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Boards want leadership and decisiveness.

Regardless of whether they aspire to the top executive spot, physician managers are likely to benefit from insights into what hospital boards want in their chief executive officers. Many of the attributes board chairs desire in hospital CEOS involve how they handle medical staff matters. in general, board chairs want leadership and decisiveness--attributes they likely would covet in any physician manager who has hospital management responsibilities.

To determine the characteristics hospital board chairs judge most desirable in their chief executive officers, a survey was distributed in March 1988. It listed 42 personal and professional attributes, as well as points of specific experience. Board chairs from throughout the country were asked to rate each of these characteristics relative to their hospital CEOS' ability to lead and manage their hospitals successfully. The chairs ranked the characteristics on a scale of 1 to 10, 10 being the highest level of importance.

Twelve hundred board chairs were surveyed. Of the 288 board chairs who completed the survey, 98.2 percent represented hospitals with 100 or more beds. In addition, 10.2 percent represented hospitals with more than 600 beds.

Personal integrity and Commitment to Quality

The survey showed that the board chairs' opinions were fairly consistent. Across all geographic and institutional size categories, board chairs ranked commitment to the highest possible quality of health care" as the characteristic they most desire in hospital CEOS (see table on page 13). They recognize high-quality health care as hospitals' first priority. This supports the viewpoint that hospitals that provide the highest quality health care will be most likely to survive and flourish. Next, board chairs said they desire "an undisputed reputation and a history of high integrity and morals" in their CEOS. Board chairs want someone whose personal behavior and honesty they can trust. As a profession, physicians place a high value on high-quality health care and also prize moral integrity. Physicians interested in management positions should find themselves unusually wen positioned and well qualified on issues of integrity and commitment to the highest possible quality of health care.

Leadership Skills

Board chairs said the next most important attribute for CEOS was leadership skills. Although its implications are broad, this ranking shows that board chairs want CEOS who can influence people's thinking and affect events over a sustained period. Board chairs believe it is critical to employ hospital CEOS who can take charge, using interpersonal skills to positively influence others. Such leadership skills also are essential for the success of a physician executive or any other person in hospital management. Without strong leadership, the hospital will have no strong sense of culture or direction. Providing high-quality health care must become part of the hospital's culture, ingrained by strong leadership from the CEO, the physician executive, and other key management positions. Only then will it be understood from the top down that all managers and employees must deliver the highest possible quality health care. This is another area in which physician managers are clearly capable of leading major changes.

The Management Team

The next highest attribute rated by board chairs was the ability to recruit and retain the best possible management team. Management expert Peter Drucker noted, "Of all decisions an executive makes, none is as important as the decisions about people because they determine the performance capacity of the organization."*

Today, a successful hospital CEO must be surrounded by a strong management team. Physician executives are an essential part of that team. Practicing physicians typically have little or no experience in hiring and retaining managers. True, they may have hired office personnel, but that differs greatly from management recruiting. To be successful, the physician executive must be capable of hiring effective people at all levels.

At times, hiring decisions carry uncertain outcomes, a variable with which physicians are already familiar. A person may not fit into a team as anticipated, for example. However, hiring risks can be reduced. First, the responsibilities and authority of the positions must be clearly thought out and drawn. Then, the needed experience, abilities, and, most important, personal characteristics required in the new person can be determined.

After the best candidates are identified, detailed and probing questions should be asked about each person's experience, abilities, management philosophy, personal philosophy, drive, motivations, character, professional interests, etc. Each position and organization has unique needs and characteristics. Understanding those needs and characteristics and finding a person who will meet them and fit with the people, culture, and philosophy of the organization is, of course, the key. Effective hiring is important throughout the organization. At the management level, a physician executive must also be willing to delegate authority and responsibility to subordinates. If he or she fails to do so, good people will leave for more satisfying professional growth opportunities.

Making Timely Decisions

The fifth highest rated attribute ranked by board chairs is decisiveness--the ability to make tough decisions on a timely basis. Like leadership, decisiveness is absolutely essential for a successful hospital CEO, according to this survey of the nation's board chairs. Unfortunately, my experience has shown that these qualities are too often lacking in hospital managers. In fact, lack of leadership, decisiveness, and solid medical staff relations are most frequently the undoing of hospital CEOS.

