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Hail to the chiefs: Healthcare's new C-suite titles are here to stay

With integration, transformation and quality becoming pillars for providers, leadership is needed at the top.

Jeff Lagasse, Associate Editor

Kathleen Kinslow is the executive vice president and chief integration officer at Jefferson Health as well as CEO of Aria-Jefferson Health.Kathleen Kinslow is the executive vice president and chief integration officer at Jefferson Health as well as CEO of Aria-Jefferson Health.

CINOs, CXOs, CCOs -- it's more than just alphabet soup. Running a healthcare organization is no longer just about the chief executive, chief operating and chief financial officers. As healthcare's complexities have become even more complex, it pays to bring a little extra depth to the leadership structure. Another helping of expertise. Another C.

New C-suite positions have been slowly evolving over the past few years. But today, those hires have added up, creating a new picture of just what a hospital administration looks like.

Kathleen Kinslow has seen a lot of that change firsthand. Kinslow is the executive vice president and chief integration officer for Pennsylvania-based Jefferson Health; she's also the CEO of Aria-Jefferson Health, and was Aria Health's CEO when the two organizations joined forces. When she added the responsibilities of CIO -- yes, it's the same three letters the chief information officer uses --  to her repertoire, it was based on the need created by the merger. That's one common way in which a C-suite gets larger.

[Also: Improving patients' access to care tops evolving list of C-suite concerns, Advisory Board survey shows]

"We take a very defined review of the organizational needs, changes in the external environment and the ability to pivot to meet our desires strategic outcomes," said Kinslow. "I think in most cases, the need for a position comes out of a strategic planning process that identifies an area that requires more high-level focus and leadership -- or it comes from the end result of such a process, like a merger. The organization focuses on needs and how we can meet them for our communities."

In Kinslow's case, the "integration" in her title refers to an important responsibility: Melding all of the elements that came together when Jefferson joined forces with its partner organizations, Aria and Abington Health. If the combined entity had been stitched together like an impromptu Frankenstein, it would have lumbered along like one.

"We know that to continue to be a transformative, innovative and industry-leading organization, we must do more than merely stitch together our strong legacy organizations," said Kinslow. "True integration means working very purposefully to build a system that delivers more value to patients -- the right care, at the right place and time, and with the same Jefferson touch for every patient, every time they see us, no matter where in the network they go."

[Also: Health system leaders focused on managing costs, improving use of data]

Her role is to lead a collaborative process to essentially build the system, working with stakeholders from physicians and nurses to managers and board members. The endgame is simply to develop an efficient, effective healthcare system that focuses on quality and outcomes.

"I think it highlights a shift in what hospitals hope to achieve when they combine," she said. "For a long time, hospitals sought partners for financial strength and stability, usually during a time of financial challenge. More recently, leaders of health systems are looking for combinations that deliver significant, strategic long-term benefits. And, I would add, Abington joining Jefferson in 2015 and Aria joining a year later are great examples. Gaining the benefits of a merger driven by strategy instead of finance requires a thorough integration process."

Learning, compliance, and more

New York-based Northwell Health is another system that has seen its share of organizational changes over the years, and it has the C-suite titles to match. Mark Solazzo, the system's executive vice president and chief operating officer, recalls that the chief learning officer, created 12 to 15 years ago, was the first out-of-the-ordinary position that was established. 

The job was founded because the organization wanted to create a learning environment that stemmed from the leadership team. The CLO has since been tasked with creating fellowship programs and different pathways for employees to continually improve their skills. Since then, a chief compliance officer, chief innovation officer, chief administrative officer and chief revenue officer have all crept into the system's highest tiers.

"It's just a reflection of the market dynamics," said Solazzo. "The healthcare marketplace has been changing markedly over the past decade, and will continue to change. We need to create an organizational structure that can respond to the marketplace changes, whether it's making sure you can compete on the people side of the business, or making sure the organization is in line with regulatory compliance."

At Northwell, incorporating these new roles onto the team is a fairly seamless process, due largely to the system's team-oriented approach. The overriding ethos is to avoid hierarchical structures as much as possible instead of relying on the leadership team's ability to function as a cohesive unit.

"Everybody has a box, but the box is fuzzy because we believe that everybody's role is to help each other," said Solazzo. "We don't focus on org charts. We focus on our objectives and how we can accomplish things as a team."

Of course, every organization is different so the successful introduction of a new C-suite role largely depends on the culture and practices of the business itself. Paul Esselman, senior executive vice president and managing director of Cejka Executive Search -- essentially an executive matchmaking outfit that focuses exclusively on healthcare, said the team-based approach is becoming ever more common, leading to fewer disruptions when a new title is minted.

"It depends on the strength of the current leadership -- what their strengths are and what their area of focus is," said Esselman. "We no longer see senior leaders working and functioning in silos. We see leadership teams being much more collaborative. And there's much more continuity. You may have a chief medical officer who works closely with the chief financial officer. All of what they do is interlinked. When you bring in new talent, you want to focus on who's going to be a compliment to that leadership team, who's going to bring new skills, and who's going to be a good fit."

Communication, as in most things is key, as is a lot of preparation. When defining what the new role will be, Esselman said it's important to consider what the new hand will be doing, who they'll be interacting with and what their responsibilities will be, not to mention the kind of background that's necessary to be successful in the role. Once that's defined, everyone in the organization should be filled in on the details. When everyone understands who the new person is and their function, it builds credibility and allows them a quick jump off the starting line.

