Financial Oversight
The Board’s Role in Cultivating Next-Generation Leaders
Organization-wide leadership development should be a board priority
By By Maria Hernandez and Karma Bass
“The need for leadership development has never been more urgent. Companies of all sorts realize that to survive in today’s volatile, uncertain, complex and ambiguous environment, they need leadership skills and organizational capabilities different from those that helped them succeed in the past.”
“The Future of Leadership Development,” Harvard Business Review, March 2019.
Although this quote was written six years ago, it holds true today — perhaps even more so. Leadership development eroded long before 2019. The COVID-19 pandemic exacerbated the neglect as organizations went into full survival mode.
This inattention to leadership development has come at a time when health care has grown even more complex with the expanding use of data and technology such as artificial intelligence and the growth of personalized care, combined with the pressures of regulatory oversight, rising costs and threatened funding.
Ensuring strong health care leadership across the board and executive leadership in the midst of major market disruption and growing complexity should be a top priority for hospitals and health systems. This article explores the board’s role in organization-wide leadership development and leadership continuity. A key focus is on the ways in which different generations at work respond to training and the important theme of transformational leadership to respond to the enormous changes taking place in health care systems today. A companion piece, scheduled for October, will follow up with the board’s own need for development and continuity.
Designing Leadership Development for a Multi-Generational Workforce
Hospitals and health systems typically invest in a range of leadership development programs to strengthen the skills of their employees, clinicians and executives. These include foundational training for new leaders, targeted development for mid-level managers, mentoring and executive coaching. Many organizations also offer formal leadership academies — structured, cohort-based programs designed to build a pipeline of leaders who understand the organization’s strategy, culture and expectations. These academies often serve as a cornerstone for cultivating internal talent and advancing long-term leadership succession.
Effective design of internal leadership academies, management training, mentoring and sponsorship programs requires a tailored approach. To begin any of these efforts, it is essential to understand that a “one-size-fits-all” approach is unlikely to succeed.
Hospitals and health systems today employ professionals from four distinct generations — Baby Boomers, Generation X, Millennials and Generation Z. Each generation brings unique values, communication styles and learning preferences. Effective leadership development programs must be designed to engage and support all generations to ensure cohesive growth and alignment across the organization.
Baby Boomers (born 1946–1964) bring deep institutional knowledge, a strong work ethic and a commitment to patient-centered care. Many are in senior leadership roles now or preparing for retirement and are motivated by opportunities to mentor others and contribute to succession planning. They typically respond well to structured programs with clear goals and appreciate respect for their experience while adapting to technological and organizational change.
Generation X (born 1965–1980) often serves in middle to senior management roles and is known for being independent, pragmatic and adaptable. They value practical, results-oriented training with a focus on strategic leadership and managing organizational complexity. Programs that provide flexibility, allow for autonomy and offer tools to navigate multi-generational teams resonate best with Generation X.
Millennials (born 1981–1996) are now the largest cohort in the workforce. These individuals often hold emerging leadership or mid-level roles. Their growth is fundamental to the future of the organization’s mission and values. They are collaborative, values-driven and seek continuous feedback and purpose in their work. They respond well to development opportunities that are open to all, emphasize the importance of digital fluency (AI, virtual interactions, online communities) and foster alignment with mission and social impact. Growth opportunities, mentorship and sponsorship are key motivators for this generation.
Generation Z (born 1997–2012) is the newest entrant to the workforce, often in entry-level clinical, administrative, or technical roles. They are digital natives who value innovation, flexibility and transparent leadership. They seek programs that are interactive, technology-integrated and that support communication skills, adaptability and early career advancement. It is this generation that was greatly impacted by the pandemic when informal coaching and key conversations were no longer part of their work life routine. Understandably, they benefit the most from formal mentoring and sponsorship programs.
Though largely retired, the Silent Generation (born 1928–1945) laid important groundwork for today’s health care systems. Their legacy of professionalism, dedication and institutional growth continues to influence the values that underpin effective leadership in modern health systems. Their engagement in leadership programs can be meaningful as sponsors and mentors to the next generation. They feel valued when their experiences and lessons learned can shed light on why key protocols or policies are followed within the organization.
Bringing all the generations together in leadership development programs is vital to the success of health systems and requires a multipronged approach. Sacramento, Calif.-based Sutter Health has embarked on several efforts: a mentor-matching solution available for all employees, a leadership academy for emerging senior leaders and an executive sponsor leadership program that engages managers who have at least five years’ tenure with outstanding performance ratings.
