Succession planning is vital new skill for physician executives. (Leading Questions).

Succession planning is becoming a vital new skill for physician executives, one that many hiring organizations now expect to see exemplified in your management career.

Having an organizational perspective and being able to mentor others are now viewed as significant proofs of leadership in today's health care marketplace. Yes, this is yet another unexpected demand on your abilities and talents--that's management for you!

In the strictest sense, succession planning is the orderly, carefully staged process by which the most senior executives and leaders of an organization are replaced when their time has come. Shelves in business school libraries contain many volumes that explore the nuances of succession planning, and specialist consultants are ready to advise organizations at the drop of a business card. A lot of effort is required to ensure that leadership replacement is seen as a smooth, seamless transition.

But succession planning is more than merely the infrequent, esoteric invocation of the loss of the key leader. It's an important executive skill that provides for the development and replacement of other important (if lesser-known) positions throughout the organization.

Anyone who has suffered the loss of the top information systems person, or tried to quickly identify a radiology department administrator or an OR director, knows from bitter experience how hard it is to operate at full capacity when a key player is not in the lineup.

Recruitment and retention of people at all levels of responsibility is most assuredly the business of the physician executive, whether through formal committee structures that provide direct input into appointment decisions or through less-formal but no less important contacts and areas of influence that may casually meet in the corridors or the lounge.

It really is your job to be watching out for the future of the organization, whether or not it's spelled out in your job description. The depth of your knowledge of the people who work in your organization is essential to identifying and fostering their ability to rise to their potential.

Even when an organization does conduct an outside search--regional or national, with or without the assistance of a search firm--it's remarkable how often the internal candidate is still chosen by the search committee. Organizations value cultural memory and consistency when qualifications are also met. Being chosen through a formal search can give enormous validation to internal candidates, as their skills have been measured against the best and brightest.

Perhaps a cultural shift

This may not be the way things are currently done in your organization. Possibly, no one has previously emphasized the value of identifying and developing leaders from within. It's easy to see which organizations do not have such a strategy in play.

* They're in a rut, often hiring people from outside who do not fit into the culture and style of the organization.

* They have no internal development program.

* Their new hires often fail and are gone in a few years, replaced by yet more of the same.

Such organizations have problems; whether the agony is prolonged or brief depends largely on the amount of their endowment, but they are surely troubled all the same.

If that scenario sounds familiar to you, something of a cultural shift may be required to make succession planning a workable strategy in your hospital or health system. Your own hard work and leadership may be needed to make it happen. Go ahead, be a hero. Other leaders need you to make clear the importance of training and development.

The fact is, there was once a large pool of qualified individuals who could be expected to hit the ground running in a new job in a new health care organization. Downsizing, limited on-the-job training opportunities and increased professional specialization have created a true shortage of top people--not only in nursing and pharmacy, but in general administration and among physician leaders as well.

The pipeline is clogged; you're no longer able to go out and find people easily, as you may have once done. Now, it's essential to know how to spot talent in your own ranks and help those individuals grow and develop.

A few suggestions

Getting started in succession planning should begin with your own position.

* Who are likely individuals to replace you should you depart the organization within a year's time?

* How ready are they to take on the responsibilities?

* What do they need to learn that you can teach, and what will require more formal education or training?

If you're lucky, you'll be able to identify two or three individuals to whom you can devote time and guidance. Let them know what you're doing as part of the process--no one can promise them a promotion, but they can be alert and get themselves ready for the possibility.

While you're looking at your own situation, you'll become more comfortable with taking the process out to the larger organization, including departments or areas that are not within your own strict purview. These are where your influence and good will are to be felt. Here are some suggestions for developing a succession process to benefit your entire organization

Identify two or three viable contenders

Just as you did for your own position, be proactive as you consider motivated, under-developed, talented yet untested people for a range of positions. You'll know which are the most vulnerable spots based on your organization's current and future program needs-pharmacy, medical records, outpatient surgery, ob/gyn--to name just a few. In each area, you should identify some bright, ambitious people who could be groomed for "stardom."

Be explicit

This is no time for games; let people know they are being targeted for development and invite them to participate fully--again, with no assurances or promises of promotion, but with the certainty that they are being strongly considered. People truly dislike secretive personnel moves and much prefer to know when they're under positive scrutiny from leaders. Knowing they are contenders gives them a confidence boost and spurs them to even better performance.

Develop screening mechanisms and standards

We can learn much from other businesses and industries. General Electric, for example, is a company that is exceptional at developing talent. Rather than going outside to hire for key jobs, GE is passionate about promoting from within when possible. The assumption is that talented, ambitious individuals should be assisted to move up within the company. To accomplish that professional development, GE devised measures for key skill levels--interpersonal, functional and organizational--that are used to create screens that both qualify people for promotion as well as indicate where greater training or effort is needed. It works for them and it will work elsewhere.

Of course, health care can provide similar examples of success. Any, number of organizations have utilized QA and continuous quality monitoring as tools for developing departmental "stars."

The Henry Ford Health System in Detroit created its "Managed Care College" as a training opportunity for everyone from physicians and nurses to housekeepers, clerks and nutritionists. The college was an excellent career development tool. The Mayo Clinic is another large health care entity known for its fine internal development strategies.

If your organization can develop a reputation as a place where people receive the attention they need to bloom and flourish--and if your leadership has played a part in enhancing that reputation--you will have served yourself and your organization very well indeed. You will leave a legacy that does you honor and inspires others to lead after you have moved on to your next challenge.

It's no accident that you can find "success" in succession planning. It's a win/win situation.

Scott Ransom, DO, MBA, MPH is vice president at Witt/Kieffer in Oak Brook, Ill. In addition, he serves as an associate professor in health management and policy at the University of Michigan and associate professor in obstetrics and gynecology at Wayne State University School of Medicine. He can be reached by phone at [phone] or by e-mail at [e-mail]