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Fire in the Eyes

July 24, 2008
by Anthony Guerra, Editor-in-Chief
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Sometimes the best way to like your job again is to try another one.

A session I attended at the annual HFMA conference in Las Vegas focused on how CFOs can position themselves for the CEO slot. While there are many challenges to pulling off this transition, it can be done, especially at a time when understanding the finances is so important to making sure a hospital survives, according to Larry Tyler, president of Tyler & Co., an executive placement firm.

Tyler described his “Magnificent Seven Competencies” for CEOs:

  • Charting a course

  • Developing work relationships

  • Broad influence

  • Structuring the work environment

  • Inspiring commitment

  • Communicating

  • Self-management

He went on to use terms like: vision, innovativeness, flexibility, and adaptability as being key CEO characteristics. Then he touched on the idea of “systems thinking,” or the understanding that, because hospital departments are so interconnected, adjustments made in one area can wreak havoc on another, unless they are made with a “system-wide” view of the organization.

Tyler went on to strongly emphasize the importance of having good relations with the clinical staff — without it, a CEO has no chance of survival.

In fact, this point was also emphasized in the second half of the session by Phyllis Cowling, president and CEO of United Regional Health Care System. She had made the move from CFO to CEO, and talked about her preparation and subsequent keys to success. Cowling definitely echoed the idea that without good physician relations, few initiatives will get anywhere (she spends much of her time and energy “managing” the 250 non-employed docs that practice at United).

Cowling also talked about how important it is for CEOs to get out of their offices, walk the floors, and be accessible. Earlier, Tyler lauded the key skills of consensus building and collaboration.

As the session went on, I realized I knew a whole crop of suitable CEOs — HCI's CIO readers.

When one reviews the list of important CEO qualities, CIOs fit the bill just as well as CFOs. When it comes to both CIOs and CFOs, only a small percentage will have the ability to inspire, and the communication skills and charisma that the top spot demands. Only a sliver of that sliver will be willing to surrender their true love of finance or IT and become the visionary salesperson/politician that most CEOs are (I don't mean that in a negative way). In fact, I think the sliver of CIOs that would make good CEOs is larger than the CFO segment. That's because successful CIOs have already cultivated most of the abilities that Tyler describes as being critical.

For example, successful CIOs must be skilled at:

Vision — Large-scale clinical implementations with minimum five-year horizons demand visionary thinking;

System-wide perspective — establishing a coherent IT strategy and supporting architecture is a great place to learn about cause and effect;

Walking the floor/communication — all savvy CIOs understand the importance of getting out of the office and putting their “boots on the ground”;

Physician relations — try and roll out CPOE in an adversarial environment, good luck with that;

Finances and budgeting — do you think these systems are cheap? Call Kaiser;

Staff management and motivation — it's not easy to get “propeller-head programmers” out of the hospital basement and into the ICU.

Despite all these advantages, it's clear that moving into the CEO role requires some adjustment. What was most important in her transition from CFO to CEO, says Cowling, is taking off the finance hat, tapping a solid CFO who could truly handle the job on his own, and coming across as a visionary CEO who's not “all about the numbers.” Any new CEOs will encounter some bias based on their background. For CFOs, it's being looked at as a bottom-line P&L bean counter. For CIOs, it will be a presupposition that IT systemic harmony trumps functionality (think of a preference for enterprise suites over best-of-breed integration pains).

If I've piqued your interest, or merely reinforced your existing hidden agenda to take over the world (or at least a hospital), Tyler offers some tips for getting where you're trying to go. First off, let the boss know it. It's critical that the CEO know your ambitions so they start mentoring you for the role (some won't embrace this, but good CEOs know they should always be grooming potential successors). Continue to build solid relationships with the medical chiefs and make sure your reputation is such that the docs wouldn't stage a massive walkout if news of your promotion hit the intranet. Work on your writing and speaking skills (Cowling had to turn in her Excel spreadsheets for PowerPoint slides).

Perhaps most importantly, groom your own successor. Find that standout on the staff and start empowering him or her with some strategic responsibilities. Give them the leeway to fail. This is scary, but it's the only way you'll truly to able to see what they're capable of.

Cowling said she left a secure CFO position, one right smack in the middle of her comfort zone, to take on a big scary CEO role (at another institution, in fact). She took a big risk, one that she lives with every day. I spoke with one vendor rep at the show who I've talked to a dozen times before. She seemed a little flat, a little tired, like she was going through the motions just one too many times. None of us wants that. CIOs can always challenge themselves by taking on more, rolling out new initiatives, or even switching institutions. Perhaps the ultimate, though, is truly taking the organizational reins. I saw a passion in Cowling's eyes that was contagious, magnetic. I didn't see that in the media rep's eyes. I think it's worth her taking a risk to get it back.

Anthony Guerra, Editor-in-Chief
Healthcare Informatics 2008 August;25(8):8-10

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