Research Paper: What is the role of a manager in succession planning in a healthcare organization?
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Research Paper: What is the role of a manager in succession planning in a healthcare organization? To achieve a successful assignment, you are expected to meet the following requirements. Scholarly Ex
An In-Depth Evaluation of Succession Pl anning and Management in Health Care Organizations A DISSERTATION SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL OF THE UNIVERSITY OF MINNESOTA BY Allison Suhler Hart IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY Rosemarie Park, Advisor April 2011 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent on the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. All rights reserved. This edition of the work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, MI 48106 – 1346 UMI 3457074 Copyright 2011 by ProQuest LLC. UMI Number: 3457074 Copyright © 2011 by Allison Suhler Hart i ACKNOWLEDGEMENTS The journey to this point in my academic career has been a long one. There are a number of individuals who have c ontributed to my success and I would like to take this opportunity to specifically thank some of them. First, I need to thank my academic advi sor, Dr. Rosemarie Park. She took on the challenge of advising me, post coursework a nd exam completion, when my advisor left the university. Rosemarie’s constant encourag ement, mentorship and support were the ultimate motivators. Without her firm, yet car ing guidance, I would not have completed this dissertation. To my friends Mary Marienau and Jani ce Engberg, Ph.D., I owe my gratitude. The countless lunches, coffee breaks and emails of encouragement helped me work through the writers block, despair at lack of progress and ultimately gave me the strength to know that I could finish this journey. To all of my other wonderful friends, Anne Marie Dominguez, Phyllis Trcka, Carole Nistler, Susie Hiemenz and many others too numerous to name, who gave me encouragement and knew better than to ask when I’d be finished, I thank you for your confidence in my ability to complete this paper! To Scarlet Tippetts for helping with transcription and proof-readi ng, I am forever grateful! And finally, an enormous thank you to my fam ily. To my parents, Fred and Mary Suhler for believing in me and encouraging me to pursue my doctoral degree, to my husband Scott Hart, for never losing faith in me and making it possibl e to get through the coursework, exams and writing and to my child ren, Elizabeth and Frederick for being the joys of my life! I am proud that you have been able to watch your mother on this journey. ii ABSTRACT This descriptive case study explored, in-depth, the succession planning and management programs in health care organizations in th e State of Minnesota. The purpose was to evaluate the extent to which succession pl anning and management programs are used in these organizations. Review of the literature showed that health care is well behind other businesses and industry in thei r succession planning efforts. To evaluate the efforts in these health care organizations, ten in person interviews were conducted with administrative and human resource leaders fr om member organizations of the Minnesota Medical Management Group Association. Part icipants were asked about succession planning and management programs within their organizations, how they prepared individuals for advancement within the orga nization, future challenges and opportunities and any critical incidents or personal expe riences they had with succession planning. These interviews were then transcribed and evaluated for any themes. There were five major themes identified through analysis. U pon evaluation of those themes, the identified challenges that these organizations faced, mirro r those outlined in th e literature review. There appears to be a lack of coordinated su ccession planning efforts across health care organizations. In order to make improvem ents and develop strong succession planning programs in their organizations, it will be n ecessary to identify the competencies needed by individuals to take organiza tions forward in an uncertain future, openly and constantly communicate employees’ strengths and areas for improvement, deepen their planning efforts past the highest level of the organi zation and continuously evaluate the changing needs of the organization among senior leader ship to ensure alignment with succession planning efforts. iii TABLE OF CONTENTS Acknowledgements……………………………………………………… i Abstract………………………………………………………………….. ii Table of Contents……………………………………………………….. iii List of Tables……………………………………………………………. vi CHAPTER 1: Statement of the Problem 1 Focus of the Research 1 Background 2 Benefits of the Research 2 Research Question 4 Rationale 4 Premise 4 Qualifications of the Researcher 5 Definition of Terms 5 Summary 6 CHAPTER 2: Review of Related Research 7 Introduction 7 Studies of Succession Planning and Management 8 Best Practices 10 Studies of Theory 11 Theoretical Background of Leadership 11 Trait Theory and Leadership 12 Behavioral Theories of Leadership 12 Situational Theory and Leadership 13 Transformational Leadership Theory 14 Chaos Theory and Leadership 15 Summary 18 CHAPTER 3: Research Methodology 20 Introduction 20 Research Questions 20 Development of Interview Questions 21 Selection of Participants to Study 21 Analysis of Interview Data 22 Data Collection 23 Participants 23 Confidentiality 24 Significance 25 Limitations 25 Summary 26 iv CHAPTER 4: In-depth Analysis of Succession Planning and Management in Health Care Organizations 27 Introduction 27 Discussion of Findings 27 Overview of Findings 27 Findings in Detail 28 Most organizations have some sort of succession planning and management activities 28 Succession planning not well defi ned in most companies 32 Communication to employees regarding succession planning and management not always clear or consistent 34 Participants feel they need better or more articulated plans to meet future needs within health care 37 There is some frustration w ith personal succession planning efforts for themselves 41 Summary 44 CHAPTER 5: Discussion 46 Introduction 46 Review of Method 47 Literature Review and Findings 47 Finding One- Succession Planning in Organizations 47 Finding Two- Succession Planning not well defined 49 Finding Three- Communication not clear or consistent 50 Finding Four- Better plans needed to meet future needs 51 Finding Five- Frustration with pers onal succession planning efforts 54 Theory revisited 54 Behavioral Theories of Leadership 55 Chaos Theory and Leadership 56 Situational Theory and Leadership 56 Transformational Leadership Theory 57 Illustration of theory through themes 58 Situational Theory and Leadership 58 Transformational Leadership Theory 58 Summary 59 CHAPTER 6: Conclusions and Implications 61 Introduction 61 Research Questions What models of succession planning are used in health care organizations in the State of Minnesota? 61 How are these plans put into effect? 62 What experiences have health care or ganizations had in development and implementation of these models? 63 Implications for health care 64 Implications for employees 66 v Implications for further research 66 Recommendations 67 References 69 List of Appendices 73 Appendix A: Invitation to Partic ipants 74 Appendix B: Consent form for Interview Participants 75 Appendix C: Institutional Review Board Approval 77 vi LIST OF TABLES Table 1- Participant Contact Data 21 Table 2- Description of In terview Participant and their Organizations 22 Table 3- Succession Planning Efforts by Participant 49 Table 4- Strategies for Succession Planning by Participant 50 1 CHAPTER 1: STATEM ENT OF THE PROBLEM As an employee in a large, world famous health care organization in the Midwest, my interest in succession planning is pers onal. I often watch in wonder as senior leadership positions are filled within my organization. How are these individuals identified as potential leaders? How do I deve lop myself or my employees into the type of employee who could attain a senior leadership position? There is no well-defined, well-communicated succession planning effort across this organizati on. While there are a number of manager and leadership developm ent classes and opportunities offered in my organization, employees do not seem to truly understand where to look and who to look to in terms of upward movement and devel opment. In my organization there does not seem to be any coordinated or communicated efforts to track high performers to specific leadership positions within the organization. This lack of coordination and planning leads to confusion and speculation each time a senior leadership opening occurs. This trickles down to middle management and lower management positions too. The pool of candidates for senior leadership comes from these ranks, but there is not a coordinated effort to develop lower-level employees into th e leaders of tomorrow. I fear that if this continues, my organization will see decreased job satisfaction and lose potential high talent individuals to other organizations. Over time, I have been told that I have been identified as “emerging talent”, yet I do not see any difference in how my career is being developed from all of those around me. There s till seems to be inquiry regarding interest, rather than a strategic assignment of pr ojects, departments or daily tasks. For far too long, the thought process has been “this individual has been here a long time and is ‘nice’, so they should get the job” (J. Arnott, personal communication, 2 May 3, 2007). This process may have worked in the past but as the pool of qualified candidates begins to shrink w ith the upcoming retirements of the Baby Boomers and the increased business pressure to stay afloat with the falling reimbursements for larger Medicare patient populations, be ing a “nice person” is not go ing to continue to be an effective means of leading the organization. In order to stay viable, health care organizations need to develop and foster robust programs to develop the leaders of tomorrow. Purpose The purpose of this study is to examine succession planning efforts at health care organizations across Minnesota. By identif ying the different succession planning efforts currently in place in a select ed sample of organizations, barriers and challenges to successful implementation can be identified. By researching these planning programs this study can be used to develop a solid model fo r fruitful succession planning efforts in health care organizations of a ll sizes and geographic regions. Rationale The U.S. labor gap will reach 7 m illion workers by the year 2010 (Corporate Training & Development Advisor, 2006). This gap will continue to grow throughout the next two decades as the Baby Boom genera tion reaches retirement. By 2012, the 55 and over segment of the workforce will have increased to 19.1% with an annual increase thereafter of 4.1% (Journal for Quality & Par ticipation, 2005). Many of the people in this ever increasing population segment hold senior level positions in organizations. The result of this workforce shrinkage is that it will become increasingly difficult for organizations to promote and retain th e best employees for middle and senior 3 management positions. Arnone (2006) identified the following as the top concerns from business and industry: availability of tale nt, talent management , retention of key employees and maintaining intellectual capital. The Cutting Edge Information’s data “Succession Planning for Results” indicates that 67% of organi zations polled do not currently have any kind of formal succession planning and management process and that in addition, 45% of the world’s largest corpor ations have no formalized and meaningful strategy in place for developing their next senior executives (Journal for Quality & Participation, 2005). This study also explor ed the considerable lack of confidence organizations have in their ability to competen tly staff senior leadership positions in the next five years as well as their assumption that there will need to be a significantly different skill set required of leaders in the future. This theme echoes through the literature time and again and is repeated over and over in all co rners of business and industry. According to Arnone (2006), nearly one in five Americans aged 65 and over is currently working. As this population rises, or ganizations need to develop mechanisms to attract and retain these older workers as one strategy for coping with the projected shortfall of workers caused by mass retirements. Health care organizations may need to use this strategy to fully develop their su ccession planning and management programs. According to Norm Devine, consultant for Development Dimensions International (DDI), (personal communicat ion, May 10, 2007), only 38% of health care organizations have formal succession plans. In conversations with Mr. Devine, it became clear that many health care organizations are looking at succession planning as a replacement planning activity rather than looking more long term at developing leadership competencies, educational programs and looking at desirable personality traits. 4 Understanding the ever changing health care in dustry and developing a strategic plan for identifying the necessary skills to successfully manage through these changes will be imperative for the continue d strength of the health care industry. In addition, organizations need to develop growth opport unities to retain talented employees by challenging their skills and finding more oppor tunity than they would find elsewhere (Corporate Training and Deve lopment Advisor, 2006). This study seeks to identify applicable th eory behind the issues that health care faces with succession planning and management and ultimately develop programs that lead to the successful implementation of these efforts across health care. Research Questions 1. What models of succession planning are used by health care organizations in the State of Minnesota? 2. How are these plans put into effect? 3. What experiences have health care or ganizations had in development and implementation of these models? Premise 1. The lack of high level qualified workers in health care organizations has resulted in a growing need to develop formal succession planning efforts. 2. Health care organizations may struggle mo re than other types of businesses with developing and sustaining succession pla nning and management programs due to the ever changing nature of the health care environment. 3. Health care organizations are looking for assistance with developing formal, effective succession planning and management programs. 5 Qualifications of Researcher I was a doctoral candidate in Human Resource Development at the University of Minnesota. Because of my twenty years of e xperience in health care organizations, I chose to focus on succession planning and management. Having a background in health care, along with the knowledge gained through c oursework, I have the necessary skills to undertake this study. In order to understand the st ate of succession planning and management in health care organizations, I conducted eleven in-person in terviews with leaders from health care organization in the state of Minnesota. Thes e interviews employed open ended questions to understand the types of programs these organizations have developed, how they identify and nurture talent, lessons learned and any persona l anecdotes they wished to share. Definition of Terms Competency assessment- the process of discovering job co mpetencies (Rothwell, 2001). Core competencies- specific core skills or characteristics necessary for successful execution of job duties (Rothwell, 2001). Health Care leader- for purposes of this research, an individual who holds a middle to senior management position in administration or human resources in a hospital and/or outpatient clinic. Health Care Organization – for the purpose of this paper, health care organization describes a hospital and/or clinic, where dire ct patient care is occurring. This can be either an inpatient or outpatient setting. 6 Job competency- “an underlying characteristic of an employee (i.e. motive, trait, skills, aspects of self-image, social role or body of knowledge), whic h results in effective and or superior performance in a job (Rothwell, 2001, p. 77). Succession planning and Management- Rothwell (2001) defines succession planning and management as “any effort designed to ensure the continued effectiv e performance of an organization, division, department or work group by making provision for the development, replacement and strategic application of key people over time.” Summary My personal experiences have led me to an interest in succession planning and management in health care. These experiences have been somewhat frustrating, leading me to believe that there are others out ther e who experience the same frustration within health care organizations. Further research ha s shown that health ca re lags behind other business and industry in development of robust and successful succession planning and management programs. Through inquiry, the ex pectation is that be st practices will emerge that can be applied to health care organizations of different sizes and patient focus. This will lead to an improvement in l eadership within health care and also lead to further research on how to keep the gains and continue to improve the process. An in depth review of the li terature shows my personal expe riences are not an isolated event in health care. The following chapter wi ll review the literature on the current state of succession planning and management in the health care and business world. 7 CHAPTER 2: REVIEW OF RELATED RESEARCH There is a wealth of information in th e literature regard ing succession planning and management. So much so, that it was imperative to limit the number used for this literature review. Much of it c onsisted of much of the same information article by article. Most of the information focuses on defini ng what succession planning and management is, what types of programs appear to be mo st successful and how to develop a successful succession planning and management program. L iterature looking at the root causes of lack of succession planning and management systems was sparse, as was information relating specifically to health care. Articles specific to health care, focused on either executive leadership development-developing leadership at the highest level of the organization or on nursing staff. For the purpose of this research, inclusion of literature was limited to those containing theoretical underpinnings and health care administrative leadership. This chapter will review literat ure to give background on what succession planning and management is, the types of programs currently in existence and descriptions of some best practices. An inte rest will also be placed on the experiences organizations have with developing a nd maintaining succession planning and management programs. There will also be focus on leadership theories and their relationship to succession planning and manage ment. Often it seems that that literature focuses on the “how” not the “why” and by unde rstanding leadership theories and how they relate to succession planning and mana gement, there is the opportunity to develop more effective programs and ensure leader ship engagement. This understanding of theory can lead to understanding how to develop a robust and complete succession planning and management program. In addi tion, understanding the current leadership 8 styles employed in organizat ions can assist in the su ccessful implementation of succession planning and management programs by identifying specific tactics that engage the different styles. Succession Planning and Management Succession planning and management progr ams focus on a systematic process for developing individuals to move into key pos itions within an organization (Harrison, McKinnon & Terry, 2006; Michaels, Handfie ld-Jones & Axelrod, 2001). These positions could be limited to the most senior executiv e positions or could apply to a broader plan for many levels of management within the organization. According to Harrison, McKinnon & Te rry (2006, p. 22), succession planning “refers to a systematic process of developi ng individuals to fill an organization’s key roles”. When an organization has a well- planned succession planning and management program, there are a number of qualified people available who are prepared to transition into a number of leadership roles (H arrison, McKinnon & Terry, 2006; Bonczek & Woodward, 2006). The lite rature stresses the importance of developing many different types of succession planning and management programs in order to meet the challenges of the coming years. According to Rothwell (2001), succession planning and management is important for several reasons: 1. the continued survival of the orga nization depends on having the right people in the right pla ces at the right times 2. as a result of recent economic restructuring efforts in organizations , there are simply fewer people available to a dvance to the top ranks from within 3. succession planning and management is needed to encourage diversity and mutil-culturalism and avoid “homosocial reproduction” by managers 4. succession forms the basis for communicating career paths, establishing development and training plans, estab lishes career paths a nd individual job moves 9 In developing successful succession pla nning and management programs, there are some common themes throughout the lit erature. Harrison, McKinnon & Terry (2006), highlight that succession planning criteria should include examples of previous success in key operational experiences c oupled with consistent dem onstration of specific and relevant behaviors that leader ship in the organization has identified as being critical for success. Succession planning and management is more about developing candidates for success rather than just f illing a position (Harrison, Mc Kinnon & Terry, 2006; Murphy, 2006; Larson, 2005; Gaffney, 2003; Cannella & Lubatkin, 1993). Growing potential leaders from within the organization, if done right, has a number of advantages. These include: increased loyalty to the organi zation, an inherent understanding of the underlying culture of the organization and indi viduals who may be more readily accepted into leadership positions by their peers, w ho have developed a trus ting relationship with them (Harrison, McKinnon & Terry, 2006; Ch ristie, 2005; Bonczek & Woodward, 2006). Byham, Smith & Paese, 2002, discuss the c oncept of developing “talent pools” in organizations. These pools consist of a numbe r of identified high potential employees within the organization. Seni or level management works with Human Resources to identify these high potential employees and work together to develop the precise competencies needed in the management posi tions. An advantage of the talent pools is the concept of having a number of employees ready to st ep into a broad range of leadership positions. The organization benefits because people are not selected for one particular position but their sk ills are honed for a wide range of activities. If individuals leave the organization, the impact to succes sion planning and management efforts is reduced by the ability to identify others w ithin the group (Byham, Smith & Paese, 2002). 10 According to Larson (2005) & Keffner & Se bora (1994), the key to succession planning is not about what is on paper, but about creating an environm ent where future leaders can grow and flourish. It also means maintain ing an awareness by leadership of the importance of identifying future leader s. If succession planning and management programs are left informal, they tend to pe rpetuate the consequence that managers will promote people most like themselves into th e leadership roles, stifling change and creativity (Byham, Smith & Paese, 2002; Rothwell, 2001). An important factor in succession pl anning is that those responsible for developing and monitoring succession planning in an organization need to have well- defined roles and responsibilities. The plan and its effectiveness n eed to be reviewed regularly, with input from se nior leadership and human resources (Harrison, McKinnon & Terry, 2006; Byham, Smith & Paese, 2002). Organizations need to develop mechanisms for measuring employees’ core and leadership competencies. It is imperative that organizations clearly identify the competen cies that will be needed to fill higher level positions, not just today but in the future as well (Murphy, 2006, Christie, 2005; Bruce, 2001; Nadler & Tushman, 1999). All leaders in the organization n eed to work together to successfully execute the succession planning process and communicate the goals across the organization (Christie, 2005). Best Practices The literature describes some best practic es that organizations are beginning to use to develop stellar su ccession planning and manageme nt programs. There are a number of factors that lead to stronger programs. For best practice organizations, senior or top level support was key (Fuller & Goldsmith, 2001; Rothwell, 2001). Pulling 11 together assessment, employee development, feedback, coaching and succession planning into one integrated system or plan is another key in developing strong succession planning and management programs (Gandossy & Verma, 2006; Christie, 2005; Fuller & Goldsmith, 2001; Rothwell, 2001). According to Haworth (2005), “organizations that are best at succession planning have adopte d the following practices: understand your business, know your people, create trust, take time to think, spot potential, seek win-win approaches, let go, create opportunities, allo w mistakes, invest in the future, use creativity, take risks, encour age them and establish a co aching culture.” Kotter (2003), suggest that developing indivi duals for leadership requires more work on the part of senior executives than many realize. It is important to identify people with great leadership potential early in their careers and to then foster the skills and competencies that will be needed to stretch and develop them over the course of time (Kotter, 2003; Kelloway & Barling, 2000). Finally, in reviewing the literatu re relating to succession planning and management, there is a dearth of inform ation related to theory relating to the development of programs and relating to the ultimate success of failure of those programs. Theoretical Background of Leadersh ip in Succession Planning There seems to be no major theoretical id eologies that play a dominant part in succession planning and management developmen t in organizations. For this research, the following theories are thought to be of great importance: trai t theory, behavioral theory, situational theory, transformational leadership theory and chaos theory. 12 Theory should be used by health car e researchers and practitioners when searching for new leaders. According to Ho ldford (2003), the following questions are the utmost importance- what do you look for if you wa nt to select an effective leader? What behaviors should you try to improve if you want to improve your own leadership effectiveness and under what conditions do diffe rent leadership behaviors work best? Trait Theory and Leadership Trait theory is an overarching term that re fers to theories based on desirable traits for leaders. This theory proposes that the gr eatest predictors of ef fectiveness and success of leaders are the traits with which these individuals are endowed at birth or develop early in life (Holdford, 2003). In an extensiv e review of the literature regarding trait theory, the most important traits are identi fied as drive, motivation integrity, self- confidence, intelligence and knowledge (Holdford, 2003). Ultimately, studies of trait theory have shown that the relationship betw een these traits and ultimate abilities and success of leaders is weak and inconsistent. In spite of the weak li nk between these traits and success in leadership, they should not be completely di scounted. Trait theory itself may not offer explanations to all facets of succession planning and management, but this theory is most certainly a pi ece of the theoretical puzzle. Behavioral Theory of Leadership The question that many organizations strugg le with is “what behaviors should our leaders possess and develop to be most effectiv e?” Behavioral theory attempts to answer these questions. When a person exhibits poten tial leadership beha vior, he or she is assessed for distinctiveness rega rding that behavior-if it dis tinguishable from behaviors of others in the group, then leader ship may be attributed to th at person (Kenney, Blascovish 13 & Shaver, 1994). Behavioral theory specifi cally identifies two primary examples of behavior that leaders adopt: these are task orientation and follower orientation (Holdford, 2003). In those leaders who exhi bit a task-oriented style, the focus is on accomplishing the assigned job, while concerns about follo wers take a back se at (Holdford, 2003). These leaders bring structure and directi on to followers by setting goals, providing training, defining expectations and limits on behavior and establishing rules and procedures (Holdford, 2003). While this behavi or can lead to structure, there comes a point where it is no longer useful as it becomes rest rictive to subordinates. Follow oriented leaders focus less on the job at hand and express a greater concern for the follower as a human being a nd not a cog in the machine (Holdford, 2003). Leaders with this orientation demonstrate behaviors such as s howing respect, gaining trust, demonstrating consideration and being friendly and approachable (Holdford, 2003). The ultimate goal should be to develop a nd promote leaders with a balance of these behaviors. Situational Theory and Leadership Situational theory attempts to develo p an understanding regarding how leaders can and should adapt to the changing dynamics of leadership situati ons. According to this theory, the greatest predictor of leadership effectiveness and success is the situation in which a leader finds themselves (Holdfor d, 2003). The traits and the behaviors are important in this theory but the focus is on specific situations. The following components, taken from Holdford (p. 1783, 2003) describe situational theory: Nature of the job – jobs can be routine or nonroutin e, structured or unstructured. A far greater level of commitment is needed in professional work settings where individuals work independently to solve complex problems. 14 Follower characteristics – Some followers are highly motivated, requiring little direction, while others are unmotivated a nd require close oversight and direction. Relationship between leader and followers – Trust is essential to a leader’s success. A good leader inspires c onfidence in and loyalty toward the leader. Organizational constraints – Many organizations place many constraints on leaders. Leaders are often hindered in th eir ability to hire, fire, discipline and reward staff. The leader’s abilities – Some leaders are more capable and experienced in dealing with leadership situations than others. Adaptability is key. The key component in situati onal leadership theo ry is the ability of the leader to adapt to diverse situations, rather than changing them (Holdford, 2003). Also, Kenney, Blascovich & Shaver (1994), offer the relationship between leaders and their subordinates explains a situa tional contingency that is a critical determinant of a leaders’ effectiveness. In today’s ever changing health care environment, those individuals strong in their ability to adapt to diverse situations can be a critical component to success. Transformational Leadership Theory Transformational leadership theory also fits into the succession planning and management equation. This theory explains one of the fundamental ways in which leaders influence followers is by creati ng meaningful work ( Purvanova, Bono & Dzieweczynski, 2006). Transformational leader s are charismatic and inspirational and provide individualized consideration to follo wers, attending to followers’ individual needs for growth and development (Bass, 1985). Transformational leadership should result in more engaged, more devoted and less self-concerned employees, as well as in workers who perform beyond the level of expectations (Purvanova, Bono & Dzieweczynski, 2006). In short, transformati onal leadership is about achieving results beyond expectations. In succession planning a nd management, this theory could be a 15 key component for success. By having leader s who possess these traits involved in the planning process, we could see greater enga gement in the process and success of the program over time. Chaos Theory and Leadership Chaos Theory deals with unpredictability and uncertainty. Chaos, or disruption, is a necessary condition for change in social syst ems (Remer, 2006). This theory plays in to the difficulties that health care organizations face with succession planning and management. As the ever changing health care world continues to evolve, it has become increasingly chaotic amid worries about how to respond to caring for aging baby boomers, filling key top level management positions amongst the rising retirements and adjusting to falling insurance and Medicar e reimbursements. The new health care legislation has added to the confusion a nd uncertainty in health care and has many organizations scrambling to understand the la w and its effects on their practice. Chaos theory offers a view into why the health ca re system is the way it is and how successful succession planning can rise from this supposed “chaos”. Chaos theory can be described as a “per iod of transition in which change occurs in unpredictable, irregular and uncertain ways” (Duffy, 2000, p. 229). According to Merry (1995), the essence of chaos is change. Chaos is not a stable condition or fixed state but it is more like changing the relati onship between things ra ther than the than things themselves (Merry, 1995). Remer (2006) , states that social systems are in perpetual chaos and that the only degree to wh ich there is any issue is that of how the interactions manifest themselves. According to Bright & Pryor (2005): The two key concepts of chao s theory are nonlinearity and recursiveness. Non-linear systems are characterized by the elements of adding up to more (or le ss) than the sum of the parts. Chaotic systems display other characteristics, such as a lack of Predictability at the micro-level, while at the same time appearing to have a degree of stability at the macro level. Their non-linear nature means that minor events can have a disproportionate outcome on the system (p.292). Remer (2006), describes chaos theory as being about patterns and how they develop and change. The patterns may be re lated to phenomena at various levels of application or abstraction from various disciplines-phys ics, chemistry, biology, ecology, sociology, psychology, anthropology or whatev er dynamical systems exist (Remer, 2006, p.56). Merry (1995), identifies five major concepts of chaos theory: trigger points, order in chaos, order from chaos, chaotic transition and self-organizing process. These concepts are outlined as follows: 1. Trigger points are an urgent se nse that a change in conditions has occurred and something mu st happen if sufficient adaptation is to occur. 2. Order in chaos is the concept that order is found in chaos through the individuals’ behavioral responses. 3. Order from chaos is the concept that order can emerge and a new Level of functioning can be achieved. 4. Chaotic transition is the time of tr ansition in which the individual experiences uncertainty, unpredictability and ambiguity. 5. Self organizing process is when the system proceeds from a state of equilibrium through chaotic disequilibrium which eventually emerges into a new way of knowing (Merry, 1995, p. 85). There are many additional components of chaos theory. These nine concepts are summarized below: 1. Phase spaces are the conceptualization of the possible views of a system. One sees only a portion of reality at one time. Different theoretical perspectives define different pha se spaces or different maps and simplifications of the system reality. 17 2. Strange attractors and their basis of attraction are the focal points for many and the most challenging patterns generated by dynamical, chaotic systems. They are sets of attracting and repelling points that make up and generate patterns. Their basins of a ttractions are the areas containing the patterns within their boundaries. 3. Fractals are measures or representa tions of complexity and the term conveys two important concepts: that what one sees depends largely on one’s perspective and that accuracy of measurement often depends on the definition of the process. Systems’ structures and patterns are fractal. 4. Self-affinity denotes the tendency fo r recursive processes to evidence recurring patterns of various types. Pa tterns tend to repeat themselves, not exactly, but close enough to be recognizable even on different levels and scales. 5. Bifurcation is splitting in two. Bifur cation increases patterns complexity. Cascade occurs when bifurcations happen at such a rate that no patterns seem discernable. 6. Recursivity is self-reflexiveness, th e feeding of information from one’s patterns back into the pr ocess of producing them. 7. Unpredictability is the inability to desc ribe with certainty the next state or the previous state of a system gi ven knowledge of its present state. Everything about a system cannot be known with absolute certainty and that any attempt to assess a situation will affect it. 8. Self-organization is the inherent tend ency for systems in chaotic state to form new coherent patterns and to re-organize, based only on the interactions of their components. 9. Resonance is the synchronicity of constituent components of a system, leading to reciprocal influence. The production of such patterns as chaos, reorganization and stagnation. Remer (2006, p. 57). Chaos theory has been studied in many scie ntific disciplines but it is starting to show its applicability to soci al research. Social systems ar e continuously in a state of chaos. Change is something that is occurri ng all the time and with that change or as a result of it, there is chaos. According to Remer (2006), all dynamical systems, human or otherwise, are recursive and ad just by means of feedback loops. “These systems develop a and adapt their patterns of behavior, t houghts and interactions in complex, chaotic manners” (Remer, 2006, p.56). 18 Summary In developing and maintaining successful succession planning and management programs in health care, there needs to be an understanding of all th e discussed theories, their implications for the future of health care organizations and their management structures. If programs are developed wit hout an understanding of underlying theory, there is a strong likelihood of failure. This is due to not completely understanding the nature of the individuals invol ved, their motivations and extern al pressures that can affect how succession planning and management pr ograms are developed and executed. Trait Theory is based on the concept of identifying desirabl e traits for leaders. This is key in the succession planning process. As talent is developed, there must be identifiable traits that these employees possess. Behavioral Theo ry seeks to identify what behaviors leaders should possess. This is also an integral part of succession planning as there are some behaviors that are more desirabl e and necessary in leaders than others. Being able to have these specific behaviors articulated as part of leadership development is essential to successful leadership development. Situati onal Theory focuses on how leaders can and should adapt to changing dynamics of leader ship situations. If a succession planning program can put emerging leaders into varied and challenging situations in the work place, there is the opportunity for the empl oyee and their superior to assess their readiness for further responsib ility. Transformational Leader ship Theory focuses on the assumption that leaders influence follower s by providing meaningful work. This is important to succession planning and management on different levels. It encompasses the employee being developed, along with the ability of their superior to engage them in the process. Leaders need to be able to motivat e and engage their employees in order to be productive. Those being developed for leader ship should possess the ability to create meaningful work for themselves and others. Ch aos Theory states that chaos or disruption is a necessary condition for change in social sy stems. This fits into succession planning in health care with the ever changing needs of the workplace. Health care is in a nearly constant state of change and those who lead during these times need to be able to understand that chaos is a constant a nd predictable part of health care. In addition, it is important to look to th e current succession planning and management programs to learn best practices and disc over further opportunities to improve. How I plan to conduct an in depth analysis into existing succession planning and management programs will be outlined in the next chapter. 20 CHAPTER 3: RESEARCH METHODOLOGY The first step in conducting my resear ch was developing specific research questions related to succession planning and management. The research questions developed for this study were as follows: 1. What models of succession planning are used by health care organizations in the State of Minnesota? 2. How are these plans put into effect? 3. What experiences have health care orga nizations had in the development and implementation of these models? The method used to answer these questions was a descriptive case study using qualitative in-person interviews to identify models used in succession planning and management. This descriptive methodology was chosen in order to truly get to the experience of administrators and human resource prof essionals with succession planning and management. According to Patton (2001), “qua litative designs are naturalistic to the extent that the research take s place in real-world settings and the researcher does not attempt to manipulate the phenomenon of inte rest. The phenomenon of interest unfolds naturally in that it has no predetermined cour se established by and fo r the researcher such as would occur in a laboratory or controlled setting”. Conduc ting interviews with health care professionals in their ow n environment, on their own experiences with succession planning and management, yields data that is far richer than that of a survey or focus group. These experiences have been categorized in order to draw conclusions. According to Yin (2003), case study is best used when a “how” or “why” resear ch question is being asked about a contemporary set of events, ove r which the investigator has no control. 21 The descriptive case study approach was used in order to look at how different health care organizations are empl oying succession planning and management tactics. This approach was successful in looking at the cu rrent state of planni ng in organizations, where they came from and where they want to be in the future. This gives a real-life look at succession planning and management in action. Development of the Interview Questions The interview questions were develope d after reviewing the literature to determine what experiences leaders have with succession planning and management programs currently used in health care orga nizations. The interview questions covered the individual’s experience with succession pl anning, what the succession planning and management process is, whether or not succession planning is formal or informal in their organization, what they felt the most important criteria for choosing individuals was, and whether or not they felt that the process was working. These interview questions were open ended with the intent of allowing th e interviewee to fully articulate their experiences. The interview questions were as follows: Interview Questions-An In-Depth Evaluati on of Succession Planning & Management in Health Care Organizations 1. Do you have a succession plan in place in your organization? 2. What does this succession plan look like? Describe plan. 3. How do you choose individuals for advancement through a succession planning program? 4. How do you prepare selected individuals for advancement in your organization? 5. Looking back, what are the lessons lear ned and if you were to do it again, how would you do it differently? 22 6. Looking ahead, what would you consider th e biggest challeng es/opportunities and needs for your succession planning over th e next 5 years? 10 years or longer? 7. Do you have any advice on how to do this well? 8. Do you have any critical inci dents or practical stories that would illustrate your planning? 9. Do you have any personal experiences with succession planning and your career that you care to share? Selection of Participants Participants were contacted via an email invitation to participate in the interview process. This invitation provi ded an introduction to the study and information on the interview process. Participants were intervie wed in person, with the exception of two that needed to be done via phone for travel reason s and the interviews we re tape recorded for transcription and analysis. Three of the i ndividuals who agreed to participate were eventually not used due to scheduling conflic ts preventing the interviews from occurring. Table 1 Participant Contact Data Participants Contacted Yes to Participate No to Participate/No Response 45 13 32 Analysis of Interview Data Interview results were analyzed to look fo r trends, obvious differe nces in practice and possible best practices in succession planning and management programs in the health care industry. I transcribed almost all in terviews in order to immerse myself in the data. Using this immersion, I was able to id entify and categorize tr ends. The results of 23 these trends are the basis for recommendations for best practices and the impetus for developing future research. Data Collection Data was collected through an in-person interview of senior administrative leaders and human resource leaders in health care or ganizations. The health care organizations were selected due to their geographical loca tion in Minnesota. There were approximately forty-five indivduals contacted with the goal of being able to conduct 10 interviews. The interviews included participation from seven different organizations. These organizations and the individuals within were identified by using contacts from the membership of the Minnesota Medical Group Management Asso ciation. The organizations participating included smaller, independent outpatient practices, along with mid-to large sized organizations that included clin ic and hospital based operations. Data was analyzed to determine any themes in the interview text. These themes were then examined in depth to determine re levant information. Analysis of the textual data was done by hand in order to fully understand the data gathered. The interview contained open-ended ques tions that sought to identify the successes and barriers that these individuals have faced with succession planning and management in their organizations and also in their personal wo rk experiences. The invitation to participate in the interview process can be found in Appendix A, on page 74, while the consent form can be viewed in Appendix B on page 75. Participants Participants in this survey were middle to senior administrative leaders in health care organizations across Minneso ta. This sample was chosen due to convenience for the 24 completion of the research. The leaders in cluded were those who self-identified as participating in succession planning and mana gement efforts within their organization. These individuals were identifie d as actively partic ipating in the choosing of individuals for further growth and promotion within the organization. Table 2 Description of Interview Partic ipants and their Organizations Participant Job Level 80-200 employees 200-5000 employees 5000-15,000 employees 15,000-30,000+ employees Vice President or Equivalent 1 1 2 President Level or Equivalent 1 2 CEO 1 1 Human Resource leader 1 Confidentiality In order to mitigate the risk of disclosure in this research, careful thought has been given to the design of this study. It will be imperative to maintain confidentiality of the individuals participating. Their identities we re known only to me. In addition to personal confidentiality, there was a need to assure the confidentiality of the organizations themselves. The interview questions were desi gned so the informati on being collected is useful to the study but not intrusive enough th at any proprietary information is being revealed. Findings do not include informa tion that would inadvertently identify individuals or organizations. All participants in the interviews were provided with an informed consent letter as part of their invitation to part icipate. This allowed participan ts the opportunity to see, in writing, the scope of the resear ch being conducted. They had the option to withdraw at any point. Information was included informing them of their right to see the finished 25 research, their right to end participation at any time as well as access their own responses to the interview questions. Significance There are a number of benefits that will be derived from this research. The ultimate goal is to identify a model(s) for health care organizations to use in succession planning and management efforts. If factor s that contribute to successful succession planning and management can be identified, this research would be the basis for change within organizations. This research will also identify areas of strength and opportunity within health care organizations’ current suc cession planning efforts. Identifying areas of opportunity will enable organizations to begi n the development of or improvement of, succession planning efforts. This research wi ll also identify areas for further study on succession planning and management that will lead to the addition of new and valuable research to the field. Limitations There are some limitations to this res earch that must be addressed. The small sample size is a potential issue. The argument c ould be made that the size is too small to be relevant in looking at health care organizations as a whole. Also, the common geographic location could potential ly lead to issues with gene ralization across health care organizations around the United States. In spite of these possible limitations, it is my impression from reviewing the literature, that health care organizations, regardless of size or geographic location, lack a cohesive model for succession planning and management. 