Author Affiliation: Principal, Joan Ellis Beglinger Designing Tomorrow, Cross Plains, Wisconsin, and Consultant, Tim Porter O’Grady Associates, Inc., Atlanta, Georgia.
The author declares no conflicts of interest.
Correspondence: Ms Beglinger, 3528 Timber Lane, Cross Plains, WI 53528 ( firstname.lastname@example.org).
This department column is devoted to posing thought-provoking insights about transitions through, to, and from administrative roles in nursing. In this article, I explore an effective approach to succession planning for the role of director of surgical services, implemented in my role as chief nursing officer for a tertiary, acute care hospital. The plan provided a creative solution to the succession challenge and important lessons learned.
The nursing workforce is aging as the demand for nursing care increases, driven by a population that is living longer with complex, chronic diseases. Ensuring that we will have adequate numbers of nurses to provide care in the years to come is the focus of 1 of the recommendations of the Institute of Medicine’s Future of Nursing report.1 Ensuring that there will be adequate numbers of highly qualified, engaged nurses to lead and manage the healthcare system in the future must be a focus for all nurse leaders.
In 2008, I was practicing with the most highly expert and effective director of surgical services I had ever worked with. Her responsibilities included the operating suite, postanesthesia care unit, perfusion, and sterile processing. This nurse leader had extensive clinical background in operating department nursing, as well as vast management expertise. She joined our organization as we were about to occupy a newly constructed 22-room operating suite. The transition occurred seamlessly, revealing a leadership style and expertise that inspired confidence and drove outcomes.
Anyone who has served as the administrative lead of a surgical service knows that the director is 1 of the most challenging positions in acute care. Recruiters claim that it is 1 of the most difficult searches in healthcare today. The multiple constituencies served, the skills required, and the magnitude of resources consumed make this service area very high stakes. It is a major challenge to find someone with the temperament to effectively lead the diverse stakeholders and the skills to effectively manage the very significant resources involved.
Several years into the director’s tenure, I found myself both appreciating her effective management and worrying about the fact that she was already technically near retirement age. A recent survey of operating department leadership identified that 50% of respondents reported that their organization had no succession plan for their role. Furthermore, respondents believed that it would be difficult to attract attention to this issue among administrators because it was a problem that seemed to be in the very distant future.2 I began to devise and promote a succession plan.
It was clear to me that a gap in leadership for a prolonged period in this essential service would have a deleterious and costly impact to our organization. A search for an individual with the skill and demeanor we would seek would undoubtedly be a long one, lasting months, if not years. I became convinced that the approach should be to hire a successor to the director, before any retirement plans. The period of overlap might be greater than a year, but the direct and indirect cost would be less than a long search conducted after a retirement.
The steps that I followed were as follows:
1. Engage the current director in the plan:
* I assured her that her tenure in the role would be solely at her discretion. There would be no pressure to retire once a successor was recruited, even if the overlap extended beyond a year.
2. Enlist the support of the administrative team by making the case:
* A prolonged vacancy in the director position would be disruptive, even with an interim director in place. It would be costly in quantifiable terms because interim directors in this area can exceed $300,000 per year in fees and expenses and, the even harder to quantify cost of instability. The cost of overlap created by the proposed plan would be cost-efficient in the long run.
* Recruiting a successor with the current director in place would enable a smooth and seamless transition of leadership, resulting in little, if any, disruption to the operation at the time of the director’s retirement.
* The new position would be called associate director of surgical services and would be created solely for the purpose of succession planning. This position would be eliminated when the current director retired.
Support was secured from both the current director and administrative team. The plan was communicated to the organization, with a particular focus on the operating suite stakeholders. Search firms were enlisted. The reluctance with which the plan was received by the search firms’ recruiters was unexpected. Many felt that highly qualified candidates would be resistant to the concept of transitioning into full managerial control over time. Although this may be true of some, I believed that the kind of visionary leader I was seeking would be excited by the prospect of an organization willing to invest proactively, with the long-term in mind.
We set the bar high and were determined not to settle for any candidate who was not an ideal fit. A number of candidates were presented and rejected. Finally, after a 2-year search, we found our perfect match. Immediately, she proved that she was a great fit for the organization and would undoubtedly provide effective leadership for years to come.
Despite our success and enthusiasm for our approach, there were a number of important lessons learned:
* Although we knew we were making it up as we went, we realized after several months that we needed a clearly defined approach to transitioning responsibility over time. The lack of a specific plan resulted in confusion and uncertainty for staff and physicians and frustration for the associate director. The director, associate director, and I remedied this by developing and communicating a plan for systematic transitioning of role responsibilities on a defined timeline.
* Despite our shared investment in our plan, managerial styles vary. It is expected that a new manager will do things differently than his/her predecessor. It became clear to all of us that, at some defined point in time, the current director needed to step aside to afford her successor the opportunity to fully spread her wings. We addressed this by setting a date certain by which the new director would fully assume leadership of the surgical services. The current director would then be freed up to apply her considerable skill to other needs in the hospital until her retirement. This solution proved to be highly satisfactory from everyone’s perspective.
1. Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2011.
2. Patterson P. An OR leadership crisis is looming, but is the C-suite listening? OR Manager. 2012; 28 (12): 1–12.