Understanding costs and learning to listen: 3 executives on the CFO-to-CEO transition

Hospital CEOs have faced many changes and challenges during the pandemic, from staffing shortages to digital transformations. 

Meanwhile, CFOs have navigated these issues alongside them and remain crucial partners in planning for the future.

This is particularly true because of CFOs' financial acumen, which can be an important asset if they decide to seek a CEO position.  

For a deeper dive into the CFO-to-CEO transition, including opportunities and potential obstacles, Becker's interviewed three hospital executives: 

  • Melissa Atkins, CEO and CFO of Graham County Hospital in Hill City, Kan.
  • David Cauble, president and CEO of Sky Lakes Medical Center in Klamath Falls, Ore.
  • John Langlois, CEO of Prime Healthcare's Riverview Regional Medical Center in Gadsden, Ala.

Mr. Langlois has served as CEO of Riverview Regional since May 2017. Before that, he was CEO of Walker Baptist Medical Center in Jasper, Ala., after serving as the hospital's CFO. He also served as CFO of Citizens Baptist Medical Center in Talladega, Ala.

Ms. Atkins was hired as CFO of Graham County Hospital in October 2008. She was appointed CEO in 2012 and has maintained her CFO title.

Mr. Cauble became CEO of Sky Lakes in March. He took the job after serving as executive vice president and CFO of Children's Mercy Hospital in Kansas City, Mo.

The executives said their financial background and mentors helped ease their transition into the CEO role. They discussed what it was like to move into the CEO role, shared the hardest part about the transition and offered advice to peers looking to make the same move. 

Editor's note: Responses were lightly edited for clarity and length.  

Question: What was the transition from CFO to CEO like?

Melissa Atkins: I was able to understand the whole revenue cycle from the moment people walk in the door until the bills go out. Understanding how we get paid from the different commercial carriers, understanding the chargemaster, understanding the cost report was extremely beneficial when I became CEO. 

David Cauble: The transition has gone well, and the experience is consistent with what I expected. Serving a smaller community brings with it a level of visibility and responsibility that is significant, and it is important to understand the impact the hospital system has on the region. The visibility of the role was not a surprise, but there is a meaningful difference between knowledge of something and actual lived experience. Sky Lakes has a great legacy of caring for this community and it has been a wonderful experience to engage with hospital staff and members of the community to hear the stories about what makes it special. Everyone from the board to community leaders to staff has been very welcoming, and I am excited to be here and honored to have the opportunity to lead this wonderful enterprise.

John Langlois: I had to put in a lot of hard work. But I've also been very blessed to work with smart, talented people. I was smart enough to learn from them. So many CEOs contributed to my growth. 

Q: What prepared you for the transition?

MA: Had I not been the CFO, there are other leadership roles or other things that can prepare you for this CEO position. But I felt like the financial part of it was such a crucial part, especially at a critical access hospital, especially in struggling times. We do get a little tax money from our county, and I was the auditor for the county when I was in public accounting, so I had a strong basis in tax and how that works. We implemented a sales tax for the county. So, my background with [the] county also helped. I'm an accountant. I focus on financial statements and what the financial statement truly tells me, and understanding the debits and the credits and the accruals and the payables and the receivables and how the computer system works. That was a huge bonus for me to have that understanding.  

DC: I have experience in a variety of organizations from small community hospitals, large academic medical centers and national health systems, and those opportunities provided a great environment to learn and grow as a leader. I am also fortunate to have strong advice and counsel from those that I trusted that could help guide me through the growth process. Listening to and observing other leaders offered an additional opportunity to learn and better understand where I needed to grow and focus on my development. 

JL: Going from CFO to CEO is a completely different job. But I've been in so many positions, from the insurance side to the consulting side to the hospital side, and worked with so many great people. The transition was easier than I thought it would be. One difference was having to say "no" an awful lot as CFO to saying, "How can we make this work?" I'm glad I got the background in the CFO world and can understand the numbers. 

