The first year as a hospital or health system CEO can be a crash course in leadership and personal growth. Transitioning from another C-suite role to the top job often brings unexpected challenges — opportunities to define one’s vision.
Becker’s connected with a new hospital CEO along with three retiring leaders who reflected on their own first year as CEO and the lessons that stayed with them.
The leap to CEO
Rob McLin, who is retiring in 2026 after serving as president and CEO of Good Samaritan in Vincennes, Ind., since 2010, said his biggest surprise as a first-time CEO was how fast-paced the job was — particularly compared to his prior role as CFO.
“I didn’t recognize and appreciate as much as I should have the concept that ‘the buck stops here,'” Mr. McLin told Becker’s. “When you’re CFO or COO, you always have that last level of the CEO to lay off things, and there was nobody to lay it off to.”
Neil Meltzer, president and CEO of Baltimore-based LifeBridge Health, also plans to retire in 2026. He has been with the five-hospital system for 37 years, holding various leadership roles before becoming CEO in 2013.
“As a result, in every step, I’ve gone from being someone’s peer to being someone’s boss, and then being someone’s peer again to being someone’s boss,” Mr. Meltzer told Becker’s. “I wish I was more aware of how difficult it is to make that transition.”
Julie Freischlag, MD, CEO and chief academic officer of Winston-Salem, N.C.-based Atrium Health Wake Forest Baptist, will retire at the end of 2025 after serving as CEO since 2017. She told Becker’s one of the most important steps for a new CEO is assessing what is working and what is not.
“The best thing is to figure out who on your team has a great knowledge and history of the institution that can be honest with you and help you understand where they came from,” she said.
It can be tempting to move quickly on issues, Dr. Freischlag said, but understanding the history behind a problem — and the risks and opportunities tied to change — is critical.
“That is really helpful, because as you change culture, you need to have buy-in from somebody,” she said. “And if you are telling them they’ve been doing it wrong for a long period of time, then some won’t want to do it your way.”
Michael Garcia, RN, marked his first full year as CEO of Houston Methodist Sugar Land (Texas) Hospital in February. Having served as a hospital COO before that, Mr. Garcia told Becker’s the role change meant shifting from executing a CEO’s vision to setting and executing strategy with the leadership team.
Unplanned lessons
One of Mr. Garcia’s early challenges was learning the layout of the hospital and how staff move throughout the facility.
“Understanding how to quickly get from point A to point B and making sure that I introduce myself to everyone here was a priority for me, and it took a lot of time,” Mr. Garcia said. “Knowing how our employees get from one location to another also helps me understand the challenges for each department. What path do transporters take? How does food service deliver meals?”
The health system also navigated two significant weather events in his first year. A hurricane in July disrupted power and IT systems for two days, and a snow and ice storm in January forced cancellations of outpatient procedures, tests and surgeries.
“Those two weather events had two completely different challenges,” Mr. Garcia said. “It was rewarding for me to have been able to weather those two events with the team in house, making sure that we provided care to all of our patients and rescheduled everyone that was canceled due to the weather.”
Burnout and delegation
Looking back, Mr. McLin said he did not prioritize work-life balance enough in his first year.
“I didn’t realize that the work-life balance could eat you alive,” he said. “As a CEO coming in, you want to do everything, and that can be a disaster if you don’t do a good job proportioning your time appropriately between your work and the rest of your life.”
He also said carrying his CFO mindset into the CEO role — feeling the need to take ownership of all work — was not beneficial.
“The lack of delegation nearly killed me,” he said. “My leadership has evolved in the art of delegation and understanding how important it is to surround yourself with good people and give them the responsibility to work on things.”
One of his biggest early challenges was building relationships with physicians — especially coming from a finance background. It aligned with a major accomplishment: the purchase of a large provider group.
“I came right out of the gate negotiating with them, employing them and purchasing their building,” Mr. McLin said. “That gave me an opportunity to create some credibility, work hand in hand with them, not be heavy-handed in what I was doing, but help them understand the vision of Good Samaritan.”
Building relationships
Dr. Freischlag emphasized the importance of building relationships early and advised new CEOs to be patient in attempting to win over skeptics.
“I wouldn’t count people out early,” she said.
Mr. McLin said realizing the importance of visibility was a turning point for him.
“As CEO, you don’t walk by anybody without acknowledging them,” he said. “You recognize people and appreciate them. That was something that I had to remind myself: Never be too busy to talk to people every single day.”
In the past year, Mr. Garcia has come to value tailoring leadership to Houston Methodist Sugar Land’s specific needs.
“I recall in my first year looking back having to be more mindful to learn more about the campus and its people and focus on what works for us here, because what works for one campus may not work here,” he said. “A huge lesson for me as a leader was to make sure that I was mindful of how I communicate with people, understanding their priorities.”
For the next CEO in line
Mr. McLin offered several pieces of advice for new CEOs: Set time aside for yourself, be kind to everyone, build a trustworthy leadership team and find a mentor.
“As a new CEO, you’re going to be tested right out of the gate,” he said. “The best thing to do is stay honest and firm to your principles.”
Mr. Meltzer said what has remained consistent throughout his leadership journey is the importance of being relatable.
“You’ve got to be human,” he said. “I’ve learned that people will follow much easier if they relate to you as a human being, if they understand that you have flaws, too.”
Through LifeBridge Health’s emerging leadership program and at universities, Mr. Meltzer teaches future leaders the same guiding principle: “If people can’t relate to you, you can’t lead.”