26 Summary In order to most effectively understand the experience of succession planning and management in health care, the decision wa s made to employ a qualitative method of inquiry, using open ended inte rview questions. By employing this method, I was able to not only gather information about the practices but evaluate the feelings and experiences of those involved in the process. This improved understanding of why some programs succeeded, while others failed, as well as bringing an understanding of the human element to the research. The following chap ter will offer an in-depth discussion and summary of the interviews and the themes that emerged. 27 CHAPTER 4: AN IN DEPTH ANALYS IS OF SUCCESSION PLANNING AND MANAGEMENT IN HEALTH CARE ORGANIZATIONS Chapter Three explained the method for gathering the info rmation regarding succession planning and management programs in heath care organizations in Minnesota. Chapter Four will summarize, in the particip ants’ own words, their experiences with succession planning and management in their organizations and with their own careers. Ultimately, ten interviews were conducted with administrative and human resource leaders from eight different health care or ganizations in the State of Minnesota. The positions that these individuals held were Vice President, President, Director or CEO level. The size of the organi zations ranged from 80 to over 30,000 employees. In order to protect participants’ confidentiality, any direct quotes listed in this chapter will use numbers as identifiers. (S ee Table 2, Chapter 3). A number of common findings emerged during the course of the participant interviews. Upon evaluation of the text, there were five major findings that became clear. This chapter will discuss these findings in detail and provide direct quotes from participant interviews to support them. Findings There were five major categories that b ecame apparent during the evaluation of the transcripts. One recognized that all of the participants said their organizations had some kind of succession planning in place , these plans were a combination of very formal programs, to more informal activities. Finding Two, Succession planning not well defined in most companies, regardless of having formal or informal programs, in that most didn’t have regimented forms of communication and development programs in place. Finding 28 Three identified that communication to employees about their place in succession planning was not always clear or consistent, there did not seem to be a lot of coordinated education and mentoring for high potential employees across the different organizations. Finding Four was a feeling from participants that they needed better or more well articulated plans to meet the fu ture needs within health care in that the programs could be more directive and also could cross more layers of employees than they currently do. Finding Five identified a se nse of frustration among some with their own career succession planning and management and how it is communicated and executed, resulting in feelings of being “passed over” or just not having a good idea where they and their talents fit in in the organization. The following section will describe the themes in detail. Questions: Do you have a succession plan in pl ace? What does this succession plan look like? Finding 1- Most organizations ha ve some sort of succession planning and management activities In interviewing the participants in this re search, it was discover ed that all of the organizations had some type of succession pl anning and management in place, whether they identified it as succession planning sp ecifically. This varied between being a program for administrative leaders, physicia n leaders and plans for specific departments within an organization. As these programs va ried in what population of employees they covered for succession planning, they also vari ed in what constituted “formal” to an organization. Many of the organizations said they had succession planning but in the next question in describing the plan, it could be accomplished with a once yearly discussion 29 with an employee, to a structured, we ll communicated development plan for the employee. Participant 7 had this to say regarding the su ccession plan in place in their organization. So, our company, has an annual pe rformance appraisal expectation that a supervisor will do for the st aff and as a part of that annual performance review process it in corporates ever ything from 360 feedback to feedback from all levels of the organization, of individuals who report to the indivi dual, of their peer group, and of physician staff that they may inter act with. And on an annual basis, there is an expectation that that wi ll occur and as a result of that there’s the opportunity then to pl ace the individuals in a four-grid matrix related to, umm, their leadership potential. So, it includes Solid Contributor…let me start on the left side…it starts Limited Performance Potential, meaning likely has an improvement plan underway in order to be a strong co ntributor in the role. Then, Solid Contributor is a very ta lented individual who is in the right role and is unlikely, either out of their own interest or the contribution capability, to move up in the or ganization. Emerging Talent would be someone who may be ready for advancement in the next five years; while High Performance Pote ntial individuals would be ready now or within the next two years. And by placing people in that grid if you will, it provides an opportunity for the supervising manager or the peer group of that supervising manager to ensure that individuals anywhere along the grid have an opportunity to take on addition roles in the organization to grow and develop, and further their skill set. And is also provides an opportunity for the supervisor to have a thoughtful dialogue with the in dividual either during the performance review or sometime sh ortly thereafter about: what are the goals of the individual in the coming year? [Participant 7]. Another perspective offered on formal succession planning and management comes from Participant 3. We have a very detailed plan that encompasses president, vice president, directors and other similar positions. It starts with a review of job descriptions, the person in the organization who is responsible for that position currently selects two or mo re candidates, try to have at least two candidates who are selected as candidates for the succession plan. The internal candidates, that rea lly would be really the internal candidate, we often use the suggestio n that this could be the interim 30 position if there were une xpected circumstances and/ or accidental injury or illness that would take the person out of their position. [Participant 3]. An insightful quote from Participant 9 offe rs up that although there is a formal plan in place, there is concer n that it may not be enough. On the administrative side…let me ju st say this and then I’ll pause…on the administrative side, we periodically over th e years have identified leaders. We’ve had different processes in place; we’ve used different nine-cell grids to a four-cell grid, etc., etc. And what I would tell you is that we identified a leaders and not convinced…and I’m an administrator so I own a piece of this…I’m not convinced that it’s a stand-alone piece of work, and until we integr ate it into a…some sort of a leadership model it’s gonna not be as impactful [Participant 9]. Participant 4 talks of succession planning that happens within their specific department. Ok. Our department does have a succession plan in place. It’s something that they’ve been putting more focus towards over the couple of years. We’ve made a very concerted effort to do succession planning primarily for management positions within our division. And then we manage that at a employee level, so that within the six units within our di vision we work individually with our analysts building those succession plans and then feeling that up to our leadership team.[Participant 4] Participant 5 talks of not having a defined succession planning model in place, but speaks to what they would like to do in the future a nd some of the challenges they face in just trying to build their small practice. I actually don’t have it in pr actice right now, but I reall y, I really hope I’m . . . I have a new, a position out for an additiona l accountant person, but it’s constantly in the back of my mind that I need to look for . . . I mean, our management team is very, very lean. It’s too sma ll for as big a company as it is. At some point in time, I would like to ha ve that person come into that sort of assistant administrator role that woul d be, maybe younger, new in the, in the environment that I could start grooming for th is, for this role. But, I think typical, at least all of my experience in independent practice, is there’ s been very little room for having somebody on staff that coul d be that person because your cost factor of having people at that kind of le vel of compensation just doesn’t exist. And typically, in that independent practice, I just . . . My experience is I haven’t had that skill set of somebody that’s able to kind of move forward. But I think I have that potential here. I de finitely have that potentia l. Now, where I was last, that was kind of interesting because they sort of did the round-robin when they 31 somebody left, they sort of did a round-robi n of looking to see who might be able to move into that next role, and one thing that I find that the small . . . the smaller you are, the harder it is for people to accept somebody moving up . The bigger you are, where people, there are more layers of infrastructure and infrastructure the easier it is. I mean just taking somebody that’s, you know, rank and file anywhere and just moving them to a lead positi on is, really takes a lot of support and training and finesse, and expl anation, and preparation, and . . . We’ve spent so much time here just acting that the whole training program is a big hole. I mean that’s just a, it’s just a bi g piece in my career that’s just been left out as far as being able to groom people for the next step. [Participant 5] Participant 8 speaks to the limited succession planning that was occu rring within their larger organization. We talked about succession planning a lot, “a lot” meaning 3-4 times a year. And, and our h…one time we actually did do a formal plan…do you think she can see my hands…we did a formal plan, like who we thought was…and we kind of rated A-B-C .Just because we had read about it from the guy from GE, remember? Jack Welch did that, yes, so…we kind of did that with the leaders that we did have in place and then who potentially were future leaders. But w…but there was never a formal plan in place. And when anybody le ft, a manager or a VP for that matter, sometimes their jobs would be posted for months because there wasn’t a formal plan. [Participant 8]. Finally, Participant 10, who ha s a senior leadership posit ion, speaks to a lack of communicated succession planning efforts. You know, not one that is either fully disc losed or articulated. And I’m part of the hospital president group, so I’m not at the highest level of the organization for a corporate standpoint, but the answer’s “ no,” not that I’m aware of. The senior level, the joint…or the executive committee have something that’s not been articulated to my level of management. [Participant 10] While these organizations have some sort of succession planning, it is not always formal, nor well communicated with the sta ff. Even though not all of the above quotes involved formal succession planning and manage ment in their organizations, there is a desire or plan to identify talented individua ls to move into management programs in the future. 32 Question: How do you choose individuals for advancement through a succession planning program? Finding Two- Succession planning not well defined in most companies, regardless of having fo rmal or informal programs. Many of the participants spoke of different approaches to preparing employees for advancement. Some organizations discussed having formal educational opportunities for employees or the ability to send these empl oyees to leadership development off-site. Others talked of providing “stretch assignments ” to develop skills. Still others used a lot of employee interest, coupled with finding assignment opportun ities to help with growth and development. The following qu otes point to this theme. Participant 3 speaks to how the organization prepares individuals for advancement. We do sponsor class work, we have a ha ndful of individuals that…where they would have class work, typically everyone who would be considered, at least in a Bachelor’s degree position, has a Bachelor’s degree. If they were in a position that required a Master’s, we have a for a small number of people enrolled…helped them pay for the Maste r’s program, but I think, frankly, most individuals are pursuing advanced degr ees on their own. We have also done stretch assignments. We’ve rotated indi viduals through a variety of clinical programs and so we had a director who wa s very successful in the management of a hospital based endoscopy program and wa s given the opportunity to manage a clinic and residency program, and even though the position was really felt to be the same level, it’s not a major promotion either in pay or in responsibility but one of versification of the indi vidual’s experience to have th em advance to a VP level position in the future. [Participant 3]. Participant 4 talks of how their specific de partment works with employees in terms of preparation. Sure. There’s that standard organizational template that we’ve pulled a customized for our department, so we cu stomized it in the specific areas in the traits that we were looki ng for unit head positions specifically. So the first step that we do is gauge interest in…from our analysts in moving into the unit head positions and if they are interest then we complete that document. Then we take those documents and the unit heads come t ogether and we complete like an excel 33 spreadsheet and we categorize the candi dates based on “ready now, ready in the next 1-3 years, and future 5+ years (I th ink).” Yeah, we gauge interest. I mean, we want them to have an interest in goi ng into management positions because what we’ve found is that there’s some people that make great analysts and some people that make great managers and they’re not always the same people. So one is their interest and the other is our interest in them. And, so yes, we would approach…certainly approach people that we felt had high potential and then we would, you know, ask them their interest in long-term plans; either within our division or the organization. One is thr ough project opportunities, so giving them large lead roles on large complex projects. We also look for opportunities to serve on committees…umm…and maybe leading in ternal committees or sitting on institutional committees.[Participant 4]. Participant 6 describes educational opport unities provided for all staff within their smaller organization. Yes, we actually do a training…well, we actually do a few different things…so, for…again, for our technician s and assistants, kind of th e clinical operations staff, we do a annual educational meeting, and it ’s kind of a one-day… and it’s in October every year, so, we do a one-day kind of…and then we have a variety of speakers…sometimes they’re internal, some times it’s external. And then if they need to get continuing edu cation credits for the certif ication, we’ve applied for those, so that they can get those. So they do some internal…and then we do…which is, it’s broader based, but for all our referring doctors, we put on what we call an annual update course, and someti mes we do that for our staff as well, that our physicians particip ate in, so it might be…like we’ve got Glaucoma is one of our sub-specialties…maybe it’s about Gl aucoma or a cornea or a just kind of some…what’s going on in the industry or what are the new techniques, procedures, you know, studies, that t ype of thing. [Participant 6]. Participant 7 details the different ways of pr eparing individuals for advancement in their organization. They are careful to note that people are not “chosen ” for specific positions, but must work on development and compete for the positions. Well, “choose” is a word that we don’ t use; we don’t tap people on the shoulder to take on roles. We offer opportunities for fo lks, so within Operations now, as we have open positions or committee assignments, we do our best to publicize that generally to let the forty-something pe ople who may want to volunteer to make it…make their interest known to their boss who can then he lp bring that in: is this the right time? Within Human Resources, we have a multitude of offerings for individuals depending on their interest and what th eir current roles are, and what the institutions needs are. So, for example, with the Quality Academy, with redesign 34 and value improvement expectations, we have set the expectation that Administrators will achieve a silver level of competency in, umm, LEAN methodology, if you will. So, it’s a mixed mode l, I think if someone had a deficit they’d be encouraged by their supervisor to, to en roll in a program and then depending on the person’s role and assignm ent they may see the need to take a team through Teams Training and the like. So, there, there’s a big portfolio of offerings and it’s somewhat individual spec ific depending on what their role is or what their long-term career goals ar e. We also do encourage multi-site responsibilities, so as we in the practi ce start to developing councils and whatnot there will be an opportunity for folks to reach out of their normal comfort zone, which would be the local responsibilities to have more of an Enterprise responsibility for coordinating at least, which should lead to growth opportunities for them in their career if you think about our organization coming together.[Participant 7]. The above quotes have some similaritie s in terms of offering some stretch assignments and educational opportunities for their staff. The interesting point underlying these quotes is that none of these organizati ons seem to have a well defined program for advancing the employees. There are not sp ecific competencies, opportunities or assignments that talented employees are steer ed toward. It become up to the employee to find their way upward. Question: How do you prepare selected individuals for advancement in your organization? Finding Three- Communicati on to employees regarding succession planning and management not alwa ys clear or consistent Often it seems that there are not specific discussions occurring with subordinate staff regarding their future pot ential or with thos e who need improvement. There is a lot of assumption that occurs with succession planning in terms of people knowing where they stand, gauging interest a nd lack of mentoring. Many of the organizations talk about the employee initiating interest in advancement, rather than having t hose discussions with them ahead of time. The following quotes outline this. 35 Participant 5 talks about a current situati on with an employee. One who has a clear understanding of her future, a nother one that does not. The marketing director know absolutely…that I, I don’t know where the position’s going to go; should it be a part of the management team, should it not, should it supervise staff, should it not? We’ve had that type of exact dialogue and she’s, you know, very much a part of that whol e process. With the customer service support person, she along with all the customer servic e staff know that there’s going to be a lead position posted with the next couple of months, so she has told me she’s very interested and she’s as ked if she can apply for it. I said “certainly…”and she has but we haven’t had a direct dialogue about her in the role with me says “of course, that’s why I’m giving you these things.” I think it’s very much an unwritten…[Participant 5]. Participant 2 talks about th e struggles with communicati ng poor performance with employees, which can interfere with effective succession planning. So we also had trouble, and I think entire organization str uggles with this too, is if people aren’t doing the job, you know if they are breaking policy and committing crimes, I think you have to just get rid of th em. If they aren’t but they just aren’t quite doing the job, I think the organiza tion struggles with getting those people “off the bus,” and I think that is a huge barrier in succession planning. We haven’t done, in my opinion, a good job of truly training supervisors to manage performance. If we had done that and if that was an accepted norm here where, not necessarily the GE model where you wipe out the bottom 10% every year, but you need to put the people where appropr iate on performance improvement plans and point out their weaknesse s. I can’t tell you the number of times when I was fairly new to the department, I would look back at an employee’s performance evaluation or the massive stack of them. In my opinion, they were underperforming in a number of areas. We looked back at previous PAs and it was spotless. [Participant 2]. Participant 7 speaks of how the process for pr omotion works within their organization. We offer opportunities for folks, so with in Operations now, as we have open, positions or committee assignments, we do our best to publicize that generally to let the forty-something people who may wa nt to volunteer to make it…make their interest known to their boss who can then help bring that in: is this the right time? And, and as you know, we have a posting process for promotional opportunities, so individuals would need to decide if th ey want to apply, and apply, and then be sorted out through the winnowing down pro cess depending on the key attributes we’re looking for. [Participant 7]. 36 Participant 8 talks about the discussions th at would occur with employees in their organization. Again, there was guidance but nothing too prescriptive and the employee was left to navigate this on their own. Well, in my organization when we did performance reviews we always said, you know, “here’s something for the next year,” and…until they had their major lay off…last year…a year ago…they had a depa rtment that had all the great education when you were there, they had everythi ng, so you would recommend things for them to go to. I always encouraged reading journals and certain journals that gave them information. We suggested mentor ing with others, you know, like following a VP around, or doing what you could do w ith that. I don’t th ink many of them did that, but we did make that suggestion. And, what else did we do? Learn from other managers because some people had weak points. And let’s see, go visit with…especially the younger ones, even t hose that came out of grad school, they had…they were nervous about managing pe ople, but yet those grad school guys were the ones that had Excel experience, so we all kind of learned from them. And then there were the nurses, you know, we all kind of learned…so, we tried to learn from each other in our group of 7 or 8 people. [Participant 8]. Participant 10 spoke of frustration in tryi ng to fill an open leader ship position and the difficulties with finding the right candidate. So, recently, I just did a recruitment for th e director of patient care services , it’s a nursing, a nurse executive position. And, I wa s…I followed the same process that I described; we had some in ternal candidates, I opening it up externally. Actually didn’t find anyone on the first run from the pool with the exception of one person who ended up taking another job, then I opened it up again and I had a real challenge in trying to iden tify internally who were candidates for the position. It was, “well, so-and-so might be intere sted” type of thing. Now, you know, the bottom…the good thing is I that I got a great candidate who was a…or is a manager of intensive care at one of the hos pitals and she’s movi ng into a director position. Now, it would have been helpful to know that she had high potential, which everyone told me, but we would have been able to iden tify her sooner than four or five months into the process. [Participant 10]. Open, honest and continuous feedback to employees seems to be missing in many organizations. Employees don’t know where they stand in terms of being considered for promotional opportunities, career development discussions maybe take place once a year and the employee is often left to navigate the institutional offerings on their own. 37 Questions: Looking back, what are the less ons learned and if you were to do it again, what would you differently? And Looking ahead, what would you consider the biggest challenges/opportunities fo r succession planning over the next 5 years, 10 years & beyond? Finding Four- Participant s feel they need better or more articulated plans to meet future needs within health care The looming retirements of the Baby Bo om generation and the rapidly changing face of health care are the two huge challenges that almost all of the participants spoke about. These two factors point to the need, in the pa rticipants’ eyes, point to the need for more effective succession planning programs in their organizations. This was true regardless of whether they currently have a formal, informal or no succession planning in place. Participant 2 speaks of the need for better communication of where people are in their career development and the need for preparati on for senior leadership positions that will be vacated in the next five years. Well, I think, again in my opinion, the succession planning here has some holes, and I would personally going through it, I feel like it’s kind of like running for office. So when you want a promotion or think you deserve a promotion, you will have to kind of bang on doors and visit pe ople door to door to kind of market yourself. If you do achieve it, I think there is a natural lu ll, and this is true with myself too, you kind of go back into your hole for a while because in your mental state you are not ready for a promotion he re because I think a lot is tied to experience, longevity, seniority, and all so rts of things. So I would imagine the next step when I think, whenever that is that I am eligible for promotion or move, you start up that campaign again and you try and knock on doors and get back with these people. I think alternatively a lot of other places ha ve handled it with a more concerted effort for succession pla nning where you have kind of an assigned mentor and somebody that is helping you navigate through the system, and I think that is what is missing here. Even fo r the people that are really good, I think they’re basically on their own to determine their career path. In some cases that is good because maybe they end up with positions that are good, but in other cases I 38 think the institution is missing out on good synergies because they aren’t keeping in touch with the people that can provid e them with the help. I think this organization, like a lot of other places , is going to struggle with the Baby Boomers retiring. Personally, I feel enc ouraged about that because of the stage of my career that I am in—maybe there wi ll be a lot of opportunity—but also I am not necessarily endeared to this organi zation because I don’t feel like anybody is watching out for my career here. I feel like it is up to me. I also feel like if I did choose to go to the outside, it really wouldn’t matter that much to anyone here, at least that’s my perception. So I think th at is the disconnect because I think if you talk to a lot of our collective bosses, a nd I told them that they would say, “Oh, you’re kidding me,” “We wouldn’t want you to leave.” They have no real quantifiable answer for what they’re doi ng for me as far as career planning. [Participant 2]. Participant 3 talks about the looming turnove r in their organization over the next ten years and the challenges that this presents. I think we are quite like quite a few orga nizations in that we’ll have a lot of turnover in the next 10 year timeline, so the challenge will be to move through a significant number of leadership changes and to accomplish this smoothly. That’s what I would see as immediate. Longer term , the challenge is pe rhaps more one of identifying the physician leadership com ponent in the organization. In a smaller organization like this, there aren’t as many individuals who have an interest in the leadership roles. [Participant 3]. Participant 5 talks about the ski ll set that will be needed in administrative leaders in order to grow their small practice. Yeah, well clearly it it the…it is the growth in the administration role. I mean if I really carry forward these plans that this group has, which is local, regional, national, center, umm, one-cen ter joint ventures with system partners, I mean all of that, then the depth of the administrati on has to get bigger and so that then that really does force me to go to that assist ant administrator role , look for that person who has that drive and initi ative and start going from there, because there really needs to be two people now and we’ll need to be three or four people down the road as we start negotiating. And then th e other part of succession planning will be a true position leader and that piece is , is being talked about right now because the, the company actually is still run by the founding physician who is sixty-three years old. And though he fully intends to practice at least another ten years, there’s still is original structure se t up about him being a founding board of governor, and that, of course, will never ex ist, there will never be a founder again. So, decision makers at the physician level will be on an equal footing with regard to ownership, so what does that mean with regard to decision making? In order for us to continue to have this growth pattern, there’s gonna have to be a go-to 39 person and how do we develop that? So we ’re just in the beginning stages of talking about that. For the first time ever we have instead of two owners, we will have three owners January 1. So, that di scussion is, is happen ing. [Participant 5]. Participant 6 talks of the uncertainty with the future of health care. Well, and I think some of these may be ki nd of verbose, but I mean, I think that healthcare, you know the hea lthcare reform efforts, I th ink it’s a little challenging right now to kind of…we’re pretty good at planning fr om a financial standpoint, but because there are too many variable s that you don’t know what’s going to happen with reimbursement, what’s going to happen with like a combo-care organization or integrated delivery systems, or how is that all going to play out and how are we going to fit into that picture. [Participant 6]. Participant 7 talks of the challenges of lo sing Baby Boomers, making sure current staff develop the necessary skills for senior leadership and continued growth for the organization. Well, we’ll have a batch of individuals who are baby-boomers in the next five to seven to ten years where they’ll be, where th e majority of senior leaders will retire within the next ten years, and we went th rough a wave of this a few years about as well, so that will be a challenge, the stru cture of our organization is uncertain if you go out three to five years. So, many of the positions we have today that are site-centric will be single …Our organization going forward as much as Finance and HR have restructured, I think Operati ons or my world will restructure and so it’s hard to know what positions will…wha t the breadth of the responsibilities will be two to five years out. So, if I stay at the traditional level, the retirements will be many and I think we’ve got a lot of benc h strength. I’m not overly concerned that we’re not going to have folks prepared for those. And then the Enterprise-like roles I think we’ll get where we need to go because of the councils and other opportunities in the next two years as we bring the practice to gether. So that’s, that’s good, but it remains to be seen. The, the…in the area of diversity, we’ve got a long way with ethnic di versity and external k nowledge coming into the organization, so I would say, as we op erationalize the 2011 Operating Plan going forward will increase the organizations presence. We don’t have multi-culturalism built into the fabric of the organization a nd we don’t have partnerships with other Healthcare entities like the Affiliated Practice Network st rategy, or some sort of global footprint, whether it be India or somewhere else. So, I think we’re vulnerable about, umm, how we partner at the business leve l with the care delivery in a non-traditional format. So, ar e…there’s a lot of things…lot of flux right now with both structure and, umm, what’s going to happen and the national and international scene with healthcare reform? How’s that? [Participant 7]. 40 Participant 9 speaks more of the competencies that will be needed in order to bring their organization through the constan tly changing environment. Well, I think at a broad level and then I’l l talk operational… at a broad level our business needs for leaders are changing. And so the business…the competencies that we want from our leaders may be a little different today than they are two years ago and probably two years from now. We’re looking for somebody that’s much more savvy and that can influe nce. We’re looking for somebody who can innovate business models across the pract ice. We’re looking for somebody who can engage and rally the troops. And so, and really understand our competitors, you know, I call them our competitors colleagues. We’re looking for somebody, you don’t need an M.B.A. but you need somebody who understands the economic environment and the competitive challenges that are happening in healthcare, in government, and regulatory. Because…and wh at your customers want. That, that is very different thinking for this orga nization. You know the at titude is often like the…I always think about “If you build it, they will come.” Well, guess what? We built it and now we have to start thinking about different business models, that of a very different skill set of a leader. I th ink our challenge is go ing to be to make sure that we are preparing leader s to manage given the complexity. You know, so, that’s kind of the…and by the way, that ’s probably all companies, trying to manage the complexity of the ma trix organization. [Participant 9]. Finally, Participant 10 spoke of the fear that the up and coming leaders do not have the education nor experience necessary to effectively lead when the current leaders are gone. Well, challenges one is that…I think with in the organization, we have leadership that probably in the next five years we ’re pretty well secu re, but going out, you know, we’ve got people that are in their la ter fifties and early sixties and their going to be wanting to retire. I think the challenge is the way we have defined and worked the time commitment on the position with leaders that are in their later forties, fifties, and early sixties may be different that the time commitment those succeeding us will want to give. So, I don’t know if that’s true or not…does that change with age or…but I think that’s a challenge, I think that’s clearly a challenge. The…I guess one of my concerns is that we have leaders…and this is a bias, so I don’t know that they’re, I d on’t know if the research bears it out, Allison, but the bias is that we have l eaders throughout the organization, and if we’re talking…if we’re not ju st administrative leaders, we’re also talking about clinical leaders, but fr om an administrative stan dpoint, that there’s some experience and knowledge in clinical opera tions, hospital operations that…doesn’t seem like the candidates I get from the graduate school revi ew panel at the University of Minnesota, have had any kind of clinical or experience. So, that’s a concern I guess. [Participant 10]. 41 Question: Do you have any critical incidents or practical stories that would illustrate your planning? Finding Five- There is some frustration with personal succession planning efforts for themselves One last common theme that ran thr ough the interviews was the lack of succession planning efforts or failed successi on planning efforts in these leaders’ own professional lives. Participant 2 speaks to the feeling of bei ng alone in figuring ou t their own succession planning and preparation. I feel like my preparation is fairly good to potentially move on to the next level, but what I don’t know is if that is necessa rily in the cards for me here, and that kind of points back to there is nobody nece ssarily looking at my career here, at least that I know of. And I think that the preparation that I’ve done and feel good about has been done by me personally. I’v e felt like I’ve had to take that on my own and really convince peopl e that I need to be invol ved in this professional organization or take this class or do that . And I think you need to do that because you have to do that for yourself, but at the same time it doesn’t leave you with most good taste in your mouth about your pot ential. So I guess I’m really reticent to comment on where I think I’m going to be at this organization if I chose to stay here, because I truly don’t know. I m ean, you know, you know as we discussed, it’s timing, you know. I mean, I don’t know if these positions come open. A lot of people say, “Well, you’ve got to interview multiple times to do that.” You know that I think people really would help me. I mean, you know I don’t feel like I get a lot of doors slammed in my face, but, you know, it’s hard to know when to start that campaign. Because what I th ink nebulous here is the emphasis on seniority. So in order to be an associate administrator, for instance, I mean I think Person X is probably the youngest one. In general, I think, you know, well and I suppose Person Y, too, may be about the same age, but they bring a mix of experiences, but I have no idea what we nt into that progression. You know, I don’t know what skill sets they have th at are unique. I don’t know. You know, all those decisions were made, and I don’t know, you know, for in my own case I don’t know what emphasis they’re going to place on diversity. You know, so being a white male, you know, I don’t know if that is going to be a detriment or whether it’s not going to matter. Or what ? So, I mean I think there are so many unknowns at our organization, um, so, I don’ t know. I think I will probably look outside at some point too just to make sure that I am doing a good job of doing that. I haven’t made any decision to stay here my whole career necessarily. Yeah, even the rotations too there is no science behind that. I mean, if you ask anybody, even the people that are theoretica lly in charge of the rotation or the people that are being rotated, nobody knows wh at’s next for them. You know. I think it’s really an informal survey of what do you think you want to do? or who 42 do you work well with? But, you know, I don’ t know. Well, and I think a lot of that’s done in a reactive fashion, which you always need to do that. I mean if somebody leaves you have to set have to backfill them, but you know as far as the rotations, it maybe starts with somebody that needs to rotate for some reason . . . and then just this massive domino effect that creates all this chaos and people aren’t sure what’s going on. You know, I think that a lot of people that have stayed here a long time have gotten used to that and just accep ted it as the norm, but, I mean, if you are relatively new to the system you kind of look at it and say, “That’s just kind of crazy, I don’t know if I want to put up with that.” Then, you know, the progression that you and I just we nt through wasn’t that great either because, you know, they don’t link skill set with position, so you interview to be an OA. They may have several. Th ey may call you and say, “Hey, what do you think you want to do.” . . . and you answer those questions, but you aren’t sure where that is going to land and the landscape is unclear too. I didn’t know how to comment about the other roles because I didn’t know anything about it. You know, I mean how could I want or now wa nt that? . . . Yeah. So, the whole process I just kind of left underwhelmed with it. I mean, I was happy to be promoted, I guess. That was the good thing. I mean they gave me more money to do my job, and, you know my current job is going fine, but I left with no confidence that succession planning is a high priority with anybody. I mean, I think it’s a high priority to fill an open sl ot but, . . But I also think the next time there is an OA opening there will be a huge amount of interest and a massive applicant pool. [Participant 2]. Participant 4 speaks of her luck with havi ng good mentors and help with some of her career planning but also states that she doesn’t believe that any of this was part of a formal succession plan. I have been very fortunate to have good mentors I think and good management, and I think both are very critical in th e succession planning process. People that have taken the time to just invest in me and challenge me and push me outside my comfort zone and give me opportunities a nd support me through the process. So, I think my experience has been very positive. Now, I don’t know if I was ever part of ant succession planning plan. You know I can tell you, even though…and I said that my succession planning experience has been positive for myself, I would say my career path has been not well planne d out. Nobody has ever talked about or ever asked me what my long…what my fi ve year goal is. I’ve never been asked that. So, I’ve never been asked that by my division chair, my section head, or…and I was never asked that as a unit head. Now I’m hoping…I do ask my employees that and I think, I’m hoping the other unit heads do to. Especially as much as we’ve been talking about it, but I was never asked that . [Participant 4]. 43 Participant 6 spoke of her experience in leaving an organization and the havoc that occurred. It definitely was an example of what can happen with lack of succession planning. The experience stuck with the indi vidual and helped ensu re that in future situations that they had contro l over, they would make sure to have a succession plan in place. Well, I know…and I know that because you ki nd of keep this objective…but I was at another practice for many years and when I chose to leave, you know, they didn’t have any succession plan there, no plan on what to do and I, was able to do some things, but I think it just illustrates th at if you don’t have any plans things can change, and something happens, and…So I, I think it’s just always trying to think forward, anticipate and, you know, have that in your thought process, so at least if something happens you do have some plan and your not starting from, “ok, now what do we do now? We just thought that person would be here forever.” You know? And I think it, it was easier because they already had that kind of a culture just from the whole teaching and education so they had a, you know…it wasn’t as difficult as it might be if you didn’t have…I think with, to me, actually in my role or anybody in a leadership role…it’s always that balance between, you know, you have to have some external focus as we ll as an internal focus and if you get too far either way, it could cause a problem, but just, you know, trying to maintain that balance, so…[Participant 6]. Participant 7 had a sense of awe at where their career had taken them. There were no discussions about career aspi rations or whether they were considered for promotional opportunities during their career within the organization. Frankly, during my twenty-four years at this organization, no one ever had that discussion with me. I never knew that I was either considered Emergent Talent/High Potential. Whenever I recei ved a promotion I was astounded because I didn’t know I was likely to have that oppor tunity. So, it was just fortuitous or by someone encouraging me or, in those days , saying, “well, we’re going to try this experiment, are you willing to take this role?” and I naively would say, “yes.” [Participant 7]. Participant 8 talked about complete lack of career direction from their manager. I have my own succession planning…in my head, but I don’t think it was formal. I thought it in my own head. And I remember one at one of my reviews with my manager, I said, “I just think I need to do something different before I retire, and I 44 don’t know what that is yet.” She didn’t l ead me down any avenues at all; I think it’s who you work for too. [Participant 8]. Participant 10 shared the experience of ha ving a well-defined succession plan and then having that plan shattered when the economy forced lay-offs from the organization. Actually, we had a plan, so the plans don’t always get implemented as intended. And there’s no…there are no guarantees, ev en with a plan. So, I was over at Company X, as you know. I would have been the next president of the foundation at Company X and given the 2008 downturn in the market, it turned out that I wasn’t; we ended up going through layoffs, as you might know. And I was laid off and whatever it was, who was around fo r it, it doesn’t really matter. So, the plan, there was a plan in place and actually we did have a plan at our organization to the degree of the vice presidents and so me of the directors, we were just kind of working it at the director le vel, so we actually had a pr etty good plan. [Participant 10]. The findings outlined in this chapter give a snapshot of the lack of coordinated or well-communicated succession planning and management programs in health care organizations in the State of Minnesota. Finding 1 showed that there are varying levels of formal and informal succession planning effo rts within the health care organizations interviewed. Although not all of them have form al programs, all of them were thinking of succession planning in their organizations. This inconsistency in planning led to missed opportunities within many organizations in terms of capturing and developing solid talent. Finding 2 identified some best prac tices that emerged from organizations. The ability to identify potential talent, offer internal and/or external educational experiences and the opportunity for individuals to take on assignments meant to st retch their abilities are seen as solid ways to move individuals forward in an organization. Finding 3 showed that there is a fundamental lack of communication to empl oyees. Even in organizations that had formal succession planning and management programs, the level of communication with potential talent was l acking. Communication varied from a well- 45 developed talent management program in one organization, to yearly discussions in another, to the organizations that had not yet talked with employees regarding their plans for them. Finding 4 showed that all of the orga nizations felt that they could do better with succession planning and management. There was a feeling that the plans needed to be better developed, articulated or identified. Ma ny felt that there was a disconnect to their strategic plan, that those being considered for development lacked some of the fundamental skills needed or that there ha d not been the time a llotted to developing a comprehensive program. Finding 5 focused on the interviewees’ personal experiences with succession planning in their own car eers. The general co nsensus among the participants was that they had experienced l ittle guidance, a lack of support and a general sense of a meandering career path that led them to where they are today. These findings are consistent to the literature reviewed. Chapter 5 will discuss the findings in more detail and also look at the possible lack of theoretica l understanding that contribute to this issue. 