C-Suite Competencies in an Era of Health Reform

By Rose O. Sherman, EdD, RN, FAAN

Many young nurse leaders aspire to executive roles in health care and wonder what key competencies they will be expected to have in this changing health care environment. A study released in April 2014 by the American Hospital Association titled Building Leadership Team for the Health Care Organization of the Future provides some interesting insights based on surveys done with over 1000 healthcare executives and follow-up interviews with 25 senior executives. The research sought to answer questions about key leadership capabilities needed, how executive roles are evolving, new roles and titles and key strategic challenges.

Key Strategic Priorities

Healthcare organizations today are focused on the triple aim – better care, better health and lower costs. There is now rapid movement toward value-based contracting from the historical focus on volume and fee for service. Health care leaders are working diligently to plan as the sands of health reform keep shifting. The top three key strategic priorities among leaders surveyed included 1) Improved efficiency through higher productivity and financial management 2) Joining and growing integrated networks to deliver care and 3) Aligning with other institutions along the continuum of care to provide better care coordination.

Talent Gaps

The movement from a focus on healthcare which has been hospital centric to community-based has created some notable talent gaps on executive healthcare teams according to those surveyed. The 3 top talent gaps noted were 1) A lack of experience with non-traditional partners and joint ventures 2) Community health and population management experience and 3) Experience with transformational change/change management.

New Titles

There are interesting new executive titles emerging in the changing health environment. A primary goal of these jobs is to bolster the organization’s ability to drive innovation. Some of those reported include the following:

Chief population health manager
Chief clinical transformation officer
Chief experience officer/patient engagement
Head of technology innovation
Vice president of clinical transformation
Vice president of clinical informatics

The Evolving Role of the CNO

Not surprisingly, the role of CNO is evolving in many organizations to be much broader in scope and operational across a number of different clinical program areas. CNOs are moving from a role of primarily advocating for nursing to taking a larger responsibility in planning care across the continuum. This means that collaboration, strategic thinking and excellent communication skills are essential. It was also noted in the report that increasingly, clinical executives such as the CNO are moving into CEO and COO roles. There are also an increasing number of CNOs who have responsibility for systems of care.

Key Leadership Competencies

To achieve all of the expectations today, C-suite leaders need to have broad leadership skills and collaborative abilities across settings. During the next three year, the following skills will be most critical:

Critical thinking/strategic planning
Innovative thinking/creativity
Transformational change/change management

Along with population health management, these skills were also noted to be the hardest to find in health care today. Although there has been a great deal of discussion in the literature about bringing leaders in from outside healthcare to help drive change and offer a fresh perspective, the survey respondents caution that their experience with this has been that healthcare is complex, heavily regulated and has a steep learning curve for newcomers. A more effective strategy has been internal team development.

These findings provide important guidance to nurses interested in advancing their careers. It is clear that there will be enormous opportunity but there is also a need for current leaders to work on their continuing education, take stretch assignments and develop in some of the key areas where there are talent gaps.

Read to Lead

SpencerStuart in Collaboration with the American Hospital Association. (April 2014). leadership-team-future-2014