Q: How has the transition informed your leadership?

MA: Being able to answer questions from the local elected board.

DC: Experience is a great teacher, and my career path has given me the opportunity to learn from a variety of leaders in different environments and situations. As I learned from others and applied those learnings to develop my unique approach, I found what worked for me and what was not a good fit. My greatest success as a leader has come through intentional investment in the lives of others and building a strong community of talented leaders that is focused on a shared mission and vision. Focusing together on a shared purpose enables the team to prioritize and align around what is most important and creates an environment of trust and commitment that extends beyond any single leader or individual. 

JL: My style and approach has always been the same regardless of the title. It's putting out a quality product, and the business will come to you. I learned a long time ago from the many people I worked with that culture beats strategy every time. That sank in for me. And when I came to Riverview Regional, I had that opportunity to bring the culture change that needed to happen, one of transparency, one of openness. We expect to win, and we've done well. Our quality scores show that. 

Q: What was the hardest part about the transition?

MA: I've only been in Graham County and worked at one hospital. My only negative is this is the only thing I've seen.

DC: The biggest challenge I faced in moving from a CFO to CEO was overcoming the historical view that limits CFOs to the world of financial matters alone. The CFO today is a strategic partner to the CEO and is involved in virtually every aspect of the healthcare system. Some boards and search firms are beginning to recognize the great strength that many CFOs offer and have shifted their selection process to include CFOs. I am hopeful that as more CFOs find success as CEOs the scope of searches will broaden to include more finance executives in the process. 

JL: Recruiting physicians has been [the] biggest challenge, in addition to the pandemic. Gadsden is not a small community and is close to Birmingham, Ala., and Atlanta, but it's still hard to recruit. 

Q: What advice do you have for other hospital leaders wanting to make the transition from CFO to CEO?

MA: The more department managers know, the more you can make a team decision, whether it be salary increases or benefit increases. They need to understand what the total cost will be.

DC: Seek out mentors that will invest in your development and help prepare you for a CEO opportunity. Many of the CFO-to-CEO opportunities are promotion opportunities within an existing organization. As more CEOs and boards begin to think about succession planning, do not be afraid to have a conversation with the CEO about development opportunities. Seek out stretch assignments that will increase experience and demonstrate competencies in the areas that are important to boards. Ask how you can become a part of the succession process; expressing your interest may spark some great discussions and provide you with valuable feedback on how you are viewed by others. Passively waiting to be asked seldom works, so take the initiative and engage in the process.

JL: The best thing is to learn and ask a lot of questions. It was not my desire to get into [the] CEO world, but the opportunity came. It was nerve-wracking, it was tough. That's the biggest thing. It's hard work. Nothing came easy. I had to uproot my family various times when my kids were younger. Stay focused on what your goals are. Be willing to listen and learn from those above you.  

Q: What can they expect?

MA: Try to help the department managers understand the finances and where the administration is coming from, but also listen to where department managers are coming from — the clinical aspect and what they need. You can't focus all on the money. You have to have that open communication and look at it from both ways.  

DC: Anyone starting this journey must decide that they are committed to finding a CEO position. I often received feedback that it would be challenging to make the transition from CFO to CEO and that I might want to consider a move to COO or perhaps take a CFO position in a larger enterprise. Others were much more encouraging, but everyone cautioned that the process might take longer than I expected, and patience would be required. Most organizations engage national search firms to fill the CEO position, so you will need to develop relationships with different firms. There are some very helpful recruiters that do a great job sourcing candidates, but they need to know and understand your commitment to CEO opportunities. The recruiters are trying to find qualified candidates and good CFOs are in demand and hard to find, so it is only natural that they may try to encourage a good candidate to pursue a new CFO opportunity. If you are divided in your search priorities, it adds to your challenge to convince a recruiter that you are serious about CEO opportunities.  

JL: Going from CFO to CEO is a completely different job. The biggest thing was having to say "no" as CFO. I'm glad I've got the background as a CFO.

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