Trauma in traditions

It doesn’t grab the splashy health care headlines. It does affect efficiencies and costs at the nation’s elite medical centers. Many Americans may know about looming shortages of doctors and nurses. But, quietly, some leading clinical care and research institutions are struggling to fill top leadership posts, Korn Ferry Hay Group research has found.

“Health care has become a complex, matrixed enterprise,” says Bernard Godley, MD, PhD, a senior client partner in the firm’s Academic Health Center Practice. “The talent to run top institutions, with thousands of employees and revenues running into the billions of dollars, was never in great supply. And with the pressure from patient-consumers and forces like the Affordable Care Act to provide ever more accessible, cost-efficient, and always-compassionate medicine, many institutions are struggling to keep up with their leadership needs.”

The firm’s new study cites published findings that medical schools sought on average to fill 4.1 chair or center director positions in a two-year period; 75% of responding CEOs at major teaching hospitals said they had filled an executive position within a similar two-year period.

Filling such talent gaps may not seem daunting in the corporate world, but elite medical centers are facing big challenges to do so, says Warren E. Ross, MD, a senior client partner and global sector leader for Korn Ferry Hay Group’s Academic Medicine Practice.

“American health care has been well served by its grounding in academia, where our medicine benefited by its roots in rich, robust, and rigorous science,” Ross says. “But in the academy, our medical schools, teaching hospitals, and academic medical centers that specialize in first-rate clinical care and research also acquired some unfortunate traditions in recruiting talent.”

When top jobs open up, academic medicine fills them in a deliberate, grinding, and inclusive way. Search committees convene with, on average, 10 members and sometimes as many as 20, the firm’s study says. These executives, clinicians, and researchers must coordinate and clear hectic schedules for months of meetings, taking them away from the already-heavy burdens of their regular duties.

Even with human resources staff support, and less often with external experts, committees debate basics, often reconsidering these for each new search: finding the best candidates; figuring out how to reach them; deciding how to screen them; determining when to bring them in and how; agreeing on how to interview them; and deciding how to assess, beyond formidable résumés, critical issues such as how a leader will fit into a medical center’s culture. Meantime, as these concerns are weighed over months, important business initiatives can’t get under way because they rely on filling a key leadership role.

The firm’s study says academic medicine must pry itself from this inefficiency, starting by applying familiar concepts and approaches adopted from other business sectors. Many in health care know how to improve via Lean methods, developed by Japanese carmakers to boost efficiency, eliminate waste, and speed production. If academic medicine would use these methods to improve its talent dealings, it could benefit, the study says. It also reports on favorable outcomes from tapping external expertise: outside firms’ searches for medical school clinical chairs went three months faster than those conducted in-house.

“Health care now comprises 18% of the US GDP,” Godley says. “We know that we must reduce costs, increase efficiencies, and provide the safest and best clinical care and research possible for patients. So every way we can find to make the system work better is critical—and this needs to start at the top, where great leaders need to get into their roles swiftly and well.”