long-term success while remaining focused on the values and purpose that unite us.
Craig Albanese, MD, President of Integrated Care & Coverage, Kaiser Permanente (Oakland, Calif.)
One of the most important responsibilities of a leader is developing other leaders.
Succession planning is often treated as a periodic exercise: identify critical roles, name potential successors and review readiness. That work matters. But continuity is built much earlier, through the way leaders develop people every day.
Organizations should strive to develop and promote talent from within. Internal leaders understand the mission, the culture and how work gets done. They carry important relationships and institutional knowledge. Promoting from within also sends a clear message to employees: strong performance, continued growth and meaningful contribution can lead to broader opportunities.
But internal promotion should not become an automatic rule. Leaders must be candid about what the organization needs, whether someone is ready and when an outside perspective would strengthen the team. The objective is not to favor one source of talent. It is to place the right leader in the right role at the right time.
Organizations build stronger continuity when they intentionally broaden leadership opportunities and create pathways for talent from different backgrounds, experiences and disciplines. A wider pipeline increases organizational resilience and leadership capacity.
A deep bench is built through real work, not classroom instruction alone. Emerging leaders need opportunities to solve difficult problems, lead across organizational boundaries and make decisions with meaningful consequences. They need candid coaching. They also need room to make mistakes, learn and adjust.
Leaders should regularly ask:
- Who is ready for a broader assignment?
- Who needs experience outside their current area?
- Who demonstrates sound judgment when conditions are uncertain?
- Who develops other people rather than simply delivering individual results?
Those questions should be part of how the organization is run, not reserved for an annual talent review.
Continuity also depends on reducing how much knowledge resides with any one person. Clear priorities, common measures, regular feedback and open problem-solving help teams understand both what must be accomplished and how decisions are made. When a leader changes, the work should not have to be rediscovered.
This is especially important in healthcare. Leadership transitions cannot interrupt the care members and patients depend on. A strong organization preserves direction because its people understand the mission, know the priorities and are prepared to step forward.
Ultimately, succession planning is not about creating a list of names. It is about creating an organization in which leadership is continually being developed, knowledge is shared and people are ready to take on greater responsibility. When that work is done consistently, a transition at the top does not create a loss of direction. It demonstrates the strength of the organization.
Damond Boatwright, President & CEO, Hospital Sisters Health System (Springfield, Ill.)
Bill Frist Sr. once said, “Good people beget good people.” In my view, that simple truth lies at the heart of succession planning and leadership development.
Succession planning is essential to ensuring continuity, maintaining stability and preserving trust throughout an organization. Yet it is about more than preparing the next leader. It also requires humility and wisdom to recognize when it is our time to let go and entrust our values, lessons and responsibilities to those who follow.
We often hear the phrase, “We are all replaceable.” Perhaps, instead, it should serve as a reminder that thoughtful leadership transitions can reinforce the principles and values that endure long after any one individual’s tenure has ended.
Humbly, I do not believe any of us are truly replaceable. Each person brings unique gifts, experiences and influence that shape the people and organizations around them. Whether our time is short or long, we have the opportunity to leave a lasting legacy, not by holding on indefinitely, but by intentionally developing others and preparing them to carry the mission forward for generations to come.
Given this, organizations should seek stability in their culture and systems while fostering growth in those who lead others. This is actualized through the intentional identification, development and selection of leaders whose capabilities align with both the mission and the future needs of the organization.
We should be asking ourselves:
- Does our culture support organizational goals? Culture is about knowing the experiences and behaviors that support the mission of the organization. This requires a deep understanding of how culture shapes care delivery and operational success.
- Do we know tomorrow’s leadership needs? Succession planning is about positioning for the future. It requires knowing what is needed for future success (not today’s success). Build and articulate profiles of success that transcend current structure and paradigms.
- Are we providing access and development to all future leaders? Share and recognize these profiles. They should be known and discussed. Note: not every future leader demonstrates ambition as a leadership style.
- Are we providing strong feedback to leaders? Test next-generation leaders — provide them opportunities to demonstrate and learn from ever-increasing operational challenges — while providing meaningful feedback for growth.
- Is our senior leadership team/the board taking time to build a future that does not include them? Regularly evaluate and discuss the successes and failures of these leaders and what the organization can do to support leadership growth.
Ultimately, leadership is not measured solely by what we accomplish during our tenure, but by what endures after we are gone. The greatest leaders build cultures that last, develop people who exceed them and create systems strong enough to thrive for future generations. In that sense, succession planning is not merely a business process; it is one of the highest forms of stewardship.
Kevin Mahoney, CEO, University of Pennsylvania Health System (Philadelphia)
The healthcare landscape is always evolving, whether through leadership changes, new technologies, economic pressures or policy shifts. In that environment, continuity is a strategy that helps organizations adapt while maintaining progress toward long-term goals. At Penn Medicine, we are focused on building a strong pipeline of talent, from introducing people to careers in healthcare to preparing future organizational leaders. That includes mentorship, professional development and opportunities for people to take on broader responsibilities over time. We want individuals who understand the organization, uphold its culture and are ready to assume greater responsibility when needed.
Continuity also depends on preserving institutional knowledge. Our health system traces its history back 275 years to the founding of Pennsylvania Hospital, the nation’s first hospital. Across that time, many people have served in leading roles, yet the institution’s purpose and direction have remained the same. Sharing knowledge, developing future talent and preparing for succession help ensure that expertise is carried forward from one generation to the next. Together, those efforts help Penn Medicine navigate an evolving environment while staying committed to the mission and long-term vision that shape our work.
