Has the C-Suite Gotten Too Big?

July 27, 2020

Where some see bloat and trendiness, others see nimbleness and responsiveness.

The alphabet soup of healthcare C-suite titles seems to be in constant flux, with new titles popping up as part of the leadership. Some of the titles — chief people officer, chief wellness officer — may induce eye rolls because of the touchy-feely factor. But in many cases, they reflect new priorities and cultural shifts. The CEO and healthcare systems’ boards of directors are adding to the C-suite or renaming old positions as a response to competition and the need for greater accountability.

Determining the size of the C-suite and the titles within it is a case-by-case proposition.

“The C-suite should only be as big as it needs to be to be responsive to the needs of that business,” says Joseph Fournier, J.D., M.H.A., president of InveniasPartners, a healthcare executive search and strategy company in Chicago. The core leadership almost always includes the CEO, chief financial officer (CFO), chief operating officer (COO) and, for healthcare systems, chief nursing and physician executives, he says.

“Then we need to start filling in around that,” Fournier says.

Trending titles

Trendy titles may be relevant even if they sound less traditional. They often represent new challenges or a focus affecting the culture and bottom line.

CDO
With the growth in electronic health records and other digital initiatives, the chief digital officer(CDO) role is gaining prominence, according to Fournier. The chief information security role is also picking up steam because of cyberattacks and the risks posed by health and financial information data breaches. The CDO might also oversee the chief analytics officer (CAO), who is responsible for sifting through the terabytes of healthcare data that many healthcare organizations have at their disposal because of EHRs and that old mainstay, claims databases. “There’s a need for usable data that tells real stories about patients and can connect to health information,” Fournier says.

The CAO’s position also is climbing up the organizational charts of payers, notes Thomas Quinn, senior partner and managed care practice leader at WittKieffer, an executive search firm in Boston. Harnessing data to make quick decisions is critical when a member is at high risk of hospital admission or is a high utilizer. Identifying and sharing that information with the care management team can affect the patient’s health and care, as well as associated costs and revenue. “We’re seeing that role being elevated, put under the CFO or sometimes the COO,” Quinn says.

CWO
In 2017, California’s Stanford Medicine became the first academic center to add a chief wellness officer (CWO). Since then, at least a dozen more centers have added a CWO, sometimes called chief well-being officer. The focus has been on helping physicians and other caregivers with burnout and making sure they have appropriate services to deliver safe and effective care, according to Fournier. But the position and the person in it have a broader role, he says.

“A chief well-being officer can really understand the goals of the business and the needs of the patients and (can) integrate well-being into the culture and DNA of the organization,” Fournier says. The position may not succeed in all healthcare organizations — leaders who stick to traditional thinking may not be receptive to a role that can be thought of as coddling, he notes.

CGO
Among payers, the chief growth officer (CGO) is catching on, says Quinn. He differentiates the role of CGOs from traditional sales because CGOs are supposed to think and act more strategically. It’s the CGO’s job to scout out potential partners and alliances to grow membership and suss out new market segments. The role uses “a different skill set than a traditional sales guy who works the brokers,” says Quinn. Whereas the marketing staff may have undergraduate degrees, a CGO probably has a master’s degree —or at least that skill set.

CGP
Another hot title is chief of government programs (CGP)or government markets, says Quinn. Margins have been better in Medicare and Medicaid dual programs in the past four to five years, he says, and the role, which spearheads federal solutions, reflects that.

Size matters

Adding C-suite titles can help solve real problems as well as give an organization additional cachet. But the titles also can be a luxury. Smaller and midsize hospitals are not typically adding the management titles seen elsewhere, with the exception being some academic institutions that are more willing to invest at the C-suite level, says Brandt Jewell, senior vice president at Coker Group, a national healthcare advisory firm in Alpharetta, Georgia. “Smaller and midsize hospitals don’t have that bandwidth,” Jewell says.

Physician leadership positions lag in systems with fewer than hundred providers, observes Jewell. Partly it’s because the systems may not have enough doctors to invest in the chief medical officer role. But Jewell says he’s observed that doctors tend to be less interested in working with the profit-and-loss statements and more interested in value-based care. That’s an area where physicians can be more easily recruited for leadership development.

Which titles are needed?

Boards and organizational leaders use titles to delegate accountability for things they consider important. “When I see C-suite invest in a new C role around something like value-based care, it’s saying, ‘This is important to us, and we need someone with the highest level of expertise to focus on it,’” says Jewell.

Fournier says organizational leaders — often the governance committee of the board and the executive committee — need to hash out what they are trying to accomplish. In a highly competitive environment, executives should look at the factors that make their organization stand out. If a certain factor or experience is critical to success, the organization can signal that strength with a position and a title — and with putting a strong leader in that role, says Fournier. This doesn’t mean the position needs to be at the C-suite level, but the person needs to have the operational abilities and budget to succeed. “The executive team needs to think about how to attach people and strategy … and look at the critical bodies of work to see where that role needs to sit,” Fournier says.

Payers and providers used to live in their own bubbles, but healthcare systems are expanding how they do business, including entering into joint ventures. A person running a joint venture may have the title of president without having many executives reporting to them, says Jewell.

Changing with the times

The CEO, the CFO, the COO, the CIO — those are C-suite constants that aren’t going away. But Fournier says C-suite organization and titles should be viewed as dynamic, notstatic. Roles may emerge and then fade away. “Or they may decide after a while that it’s not a role that matters, because the C-suite roles become synthesizers of information. They’re really there to tie together workstreams for leaders,” Fournier says. A chief experience officer might, for example, oversee the work of those responsible for both the employee experience and patient experience. The chief legal officer may oversee the risk portfolio, including the chief compliance officer and general counsel.

Mergers are another time to reconsider the structure of the C-suite. “In general, consolidations have taken away more executive jobs than they’ve created,” notes Quinn. Many of these deals are set up to allow the local hospitals to continue running themselves, at least for a few years, says Jewell. “Every local hospital has their own C-suite to go along with the regional and national C-suites. A lot of systems are hesitant to blow that up locally,” he says.

Often the layoffs occur at the operational level, affecting employees in human resources, revenue cycle management and technology as those functions get pulled into a centralized operation in the name of efficiency and standardization. With many acquisitions, the C-suite stays put for two to four years, and then changes may be made.

C-suite roles will continue to change with healthcare trends. Roles may disappear when a particular person leaves; the executive committee and board may use the departure as an opportunity to tweak a role and title — or abandon it because more pressing issues have arisen.

It would not be surprising to see positions added related to emergency preparedness, diversity and inequity — if not to the C-suite, at least to the level in the organizational chart that reports to the C-suite. “As different needs emerge in the organization and at different times, some roles become more prominent or get more attention than others,” Fournier says.

Deborah Abrams Kaplan covers medical and practice management topics.

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