Why use and what to expect from an interim healthcare executive?

Leah Curtin, RN, DSc(h), FAAN -

When I was a youngster, I loved the program "Have Gun: Will Travel." Paladin, the lead player, was a gentleman troubleshooter who lived in San Francisco but traveled around the Old West working as a mercenary gunfighter for people who faced difficult, if not downright unruly problems.

Highly experienced and highly educated, he preferred to settle problems peacefully if possible, bringing about the desired change and moving on. He was a fierce advocate with a clear ethical bottom-line -- the quintessential Interim Healthcare Leader.

Why Consider an Interim Healthcare Leader?
Hiring decisions are always important, but some positions are key to the organization's success. Hiring the wrong person into a key position is one of the most damaging and mistakes an organization can make.

#1. Time - When a leadership position goes vacant, especially when it's unexpected (death, spousal move to another region, higher level– or pay – somewhere else, dismissal), there is great pressure to fill it as soon as possible. In an ideal situation, you find the perfect person for the position — someone who hits the ground running, increases your unit's performance, and eases your workload. A carefully crafted hiring process can help avoid most mishaps. However, that is rare and, according to Harvard Business Review, taking the time to make good hiring decisions is crucial. "You can greatly reduce your chances of getting hiring decisions wrong by following a clear and consistent approach that includes knowing the traits valued across the organization (such as humility or an entrepreneurial spirit); conducting fair, structured interviews that include multiple people from the organization; and agreeing on a standard ranking system to evaluate candidates."

There is a lot of pressure in hiring. You need the position filled now. That's why it's a key position! Yet, the experts advise: "Getting the right person for the job requires time and discipline." Just what you do not have when you need it! So, increasingly, hospitals are turning to Interim Leadership Organizations to buy them the time they need to 'do it right.' They are using Interim Leaders for positions ranging from Senior Management to key departmental managers. But it is not the same. You are not 'marrying this person!

#2. Specific Projects - Hiring an interim healthcare executive or clinical director to oversee a critical or potentially difficult project has its benefits. Doing so allows hospital leaders to draw on the knowledge of an individual with experience and skills specific to the task at hand.

#3. Change Management - Conducting a change management phase/process, or business restructuring which needs specialist resource and expertise. Organizations often hire an Interim leader to plan, implement and control change, however, that change is to come about. By using interim managers, organizations seek to improve or innovate to take advantage of the specialist skills interim managers offer; sometimes to give breathing space to the current organization. And sometimes because the Interim Leader will leave when the organization's goal is completed and take with him/her much of the anger and hurt feelings that often accompany organizational change. You need a troubleshooter.

#4. Fresh Eyes - Handling a business situation which needs objective evaluation, recommendation and implementation where there is no time to do this using internal staff.

#5. Crisis - Carrying out crisis management activity – offering expertise to the management team in managing transition, mergers, acquisitions. Perhaps revamping an organization that is on the verge of failure – perhaps even in immediate jeopardy.

What an organization has a right to expect from an Interim Leader
Any organization hiring an Interim Leader has a right to expect the following:

Entry Services – An Interim Leadership agency (or at least a good one) ensures that the requirements of the client hospital and the scope of the project is attainable and is matched with the correct candidate. This results in further conversations with the candidate and client hospital to attain provisional engagement of the interim manager.

Objectivity – Interim managers are unencumbered by organizational politics or culture (although they should be sensitive to the culture when implementing change) and as such can concentrate on what's best for the hospital/system as a whole. They will leave soon, so they are no threat to anyone.

Diagnosis –The interim manager comes briefed on the current situation, including how it came about, and requirements of varying and various stakeholders (internal and external). Thoroughly briefed before taking the position, upon arrival the Interim Leader not only will be informed and ready, he/she will do further research and develop greater understanding of what the situation is, which may raise issues not covered at initial entry (or the issues may be different in scope than that which was expected).

Recommendation– The Interim Leader will be expected to present more detailed recommendations, which will act as the interim's assignment/objectives and plan. It's very common for this proposal to challenge the hospitals' understanding of the situation, but that's what the interim's experience and expertise will bring at this initial phase. Interim managers will need to propose the solution most likely to be effective – again, not necessarily the original proposal.

Expertise – Interim managers typically operate at a senior level in the organization, often over-qualified for the roles they take on, bringing skills and knowledge not otherwise in place, in order to address a specific skills-gap or problem. Their experience means they are productive – and make a noticeable change – from the outset.

Effectiveness – Operating at a senior level, the interim manager has authority and credibility. They're not just warm bodies holding the fort, they add value to an organization, particularly when the work and the decisions which have to be made are difficult.

Speed – interim managers can be in place within days rather than the weeks or months needed for skillful hiring practices. Their experience enables them to conduct and complete assignments effectively and with due speed.

Accountability – Consultants are those to whom an organization comes for advisory roles. Interim leaders take responsibility for and manage a business or project in their own right, being held accountable for outcomes and being key to the successful delivery.

Commitment – Interim managers are only as good as their track record, and are therefore committed to maintaining high professional standards to ensure future work. They are not merely motivated by the daily rate. They have a stake in the success of the assignments they undertake – their reputation and future business depend on their success.

Implementation – this is where the interim differs from the consultant. Interim will need to take responsibility for managing the intervention/project/solution, including tracking progress and feeding back to the client. Interim will get as close to the situation as is necessary, although remaining an independent practitioner. And, as seen previously, they should be unencumbered by company politics or culture when achieving the outcome.

A graceful exit...
In an interim role, you know it is not going to be permanent, so you need an exit plan that's good for the organization and good for the Interim Leader. It ought to consist of helping the permanent person transition to the role, and perhaps providing ongoing coaching as needed. Interim Leaders should know when the assignment will finish, through their managing of the assignment in implementation. They will need to ensure objectives have been met, and the client hospital is satisfied. There often will be a handover, involving knowledge training, maybe determining successors to the interim or completing/recruiting individuals/teams to carry on the changes wrought. In any case, it is important to plan an exit strategy that minimizes the shock of another change to employees, maximizes the permanent leader's likelihood of success and optimizes outcomes for the whole organization when the interim role comes to an end – which it most definitely will.

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About the Author
Nurse leader Leah Curtin, RN, DSc(h), FAAN, is a Compass Clinical Consulting Senior Advisor. She is an internationally recognized nurse leader, ethicist, speaker, and consultant in the nursing field. Ms. Curtin has authored 360 articles, primarily published in peer-reviewed journals, and more than 450 editorials, and has authored or co-authored several books for nursing professionals on topics such as nursing delivery models and nursing ethics. In 2009, she was declared a "Living Legend in Nursing" by the American Academy of Nursing for her extraordinary and sustained contributions to nursing as a role model, and the positive impact of her career in influencing nursing and healthcare.
Contact: LCurtin@Compass-clinical.com

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