Youth and the hospital e-suite

It is generally accepted that executive development and succession planning are critical tools in organizational development.

Less discussed, however, is what happens when the executive development process leads to a young CEO taking the helm of a complex health care system — often filled with stakeholders who have significantly more experience than the new leader. These stakeholders can include employees, physicians, governing board members, community leaders, elected officials and volunteers.

The challenges of a health care organization faced with introducing and integrating a young executive are significant and must be deliberately addressed to ensure immediate and long-term success for the enterprise.

Over the past 10 years, I have asked key stakeholders to describe their feelings when they learned a young leader would be joining their team. “Shock,” “anger,” “confusion,” “frustration,” “insulted,” “guarded” and “apathy” have been among the responses. These initial reactions, combined with the inevitable mistakes made by any new executive (young or old), can make the first few months of a new leader’s term difficult. Some of my personal experiences illustrate this point.

My first true leadership role was as senior director of operations at a 380-bed hospital in Reno, Nev. The first department to report to me was the hospital laboratory. Upon learning of this new reporting structure, the director of laboratory services — who had a tenure of more than 20 years  — told his peers that he would rather quit than work under a young, inexperienced leader like myself. He believed that because I was a young executive, I would want to prove I belonged and would micromanage the laboratory. In addition, he didn’t have any information on my background and thus was left to form his own assumptions about my ability to serve as a leader.

Looking back, I can clearly identify mistakes I made that caused his frustration and apprehension. Most notably, I didn’t collaboratively or effectively manage communications with employees about why the reporting change was occurring and the value I could bring to the department. I should have proactively helped to shape communication on the new reporting structure (with talking points, internal emails and so forth) to paint an accurate picture of my readiness for the position.

In the end, the laboratory director and I developed a wonderful relationship after I was able to demonstrate through actions that I would do everything possible to ensure his success and the success of the department (and not simply my career advancement). Today, I consider him a close friend who taught me much about how to lead a group of people.

Three years later, I was named chief operating officer at a different hospital. I thought my initial meetings with the staff I directly supervised went well. Little did I know that, after meeting me, the director of imaging services thought she was going to have to “change my diapers” — not the first impression I, or anyone, would have wanted to make.

Why did this occur? Quite simply, I didn’t present myself with the appropriate executive decorum: I smiled too much and was too friendly. Although this is my normal demeanor, I might have had greater success by initially establishing credibility as a serious executive.

I also assumed that the director would be comfortable allowing me to learn from her and would be happy to answer my rudimentary questions to help me become a better COO. Unfortunately, asking such questions only reinforced her initial perception of me. I would have been better served seeking guidance from peers in other hospitals.

Core values

Learning from my mistakes, observing others in similar situations and having discussions with mentors revealed to me five key values that young executives can pursue when tasked with leading an experienced workforce: integrity, respect, curiosity, communication and persistence. Each involves specific behaviors that can contribute to a young leader’s success.

Integrity: Be willing to learn from mistakes (publicly, if necessary); act on behalf of the organization, not from self-interest; avoid hubris at all costs.

Respect: Embrace the successes of the organization and its predecessors while integrating them into the future; maintain a sense of perspective and self-awareness about strengths, weaknesses and tendencies; be willing to reach out and learn from mentors who have been in similar situations.

Curiosity: Allow yourself to be a dynamic leader — your energy will reverberate throughout the organization; never stop asking “why” while at the same time showing respect for tenured professionals who may indeed have the answers.

Communication: Learn how to tell a good story and craft a message that resonates with its audience; dress, behave and speak like an executive with years of experience (inside and outside the hospital).

Persistence: Demonstrate grit in the face of adversity; avoid taking resistance personally; embrace risk as an element of personal and organizational growth.

Relationship with the board

A young CEO also needs to immediately establish a strong rapport with the hospital’s governing body. A few considerations should be:

  • Clearly establish expectations during the interview process: Is the incoming CEO expected to lead change? Is the executive team receptive to a young CEO? Are all key stakeholders (e.g., civic leaders) comfortable with someone young leading one of the community’s largest employers? These are questions only the board can answer and are essential to determining the organization’s readiness for such a leader.
  • Identify one or two key board members who are willing to serve as champions of a young CEO, inside and outside the hospital. They can lend credibility, support and guidance to the young CEO in the early months of his or her tenure, something that can be invaluable in attempting to overcome the inevitable hurdles that confront a new leader upon entering an organization.

Properly managed and supported, the introduction of a young leader can infuse an organization with optimism, energy and fresh ideas vital to success in today’s changing health care landscape. Boards can play a key role in ensuring young CEOs receive the guidance and support they need to capably assume their new role.

Nicholas R. Tejeda, F.A.C.H.E. (, is CEO of The Hospitals of Providence Transmountain Campus in El Paso, Texas, a new teaching hospital that is a partnership between Tenet Healthcare and the Texas Tech University Health Sciences Center.