What Is the Board’s Role in Leadership Development?
Board support is essential to the success of these leadership development efforts as it signals organizational commitment, ensures adequate resource allocation, and reinforces that developing the organization’s future leaders is a strategic priority critical to mission fulfilment and long-term organizational success.
Additionally, ensuring strong health care leadership in the midst of market disruption and growing complexity should be a top priority across the entire enterprise. Recruiting, retaining and engaging the workforce is often the strategic imperative. The board can show its support and interest in leadership development efforts by asking good questions about the efforts underway to not only find and retain but also engage and develop the workforce. Expecting budget line-items dedicated to staff development — specifically leadership development — is another key way boards can encourage and prioritize this work at your hospital or health system.
Boards should also recognize that existing best practices on leadership development can be sourced among a range of professional organizations. For example, the American College of Healthcare Executives has a comprehensive tool for assessing the competencies of health care leaders. The assessment encompasses five competencies ranging from leadership, communication and business skills to professionalism and knowledge of the health care system.
Growing Our Own Future Leaders
To gain clearer insight into the organization’s leadership development strategy, boards could also ask about system-wide succession planning practices. Ideally, the board sets the expectation that the CEO holds each senior leader accountable for identifying and developing up to three potential successors: one ready now, one ready within a year and one who could be ready in two to three years. This approach requires a robust pipeline of internal talent and meaningful opportunities for staff to build leadership competencies aligned with the organization’s mission, values and patient needs. Boards can strengthen these efforts by supporting investments in programs that tap into the experience, potential and aspirations of current employees.
High-level leadership development should also include training on governance — an area too often overlooked. Many new CEOs learn to work with a board entirely on the job, without prior preparation. Providing executive leaders with a clear understanding of board roles, norms and best practices for engagement and communication can accelerate their effectiveness and ease the transition into top leadership roles.
Building the Self-Aware Leader
In recent years, leadership development has evolved to emphasize so-called “soft skills” such as empathy, self-awareness and relationship-building — qualities increasingly recognized as essential for leading in high-stress, mission-driven environments like health care. To address this, health systems have centered new training on building key competencies that include self-awareness, responsiveness, a flexible style, advocacy and sector knowledge (see sidebar, The Transformational Leader, previous page). Many programs now integrate such elements, including servant leadership principles and leadership and work style assessments, as well as training focused on compassion, emotional intelligence, resilience and reinforcing connection to the organization’s mission and values.
Leaders trained in concepts such as empathy will better understand the struggles and pressures of their workforce and are more likely to take effective steps to address burnout, quiet quitting and disengagement. Leaders who show empathy and compassion will imbue their workers with greater resilience and fortitude to flourish both professionally and personally. Research shows that employees who have been shown empathy and compassion are more likely to demonstrate those same qualities toward the plight of patients and their families, creating a virtuous cycle that enhances patient satisfaction, employee engagement and ultimately the quality of care provided.
Access is Essential
Boards should also be aware of who has access to these leadership development opportunities and how workers are recruited and accepted into them. Without intentional efforts to ensure broad access, there may be managers in the organization who consistently receive high evaluations yet aren’t invited to participate because they do not fit the traditional conception of “a leader.” Clearly defined and widely communicated application processes — along with opportunities for employees to self-nominate to these programs — can be essential in retaining highly engaged employees who aspire to become your organization’s future leaders. When executed effectively, these professional development programs should result in stronger employee retention, improved scores in annual engagement surveys and fewer regretted departures among employees who do leave.
Leadership Is a Board’s Legacy
A board’s work covers an array of areas from policymaking and decision-making to setting strategic direction and overseeing quality. The board’s most lasting impact, however, may not be a policy or a program, but the people it empowers to lead.
Ensuring a succession of strong leadership requires understanding the needed competencies and ensuring the organization is cultivating those competencies in the next generation of leadership. The board, in effect, should model strong leadership development practices. These board-specific practices will be presented in the companion piece to this article.
In an environment as dynamic and high-stakes as health care, continuity of capable leadership isn’t simply desirable — it’s indispensable. A board that takes seriously its role in shaping and sustaining leadership ensures not only the stability of its organization today, but also its success for years to come.
Karma Bass (kbass@viahcc.com) is CEO and managing principal of Via Healthcare Consulting, based in Carlsbad, Calif. Maria Hernandez, Ph.D., (maria@impact4health.com) is president and COO of Impact4Health, based in Oakland, Calif.
Please note that the views of authors do not always reflect the views of AHA.