Interim leadership in healthcare: Pros and cons

At hospitals and health systems, interim leadership is brought in when an executive position becomes vacant, whether that be through a resignation, promotion or other means. 

There are differing views on interim leadership and whether it helps healthcare organizations. 

An article from Summit Talent Group, a Columbia, Md.-based boutique executive search and interim leadership placement firm, lists various ways an interim leader can help hospitals. These include filling a vacancy; helping with new, complex projects; and providing ample opportunity to improve quality.

"An interim can look at the organization with neutral eyes to spot issues in the supply chain, inventory management, efficiency, patient service and more. An interim leader can be a great resource for improving service and optimizing performance," the article states.

However, Jeffrey Sonnenfeld, senior associate dean and professor at the Yale School of Management, stands in stark opposition to interim leadership, except in a select few special cases. Mr. Sonnenfeld has written and researched extensively about leadership, and is of the opinion that interim leadership is a form of "kicking the can down the road."

He told Becker's that interim leadership presents a whole host of challenges for organizations, arguing that interim leadership should be avoided at all costs. 

"It often shows an unprepared or cowardly board and it papers over a lack of planning that even at a time of crisis, the board should have heard a contingency plan other than to ask somebody to step in on an interim basis," he said. 

He also argues that those in the interim position feel bound by certain limitations, knowing that their position is fragile and temporary, thus they often lack the drive and guts to make difficult decisions. Included in that paralysis of decision-making is lack of commitment to a strategic path, which can keep the company at a standstill in the face of competitive arenas and potential for bold thinking. 

This, in turn, affects the employees of the company, often forcing them to retreat to routine and ritual instead of creating bold or innovative initiatives. 

"A lot of internal management decision-making becomes very balkanized into political factions.  You see different groups that think that they're going to be the winners or the losers after the ultimate succession," he told Becker's. "So there's a lot of political jockeying where people are trying to cement themselves in ways other than through merit."

Finally, interim leaders can also cause confusion and signal disruption to external stakeholders and shareholders. The interim leader can only give a limited view on the direction of the organization, putting it into a kind of holding pattern. 

The only time he recommends implementing an interim leader is during an unforeseeable crisis.

"There could be times where very briefly, you have an interim until that outside party, you know, if there's a major scandal, that's understandable, or a sudden meltdown, but these are the exceptions and not the rule," he said.

He also said that in rare cases where the interim leader is well-known to the organization, highly trusted and without ulterior motives, they can act as a good stabilizer for an organization in crisis. In general, he advises boards to always be on the lookout for eligible candidates, especially those they can promote from within the organization.

"Internal candidates often get disparaged because they are so well-known that you are aware of their strengths, but they often overplay their weaknesses," he said. "Errors that happened in [their] early career continue to get recycled, and people remember for decades later, a misstep when somebody was learning along the way."

Sanford approach to succession planning

Jennifer Grennan, executive vice president and chief administrative officer of Sioux Falls, S.D.-based Sanford Health, told Becker's her organization has long recognized the crucial role leaders play. 

"We approach succession planning through a leadership development lens and have specific strategies and programs in place to invest in our leaders and create pathways for professional growth," she said. "This also helps us develop a deep bench of internal talent to meet our organization's leadership needs now and in the future."

She gave the example of Randy Bury, who recently retired after serving in dozens of leadership positions for more than four decades with Sanford. 

Mr. Bury joined Sanford in 1981 as an unpaid intern at the health system's medical center in Sioux Falls. He then was offered his first paying job within the health system and continued to serve in roles at its medical center in Sioux Falls, including COO, chief administrative officer, executive vice president and vice president of patient services. He also was Sanford Health's chief administrative officer and served as senior vice president of health services administration. 

In 2018, Mr. Bury was nearing the end of his career, but a leader was needed for the Good Samaritan Society after the nonprofit provider of senior care and services merged with Sanford, Ms. Grennan said.

"Randy had the right depth of experience and was appointed president and CEO of the Good Samaritan Society in 2019," she said. "Simultaneously, Randy's transition opened the door for one of our longtime leaders, Matt Hocks, to seamlessly step into the role of COO for Sanford Health. Randy spearheaded integration efforts with Sanford Health and led the division through the COVID-19 pandemic before retiring at the end of 2021. Matt's leadership has been instrumental in guiding Sanford Health through the unprecedented challenges over the last three years."

Mr. Sonnenfeld wrote in February that interim CEOs should be the last option for a company and usually indicate poor planning. 

Regarding this viewpoint, Ms. Grennan said "thoughtful, deliberate and strategic internal succession planning for a president and CEO role is designed to help ensure that when a transition occurs, whether planned or unplanned, the organization is well positioned to continue to advance its mission and lead its people and the communities it serves." 

She said a benefit of having a permanent CEO replacement is that it can provide assurances of stability, more effectively enable business continuity and cultivate trust within the organization.  

Still, Ms. Grennan said organizations have unique needs to consider in terms of leadership transitions. 

"For example, when our CIO vacated the role in early 2021, rather than naming an interim leader or a permanent replacement immediately, we decided it would be best to identify a leader among leaders to make sure the work and collaboration continued while we conducted an executive search to identify the strongest internal and external candidates," she said.   

Additionally, she said Sanford Health's approach to the transition "allowed us to express confidence in the existing team, provided opportunities for individuals to naturally step up and assume responsibilities and allowed new leaders to emerge." 

In contrast, Ms. Grennan said one challenge with interim leadership roles is they may offer a limited ability to influence or make decisions.  

"Interim leaders sometimes feel like they are in a perpetual job interview, which can create uncertainty, diminish trust within an organization and put business continuity at risk," she said.  

"Effective succession planning can serve as a valuable competitive differentiator. Sanford Health believes in the importance of deliberate succession planning at all levels of the organization to ensure we have the right leaders in the right places to meet the needs of our patients and communities for years to come."

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