Succession planning appears to be a logical and essential component of human resources and leadership planning. However, the complexities and requirements of a successful succession planning process are significant and generally not well understood. Perhaps for this reason, succession planning often yields disappointing results. It is inherently an imperfect management process—as seen, for example, when an identified internal successor leaves an organization for a more immediate opportunity elsewhere. My experiences as CEO of Henry Ford Health System for 14 years and as chair of three compensation committees (for two public companies and one foundation) have given me a unique understanding of the challenges and opportunities of succession planning. This article highlights the myths, realities, and building blocks of effective succession planning in healthcare organizations.