November 2009
November 2014

Statement of the Issue

Having a strong leadership team is key for any organization. However, when leaders 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 leadership 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 team morale. At the organizational level, unsuccessful 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 leaders 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 leader into the new role as quickly and as efficiently as possible. The goal should be for the individual to sufficiently understand 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. The process should be in writing and contain as much detail as necessary for successful implementation including assignment of accountabilities for various action steps in the onboarding process and a means to document progress.
  • Adopt a longitudinal, phased approach to onboarding, including:
    • Use prework in advance of the actual start date in order to clarify expectations. Ideally, expectations would be delineated as measurable objectives that can be tracked in the first year.
    • Provide an assessment to the individual that helps him/her identify his/her skills and opportunities for development and how well they align with organizational expectations.
    • Prepare the organization for the arrival of the leader and aid the selected candidate in building communication bridges with key individuals.
    • Create a first-days-on-the-job schedule that establishes a formal process for the new leader to become 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.
    • Establish the first weeks on the job as a period of active listening on the part of the new leader to learn more about the organization, its departments, and the associated people and systems, rather than a focus on immediate actions.
    • Ensure during the first month on the job the new leader establishes and employs a system to identify, sort and manage priorities and specific measurable goals, distinguishing between short-term and long-term initiatives.
    • Devote sufficient time during the first months to ensure 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.
  • Provide the new leader with knowledge and insight about the organization’s culture and heritage. Understanding culture and the social organization are as important as learning the strategy and operations focus.
  • Allow for the basics in educational training and do not cut corners on training that is required for others. Subordinates are aware of norms, policies and processes and other leadership expectations.
  • Consider assigning a mentor—someone who is not the individual’s direct supervisor—to be a sounding board, monitor progress on the onboarding plan and provide feedback and been-there-done-that kinds of intelligence to help the new leader navigate organizational dynamics that may not be evident. A key priority for the mentor could be to accelerate the new leader’s attainment of knowledge of expected leadership competencies and norms within the environment.
  • Support opportunities for the newly installed leaders to achieve early substantive successes that will demonstrate effectiveness and help build personal credibility. At the same time, recognize that a new leader’s propensity to make fast and positive first impressions may be inappropriate; provide counsel as necessary.
  • For the new leader that has relocated from another community, ensure attention is given to helping the spouse/significant other and family get introduced to the community and its resources. In addition, if the individual has relocated alone it is equally important to pay attention to community introduction and inclusion to ensure he/she does not become isolated outside of work.
  • Encourage the newly installed leader to monitor his/her progress in achieving onboarding goals and to consider sharing his/her assessments with his/her supervisors to demonstrate accomplishments and ensure priorities remain aligned.
  • Establish 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 10, 2014.