46 CHAPTER 5: DISCUSSION I undertook this particular re search because of my pers onal interest in succession planning and management in hea lth care. In my professional car eer in health care, I have felt a disconnect between the work I do and how I will get to the next level of leadership. There was a sense that no one was looking out for me and my career aspirations and I wondered how those I saw attaining the higher le vels of leadership ma naged to get there. Did they have someone-a mentor or superio r-assisting them along the way or were they just trying to navigate their career path on their own? I al so felt that I did not understand my organization’s plans for the future, fo r me and those collea gues around me. As I learned in my coursework how organizations worked, I began to apply the knowledge to my own career. I also began to look critica lly at my organization and the health care industry as a whole. We have such an im portant place in people’s lives, why do we do such a poor job at planning for the future or our organizations. We engage in strategic planning, quality efforts and continuously try to stay ahead of changing laws and regulations, but we spend such little tim e focusing on those who will lead us through these changes. This self-reflection led me to this research. I wanted to know what other health care organizations were doing with succession planning and management. Could we learn from each other? Was the literature co rrect in stating that he alth care lags behind other business and industry? What experiences did other health care l eaders have to share on this topic? Chapter 4 outlined the specific comments and findings were identified. This chapter will discuss how these themes and comme nts relate to the literature and to the theoretical ideologies outlined in Chapter 2. 47 Review of Method Interviews were conducted with health care leaders from or ganizations in the State of Minnesota. There were ten conduc ted in all, encompassing eight different organizations. These organizations ranged in size from relatively small organizations employing 80 employees to extremely large employing 30,000 or more. The interviews conducted were with individuals who were at the Director, Vice-P resident, President, CEO level or equivalent. They were activel y engaged in the development and planning for future needs of their organization’s and were responsible for succession planning activities. These interv iews were audio taped and transc ribed. I spent a large amount of time re-listening to these tapes and reading the transcripts. This process led me to identify specific findings for each question that emer ged from the discussions. I was able to extract these findings from the comments of the participants. After this analysis, I returned to my literature revi ew to validate the findings. Literature Review and the Themes After the findings through the transcripts were identified, I was able to evaluate these in comparison to the lite rature review that was conducted. Much of that information really meshed with the findings of my research. Finding One- Most organizations have some sort of succession planning and management activities, although most not formalized. The literature spoke to the lack of official succession planning and management activities in health care (Norm Devine, pe rsonal communication, 2007). This was true in the organizations represented by the particip ants. Only two of the organizations had a very formalized process in place. Others had some succession planni ng activities but they 48 were hit or miss, while others failed to ha ve any type of articu lated succession planning occurring. This lack of formalized and st rategic planning has b een identified in the literature going back a number of years. What is interesting to me is why this is still occurring. There is a noted deficiency but it ha s not been corrected. Wh y is this? I suspect that this is true because there are so ma ny other needs and changes to respond to that succession planning becomes a “nice to have” rather than a “must do”. Until there is a sense of urgency in these organizations and their attitude toward succession planning, there is no motivation to change. This situat ion may be occurring now with the even more rapidly changing health care environment. Th e passage of the American Recovery and Reinvestment Act (ARRA) and health care refo rm legislation have challenged all health care organizations with new requi rements, regulations and milest ones that need to be met. The challenge for organizations will be to be nimble enough to adapt quickly in order to meet these requirements. Although many busin esses experience rapidly changing work environments, health care seems to be at the forefront of this. Health care is an ever changing environment and is in a very reactio nary state rather than being proactive in how they meet new challenges. If they were to develop solid succession planning efforts, they could turn this tide a nd begin to anticipate change and how to adapt their care models and lead their employees through the changes in a deliberate manner. Developing and implementing formal succession planning pr ograms will be imperative to the survival and success of an organization. Health care will need the right leaders in place in order to survive the changes. Table 3, p. 49, shows the distribution of succession planning and management efforts in the organi zations of the participants. 49 Table 3 Succession Planning Efforts By Participant Succession Planning and Management Efforts Participant Defined Succession Planning and Management Program #2, 3, 4, 7, 9 Informal Succession Planning and Management Efforts #5, 8 No Articulated Succession Planning and Management Efforts #1, 6, 10 Finding Two-Succession planning not well defined in most companies, regardless of having formal or informal programs. During the course of studying the text of the transcripts, it became clear that none of the organizations had a well-defined proce ss for developing their future leaders and identifying talent. The responses ranged from well-defined development programs for their staff to educational oppor tunities to yearly discussions regarding employee progress and development. This lack of consistent development of staff is a big problem for organizations. Solid succession planning and management programs need to have well defined development programs as a foundati on. In the literature, Larson (2005) talks about creating an environment within the organization in which employees grow and flourish as a means of developing strong su ccession planning strategies. Meeting with employees yearly to discuss goals and assi gnments does not provide a solid framework for them to work through. Although that met hod provides a set time for career planning discussion, it puts the responsib ility solely on the employee ra ther than having the more specific guidance of the supervisor or or ganization. There needs to be a clearer mechanism for attaining competency deve lopment, educationa l opportunities and employee development. Table 4 shows the components of best practices that emerged 50 from the interviews and which organizati ons have developed components of these practices. Table 4 Strategies for Succession Planning By Participant Strategies used in Succession Planning and Management within the Organization Participant Tuition Reimbursement # 2, 3, 4, 7 Specific employee development template #2, 3, 4, 7 Internal training opportunities # 1, 2,, 3, 4, 7, 8 Offering developmental assignments (i.e. stretch assignments) within organization # 3, 4, 7, 8, 10 Specific employee development plan # 2, 3, 8 Although not all of the organizations employed these best practices, they can be viewed as components of a successful program if put together. Other indus tries employ many of these tactics, along with looking at succession planning as an integrated process in the organizations. Developing pools of successful candidates for a number of high level jobs instead of investing in just one or two individuals is another best practice seen in business that health care could learn from. Health care may be unique with their focus, but they can still take nuggets of information from business and industry. Finding Three- Communication to employ ees regarding succession planning and management not always clear or consistent. There was a clear message in the interv iews regarding a l ack of communication with employees regarding where they fit in succession planning and management within their organizations. This finding fits in dire ctly with literature on succession planning. Rothwell (2010), speaks of finding that very few organizations make it a practice to 51 inform employees that they are being consid ered as being a successor. A couple of the participants spoke to having their eye on ta lented employees but they had not had any discussion with these employees about their potential within the or ganization. As stated earlier, another spoke of using the yearly performance appraisal process for having discussions with the employee regarding th eir career development prospects. One participant spoke of the very well developed program within their organization, wherein high potential employees were aware of thei r potential and they were encouraged to actively seek out opportunities for further de velopment. This organization also actively worked with their high potential employees to identify projects, assignments and outside educational opportunities to enhance career de velopment. Communication is key to any succession planning and management program. Employees need to know where they fit in the direction and future of their organiza tion. Christie (2005) ta lks of leaders working together to communicate needs and opportunities available to their staff and this is key for organizations if they are to be succe ssful in developing and implementing succession planning and management programs. Byham, Smith & Passe (2002) and Rothwell (2001) also talk about the importance of regular review and feedback of performance to employees. If you are to truly develop tale nt, you need to be having open, honest and frequent communication with th ese individuals in order to set expectations and outline programs for development. Health care organiza tions need to see the importance of this feedback loop and build regular opportunities to meet with supe riors into these programs. Finding Four- Participants feel they need better or more articulated plans to meet the future needs within health care. 52 This finding is an important one. All of the participants felt that they either needed to start formal succession planning effo rts or needed to re-evaluate their current efforts. Health care is an ever changing field and this means that the skills needed to be successful are ever changing. Organizations need to be far-sighted enough to anticipate the skills necessary to take their organizations through the next five to ten years and beyond. They also need to understand the attitu de of their employees. Gone are the days when people stayed in an organization for their entire career. Empl oyees now see that they may need to move around in order to achieve success. Byham, Smith & Pease (2002), speak to the need to have “talent pools ” rather than looking at one individual for each position available. Participant 7 spoke of having a number of individuals prepared to move up and compete for senior leadership pos itions. Participant 3 also spoke of having at least two people identified for specific positions in orde r to give the organization and the employee some choice. Participant 2 and Participant 4 also spoke of having a number individuals to choose from for potential posit ions within their respective departments. These strategies are a good place to start. I think that these pools are focused on the middle to upper levels of management positions , but I think there could be much benefit to employees and the organization as a whole, if this strategy were employed at lower levels. I think there is the potential to miss opportunities to grow emerging talent at a lower level. Keeping people in an organi zation longer has many benefits, such as an understanding of the organi zations culture and operati ons and by developing people earlier on, you gain some of these advantages . Those organizations th at are just in the planning stages of developing a succession planning and management program could do well to use talent pools as a starting point. 53 The most important aspect of succession planning and management is the development of specific competencies fo r leaders. Murphy (2006) discusses the importance of identifying specific competencies necessary for success in different roles. There are some leadership competencies that are consistent for success, while there are many job-specific competencies that need to be identified for each leadership position. Identifying these competencies and clear ly communicating these to employees is paramount in the development of strong ca ndidates for future leadership positions. Employees need to know what skills are necessa ry to be successful in their positions. They also need to know what they need to develop in order to be competitive for promotional opportunities. Finally, there is a sense that wit hout developing specific competencies, communicating with employees and identifyi ng specific development programs that there is no good idea of what is needed for future l eaders. This can lead to the same type of people and ideas continuously being promote d. In the literature, Rothwell (2001) and Byham, Smith & Pease (2002), talk of organi zations becoming very homosocial in their promotional moves. This is the phenomenon of promoting those most like themselves within the organization. Organi zations that do not have well articulated competencies and well developed succession planning programs ar e most at risk of this phenomenon. By promoting the exact same type of leader ove r and over, there is the danger that true change cannot happen, as well as the concern that it will cause an organization to be unable to quickly adapt to the barrage of changes that the future will bring. Finding Five- There is some frustration with personal succession planning and management efforts for themselves. 54 The last finding had to do with personal experiences that the participants had had in their own careers. Their frustrations, tria ls and successes really mirror some of their current programs. None of th e participants had any real development or guidance during their careers. Participant 2 spoke eloquently about feeling that any time they felt ready for a promotion, that they needed to “campaign” in order to be noticed. Pa rticipant 4 felt luck that there had been some strong mentorship to help guide them up to this point but that currently, there was no guidance for future oppor tunities. Participant 7 expressed shock at where their career path had taken them. Ther e had been no one talking with them about their potential or what positions they should be striving to attain. Th ese are just a few of the experiences but the main theme remains the same-hea lth care does not do a good job with succession planning and management. Im agine how different the experiences could have been or could continue to be for these leaders, if they had an understanding of their potential and where they fit in to the organizations strategic plan. Most of them are trying or at least see the need for developing su ccession planning within their organizations. This is an important fact to note. They didn’t think the “status quo” was acceptable and were hoping to change that. Although they may have a long road, the understanding of the need for these programs is a step in the right direction. Theory Revisited In Chapter Two, theory was discussed. Th e following five theories were thought to play a role in successful succession pl anning and management efforts: Trait Theory, Behavioral Theory, Transformational Leadersh ip Theory, Chaos Theory and Situational Theory. It was interesting to see that after conducting the in terviews, only some of these theories had some influence on how and/ or why succession planning programs were 55 developed or not within health care organizations. Of the five theories identified, two really stuck out in how they fit in with the themes. There were two ot her theories that had small mention in the interviews. This section wi ll discuss the themes in relation to theory and also focus most strongly on Situationa l Theory and Transformation Leadership Theory. Understanding those two theories ma y be key to helping organizations develop strong succession planning and management programs. Behavioral Theory is based on distin guishable leadership behavior (Kenney, Blascovich & Shaver, 1994). Ther e are behaviors that identify individuals as leaders in an organization. These behaviors arise in situati ons that set those with leadership potential apart from everyone else. This is an importa nt theory to keep in mind while evaluating individuals for advancement. There are specific behaviors that need to be identified as desirable as an organizati on develops competencies and develops programs for developing their future leaders. There are two components to Behavioral Theory-task oriented or follower oriented leadership. Task oriented leaders are very structured and directive, while follower oriented leaders fo cus on the job at hand and express a greater appreciation for their followers (Holdford, 2003). In order to identify the most successful behaviors desired in future leaders, organi zations should identify those behaviors that result in a balance between the task oriented and follower oriented behavior. Participants identified the need for different behaviors from future leaders. Participants 2 and 3 specifically talked about beha viors exhibited in the workpl ace and how these related to their search and development of emerging tale nt. These behaviors may not have been the same for each organization but each participan t could identify the behaviors that were important to be seen in l eaders in order to grow or sustain their organizations. 56 Chaos Theory plays into the current state of health care. This theory deals with unpredictability and uncertainty. These are two situations ar e what health care workers are dealing with on a daily basi s. The constant changes in regulations and the need to keep up in a rapidly changing environment lead to what can be described as “organized chaos” in many organizations. Merry (1995), stat es that the essence of chaos is change. Remer (2006) states that social systems are in perpetual chaos and that the only degree to which there is any issue is that of how the in teractions manifest themselves. Chaos can be a detriment or a motivator depending on how it affects the staff and operations. Organizations can learn from chaos in that it does have a patter n, and these feedback loops can be used to identif y possible strategies for dealing with the changes. When developing succession planning and manageme nt programs, organizations need to understand how chaos relates to their current s ituation and the skills individuals will need in order to deal with the c onstant change within the orga nization. Participant 5 spoke of trying to keep up with the rapidly changi ng health care environment and the rapid changes in the development of their practice. This was a small group but they were seeing significant growth over a short period of time. This organization was without formal succession planning and management program s. They were thinking of succession planning and wanted to develop these progr ams, but felt they were focused on just keeping up with change and did not have th e luxury of spending time on this activity. Situational Theory Situational Theory deals with how l eaders can and should adapt to changing dynamics of leadership situations. The greatest predictor of leadersh ip effectiveness and success is the situation in wh ich a leader finds themselves (Holdford, 2003). This theory 57 really needs to be taken into consider ation when developing succession planning and management programs. The best opportunities to learn and grow ar e often the challenges that new situations offer us. Participan ts 3,4 and 7 spoke of offering “stretch” assignments or the opportunity to work in different areas. This proved to be a great predictor of success and was useful in ga ining the employee new skills. By showing a strong ability to adapt in situations, employe rs can see if their employees possess this critical component to success. Transformational Leadership Theory Transformational Leadership Theo ry is about achieving results beyond expectations. The central premise is that leaders influence followers by creating meaningful work (Purvanova, Bono & Dz ieweczynski, 2006). These leaders are charismatic, inspirational and provide indivi dualized consideration to their followers (Bass, 1985). These leaders are ca reful to attend to their follo wers’ needs and to be able to identify their followers’ needs for growth and development. Leaders with this style should result in a more engaged, devoted a nd less self-centered employees (Purvanova, Bono & Dzieweczynski, 2006). Understanding this theory is important to those leaders developing succession planning and management programs, as they themselves need to possess these skills and need to be able to id entify and build these skills in their future leaders. Participants 3, 4, 7 and 9 spoke of having emerging leaders in situations that would test their ability to motivate and lead their gr oups through change. Although not stated as Transformational Leadership, per se, the underlying ability they were looking for was to effectively lead and offer meaningful work to others. This theory is imperative 58 to the success of a program, because it focuses on the employee and getting positive results. Themes and Theory There are a number of ways that the themes and words of the participants identified through data immersion correlate with the theories outlined above. I feel that chaos theory runs through all of the them es because of the lack of organization, communication and execution of the programs. A ll of the participants spoke of In order to develop strong succession planning and ma nagement programs, leaders will need to understand that by not formalizing a mechan ism for development and promotion, they will be continuously throwing their organizatio ns into chaos when a replacement for a leadership position occurs. Situational Theory already seems to be ingrained in the practices of many of the organizations. Although succession planning and management preparation is not well- defined, per Theme Two, many of the orga nizations talked about giving “stretch” assignments to staff. This puts them in positions to challenge themselves and see if they have the skills and knowledge to push them to the next level. By seeing if high potential employees have the leadership sk ills to move to the next level, organizations can better plan and prepare their employees. This is an important point to include in any succession planning and management program that is be ing developed and I w ould suggest it as a “best practice”. The knowledge of the importance of Tr ansformational Leadership Theory in developing and supporting a succession planni ng and management program is also paramount. The leaders need to understand thei r own importance in th e process and what 59 skills they bring to the table in terms of empl oyee development. If they want to continue to improve their existing programs or develop ones that are successful, they need to have an understanding of the skills they must possess in order to grow successful leaders. The participants spoke of disappointment in the l ack of involvement of their own managers in developing their leadership track, but ma ny did have mentors or colleagues who possessed the traits of a Transf ormational leader. They were able to be motivated by and encouraged by someone to stretch them selves and reach higher. Having a good understanding of this will assist them in developing programs in which they and other senior leaders will be engaged and active partic ipants in the future of the organization. Summary The biggest take away from the interviews is that the health care organizations really do fit the description of the state of succession planning and the health care industry. Health care organizations across the st ate of Minnesota struggle just like health care organizations across the country. There is a lack of coordinated efforts across most of the organizations identified in this resear ch. There is urgency in these organizations to get solid succession planning and management pr ograms in place to deal with the loss of senior leaders to the mass retirements that will be occurring over the next five to ten years, as well as to continue to stay viable in an ever-changing h ealth care environment. Health care must decide that proper succession planning is vital to the survival of their organizations and this realization needs to be from the top down. CE O’s and other senior leaders must lead this charge and tie it to their strategic planning in order for these processes to become ingrained in their cult ure. Although the job market may be shaky at the present time due to the economy, there wi ll be more and more pressure to keep top 60 performers as the Baby Boom generation reti res. The only way to succeed is to make succession planning more than an exercise that needs to be crossed off the organizational “to do” list. In terms of theory and succession planni ng and management, I would propose that the reason so many programs either fail or have difficulty getting traction within an organization is due to the lack of theore tical foundation for creating and nurturing tomorrow’s leaders. By understanding the ba sic theory underlying their programs, they can begin to develop and implement successi on planning and management efforts that can be easily understood and sustained. Chapter 6 will outline how this research addressed the initial research questions from Chapter 1, as well as offer recomme ndations for developing successful programs and additional research on the topic. 61 CHAPTER 6: CONCLUSIONS AND IMPLICATIONS The research questions asked in this resear ch are: What models of succession planning are used by Health Care Organizations in the State of Minnesota? How are these plans put into effect? and What experiences have health care organizations had in development and implementation of these models? The conclu sions that I reached in this study will be organized according to these questions and w ill be presented fully in this chapter. What Models of Succession Planning are used by Health Care Organizations in the State of Minnesota? There are a number of models for succe ssion planning and management that are being used in health care orga nizations across the state. Some of these models involved matrices that identify those who are currently ready for advancement or those who have potential. Other organizations ha ve detailed profiles on their staff and work closely with them to develop their potential. Still ot hers have no formal programs in place. In conducting the interviews, I was st ruck by how closely reality in these organizations and their succession planning effo rts mirrors what the literature review showed. Health care lags behind industry in their succession planning efforts and these interviews outline the fact that although ma ny organizations say they employ some sort of succession planning, the number of them doing it effectively is very small. Two of the organizations had very stru ctured succession pl ans-one utilizing a matrix, the other, basing their efforts on em ployee performance and development. While they both had these efforts, only one seemed to truly work directly and openly with their employees to gauge interest, select specifi c educational and deve lopmental opportunities and have pools of individuals for specific roles within the organization. A couple of 62 leaders interviewed had well de fined plans for their employees yet these individuals did not have a defined plan for themselves. Their direct supervisors had not had any meaningful conversations with them regard ing further leadership opportunities within their organizations. Other leaders expressed a strong desire to develop a defined succession planning and management program within their organi zations. These organizations tended to be smaller in size and growing their practices. They saw the need to identify the next leaders and to recognize and grow the potential of their current employees. They may not have formal succession planning efforts in place, but are laying the ground work with identifying competencies for administrative staff, providing oppor tunities for stretch assignments and working to guide em ployees to appropriate roles. How Are These Plans Put into Effect? There were different ways in which orga nizations put their succession plans into effect. Some of the organizations worked more on developing plans within specific departments, while others looked at specific roles. A few of the organizations identified speci fic leadership positions that they were targeting with succession planning efforts. This led to the ability to develop high potential employees for a variety of positions with in the organization. Others had succession planning programs implemented first in sp ecific departments and then saw succession planning efforts spread to highe r levels of the organization. The organizations that had not deve loped formal succession planning and management programs had their eye on some sp ecific positions with in the organization that they felt would benefit from ha ving more organized planning efforts. 63 What Experiences Have Health Care Organizations Had in Development and Implementation of These Models? Overall, these health care organizations have not had a lot of experience with developing and implementing succession plan ning and management programs. The well developed models that were e xplained were both fairly new in their implementation so there is not enough information to determine if the efforts will be successful or sustained over time. It is positive to note that they ar e trying. The organizati ons that do not have formal plans seem to be looking for a good model to emulate as they work on development. There also seems to be an underlying sens e of frustration as to how to do this correctly. Participants 3 and 4 both talked of difficulties in getting started with the programs in their departments both with findi ng qualified employees to work with and with finding agreement amongst the leadersh ip teams in terms of what skills and competencies were most desirable. For this study, the smaller the organization, the less succession planning and management they were likely to be involved in. These small organizations did want to do more strategic succession planning but they were primarily focused on growing their practices. The larger organizations had formal programs in place, but it was the mid-sized organizations that seemed to have th e most well-defined and followed succession planning programs. I believe that the mid-sized organizations were solid in their strategic plan and had the time to focus on successi on planning. The largest organizations were formal in their programs as well, but were so big, that succession planning was harder to manage. 64 Implications As I undertook this research, I felt that there would be implications for the health care industry as well as for employees within health care organizations. This section will discuss these implications. Implications for Health Care This research has many implications for health care. It can assist organizations with development of programs, foster a bette r understanding of the needs and challenges in health care and can lead to an understan ding of theory and development to leaders. Pointing out the weaknesses of the curre nt state of succe ssion planning and management can help organizations avoid the pitfalls identified. There is a huge need to engage in planning for the future in organi zations due to the looming retirements and rapidly changing environment. Organizations can use this research to justify the need to expend time, energy and resources towa rd developing succession planning and management programs. By understanding what other health care organizations are doing formally, there can be a better understanding of the current and future needs in their own organizations. This understanding can help with the developm ent of their own programs. There is much to learn from knowing what other organizations are doing and whether or not these programs are successful. Bringing an understanding of theory a nd how it relates to the development of succession planning and management programs is another implication. As noted in Chapter 5, there seems to be a lack of general understanding of theory in health care. By 65 developing an understanding of theory, orga nizations can build programs that have a basis in specific theories, which will allow them to be more successful. Chaos theory really outlines the current state in which I believe health care is functioning. Leaders may balk at that assertion, but the fact is that many organizations are struggling to keep up with the rapid changes occurring and this reac tive mode is keeping them from developing proactive solutions to their leadership gaps. If leaders understand that they are operating in chaos mode that this mode is actually more predictable by understanding chaos theory, there can be the foundation for developing successful development programs for employees. Identifying key behaviors in high potential employees and understanding how these behaviors lead to success or failure in leadership is also paramount. Right now, organizati ons are trying to develop leadership competencies but may be leaving out the ke y behaviors that can predict success more than one specific job skill. An understanding of Behavioral Theory can lead developers of succession planning and management programs to develop programs that help nurture the behaviors that will lead to th e most successful leaders. This can also help weed out from leadership, employees that lack ability to e ngage in the fundamental behaviors that lead to success. Transformational leadership is another theory that needs to be well understood by leaders in health care organizations. If it is imperative that suc cession planning become ingrained in the culture of an organization, it is equally im perative that senior leaders understand their role in making this happen. By understanding that their behavior and engagement is an important aspect of the success of succession planning and 66 management programs, they can develop a program for their employees that exceeds everyone’s expectations. It seems that many of the current progra ms are put together without any basis or understanding of theory and I would propos e that it why they may not be wholly successful. Without an understanding of what factors may be affecting the planning and execution of the programs, these cannot be fully successful. This research will also allow organizati ons to add more layers to their planning. This means that organizations understand that developing solid succession planning means more than just offering classes, but involves an understanding of theory in relation to leadership, developing competencies that cover the skills and traits necessary for successful leadership and offering opportunitie s for employees to stretch and develop their skills. Implications for Employees It is my hope that this research is ab le to be put in practice in health care organizations. If this is the case, high potenti al employees can benefit from this research in more structured succession planning and management programs. By becoming more structured, employees are able to understa nd where they fit in strategically in the organization, what is expected of them and th e tools they have available to them in order to further their careers. Implications for Further Research There are a number of im plications for future research that were identified through this study. They will be discussed below. 67 This research study conducted eleven in pers on interviews. It woul d be interesting to conduct a wider number of interviews in orde r to validate the findi ngs. There are still some health care organizations within the State of Minnesota that were not a part of this study and it would be helpful to understand if their experiences are in line with the eight organizations that were contacted. Another aspect to the study was that it was limited to the state of Minnesota. If further research is to be done , it would be prudent to interv iew leaders in organizations across the United States. This would give furt her credence to literature showing that health care as a whole does a poor job with succession planning and management. Another interesting vein to explore would be to interv iew employees in more sub- ordinate positions, possibly those in lower le vel leadership positions. In the current research, the participants talked of their own frustrations with succession planning and management in their own careers. It would be interesting to see if their subordinates felt the same frustration in thei r own careers. Being able to understand whether or not the impressions of leaders are in sync with thei r employees would be fascinating. I noticed a bit of this in the interviews as a couple of organizations had more than one interviewee. These interviews showed some frustration with the current succession planning process, while the other participant spoke more positively about the process. Being able to validate the impact of succession planning a nd management programs is essential for ongoing success. Recommendations The time has come to discuss recommendations for developing succession planning and management programs in health care organizations. 68 First off, it is imperative that organiza tions identify competencies necessary for the positions at hand. These competencies must then be clearly articulated to employees in order for understanding to occur. The ne xt is for there to be honest and regular dialogue with employees in regard to their pe rformance. Those that are high potential or exceptional performers must be told of their status and steered to development programs, if they so have the desire. Those who do not meet the leadership competencies should also have open, honest feedback and be c ounseled on better career options within the organization or be encouraged to find opportunities elsewhere. Organizations need to have well-d eveloped programs offering training and education to their employees. These can be in ternal, external or a combination, but they need to be offered across the board and be an expectation to participate in order to attain promotional opportunities. Finally, organizations need to see su ccession planning and management as a strategic priority and treat it as such. There seems to be the attitude that succession planning is an optional exercise or that it is something to be checked off on the list of things that have been accomplished duri ng the year. Until leadership sees the development of their employees as paramount to the success of th e organization, I think health care will continue to struggle. My hope is that this research will help convince organizations of the importance of planning for the future by investing in their most precious resource, their employees. 69 REFERENCES Anderson, M.J. (2010). Making the future po ssible: Succession as a component of strategy. Of Counsel, 29:5, May 2010, p. 13-17. Arnone, W.J. (2006). Are employers prepared for the aging of the US workforce? Benefits Quarterly, Fourth Quarter, 7-12. Barnett, R . & Davis, S. (2008). Creating great er success in succession planning. Advances in Developing Human Resources, 10, 721-739, 2008. Bass, B.M. (1985). Leadership and performance beyond expectations. New York: Free Press. Bonczek, M.E., Woodward, E.K. (2006). Who’ll replace you when you’re gone? Nursing Management, 31-34 August 2006,. Bright, J.E.H. & Pryor, R.G.L. (2005). The chaos theory of careers: A user’s guide. The Career Development Quarterly, June 2005, 53, 291-305. Bruce, A. (2001). Leaders start to finish: A ro ad map for developing tr aining leaders at all levels. ASTD. Buckingham, M. & Clifton, D.O. (2003). The tr aces of talent in business leadership, Jossey-Bass. Byham, W.C., Smith, A.B. & Paese, M.J. (2002). Grow your own leaders: How to identify, develop and retain leadership talent. New York, London: Prentice Hall. Cannella, A., Jr. & Lubatkin, M. (1993). Succession as a sociopolitical process. Academy of Management Journal, 36, 763-793. Charan, R. Drotter, S. & Noel, J. (2003). Six leadership passages, in Business Leadership, Jossey Bass. 70 Christie, S. (2005). Succession planning: There are no magic bullets. Policy & Practice, September 2005, 16-17. Edwards lifesciences institutes succession plan ning program, uses success factors tools. Corporate Training and Development Advisor, August 18, 2006, 11, 1-3. Training industry thrives as employment rises, su ccession planning becomes key. Corporate Training and Development, April 28, 2006, 11. 1-3. Duffy, J.A.(2000). The application of chaos theory to the career-plateaued worker. Journal of Employment C ounseling, December 2000, 37, 229-236. Fulmer, R.M. & Goldsmith, M. (2001). The lead ership investment-How the world’s best organizations gain strategic advantage th rough leadership development. New York, Atlanta: AMACOM. Gaffney, S. (2005). Career development as a retention and succession planning tool. The Journal for Quality and Participation, Fall 2005, 7-10. Gandossy, R.P. & Verma, N. (2006). Passing the torch of leadership. Leader to Leader, Spring 2006, 37-44. Gornick, M.E. (2010). Anticipating change. T+D, July 2010, 80. Harrison, M., McKinnon, T. & Terry, P.(2006). Effective succession planning-How to design and implement a succession plan. Training and Development, October 2006, 22-23. Holdford, D.A. (2003). Leadership theori es and their lessons for pharmacists. American Journal of Health-System Pharmacists, 60, 1780-1786. 71 Holtan, E.F. & Burnett, M.F. (1997). Quantita tive research methods in Human Resource Development Research Handbook. R.A. Swanson & E.F. Holtan, editors. San Francisco: Koehler Publishers. Succession planning facts & fantasies. The Journal for Quality and Participation, Fall 2005, 4-6. Kelloway, E.K. & Barling, J. (2000). What we have learned about developing transformational leaders. Leadership and Organization Development Journal, 21, 355-362. Kenney, R.A., Blascovich, J., Shaver, P.R. (1994). Implicit lead ership theories: prototypes for new leaders. Basic and Applied Social Psychology, 15 (4), 409-437. Kesner, I.F. & Sebora, T.C.(1994). Executiv e succession: Past, present and future. Journal of Management, 20, 327-372. Kleinsorge, R. (2010). Expanding th e role of succession planning. T+D, April 2010, 66- 69. Larson, L. (2005). Succession planning: attitude, action. Policy & Practic e, September 2005, 16-17. McAlearney, A.S. (2010). Executive leadership development in U.S. health systems. Journal of Healthcare Manage ment, 55:3, May/June 2010, 206-221. Merry, U. (1995). Coping with uncer tainty: Insights from the new sciences of chaos, self- organization and complexity. Westport, CT: Praeger. Michaels, E., Handfield-Jones, H. & Axelr od, B. (2001). The war for talent. Boston: Harvard Business School Press. 72 Murphy, S.A. (2006). Executive development and succession planning: qualitative evidence. International Journal of Poli ce Science and Management, 8, 253-265. Nadler, D. & Tushman, M. (1999). Strategic imperatives and core competencies for the 21 st century. Organizational Dynamics, 28, 45-60. Paradise, A. (2010). Many barriers in hibit success of succession planning . T+D, June 2010, 60-62. Purvanova R.K., Bono, J.E. & Dzieweczynski , J. (2006). Transformational leadership, job characteristics, and organiza tional citizenship performance. Human Performance, 19 (1), 1-22. Remer, R. (2006). Chaos theory links to mo renean theory: a syne rgistic relationship. JGPPS, Summer, 2006, 55-84. Rothwell, W.J. (2001). Effective succession pl anning-ensuring leader ship continuity and building talent from w ithin. Atlanta: AMACOM. Rothwell, W.J. (2010). The future of succession planning. T+D, September 2010, 51-54. Sieber, J.E. (1992). Planning ethically responsible resear ch: A guide for students and internal review boards. New bury Park: Sage Publications. Wills, G. (1992). Enabling managerial growth and ownership succession. Management Decision, 30, 10-26. Yin, R.K. (2003). Case study research de sign and methods. Thousand Oaks: Sage Publications. 73 LIST OF APPENDICES APPENDIX A Invitation to Participate Letter APPENDIX B Participant Consent Letter APPENDIX C University of Minnes ota, Institutional Re view Board Approval 74 Appendix A: Invitation to Participate You are being asked to participate in a re search study. I, Allison Suhler Hart, am the investigator for this study. I am a doctor al candidate in Work and Human Resource Development at the University of Minnesota a nd these interviews will be the basis for my doctoral dissertation-An In-Depth Evaluati on of Succession Planning and Management in Health Care Organizations. You have been selected to participate because of your current employment at one of the major health care providers in the State of Minnesota. The study is looking at your perceptions of, knowledge of and experiences with succession planning and management in your organization. Your responses will provide valuable information regarding succession planning and management in health care organizations. This interview will require approximately 30-60 minutes of your time to complete. Interviews will be scheduled in a one-on-one, face to face setting. Participation is completely voluntary. If you would like more information about this research or would like to schedule an interview ,please contact me at 507-252-1687 or at [email protected]. Thank you in advance for your participation, Allison Suhler Hart 75 Appendix B: Consent Form CONSENT FORM An In-Depth Evaluation of Succession Pla nning and Management in Health Care You are invited to be in a research study of succession planning and management activities in health care organizations. You were selected as a possible participant because of your leadership position within your organization.. We ask that you read this form and ask any questions you may have before agreeing to be in the study. This study is being conducted by: Allison Suhl er Hart, Ph.D. Candidate, University of Minnesota Background Information The purpose of this study is: Evaluate the succession planning and management efforts that are currently being used in health care or ganizations. I am partic ularly interested in how these plans were developed, put into effect and what the experiences of those in the health care organizations have been with these programs/efforts. Procedures: If you agree to be in this study, we w ould ask you to do the following things: We will schedule a 60 minute time to do a f ace to face or phone interview covering 10 questions regarding succession planning and ma nagement efforts in your organization. These interviews will be audiotaped and then transcribed. I will be the only individual with access to these tapes and no identifying information will be transcribed. Risks and Benefits of being in the Study All studies have some inherent risk to the participant. This study has minimal risk. The biggest risk for this research is that of disclosure: There is the possibility that someone may be able to identify the individual inte rviewed or determine the organization. All precautions will be taken to insure this does not happen. The benefits to participation are: There ar e no benefits to partic ipating in the study. Compensation: There is no compensation offered for this study. 76 Confidentiality: The records of this study will be kept private. In any report that may be published, no information that that may make it possible to identify a subject will be included. Research records will be stored secure ly and only researchers will have access to the records. Audio tape recordings will be destroyed upon their transcription. Voluntary Nature of the Study: Participation in this study is voluntary. Your decision whethe r or not to participate will not affect your current or future relations w ith the University of Minnesota. If you decide to participate, you are free to not answer any question or wi thdraw at any time with out affecting those relationships. Contacts and Questions: The researcher conducting this study is: Alli son Suhler Hart You may ask any questions you have now. If you have questions later, you are encouraged to contact me at 507- 252-1687, [email protected]. My advisor is Rose marie Park at the University of Minnesota. She can be contact ed at 612-625-6267 or at [email protected] . If you have any questions or concerns rega rding this study and would like to talk to someone other than the researcher(s), you are encouraged to contact the Research Subjects’ Advocate Line, D528 Mayo, 420 De laware St. Southeast, Minneapolis, Minnesota 55455; (612) 625-1650. You will be given a copy of this in formation to keep for your records. 77 Appendix C: Institutional Review Board Approval
