The CEO's Guide to Getting Fired

What does it take for a healthcare CEO to get fired these days?

It's a word you don't hear much in healthcare — they are often framed as something more delicate, such as early retirements — but firings are happening. CEOs get fired for a wide range of reasons, some more egregious than others.

Most often, a firing is nothing more than the end result of a widening schism between the CEO's vision and that of the board. It is not as dramatic as one might think. And despite the connotation of the word "fired," especially in the niche world of healthcare CEOs, it certainly doesn't mean the executive is doomed.  

Christine Mackey-Ross, senior vice president at Witt/Kieffer, provided some insight as to why CEOs get fired, what CEOs should say to people when they are fired and why she believes many  good leaders get fired at least once.

1. It takes extreme circumstances for the exit to be communicated as a firing. A felony, offensive speech or financial malfeasance — those are automatic situations in which a CEO would be fired. This is especially true in healthcare, where more nuanced CEO exits commonly "have flowers around them," meaning they are positioned as retirements or the pursuit of new opportunities. "It's more of an approach with dignity," says Ms. Mackey-Ross.

2. CEOs serve at the pleasure of the board. Some executives forget this, especially if they've led the organization for 10 or 20 years. They begin to think they are indispensable and that the hospital or health system is "their shop," says Ms. Mackey-Ross. But CEOs can find themselves fired if they have a significant difference of opinion with the board, particularly if it regards the future strategy of the organization. Sometimes the board will simply say it can't work with the CEO anymore.  

Maybe the board wants to pursue and execute a merger and the CEO doesn't, for instance. Financial performance, physician relationships and quality metrics are other grounds in which a board may decide to start a search for a new CEO. Another red flag? Unionization. "If you have a union arrive in your hospital, that's a problem that causes the board to take a second look," says Ms. Mackey-Ross. "It implies employees are disenfranchised from their leadership."

3. Sometimes CEOs throw up their hands. It would be inaccurate to paint all CEO firings as board-driven decisions. Sometimes CEOs further their own terminations, particularly if it is about something that weighs heavily on their minds. "I've seen people leave, saying, 'This budget can't leave us providing quality patient care.' They throw up their hands and say, 'Look, I can't participate in this. I don't think it's right.'" Ms. Mackey-Ross has seen situations like this play out a few times, although such instances are rare.

4. Not all board-CEO breakups are hostile or dramatic. It doesn't have to involve a high-level fight, act of recklessness or door-slamming conflict. More often, a CEO's firing or forced resignation is just the nature of life in the C-suite. Multiple discussions between the CEO and the board will show the gap in their thinking is widening rather than narrowing. A firing is rarely the result of a single conversation, and Ms. Mackey-Ross says she cannot recall an instance of a CEO saying to the board, "If you do this, I will quit and walk out the door." CEO-board relationships are sophisticated, complicated and coordinated, meaning most firings or resignations will be, too.  

A hospital or health system may face circumstances that, in board members' opinions, require skill sets or expertise the CEO does not possess. "Every CEO starts as the right person for the organization, but over time those circumstances and skill sets change," says Ms. Mackey-Ross. Abrupt CEO exits are rare. More often, healthcare organizations stage these departures, either letting the CEO continue to work while they search for a replacement or appointing an interim.

5. "Good people get fired at least once." That's what Ms. Mackey-Ross likes to say. She frowns upon the idea that CEOs who have been fired are any less qualified, talented or valued in the healthcare industry. "I don't think that assumption — 'If people are fired, we shouldn't touch them' — I don't think clients automatically feel that way," she says.

Instead, hospitals or health systems considering previously-fired CEOs will want answers. They want to know their divorces from the previous organizations were "clean," without malfeasance or fraudulence. "At senior levels, everybody knows those sorts of things happen: You were the right person [for the job] yesterday, but not today."

6. CEOs need to come clean to avoid assumptions. Explaining the reason you were fired is not easy. It's (hopefully) a long story, and many people opt to say they left the organization in search of new opportunities. Ms. Mackey-Ross discourages this expression.

"I can't tell you how many unemployed people call us up and say, 'I just decided to go in a different direction,'" she says. "I so don't believe that when people say it. It immediately makes me suspicious. I don't think people quit high-paying jobs to 'change direction' without holding another high-paying job."

The best thing to do? Build your case. Explain what happened as best, and concisely, as you can. Have answers ready. Consider the example of the CEO who was fired after disagreeing with the board decision to merge with another organization. She must be able to explain why she opposed the merger and why she felt strongly enough to lose her job over it.  

More Articles on Healthcare CEO Careers:
3 Phases of a CEO's Tenure
Does CEO Tenure Affect the Value of Hospitals?
The Hospital CEO's Ultimate Dashboard: What to Check Daily, Quarterly and Yearly


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