Health systems revamp the COO role

The COO has had a tough year.

Financial struggles at health systems put their efforts under a microscope, and in some instances led to their role being eliminated entirely. Both Confluence Health in Wenatchee, Wash., and Sovah Health in Danville and Martinsville, Va., cut the role earlier this year. But that doesn't mean all systems are souring on the role; it's just evolving.

For example, ThedaCare in Neenah, Wis., combined the CFO and COO roles this year, while Chesapeake (Va.) Regional Healthcare created a hybrid COO and chief nursing officer role.

"A dual focus on nursing and operations allows for better collaboration and continuity of care through disciplines such as pharmacy, rehab services, our diagnostic services, home health and hospice, and overall service line development," Amber Egyud, DNP, RN, chief nursing officer and COO of Chesapeake Regional, told Becker's. "All of it is so integrated into patient care that having a dual role makes the most sense from a planning and alignment perspective and a collaboration perspective. It brings everyone to the table with the right insights because we all have a piece of the puzzle."

There has also been an upswing in hospitals and health systems naming COOs recently. Orlando (Fla.) Health named Corey Snider, former regional COO for Sioux City, Iowa-based UnityPoint St. Luke's, to assistant vice president and COO of its Winnie Palmer Hospital for Women and Babies, in mid-October. Piedmont Augusta (Ga.) also named a new COO in recent weeks.

Traditionally, COOs were tasked with managing day-to-day operations and others are focused on mentorship, according to a McKinsey report examining COOs. These executive leaders can also spark digital transformation and ensure artificial intelligence is integrated appropriately.

"In an uncertain post pandemic environment, the COO role is evolving from its roots in the back office into a catalyst for technology-driven growth, strategic expansion and employee empowerment. As chief executives increasingly become the public face of organizations and deal with external constituencies and stakeholders, it often falls to COOs to provide internal leadership and direction," the report states.

Tim Johnsen, BSN, RN, senior vice president and COO of Presbyterian Delivery System at Presbyterian Healthcare Services in Albuquerque, N.M., oversees operations across the nine-hospital system and medical group. He told Becker's the workforce is stabilizing post-pandemic, and the system is experiencing month-over-month growth in retention. With the workforce anxiety and stress of the pandemic dissipating, he is looking forward to developing career paths, integrating more automation and supporting smart growth next year.

"We are still very busy in our metropolitan areas and some of our regional areas as well. Smart growth may be counterintuitive in a fee-for-service environment but as an integrated health system, we look at that differently," Mr. Johnsen said. Leaning into value-based care will be a big part of his role moving forward as well.

Deepak Sadagopan, COO of population health at Renton, Wash.-based Providence, said his role will evolve in the coming year to scale adoption of value-based transformation across the health system and use AI and digital technologies to expand capacity. He'll also be tasked with expanding health equity and developing partnerships with the community, payers, legislators and fellow partnerships.

"Economics of healthcare continue to be challenging. Costs of premiums continue to rise, cost inflation for healthcare delivery systems continues to rise at 8% to 10% per year. Value-based transformation offers a path forward to sustainability," he said. "Healthcare as a service is increasingly moving out of hospitals and clinics offices toward homes, just as all other services are. We ought to meet our patients where they are, at their homes, in communities. The combination of value-based models and community partners is essential to meet this change."

West Des Moines, Iowa-based UnityPoint Health recently named regional COOs, including Michelle Niermann, who was named COO of the East Division. She said on the "Becker's Healthcare Podcast" that the role historically had responsibility for liasoning with the system's markets and some system services provided centrally.

"With this evolution of organizational design, my counterpart who is the West Division chief operating officer, and I are really charged to do a few things," she said. "First and foremost, be of good support to our market presidents across our eight UnityPoint Health markets to support them in their roles. We have several who are new, so encourage them, help them grow into those roles to be of good service to the organization and to the communities."

She said the regional COOs are also focused on achieving greater benefits of "systemness" as the organization grows. The health system is changing the emphasis for COOs at the market level working with market presidents. The market presidents should know their current performance, understand barriers to the next level of improvement, and be the face of the organization with team members and physicians. The COO works with the market presidents to become more forward-thinking.

COOs are currently struggling with appropriate time allocation, with many developing just one-third of their time between strategic planning while the rest is split between people management and other operational priorities, according to the McKinsey report. But organizations will need COOs to keep evolving as workforce challenges change, automation increases and real-estate issues arise.

The most successful COOs moving forward will be better able to anticipate change, gauge the workforce market, effectively engage with their boards and elevate within the C-suite.

"The COO role has traditionally taken a backseat to other C-suite functions within the organization. Its recent resurgence and increasing visibility showcase the importance of the job building strategic resilience and positioning organizations for success in a dynamic and rapidly changing environment," Darryl Piasecki, managing partner at McKinsey, wrote. "But the skills aren't enough. COOs must develop new capabilities and strengths to take on complex and uncertain tasks that await them."

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