Research Paper: What is the role of a manager in succession planning in a healthcare organization? To achieve a successful assignment, you are expected to meet the following requirements. Scholarly Ex
Value in the middle: cultivating middle managers in healthcare organizations Alan Belasen MBA Program, Empire State College, Saratoga Springs, New York, USA, and Ariel R. Belasen Department of Economics and Finance, Southern Illinois University Edwardsville, Edwardsville, Illinois, USA Abstract Purpose–Senior executives in healthcare organizations increasingly display preference for a closer handling of operational levels, bypassing middle managers, and de-emphasizing the need to cultivate the next cadre of leaders, creating the potential for leadership and performance gaps. The authors argue that middle managers are a vital resource for healthcare organizations and review the benefits for including them in leadership development and succession planning programs. The paper aims to discuss these issues. Design/methodology/approach–Current theories and common practices in addition to data collected from government sources (e.g. BLS), business and industry surveys and reports (e.g. Moody’s, Witt/Kieffer, Deloitte, American Hospital Association) are used to classify the roles, skills, and strategic value of middle managers in healthcare organizations. Findings–The combination of a greater executive span with less hierarchical depth creates a dual effect of devaluing middle management, and a decrease in middle managers’autonomy. Healthcare middle managers who stay away or lay low further trigger perceptions of low expectations leading to low morale and high levels of stress. Others become hypereffective or develop exit strategies. Major problems are: rising turnover costs; and insufficient attention to succession planning, internal promotion, and leadership development. Practical implications–The outcomes of this study are useful for management development, particularly at times of change. Practitioners and researchers can have a better understanding of the value of middle managers and their development needs as well as the factors and dynamics that can influence their motivation and affect retention. Originality/value–Understanding and implementing the ideas developed in this paper by healthcare organizations and other companies can lead to a drastic change in the current perceptions of the importance of middle managers and should lead to long-term retention, well-being, and extrinsic benefits for both the company and its employees. KeywordsSuccession planning, Healthcare middle management, Hypereffective manager, Middle manager development, Turnover costs, Morale Paper typeViewpoint Introduction TheOccupational Handbook of the Bureau of Labor Statisticsincludes planning, directing, and coordinating medical and health services as the primary responsibilities of middle managers. Middle managers might manage an entire facility or specialize in managing a specific clinical area or department, or manage a medical practice for a group of physicians. Typically they work to improve efficiency and quality in delivering healthcare services; stay current with new laws and regulations for compliance; supervise assistant administrators in large facilities and manage finances such as patient fees and billing. Middle managers also create and monitor work Journal of Management Development Vol. 35 No. 9, 2016 pp. 1149-1162 © Emerald Group Publishing Limited 0262-1711 DOI 10.1108/JMD-12-2015-0173 Received 8 December 2015 Revised 1 June 2016 Accepted 31 July 2016 The current issue and full text archive of this journal is available on Emerald Insight at: www.emeraldinsight.com/0262-1711.htm 1149 Middle managers in healthcare organizations schedules and represent the facility at investor meetings or on governing boards. They keep records of the facility’s services such as number of inpatient beds used; as well as communicate with members of the medical staff and department heads (Bureau of Labor Statistics, 2016). Nevertheless, many middle managers,having reported feelings of being underappreciated, typically point to the lack of information or poor communication from senior executives (Belasen, 2014). Studies show that middle managers operate within the realm of difficult policies, procedures, and guidelines (Morris and Upchurch, 2012), and without a consistent flow of communication from the top, are often left unsure of what is required of them (Dance, 2011). Currie (2006) describes middle managers in healthcare settings as reluctant but resourceful individuals operating at the junction of top-down and bottom-up predicaments with the constant need to revalidate their worthiness. Middle managers have been perceived as intermediaries that impede organizational efficiency (Embertson, 2006) such that some scholars have pondered whether or not middle managers are necessary within an organizational structure (Hamel, 2011). Have middle managers’roles been undervalued as top executives are prepared to handle the new healthcare regulatory requirements (Belasenet al., 2015)? Are healthcare middle management roles still tenable? Are they well regarded and targeted for succession planning? Are middle managers in healthcare organizations well prepared for new structural challenges? Insufficient middle manager development could lead to the risk of burnout, rising turnover costs as well as and undermining succession planning. Reportedly, higher turnover rates among middle managers might also weaken organizational performance and diminish the vital connection between strategy thinking and planning and implementation (McKinneyet al., 2013). In this paper we discuss the significant role of middle managers in healthcare organizations operating in environments of change, the importance of recognizing the conditions leading to low morale, and the rising costs of turnover and leadership discontinuity in healthcare organizations. We then address the need for building a strong talent pipeline through middle manager development. Roles and skills According to the Bureau of Labor Statistics (2016), as of 2014-2015, middle management has made up 7.6 percent of the US workforce, which has equated to roughly 10.8 million managers. In the healthcare industry, the 333,000 middle managers are an important part of the organizational resources, with most working in state, local, and private hospitals (39 percent); ambulatory healthcare services (26 percent); group medical services and outpatient healthcare centers (16 percent); nursing and residential care facilities (11 percent); and government (8 percent). Employment of medical and health services managers is projected to grow by 17 percent from 2014 to 2024, much faster than the average for all occupations. The median annual wage for medical and health services managers was $94,500 by mid-2015. Most medical and health services managers work in offices in healthcare facilities, including hospitals and nursing homes, and group medical practices. In hospitals, for example, middle managers convert strategic goals into actionable improvement plans at the department or work unit level, engage employees in safety and quality assurance efforts through CQI and Kaizen, and identify processes for continuous improvement. A sample of these roles appears in Table I. Middle managers act like a resource to first line supervisors and peer managers and are on the lookout for 1150 JMD 35,9 tradeoffs that often escape the attention of senior executives and that are essential for the performance of the organization (Osterman, 2009). They use a variety of channels to respond to questions, give feedback, and help increase employee satisfaction (Madlock, 2008). Some scholars would liken a middle manager’s responsibilities to those of a strategist or change architect who facilitates the communication about corporate thought, action, and results (Pappaset al., 2004; Wooldridgeet al., 2008). Middle managers with active involvement in the strategy process have been found to demonstrate higher levels of commitment to organizational goals and contribute to the success of strategic initiatives (Beck and Plowman, 2009; Huy, 2001; Vila and Canales, 2008). Furthermore, evidence suggests that middle managers’upward leadership and downward influence appear to affect the alignment of organizational activities within the strategic context. They instigate change in communications with executives and help implement innovation in interactions with lower levels (Belasen and Rufer, 2013; Floyd and Lane, 2000; Rouleau and Balogun, 2011). A variety of healthcare occupations bring with them different cultures and communication practices that must be bridged and mobilized from the middle-out for optimal operations. Middle managers make substantial qualitative and quantitative contributions to their organizations, and have the know-how to move work forward with tact and velocity. They understand the complexity of their work environment and feel energized by being the conduit between corporate thought, action, and outcomes (Haneberg, 2010). As a result, they are able to provide much richer views to problem solving communication with diverse insights. Middle managers are centrally located within the chain of command and typically perform or directly influence three important tasks: first, technical tasks linked to the operating core, routines, and compliance; second, people tasks involving leading frontline teams, motivating, and guiding employees; and; third, strategic tasks associated with financial reports, analysis of continuous improvement projects and participation on boardroom discussions (Belasenet al., 2015). They work to accomplish core tasks and ensure continuity, keep the organization going and attain positive organizational outcomes. Middle managers implement strategy, translate goals from executive level to lower levels, create local relevance, interpret shifting contexts, clarify words and actions of executives, and promote organizational discourse. A sample of their skills and abilities appears in Table II. Nursing home administratorsManage staff, admissions, finances, facilities and care of residents in nursing homes Clinical managers Oversee specific departments, such as nursing, surgery, or physical therapy, with responsibilities based on the particular specialty. Clinical managers set and carry out policies, goals, and procedures for their departments, evaluate the quality of work processes and write reports and budgets Health information managersResponsible for the maintenance and security of patient records. They must stay up to date with evolving information technology, current and proposed laws concerning health information systems. Health information managers must also ensure that databases are complete, accurate, and accessible only to authorized personnel Assistant administratorsWork under senior executives in larger facilities and often handle routine decisions. They also direct activities in clinical areas such as nursing, surgery, therapy, medical records, or health information Source:www.bls.gov/ooh/management/medical-and-health-services-managers.htm#tab-2 Table I. Roles and responsibilities 1151 Middle managers in healthcare organizations Middle managers’central position within the hierarchy reinforces their mediation roles in interpreting critical events and creating shared meaning (Beck and Plowman, 2009). As opinion leaders within the communication network of healthcare settings (Pappas et al., 2004; Valentino, 2004), they also act as“sense-makers”to frontline employees (Rouleau and Balogun, 2011). They balance competing commitments for change and continuity (Vilkinas and Cartan, 2006), provide structure and direction and react to the emotional needs of employees for consistency, dependability, and clarity (Belasen and Frank, 2010). Middle managers’duality of operating experience and proximity to decision makers make their“clutch roles”during transitions critical for organizational success. They search for new opportunities, evaluate the merits of strategic initiatives and propose new projects (Mantere, 2008). In healthcare organizations, middle managers make significant contributions across the healthcare organization in their roles of entrepreneur, communicator, therapist, and stabilizer (Embertson, 2006). A crack in the armor The Affordable Care Act (ACA) has fueled a large number of mergers within the healthcare industry as it altered the way insurance companies reimburse healthcare providers and the drive toward more efficient outpatient. Simultaneously, we are seeing significant convergence across industry sectors, blurring the lines between payers and providers (Woodson, 2015) as most integration occurs clinically or financially, horizontally or vertically, and the relationships can range from loose affiliations to complete mergers (American Hospital Association, 2014). The results have been notable: 105 deals were initiated in 2012 alone, up from 50 to 60 annually in the pre- ACA years (Wall Street Journal, 2013). This number jumped to 140 in 2014 (Gamble and Sachs, 2015). The report of Moody’s (2015) on healthcare trends also projects a continued consolidation in the healthcare industry in 2016 and beyond. To meet the new challenges hospitals have been re-instituting reforms and structural changes including team-based design, inter-professional collaboration, and shared leadership that worked well in the past (Alvesson and Sveningsson, 2003). Shared leadership in healthcare organizations and other contexts is well documented in the current literature (Chreimet al., 2010; Deniset al., 2010). These changes, however, were needed primarily in response to integration challenges at the operational level since work units in healthcare are particularly specialized with little opportunity for organizational synergy (Gilmartin and D’Aunno, 2007; Tucker and Edmondson, 2003). Analytical and adaptation skillsEnable understanding of current regulations, new or proposed policies Communication skills Help facilitate exchanges with executives, peer managers and health professionals Detail oriented Allow middle managers to organize and maintain scheduling and billing information for very large facilities such as hospitals Interpersonal skills Support effective communication with physicians, staff, and patients; Problem solving Provide creative solutions to staffing or other administrative problems; Innovation Source of innovation and the ability to respond to stakeholder expectations. Technical skills Keep currency with advances in healthcare technology and familiarity with coding and classification software and electronic health record (EHR) systems as facilities adopt these technologies Source:www.bls.gov/ooh/management/medical-and-health-services-managers.htm#tab-4 Table II. Skills and abilities 1152 JMD 35,9 At the same time, healthcare units and teams operate in environments that are largely influenced by broader institutional goals (Finnet al., 2010) where middle managers are most needed for guiding and directing frontline teams to carry out the mission (Shaw, 2005). Yet, detractors have continued to call for the elimination of middle management through delayering (Hamel, 2011). Delayering by which senior executives become directly connected with lower levels has the dual effect of increasing executive span and decreasing depth through functional centralization. Evidence suggests that the number of managers reporting directly to the CEO has increased steadily from an average of 4.4 in 1986 to 8.2 in 1998 (Rajan and Wulf, 2006). At the same time, the number of positions between the CEO and department managers (or division heads) has decreased by more than 25 percent. These trends have dominated non-medical industry Fortune 500 companies as well (Neilson and Wulf, 2012). While the elimination of middle management layers has pushed some decision making down to the frontlines and provided companies greater flexibility in responding to customers, research shows that the addition of senior executives (e.g. finance, legal, marketing, R&D) and corporate staff roles to the C-suite added to the CEO’s span of control and shifted decision making power up, not down (Guadalupeet al., 2012). In hospital settings and health systems, frustrated middle managers react to their loss of autonomy by sliding out to isolated, out-of-reach positions, in effect choosing an avoidance strategy (Garcia, 2006). Unable to handle cross-over pressures, they tend to stay away or lay low, fueling the image of“uncommitted managers”(Carlstrom, 2012). Behavioral economists suggested that the most basic human desires are meaningful validation and appreciation, the key drivers for work motivation (Ariely et al., 2008). Rather than providing them assurances, hospital administrators react harshly by typecasting middle managers as abdicators or low performers that must be further avoided or by-passed. When their valuable contributions go unnoticed by senior executives who frequently favor a non-affective task focus (Huy, 2011), middle managers experience negative feelings of“forgotten practitioners”(Hayes, 2005). The constant pressure on middle managers to focus on daily routines away from strategic circles places them in sink-or-swim predicaments creating the impression that middle management is an occupation whose autonomy is largely constrained (Osterman, 2009). Having the dreadful task of absorbing the discontent of upper and lower levels yet without much decision-making authority, middle managers tend to internalize failure and suffer higher rates of depressive symptoms and anxiety than those at the top or bottom. Symptoms of depression were reported by 18 percent of the supervisors and managers compared to 12 percent for employees (Prinset al., 2015). Occupying what the researchers labeled“contradictory-class location,”middle managers are expected to enforce strategic policies from the top–ones they did not develop–on subordinates who might object to those new policies. They feel increasingly isolated from the management team, lose confidence in their judgmental abilities and, uncertain about their future–respond by shifting commitments. It is the diminished role in decision making, the freedom to determine“how to get there,”the making of the decision, not the execution, that is demoralizing (Belasen, 2014). Trapped, stressed, and unappreciated The way executives relate to their middle managers is subtly influenced by what they expect of them. If their perceptions of mediocrity lead to setting up low expectations, the productivity of the affected middle managers is likely to be perceived as poor, 1153 Middle managers in healthcare organizations which in turn reinforces that initial perception of unmotivated middle managers (Belasen and Fortunato, 2013). They are perceived as mediocre or weak performers who tend to live down to the low expectations that senior executives have set out for them, in effect perpetuating a vicious cycle of perceived incompetence (Manzoni and Barsoux, 2002). This self-reinforcing process, prime for conditions of failure, is also known as the Pygmalion effect (Livingston, 1969). Pygmalion refers to a person who consciously or unconsciously is aware of an expectation and acts in a way that is consistent with that expectation. When the emotional impact of the work middle managers perform is not acknowledged, they further feel lonely, unhappy and abandoned (Kuyvenhoven and Buss, 2011). More than two decades ago Jackson and Humble (1994) observed similar behavioral responses:“As steep hierarchies have flattened, opportunities for promotion have disappeared; many remaining middle managers feel cheated and trapped”(p. 17). Zenger and Folkman (2014) examined the demographic characteristics of unhappy employees among more than 320,000 individuals in a variety of organizations and found that 16,000 (5 percent) were middle managers. The main sources of unhappiness included poor leadership as the number one reason followed by“no career or promotion opportunities,”“work lacks meaning and purpose,”“being treated unfairly compared with others,”“feeling under-appreciated,”“overworked,”and“viewing the organization as inefficient and ineffective.”For healthcare organizations with fairly narrow profit margins–turning that 5 percent around could have a dramatic effect on the bottom line –especially since 48 percent of the middle managers reported that they plan to leave their current jobs in two years or less (McKinneyet al., 2013). Deloitte Consulting LLP (2014) reports that 79 percent of business and HR leaders worldwide believe they have significant retention and engagement issues. Becoming hypereffective Conscious about the likelihood of being eliminated, demoted, or by-passed, surviving or hopeful middle managers attempt to“prove their premium”by working excessively hard, becoming hypereffective (Belasen, 2012). Pressure to increase hours at work comes from the need to perform their roles better but also from the need to pick up the slack left from those who remained uninvolved or were let go. On the surface, hypereffective managers appear more productive and with a greater desire to achieve organizational goals. However, a great deal of personal time is lost in order to maintain or achieve the goals of the organization, often leading to role tension and cognitive dissonance (McConville, 2006). There is a tradeoff in that hypereffective managers find fewer opportunities to diminish the performance of some roles in order to increase their attention to other roles (Belasen and Frank, 2004). Hypereffectivity may sound good as it tends to transform middle managers into conservative and overworked managers who are pushed to the limits by the expectations of those above them who demand nothing short of better results. However, the pattern of change in the tasks and responsibilities underlying the roles performed by hypereffective managers suggests a severe loss of discretionary time and an increase in the sense of powerlessness (Belasenet al., 1996). Interviews with surviving middle managers by these authors revealed that they work more and produce more with the same pay, often without recognition. Others have inherited more tasks and greater responsibilities that require monitoring, not necessarily decision making (Belasenet al., 2015). As discussed below, added responsibilities coupled with insufficient middle manager development lead to burnout and higher rates of turnover which subsequently undermine succession planning. 1154 JMD 35,9 The dual challenge of transition and turnover Turnover can cost a hospital as much as 5.8 percent in lost revenues with turnover among middle managers accounting for as much as 34 percent of those losses (Waldmanet al., 2004). According to the American Hospital Association (2013) the percentage of hospitals with negative operating margins in 2011 was 30.5 percent. By concentrating on reducing turnover an organization could possibly improve its operating margin. The healthcare industry is growing and the need for healthcare managers is expanding so hospitals and other healthcare organizations will be competing over the same human capital resources. In fact, employment of medical and health services managers in the USA is estimated to grow 23 percent by 2022, much faster than the average in other sectors. To reduce turnover, executives must build a culture of trust and employability, revamp middle manager development programs and promote from within. Are executives prepared for these challenges? Prior to the massive consolidation in the healthcare industry in 2013-2016, healthcare CEOs were delaying their departure from their posts with 54 percent indicating that they have no plans to retire any time soon despite the fact that 73 percent of them are between the ages of 55-62 and 24 percent are age 63 or above (Witt Kieffer, 2012). Over 51 percent of the surveyed CEOs by Witt Kieffer (2012) indicated that they have worked with the senior management team to identify potential successors; 39 percent have developed a formal planning process with their boards; 34 percent mentored their successors; and 29 percent have identified a successor to step into their roles. At the same time, 63 percent claimed that they are“too young”to retire. While they understand the importance of grooming the next successor, they do not see this as an urgent matter. Meanwhile, overburdened and undertrained middle managers have been on the verge of burning out, just as they were being considered for fewer senior leadership roles (McKinneyet al., 2013). Recently, however, the movement of hospital CEOs out of their positions has begun to shift. Challenger, Gray & Christmas, Inc. (2015) survey found that of the 1,246 CEO changes in 2013, healthcare led the way with 265 departures. In 2014 the number of announced departures jumped to 294, an increase of 10.9 percent. In 2015, out of the 230 CEO departures in the healthcare industry, 137 CEOs stepped down from their hospital positions. As CEOs exited the workforce, the problem of how and who will fill the gaps left behind became even more acute as many organizations were unprepared to handle these departures systematically. With rising CEO turnover rates, hospitals need to develop adequate succession programs to identify and train new leaders. Moreover, these programs should build a strong talent pipeline with those already working within the organization, especially since it costs less to develop and retain a cadre of leaders in-house than to hire and train new managers (Dubeet al., 2010). Grooming middle managers for senior leadership positions makes sense. Middle managers who are appreciated and are also targeted for upward mobility are more satisfied, productive, and committed. This aligns well with senior executives’goal to reduce the financial burden of turnover (Coyneet al., 2010). Additional mitigated costs are opportunity costs, e.g., retraining replacement employees and by-product costs, e.g., adverse patient outcomes and low energy levels often exhibited by staff during stressful situations. Value in the middle Birkenet al.(2012) sought to identify the relative contribution of middle managers to innovation-related outcomes and found that their influence on employees was 1155 Middle managers in healthcare organizations positively related to outcomes of effectiveness, competitive positioning, operating efficiency, and financial performance. Variation in healthcare quality was related to either circumvention of middle managers or poor communication of key strategic and clinical information across sites, units, and teams. Mollick (2012) found that it was middle managers, rather than innovators or organizational strategies, who best explain variation in firm performance. Managers accounted for 22.3 percent of the variation in revenue among projects, as compared to just over 7 percent explained by innovators and 21.3 percent accounted by organizational strategy. Even in a young industry that rewards creative and innovative products; innovative roles explain far less variation in firm performance than do managers. While innovators may come up with new ideas and concepts, middle managers play a critical role in determining which ideas are given priority and support (Belasen and Rufer, 2013). The lack of proper presence of middle management in innovation implementation can stymie hospital turnaround (Freed, 2005), especially since middle managers help remove barriers to problem solving, stimulate innovation and execute strategic change (Currie, 2006). Another study found that while the majority of the change efforts failed – the hallmark of the successful 32 percent was the involvement of mid-level managers two or more levels below the CEO (Tabrizi, 2014). Pearceet al. (2009) found that while the leadership of CEOs is of enormous importance, the truly high performing organizations are the ones led by teams. Our experience shows that in hospitals middle managers have been able to shift from team builder to team leader and effectively initiate inter-professional collaborative efforts (Belasen, 2013). Discussion and conclusions Research has shown that healthcare management practices are founded on a culture and tradition of hierarchical hospital leadership. Conversely, successful strategic implementation in healthcare organizations is mostly the result of interfunctional collaboration and effective middle management (Belasen, 2014; Skela and Pagon, 2008). Unfortunately, the inclusion of middle managers in leadership development and succession planning has been found to be extremely poor. As discussed earlier, healthcare executives are not placing enough emphasis on cultivating the next cadre of leaders that will be required to sustain competitive advantage and business continuity. Often the importance of involvement in decision making and strategizing is taken for granted by top executives who leave overwhelmed middle managers, tied to tasks and operational issues, without the ability to step forward and exhibit their stronger strategizing skills (Lam, 2015). The feelings of being undervalued or unappreciated can be carried over and lead to anxiety and depression or even to the hypereffective conundrum discussed above. Embertson (2006) argued that the role of middle managers in strategic formulation and implementation has largely been overlooked and makes a strong and compelling case for effective middle management development in healthcare organizations. Well-designed leadership development programs and succession planning along with willingness by senior executives to acknowledge the“value in the middle”and promote from within can create the pathways to bridging the leadership gap in healthcare organizations. These observations point to a critical area where succession planning practices can and should be improved–the CEO and the board need to initiate the selection of internal candidates and ensure their preparation to lead and manage organizational transitions (Belasenet al., 2015). Senior executives should set out realistic expectations that lead to positive outcomes and that are relevant for middle 1156 JMD 35,9 managers (Alvarez, 2007; McGurk, 2010). It is important, however, that middle managers communicate their indispensability to senior executives (Zengeret al., 2011). They need to take the vision and goals of organizational leadership and cascade them appropriately so that frontline teams are aligned with that vision. Davenport and Harding (2010) recommended that middle managers become“off-stage managers”who focus on managing the environment, not the people. The off-stage manager creates an enabling and empowering environment where frontline teams and employees are entrusted with discretionary power to identify issues and solutions. Similarly, Kelly and Nadler (2007) suggested that middle managers should shift their focus to influencing processes and decisions, rather than controlling them. Sliding up to a governance role or down to an advocacy role, for example, could allow middle managers to use their repertoire of roles flexibly, especially during organizational change (Hales, 2006). Giving value to middle managers, as well as any employees, is one of the keys to inspire people, increase their performance and improve their leadership capacity. Understanding and implementing the ideas developed in this paper by healthcare organizations and other companies could lead to a drastic change of the current perception of the importance of middle managers as well as lead to a long-term retention, well-being and benefits for both the organization and its employees. Directions for future research Raelin and Cataldo (2011) found that middle management represents a highly relevant case to investigate a variety of organizational situations where a lack of empowering interface was an important factor in the failure of change implementation. We believe that this failure could be also viewed as cause or consequence of the reduction of the middle managers autonomy and control and therefore should be the subject of further research. Pink (2009), for example, argued that intrinsic motivation needs to take a prominent role in communicating and motivating employees, with a focus on giving them more autonomy, more opportunities for mastery, and to build consensus around organizational purpose. Both longitudinal and cross-sectional studies can help evaluate the overall effects of bypassing middle managers on organizational performance. Studies can also be designed to evaluate the ways by which healthcare CEOs and their boards initiate the internal selection of successors to ensure leadership continuity, support the development of middle managers, and respond effectively to strategic and structural challenges. Belasen and Frank (2010) confirmed the existence of primary message orientations used by managers with those reporting to them. They also quantified the extent of the shift of message orientations in environments of change. An interesting area of research could involve the message orientations used specifically between senior executives and middle managers with the goal of demonstrating the importance of middle management. References Alvarez, R. (2007),“Putting the Pygmalion effect to work in modernizing healthcare”,HCIM&C, 2nd Quarter, April, pp. 6-7, available at: http://castleknockcommunications.com/PDF/CHI_ Alvarez_2007.pdf Alvesson, M. and Sveningsson, S. (2003),“The great disappearing act: difficulties in doing ‘leadership’”,Leadership Quarterly, Vol. 14 No. 3, pp. 359-381. 1157 Middle managers in healthcare organizations American Hospital Association (2014),“American Hospital Association”, available at: www.aha. org/content/14/14mar-provintegration.pdf American Hospital Association (2013),“Trends affecting hospitals and health systems”, TrendWatch Chartbook, p. 39, available at: www.aha.org/research/reports/tw/chartbook/20 13/13chartbook-full.pdf Ariely, D., Kamenica, E. and Prelec, D. (2008),“Man’s search for meaning: the case of Legos”, Journal of Economic Behavior & Organization, Vol. 67 Nos 3-4, pp. 671-677. Beck, T. and Plowman, D. (2009),“The role of middle managers in animating and guiding organizational interpretation”,Organization Science, Vol. 20 No. 5, pp. 909-924. Belasen, A.T. (2012),Developing Women Leaders in Corporate America: Balancing Competing Demands, Transcending Traditional Boundaries, Praeger, Santa Barbara, CA. Belasen, A.T. (2013),Middle Managers: The Unsung Heroes in Transforming Healthcare Organizations, Association of University Programs in Health Administration, Monterey, CA. Belasen, A.T. (2014),“The ambiguous and underappreciated role of middle managers in healthcare organizations”, paper presented at the Academy of Management Meeting, Healthcare Division, Philadelphia, PA. Belasen, A.T. and Fortunato, M. (2013),“Situational motivation: challenging the binary”, in Michele Paludi (Ed.),Implementing Best Practices in Human Resources, Praeger, Santa Barbara, CA, pp. 173-196. Belasen, A.T. and Frank, N.M. (2004),“The perceptions of human resource managers of the shifting importance of managerial roles in downsizing organizations”,International Journal of Human Resources Development and Management, Vol. 4 No. 2, pp. 144-163. Belasen, A.T. and Frank, N.M. (2010),“A peek through the lens of the competing values framework: what managers communicate and how”,The Atlantic Journal of Communication, Vol. 18 No. 5, pp. 280-296. Belasen, A.T. and Rufer, R. (2013),“Innovation communication for effective inter-professional collaboration: a stakeholder perspective”, in Pfeffermann, N., Minshall, T. and Mortara, L. (Eds),Strategy and Communication for Innovation, 2nd ed., Springer, Heidelberg, pp. 227-240. Belasen, A.T., Benke, M., DiPadova, L.N. and Fortunato, M.V. (1996),“Downsizing and the hyper- effective manager: the shifting importance of managerial roles during organizational transformations”,Human Resource Management Journal, Vol. 35 No. 1, pp. 87-118. Belasen, A.T., Eisenberg, B. and Huppertz, J. (2015),Mastering Leadership: A Vital Resource for Healthcare Organizations, Jones & Bartlett Learning, Boston, MA. Birken, S., Shoou-Yih, D. and Weiner, B. (2012),“Uncovering middle managers’role in healthcare innovation implementation”,Implementation Science, available at: www. implementationscience.com/content/7/1/28 (accessed December 5, 2015). Bureau of Labor Statistics (2016),US Department of Labor, Occupational Outlook Handbook, 17th ed., Medical and Health Services Managers, Washington, DC, available at: www.bls.gov/ ooh/management/medical-and-health-services-managers.htm (accessed May 22, 2016). Carlstrom, E.D. (2012),“Middle managers on the slide”,Leadership in Health Services, Vol. 25 No. 2, pp. 90-105. Challenger, Gray and Christmas Inc. (2015),“CEO report”, available at: www.challengergray.com/ press/press-releases/2015-december-ceo-report-114-ceos-out-december-bring-yearly-total-1221 Chreim, S., Williams, B., Janz, L. and Dastmalchian, A. (2010),“Change agency in a primary healthcare context: the case of distributed leadership”,Health Care Management Review, Vol. 35 No. 2, pp. 187-199. 1158 JMD 35,9 Coyne, K.P., Coyne, S.T. and Coyne, E.J. (2010),“When you’ve got to cut costs–now”,Harvard Business Review, Vol. 88 No. 5, pp. 74-82. Currie, G. (2006),“Reluctant but resourceful middle managers: the case of nurses in the NHS”, Journal of Nursing Management, Vol. 14 No. 1, pp. 5-12. Dance, A. (2011),“The ambiguity of the middle management role”,availableat: www.managerperformance.co.uk/wp-content/uploads/2015/02/Ambiguity-of-the-Middle- Manager-Role.pdf (accessed October 15, 2015). Davenport, T. and Harding, S. (2010),Manager Redefined: The Competitive Advantage in the Middle of Your Organization, Jossey-Bass, San Francisco, CA. Deloitte Consulting LLP (2014),“Global human capital trends 2014: engaging the 21st-century workforce”, available at: http://d27n205l7rookf.cloudfront.net/wpcontent/uploads/2014/03/ GlobalHumanCapitalTrends_2014.pdf (accessed December 1, 2015). Denis, L., Langley, A. and Rouleau, L. (2010),“The practice of leadership in the messy world of organizations”,Leadership, Vol. 6 No. 1, pp. 67-88. Dube, A., Freeman, E. and Reich, M. (2010),Employee Replacement Costs, Institute for Research on Labor and Employment, Berkeley, CA, available at: http: //escholarship.org/uc/item/7kc2 9981 (accessed December 1, 2015). Embertson, K. (2006),“The importance of middle managers in healthcare organizations”,Journal of Healthcare Management, Vol. 51 No. 4, pp. 223-232. Finn, R., Currie, G. and Martin, G. (2010),“Teamwork in context: institutional mediation in the public service professional bureaucracy”,Organization Studies, Vol. 31 No. 9, pp. 1069-1097. Floyd, S. and Lane, P.J. (2000),“Strategizing throughout the organization: managing role conflict in strategic renewal”,Academy of Management Review, Vol. 25 No. 1, pp. 154-177. Freed, D.H. (2005),“Hospital turnarounds: agents, approaches, alchemy”,Healthcare Manager, Vol. 24 No. 2, pp. 96-118. Gamble, M. and Sachs, B. (2015),“60 statistics and thoughts on healthcare, hospital and physician practice M&A”,BECKER’s Hospital Review, July 22, available at: www. beckershospitalreview.com/hospital-transactions-and-valuation/60-statistics-and-thoughts- on-healthcare-hospital-and-physician-practice-m-a.html (accessed October 1, 2015). Garcia, V.C. (2006),“Putting conflict management into practice: a nursing case study”,Journal of Nursing Management, Vol. 14 No. 3, pp. 201-206. Gilmartin, M.J. and D’Aunno, T.A. (2007),“Leadership research in healthcare: a review and roadmap”, in Walsh, J. and Brief, A.P. (Eds),Academy of Management Annals, Lawrence Earlbaum Associates, NJ, pp. 387-438. Guadalupe, M., Wulf, J. and Li, H. (2012),“The rise of the functional manager changes afoot in the C-suite”,The European Business Review, May-June, pp. 9-13, available at: www.european businessreview.com/?p=2887 (accessed October 15, 2015). Hales, C. (2006),“Mowing down the line, the shifting boundary between middle and first-line management”,Journal of General Management, Vol. 32 No. 2, pp. 31-55. Hamel, G. (2011),“Let’s fire all the managers”,Harvard Business Review, Vol. 89 No. 12, pp. 48-60. Haneberg, L. (2010),The High Impact Middle Manager: Powerful Strategies to Thrive in the Middle, ASTD Press, Alexandria, VA. Hayes, D. (2005),“New effort to boost middle manager skills is under way”,Community Care, Vol. 1559 No. 4, pp. 1-2. Huy, Q.N. (2001),“In praise of middle managers”,Harvard Business Review, Vol. 79 No. 8, pp. 72-79. 1159 Middle managers in healthcare organizations Huy, Q.N. (2011),“How middle managers’group focus emotions and social identities influence strategy implementation”,Strategic Management Journal, Vol. 32 No. 13, pp. 1387-1410. Jackson, D. and Humble, J. (1994),“Middle managers: new purpose, new directions”,Journal of Management Development, Vol. 13 No. 3, pp. 15-21. Kelly, J. and Nadler, S. (2007),“Leading from below: CEO’s can’t change companies on their own; the secret is to foster a leadership mentality throughout the ranks”,The Wall Street Journal, March 3. Kuyvenhoven, R. and Buss, C. (2011),“A normative view of the role of middle management in the implementation of strategic change”,Journal of Management and Marketing Research, Vol. 8 No. 1, pp. 1-14. Lam, B. (2015),“The secret suffering of the middle manager”, available at: www.theatlantic.com/ business/archive/2015/08/middle-managers-stress-depression/402193/ (accessed December 1, 2015). Livingston, J.S. (1969),“Pygmalion in management”,Harvard Business Review, July-August, pp. 81-89. McConville, T. (2006),“Devolved HRM responsibilities, middle managers and role dissonance”, Personnel Review, Vol. 35 No. 6, pp. 637-653. McGurk, P. (2010),“Outcomes of management and leadership development”,The Journal of Management Development, Vol. 29 No. 5, pp. 457-470. McKinney, R., McMahon, M. and Walsh, P. (2013),“Danger in the middle: why middle managers aren’t ready to lead”, Harvard Business Publishing Corporate Learning, Boston, MA, pp. 1-8, available at: www.harvardbusiness.org/sites/default/files/PDF/17807_CL_ MiddleManagers_White_Paper_March2013.pdf (accessed May 12, 2015). Madlock, P. (2008),“The link between leadership style, communicator competence, and employee satisfaction”,Journal of Business Communication, Vol. 45 No. 1, pp. 61-78. Mantere, S. (2008),“Role expectations and middle manager strategic agency”,Journal of Management Studies, Vol. 45 No. 2, pp. 294-316. Manzoni, J.F. and Barsoux, J.L. (2002),The Set-up-to-fail Syndrome: How Good Managers Cause Great People to Fail, Harvard Business School Press, Boston, MA. Mollick, E.R. (2012),“People and process, suits and innovators: the role of individuals in firm performance”,Strategic Management Journal, Vol. 33 No. 9, pp. 1001-1015. Moody’s (2015),“Global healthcare industry will see continued rise in demand, budgetary pressures in 2016”, available at: www.moodys.com/research/Moodys-Global-healthcare- industry-will-see-continued-rise-in-demand–PR_340985 (accessed March 15, 2016). Morris,J.andUpchurch,B.(2012),“The practices of successful middle managers”, available at: www.businessknowhow.com/manage/successful-manager.htm (accessed December 1, 2015). Neilson, G.L. and Wulf, J. (2012),“How many direct reports?”,Harvard Business Review, Vol. 90 No. 4, pp. 113-119. Osterman, P. (2009),The Truth about Middle Managers: Who They Are, How they Work, Why They Matter, Harvard Business School Press, Boston, MA. Pappas, J.M., Flaherty, K.E. and Wooldridge, B. (2004),“Tapping into hospital champions- strategic middle managers”,Health Care Management Review, Vol. 29 No. 1, pp. 8-16. Pearce, C., Manz, C. and Sims, H. (2009),“Where do we go from here: is shared leadership the key to team success?”,Organizational Dynamics, Vol. 38 No. 3, pp. 234-238. Pink, D.H. (2009),Drive: The Surprising Truth about What Motivates Us, Penguin Riverhead Books, New York, NY. 1160 JMD 35,9 Prins, S.J., Bates, L.M., Keyes, K.M. and Muntaner, C. (2015),“Anxious? Depressed? You might be suffering from capitalism: contradictory class locations and the prevalence of depression and anxiety in the USA”,Sociology of Health & Illness, Vol. 37 No. 8, pp. 1352-1372. Raelin, J.D. and Cataldo, C.G. (2011),“Empowering interface and the failure of organizational change”,Journal of Change Management, Vol. 11 No. 4, pp. 481-507. Rajan, G.R. and Wulf, J. (2006),“The flattening firm: evidence from panel data on the changing nature of corporate hierarchies”,The Review of Economics and Statistics, Vol. 88 No. 4, pp. 759-773. Rouleau, L. and Balogun, J. (2011),“Middle managers, strategic sense making, and discursive competence”,Journal of Management Studies, Vol. 48 No. 5, pp. 953-983. Shaw, K. (2005),“Getting leaders involved in communication strategy: breaking down the barriers to effective leadership communication”,Strategic Communication Management, Vol. 9 No. 6, pp. 14-17. Skela, S.B. and Pagon, M. (2008),“Relationship between nurses and physicians in terms of organizational culture: who is responsible for subordination of nurses?”,Croatian Medical Journal, Vol. 49 No. 3, pp. 334-343. Tabrizi, B. (2014),“The key to change is middle management”, available at: https://hbr.org/2014/ 10/the-key-to-change-is-middle-management/ (accessed December 1, 2015). Tucker, A.L. and Edmondson, A.C. (2003),“Why hospitals don’t learn from failures: organizational and psychological dynamics that inhibit system change”,California Management Review, Vol. 45 No. 2, pp. 55-71. Valentino, C. (2004),“The role of middle managers in the transmission and integration of organizational culture”,Journal of Healthcare Management, Vol. 49 No. 6, pp. 393-404. Vila, J. and Canales, I.J. (2008),“Can strategic planning make strategy more relevant and build commitment over time? The case of RACC”,Long Range Planning, Vol. 41 No. 3, pp. 273-290. Vilkinas, T. and Cartan, G. (2006),“The integrated competing values framework: its spatial configuration”,Journal of Management Development, Vol. 25 No. 6, pp. 505-521. Waldman, J.D., Kelly, F., Arora, S. and Smith, H.S. (2004),“The shocking cost of turnover in healthcare”,Health Care Management Review, Vol. 29 No. 1, pp. 2-7. Wall Street Journal (2013),“Middle managers by the number”,Wall Street Journal, available at: www.wsj.com/news/interactive/MIDMANSALARY (accessed October 15, 2015). Witt Kieffer (2012),“Healthcare CEOs and the need for better succession planning”, available at: www.wittkieffer.com/file/thought-leadership/practice/Healthcare%20CEOs%20and%20 Succession%20Planning(1).pdf (accessed October 15, 2015). Woodson, B. (2015),“Behind healthcare’s M&A boom”,FORTUNE, available at: http://fortune. com/2015/08/18/healthcare-ma-aetna-anthem-cigna/ (accessed December 1, 2015). Wooldridge, B., Schmid, T. and Floyd, S. (2008),“The middle management perspective on strategy process: contributions, synthesis, and future research”,Journal of Management, Vol. 34 No. 6, pp. 1190-1221. Zenger, J. and Folkman, J. (2014),“Why middle managers are so unhappy”, available at https:// hbr.org/2014/11/why-middle-managers-are-so-unhappy (accessed December 1, 2015). Zenger, J., Folkman, J. and Edinger, S. (2011),“Making yourself indispensable”,Harvard Business Review, Vol. 99 No. 10, pp. 84-92. About the authors Alan Belasen, PhD, led the design and implementation of the SUNY/ESC MBA in Management, MBA in Global Leadership, MBA in Healthcare Leadership and the MBA Pathway for Veterans, which he chaired between 2004 and 2015. Dr Belasen received the Outstanding Reviewer Award 1161 Middle managers in healthcare organizations from AOM, Management Education and Development, five times. He is also the 2014-2015 recipient of the SUNY Chancellor’s Award for Excellence in Scholarship and Creative Activities. Dr Belasen has provided training and development to hundreds of managers and executives in various industries and organizations. He is the author of five books, most recently:Mastering Leadership, Jones & Bartlett Learning, 2015. Alan Belasen is the corresponding author and can be contacted at: [email protected] Ariel R. Belasen, PhD, is an Associate Professor of Economics and Finance at Southern Illinois University Edwardsville. For the past decade he has been conducting research on human development and anti-corruption endeavors as well as on disaster recovery efforts. Dr Belasen’s work has resulted in dozens of conference papers, book chapters, and journal articles published in American Economic Review,Journal of Human Resources, and Intelligence, among others. Dr Belasen has provided management consulting to healthcare and business organizations in the areas of performance optimization and project management. For instructions on how to order reprints of this article, please visit our website: www.emeraldgrouppublishing.com/licensing/reprints.htm Or contact us for further details:[email protected] 1162 JMD 35,9
