Adopting a Systematic Approach to Bringing
Healthcare Executives Into a New Position or Organization

November 2009

Statement of the Issue

Having a strong managerial team is key for any organization. However, when executives undertake a new role, whether in their current organizations or a new one, there are potential risks to both the organization and the individual’s success. Such personnel changes alter the composition of a managerial team and, if unsuccessful, can negatively impact organizational effectiveness and efficiency as well as the individual’s own career.

For the organization, the nature of risk may be dependent on the role and level of the newly introduced professional. At the departmental level, an unsuccessful transition may be revealed in diminished productivity, deteriorating quality of service and decreased work team morale. At the organizational level, unsuccessful organizational leadership transitions have been linked to increased external threats by competitors in the form of new marketplace initiatives and attempts to recruit key employees and physicians. Internal threats include instability in leadership positions and the postponement or cessation of important initiatives such as physician recruitment, community outreach, strategic planning and new service development.

For the individual experiencing an unsuccessful transition, associated risks include diminished prospects for further career advancement, economic hardship and emotional distress stemming from a failure.

In an effort to decrease the risks that occur when individuals take on a new role or join a new organization, many leading organizations have adopted onboarding systems for executives and high-level directors.

Policy Position

The American College of Healthcare Executives encourages healthcare executives and their organizations to adopt a systematic onboarding process that ensures that executives undertaking new roles receive the necessary support to increase their potential for success. Components of the process include the following initiatives:

  • Design and implement a carefully planned and structured acculturation process that moves the executive into the new role as quickly and as efficiently as feasible. The process should focus on the individual sufficiently understanding the new role, its organizational context, goals and objectives, and key relationships in order to reach a point of effectiveness with the fewest missteps possible.
  • Adopt a longitudinal, phased approach to onboarding, including major elements such as:
    • Using prework in advance of the actual start date in order to clarify expectations, begin preparing the organization for the arrival of the executive and aid the selected candidate in building communication bridges with key individuals
    • Creating a first-days-on-the-job schedule that establishes a formal process for becoming well acquainted with key staff members and by which the new individual conveys personal values and core expectations and begins building solid relationships and trust
    • Establishing the first weeks on the job as a period of active listening to learn more about the organization, its departments, and the associated people and systems, rather than a focus on immediate actions
    • Ensuring that during the first month on the job the new executive establishes and employs a system to identify, sort and manage priorities and specific measurable goals, distinguishing between short-term and long-term initiatives
    • Devoting sufficient time during the first months to ensure that the new incumbent and the direct supervisor systematically work to develop the foundation for a productive relationship, agreeing on the attainment of unambiguous mutual expectations related to the content of the individual’s job and to organizational priorities
  • Support opportunities for newly installed executives to achieve early substantive successes that will demonstrate effectiveness and help build personal credibility.
  • Encourage newly installed executives to monitor their progress in achieving onboarding goals and to consider sharing their assessments with their supervisors to demonstrate accomplishments and ensure priorities remain aligned.
  • Consider establishing similar acculturation processes for new clinical leaders who may have had limited executive experience in their earlier professional roles.

Systematic and comprehensive onboarding has become a routine best practice in many industries. Healthcare organizations, too, should capitalize on the advantages of onboarding realized by individuals and organizations by adopting a well-structured process.

Approved by the Board of Governors of the American College of Healthcare Executives on November 16, 2009.