Is Healthcare “Good to Grow”?:  Rethinking Leadership Talent Acquisition

One of the greatest strengths and most vulnerable weaknesses of the American medical system is our commitment to subject matter expertise as the dominant criteria for authority and career advancement.

Healthcare has traditionally taken this approach to recruiting talent, largely based on peer-review of credentials. This served the medical community well when departmental identity and membership (driven by specific education and training criteria) were the core organizing principles of healthcare delivery; it continues to be the critical when seeking specific clinical skills or vertical subject matter expertise.

However, more often than not when healthcare organizations need ‘enterprise-level’ leadership, they mine their departmental talent pool or recruit from outside an institution based on a model of ‘similarity’ of title or organization type.

It is well established that species cannot evolve without diversity in their gene pool. If healthcare is to advance and thrive in the coming millennium, there will be a need to reconsider the entire process of recruiting and evaluating leadership talent.

Medicine is not the only realm where there is a delicate balance between talent and management in service of real-time world-class performance, yet remains one of the only industries organized in domain-based verticals. In equally complex and mission-critical non-healthcare organizations – Apple, Google, GE, Boeing, Dodge – there are horizontally organized teams that are dangerously nonexistent in healthcare organizations of similar size and complexity. 

The fact is that the "credentialing" approach to healthcare leadership recruitment is major barrier to healthcare reaching its full potential. Sometimes there are non-obvious, but easily transferable and critically valuable skills and experience embedded in a non-traditional professional resume. However, experts in healthcare verticals may not have the depth of professional experience to adequately understand and evaluate ‘outside-domain’ candidates.

First, there is the issue of title parity (or lack of it). A corporate vice president may have substantially more, and far broader responsibilities than a hospital vice president. A corporate VP may be a division leader, with oversight over multiple domains (e.g., sales, technology, marketing, product management), rather than the domain specific responsibilities of most hospital VPs (e.g., service line or service domain [e.g., dietary services]).

Second, there is the risk of ‘fallacy of comprehension’, when we believe we understand something, or its value, but in reality we do not. This phenomenon is especially common in healthcare, where professional success is often based on the capacity to comprehend and assess complex situations. 

However, the capacity to analyze and assess skills in one domain is not always transferable to others. Unconscious, but significant bias in candidate selection may come into play when evaluating the ‘credentials’ of non-traditional candidates. 

Leadership experience in ‘operations management’, ‘product management’ and ‘business development’ are three areas in which the corporate competencies are virtually unrecognizable – but may far deeper and more valuable – than the equivalent functions in healthcare system labels. More important, healthcare executives may be completely unfamiliar with the full depth and scope of positions such a ‘general manager’, or disciplines such as ‘behavioral economics’. Entrepreneurial experience, even transitional, may have provided experiences with team leadership and corporate development that are not fully understood – and therefore devalued – by many healthcare organizations. 

Many academic and professional disciplines outside of healthcare have knowledge and tools that might productively contribute to the healthcare community's goals for improving the quality of care delivered to individuals and the quality of health of populations. However, this might be done in ways that are not native to healthcare thinking or operations. The "fallacy of comprehension' then becomes a barrier to knowledge and skills transfer from outside of healthcare because they are not necessarily recognized during the candidate assessment process.

An interesting analogy can be made between healthcare leadership and orchestral performance. The world-renowned conductor and pianist Daniel Barenboim once said:

“To be a great conductor requires the ability to make people want to play, it requires the ability to animate the orchestra, to teach, to cajole, and at the same time, to learn from what you hear from good players in the orchestra. In every orchestra there is somebody that always shows you something that you haven’t quite thought of before.”

Extraordinary healthcare is symphonic – each instrument being played perfectly by a “subject matter” expert, each player playing a different line of music that, in total, creates a concordant experience for the patient. The conductor does not need to be able to play every instrument, nor even ‘lead’ the orchestra, but to envision the performance as a whole and serve an essential integrating, coordinating role. Even the most virtuoso players understand they cannot conduct and sit first chair; they respect, trust and defer to the conductor because they understand that their solo may be in their hands, but the symphony only exists in the collective effort.

Achieving consistent world-class performance in healthcare – especially for emerging operating models such as population health management – will requires a diversity of skills and experience beyond what is necessarily innate to the healthcare professional community. This will require the talent identification and recruitment process to be less about assessment of ‘credentials’ and more about being open to “something you haven’t thought of before” and exploring the potential of skills and experience from outside of healthcare to contribute to clinical, operational and financial objectives of healthcare delivery organization.

Species with limited genetic variation are less able to adapt to changing environmental conditions. Looking at healthcare are a species, we would benefit considerable if we diversify our professional and conceptual leadership DNA. This will require a critical look at our own biases in the talent acquisition process, flexibility in our process of understanding and assessing the competencies of candidates beyond formal credentials or equivalent titles and a willingness to allow our organizations and systems evolve in ways we may not envision today

© Steven Merahn, MD 2015