Research Paper: What is the role of a manager in succession planning in a healthcare organization? To achieve a successful assignment, you are expected to meet the following requirements. Scholarly Ex
Succession Planning Within the Health Care Organization: Human Resources Management and Human Capital Management Considerations Joycelyn Desarno, BSN, CCRN, Miguel Perez, MSHCA, Rachel Rivas, MSN, RNC, Irene Sandate, DNP, MSN, ACNO, Charles Reed, PhD, ACNO, and Ileana Fonseca, MSN, RNC There is a growing need for capable leaders to replace incumbents in critical po- sitions in cases of resignation, retirement, promotions, death, growth, expansion, and creation of new positions. Developing an effective succession planning process can guide organizations to evaluate their present situation and decide the critical employees who will ultimately step into leadership and senior management posi- tions. This paper discusses succession planning within a Magnet ® health care or- ganization and knowledge management of its human resources and human capital. S uccession planning is an essential element of filling leadership roles in the workforce. In his bookEffective Succession Planning,William Roth- well 1writes that“succession planning is a systematic effort by an organization to ensure leadership conti- nuity in key positions, retain and develop intellectual and knowledge capital for the future, and encourage individual advancement.”Succession planning helps an organization prepare for the inevitable movements of people who create gaps in the hierarchy that need to be filled by qualified replacements. Such voids can be thwarted by having a succession plan that is readily available. 2Succession planning also involves an orga- nizations’knowledge management of its human capital and human resources. Human capital refers to the knowledge and competencies of organizational em- ployees, their reactions to challenges within the orga- nization, their entrepreneurial spirit, and the capacity to innovate. 3Human resources pertain to individuals who currently contribute to the industry, those who will contribute to the future, and those who have contrib- uted in the past. Human resources also refer to the management of these individuals’contributions. IMPLICATIONS OF SUCCESSION PLANNING In the health care industry, critical talent shortages, the high turnover rate among leaders, and attracting em- ployees from other organizations present a significantchallenge. 4Nowhere is the need for effective succession more evident than in the complex health care industry. Leaders face unparalleled pressure to transform their organizations to meet the increasing demands for cost- effective, high-quality care and follow legal statutes. Health care organizations need to create best practices related to succession planning and talent management. Hospitals that have adopted talent management and succession planning best practices are associated with high scores on the Centers for Medicare & Medicaid Value-Based purchasing metrics tied to reimbursed rates for Medicare & Medicaid programs. Poor suc- cession planning may lead to decreased quality of care, which can stifle reimbursement, says Kevin Groves, PhD, associate professor of organizational theory and management at Pepperdine University Graziado School of Business and Management. He further stated KEY POINTS Implications of an effective succession planning in an organization. Importance of knowledge management and transfer in staff engagement Identify organizational competencies and values in planning and managing a succession program www.nurseleader.comAugust 2021411 that hospitals that desire high engagement levels should know that the best way to move to peak engagement is through proper succession planning. Individuals are more likely to be engaged at work when they feel valued and their organizations are devoted to devel- oping their skills and creating avenues for promotions or advancements. 5 Developing and keeping leadership is both a stra- tegic and economic necessity. By filling positions internally, organizations cut down on hiring costs, ramp-up time, and lost productivity. Internal hiring also eliminates employee turnover resulting from a poor fit with the culture of the organization. The or- ganization must continually develop capable candi- dates ready to fill critical positions and ready to step in when there are unexpected losses of key leaders. 6 Some organizations’succession planning is designed exclusively for the top executives. Therefore, no one is in line to fill the positions that the retirees will leave vacant. That scenario will cripple the organization. Moreover, organizations need to recognize every em- ployee’s value, not just those designated as“high po- tential,”to the training and workshops targeted to support the development of those who are identified as successors. 2The criteria to assess potential must be fair and objective, and every team member must know what it takes to be a leader. Preparing employees for their future roles by giving them more complex work, and investing in their growth keeps them focused, engaged, motivated, and loyal to the company. KNOWLEDGE MANAGEMENT IN SUCCESSION PLANNING Knowledge management is creating, sharing, using, and managing the knowledge and information of an orga- nization. 7 Duhon, 8 an industry expert, described knowledge management as“a discipline that promotes an integrated approach to identifying, capturing, evalu- ating, retrieving, and sharing all enterprise’s information assets”. These assets may include databases, documents, policies, procedures, and previously uncaptured exper- tise and experience in individual workers. Furthermore, knowledge management is useful in overcoming health care challenges, such as rising costs and increasing demands for improving care delivery by helping the or- ganization and staff members make more informed de- cisions by using tacit and explicit knowledge. 8Ultimately, it will lead to rendering high-quality care, decreasing errors, and lowering care costs. Another key to knowl- edge management is the ability to organize and store knowledge and information for later retrieval. KNOWLEDGE TRANSFER The use of both people and precise (explicit) knowledge is included in the steps in building a knowledge man- agement system. The people (tacit) knowledge includes mentoring, experiences, employees’external andinternal education, teams, and a culture of lifelong learning. By contrast, the precise (explicit) knowledge comprises e-portals, collaboration tools, research data, best practices, and several information systems. 9In terms of health care organizations, explicit knowledge refers to the manuals, reports, and formulas created to communicate information whereas tacit knowledge refers to staff members’experiential knowledge that is not easily expressed or shared, such as personal intui- tion and insights. 10 When a vital member of your team decides to leave, one of your most urgent priorities is knowledge transfer. This individual possesses critical knowledge, and if that information leaves with her/him, the con- sequences will be felt throughout the organization. A critical employee’s departure triggers a scramble of meetings to obtain as much knowledge as possible before leaving. Knowledge transfer is about identifying knowledge that already exists, acquiring it, and subse- quently applying it to develop new ideas or enhance the existing ideas to make a process faster, better, or safer than they would otherwise be. There are numerous reasons to develop a knowledge transfer strategy. Organizations must consider how a robust knowledge-sharing process positively impacts their onboarding and intern programs, or employees mov- ing to a new role. 11 Proactive knowledge transfer en- ables organizations to identify and capture the skills and competencies of retiring employees to develop successors and facilitate smooth transitions. As hospi- tals look at their succession plans, knowledge sharing can play a vital role in ensuring that replacements have the necessary knowledge and expertise. Thus, success- ful application of knowledge during a knowledge transfer process usually results in reduced errors, improved quality, speeding up decision making, lower cost, speeding up training and learning, and innova- tion. 12 The University Health System (UHS) of San Antonio, a Magnet ®health care organization, values mentoring as a tool to create a“win-win”opportunity for staff members. In addition to informal mentoring, the Health System offers structured mentoring pro- grams for the following groups of employees: New Directors—a competency-based program that partners new directors with seasoned directors. New Staff Nurses—a competency-based program in which preceptors help nurses learn their unit’s spe- cific competencies. Administrative Professionals—a competency-based program that promotes success in administrative posi- tions. Preceptor training is also offered, supporting experienced and inexperienced nursing staff by teach- ing the skills necessary to precept new employees hired onto their units. UHS also established a policy to define and outline the process of succession planning for leadership development. The organization believes the succession 412August 2021www.nurseleader.com planning process would develop the employees’ knowledge, skills, and abilities, and prepare them for advancement while improving retention to ensure a return on the health system’s training investment. It is stated in the policy that succession planning should not be misinterpreted as replacement planning, which provides for temporary placement in key positions when an unexpected vacancy occurs. UHS may pro- vide“interim”placement as needed. The health system also believes that developing talent within the system yields future leaders. Through their knowledge and experience in the organization, they have earned senior leadership members’trust and are more likely to be accepted as knowledgeable, capable leaders. The pol- icy further stated that individuals responsible for suc- cession planning must guide individual development for those on the plan and utilize well-defined roles and responsibilities. The succession plan should be in agreement with the organization’s strategic goals, and it is for this reason that the plan must be reviewed regularly. Outlined below are the components of the UHS policy. Selection Criteria Employees selected will be identified based on their readiness to fill specific roles within the health system and display the following behaviors and accom- plishments. Significant contributions to the health system Displayed capable performance beyond what is required Behaviors match the expectations of the organization Demonstrated personal and interpersonal skills and is accepted by subordinates and colleagues Demonstrated initiative, risk-taking, and policy as- sessments skills Being able to convey the mission and vision of the health system in a manner that inspires and moti- vates others to succeed Demonstrated self-knowledge and self-development Demonstrated conflict resolutions skills Demonstrated financial, problem-solving, and stra- tegic thinking skills. Roles and Responsibilities The president/chief executive officer (CEO) oversees the succession planning process and updates the board at least twice a year. His role is to ensure that the process considers all capable employees and uses the succession criteria established by University Health System. The division of organizational development will be responsible for the design of the succession planning process. The senior vice president, chief administrativeofficer, organizational development will secure approval from the president/CEO for all proposals. The organizational development division also en- sures a pipeline of diverse employees who will enhance leadership competencies and capabilities. Employees shall own their development by assuming responsibility for succession planning. To progress within the succession plan, the employee must continue to demonstrate appropriate behaviors and continue to exceed the expectations of the organization. Succession Planning Process The president/CEO with the leadership team will implement the following steps Step 1: Link Strategic and Workforce Planning Decisions. The mission, vision, and values of UHS must be in alignment with the succession planning process. Also, the workforce planning decisions must be included in the strategic planning process. Future human capital requirements will also be identified in this step. Step 2: Analyze Skil l Gaps This step involves the core competency requirements of succession planning. UHS can assess skill needs for positions in the organization by focusing on talent management. Step 3: Identify Talent Pools This step involves the recognition of the organiza- tion’s current talent pool. The organization will have an immediate talent pool when assessing the current workforce’s competency and skill levels is being implemented periodically throughout the year. Step 4: Identify Learning and Development Strategies This step involves mentoring and coaching, internal and external education opportunities, position observation, assessment, and feedback. Step 5: Implement Succession Strategies This step involves the application of the identified learning and development strategies. Performance management, compensation, recognition, retention, and workforce planning are succession strategies and must be linked to human resources. Step 6: Monitor and Evaluate the Program This step involves tracking, evaluating, and providing appropriate feedback to the employees. The health system must convey to the employee when skill gaps are identified. Leaders are also required to give feedback regarding internal talent and internal hires. Most importantly, The health system must ensure that the succession planning process is responsive to the organization’s changing needs and requirements. www.nurseleader.comAugust 2021413 Succession Planning Evaluation The outcomes of the succession plan will be measured by using key metrics such as: The number of employees on the succession plan placed in key positions over each calendar year Increased employee retention Improved employee satisfaction Enhanced commitment to work and the workplace EXAMPLE OF SUCCESSION PLANNING FOR AN ACNO (CHARLES REED) Tommye Austin, PhD, MBA, RN, NEA-BC, chief nursing officer, advocated for creating 3 associate chief nursing officers (ACNO) positions to assist in leading the nursing workforce within UHS. Nelson Tuazon, DNP, DBA, RN, NEA-BC, CENP, CPHQ , CPPS, FNAP, FACHE, VP/ACNO, adult services Irene Sandate, DNP, MSN, RN, NNP-BC, VP/ ACNO, pediatric and maternal services Charles Reed, PhD, RN, CNRN, VP/ACNO of clinical excellence and ancillary services Charles completed the CNO self-assessment that Tommye provided to all the CNOs to ascertain focus and training areas that would be favorable for his success. The tool serves as a platform for formal learning, self-paced learning, and experiential learning. The tool also provided a CNO onboarding plan for the new ANCOs. Charles also completed the 2-day Crucial Conversations Course. Dr. T. Austin taught the course and showed how as the chief nursing officer, she applies her crucial conversation skills in all settings from the boardroom to leadership meetings and her interactions with patients and with staff at the unit level. As part of Charles’s professional development, he was encouraged to join the Texas organization of Nurse Executives. As a member, he has the opportunity to display leadership, not only at UHS, but also in the Texas community, as well. EXAMPLE OF SUCCESSION PLANNING FOR A NURSE DIRECTOR Background: Nurse Director: Gennine Yahya, BSN, RN, CCRN, patient care coordinator, neuroscience intensive care unit. Succession planning activities include: 1.Identifying a nurse with potential In January 2016, Eric Dahl, BSN, RN, executive director, Sky, ICU/ACU, recognized Gennine Yahya as an up-and-coming leader within UHS. Gennine’s strength as a team leader while meetingorganizational goals and facilitating high-quality care was recognized as a key criterion for poten- tial advancement. Eric met with Gennine to review the executive director’s job description. They were able to form some action steps to ensure Gennine gained the experience and qualifications to be considered for a future executive director role. 2.Offering education: In March 2016, Eric identified several leadership courses that would support addi- tional skills for Gennine and contribute to her leadership development. In October 2018, Gennine completed the PCC Development Course, which was an excellent opportunity to network with others and build re- lationships. This course includes education on time management, human resources, financial management, and self-care. From July to December 2016, Gennine attended the Management Development Academy (MDA) using flexible scheduling accommodations offered by the health system. The MDA, presented by the Center for Learning Excellence, provides learning sessions on building trust and commitment, communicating ideas effectively, collaborations, increasing productivity, and leading with purpose and passion. In August 2017, Gennine attended the“Service Recovery: Turning Lemons Into Lemonade” presentation held at the hospital to learn about customer service and meet patients’expectations to ensure that they have a positive experience. In February 2018, Gennine completed a crucial conversation course to understand better the criticality of communication between leaders and staff, health care providers, and patients/families. 3.Supporting education: As of January 2016, a nursing executive position would be expected to have a masters-level academic degree. Eric provided information and helped Gennine evaluate various MSN program options. Gennine selected Western Governors University (WGU) for her MSN program and started in the summer of 2019. UHS has an affiliation agreement with WGU, and this agree- ment affords Gennine a discounted rate and an opportunity for tuition reimbursement. 4.Certification assistance: Gennine took the online certification review course available to employees through the healthstream. In April 2019, Gennine achieved certification as a certified nurse manager leader, which supports her future role as a nursing director. CONCLUSION Succession planning is a methodical process to building a leadership pipeline and a qualified talent pool to ensure leadership continuity for an organization’s 414August 2021www.nurseleader.com survival and success. Furthermore, planning and managing individuals’career to optimize their needs and aspirations contributes to employee engagement, retention, and reduce the intent to leave the organi- zation. Critical to an organization’s success is the knowledge management of their human capital through knowledge transfer and sharing. REFERENCES 1.Rothwell W.Effective Succession Planning: Ensuring Leader- ship Continuity and Building Talent From Within.5th ed. New York, NY: AMACOM; 2015. 2.Fried B, Fottler M.Human Resources in Healthcare: Managing for Success.4th ed. Chicago, IL: Health Administration Press; 2015. 3.Chien S, Chao M. Intellectual capital and new product sale performance of theﬁnancial services in Taiwan.Serv Ind J. 2011;31(16):2641-2659. 4.Zaballero A, Rothwell WJ, Coidakis-Barss C. Making the Case for Succession Planning in Healthcare. Association for Talent Development. Available at:https://td.org/insights/making-the- case-for-succession-planning-in-healthcare. Accessed July 1, 2020. 5.Weiner LJ. 3 Hidden Beneﬁts of Succession Planning. HealthLeaders Media. Available at:https:// healthleadersmedia.com/strategy/3-hidden-beneﬁts-succes- sion-planning. Accessed June 30, 2020. 6.Moore J. The Critical Importance of Succession Planning. HR Daily Advisor. Available at:http://hrdailyadvisor.blr.com/2017/ 08/04/critical-importance-succession-planning. Accessed July 2, 2020. 7.Girard JP, Girard JL. Deﬁning knowledge management. To- ward an applied compendium.Online J Appl Knowl Manage. 2015;3(1):1-20.8.Ayatollahi H, Zeraatkar K. Factors inﬂuencing the success of knowledge management process in health care organizations: a literature review.Health Inf Libr J. 2019;37(2):98-117. 9.Fibuch E, Van Way CW III. What is a knowledge management system.and why should I care?Physician Exec. 2011;37(5):34-39. 10.Yoo KH, Zhang YA, Yun EK. Registered nurses (RNs)’knowl- edge sharing and decision-making: the mediating role of organizational trust.Int Nurs Rev. 2019;66(2):234-241. 11.Maestro.com. How to Effectively Complete a Knowledge Transfer Plan. 2020. Available at:https://meetmaestro.com/ insights/how-to-effectively-complete-a-knowledge-transfer- plan/. Accessed July 6, 2020. 12.Liyanage C, Elhag T, Ballal T, Li Q. Knowledge communication and translation- a knowledge transfer model.J Knowl Manage. 2009;13(3):118-131. Joycelyn Desarno, BSN, CCRN, is NICU Staff Nurse III at University Hospital San Antonio in San Antonio, Texas. She can be reached [email protected]. Miguel Perez, MSHCA, is a Professor at Texas A&M -Corpus Christi, Texas. Rachel Rivas, MSN, RNC, is the Executive Director of NICU, UHS, San Antonio Texas. Irene Sandate, DNP, MSN, is Associate Chief Nurse Ofﬁcer of Womens and Childrens at UHS, San Antonio Texas. Charles Reed, PhD, Associate Chief Nurse Ofﬁcer of Center of Learning Excellence at UHS, San Antonio, Texas. Ileana Fonseca, MSN, RNC, is the Magnet Director at UHS, San Antonio Texas. 1541-4612/2021/$ See front matter Copyright 2020 by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.mnl.2020.08.010 www.nurseleader.comAugust 2021415
Research Paper: What is the role of a manager in succession planning in a healthcare organization? To achieve a successful assignment, you are expected to meet the following requirements. Scholarly Ex
Leadership Competencies and Patient Experience: A Literature Review. Laurie Latvis, John Fick and Lihua Dishman, A.T. Still University Over 150 theoretical and empirical literatures were reviewed in relation to patient experience and senior leadership competencies. The literature review found improving the patient experience is a top priority of health care leaders in the United States and has been positively associated with adherence to medical treatment, use of preventive services, and positive quality outcomes, and an improvement in patient safety. Survey results of patient experiences are used in reimbursing hospitals through value-based reimbursement programs that can significantly affect a hospital’s financials. between physicians and patients is a strong determinant of patient satisfaction. The literature demonstrated that when patients are not satisfied it might result in a delay of treatment and decrease quality of care. Senior executive leaders must model certain leadership behaviors and certain competencies must increase to make changes in the status quo, focus on creating change, have vision for the organization, and lead people to embrace the vision of the organization, which includes a focus on patient experience. Overall, literature is present for competencies required of leaders, although there is a gap in the literature of what characteristics are needed to effectively improve a patient’s experience in an acute care hospital aside from enhancing overall. Understanding Operational Succession Planning and Employee Turnover of Healthcare Organizations.Heather Moore, Lihua Dishman and John Fick, A.T. Still University As the population ages and healthcare acuity increases, turnover has increased at a time when the healthcare industry increasingly requires skilled leadership. Operational Succession Planning (OSP) has emerged as a feasible solution to healthcare’s leadership deficit, which linked to organizational financial and overall performance. Employee Turnover (ET) concerns employee departures from workplaces. The OSP and ET constructs guided a systematic selection and review of more than 110 theoretical and empirical articles from peer-reviewed healthcare management and general business journals. Emerged from the extant literature were three primary OSP dimensions: replacement planning, leadership development, and knowledge management; and three primary ET dimensions: monetary costs, employee satisfaction, and patient satisfaction. Replacement planning was in frequent practice but insufficient because it did not develop leaders or preserve organizational knowledge, whereas succession planning required developing internal talents into leaders and transitioning knowledge between generations of leaders. Leadership development and knowledge management were essential to preserving organizational continuity and competitive advantages. ET negatively affected organizational operations. Specifically, ET raised operational costs, decreased employee satisfaction because it lowered morale while increasing workload demands of remaining employees, and impeded patient satisfaction. This systematic review indicates an empirical 52 MICHIGAN ACADEMICIAN literature gap regarding the OSP-ET relationship, particularly for medical practices. Breastfeeding Considerations and Practices of Ghanaian Women Living with HIV with Low Birthweight Babies.Kwame Sakyi, Oakland University, Center for Learning and Childhood Development-Ghana; Prince Owusu, Center for Learning and Childhood Development-Ghana; Celeste Zabel and Erica Willemsen, Oakland University In many sub-Saharan African countries like Ghana HIV has been shown to increase the risk of having a low birth weight baby (LBW). Given concerns about mother-to-child transmissions of HIV, HIV stigma, and challenges LBW babies have with breastfeeding, this study sought to characterize the breastfeeding experiences of LBW mothers living with HIV. Participants included 15 postpartum women living with HIV with LBW infants in Accra, Ghana. Qualitative interviews were covered breastfeeding considerations, experiences, and practices. Data was analyzed using thematic analysis. Mothers who were concerned about their infant getting HIV through breastfeeding reported adhering to ART. After childbirth, mothers related that their child’s small appearance suggested that they may be HIV infected. This perception, we found, resulted in a few of the mothers discontinuing or not initiating breastfeeding. Some mothers did not breastfeed regardless of their baby’s birthweight. To avoid HIV stigma, a few mothers used their babies’ small appearance, as a reason for not breastfeeding, instead of their intentions to prevent mother-to-child transmission of HIV. The concern of spreading HIV, and the perception that LBW infants may already be infected HIV-infected play a significant role in mother’s decision to breastfeed LBW infants in Ghana. How Does Formal Succession Planning Affect Leadership Sustainability and Organizational Performance of United States Hospitals?Samuel K. Ndinjiakat, John W. Fick and Lihua Dishman, A.T. Still University United States hospitals lacked well-coordinated succession planning programs to align high performers to specific leadership positions from frontline supervisors to C-Suite executives. The purpose of this qualitative study was to explore the effects of U.S. hospitals’ formal succession planning on their leadership sustainability and organizational performance. Leadership sustainability is observed when an intervention has become integral to routine practice, continuing until implementation support ceases. Organizational performance consists of financial and nonfinancial factors used to determine the degree of goal attainment. A sample of 12 hospitals from all nine regions of American Hospital Association was selected using a purposeful case sampling strategy for achieving study results’ greater reliability. A survey questionnaire with demographic and open-ended questions was sent to survey participants via SurveyMonkey. Data were analyzed using MAXQDA. Several salient findings emerged. Most hospitals 53 Reproduced with permission of copyright owner. Further reproduction prohibited without permission.
Research Paper: What is the role of a manager in succession planning in a healthcare organization? To achieve a successful assignment, you are expected to meet the following requirements. Scholarly Ex
Leading Tomorrow’s Healthcare Organizations: Strategies and Tactics for Effective Succession Planning Author(syf $ Q Q 6 F R W W % O R X L Q . D W K U Q – 0 F ‘ R Q D J K $ O O V R Q 0 1 H L V W D G W D Q G % U D G O H y Helfand Source: The Journal of Nursing Administration, Vol. 36, No. 6, Special Issue Devoted to Strategic Succession Management (JUNE 2006yf S S 0 Published by: Lippincott Williams & Wilkins Stable URL: https://www.jstor.org/stable/26818787 Accessed: 09-11-2021 21:07 UTC JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact [email protected]. Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at https://about.jstor.org/terms Lippincott Williams & Wilkins is collaborating with JSTOR to digitize, preserve and extend access to The Journal of Nursing Administration This content downloaded from 184.108.40.206 on Tue, 09 Nov 2021 21:07:12 UTC All use subject to https://about.jstor.org/terms JONA Volume 36, Number 6, pp 325-330 ©2006, Lippincott Williams & Wilkins, Inc. THE JOURNAL OF NURSING ADMINISTRATION Leading Tomorrow’s Healthcare Organizations Strategies and Tactics for Effective Succession Planning Ann Scott Blouin, PhD, RN Kathryn 0. McDonagh, PhD, RN, FAAN Allyson M. Neistadt, MPH Bradley Helfand, MA, MPH Hospitals and health systems today are challenged by the lack of consistent workforce planning which has resulted in a significant dearth of effective suc cession planning strategies and tactics for the ex ecutive suite as well as middle management. This article discusses how the healthcare industry lags behind other corporate organizations in creating a succession plan and in retaining top leadership talent. It also provides practical approaches for suc cession planning in healthcare and identifies the key elements of succession planning for the chief execu tive officer and other senior leaders. “My main job was developing talent. I was a gardener providing water and other nourishment to our top 750 people. Of course, I had to pull out some weeds, too.”1 – Jack Welch Jack Welch, the iconic former chief executive officer (CEOyf R I * H Q H U D O ( O H F W U L F & R U S R U D W L R Q Z D V F U H G L W H d with having a “green thumb” when it came to growing leaders in his proverbial garden of talent. However, he never attempted to apply his executive cultivation techniques to the healthcare delivery field, where a harsh climate of shrinking margins, noncompetitive compensation packages, missed mentoring and leadership development opportuni ties, and ill-defined career paths have created a Authors’ affiliations: Principal (Dr Blouinyf 0 D Q D J H U 0 s Neistadtyf D Q G 6 H Q L R U & R Q V X O W D Q W 0 U + H O I D Q G f, Deloitte Con sulting, LLP, Strategy & Operations Practice, Chicago, 111; Chief Executive Officer (Dr McDonaghyf & + 5 , 6 7 8 6 6 S R K Q + H D O W h System, Corpus Christi, Tex. Corresponding author: Dr Ann Scott Blouin, Deloitte Consult ing, LLP, 111 South Wacker, Chicago, IL 60606 (annblouin@ deloitte.comyf . widely recognized draught of future leaders.2’3 The leadership crisis at the top is exacerbated by high turnover rates. According to the American Hospital Association, the median tenure for CEOs is only 4 years.4 A supporting longitudinal study (1995-2002yf of CEO turnover at worldwide publicly traded companies (N = 2,500yf I R X Q G W K D W K H D O W K F D U H b annual turnoveryf D O R Q J Z L W K W H O H F R P P X Q L F D W L R Q V , energy, and information technology ranked as the “highest risk” industries for executive departure.5 The industry is increasingly challenged to find internal talent to fill these frequent vacancies. It has become more common to see a hospital board of directors coax a CEO out of retirement, such as Northern Arizona Healthcare did with Fred Brown, the former chief executive of BJC Healthcare or look to an industry outsider, as was the case with Detroit Medical Center when they appointed former Wayne County Prosecutor Michael Duggan as CEO. Although there is no “quick fix” solution, healthcare organizations must begin to follow the private sec tor’s lead in taking a disciplined approach toward succession planning that will yield sustained leader ship talent over time. The purposes of this article are to abstract leading practices from within the industry and the private sector and to summarize the most effective succession planning tactics in the context of a “real-world” case study at a health system in Texas. Succession Planning and Its Implications for Organizational Continuity Continuity is a vital aspect of effective organiza tions. This is an axiom that may have even greater JONA • Vol. 36, No. 6 • June 2006 325 Leading Tomorrow’s Healthcare Organizations Strategies and Tactics for Effective Succession Planning Ann Scott Blouin, PhD, RN Kathryn J. McDonagh, PhD, RN, FAAN ALLyson M. Neistadt, MPH Bradley Helfand, MA, MPH Hospitals and health systems today are challenged by the lack of consistent workforce planning which has resulted in a significant dearth of effective suc cession planning strategies and tactics for the ex ecutive suite as well as middle management. This article discusses how the healthcare industry lags behind other corporate organizations in creating a succession plan and in retaining top leadership talent. It also provides practical approaches for suc cession planning in healthcare and identifies the key elements of succession planning for the chief execu tive officer and other senior leaders. This content downloaded from 220.127.116.11 on Tue, 09 Nov 2021 21:07:12 UTC All use subject to https://about.jstor.org/terms relevance for hospitals, whose executive leadership and clinical services are tightly woven into the fabric of the surrounding community.6″8 Disrup tion in an organization’s continuity can have dire consequences, according to executive search firm Witt/Kiefer: “Health care faces numerous chal lenges when it does not plan succession: loss of confidence from the community and employees; unfinished business; negative impact on financing; and evisceration of image and history.”9 Unlike other challenges faced by hospitals in areas such as reimbursement, regulation, and technology adop tion, where trends develop gradually over time, threats to continuity often cannot be anticipated ahead of the immediate event. In the recent case of McDonald’s, the sudden and unexpected deaths of consecutive chief execu tives Jim Cantalupo and Charlie Bell created a high profile example of organizations needing to manage worst-case scenarios.10 Although McDonald’s rep resents the extreme end of the spectrum, both in the nature of chief executive departure and the quality of response to the succession challenge, it raises serious concerns about preparedness in an industry where only 21yb R I I U H H V W D Q G L Q J K R V S L W D O V S R V V H V V a CEO succession plan compared with 64yb R f private-sector companies.4’11 Those hospitals that choose not to invest in succession planning, accord ing to a survey done by Andrew Garman and Larry Tyler, outline reasons such as “not a high enough priority right now (46yb f,” “current CEO is too new (31yb f,” and “no internal candidate to prepare (25yb – 7 K H V H W S H V R I U H V S R Q V H V I U R P K R V S L W D l chief executives and boards may represent a mis understanding of the intrinsic value and criticality of succession planning to the organization’s strategic mission and operational goals. The Scope of Succession Planning Succession planning is often overly simplified as the process of selecting the next chief executive. In fact, it extends well beyond the executive search and appointment process into areas such as leadership development programs, mentoring networks, per formance assessment, governance theory, aligning organizational goals with human capital, and overall workforce planning. It is essentially the process of building the internal leadership “pipeline.” When that pipeline is broken or nonexistent, it forces organizations to shift their sole focus to external sources of candidates who have been shown to have lower success rates than those promoted internally. Several studies have documented that outsiders have a 50yb R U J U H D W H U I D L O X U H U D W H L Q W K H L U Q H Z F K L H f executive role, although insiders fail 40yb R U O H V V R f the time in the same position.13’14 Lessons on Succession Planning From Industry and General Business Literature The existing literature on succession planning can be subdivided into 2 broad groups: healthcare-focused and general business. Publications in the healthcare field are primarily being produced by affiliates of executive search firms. The management literature on succession planning tends to be specific and uses case studies and tools to shape recommendations. Rothwell’s article “Putting Success into Your Succes sion Planning” has an entire section dedicated to the question of “Should You Worry [About Succession Planning]?” and offers a scorecard tool to determine if the previously occupied position’s responsibilities should be reallocated within the organization or passed on to a successor.15 One might argue that the analogy between succession planning for a major Fortune 500 public company and a 250-bed suburban community hospital can be described as tenuous. Is it realistic that “X hospital” will be able to implement a sophisticated workforce planning human resources information system like the one used by Eli Lilly?16 Can a not-for-profit health system, with its account ability to community stakeholders, afford to take the same pure performance appraisal-driven ap proach of weeding out 10yb R U P R U H R I W R S O H Y H l managers as Jack Welch did during his tenure at General Electric? As an illustrative business example, in his article “Ending the CEO Succession Crisis,” Charan dis cusses the performance assessment model used by General Electric called “Session C,” their annual dialogue for how leadership resources compare to business strategy.11 In his description of Session C, otherwise known as “tandem assessment,” Charan gives pointed details about the process. The who consists of approximately 20 to 25 potential CEO candidates. The what is described as a 3- to 4-hour interview with human resources executives outside of the candidate’s own business unit. The where includes an organization-wide fact-finding mission to collect 360-degree reviews, massive reference checks, interviews with superiors, subordinates, and peers, psychological examinations, etc. The when occurs annually. The why, in essence, gives the candidate 2 new mentors to expand their network because the process gives the candidate a mirror into their leadership evolution and by 326 JONA • Vol. 36, No. 6 • June 2006 d of the spectrum, both in the ive departure and the quality uccession challenge, it raises t preparedness in an industry eestanding hospitals possess a n compared with 64yb R f lies.4’11 Those hospitals that l succession planning, accord iy Andrew Garman and Larry such as “not a high enough yb f,” “current CEO is too new ternal candidate to prepare yf H V R I U H V S R Q V H V I U R P K R V S L W D l boards may represent a mis itrinsic value and criticality of o the organization’s strategic Lai goals. ssion Planning often overly simplified as the should be passed on t One n succession company ; hospital ca that “X h sophisticatf informa tioi Can a not-i ability to c the same proach of managers £ General El« As an i “Ending th cusses the General El dialogue fc business sti otherwise 1 This content downloaded from 18.104.22.168 on Tue, 09 Nov 2021 21:07:12 UTC All use subject to https://about.jstor.org/terms assigning 2 human resource executives outside of the candidate’s business unit to conduct the inter view. Finally, the how is the final product of a 15- to 20-page report charting the candidate’s work and development that goes to the candidate, their busi ness leader, their human resource leader, and to corporate headquarters where it is read by General Electric’s chairman, 3 vice chairman, and Senior Vice President for human resources. Perspectives offered in the healthcare literature may be potentially narrow or biased at times, but recognize the unique challenges of the industry. Perspectives offered in the general business literature tend to be very specific in their recommendations and case studies, yet may lack direct applicability to the organizational characteristics of hospitals. We propose that combining the 2 approaches yields a more comprehensive view of succession planning. The Importance of Leadership Development Programs to Succession Planning Collins notes in Good to Great that companies that excelled long term focused on who first and then what.17 Even before sorting out an effective strategy for the organization, they first got the right people “on the bus” and the wrong people “off the bus.” Thus, an effective leadership development program is absolutely vital to become and remain a thriving and successful organization. One of the best examples of a rigorous leader ship development plan was the one initiated by Jack Welch at General Electric.18 This plan was referred to as the “vitality curve;” it differentiated leaders through a ranking process and rewarded top per formers through promotions, salary increases, stock options, and other recognition. CHRISTUS Spohn Health System: A Case Study in Leadership Development Using Jack Welch’s type of approach for leadership development, CHRISTUS Spohn Health System located in Corpus Christi, Tex, initiated a robust leadership development program. Due to the lack of certain skills and talent necessary to fulfill the organization’s goals, the CEO set out to address succession planning needs. The executive team made a unified commitment to remove marginal leaders, import new high-performing leaders from the out side, and focus on the development of the leaders in place (designated as the leadership portfolio pro cessyf 6 S H F L I L F D O O H D F K O H D G H U L Q W K H R U J D Q L ] D W L R n developed an individual leadership portfolio in collaboration with their executive. The portfolio included educational background, credentials, and experience in leadership and a plan for development. In addition to the portfolio, the executive team ranked each leader either an “A,” “B,” or “C.” Criteria were developed for each category so the ranking process had internal consistency across the organization. Those designated as “A” players were high-performing leaders who were provided rewards, specialized mentoring, and educational courses, as well as given challenging assignments. Most impor tantly, “A” players also receive the personal time investment of executives committed to their career goals, including the CEO. A career plan is devel oped with opportunities for new experiences built into that person’s agenda. Although “B” leaders are solid players, they have certain leadership developmental needs. An action plan to address those needs is developed with the assistance of their assigned executive and staff in the organizational development department. Because most leaders are in this category, all leadership courses are focused on the needs of this group and the requirements of the organization. In addition, “A” leaders and senior executives act as mentors to “B” players to assist them in their growth and development. “C” players are ineffective leaders and are given a 90-day workplan to either improve significantly or be removed from their leadership position. The leadership portfolio process has raised the expecta tions of leaders dramatically in the organization. This new approach helps avoid the tendency to focus on short-term crises. It highlights how weak leader ship and lack of planning affect the organization in the long run. Thus, a commitment to leadership excellence becomes a part of the culture and creates a magnet effect for future leaders and staff who value the support of strong leadership. Translating Theory Into Practice: Tactical Strategies for Succession Planning As organizations wrestle with leadership transitions and effective stewardship of scarce resources, boards must assume a primary role and considerable inter est in identifying and retaining potential successors for today’s senior leadership positions. The dearth of experienced, educated healthcare administrators, especially where a clinical background is deemed a requisite or helpful context, exacerbates the diffi culty in succession planning around today’s retiring middle and senior managers. Specific strategies and JONA • Vol. 36, No. 6 • June 2006 327 specific in their recommendations inv( yet may lack direct applicability goa ional characteristics of hospitals. ope combining the 2 approaches yields intc insive view of succession planning. hav acti e of Leadership Development accession Planning mo< Irood to Great that companies that cou m focused on who first and then the are sorting out an effective strategy “A” ion, they first got the right people “B” 1 the wrong people “off the bus.” dev ; leadership development program I to become and remain a thriving a 91 ganization. or 1 •est examples of a rigorous leader- leac : plan was the one initiated by Jack tion Electric.18 This plan was referred Thi: y curve;” it differentiated leaders on : ig process and rewarded top per- ship nrr*mnfir*nc colonr inrrpicpc ctr>rl/ flip This content downloaded from 22.214.171.124 on Tue, 09 Nov 2021 21:07:12 UTC All use subject to https://about.jstor.org/terms tactics can be applied from other industries and businesses to pragmatically prepare for the inevitable leadership transitions that occur with retirement, promotion, geographic relocation, and life events. Strategies and tactics that promote effective suc cession planning for healthcare management posi tions are shown in Figure 1. As individual leaders join a healthcare organization, an assessment of their potential for future success based on their at tributes, abilities, and career objectives should be initiated and routinely “refreshed.” For example, Colgate-Palmolive starts formal leadership evalua tion in the first year of employment.13 Skills essen tial for tomorrow’s leaders in healthcare include effecting strategic growth and improved revenues; managing quality, cost and service expectations; implementing effective communications and nego tiations; balancing human and capital investment financial requirements; managing physician and community relationships; and developing leaders for the future.16 Demand forecasting is critical for where, when and what type of leaders are essential to prepare and protect the organization for the future. Pynes de fines “demand forecasting” as the anticipation of the leadership workforce that will be needed to ac complish future functional requirements and carry out the mission of the organization.19 Understanding the length of leaders’ tenure expectations, future skills requirements, internal candidate pool avail ability, and investments needed to adequately meet tomorrow’s leadership roles must be a deliberate, planned process (like at CHRISTUS Spohnyf Q R W D n accident of circumstances. Deliberate and objective evaluations of high-performing individuals should be flexible and fluid, with leaders being added and removed from the candidate list, as is done at Eli Lilly.16 For instance, high-performing leaders would be very visible in the organization, taking on challenge assignments and expanding their respon sibilities as they mature as leaders. They have a competitive edge when promotions become avail able. Many current CEOs refer to the factors that led to their success which include these formalized opportunities for growth. Interestingly, as noted, internally developed and promoted candidates have often been more successful in the long range than external candi dates for senior positions coming from other busi ness industries.13 This is most likely due to a more highly refined understanding of cultural norms and values, diminished organizational “learning curve,” and long-standing interpersonal loyalty and sup port from within the organization. Gaps between the competencies of the currently identified high performing individuals and future role/position requirements need to be specifically addressed in performance planning and development plans. For example, Dow uses a benchmark of 70yb W R b of internal candidates’ promotion as a marker of organizational success.16 Intentional formal and informal mentoring by committed leaders who are a “step ahead” is a critical component of effective succession planning. Giving talented future leaders the time, energy, advice, and experiences to gain new competencies and learn how to begin to prepare for future roles and responsibilities becomes the “gift” a current leader can bestow upon a future leader. Mentorship comes in many forms, from the casual coaching “in the moment” to the formal appointment that places high performers in the “spotlight” to demonstrate their abilities. Feedback to high performers, both positively noting accomplishments and construc tively discussing areas for improvement, should be timely, not “saved” for midyear or annual perfor mance review processes. This exposure to “career broadening” opportu nities should be deliberate, planned, and discussed as part of an ongoing commitment to developing tomorrow’s cadre of leadership candidates. Exam ples of “career broadening” opportunities can be seen in Figure 2. Although some have obvious short term potential visibility, other opportunities build an increasing leadership portfolio of long-range skills and abilities. • Early and frequent identification of successor candidates; ■ Demand forecasting and gap analysis for future role and key position needs; ■ Intentional formal and informal mentoring and coaching; ■ Exposure to “career broadening” future role development competency opportunities; ■ Resource dedication for leadership development, including formal education for new competency development; and ■ Serious evaluation when desirable successor candidates who are high performers leave the organization. Figure 1. Strategies for effective succession planning. 