When C-level roles are too big for one person

Top executives at health systems have a lot on their plates, often making multipronged decisions that involve financial, operational and clinical considerations. The right person can handle all that pressure — but maybe it's best if they don't have to. 

At least, that's the sentiment at Indianapolis-based IU Health, which recently eliminated its chief operating officer role and split the responsibilities between a two-man team. Ron Stiver, former president of system health solutions, now serves as senior vice president of system healthcare operations alongside Brian Shockney, former president of the system's South Central region, who was promoted to senior vice president of system regional operations. 

Growth and timing catalyzed the switch, the pair told Becker's. When former COO Michelle Janney, PhD, RN, announced her retirement, it gave leadership a chance to step back and evaluate. Their consensus: the job had gotten too big for one person. 

"We've grown as a health system. And as we've seen across U.S. healthcare, it continues to be a necessity to bring on more physician groups and hospitals as the financial picture the past few years has gotten more grim than it has in my career," Mr. Shockney said. "And so when that expansion occurs, you tend to add additional responsibilities." 

IU Health is accelerating growth into different care settings while continuing its focus on high-quality acute care operations; at the same time, it's attempting to bring down care costs yet remain on the cutting edge as Indiana's only academic health center. Each of those are "pretty big jobs," according to Mr. Stiver — so the tasks were divided. Mr. Stiver leads home health operations, joint-venture ASCs, a community health team and a value-based care team. Mr. Shockney leads the hospitals, outpatient centers, and their executive and support teams. The arrangement is incumbent on teamwork.

"We always say, we're not a standalone home-based company or a standalone urgent care center," Mr. Stiver said. "We have a home health agency and urgent care network within an integrated system. And it has to feel that way to the consumer and the patient, which means [Mr. Shockney and I have] got to work hand-in-hand." 

A team-based mentality is at the core of academic medicine, Eric Monday, PhD, co-executive vice president for health affairs at Lexington, Ky.-based UK Healthcare, told Becker's. He has been sharing the role with Robert DiPaola, MD, since December. 

"So much of what we teach our students is to work in teams," Dr. Monday said. "And so I think in some ways, we're just evidencing what we're asking our groups to do, right? We're only as good as we're able to make decisions together." 

The decision to split the role was part of a "strategic refresh" similar to IU Health's growth plan.  UK is building an ambulatory platform, advancing specialty care and redefining the academic part of its health system — for example, aiming to leverage educational programs to build a bigger healthcare workforce in Kentucky. 

With Dr. DiPaola overseeing the clinical side of the job and Dr. Monday handling finance and infrastructure, forward motion has been more efficient. 

"I think there has been a really incredible synergy," Dr. DiPaola said. "We're able to come together, move faster, than we could with either one of us alone." 

That newfound agility was also noted by Mr. Shockney, nearly 200 miles away. 

"There are tectonic shifts in healthcare that are requiring that we respond in different ways from a leadership perspective, that allow us to be agile, allow us to make sure that we're ensuring that we're having good quality oversight, operational efficiencies, those kinds of things," Mr. Shockney said. "When you look at the centralization of those, it can be overwhelming. And so [dividing a top role] allows us, throughout the whole health system, to respond to those things better." 

And under well-designed teams of two, organizational cohesiveness has become more feasible, leaders from both systems noted.  

"We believe org structures and org design are best formed around what you want to achieve," Dr. Monday said. "We do believe strongly that the more we can integrate horizontally and vertically, the better we can be — if you will, better together." 

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