Coping with Leadership Turnover

Posted on August 13, 2014

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In past blog posts related to healthcare projects, I probed the value of process over people.  To clarify, I am not implying people are not important, only that a process govern the way people interact at all times—a process that is well constructed and not easily changed by the very people who attempt to work within it.

Question:  Given that a business’s resources (people, intellectual property) feed the processes that are the framework for organizational success, why is it so important to handle personnel change so fluidly, yet consistently?

Answer:  Because people change all the time.

In my own company, I know that is true, and likewise in healthcare systems.

While cleaning my desk, I found a hard copy phone list from the first month I joined Haskell in 2007.  We had about 425 home office staff then; today we have 400 so the comparison is pretty relevant.  Seven years later, only 48% of the names are still with the company, an average of about 7.5% turnover each year—pretty common considering our industry and the drastic economic shift between 2007 and today.

I enjoyed a similar walk down memory lane with a friend at a major health system I visited a few months ago.  I pulled an org chart of corporate leadership for his 400-bed hospital from my file, and brought it with me.  It was from September 2010, and just for kicks, I asked my friend in Facilities (20+ years with his system) to check off who had left.  The result:  out of 50 executive positions Director and above, 15 had changed, for a turnover of 30% in 42 months, or 8.5% average turnover per year.  This was a pretty close comparable to what my company exhibited.  Similar to Haskell, his hospital had not created or eliminated a significant number of positions, so the comparison at 50 was good.

Note this informal analysis does not account for employees who joined either Haskell or the hospital after the beginning of our time bracket, 2007 or 2010, respectively, and departed before this year.

What this shows is that organizations evolve and individuals come and go, sometimes frequently.  To effectively manage anything, it is important to protect and rely on the parts that change the least—and that is definitely not the people.  Personnel is dynamic.  There will always be people to manage an organization, but the management framework, decision processes, and culture make an endeavor successful.  Those are paramount; the rest are variables and fit in to support.

Similar to the Exempla Heritage project I visited which had to accommodate major changes due to its timeline, healthcare capital projects take time to execute.  To avoid budget overruns, scope creep, schedule delays and rework—all of which cost many multiples more when a project is in-progress as opposed to in-planning—ensure your project leadership is bullet-proof from a human resources standpoint.  Have a Plan B.  Consider cross-training staff in case a COO or Clinical VP or Facilities Director or Project Manager leave.  Create checklists and protocols so almost anyone can step in and finish a project in a pinch.  Expect the unexpected.

And hospitals should be firm with new hires in light of in-progress projects:  he or she may be a VP or C-suite administrator, but they are late to the game from a project standpoint.  The executive may have power, but is still an organizational newbie, and does not yet have the benefit of the history of decision-making behind that capital project, let alone the required institutional knowledge, to effectively reorganize an investment begun before they arrived, and which will last long after they are gone.

Uncertainty is the name of the game, and projects are full of it.  Lessen the impact of expected change within the bounds of the project by proactively managing the change outside the project.  This will only benefit the project by minimizing in-project change, instead of feeding the amount of in-project change.  Less chaos is less management, and more resources for care to go around.

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