328 JONA • Vol. 36, No. 6 • June 2006 Figure 1. Strategies for effective succession planning. This content downloaded from 126.96.36.199 on Tue, 09 Nov 2021 21:07:12 UTC All use subject to https://about.jstor.org/terms Assuming over-arching problem-solving for key strategic problems such as Eli Lilly does with its “action learning” plans; Key task force and committee appointments; Board presentations on key initiatives; Assuming an important project or strategic assignment with larger profit and loss (P&Lyf U H V S R Q V L E L O L W L H V ; Formal administrative internships or fellowships; Selection for an elite business club or local civic or community organization; Leadership position in an industry membership such as the American College of Healthcare Executives, Healthcare Financing Management Association or American Hospital Association; or Formal sponsorship to an advanced continuing education program at such locations as Harvard Business School or Northwestern’s Kellogg Graduate School of Management. Figure 2. Career broadening experiences. These career advancement investments in high performing individuals require funding; an esti mate from other industries targets as much as 3yb of salaries and benefits to be budgeted for train ing to effectively address competency development. Underinvesting in career paths for current high performing individuals can result in those indi viduals’ lack of readiness to assume leadership positions when they become available or actually leaving the organization to locate better advance ment opportunities elsewhere.7’8 Finally, astute organizations evaluate risks of “flight talent” and try to prevent actual resignations of high-performing individuals. For example, at Colgate-Palmolive, their global growth program mandates that all senior managers retain 90yb R f their high-potential individuals or risk losing per sonal compensation.’1 Those managers who have consistently performed at a superior level and who are capable and desire additional responsibilities need to be continually assessed relative to their “flight risk.” Employing the “golden handcuffs” philosophy by simply paying at the top of the market is generally deemed insufficient to retain top talent who is seeking meaningful promotions and additional learning.6 Challenges purposely directed toward keeping these individuals learning and achieving superior performance, coupled with effective and meaningful rewards and recognition (both economic and non-economicyf D U H H V V H Q W L D O W o retain leaders in today’s competitive and increas ingly more complex healthcare environment. Past, Present and Future: The Process of Succession Planning A critical role of executive leaders is to look out over the horizon and anticipate what factors will impact their organization and then develop plans to adapt and thrive in the changing marketplace. One could argue that nothing is more strategic than who will lead an organization into the future. The best plans still need the leadership talent to navigate the com pany through challenging times. Succession planning specific to the CEO role has its own unique challenges. There are limited numbers of top positions, and because of the dif ficulties and challenges of leading a complex or ganization, there are typically a finite number of candidates able to assume such positions. There is also significant resistance to succession planning by boards and by the incumbent CEOs themselves. Although it may be awkward and uncomfortable to face the inevitable change in leadership, the long-term stability and success of the organization depends on proactive planning. Chief executive officers may be reluctant to lead the process due to their egos or a lack of comfort in the security of their current role.20 Flowever, as Freeman con tends, the true legacy of CEOs is what happens after they leave office. Thus, it is critical that boards of directors, CEOs, and others in organiza tions develop current plans for future leadership succession that include development of a talent pool, a comprehensive leadership development plan and a process of executive recruitment that is driven internally and not by outside search consultants.” No doubt the succession planning process is critical for the CEO position but it is also crucial for the other top executives in the organization. Chief operating officers, chief nursing officers, and chief financial officers who surround the CEO are the linchpin positions that create successful teams to lead the organization into the future. Never has develop ment of top executive leadership been more im portant, as the demographic data demonstrate that JONA • Vol. 36, No. 6 • June 2006 329 Figure 2. Career broadening experiences. This content downloaded from 188.8.131.52 on Tue, 09 Nov 2021 21:07:12 UTC All use subject to https://about.jstor.org/terms thousands of healthcare workers will be retiring in the next several years. This will create a talent gap that will result in intense competition for future talented leaders.15 Thus, it is not sufficient for boards to consider succession planning from a traditional CEO perspective only. It is imperative to plan for the entire leadership team and create a process that cultivates leadership throughout the organization and to greater depths, so that potential young leaders can move from entry level positions throughout the organization. This search for talent potential should have a public persona in the organization and no longer be shrouded in secrecy as it was in the past.21 In summary, as the need for talent gets more and more competitive, hospitals and health systems will want to be known for energetic and committed leadership development. Young leaders will recog nize those organizations that invest in their leader ship potential and want to be a part of growing and leading a successful and enlightened healthcare environment. Our future success for innovative solutions to today’s healthcare problems depends on leaders planning effectively for tomorrow. References 1. Garten JE. Economic Viewpoint. Bus Week Online. September 10, 2001. Available at: www.businessweek.com. Accessed December 1, 2005. 2. Doody MF, Phillips AW. Preparing Future Leaders in Health Care: A Confidential Survey of Healthcare Chief Executive Officers. Oakbrook, 111: Witt/Kiefer; 2002. 3. Larson L. Your CEO: Are you short-staffed or short-sighted? Trustee. July/Aug 2001:15-18. 4. Dolan TC. Increasing succession planning. Healthc Exec. May/June 2005:6. 5. PRN Newswire, May 12, 2003. Available at: http://www. prnewswire.co.uk/cgi/news/release?id=102155. Accessed December 1, 2005. 6. Witt/Kiefer in conjunction with California State Uni versity Los Angeles. Follow the Leaders: How Healthcare Leaders Mentor and Develop New Executives for Leader ship Succession. Los Angeles, Calif: Witt/Kiefer; Dec 2004: 1-8. 7. Witt/Kiefer. Succession planning tops healthcare leadership strategies. Perspectives. Winter 2004:1-2. 8. Witt/Kiefer in conjunction with California State Univer sity, Los Angeles. In: Putting Succession Planning into Play: Identifying and Developing the Healthcare Organi zation’s Successors. Los Angeles, Calif: Witt/Kiefer; 2004: 1-8. 9. Witt/Kiefer in conjunction with California State University, Los Angeles. In: View From the Top: CEO Perspectives on Leadership Talent, Executive Development, and Succession Planning in Healthcare Organizations. Los Angeles, Calif: Witt/Kiefer; May 2004:1-8. 10. Hymowitz C, Lublin JS. Lesson From McDonald’s Tragedy: Always Have A Succession Plan. Wall Street Journal Online. April 27, 2004. 11. Roszak DJ. Most freestanding hospitals do not conduct leadership succession planning. Hosp Health Netw. 2005; 79(1yf . 12. Garman AN, Tyler JL. What kind of CEO will your hospital need next? A model for succession planning. Trustee. October 2004:38-40. 13. Charan R. Ending the CEO succession crisis. Harv Bus Rev. February 2005;83(2yf . 14. Byham WD, Nelson GD. Succession planning Rx: developing the next generation of leaders. Health Forum J. November December 1999;42(6yf . 15. Rothwell WJ. Putting success into your succession planning. J Bus Strategy. May/June 2002;23(3yf . 16. Conger JA, Fullmer RM. Developing your leadership pipe line. Harv Bus Rev. December 2003;81(12yf . 17. Collins J. Good to Great: Why Some Companies Make the Leap and Others Don’t. New York, NY: HarperCollins Publishers; 2001. 18. Welch J. The Vitality Curve: Dare to Differentiate People. Leadership Excellence; 2005. Available at: www.Leader Excel.com. Accessed December 1, 2005. 19. Pynes JE. The implementation of workforce and succession planning in the public sector. Public Pers Manage. 2004;33(4yf : 389-404. 20. Freeman KW. The CEO’s real legacy. Harv Bus Rev. November 2004;82(llyf . 21. Beeson J. Succession planning. Leading edge practices: What best companies are doing. Across Board-, February 2000; 37(2yf $ % , , 1 ) 2 5 0 * O R E D O . 330 JONA • Vol. 36, No. 6 • June 2006 References 1. Garten JE. Economic Viewpoint. Bus Week Online. September 10, 2001. Available at: www.businessweek.com. Accessed December 1, 2005. 2. Doody MF, Phillips AW. Preparing Future Leaders in Health Care: A Confidential Survey of Healthcare Chief Executive Officers. Oakbrook, 111: Witt/Kiefer; 2002. 3. Larson L. Your CEO: Are you short-staffed or short-sighted? Trustee. July/Aug 2001:15-18. 4. Dolan TC. Increasing succession planning. Healthc Exec. May/June 2005:6. 5. PRN Newswire, May 12, 2003. Available at: http://www. prnewswire.co.uk/cgi/news/release?id=102155. Accessed December 1, 2005. 6. Witt/Kiefer in conjunction with California State Uni versity Los Angeles. Follow the Leaders: How Healthcare Leaders Mentor and Develop New Executives for Leader ship Succession. Los Angeles, Calif: Witt/Kiefer; Dec 2004: 1-8. 7. Witt/Kiefer. Succession planning tops healthcare leadership strategies. Perspectives. Winter 2004:1-2. 8. Witt/Kiefer in conjunction with California State Univer sity, Los Angeles. In: Putting Succession Planning into Play: Identifying and Developing the Healthcare Organi zation’s Successors. Los Angeles, Calif: Witt/Kiefer; 2004: 1-8. 9. Witt/Kiefer in conjunction with California State University, Los Angeles. In: View From the Top: CEO Perspectives on Leadership Talent, Executive Development, and Succession Planning in Healthcare Organizations. Los Angeles, Calif: Witt/Kiefer; May 2004:1-8. 10. Hymowitz C, Lublin JS. Lesson From McDonald’s Tragedy: Always Have A Succession Plan. Wall Street Journal Online. April 27, 2004. 11. Roszak DJ. Most freestanding hospitals do not conduct leadership succession planning. Hosp Health Netw. 2005; 79(1yf . 12. Garman AN, Tyler JL. “What kind of CEO will your hospital need next? A model for succession planning. Trustee. October 2004:38-40. 13. Charan R. Ending the CEO succession crisis. Harv Bus Rev. February 2005;83(2yf . 14. Byham WD, Nelson GD. Succession planning Rx: developing the next generation of leaders. Health Forum J. November December 1999;42(6yf . 15. Rothwell WJ. Putting success into your succession planning. J Bus Strategy. May/June 2002;23(3yf . 16. Conger JA, Fullmer RM. Developing your leadership pipe line. Harv Bus Rev. December 2003;81(12yf . -t —I 11* T 1 . S~l , TV7I c . . 1 f . 1 . 1. _ 17. Collins J. Good to Great: Why Some Companies Make the Leap and Others Don’t. New York, NY: HarperCollins Publishers; 2001. 18. Welch J. The Vitality Curve: Dare to Differentiate People. Leadership Excellence; 2005. Available at: www.Leader Excel.com. Accessed December 1, 2005. 19. Pynes JE. The implementation of workforce and succession planning in the public sector. Public Pers Manage. 2004;33(4yf : 389-404. 20. Freeman KW. The CEO’s real legacy. Harv Bus Rev. November 2004;82(llyf . 21. Beeson J. Succession planning. Leading edge practices: What best companies are doing. Across Board-, February 2000; 37(2yf $ % , , 1 ) 2 5 0 * O R E D O . 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Research Paper: What is the role of a manager in succession planning in a healthcare organization? To achieve a successful assignment, you are expected to meet the following requirements. Scholarly Ex
FORMAL SUCCESSION PLANNING IN HEALTHCARE ORGANIZATIONS: MEETING LEADERSHIP N EEDS IN A CHANGING AMERICAN WORKFORCE A DISSERTATION SUBMITTED TO THE FACULTY OF THE SCHOOL OF EDUCATION SPALDING UNIVERSITY LOUISVILLE, KENTUCKY BY FREDA BAILEY SHIPMAN IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF EDUCATON LOUISVILLE, KENTUCKY MAY 3, 2007 UMI Number: 3263463 3263463 2007Copyright 2007 by Shipman, Freda Bailey UMI Microform Copyright All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. ProQuest Information and Learning Company 300 North Zeeb Road P.O. Box 1346 Ann Arbor, MI 48106-1346 All rights reserved. by ProQuest Information and Learning Company. iii Copyright 2007 by Freda Bailey Shipman iv ACKNOWLEDGMENTS “No Matter what accomplishments you make, somebody helps you,” Althea Gibson I would like to thank my dissertati on committee members for their support and assistance in completing my study. Their input and comments helped guide me and maintain my focus. Special thanks to Dr. Mary Angela Shaughnessy who encouraged me to pursue the doctoral program of studies at Spalding University. I wish to thank Dr. Marie Sanders for her willingness to serve as my committee chair and her time and patience while working with me, as well as the committee members; Dr. Erlene Grise- Owens and Dr. Hope Zoller Stith. To my frie nd and colleague, Mrs. Gabrielle T. Ingram who initially informed me about the Spalding doctoral program I extend my gratitude, and to Mrs. Jo Russell, Mrs. Jaymne Hamner , Mrs. Sharon Jarnagin Ivey Patterson, Ms. Sheila Stuckey, Ms. Deborah Tazewell for thei r time, patience and technical expertise. I would like to thank my husband, Keith, Sr. and to my sons, Keith, Jr. and Thomas for their support during the past three years for often making sacrifices in order for me to be able to attend and participate in the doctoral program. To my parents, Thomas Edward Bailey and Bermadean Wyche Bailey who encouraged me to complete this degree and gave me my strong value fo r education and continued lifelong learning. To my grandparents who early in my childhood made their own sacrifices to ensure my success. To my sister, Dr. Paron T. Bailey who has been my inspiration and has been supportive through the years, and to my frie nd, Dr. Linda Larkin-Scott who provided me with encouragement and support in the comp letion of this dissertation and to my references: Mrs. L. Sue Stevens, Mrs. Be tty B. Parham and Dr. Terri Moore Brown for their belief in me. To my supervisor, Dr. James A. Flueck, my co-worker, Mrs. Deidre v K. Garrett. To my cohort, particularly Peg Ehlers, Tim Crook, Nick Gargala, Dr. Connie Hayes, Dr. Kevin Hubb, Dr. Larry Owens, Dr. Keith Newman, D’Artagnan Ramsey, Loretta Shake, Chad Wallace, and Deborah Wallace who were supportive and assisted me on my journey; it is to these especial people I dedicate this dissertation. vi ABSTRACT This research is a qualitative study that investigates succession planning management in four (4) Kentucky healthcare organizations as it relates to the changing workforce demographics. In planning for the 21 st Century workforce, organizations are becoming increasingly aware of the aging workforce a nd implementing strategies to develop career development programs to identify and devel op employees for middle and upper levels of leadership. America’s workforce is aging w ith large numbers of employees eligible for retirement. The supply of future workers a nd leaders within healthcare organizations is dangerously reduced if health care organizations do not plan for the large numbers of employees eligible for retirement. This st udy analyzed the trends expected to impact healthcare organizations as leadership tran sitions occur among an aging population and workforce. This research study examined how four (4) Kentucky healthcare organizations identify potential leaders; use mentoring to address succession plans; retain employees and prepare for workforce dive rsity; and develops leaders within the organization. A major finding of this study was the consistency among all four participant organizations. The findings reflec t the need for healthcare organizations to create formal succession plans to address work force and leadership shortages. The study reveals that none of the participant organi zations have formal succession plans, and leadership development training is in the infa ncy stage of development. The implications for healthcare organizations are signifi cant and demand action now. A crisis in healthcare and related or ganizations can be alleviated if leaders take action to address the aging and shrinking workforce and plan fo r leaders using mentoring and formal succession planning. vii TABLE OF CONTENTS ACKNOWLEDGMENTS……………………………………………………………… ……………………. iv ABSTRACT……………………………………………………………… ……………………………………….. vi CHAPTER I: INTRODUCTION ……………………………………………………………… …………….1 Significance of the Problem/Research Questions ……………………………………………………7 Research Questions……………………………………………………………… ……………………… 11 Purpose of the Study ……………………………………………………………… …………………………12 Assumptions and Limitations ……………………………………………………………… …………….14 Definitions of Terms……………………………………………………………… …………………………15 CHAPTER II: REVIEW OF THE LITERATURE ………………………………………………….19 Effective Succession Planning ……………………………………………………………… ……………21 Table 1: Characteristics of and Ba rriers to Effective Succession Planning …………. 25 Benefits and Challenges of Succession Planning …………………………………………….. 27 Leadership Development in Healthcare Organizations ………………………………………….28 Workforce Retention……………………………………………………………… ……………………. 29 Table 2: Recommendations for Identify ing Leaders within an Organization………. 30 Table 3: Recommendations for Hiring Leaders in Organizations ……………………… 30 Leadership Shortage……………………………………………………………… ……………………. 34 360 Degree Feedback ……………………………………………………………… ………………….. 36 Mentoring to Develop Succession Plans in Healthcare ………………………………………….37 Succession Planning and Mentoring……………………………………………………………… 40 Readiness for Leadership……………………………………………………………… ……………… 41 Workforce Diversity and Mentoring ……………………………………………………………… ……42 viii Challenges of Mentoring……………………………………………………………… ………………. 47 Employee Retention in Healthcare ……………………………………………………………… ……..48 Workforce Diversity in Healthcare Organization ………………………………………………….50 Generational Diversity……………………………………………………………… …………………. 53 CHAPTER III: METHODOLOGY ……………………………………………………………… ………..56 Introduction……………………………………………………………… ……………………………………..56 Purpose of the Study ……………………………………………………………… …………………………56 Research Design……………………………………………………………… ……………………………….57 Populations and Sett ings/Data Collection …………………………………………………………….59 Limitations and Summary ……………………………………………………………… ………………….60 CHAPTER IV: RESULTS ……………………………………………………………… ……………………62 Data Analysis……………………………………………………………… …………………………………..63 Edited Participant Organization Responses ………………………………………………………….63 Question #1……………………………………………………………… ………………………………… 64 Figure 1: Formal Succession Planning ………………………………………………………….. 65 Participant Organization A……………………………………………………………… ……. 65 Participant Organization B……………………………………………………………… …….. 65 Participant Organization C……………………………………………………………… …….. 66 Participant Organization D ……………………………………………………………… ……. 67 Question #2……………………………………………………………… ………………………………… 68 Figure 2: Define Key Positions ……………………………………………………………… …….. 69 Participant Organization A……………………………………………………………… ……. 69 Participant Organization B……………………………………………………………… …….. 69 ix Participant Organization C……………………………………………………………… …….. 71 Participant Organization D ……………………………………………………………… ……. 72 Question #3……………………………………………………………… ………………………………… 74 Figure 3: Performance Management ……………………………………………………………… 75 Participant Organization A……………………………………………………………… ……. 75 Participant Organization B……………………………………………………………… …….. 76 Participant Organization C……………………………………………………………… …….. 77 Participant Organization D ……………………………………………………………… ……. 77 Question # 4……………………………………………………………… ……………………………….. 78 Figure 4: Identifying Successors for Key Positions …………………………………………. 79 Participant Organization A……………………………………………………………… ……. 79 Participant Organization B……………………………………………………………… …….. 79 Participant Organization C……………………………………………………………… …….. 81 Participant Organization D ……………………………………………………………… ……. 81 Question #5……………………………………………………………… ………………………………… 81 Figure 5: Identifying High Potential Employees …………………………………………….. 82 Participant Organization A……………………………………………………………… ……. 82 Participant Organization B……………………………………………………………… …….. 83 Participant Organization C……………………………………………………………… …….. 85 Participant Organization D ……………………………………………………………… ……. 85 Question #6……………………………………………………………… …………………………….. 86 Figure 6: Individual Development Plans ………………………………………………………. 87 Participant Organization A……………………………………………………………… ……. 87 x Participant Organization B……………………………………………………………… …….. 87 Participant Organization C……………………………………………………………… …….. 88 Participant Organization D ……………………………………………………………… ……. 88 Question #7……………………………………………………………… ………………………………… 89 Participant Organization A ……………………………………………………………… ……. 90 Participant Organization B……………………………………………………………… …….. 90 Participant Organization C……………………………………………………………… …….. 90 Participant Organization D ……………………………………………………………… ……. 90 Question #8……………………………………………………………… ………………………………… 91 Figure 8: Healthcare Organization Special Programs ………………………………………. 91 Participant Organization A……………………………………………………………… ……. 91 Participant Organization B……………………………………………………………… …….. 92 Participant Organization C……………………………………………………………… …….. 93 Participant Organization D ……………………………………………………………… ……. 93 Question # 9……………………………………………………………… ……………………………….. 93 Figure 9: Succession Planning Evaluation Activities ………………………………………. 94 Participant Organization A……………………………………………………………… ……. 94 Participant Organization B……………………………………………………………… …….. 94 Participant Organization C……………………………………………………………… …….. 95 Participant Organization D ……………………………………………………………… ……. 95 Question # 10……………………………………………………………… ……………………………… 95 Figure 10: Special Challe nges with Succession Planning ………………………………… 97 Participant Organization A……………………………………………………………… ……. 97 xi Participant Organization B……………………………………………………………… …….. 98 Participant Organization C……………………………………………………………… …….. 98 Participant Organization D ……………………………………………………………… ……. 99 Patterns and Themes……………………………………………………………… ……………………….100 Table 5: Patterns and Themes of Survey Responses ……………………………………… 100 Research Questions and Summary of Responses ………………………………………………..101 Summary……………………………………………………………… ……………………………………….105 CHAPTER V: ……………………………………………………………… ……………………………………106 DISCUSSIONS, IMPLICAT IONS AND RECOMMENDATIONS …………………………106 Introduction……………………………………………………………… ……………………………………106 Discussion of Results ……………………………………………………………… ………………………109 Implications……………………………………………………………… ……………………………………110 Recommendations for Further Research …………………………………………………………….11 2 Conclusion……………………………………………………………… …………………………………….113 APPENDICES ……………………………………………………………… …………………………………..125 Appendix A. Research Ethics Approval Letter …………………………………………………..125 Appendix B. Spalding University Research Ethics Proposal ……………………………….126 Appendix C. Letter to Survey Participants………………………………………………………..129 Appendix D. Informed Consent……………………………………………………………… ……….131 Appendix E. Interview Guide Questionnaire ………………………………………………………133 Appendix F. Doctoral Dissertation Proposal Acceptance Form ……………………………135 BIOGRAPHY……………………………………………………………… ………………………………..136 xii LIST OF TABLES Table 1: Characteristics of and Barriers to Effective Succession Planning ………………… 25 Table 2: Recommendations for Identify ing Leaders within an Organization……………… 30 Table 3: Recommendations for Hiring Leaders in Organizations …………………………….. 30 Table 4: Benefits and Challenges of Workforce Diversity ………………………………………. 44 Table 5: Patterns and Themes of Survey Responses…………………………………………….. 100 xiii LIST OF FIGURES Figure 1: Formal Succession Planning……………………………………………………………… …. 65 Figure 2: Define Key Positions……………………………………………………………… ……………. 69 Figure 3: Performance Management ……………………………………………………………… …….. 75 Figure 4: Identifying Successors for Key Positions ………………………………………………… 79 Figure 5: Identifying High Potential Employees……………………………………………………. 82 Figure 6: Individual Development Plans……………………………………………………………… 87 Figure 7: Replacement Charts……………………………………………………………… ……………… 89 Figure 8: Healthcare Organization Special Programs ……………………………………………… 91 Figure 9: Succession Planning Evaluation Activities……………………………………………… 94 Figure 10: Special Challenges with Succession Planning ……………………………………….. 97 1 CHAPTER I: INTRODUCTION Because of the aging workforce, healthcare organizations are facing a leadership and workforce crisis. Today’s employees are working in an information age and knowledge-based economy. Baby boomers are often seasoned professional employees with a wealth of information, knowledge and experience regarding technical and program skills, and are considered the historians for the organizations of which they are employed (Schiller, 2005). Younger employers (generat ion Xers) often lack the experience, work ethic and life experiences of their predecessors. It is critical for healthcare organizations to position themselves for success and focus on the fundamentals that will help healthcare organizations sustain themselves in the 21 st Century. This is a qualitative study that investigates the characteristics of a formal succession plan and identifies ways healthcare organizations can make succession planning mo st effective to ensure organizational success over time. The past decade of downsizing and reorganization has robbed organizations of developing leadership talent waiting in the wings to step into leadership roles. Additionally, an increasing numb er of employees are retiring with fewer years of service and at younger ages, fewer are entering th e workforce and more employees desire flexible work schedules (GAO-01-241, 2001). These trends have reduced America’s 2 workforce and limited the job opportunities for workers with the potential, energy and innovative ideas needed for today’s knowledge-based workplace (Rothwell, 2001). The supply of future workers and leaders within healthcare organizations is dangerously reduced if healthcare organi zations do not plan for the large numbers of employees eligible for retirement and the large number of senior employees leaving organizations (Camden, 2005; Goddard, 1989; Schiller, 2005). According to the Bureau of Labor Statistics, healthcare is one of the fastest growing occupational areas. Fourteen of the 30 fastest growing occupations are related to healthcare. “Employment of medical and hea lth service managers is expected to grow faster than the average for all occupations through 2012, as the health services industry continues to expand and di versify” (Braddock, 1999, p. 55). Mentoring and succession planning are leadership development models that contain aspects for identifying and retaining talent for future leadership roles within an organization. Soonhee (2003) defines succes sion planning as an ongoing process of systematically identifying, a ssessing and developing organiza tional leadership to enhance performance. Similarly, Rothwell (2001) defi nes succession planning as a deliberate and systematic effort by an organization to ensu re leadership continuity in key positions, retain and develop intellectual knowledge cap ital for the future, as well as encourage individual advancement. Succession planning presents a paradigm shift for human resource management to help organizational l eadership identify, recruit, train and retain a pool of employees who demonstrate high poten tial for leadership development. To ensure leadership progression for the next ge neration of leaders, succession planning is a 3 model that involves strategic planning within organizations with the purpose of mentoring and grooming younger employees for pos itions of leadership (Rollins, 2003). As reflected in much of the literature, mentoring is a recurring trend supporting succession planning. Mentoring is not a new conc ept and dates back thousands of years. According to Greek Mythology, in 800 B. C. Od ysseus, the king of Ithaca was headed off to fight in the Trojan War and left his s on Telemachus at home in the care of a friend, Mentor. In many ways, the defi nition of mentor relates to this Greek Myth, as mentoring is a form of supporting and teaching others who have a desire to learn (Leahy, 1996). Mentoring is an exchange of learning. According to Dolan (1996), healthcare management has a great tradition of mentor ing. Studies confirm what many intuitively know – the single most important influence in a person’s life is the relationship with a caring adult, which is the cornerstone of mentoring (Coughlin, Wingard, & Hollihan, 2005). There are many definitions of mentoring; however, the literature reveals several common themes. A mentor is typically an experienced, high ranking organizational member who assists in the career development of the person being mentored (mentee) by serving as a coach, sponsor and advocate (Kram, 1985; Noe, 1988). The person being mentored is a new or less experienced orga nizational member. Mentors are defined as those who help to shape the professiona l identity (Javidan, Bemmels, Devine, & Dastmalchian, 1995), model appropriate profes sional behaviors (Ragins, 1989), render guidance and support (Burke, 1984), teach the in tricacies of the work environment (Kram & Isabella, 1985), provide political sponsorship (Kanter, 1997), and facilitate entry into organizational and professional networks (Ibarra, 1993). Leahy, (1996) defines 4 mentoring as a “mutually agreed-upon relationship between an experienced company veteran or industry veteran and a less experi enced worker who’s eager to learn” (p.1). Kibby (1997) defines a mentor as one who brin gs in a rich history of experience and wisdom learned in the school of life–an inva luable asset to any organization that can reveal hidden opportunities and help the company avoid pitfalls and mistakes. Succession planning and mentoring are hum an resource tools that compliment each other. Organizations ar e realizing the benefits of mentoring as a strategy for succession planning and are investing in formal programs to serve as career development and management training tools (Burke , McKeen, & McKenna, 1993). Succession planning is a tool that ensures that the right people with the right skills are in the right place at the right time to meet the orga nization need over time (Rothwell, 2005). Labor market trends and the demand for critical skills dictate that organizations can no longer neglect the critical task of pla nning their future workforce. According to Rothwell, Prescott, and Taylor (1998) some of the trends in the workplace and workforce include: 1. Changing technology 2. Increasing globalization 3. Continuing cost containment 4. Increased speed in the market place 5. The growing importance of knowledge capital 6. An increasing rate and magnitude of change Competitive organizations know that investing in their workforce through career development opportunities pays off in multiple ways. Benefits of career development 5 include attracting, retaining and developing employees with talent and potential. Career planning gives individuals an opportunity to identify their career goals and develop themselves to achieve those goals. “Wit hout career planning, succession planning is a wish list; without succession pl anning, career planning can be a roadmap leading to an uncertain destination” (Rothwell, Ja ckson, Knight, & Lindholm, 2005, p. xv). Planning for human resources needs is one of the greatest challenges facing managers and leaders today. In order to m eet this challenge, a uniform process that provides a disciplined approach for matching human resources with the anticipated needs of the organization is essential. Formal succession planning is necessary to organizational success and long-term viability. The United States workforce is growing older in the 21 st Century. Between 1998 and 2008, several job vacancies will occur due to retirement. “Sixty-four million baby boomers (over 40% of the US Labor Force) are looking at retirement in large numbers by the end of this decade.…By 2010, the number of US workers ages 45-54 will grow by 21%, while the number of 55-64 year olds will expand by 52%. Many in the latter age group are looking ahead to re tirement” (http://www.conference-board.org, retrieved 11/14/05, pp. 10-11). According to (Rothwell et al., 2005), workforce statistics alone should motivate healthcare organizational leader s to act in thoughtful ways to ensure the long-term organizational leadership stab ility. These statistics have far-reaching implications for the United Stat es and international economies: • One in five senior executives in Fortune 500 companies is eligible for retirement within the next five years. 6 • About 80 percent of all senior ex ecutives and about 70 percent of all middle managers in the U. S. Federal governments are eligible for retirement during the current administration’s term in office. • About 50 percent of the entire federal government workforce is eligible to retire now. • One million college professors will soon be eligible for retirement. Because of the aging workforce, formal succession planning and mentoring should be high on the list of human res ource goals for organizations. In the 21 st Century, turnover and change among employees and with in leadership and management staff is now a common occurrence. Leaders and employees are leaving the workforce due to retirements, disability, death, downsizing, earl y retirement, lack of commitment, natural disasters, need for flexibilit y, and an individual’s desire for entrepreneurial pursuits. America’s workforce is aging with a large number eligible for retirement, which also means that senior employees are leaving the workforce in large numbers (Braddock, 1999). In today’s workforce, many baby boomer s have numerous roles including dual career families, caring for parents, long commutes, smaller families, fast-paced lifestyles, living away from extended families, and a dditional workplace demands (Camden, 2005). The various personal roles and workplace requi rements may also be reasons why people are opting to leave the workplace when or be fore they are eligible. The mass exodus of employees exiting the workforce is presen ting challenges for organizations, while providing opportunities for those seeking employment and advancement in their careers. Additionally, the growth rate of the labor force is expected to decline secondary to a 7 decline in population growth and a reduction in overall work force participation, including women’s labor force. The Bureau of Labor Statistics (BLS) projects a slowing of growth in the labor force, from a rate of 1.7 perc ent per year between 1950 and 2000 to just under 0.8 percent per year between 2000 and 2050….In the current decade and in the years after 2030, th e 16-64 age group will grow at the same rate as the overall population. From 2010 – 2030 the increase in this group will be between 0.2 and 0.3 percent, lower than the total population growth (Schiller, 2005, p. 31). Significance of the Problem/Research Questions Succession Planning is a t ool that is synonymous with an old parable about fish: “Give people a fish and they can eat for a day; teach people how to fish and they will eat for a lifetime” (Chinese proverb). The concept of succession planning dates back to biblical wi sdom of leadership. “The leaders of the Bible, as well as today’s most astute business and civic leaders, wanted competent, mature leaders with the right priorities and values following in their shoes (or sandals)” (Wolfe, 2002, p. 196). The idea of succession planning was first introduced in the 20 th Century by Henry Fayol (1841- 1925) who claims that management has a responsibility to ensure “the stability of tenure of personnel” (Rothwell et al., 2005). Help me to develop leaders in every generation, and I will perpetuate the organization forever….The most su ccessful, long-lasting organizations make a conscious effort to devel op leaders in every generation. 8 Leadership development training programs in the 21 st century mirrors biblical leadership with succession planning. In the beginning of time, leadership development and su ccession planning were not done consciously. Much of the activ ities took place naturally and spontaneously. The organization that began in Biblical times (religion) has sustained itself for almost sixty centuries; modern corporations would do well to borrow some of its techniques (Wolfe, 2002, p. 195 – 200). Succession Planning and mentoring are to day’s human resource tools that can help organizations become “great” while focusing on future and current needs and identifying talent within an organization. Collins (2001) studied “great companies” and what makes great management and organizations. He states that organizations must have the right people on the bus, the wrong peopl e off the bus, the right people in the right seats and then figure out where to drive on the right bus at the right time. In developing disciplined people, leaders always think first about “who” and then about what (p. 13). This approach is helpful to organizations in identifying people with the right skills needed for leadership and other key positio ns within an organization. Collins (2001) wrote about building lasting or ganizational greatness; he identified this as “clock building, not time telling” (p. 199). Truly great organizations prosper through multiple generations of leaders, as opposed to an organization built around a single great leader, great idea, or specific program. Succession planning and mentoring are receiving increased attention within healthcare organizations’ strategic plans for l eadership development. With the number of employees within the workforce now eligible for retirement, organizations are quickly 9 trying to identify new talent to step into the roles of those employees slated to exit the workforce. Succession planning and mentori ng are human resource tools that assist organizations with developing strategies to prepare for workforce changes that could occur at any time, thus reducing panic w ithin an organization and providing a smooth transition when leadership changes occur. Th is strategy ensures a successful transfer of knowledge without changing the culture, sy mbols, structure and politics of an organization too drastically. This proactive approach eliminates the lag time common in the hiring process by successors when leadership positions change (Wolfe, 2002; Rothwell, 2001; Jacobs & Fraser, 1987). Succession planning and mentoring helps orga nizations identify talent within the organization, leaves a legacy and prepares those individuals for expanded roles. Mentoring helps organizations grow by planning for the future, planning for succession and transmitting knowledge. It also prom otes healthy organizational growth by establishing and strengtheni ng networks and communicati on between generations of employees. Succession planning and mentoring are altr uistic and may affect the bottom line as teaching tools that satisfy an individual’s ne ed to help others. Most people have an inner need to assist others and be instru mental in promoting individual growth and developing future leaders. The long-term positive effect of mentoring may fulfill this need and enhance leaders’ se lf-esteem. Drucker (1998) suggests that many variables create a leader which include s work experience, hardship, opportunity, education, role models, and mentors. 10 Succession planning is a tool that is synonymous with the old parable about fish, and a saying about turtles and helpin g others: Alex Haley, author of Roots, says, “Whenever you see a turtle on t op of a fence post, you know he had a lot of help getting there.” Aletha Gibson wrote, “No matte r what accomplishments you make, somebody helps you.” As Einstein observed, we all st and on the shoulders of giants who came before us. Succession planning and mentoring al lows healthcare organizations to plan for future leaders’ departures; thus becomes pr oactive in addressing the potential gaps of knowledge among essential leadership personne l and high priority occupations within healthcare (Pieper, 2004). Fulfilling the responsibility to give, most leaders want to repay an organization that has provided opportunity to them. Providing future leaders with mentors is one of the best ways to ensure the long-term su ccess of the organization. John Maxwell is known as one of America’s experts on leadersh ip and espouses a leader’s “daily dozen,” where he encourages leaders to look for potential leaders and provide leadership experiences. Maxwell (1995) writes that what leaders do best is help others succeed by “leading, empowering and then getting out of the way” (p. 308). Leaving a legacy of leadership is the responsibility of the lead er, the lasting value that will be measured by the leaders’ successors (Maxwell, 1998). In order to be effective, succession pl anning and mentoring must have the support of human resources and top management with in an organization. Resources are needed to fund programs to develop and cultivate new l eaders. In efforts to develop a successful program, potential successors must be identifi ed early in their careers, as change in leadership is generally stressful for most or ganizations. An effective succession plan can 11 help reduce stress in the workplace among the st akeholders. A change in leadership can be a smooth process that eliminates or decreases organizational in stability and improves the organizations effectiveness when successi on planning and mentoring are part of the organizational culture (Abrams & Bevilacqua, 2006) . Research Questions This study examines the demographic predictions expected to impact healthcare organizations as leadership transitions occur due to an aging population and workforce. The following research questions guided the researcher: 1. What are the characteristics of an effective succession plan? 2. Are healthcare industries identify ing potential leaders for future organizational needs? 3. Are healthcare industries using mentoring to develop succession plans? 4. Are healthcare industries addressing employee retention? 