February 28, 2018 –

A conversation with Rachael Burns, Vice President, Search Consultant

The uncertain fate of the Affordable Care Act (ACA) and insurance carriers’ coverage practices, has led to a burgeoning increase in demand for demonstrated leadership to help navigate the evolving healthcare landscape. We asked healthcare executive search insider Rachael Burns for advice and trends on strategies for attracting today’s top healthcare leadership candidates. Burns is a vice president and search consultant with Cejka Executive Search, a nationally recognized search firm focusing exclusively on the healthcare industry for more than 35 years.

Q: How would you describe the current healthcare landscape?

A: I would describe it as cautious, uncertain and somewhat anxiety laden. Healthcare organizations have navigated more change in the past six years than they have in the last three decades — electronic health record systems (EHRs), patient consumer ratings, bundled insurance payments, value-based care, and population health management, to name a few. The past election season added yet another level of uncertainty — the potential repeal and replacement of the ACA.  With the new presidential administration now in office for nearly a year, early healthcare reform efforts have failed and a rising number of healthcare insurers and providers are exiting the ACA’s healthcare exchange.

Q: What impact is this having on the strategic direction of the medical institutions that deliver patient care?

A: Over the past six years, the majority of medical institutions have been working toward developing a more robust value-based care model in response to the ACA. Healthcare institutions are now trying to anticipate the repercussions of the most extreme scenario: a complete dismantling of the ACA, and all of the many iterations that exist in between. In terms of strategic direction, they are asking themselves difficult questions such as:

• What is the impact of a significantly reduced number of individuals supported by Medicaid? A significantly reduced number of insurance carriers in certain geographic markets?
• What about the transparency and value patients have come to expect regardless of the law?
• How will all of these factors influence the financial health of these institutions?

Although there are not any solid answers, the critical discussions happening today in healthcare organizations are taking these scenarios into account.

Q:  What type of leadership is most in demand for an evolving healthcare landscape?

A: Whether an administrative leader or physician executive, I’m seeing three primary leadership competencies that are most in demand:

First, is analytical, strategic, and innovative thinking. The role of the healthcare executive is evolving. We see physician and administrative leaders increasingly expected to validate short and long term strategies based on the financial impacts as well as the potential implications those financial decisions may have on the quality and accessibility of care. The responsibility for supporting the long-term vision, growth, and financial stability of a healthcare organization has expanded beyond the traditional c-suite of executive leaders.

Second, is the ability to engage employees and the community as an ambassador of the organization’s vision and strategy. Today’s healthcare leader needs to be visible and accessible, more so than ever before. They need to move outside of their corporate offices, to the hospital and the community; it’s the only way to really understand the needs of employees and what is most important to patients.

Visibility and communication are key. Due to healthcare’s ever-changing landscape, it’s difficult for patients and the broader community to decipher what is occurring at the legislative level and how it impacts them directly. Today’s healthcare leader is often charged with communicating these changes and at the same time, reassuring their community that the mission and vision of the healthcare organization remains the same and will continue to provide quality healthcare.

Third, is being able to build strong relationships throughout the community to further care delivery objectives. Because the national healthcare agenda is complex and uncertain, there is more emphasis on leaders being able to develop partnerships and entrepreneurial care models with outside providers and community resources to help ensure access to quality care and mitigate the costs of delivering care due to uncertainty around government funding.

Overall these three competencies are the trifecta of skills most important for today’s healthcare leader. They are passionate visionaries who are collaborative by nature and effective communicators. They are capable of not only helping to define strategic direction in a very uncertain market, but possess traits necessary to advance an organization’s key objectives for delivery of care and growth, while ensuring the long term financial health of their organization.

Q:  Where do these multifaceted healthcare leaders come from, in terms of recruitment?

A:  They tend to come from more progressive healthcare organizations — those with early achievements in value-based care and population health, such as clinically integrated networks, complex and matrix systems working with employed and community physicians, and those that have lived through the physician-hospital organization (PHO) models of the nineties. These types of organizations expose and develop leadership aptitude from early career, and tend to nurture those employees to become more adaptive and resourceful leaders.

Q:  For these candidates in high-demand, what is most attractive in a job offer?

A:  Most of the leading executive candidates I work with are interested in having a greater impact on the way healthcare is being delivered, although what attracts them to a certain position may greatly vary. For some, the opportunity to extend their success into a larger, statewide or regional clinically integrated system with the likelihood to impact a broader population can be very attractive.  Others may be attracted by the possibility to develop a new strategy, introduce or expand clinical offerings or focus on elevating the quality of care and patient experience.

Q:  What advice can you offer organizations currently looking to fill healthcare leadership roles?

It’s important to look beyond a person’s current title or credentials. You really need to carefully examine the skills and attributes required by your organization today, while still giving thought to those that will be needed tomorrow. Throughout the interview process, review the cultural environment they’ve been in and how they’ve responded within that environment to the challenges and opportunities presented. A successful leader in a resource-constrained medical center in rural America, for example, has different experience to draw from than a successful leader located in a major metropolitan city, with greater competition. In all, one should consider how those experiences will translate into a new setting.

Q: What is the most common challenge organizations face in recruiting healthcare leaders?

The most common challenge I find is that current fair-market value compensation is often misaligned with the organization’s expectations, especially for new and emerging roles (which are plentiful in today’s environment). Often compensation trends aren’t yet established for these roles and are dependent on the supply and demand of the current leadership candidate pool. Additionally, some of the recruitment engagements I have conducted have been occupied by a tenured individual, so a health system or hospital will most likely be unable to hire a replacement at the same compensation level due to dynamic market changes. It’s a challenge because establishing compensation for a new position or adjusting compensation for a newly vacant position often impacts the pay grades of other leaders within the organization – something most organizations do not take into account.

Q: How does an organization overcome a misalignment on compensation?

A: Understanding current market conditions is a necessary first step when approaching an executive leadership search. Any potential candidate who fits the specifications, regardless of the pay range, should be screened. But only the most qualified and interested individuals should be presented to the client. This allows the search committee or the board of directors to evaluate the position’s compensation based on the current available talent in the market and what they’re being paid. This knowledge facilitates discussion around what is most important to the organization, within the context of what is affordable. Some clients have elected to upgrade the compensation based on their level of interest in a candidate. Whereas other clients, who realized they couldn’t afford to hire someone who brought everything they were looking for, prioritized the most critical requirements and selected a candidate who was the closest fit.  For example, they might hire someone who comes from an organization only half their size or someone with fewer years of experience whom they believe can grow into the position. Or they might forego an MBA requirement because they feel the person’s work experience demonstrates the ability to take the organization where it needs to go. Some employers choose to be flexible on the hard skills, but rarely has a client ever hired a candidate who had the technical skills but was a poor cultural fit. When it comes to searching for a leader who will leave a lasting legacy with an organization, cultural fit is a trait that is non-negotiable.