Pete November, CEO, Ochsner Health (New Orleans)
Leadership transitions are a reality in healthcare, but continuity doesn’t happen by accident. It requires investing in people long before a role changes hands. At Ochsner, we see succession planning as part of our responsibility to our patients, teams and communities. It’s not simply about identifying a replacement; it’s about developing leaders who understand our mission, strengthen our culture and are ready to help shape what comes next.
We create opportunities for emerging leaders to grow through meaningful experiences, expanded responsibilities and mentorship. Just as important is passing forward the knowledge that can’t be captured in an organizational chart or strategic plan. It’s the lessons learned, relationships built and understanding of what makes an organization successful. When experienced leaders take the time to teach, coach and share their perspective, they help ensure that institutional knowledge endures across generations.
As we look ahead, we’re mindful of our responsibility to carry forward Ochsner’s nearly 85-year legacy. Since our founding as a group practice, collaboration has been at the heart of who we are. What distinguishes Ochsner is our ability to bring talented people together around a shared purpose, and that foundation has helped make us stronger through times of change. When developing people becomes part of the culture, leadership transitions become less about disruption and more about carrying the mission forward. The faces around the table may change, but our commitment to serving patients, communities and one another remains constant.
Robert Garrett, CEO, Hackensack Meridian Health (Edison, N.J.)
We believe that succession planning is a continuous and proactive process, not just a strategy to activate when there’s a pending vacancy. We focus on continuously identifying and developing future leaders, preserving institutional knowledge and cultivating a deep and diverse talent pool.
We are constantly scanning for high-potential individuals and supporting them with an array of options to advance their careers. Not only do we provide tuition reimbursement, but we have multiple training programs for all levels — from helping entry-level employees gain skills to join our care teams to advanced coaching for leaders who are VPs and above. I always tell my leadership team that I still benefit from working with a coach, more than 40 years into healthcare leadership. We also support future leaders with many mentoring programs, which is another key to sharing institutional knowledge to avoid gaps that might occur.
I also believe that a health system must create a culture of continuous learning and improvement, values that are at the core of a high-reliability organization. This is not only essential to improving quality, patient and team member experience, but is also part of the DNA of a successful leader. And while I’m mentioning culture, it’s essential that we focus on team member well-being and retention. As is often said, culture beats strategy every day and particularly in these challenging times, we need to not only build strong pipelines of qualified candidates, but make sure we are doing our best to avoid burnout, help people advance their careers and find a good work-life balance.
Robert Stone, CEO, City of Hope (Duarte, Calif.)
Maintaining a strong culture during leadership transition is essential for any institution — and especially for an organization like City of Hope with a 113-year legacy. While we are always adapting our strategies for a changing environment; what shouldn’t change is our focus on the patient and our willingness to innovate.
We intentionally create a leadership culture where those priorities are part of every decision we make. Responsibility is shared across a range of leaders, with every person seeing themselves as part of a team that is collectively focused on the big picture of supporting cancer patients. We also have robust, long-standing leadership training programs that help us identify future leaders within the organization, sponsor them and develop growth opportunities.
Wendy Horton, Senior Vice President and President of Adult Services, UCSF Health (San Francisco)
Early in my career, I was fortunate to work alongside an experienced group of operational leaders. Executive leaders came and went, but this seasoned core provided the continuity that allowed the organization to thrive. They stewarded its culture, preserved institutional knowledge, developed future leaders and kept the mission front and center. Their mentorship taught me one of the most important lessons of my career: continuity isn’t created during a leadership transition. It’s built every day.
That experience fundamentally shaped how I think about leadership. Too often, continuity is viewed as succession planning, identifying who comes next. I believe it is much broader. It is the deliberate stewardship of an organization’s mission, culture, leadership capability and institutional knowledge so its direction remains clear even as leaders change and landscapes evolve. Culture is the thread that connects one generation of leaders to the next.
Today, I focus less on who is next and more on building leaders at every level, every day. An enduring vision must outlast any individual executive. Leadership development should be intentional through mentorship, stretch assignments and increasing responsibility. Equally important is executing the practices that create continuity: transparent decision-making, meaningful performance measures and bidirectional communication that keeps leaders connected to front-line realities.
The strongest organizations are sustained not by one exceptional leader, but by a deep bench of high-performing leaders who see themselves as stewards of something larger than themselves — and who will carry the mission forward long after we are gone.
William Morice, MD, PhD, CEO, Mayo Clinic Laboratories (Rochester, Minn.)
I think preparing your organization for leadership transition is one of the most important responsibilities for any leader, and something that ideally starts very early once you take on a leadership position. This will not only help you to delegate responsibility, it protects you, and more importantly, the organization you serve, from becoming overly dependent on you as an individual.
Early mindfulness of the need for leadership transition will require you to honestly assess the competencies and development opportunities for both you and members of your leadership team. This is critically important as you can then engage team members in opportunities that both leverage their strengths and require them to build new capabilities, with a sufficient blend of autonomy and support to make their responsibilities both challenging and rewarding. This not only leads to greater organizational effectiveness; it builds confidence in members of your team. In this way, you create a growth mindset culture that will attract talent, reinforce culture and values, and give the team the greatest chance for success, both during your tenure and after your transition.
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