5. Are healthcare industries preparing for the shift in workforce diversity? Succession planning is a relatively ne w concept within human resources management. The concept of succession planning has created a paradigm shift among human resource leaders. Traditionally, hum an resource managers took care of basic operations of the workforce and were more doc ile in their administrative functions within an organization . Today’s human resources have become mo re involved with the strategic plans of an organization and have obtained a seat at the table with top management ensuring that 12 competent staff are hired to help organizations meet their objectives and achieve success. Because this is a paradigm shift for organi zations, it is expected that there is limited research on best practices in organizations with succession plans. There is competition in the workforce among organizations to be an employer of choice in efforts to attract, recruit and retain talented employees. Therefore, human resource departments in healthcare organizations are becoming more vital in their role in helping organizations to achieve success with a smoothly operated or ganization and a well-trained and competent workforce (Rebore, 2004, Goddard, 1989, Wellins and Byham 2001). Purpose of the Study This research seeks to examine how four (4) healthcare organizations identify potential leaders; use mentori ng to address succession plans; retain employees and prepare for workforce dive rsity; and develop leaders within the organization. The implications for healthcare organi zations are huge and demand action now. Preventing a crisis in healthcare and other organizations can be alleviated if leaders take action to address the aging and shrinking workforce and prepare for a new wave of unprepared workers. According to McWilliams (2005), healthcare organizations need to implement succession planning and effective mentoring programs because: • 172 corporate vice presidents were in the World Trade Center at time it collapsed. • 87% of senior managers and 78% of middle managers in the Federal government are eligible to retire. • One in seven senior executives in the Fortune 500 is eligible for retirement in the next few years. • Airline pilots, industrial engineer s, college professors, and HR practitioners are the o ccupations with the highest percentage of job incumbents age 50 or over. 13 • Government (at all levels) and li ght manufacturing industries in the US have the most aged workforces. • Right now, one million college professors and one million public school teachers are eligible fo r retirement and 50% of all community college presidents are ready for retirement. • Nationally, half of secondary schoo l teachers are 45 years old or older, with 65% expected to retire by 2008. • 2/3rds of the increase in the “US Population between 2000 and 2050 will consist of immigrants. This means that applicants for these positions will be lacking: o English proficiency o Sufficient education and training o Citizenship” These statistics are startling and have huge implications for the 21 st Century workforce. The implications for health care organizations are critical and demand attention now. Preventing a crisis in health care and other organizations can be alleviated if leaders are proactive in th eir approaches to address the aging and shrinking workforce and prepare for a new wave of unprepared workers. An effective succession plan at a time when workforce diversity offers unique challenges regarding employee retention is e ssential to leadership identification and corporate development (Rothwell, 2001). This qualitative study will investigate the characteristics of a formal succession plan and identify ways healthcare organizations can make succession planning most effective for leadership development to ensure organizational success over time. As many organizations find themselves unprepared for leadership shifts, they must analyze changing demographics within the workforce (Rothwell, 2001). The purpose of this study is to analyze pred icted employee shortages and develop an organizational approach to address wo rkforce needs and challenges for the 21 st century. The goal of this study is to develop strategi es for healthcare organizations designed to 14 retain knowledge of retiring or departing employees while increasing knowledge and skills among current employees and those iden tified for leadership positions. Succession planning presents a paradigm shift for human resource management in helping organizational leadership to identify, recruit, train and retain employees who demonstrate high potential for leadership development. If succession planning and mentoring are employed in healthcare organizations to addr ess workforce-planning issues, then steps are needed to develop and transfer orga nizational knowledge and power to younger and newer employees, thus the need to recruit out side of the organization is reduced when workplace vacancies occur. Assumptions and Limitations The scope of this research is limited to four (4) private and public healthcare medical centers in Lexington, and Louisville , Kentucky. Data may be limited based on the numbers of healthcare organizations choos ing to complete the research survey. The literature review is limited to the past 10 years (1996 – 2006) and the literature may reflect the changing needs of employees such as flexible work schedules, virtual work assignments, family demands, and demographic tr ends as it relates to age and retirement. Data may be limited on reasons employees le ave their organizations for other than retirement reasons. There are 95 medical/sur gical healthcare facilities in Kentucky and 40 facilities with a capac ity of 150 or more beds as iden tified in the Kentucky Hospitals 2006 Guide. This research will sample only those medical/surgical fa cilities with 150 or more beds (N=4) to get a representation of succession planning management in healthcare facilities located in Louisvill e and Lexington, Kentucky. A review of the literature reveals that there are a limited number of examples of leadership succession 15 plans related to healthcare management and few peer reviewed articles or comparative studies addressing healthcare a nd its use and practice of succession planning. However, there were articles on the skills and compet encies needed for developing leaders. Definitions of Terms For the purposes of this study, the following terms and phrases are critical to this research. Several terms and definitions have meaning within the context of the succession planning experience and among human resource professionals. 1. Succession Planning Management – an effort designed to ensure the continued effective performance of an organization, division, department, or work group by making provision for the development, replacement, and strategic application of key people over time (McWilliams, 2005). 2. Technical Succession Planning – any effort designed to ensure the continued effective performance of an organizati on, division, department, or work group by making provision for distilli ng, preserving, maintaining and communicating the fruits of the organization’s institutional memory and unique experience over time (Rothwell & Poduch, 2004). 3. Mentor – A mentor is typically an expe rienced high ranking organizational member who assists in the career deve lopment of the person being mentored (mentee) by serving as a coach, sponsor and advocate (Kram, 1985). 4. Workforce Planning – A guide for developing wo rkplace competencies to meet organizational strategic plans (opm.gov). 5. Benchmarking – The approach of establis hing operating targets and productivity programs based on industry best practices (Rothwell, 2001). 16 6. Human Capital – Professional employees with a wealth of information regarding technical and progr am skills and are considered historians for the organizations of which they are employed (opm.gov). 7. Competencies – Behavior based attributes of employees, which examines their strengths and weaknesses in leadership (Rothwell, 2001). 8. Best Practice – recommended practices by subj ect matter experts who have experience, are referred to as profes sionals, and have experience with consistent success rates. 9. Traditionalists – persons born before 1945. 10. Baby Boomers – persons born between 1946 – 1964. 11. Generation X’ers – persons born between 1965 – 1977. 12. Millennials – ( also known as Generation Y, born 1978 and after). 13. Generational Differences – A shared tradition and culture by a group of people that is lifelong (Arsenault, 2004). 14. Human Resource Management (HRM) – Also known as human resources, functions to hire, retai n, develop, and motivate personnel in order to achieve the objectives of the organization, to assist individual members of the staff to reach the highest possible levels of ac hievement, and to maximize the career development of personnel (Rebore, 2004). 15. Diversity – includes people from differing cultures, races, religions, ender, physical ability, backgrounds and va lues (Ivancevich & Gilbert, 2000). 16. Retention – the act of retaining, to hold s ecure as in retaining productive employees. 17 17. Leadership – the process of influencing lead ers and followers to achieve organizational objectives through change (Lussier, 2001). 18. Replacement planning – managers identify and help groom their replacements before moving on to another position themselves (Rollins, 2003). 19. Paradigm Shift – a framework for how one views the world that affects judgment and decision making. 20. High Potential – employees who have the poten tial to move up the career ladder in 6 months, one year, three years, five years or an adequate time frame for the organization (McWilliams, 2005). 21. Employee Improvement Plan also known as an Individual Development Plan– a means for the individual to docu ment and track progress for personal and professional development activities (McWilliams, 2005). 22. Bench Strength – the availability of strong and deep pools of talent, able to assume a number of varied leadership roles at various levels within an organization (Kesler, 2002; Rothwell, 2001). 23. 360-degree feedback instrument – a tool used to gather high-quality performance feedback from peer s, superiors and customers 2004). 24. Prejudice: The tendency to form an adve rse opinion, without just cause, about people who are different from the mainstream in gender, race, ethnicity, or any other definable charac teristic (Lussier, 2001, p 436). 25. Ethnocentrism – The belief that one’s own group or subculture is naturally superior to other groups and cultures (Lussier, 2001, p. 436). 18 26. Glass Ceiling- An invisible barrier that sepa rates women and minorities from top leadership positions (Lussier, 2001, p. 436). 27. Multiculturalism – involves increasing the consciousness and appreciation of differences associated with the heritage, characteristics, and values of many different groups, as well as respecting the uniqueness of each individual (Rothwell, 2001, p. 18). 28. Healthcare Industry: Companies that develop, ma nufacture, market, and/or distribute health-related pr oducts or provide healthcare services such as hospitals, nursing homes, HMOs, me dical product suppliers, medical equipment and medical device makers, a nd medial laboratories (Healthcare Industry. n.d.retrieved 3/12/07). 19 CHAPTER II: REVIEW OF THE LITERATURE Actuaries have predicted numerous paradigm shifts and workforce shortages that will affect the American Labor Market in th e twenty-first century. America’s workforce is aging and a large number of CEO’s, management, and employees are eligible for retirement. Succession planning management in the healthcare industry is receiving increasing attention in the lite rature. Since the 1990’s, there is some discussion about succession planning and mentoring which addresses workforce concerns for future leadership. The predicted mass exodus of employees presents challenges for the healthcare industry and crea tes opportunities for those remaining employees. This paradigm shift is expected to deeply affect the healthcare industry employees and has implications for the workplace, as we know it today. It appears that healthca re industries have not prepared well for succession planning. A survey by Richard Gifford and Nancy Davidson (April 1985) shows that only 18 percent of hospital CEOs questioned ha d identified a successor to themselves as compared to 36 percent of non- healthcare corporate CEO’s. Of those hospitals CEO’s, who had selected the persons to replace them only 51 percent helped prepare that person for a leadership role as opposed to 71 per cent in the corporate sphere. Recent studies found that the average tenure of a nonhealthcare CEO is seventeen (17) years and three 20 (3) years for a healthcare CEO (Jacobs & Fr aser, 1987). According to an October 2004 American College of Healthcare Executives (ACHE) study, many hospitals do not practice adequate succession planning (Burt, 2005). The healthcare industry has grown to a market based industry subject to the changing demands of multiple stakeholders. Swift changes in technology, delivery of services, increased demand for services and decreasing revenue require organizations to make changes in order to remain viable to move employees for the next level for leadership and other positions. The dema nd for competent healthcare workers will increase as the population ages and begins to experience age related illnesses and diseases. As the baby boomer generation ages , there will be a change in the supply and demand for workers in different industries a nd occupations leading to potential shortages of workers in healthcare a nd education (Schiller, 2005). In reviewing the literature related to healthcare organizations, there is a limited amount of information regarding leadership succession planning related to healthcare management. There were few peer reviewed articles or comparative studies addressing healthcare and its participati on and engagement in succession planning. However, there is research defining the skills and competencies needed for developing leaders. The objective of this chapter is to review the literature relevant to the analysis and importance of addressing the following questions: 1. What are the characteristics of an effective succession plan? 2. Are healthcare industries identifying poten tial leaders for future organizational needs? 3. Are healthcare industries using mentoring to develop succession plans? 21 4. Are healthcare industries a ddressing employee retention? 5. Are healthcare organizations prepari ng for the shift in workforce diversity? Effective Succession Planning According to Wolfe (2002), the concept of succession planning dates back to biblical times and the wisdom Jesus exercised in his leadership role as he carefully picked twelve disciples, which allowed him to develop additional leaders. The transition from leader to leader was both smooth and rocky; however, the chosen future leader’s mission and vitality was kept intact. It also kept their leadership engine powerful. Today, organizations realize the value of having compet ent leaders as well as a pool of potential leaders from which to pick at any given time, leaders with the skills necessary to remain successful in today’s global economy. Smart companies and strong organizations have succession plans in place that have constantly assessed all of its “high potentials” so that if an emergency or planned move occurred, there would be people in place to accept the role of leadership. The U. S. government has a succession plan in place in case of the death, im peachment, or resignation of our top executives. We are all too familiar with this scenario through the cases of John F. Kennedy, Richard Nixon, Spiro Agnew, and Bill Clinton. However, succession planning exists for a reason, and smart companies ensure that they too have a succession plan in place that addresses all contingencies, even the “unt hinkable” (Wolfe, 2002, p. 199). Inevitable changes and challenges occur w ithin the workforce of an organization and may include disability, death, natural di sasters, relocation, downsizing, separations, 22 terminations and retirements. A mentorship training program is one strategy in succession planning that is designed to addre ss workplace needs. Succession planning is a very important human resource model that helps with workforce planning needs and builds bench strength within an organizati on (Rothwell, 2001). It includes mentoring new leadership and developing a plan to transfer organizational power to younger employees. According to Rothwell (2001), succession planning can be help ful and minimize disruption when senior em ployees leave an organization. Succession planning is a proactive appro ach that helps leaders deal with unexpected changes and has been defined in many different ways. However, for the purposes of this literature review, this researcher will use the definition coined by McWilliams (2005), succession planning management is an effort designed to ensure the continued effective performance of an organi zation, division, department, or work group by making provisions for the development, repl acement, and strategic application of key people over time. Added to the vocabulary of succession planning is technical succession planning. It is defined as any effort designed to ensure the continued effective performance of an organization, divisi on, department, or work group by making provisions for distilling, pr eserving, maintaining and commu nicating the fruits of the organization’s institutional memory and unique experience over time (Rothwell & Poduch, 2004). The most popular framework for understa nding succession planning is described by William Rothwell, Ph.D. Rothwell (2005) defines succession planning as an effort designed to ensure the conti nued effective performance of an organization, division, department, or work group by making provision for the development, replacement and 23 strategic application of key people over time in efforts to preserve, maintain and communicate the institutional memory and unique experience over time. Succession planning is an evolving human resource model that cannot be a one-time activity. It is an ongoing examination of what the organization should stop, start and continue (McWilliams, 2005). Organizations should examine themselves to identify potential leadership candidates. Kesler (2002) cal ls this analyzing leadership “bench strength” and consulted with 25 major companies observing various approaches to succession planning. He concluded that replacement planning was obsolete in today’s workforce and that succession planning includes a comprehensiv e set of assessment and development practices that support the entire workforce fo r identifying talent at all levels of the organization while nurturing talent and potential at all levels. He found that leadership development has been observed for more than 25 years in Fortune 500 companies such as GE, Exxon and a few others as they devel oped best practices for developing future leaders. In 1973, Walter Mahler wrote Executi ve Continuity, one of the first reports detailing reports of how l eading corporations planned for the replacement of key executives and found succession planning to be an important complement to executive leadership (Kesler, 2002). In the mid 1980s, many Fortune 500 companies adopted General Electrics (GE) approach; however, by the 1990s, succession planning was lost in organizational bureaucracy. McKinsey and Company (1997) completed a study on the “war on talent” and found many succession planning practices unsuccessful; they concluded that executive leadership had been an und er-utilized asset for two decades. 24 Labor market trends and the demand for leaders with high critical thinking ability in tandem with leadership skills dictate th at organizations can no longer neglect the critical task of planning thei r future workforce. Labor market trends and the demand for essential skills dictate that organizations can no longer ne glect the essential task of planning their future workforce. According to Rothwell et al. (1998), some of the trends in the workplace and workforce include: 1. Changing technology 2. Increasing globalization 3. Continuing cost containment 4. Increased speed in market place 5. The growing importance of knowledge capital 6. An increasing rate and magnitude of change Competitive organizations know that invest ing in their workforce with career development opportunities is an investment that will pay off in multiple ways. Benefits of career development include attracting, retaining and developing employees with talent and potential. Career planni ng gives individuals an opportuni ty to identify their career goals and develop themselves to achieve those goals. “Without career planning, succession planning is a wish list; without su ccession planning, career planning can be a roadmap leading to an uncertain destination” (Rothwell et al., 2005, p. xv ). Planning for human resource needs is one of the greatest challenges facing today’s managers and leaders. In order to meet this challenge, a uniform process that provides a disciplined approach for matching human resources with the anticipated needs of the organization is essentia l. Because of the aging workforce, succession planning and 25 mentoring should be high on the list of human resource goals for organizations (Rebore, 2004, Goddard, 1989 Wellins and Byham 2001). Although the literature does not report a formal model of succession planning, its influence appears to be borrowed from busin esses and organizations that have achieved success in identifying, developing and selecting new leaders for their organizations. The succession planning procedures differ from or ganization to organization and the political climate of the organization influences how it is implemented. The literature review yielded a number of important traits for organizations to consider in relation to best practices and reveals that ther e is no one approach that can be used for all healthcare systems. Leaders and HR personnel will need to design their succession plan based on their organizational mission, strategic goals, and workforce needs of their respective organizations. The following ta ble summarizes best practices from the literature. The table includes variables that s hould be included to develop a succession plan as well as barriers associated with strategic planning. Utilizing th is systems approach may address the predicted shortages of l eaders, which include: (The results are in Table 1) Characteristics and B Table 1: Characteristics of and Barri ers to Effective Succession Planning Characteristics of Effective Succession Planning Barriers to Effective Succession Planning • Be proactive • Communicate with all stakeholders • Identify talent at all levels of the organization • Promote from within the organization • Lack of vision • Lack of leadership support • Inertia among employees and leadership • Fear of change • Underestimating the importance of succession 26 • Embrace diversity • Flexibility within strategic planning • Create learning and performance opportunities designed to develop, and strengthen talents and skills • Identify individual and professional career growth needs • Modify the plan when needed • Use assessment to guide education and training • Measure performance by reporting and record results of succession planning • Report results to leadership and stakeholders • Celebrate achievements and begin again planning • Lack of creativity and problem solving skills • Failure to set aside fund for personnel development and training • Restriction of people within organizations with leadership skills • Personal bias • Favoritism and Nepotism • Choosing the wrong people for the wrong job • Procrastination • Missing a leader • Including too many non leaders • Does not relate to the organization’s strategic goals • Not letting people learn from their mistakes • Being impatient Adapted from: (Thorndyke & Grigsby, 2005; McWilliams, 2005; Rothwell, 2001; Rothwell, 2002; Rothwell et al., 2005; Tr opiano, Jr., 2004; Byham & Nelson, 1999; Yancey, 2001; Hutton, 2003; Bartling, 1997; Benchley, 2004; Byham, 2002; Walker, 2005; Kovach, 2005; Goudy, 2002) Because of the complexities of healthcare syst ems, there is no one size that fits all process or magic bullets for implementing a successful succession plan. A succession plan in healthcare must be attuned to current paradigm shifts that occur as the healthcare industry continues to evolve due to workforce trends, diversity, consumer, and community needs. 27 Benefits and Challenges of Succession Planning According to Abrams & Bevilacqua, (2006), the benefits of succession planning for healthcare organizations include the cr eation of organizational legacy to retain workplace knowledge and maintain strong leadersh ip, which in turn is a catalyst for long term high performance. The benefits are numerous which include: 1) preservation of workplace culture, norms and traditions 2) returns on investments, money savings 3) higher patient satisfaction rates 4) improved physician satisfaction and increased referrals 5) positive employee identification with the healthcare system 6) operational metrics improvement 7) financial metrics improvement 8) organizational survival 9) workforce retention Just as there are benefits, there are al so challenges associated with succession planning. For some leaders, retiring or leavi ng a leadership position compares to writing a will or planning one’s own funeral. Th is dynamic suggests that succession planning may be hard to implement as it addresses the emotional issues associated with change for retiring CEO’s, as well as the political interest of key stakeholders within and outside of an organization (Davis, 2005; Jacobs & Fraser, 1987). Developing a succession plan for some lead ers can be difficult due to ego related concerns or an inability to relinquish power, which makes it di fficult to think of leaving. 28 Oftentimes, organizations political issues or competing priorities replace the importance of finding and mentoring a successor. Succession plans should not occur when a leader announces their departure, but as soon as they are selected for the position. Effective succession planning encourages the leader to consciously acknowledge a “life after the leadership transition” making it less difficu lt to implement the process (Davis, 2005). Succession planning is only eff ective when used well and is supported by the CEO’s who believe in and value the plan. Leadership Development in Healthcare Organizations This literature review addresses th e concerns of succession planning at all organizational levels within the healthcare industry. The healthcar e industry is in the midst of a human resource crisis. The h ealthcare industry is comprised of business organizations in a variety of settings includi ng: managed care, long-term care, hospitals, ambulatory care and home health care. The workforce crisis began in the 1990s and continues to grow. The market for healthcare workers continues to escalate as the workforce ages and there is a decline in the number of new workers. The healthcare industry did not invest in leadership development historically to the same extent as leading companies in other sectors (Abrams & Bevilacqua, 2006). According to Garman, Tyler, Darnall, and Lerner (2004), effective healthcare leadership requi res administrators to master a host of complex interpersonal skills, including persuasion, negotiation, conflict management and understanding diverse perspectives, (p. 308). In healthcare, the gap is widening be tween the supply and demand for a skilled workforce and healthcare industries are competi ng among themselves in this talent war. 29 In an effort to become an employer of choice, healthcare leaders need to identify a pool of talented employees throughout the system , provide career planning and development activities and ensure employee accountability to ensure that their organization has the leadership talent required to succeed over time (Rothwell, Jackson, Knight & Lindholm, 2005). An investment in leadership deve lopment and training programs helps the healthcare industry develop an organizational culture that maximizes its performance and is adaptive to market challeng es (Abrams & Bevilacqua, 2006). Workforce Retention Health at Work national st udies indicates that when compared to other industries, healthcare employees are found to have the lowest level of commitment to their organization; 40% of workers in healthcare ha ve plans to leave the industry (Wilkins, 2004). The lack of employee commitment in h ealthcare industries serves as a challenge for healthcare leaders in retaining employees and empowering them with skills required to be competitive in the industry. Additionally, healthcare systems are growing in size and complexity, and the workload is beco ming more demanding, making leadership less attractive to those who mi ght be eligible or interested (Camden, 2005; D Aunno, Alexander, & Laughlin, 1996). John Maxwell (1999), one of America’s ex perts on leadership development, says that everything “rises and falls on leadership, (p.xi).” Maxwell outlines characteristics necessary to identify future leaders and te n leadership qualities one might seek when hiring new employees. Similar to Maxwell, Kouzes and Posner (2002) developed a checklist for leadership and identified the ten most mentioned characteristics for admired leaders. The following Tabl es summarize their findings. 30 12anization Table 2: Recommendations for Identifying Leaders within an Organization Recommendations for Identifying Leaders Within an Organization • Modest, conscientious, superior intellect • Visionary • Life long learner • Honesty and Integrity • Resilient • Healthy sense of ambition • Respect and genuine appreciation for others • Determination and Perseverance • Creative thinker and problem solver • Loyal • Multitalented • Reflective Table 3: Recommendations for Hi ring Leaders in Organizations Recommendations for Hiring Leaders in Organizations • Understanding the organization’s people and market • Flexibility • Transferable and diverse working skil ls including problem solving-thinking strategically 31 • Interpersonal and political skills required to interact with all levels of staff • Proven track record of success and accomplishments, drive to succeed • Visionary, forward thinking • Charismatic and influential • Positive attitude and energy • Effective communication skills and an ability to resolve conflict • Discontent with the status quo • Desire, passion, ability to lead • Self discipline and an ability to work independently Adapted from, (Maxwell, 1999; Kouzes & Posner, 2002; Bennis, 1989; Collins, 2001; Johnson, 2003; Ibrahim, Soufani, Poutziouris, & Lam, 2004) From this chart, one can deduce that ther e are leadership challenges in developing leaders. Individuals are taught to take new challenges and to do things they have not done previously which will help develop ski lls for challenge, uncertainty, turmoil and change. Maxwell, (1999) and Kouzes & Posner , (2002) feel that leaders learn lessons by doing things that they have never done. In an era when it can cost several thousand dollars to hire and train employees, it is very important that those dollars be invested wisely i.e. not multiple times for one position, which allows a good return on the company’s investment. Organizations must consider their mission, population, care, and services while ensuring the availability of co mpetent staff. Selecting leaders who meet all the criteria above may ensure the sustai nability of the organization under high quality leadership. 32 An efficient and effective Human Resour ces (HR) Department is necessary to hire, recruit, train, retain, and maintain a wo rkforce capable of leading and sustaining the ongoing achievements of management ’s objectives. An HR department can be successful in achieving these goals by keeping abreast of the current market trends in employment hiring best practices a nd being proactive in developing stra tegies that will provide for a workforce that is diverse and skilled (Rothwell, 2005). There are paradigm shifts in healthcare that the industry must consider when identifying high potential employees for leader ship development to ensure that the right person for the right job with the right skills is present at the right time. According to Harris (1996), organizations should be aware th at job stability is no longer a guarantee. The evolving workplace calls for new thinking about relationships with employees. Research reveals that workers need to be life long learners as pay is now dependent on job performance and accountabi lity. Technology is playing a critical role in the change of how, when and where organizations and em ployees do business. Organizational work is taking on a new look as employees integrat e work, community environments, roles and responsibilities of families, and personal life (Harris, 1996; Collins, 2001). Supporting the knowledge and skills need ed for healthcare leadership, Morgan Executive Development Institute (2004) identif ied five (5) performance competencies among hospitals’ and health systems’ leaders. The behavioral competencies are collaboration, innovation, continuous l earning, risk taking, work/life balance (Anonymous, 2004). Likewise, Leck and Wang (2004) identif ied five (5) core strategies that organizations use to develop effective lead ers. Organizations rely on leadership 33 development programs that develop potential le aders and maintain or improve the quality of the existing leadership in conjunction with the leadership competencies needed to create meaningful business results. A recent survey by the Council for Adult and Experiential Learning (CAEL, 2002), noted grow ing interest in “soft,” interpersonal skills to complement traditional and analyti cal business skills,” such as adaptability, agility, and the ability to view and evaluate the “big picture.” Creative problem solving, team building, communications skills, and broad social influence have been cited as key leadership competencies (Huy, 2001). Maccoby (2004) discusses the importan ce of organizations finding the right leaders. Organizations must maintain that leadership selection and development from a systems approach. For example, having a sy stematic understanding of the organizational needs helps to determine the type of lead er needed. Using the systems approach, leadership selection is based on the organizatio nal needs vs. an ideal leader who fits the mold but has no understanding of the organiza tion and its interconnecting parts, and how they influence one another (Dillon, 1998). As healthcare systems change, the requirements for leadership also changes. Byham, Nelson, and Paese (2000) suggest when de veloping criteria to select a leadership candidate, an organization may use an a ssessment center to determine targeted competencies, classify skills, and behaviors, and identify development needs; these tools can be used for organizations within and outsi de of healthcare. Leadership development from within the organization can be advant ageous for healthcare systems. Having a group of competent, highly trained individuals eliminates high cost, uncertainty and time commitments associated with recruiting fr om outside sources (Byham et al., 2000). 34 Accountability is a driving force in today’s leadership circles. Increased publicity about poor leadership decisions and attempte d cover-ups may have forced the issue of accountability to the forefront of discussion ab out responsible ethical leadership (Hocker 2003, Abrams and Bevilacqua, 2006). This para digm shift is reflected across disciplines including education, government, and busin ess organizations. The challenge for organizations is to give more reflective thought to the competencies desired for their future leadership vacancies (Rothwell, 2005). There are growing tensions among generations in the workplace and age is an important leadership considera tion. Thirty-five to forty-five years of age may be the ideal range for leaders to be taken serious ly, and a college education and professional business experience are necessary credentials to positions of leadership. It is expected that individuals between the ag es of 35-45 years have some youth, vitality, vigor, drive, and energy; they are gaining maturity and life experience (Hocker, 2003). Maturity and life experience are necessary trai ts for leadership selection. Leadership Shortage The leadership shortage presents a leadership challenge for the healthcare industry. According to the literature (B urt 2005, Rothwell, 2005), a viable solution appears to be identifying internal candidates for promotion from within the organization. This strategy provides a win- win situation for key stakeholders by increasing employee retention and thus eliminati ng the high cost and time commitments associated with recruiting and hiring leaders from outside sources. This strategy allows employees to add value to the organization by giving them rec ognition and considerations for opportunities for advancement. In attracting future leader s, Wellins and Byham (2001) report that “the 35 key is to integrate selection, retention and succession management systems thereby ensuring that the organizati on brings in the best people, keeps them around and adequately prepares them to assume future leadership roles,” (p. 06). Once individuals with leadership poten tial are identified, Leck and Wang (2004) suggest they are given assignments that stretch their areas of expert ise. Leaders should be mentored and coached by senior level st aff and finally, these leaders need guided exposure to learn about the organizational cu ltures, politics and the way things are done in the organization. The challenge for the hea lthcare industry is to identify high potential individuals early in their car eers when long-term developm ent can have the greatest impact. Leadership plans and succession planning provides healthcare systems an opportunity to develop a pool of top candidates with demonstrated leadership skills from within the organization, when an urgent need for new leadership is not needed. Historically, healthcare relied on replacement planning, an outdated HR strategy where managers were solely responsible for singling out and grooming their replacement. (Abrams and Bevilacqua, 2006). Leadership de velopment uses a broader scope to assess those with leadership potential without atte mpting to isolate single individuals to fill certain positions (Burt, 2005). From this pool, top candidates can be selected to step in when leadership positions become available. The selection process of new leaders often involves pol itics. Favoritism also influences decisions about people selected for leadership development within or outside an organization. People are often promoted becau se of their family ties or status within the organization rather than their abilities and contributions. Nepotism is practiced in 36 many businesses. Tragically, these practices erode self-esteem and potential (Hutcheson, 2003). Unfortunately when organizations a llow politics and personal preference to influence the selection process, often less talented individuals are selected wasting organizational resources (Kovach, 2005) According to Johnson (2004) and Kovach (2005), politics are played out as individuals from outside of an organization are being selected for leadership. This practice often contaminates th e selection process and creates a divide among individuals who are committed to the organization and the community it serves. The greatest mistakes the new leader often makes is coming into an organization with the intention of fixing the past mistakes of management before evaluating the people, policies and, procedures for the organization or unit (Johnson, 2004, p. 137). Persons with high levels of leadership are often selected; the challenge is to prepare them for future, larger roles and re sponsibilities. A well-designed, well-executed development program, tailored to the need s of high potential managers, can offer organizations a competitive edge by growing thoughtful, flexible leaders for the future within the organization (Kovach, 2005). However, being selected for leadership development does not guarantee a new job or promotion. 360 Degree Feedback Maccoby (2004) reports that when organi zations are understood as a system, the needs for leadership will be determined on how the system is structured with an additional challenge of fitting the leader into the leadership roles that are needed. The 360-degree feedback is a tool widely used in leadership development programs. Aspiring leaders receive anonymous feedback from peer s, subordinates, supervisors, and have 37 effective means to meet or exceed individua l and professional goals. Research shows that effective leadership development is en hanced by feedback from others (Brutus, London, & Martineau, 1999; Hazucha, Hezlet t, & Schneider, 1993; Walker & Smither, 1999). Although not foolproof, the 360-degree tool is effective in the business sector; however, the tool was not developed specificall y for healthcare administrators. In fact, prior research concluded that content from 360’s developed in one sector may not be generalized readily to other settings such as health care (Walker & Smither, 1999; Brutus et al., 1999). Another barrier to using the device is the cost of implementation and the cost for initial software setup. Fried ( 1997) reports the option of developing 360-degree assessment surveys in-house is not readily available to many healthcare organizations because of the specialized knowledge required to avoid common errors in design and delivery, an accessibility issue for some healthcar e settings. In summary, the validity of the 360-degree instrument for healthcare admi nistrators appears questionable compared to its usage in other private sector cor porate spheres (Fletcher, Baldry, & Cunningham- Shell, 1998; Lepsinger & Lucia, 1997; Garman et al., 2004). Mentoring to Develop Succession Plans in Healthcare A ream of literature has been written on mentoring, however, not much has been written specific to healthcare. Most info rmation focuses on business and organizations, therefore in this section of the literature review, the words healthcare industry and organizations will be used interchangeably to address this human resource tool. Healthcare organizations provide healthcare service such as hospitals, nursing homes, health maintenance organizations, etc. wh ereas healthcare industries refers to the 38 companies that develop, manufacture, market and/or distribute health-related products (Healthcare Industry n.d. retrieved 3/12/07). Interest in mentoring relati onships as a vehicle to guide career advancement has grown considerably in recent years and eviden ce indicates that mentees accrue substantial benefits from mentoring relationships. Thes e benefits include higher promotion rates, greater career satisfaction, a nd higher overall compensation than those who have not been mentored. Mentoring relations hips contribute to the knowledge of corporate culture for career progression, grows leaders internally, prov ides action learning activities and is cost effective (Dreher & Ash, 1990; Fagenson, 1989; Scandura, 1992; Turban & Dougherty, 1994; Whitely, & Dougherty, 1991). Mentoring has a record of accomplishment for success and is a way for leaders to create a legacy. “Everyone who succeeds has ha d a mentor,” said Donald S. Perkins, former Chairman and CEO of Jewel Companies (Roach, 1979). Mentorship training programs have increased as the demand for mentoring as an empl oyment strategy has risen in the last decade. Corporate organizations reali ze the value and benefit of mentoring in the workplace. Benefits for healthcare organizations include having a competent workforce for leadership selection thus reducing employment cost associated with recruitment, along with the uncertainty a nd the time associated with recruiting from outside sources (Byham et al., 2000). There is a mentoring crisis in the workplace, even though many organizations have developed formal mentoring programs. Recent employment trends may have a grave impact on succession planning and stride s taken to compensate for the predicted 39 shortage of labor. As companies continue to merge and diversity impacts the workforce demographics, the demand for mentoring has never been higher (Zey 1988). There have been discussions about the importance of leadership development in healthcare management and th e role mentoring plays in leadership development. According to the American Council of Hea lthcare Executives (ACHE), there has been a rebirth of formal mentoring programs in hea lthcare since 2001. However, little is known regarding the effects of mentoring in health care organizations. Mentoring is employed to improve retention and leadership developmen t. Mentoring programs, however, are not considered an automatic guarantee for upward mobility for all individuals selected to participate in such programs (Pieper, 2004). There is a recent trend toward developi ng formal workplace mentorship training programs to nurture employee learning and de velopment. The healthcare industry is being challenged to create a learning environment and develop life long learning programs for employees. Implementing mentoring programs is one method of encouraging career development across all leve ls and in particular as preparation for leadership. Mentorship traini ng programs are utilized in every arena of employment to some degree to include business, healthcare, education, government and non-profit organizations (Murray, 1991). The concept of mentoring is touted in the literature as a way to develop high potential employees and is proving advantageous for men, women and minority groups (Murray, 1991). Mentorship training program s are considered a means to develop young and high potential employees with leader ship potential by giving them impact assignments, mentoring, formal career development programs and formal education. 