Walking in each other's shoes: 2 execs describe the ideal CEO-CFO partnership

A strong partnership between healthcare executives has always been crucial — and increasingly so amid a pandemic that has affected every area of hospital operations.

Executives in the C-suite, including CEOs and CFOs, have collaborated during the public health crisis to navigate a path forward for their organizations. Here, Nancy Howell Agee, RN, MN, president and CEO of Roanoke, Va.-based Carilion Clinic and Doug Watson, senior vice president and CFO of West Des Moines, Iowa-based UnityPoint Health, discuss how the CEO-CFO partnership has changed and offer advice to their peers for building an ideal relationship.  

An evolving partnership

Mr. Watson began his current role in August after serving as CFO of the Southwest Division of CommonSpirit Health, the Chicago-based health system formed from the merger of Dignity Health and Catholic Health Initiatives in February 2019. 

He told Becker's Hospital Review he has noticed several changes among the executive team during the pandemic, including a greater movement to a management style focused on competency and situational leadership.

"An example — which I think has been fantastic for the industry — is we've seen our clinicians, our physicians and our nurses more to the forefront of our leadership and our management because this is a clinical crisis," Mr. Watson said. "The issues at hand are clinically oriented, and we're trying to deal with a disease-based pandemic. So, while the CMO might have been at the table all along, now they're front and center. They're taking leadership around a clinical issue."

He's also seen the executives come together more to solve problems. This includes working in areas that perhaps are not the executive's usual primary focus. As he described it, "the blurring of the lines of everyone coming together."

"As a finance [executive], I'm on an incident command call, and we're trying to make decisions about emergency allocation of resources, and I'm all in just as all the rest of our executive team is on trying to figure out what's the best answer for our community, what's the best answer for our people," Mr. Watson said.

Ms. Agee, who helms a $2.3 billion nonprofit health system serving more than 1 million people in Virginia and West Virginia, agreed, saying the CFO has become even more of a chief strategist at the executive table. She described the CEO-CFO partnership some time before the pandemic as "two wheels pushing a proverbial wagon," perhaps having less frequent check-ins with each other to discuss pertinent operational and planning issues. 

Now, she said, she has observed greater alignment in engagement and frequent, almost daily, interactions between the CEO and CFO and among the entire executive team. 

"It created a very tight relationship," she added.  

What makes the ideal partnership?

When it comes to the ideal CEO-CFO partnership, both Mr. Watson and Ms. Agee said they believe they have that at their respective organizations. 

Mr. Watson spoke highly of working with Linda Hunt, who oversees CommonSpirit Health's 11-hospital Southwest Division in Arizona and Nevada, as well as CommonSpirit Health CEO Lloyd Dean. And he said one of the reasons he came to UnityPoint was the opportunity to work with Clay Holderman, the organization's president and CEO.

"I'm blessed to be in an environment where it is the ideal CEO-CFO relationship," Mr. Watson said. "Some of the attributes of that are a respect for the finance expertise you bring to the table, a dual respect around 'We're trying to put the mission and the values of the organization at the hierarchy, we're trying to solve the problem and trying to figure out what the right answers are.' And everybody has a seat at the table. Everybody has an opportunity to share."

He acknowledged that the CEO ultimately must make the final decision but described the ideal partnership as one where "you feel like your issues have been heard, your thoughts have been heard," and the CFO can support the CEO's decision and rally around the direction of the organization. 

"So, a high degree of respect and collaboration between the two. I'm blessed to have that," he said. 

Ms. Agee said she, too, has an ideal partnership with Donald Halliwill, Carilion Clinic executive vice president and CFO.

She said Mr. Halliwill can "push for and push against strategy, so you have a clear understanding of financial consequences, and you can have that appropriate tension with not only what can you do [as CEO] but what should you do and what can you afford." 

One thing she said that's been helpful for their partnership is the expectation of making rounds together to see what the clinical team is doing and talk with those behind the scenes together to better understand their stressors.

"It's creating that clearer understanding of what happens in real time and how that then applies to direction, strategy," Ms. Agee said. 

Improving the partnership 

For hospitals and health systems looking to improve the CEO-CFO partnership, Mr. Watson recommended taking time to invest in that relationship and other relationships with colleagues. He said this helps foster a relationship of respect and accountability, regardless of whether you agree with each other.

This means "working on that proactively to say, 'It's important I have that kind of relationship, and I'm willing to put effort to make sure I'm behaving that way and providing feedback of what I'm expecting in return," he said. 

Mr. Watson also recommended that executives in all roles ensure they have a functional understanding of all the different aspects of the organization's business. 

"I'm not a clinician, but I need to be able to be conversationally literate and understand the issues so I can have a meaningful conversation with the CMO or CNO or department leader in the field as to what they're trying to accomplish, being able to understand the problem they're trying to solve, and how can I bring my financial expertise to help them solve the problem for the organization, for patients," he said.

And like any other professional relationship, Mr. Watson said the CFO-CEO partnership should involve "mutual respect and putting the good of the organization and our patients at the forefront. A lot of other issues can be solved if you do that." 

Ms. Agee's advice: "Be sure you're having really good conversations, really deep understanding, trying the proverbial walk in the other's shoes."

The CEO-CFO partnership is "invaluable," she added, especially "in the dark days [of the pandemic] when you are really trying to figure out what you're doing and all those days when we had to stop services and we weren't sure what tomorrow looked like."

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