"The other key element is making sure the new role fits into the organization's strategic plan," said Esselman. "How this individual will help the organization achieve that becomes critical because that ties the new role to the organization. A lot of work up front is well suited to these types of roles."

Knowing when to add another C

Every system has its own reasons for wanting to expand the C-suite, but an overarching theme Esselman has noticed is the increasing emphasis on consumerism. More than ever, patients are becoming the driver of where they're getting their care, which begets a need for more proactive care and better service. Every interaction a patient has with a health system or medical group is important, and what they experience has a large impact on their assessment of how the care is being delivered. Organizations are focused not just on quality, but the overall patient experience.

"That goes to a continuum of care," said Esselman. "Patients now want better continuity of care between the pieces of their care pathway. It takes a team. One of the things we hear more and more with our clients is a team-based approach to care. That continuum of care is looked at by the health systems to make sure there aren't any major gaps. The people in these new positions are very skilled in making sure they're pulling together the right team members … and making sure the patient has the proper care long-term."

Solazzo agrees that consumerism is one of the factors in the establishment of new leadership positions. But it's important to get the process right to ensure nobody steps on someone else's toes.

"If you don't take the right approach, you can create friction and complexity you didn't want, and confusion," said Solazzo. "You have to go back to the communication component, and make sure you have the right culture at the top. This isn't someone taking over a piece of someone else's work, but is viewed as another individual to be part of the team. If your organization isn't flexible, nimble, innovating, prepared for change, it will not do well in the creation of new positions. You have to be adaptable in this kind of environment or you die."

Flexibility stems from commitment to a team approach, he said. "It really is critical. You've got to have the executive team comfortable in their own abilities, and doing it for the right reasons. It's about creating additional resources for the overall team. Healthcare is changing rapidly. If you look at the wave of consumerism or the wave of regulatory oversight, those didn't exist at the level they exist at today. An organization that says, 'We can handle this with the people we have now,' they're not going to survive."

Kinslow said that reporting relationships often shift because in many cases -- such as with patient experience -- the need and function existed in some form prior to the new job's creation, and was likely one of the responsibilities of another executive. Part of the benefit of crafting a new position, she said, is to give a senior leader a clear focus on that area and elevate its importance within the organization.

Underpinning the successful creation of a new position is matching a job description with a skilled professional, one who can take a concept and turn it into something substantive. Everything has to line up -- the job, the candidate and their actions. Kinslow calls that value.

"Anytime a new role is added we need to ensure that it adds value," she said. "Executives need to be highly visible, responsive and demonstrate execution. The value of the executive is in his or her ability to translate ideas into action that moves the organization forward and meets the needs of the organization's constituents. For the CEO and the board, the key is to set clear expectations about the new role and communicate those widely, first among the senior leadership team and then more broadly in the organization."

Esselman believes, even more, C-suite titles will emerge, too. As hospitals, health systems and medical groups become more linked, there will be a greater need to ensure patient care and experience is consistent across the continuum. Healthcare leaders will work more with leaders outside the organization and in the communities they serve.

"We're seeing changing delivery models," said Esselman. "As we find a more consumer-driven healthcare environment, the next generation is coming up and their care and delivery are going to be looked at. You need to be responsible to what the patients' needs are, and that's going to evolve. It will necessitate leaders looking ahead, and saying, how do we take care of these patients in the future."

New C-Suite titles in healthcare

CXO -  The chief experience officer is responsible for the overall experience of a healthcare organization's products and services. The CXO is charged with bringing a holistic experience design to the boardroom, and making it an intrinsic part of the organization's strategy and culture.

CLO -  Chief learning officers are responsible for the learning initiatives in a healthcare setting. They provide direct training, education and development programs to ensure the effectiveness of their staffs.

CI(N)O  -  A chief innovation officer is primarily responsible for managing the process of innovation and change management, and in some cases is the person who not only originates new ideas but recognizes the innovative ideas generated by others. The CINO also manages technological change, sometimes under the name of chief technology innovation officer, or CTIO.

CTO -  Chief transformation officers drive the organization forward and hold accountable those responsible for the hundreds of daily actions and initiatives that underlie typical programs. Effective CTOs act as role models for the sort of behaviors needed to encourage change.

CSO -  A chief strategy officer is responsible for assisting the CEO with developing, communicating and executing corporate strategic initiatives. Part consultant, part leader and part doer, CSOs are often executives who have worn many hats for many companies.

CIO -  A chief integration officer is in charge of ensuring the coordination of all the interacting systems within the enterprise. This can involve information systems, people, ideas or processes -- or all of the above. >

CCO -  Chief compliance officers are responsible for all of the hospital's compliance activities, which can include planning, implementing and monitoring a hospital of private practice compliance plan. 

CMIO -  The chief medical information officer ensures that IT is used correctly and effectively in medical settings, and while they don't necessarily practice medicine, many do in addition to providing that medical IT support.

CQO -  The chief quality officer is a manager responsible for the quality of a hospital or system's products and services. They set goals for quality measures, set methodologies for supporting quality and follow up on key quality performance indicators.

CPO -  The chief privacy officer helps to keep personal information safe, as well as medical data and financial information. They are also responsible for ensuring data is secure from unauthorized users. 

Twitter: @JELagasse

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