While leadership is an essential quality in a successful physician executive, decisiveness is important, too. The medical staff is the hospital's most potent sales force. Yet, hospital managers have little control over the actions of physicians on the medical staff. This restriction, coupled with the need to satisfy other constituencies, makes hospital management unique in the business world. And it makes it more difficult for managers to be decisive. Yet board chairs still expect this characteristic of their CEOS and other hospital managers.

Physicians, by virtue of their education, training, and experience, are highly capable of being decisive. If a physician executive can mold this decisiveness into a team environment with multiple constituencies, he or she likely will succeed in hospital management. Such a manager will not only help the CEO, but also be judged by the board as someone with CEO potential.

Achieving Common Goals with the Medical Staff

Of the 15 characteristics rated highest by board chairs, six deal with medical staff relations. Clearly, hospital boards value the role of the physician executive and acknowledge the importance of solid working partnerships with the medical staff.

Physicians have a natural capability of forging a sense of partnership between the medical staff and administrators. They understand the challenges of practicing physicians. While this is an advantage, physicians will not thrive in hospital management roles unless they also possess the other qualities discussed in this article. However, physicians do have the opportunity to parlay the ability to handle medical relationships into a broader management role if they use other skills and personal characteristics adroitly.


This survey clearly suggests that integrity, a commitment to quality, leadership, hiring skins, decisiveness, and promoting healthy medical staff relations are far more important than specific experience or abilities in finance, marketing, or other functions. Obviously, a manager will have to demonstrate competence in some specific functions to develop a successful career. But personal characteristics and skills win ultimately mean the difference between a senior manager's success and failure. And this holds true for CEOS as well as for physician executives.


Frederick A. Halstead is President of Halstead & Associates, inc., a national management consulting and executive search firm founded in 1978 and headquartered in Dallas, Tex.

Further Reading

The following additional sources of information on evaluating the CEO were obtained through a computerized search of databases. Copies of the articles cited are available from the College for a nominal charge. For further information on citations, contact Gwen Zins, Director of information Services, at College headquarters, 813/287-2000.

Bennett, A "Executive's Work Hard to Evaluate." Modem Healfcare 9(6):53-4, June 1979.

Doody, M., and Fish, L. "CEO Performance Review: A Board Responsibility." Osteopathic Hospitals 24(5):8- 1 1, May 1980.

Ewell, C. "Same Bed, Different Dreams. Managers Need to Take the Initiative to Ensure that Boards Evaluate Their Performances Objectively and Rationally." Health Management Quarterly 10(3):9-10, 3rd Quarter 1988.

Harvey, J. "Evaluating the Performance of the Chief Executive of Officer." Hospital and Health Services Administration 23(2):5-21, Spring 1978.

Horty, J. "Chief Executives of Public Hospitals Could Be Reviewed in Open Meetings." Modem Healthcare 16(7):158, March 28, 1986.

Koontz, H. "Holding the CEO Accountable. Pan II." Osteopathic Hospitals 21(5):11-3, May 1977.

Moses, R. "Rating Your CEO: A Guide to Effective Evaluation." Trustee 39(10):11-4, Oct. 1986.

Petro, P. "CEO Evaluation Practices." Osteopathic Hospital Leadership 29(2):20-1, March 1985.

Platt, S., and others "CEO Performance Evaluation." Small Business Report 10(7):30-1, July 1985.

Ramsey, T. Measuring Management Performance: A View from the Boardroom." Trustee 32(3):39-40, March 1979. Sloan, S. Executive performance." Trustee 38(11):12,14-5, Nov. 1985.

Weil, P., and Wesbury, S. "CEO Evaluation in the 1980s. Part 2." Trustee 37(8):27-9, Aug. 1984.
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Article Details
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Title Annotation:hospital boards
Author:Halstead, Frederick A.
Publication:Physician Executive
Date:Jul 1, 1989
Previous Article:Stakeholder strategies for the physician executive.
Next Article:Creating the nexus.

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