40 Mentorship training programs offer employees the opportunity to be involved in special projects with high visibility, targeted organizational assignments, assignments with cross functional teams and interagency groups, developmental assignments, rotational assignments and details involving other organizations or other agencies (McWilliams, 2005, p. 7). McWilliams (2005) defines mentoring as the cheapest, easiest, most effective and most fulfilling means of ‘closing your gaps’ in the succession planning process. Mentoring is a cost effective tool that supports succession planning and serves as an effective way of helping employees ac quire the necessary skills, organizational knowledge, culture, and confidence to progress into more upward mobility positions within the workplace (Rothwell, 200 5, McWilliams 2005). Mentoring works simultaneously with succession planning to help with workforce retention of high performers, and aids in conflict resoluti on, enhances an individual’s confidence, reinforces cultural change and diversity, a nd supports the retention of organizational technical knowledge and culture (The Taylor Clark Partnership LTD, 2005). Succession Planning and Mentoring Mentoring is an essential factor in developing a successful succession plan. Succession planning and mentoring are human resource tools that complement each other. Organizations are real izing the benefits of mentoring as a strategy for succession planning and are investing in formal progr ams to serve as career development and management training tools (Burke et al., 1993) . A mentorship training program is one strategy in succession planning designed to address workplace needs. Thorndyke and Grigsby (2005) reiterate the need for succes sion planning and describe it as a “specific 41 type of mentoring designed to build legacy within the organization while mentoring for succession provides the retention of the knowle dge assets of the leader and leaves a continuing imprint upon the organization” (p.2) . Succession planning is a very important human resource model that helps with workfor ce planning needs. It includes mentoring new leadership and developing a plan to transfer organizational power to younger and newer employees. Succession planning can mi nimize disruption when senior employees leave an organization. Purposeful and inte ntional succession planning is a systematic process of identifying, asse ssing, retaining, developing a nd replacing organizational leadership in efforts to ensure leadership cont inuity in key positions for the future and for advancement over time (Rothwell, 2001; McWilliams, 2005; Soonhee, 2003). Healthcare organizations should ask three questions as they develop succession planning and mentoring programs: 1) What do we have? 2) What do we need, and 3) How are we going to design and implement plans? (McWilliams 2005, p. 4). Readiness for Leadership Organizations are experiencing age gaps in the workplace because of retirements, separations, downsizing, hiring freezes, buyouts and layoffs. In efforts to ensure leadership progression, succession planning has become a model for strategic planning for healthcare systems. Organizations are realizing the benefits of mentoring as a strategy for succession planning and are investin g in formal programs to serve as career development and management training t ools (Burke et al., 1993). In the 21 st Century, it is imperative that organizations make strate gic plans to address globalization, increased technology in the workplace, changing demographics in the workforce, security threats and quality of life issues (Jor gensen, 2005). It is critical to apply succession planning and 42 formal mentoring programs to healthcare in e fforts to remain competitive. Knowledge of demographic trends within the workforce and knowledge of future leadership needs will help sustain organizations for the future. Discussions among leaders in healthcare about the importanc e of leadership development and the role mentoring plays in l eadership development are on the table. In efforts to get the most out of healthcare re lations (Pieper, 2004) identifies a six-phase mentoring cycle that may help potential ment ees and mentors gain a better understanding of what to expect and to maximize the success of a mentorship. The six phases consist of 1) choosing a mentor/mentee, 2) getting ac quainted 3) setting goals, 4) growing the relationship, 5) ending the relationship, and 6) evaluati ng the relationship’s success. In healthcare, there appears to be a lack of individuals ready for leadership. Perhaps those with potential are not identified or developed which results in a shortage of new leadership (Coonan, 2005). To address the need the American College of Healthcare Executives (ACHE) chartered a Leadership Mentoring Network in 2001 to develop quality health care leaders while improving the future of leadership in the healthcare industry. Recommendations include expandi ng networking and mentoring opportunities with other healthcare executiv es, cultivating good relationships with stakeholders, creating career development opportunities , and developing guidelines for ethical decision-making. Workforce Diversity and Mentoring Healthcare organizations are providing care to a wider variety of patients as American society becomes more diverse. Acco rding to a recent report by the Institute of Medicine (2002), the healthcare needs of pa tients from minority groups are not always 43 being met. There is a lack of communication that acts as a barrier between patients and healthcare workers and can negatively affect the quality of healthcare received by minorities (Lien, 2004). In contrast, failure to achieve workforce diversity can affect patient satisfaction, public relations, staff morale, employee retention and result in financial cost to the orga nization due to discriminati on complaints (Jackson, 1992). According to Guillory, (2004), workfo rce diversity should reflect one’s community. He maintains society plays a role in correcting the existing gap among ethnic groups’, representation in healthcare organizations, which has resulted in a polarization of cultures within the community and the workplace. To realize the value of diversity in the workforce, healthcare leaders must understand the principles of diversity: value, trust, respect, excellence, comp assion, and commitment. Diversity in the workforce encompasses more than external or visible features such as age, gender, race, ethnicity, religion, disability, re ligious beliefs, and sexual orientation. Diversity also extends professions, level of education, life experiences, and even financial status thus resulting in culture or divers ity barriers that make it difficult to see beyond the surface yet, each begging for mutual respect. Two trends have given rise to th e importance of workforce diversity: demographic changes show an increased minority population in the workplace and globalization of industry and economics, thus, multiculturalism has become a way of life in the United States (Lussier, 2001). By 2008, the U. S. Census Bureau census data reveals that nearly half of all of the nation’ s new workers will be classified as minorities, i.e. women, people of color and ethnic minorities (US Census Bureau, 2001). This cultural shift changes the fabric of the workforce. As diversity increases within the 44 workforce and a growing global economy for ces organizations to rethink models of business success, healthcare organizations must decide how they will ensure organizational readiness. Aligning busine ss strategies with current and future demographic and market realities may help organizations achieve growth, profitability, and sustainability (Martino, 1999; Wh eeler, 2001; Fitzpatrick, 1997). Rothwell (2001) suggests promoting multic ulturalism in the workplace helps create opportunities for diverse groups and reflects the nation’s population. While one recognizes the strides society has made to improve under representation of ethnic and minority groups at various levels in the workfo rce, factors still exist that substantiate the continued inequality and inequity for oppor tunities among minorities. Differences of opinions about progress of minorities and the existence of prejudice and discrimination continue to vary among cultures, so much so that these differences suggest that minorities and non-minorities have problems understanding, let alone accepting, the other person’s perspective or perception on any given situ ation (Deidre K. Garrett, EEO Manager, Lexington VA Medical Center, February 13, 2007). Such awareness allows one to acknowledge that obtaining and retaining a diverse workforce will not be accomplished without challenges. Benefits and challenges of multiculturalism as it impacts organizations are outlined below in Table 4. Table 4: Benefits and Challenges of Workforce Diversity Benefits of Workforce Diversity Ch allenges of Workforce Diversity Profit, performance and talent Leadership Improved bottom line and marketing advantage Stereotypes and Prejudice Competitive advantage – can be cost effective Ethnocentrism Superior business performance Unfriendly work environment 45 Attract the best and the brightest Policies and practices that work against diversity Employee satisfaction, loyalty and organizational strength Glass Ceiling- an invisible barrier that separates women and minorities from top leadership positions Creative problem solving and decision making The cost of ignoring diversity Adapted from (McCuiston, Ross Woolridge, & Pierce, 2004, p. 74-77); (Lepsinger & Lucia, 1997). Any organization that wants to be su ccessful in the 21st Century and beyond should continue efforts that build upon the prin ciples of diversity to improve in all areas of performance including problem solving and customer service. Employing principles of diversity principles to cr eate effective work groups may improve work relationships within and among diverse culture s and decrease the number of discrimination complaints. Using the principles of diversity as cornerstones for improved employee relations underscores the importance of having and ma intaining a diverse workforce and defines the direction for the organization (Deidre K. Garrett, EEO Manager, Lexington VA Medical Center February 13, 2007). On the other hand, ignoring this need places the organization at risk for stagnation and ultim ate dissolution in an ever-changing business environment. According to Messa (1998), a diverse workforce gives organizations a competitive advantage by enabling them to be tter meet the needs of their customers, successfully compete in the global marketplace, and hire from an expanded labor pool. Mentoring is a venue that most organizations utilize in the current work environment. The question must be asked: How diverse ARE those who mentor and those WHO are being mentored? Ambrose (2003) reminds us that mentors tend to mentor someone who is “like them.” “The y often do not think about reaching out to 46 those who are different in race, culture or ge nder because they are either unaware of the need for the unknown” (p. 60). When diversity is added to the equation and design of an organization’s mentoring program, the focus can help leadership understand the value of having culturally diverse indi viduals providing input in deci sion-making processes. This mindset is especially important today as healthcare managers interact with an increasing diverse patient population (Ambrose, 2003). Effec tive leaders in healthcare must develop and carryout mentoring programs that support diversity, increase the number of minorities in the managerial and leadership ranks and strategically prepare them for upward mobility (Ambrose, 2003). Some c onsiderations for planning a successful diversity driven mentoring program include understanding differences, defining program goals, involving top leadership and soliciting input from participants (McCuiston et al., 2004). Hill (2004) studied the relationship of mentoring and race and found that mentoring programs can benefit most race gr oups typically excluded from the informal mentoring relationships includ ing women and minority groups . His study suggests that minorities are frequently left out of mentoring relationships with the dominant members of an organization’s leadership team those w ho could provide needed career advice (Hill, 2004). Both cross race and same race mentori ng relationships provide career support in terms of trust and attainment. According to Hill, same-race relationships have shorter and easier periods of initiation, provide a greate r sense of identification, increase levels of intimacy, enhance balance in work life and soci al development, and aid in grappling with issues of inclusion and professional id entity in early career phases. 47 (Rothwell et al., 2005) identifies nine commandments of a successful mentoring relationship: 1. “Be proactive: Don’t wait for your mentor or protégé to contact you. 2. Negotiate a commitment: Agree to have regular contact at predefined intervals. 3. Establish rapport: Learn as much as you can about one another. 4. Be confident: Each of you has something important to offer the other. 5. Communicate: Share your knowledge and experience openly. 6. Be a good listener: Hear what your mentor or protégé is saying to you. 7. Be responsive: Act on what you have planned. 8. Be accessible: Have an open-door or open-phone policy. 9. Take responsibility: It takes two to crea te a successful mentoring relationship.” (p. 164-165) Mentoring is necessary to nurture employee learning and development. Healthcare systems are challenged to devel op life long learning programs for employees and are implementing mentoring programs as one method of encouraging career development in preparation for future leadership. Mentoring bene fits the organization and employees by providing a cost effective wa y of developing leaders internally because those individuals are knowle dgeable of the healthcare system for which they are employed (Allen & Poteet, 1999). Challenges of Mentoring There are benefits as well as cha llenges to developing mentoring training programs for succession planning. Compared to non-mentored employees, those who are mentored often receive greater organizatio nal reward (promotions), reach financial prosperity sooner, and enjoy increased job satisfaction and commitment (Chao, Walz, & Gardner, 1992; Mobley, Jaret, Mars h, & Lynn, 1994; Roach, 1979). The positive 48 outcomes of mentoring often enhance the car eers of the mentor and the mentee. The literature supports that mentoring can help to expedite leadership development, increase job satisfaction, and influence promotional opportunities. With benefits come challenges. Ment orship training programs can fail if not supported by organizational leadership and if mentors themselves have not had training in their career development (Fracari, 2006) . Other challenges may come from selecting the wrong person as the mentor due to a mis understanding of the purpose or a lack of willingness to share helpful information with the mentee. Additionally, some mentors lack the ability to teach others or have no interest in sharing their organizational knowledge. As stated earlier Leahy (1996) found that there is a natural tendency to share one’s knowledge about the workplace; howev er, not all employees embrace the concept of mentoring and some do not feel a need or desire to share their knowledge base. He also found that some lack the ability to te ach others. The body of knowledge is limited for training the mentor and the mentee. (Rot hwell et al., 2005) discusses how mentoring contributes to career development and succession planning, citing that the organization benefits most from mentoring. The cha llenge for organizations lies in evaluating mentoring relationships including the positiv e and negative outcomes of mentoring as well as how to encourage these relationships for effectiv e leadership transition. Employee Retention in Healthcare Employees having various careers in various occupations and workplaces during their working years charact erize today’s workforce (Goddard, 1989). Given the projections for workforce shortages, employees in retirement may be asked to return to the workforce. Having a skilled workforce adds to the viability of any organization and 49 contributes to the success of healthcare systems. Replacing employees is expensive to the organization and underscor es the importance of retaining valuable employees (Rothwell, 2005). A motivated workforce is needed for excellent customer service. In healthcare, major changes are occurring: the industry is becoming more consumer driven, employs an aging popul ation, and the work is becoming more specialized due to increasing technological demands. Decisi on-making is data driven and an emphasis is placed on teamwork. There is a growing consensus that multiskilled health care employees can contribute to exte nding professional roles, reducing shortages of personnel, and reducing costs (Hyde & Fo ttler, 1995). The trend of outsourcing is occurring in positions for which recruitment is considered difficult. Other sources of labor are utilized for healthcare shortage s including volunteers, older workers, the disabled and immigrants (Mateo and Smith, 2001). To meet the workforce needs of the futu re now, healthcare organizations must understand the competencies necessary for positi ons that need to be filled; more concise job descriptions will allow for more cri tical thinking, decision-making when hiring, developing, and evaluating employees. The American workforce is becoming smaller and less sufficiently skilled; more global, vi rtual, diverse, autonomous, and empowered (Tucker, Kao, & Verma, 2005). The outlook for the American workforce is faced with enormous challenges as predictions for a gene ration of workers are expected to retire in mass numbers. The challenges signal an alert for healthcare organizations to think about expected outcomes and to examine their process in workforce development to effectively address these trends. 50 The era of downsizing has diminished the talent supply and created a new workforce of free agents, employees who work as consultants and want flexible work schedules in addition to time and an opportunity to balanc e relationships and lifestyle choices plus independence and an element of co ntrol over their work environment. Free agents are usually highly skilled employees who no longer have a desire to work in a traditional work setting (Byham & Nelson, 1999; Kennedy, 1996). If this trend is influencing healthcare organizations and is re flected in the available selection pool of prospective employees, then organizations wi ll need to validate these assumptions and make new arrangements to remain competitive in the workforce. Workforce Diversity in Healthcare Organization The United States is becoming more diverse resulting in demographic changes in the workforce. These two trends have made it imperative for organizations to address workforce diversity in ways th at create win-win situations for all parties. Another trend creating diversity among workers is globali zation; organizations are marketing their products and services worldwide (Lussier, 2001). The workforce is better educated and refl ects more diversity in their beliefs and lifestyles (Coates, Jarratt, Mahaffie 1991). Th e census data reveals that by 2008, nearly half of all of the nation’s new workers will be individuals traditionally classified as minorities; i.e. women, people of color, and ethnic minorities (US Census Bureau, 2001). Representation of minorities in top management is not a common occurrence in healthcare. Moore and Jaspen (1997) repor t that only 1% of presidents and chief executive officers were minorities from among the 5 million hospital workers in the US in 1996. This data offers an incentive to encourage organizations to prepare their 51 workforce for success by rethinking their models of business success and how they ensure organizational readine ss by effectively aligning busine ss strategies with current and future market realities to achieve growth, profitability and sustainability (Martino, 1999; Wheeler, 2001; Fitzpatrick, 1997; McBride & Bostian, 1998). Developing a multicultural leadership team remains a challenge for most healthcare organizations. The literature gives attention to the need and the challenge for leaders to understand organizational culture and the populations they serve (Washington, Erickson, & Ditomassi, 2004; Lussier, 2001). H ealthcare organizations treat patients holistically; therefore, the culture, beliefs, cust oms and traditions of their consumer base are important. Today, diversity is consider ed an advantage to an innovative employer actively engaged in maximizing hiring opportun ities. Thus, a more diverse workforce may improve the organization’s ability to comm unicate with its increasing diverse clients (Jackson, 1992). This perspect ive is especially true in the world of healthcare. In the business of health and the health of any business, the advantages of a multicultural workforce have been analyzed, pondered, examined, studied and surveyed (Washington et al., 2004). The statistics are startling and include the following: almost 30% of the US population is from ethnic or racial minority groups, 12.8% are African American, 11.9% are Hispanics, 41% are As ian and Pacific, and 1% represent other groups. Patients and healthcare workers likewi se are increasingly reflecting the ethnicity and diversity of the country. The call ha s never been louder for organizations to strengthen and encourage cultural awareness and implement organizational training in the area of multiculturalism (Mateo, & Smith, 2001). 52 Diversity in healthcare, seen at all or ganizational levels, includes people from differing cultures, races, re ligions, genders, physical abili ties, backgrounds, and values (Ivancevich & Gilbert, 2000). Four fundamental competencies of effective leadership in a culturally diverse society include: 1) A knowledge base with increased sens itivity to and an awareness of the diversities in the workforce, 2) Identification of resources, which can stre ngthen and improve the quality of life for all individuals, 3) Open communications with others about cultural differences, 4) Strategies that will enable leaders to serve as change agents to maximize the benefits of a cultural diversity workfor ce (Kappa Omicron Nu Honor Society, 2002). The benefits of cultural diversity can occur when leaders and employees accept responsibility for understanding differences and develop strategies for inclusion. Rothwell (2001) reports that encouraging diversity and multiculturalism avoids ‘homosocial reproduction’ by managers, (p. 30). Diversity must be supported from the leadership of the organization, which will support a work culture of openness, equity, tolerance and inclusion. This is a counter point to homosocial reproductions where everyone in the organization re presents the mainstream culture. Measurable benefits include improved bottom line, competitive a dvantages, superior business performance, employee satisfaction and loyalty, strengt hened relationship with multicultural communities, and attracting the best and the brightest candidates (Guillory, 2004). 53 Generational Diversity Another type of diversity is generational differences. The 21 st Century has produced a melting pot of generations that now work together in healthcare settings. Eyerman and Turner (1998) define generation as people passing through time together that come to share a common habitus, hexis a nd culture, a function of which is to provide them with collective memory that serves to in tegrate the generation over a finite period of time, (p. 93). Generational diversity is an important leadership issue and can affect how generations view leadership. The four generations are: Traditionalist (born before 1945); Baby Boomers (born 1946 – 1964); Generati on X (born 1965 – 1977); Millennials (also known as Generation Y, born 1978 and after). Raines (2002) recommends that leadership development training programs in clude generational differences to encourage conversations and avoid judging other’s percep tions. Martin and Tulgan (2002) suggest holding a diversity summit that promotes the strengths of generations. Zemke, Raines, and Filipczak (2000) recommends that leaders need to develop listening and questioning skills to offset potential conflicts before they happen. Healthcare organizations need to integrate generational differences in leader ship development training programs and be mindful of the tendency to highl ight leadership styles of past generations and incorporate action learning for younger generations. Today’s leaders need to be mindful a nd knowledgeable of the generations which they serve and examine this when selecting the individuals in terms of compatibility within the organization. Add itionally, leaders may have to consider meeting the needs and desires of employees as different generatio ns and cultures bring different values and 54 work ethics to the workplace (Arsenault, 2004) . For example, supporting generational differences can cause differences of opinions and conflict due to differing work ethics and views of relationships, authority a nd workforce expectations (Anonymous, 2006; Arsenault, 2004). Summary Dwight D. Eisenhower once said, “In preparing for battle, I have always found that plans are useless, bu t planning is indispensable.” While it is understood that plans do not always work out, having a plan help s leaders and organizations cope with unexpected changes when they occur as well as sustain themselves for the future. A review of the literature shows that healthcare industr y leaders have a tenure of three years and indicates that the healthcare industry is behind in their efforts to develop succession planning for leadership development, stability and sustainability (Jacobs and Fraser 1987). Implementing succession pl anning and purposeful mentoring programs may help healthcare systems to better develop se lection criteria for effective leadership as well as prepare for strong leadership by th eir successor and succession planning efforts (Abrams and Bevilacqua, 2006). This study explores the perceived benef its of the succession planning model with mentoring. This study also explores the limitations and challenges perceived by the healthcare industry in their organizational effo rts to remain competitive, an employer of choice and a responder to consumer dema nds. Succession planning and mentoring complement each other and some of the same characteristics for successful implementation may benefit the healthcare indus try as it grapples with the context of today’s workforce. The concepts of su ccession planning and mentoring address more 55 than the statistics of those eligible for retirement. Succession planning is about the preservation versus the potential loss of organizational knowledge, experience and expertise, continuation of effective serv ices, healthy work relationships, and the preservation of a productive and healthy workplace culture (Kouzes and Posner, 2002). While the workforce statistics are predictions of anticipated labor shortages, this study may reveal how these predictions can be used as a positive force even as it provides a major challenge for the hea lthcare industry to respond to rapid changes in workforce demographics as they impact leadership in healthcare organizations. Although the healthcare industry may be severely challenge d, and it may take years to implement and perfect a formal succession plan, the steps taken now may provide greater opportunities for future workforce generations and ensure the long term success of the organization. “While it is better to be gone and not for gotten than forgotten but not gone, it is even greater to be remembered and re vered than only remembered” (Wharton, 2005, p 278). Succession planning is a proactive approach that provides a tool for organizations to identify, develop and select employees who ar e the right people, with the right skills, at the right time for leadership and other key positions while focusing on current and future needs of the organization. When impl emented successfully a positive outcome for succession planning can reduce the high cost and time commitments associated with recruiting and hiring from outside sources. Succession pl anning also enhances the organization’s ability to maintain continuity of services as quality care and performance remains stellar qualities for th e organization (Rothwell, 2005). 56 CHAPTER III: METHODOLOGY Introduction Planning for the 21 st Century workforce is becoming increasingly difficult due to an aging workforce and issues of diversit y. Developing strategies to foster career development programs to identify and devel op employees for middle and upper levels of management is critical to th e survival of healthcare orga nizations. Within the last decade, organizations have reduced their workforce by rightsizing, downsizing, and not hiring staff for extended periods . This process has reduced America’s workforce while at the same time excluding a new generation of wo rkers with the vitality and ideas needed in today’s workplace. This trend has subseque ntly reduced the reservoir of future leaders within an organization. As diversity becomes more reflective of the nation’s populations, organizations have a responsibil ity to pursue and embrace diversity at all levels (Rothwell, 2001). Purpose of the Study This is a qualitative study to inves tigate formal succession planning management in four (4) healthcare organiza tions as it relates to meeting leadership needs in a changing American workforce. Qualitative research is used to describe problems and thus when implemented effectively can bring meaning to problems and answer questions. 57 Qualitative research is characterized by a descri ption and requires the researcher to access and gather data in natural settings under inve stigation. Thus, a qualitative analysis helps the researcher to understand a problem with a focus on process where the researcher attempts to explain why something is taking place (Denzin & Lincoln, 2000; Creswell, 2005). The objectives of this chapter are: 1) to an alyze findings in the research relative to the healthcare industry and 2) compare a select number of Ke ntucky healthcare facilities to the national trends in the workforce. Me dical facilities in Kentucky were identified from the Kentucky 2006 Hospitals Guide. A review of the literature was conducted to obtain information as to previous research on th is topic. The researcher sought to answer the following questions: 1. Are healthcare organizations usi ng recommended best practices in succession planning? 2. Are healthcare organizations identi fying potential leaders for future organizational needs? 3. Are healthcare organizations usi ng mentoring to develop succession plans? 4. Are healthcare organizations addressing employee retention? 5. Are healthcare industries preparing fo r the shift in workforce diversity? Research Design According to (Creswell, 2005), qualitativ e research studies are designed to provide information data that represent word s rather than statistics. In qualitative 58 approaches, there are no guidelines on how to analyze the data; therefore, the researcher develops their own design. This study and research design was m odeled after an interview guide for Benchmarking Succession Planning and Manage ment developed by Rothwell (2001). Dr Rothwell grants permission to use the interv iew guide in his book (p. 110). This study will use recommendations from research based best practices for succession planning and provide recommendations to sel ected healthcare organizations to develop a personalized formal process for succession planning. There are 95 medical/surgical healthcare facilities in Kentucky and 40 facilities with a capacity of 150 or more beds, as iden tified in the Kentucky Hospitals 2006 Guide. This research will sample only those medical/s urgical facilities with 150 or more beds (N=4) to get a representation of successi on planning management in healthcare. Four (4) healthcare facilities were randomly selected to participate. Each subject was mailed a questionnaire. A follow-up phone call to schedule a face-to-face interview was scheduled. Data from the oral and writt en questionnaire was aggregated to compare with recommended best practices for successi on planning. A letter of thanks to each survey participant followed the interview. An invitation to review the results of the study and recommendations for implementing formal succession planning based on best practices culled from leading businesses as they apply to healthcare organizations as identified in the literature review. The investigator took every precauti on to minimize the physical and/or psychological risk associated with completing the questionnaire. Each healthcare facility selected was named Participant Organizat ion A, B, C, and D in the order the 59 questionnaire was returned to the researcher. Only the researcher knows the letter that corresponds with each healthcare facility. The interview questionnaire consisted of ten (10) open-ended questions. Completing the survey took 45- 60 minutes (See Appendix E). Each question was open ended. The researcher identified and compared common characteristics of selected healthcare organizations succession plans to determine the degree to which four (4) Kentucky healthcare organizations use formal succession planning to develop organizational effectiveness. This resear ch builds on Rothwell’s work by adapting the model to healthcare organiza tions to examine succession pla nning in its current state of practice. Populations and Sett ings/Data Collection This qualitative study gathered da ta through a mailed questionnaire and a recorded follow-up interview with four (4) healthcare organizations in Kentucky. These face-to-face interviews provided informati on regarding the succession planning programs in place at the identified healthcare organizations. A copy of Kentucky Hospital Guide 2006 was obtained from the Medical Pub lishing Company and a random sample population of healthcare systems partic ipated in the study from within the Commonwealth of Kentucky. Informed Consent Each health care administrator who agreed to participate in the study signed an informed consent form (Appendix D) indicatin g agreement to participate in the study. 60 The researcher took every precaution to ensure confidentiality of those willing to participate. Approval to conduct this research wa s granted from the Research Ethics Committee at Spalding University (Appendi x A). The survey respondents signed a written consent form for the data they shared with the researcher, as the information was used to determine whether their healthcare organization was currently using succession planning tools and to what degree for leader ship development. The recommendations will be based on information obtained from individual healthcare organizations and included in Chapter 5. Limitations and Summary Due to many factors such as time, availabi lity, willingness to participate, etc., this study is limited to four medical/surgical heal thcare organizations with a capacity of 150 or more beds. The study’s findings may not be generalized to other populations or to other healthcare organizations due to the co mplexity of each institution as well as differences in organizational structure at each facility. In this study, the researcher chose to use four (4) healthcare organizations w ith 150 beds, which is indicative of a large healthcare facility that would benefit fr om a succession plan for leadership and continuous service. This chapter describes in detail the st eps involved in the study. This yielded important information regarding formal su ccession planning management of healthcare facilities in four (4) Kentuc ky healthcare organizations and the impact on leadership development in healthcare. Participants w ill have access to the results of the study and recommendations based on the research to cr eate or improve their efforts in formal 61 succession planning. These findings may have implications for all healthcare organizations that need to develop and implement succession planning. This study used the predicted employment tre nds affecting the healthcare industry. As the healthcare industry prepares for the 21 st century workforce to addre ss the projected employment deficit with a thoughtful process for change rather than a magic bullet approach to address the magnitude and complexity of th e problem. The following chapter will offer the results of the study. 62 CHAPTER IV: RESULTS This chapter focuses on the findings of the interviews conducted with four health care medical/surgical facilities in Kentucky with 150 or more beds. The facilities were randomly selected to particip ate in the study. Four (4) participating organizations in Kentucky were surveyed to determine the de gree to which they use formal succession planning management as part of their orga nizational planning. The purpose of this research was to examine how four (4) healthca re organizations identify potential leaders; use mentoring to address succession plans; retain employees and prepare for workforce diversity; and develop leaders w ithin the organization. This chapter discusses the results of the study based on the research questions posed to each randomly selected healthcare organization. The sample size was representational of 10% of the medical/surgical healthcare facilities in Kentucky with a capacity of 150 or more beds, as identified in the Kentucky Hospitals 2006 Guide. This research sample d only those medical/surgical facilities with 150 or more beds (N=4) to obtain a sample representation of formal succession planning management as utilized in Kentucky healthcare organizations. 63 Data Analysis Data analysis for each participating organization interviewed consisted of transcribing and classifying the audiotape in terview questions and field notes collected from the four participant organization interv iews. The audiotapes were transcribed in narrative text, and the transcribed interviews formed the database for the researcher’s content analysis literature. Based on the res ponses from each participant, the researcher utilized the content method of data analysis to analyze the tran scripts in order to look for emerging themes among the partic ipants’ responses. Later, the researcher reviewed each of the responses in order to synthesize the themes. Qualitative interviewing is utilized to understand the central phenomenon of the probl em studied and to analyze the data for themes and provide an interpretation of the meaning of the information gleaned from the study (Creswell, 2005). Edited Participant Organization Responses The following section provides edited participant organization responses to the survey questions from the participating orga nization audiotape interviews. In reporting the results of the study, the healthcare organi zations are referred to by an alphabetical letter to ensure confidentia lity. A summary of all respons es are introduced prior to individual participating organization responses to the intervie w questionnaire guide. This is done for the convenience of the reader to gain an overview of their responses as well as a full report of individual or ganizational responses. The following key medical center personnel were interviewed and reported the following participant organization responses: • Participant Organization A: Director of Education 64 • Participant Organization B: Vice Pres ident of the Medical Center and the Director of Educational Development • Participant Organization C: Vice Pres ident of Education and Development • Participant Organization D: Vice Pr esident of Human Resources and the Manager of Recruitment and Retention Question #1 What goals and objectives have been established for succession planning and management in your organizations? 100% of the participant organizations surveyed had established no formal succession planning and management program in their organization. 50% of the survey participant organizations had recruited and hi red an individual responsible for developing goals and objectives for succession planning in their organization through education and training departments, which appeared to be closely aligned with human resources. 100% of the survey participant organizations had established leadership development training programs in efforts to develop an internal pool of leadership talent. 25% of the participant organizations were developing a leadership development training program to create a more equitable process for their empl oyees to access higher levels of leadership within multiple levels of the organization. The leadership development training programs are designed to include competencies needed in healthcare as identified by their respective organizations and the Healthcare Advisory Board, a national organization that benchmarks core leadership competen cies for healthcare organizations. Figure 1: Formal Succession Planning r= Formal Succession Planning No Fo r ma l Succesison Plan, 100% Participant Organization A In the interview, Participant Organizati on A noted that healthcare has not kept pace in response to strategic planning to th e degree of business corporations. In August 2006, Participant Organization A hired a talent manager to further define goals and objectives as the position develops. New initiatives and programs are planned for leadership development. The leadership track included modules for frontline managers in performance management, behavioral manageme nt, strategic planning, diversity, conflict resolution, leadership et hics and leading from the heart, and the mission and values of the organization. Modules on quality improvement, budget and finance are slated for 2007. The core program has been running for 4 y ears and the programs are designed for people already in management and for low-level supervisors. Participant Organization B The interviewee reported that Participan t Organization B does not use succession planning geared toward specific job and pos ition placement. They do not identify employees to move into roles as successors for leadership positions. Participant 65 66 Organization B has a model for creating and de veloping a pool of employees for a variety of positions as vacancies occur. Their prim ary goal and objective is to have a pool of internal candidates; however, they do not always recruit from th at pool of internal candidates for every position, but wherever possible they try to provide the first opportunity for internal applican ts. Most senior team members have been promoted from within the facility and have worked in othe r assignments prior to their current roles. Although no formal program is in place, prom otions from within are evident with the following positions: vice president, vice president for cardiac, chief financial officer, chief nurse for clinical services and the e ducation director. Participant Organization B reports a good retention rate with low turnover and provi des opportunities for employees to develop themselves th rough education and training. Participant Organization C The senior leadership team for Participan t Organization C sensed the need to have a greater focus on leadership development and succession planning, and created the position Vice President for Education and De velopment in March 2006. Their goals are 1) to improve the current level of performan ce 2) to prepare employees interested in leadership for greater responsib ilities within the organization. Participant Organization C organized their leadership group into three groups: 1) Emerging Leaders – clinical and non-clinical staff that do not cu rrently have supervisory responsibilities; 2) Operational Leadership – a core middle management group that currently manages a department or a group of departments; 3) Strategic Leader s – current leadership made up of vice presidents, senior vice presidents, executive vice presidents and presidents of the hospitals. Each level is de signing a model to develop em ployees, which includes career 67 planning as well as individual and professional development. Participant Organization C plans to use some components of the 360-degree instrument to measure the skill set of the directors and executives in the organization. Succession planning appears to fit into the organizations’ development model. Participant Organization C will implement career planning and individual development planning, to create a succession plan. Participant Organization D Participant Organization D reported an in formal process was in place and had completed an analysis of their leadership gaps. They are knowledgeable of the retirement dates of the leaders in high profile positio ns. In 2001, they developed an internal Leadership College. Initially, they provided training to their directors and managers in the Leadership College. Subsequently, the Leadership College was opened to new leaders i.e. supervisors, managers, or director positions, during the first year of employment. New leaders are taught the cu lture of the organization, philosophy and the service excellence model, employment law, service requisition, and the Continuous Quality Improvement (CQI) process. After completing the core phase of the college, they began the developmental phase. The Leadership College is open to any employee with their supervisor’s concurrence. Partic ipant Organization D uses an informal process to create a pool of leadership talent. They use an informal process so that employees are not setup for disappointment or failure in the event that they are not successful. Participant Organization D does not have a formalized process to test or identify individuals who may have certain skills and observed leadership behaviors. When employees have been in their role less than two years, goals are developed from their performance appraisal. Based on the developm ental needs of new leaders, their manager 68 may assign certain levels of classes to address the developmental skills model identified by the performance appraisal. Participant Or ganization D uses the MBTI – Myers Briggs for their training instrument. They also o ffer virtual learning and some classes with learning labs to simulate the work envir onment for making patient rounds, employment interviews or making tough decisions, which offers an opportunity for role-playing in any of these training areas. Question #2 How does your organization define key positions? What positions, if any, are given special attention in your succession-pl anning program? Why are they given that attention? 50% of the participant organizations repor ted their process was confidential and monitored behind closed doors where decisi on making was subjective. 25% of the participant organizations made their decisi ons based on data obtained from the Kentucky Hospital Association (KHA), which tracks and predicts employment trends to compare their expected shortages with national data. A tuition reimbursement program is developed for those occupations with exp ected workforce shortages. 25% of the participant organizations identified one successor to promote for a key position. Figure 2: Define Key Positions De fine Ke y Positions Subjec tive dec s ion making50% Dat a Driven 25% Management Selection 25% Participant Organization A Participant Organization A practices th e Jack Welch Succession Planning GE Model, which is monitored behind closed doors and the process is confidential. The 360- degree assessment is a learning contract that is shared with the executive team and a strategic program is incorporated. The 360 is the instrument used to identify the “shinning stars” in the orga nization. In 2007, executives an d directors will use the 360 degree assessment for front line managers, thos e who have a staff of 75 people or more. The CEO has access of all cumulative summary reports for the 360-degree assessment. Participant Organization A uses the 360 to determine the shinning stars for future leadership opportunities w ithin their organization. Participant Organization B Participant Organization B reported that th eir education director was selected and developed for that position. The education di rector holds a Masters Degree and replaced the leadership coach who was on the verge of retirement after 48 years of service. 69 70 Participant Organization B retained the leadership coach as a board member and transitioned her as a mentor to nurture new leadership directors. This gave the new director an opportunity to learn the job. They report that the selection was based on observations and the potential they saw in the individual as a clinicia n, the quality of her relationships with employees and her abil ity to get people together to get work assignments completed. The new education dire ctor received training at the Centers for Creative Leadership and was certified in ad ministering the 360 assessment and the Myers Briggs. Participant Organization B reported that this was the only position for which they had developed or groomed an employee. They reported that they provide employees with leadership, skill sets, competencies which they listed as critical to performing well in healthcare as a leader. Once their employees participate in the leadership development program, they are assigned a mentor. Participant Organization B has looked at many different models and collaborated with the Healthcare Advisory Board, a national group in Washington, D.C. that identifies best practices within healthcare (www.advisory.com). The Healthcare Advisory Board identifie d 56 different competencies required for healthcare. They looked at in ternal needs in the hospital as well as skills needed for vacant positions. They tapped several sources in their organization and worked collectively to agree on the core sk ills needed at their facility. Those competencies are targeted in thei r Evolving Leaders Training Program. The following competencies are targeted: budgeting, finance, emotional intelligence, personal intelligence, human resources, me ntoring, and coaching. The leadership curriculum matches the mission and values of their decisions based on an organization’s 71 needs assessment tool. They benchmark the core competencies with the Healthcare Advisory Board then match them to the organizations needs. Employees are identified for the Evolving Leaders Training Program by their supervisor and based on their inte rest in leadership. There are three levels of leadership training. The introductory leve l of leadership training allows employees who wish to explore opportunities in leadership decide if they want to enga ge in level one curriculum. Employees can self-select up to level five (t he executive leadership program) which is a fellowship — a graduate program for those who have completed graduate school or are in a graduate degree program and have comp leted all the other executive leadership curriculum requirements. The Master’s Degree is not discipline specific for the executive leadership program. They have a committee that matches the mentees with the mentors based on individual developmental goals. Participant Organization B has 2300 employees and all employees have the opportunity to participate in leadership training with approval from their manager who offers mutual support as employees begin taking level one classes. Employees can determ ine their own pace in the developmental program. Participant Organization B does not typica lly define key positions. They plan a general leadership development program that teaches people the skills and competencies identified by the National Think Tank as skills needed among desired employees. Participant Organization C Participant Organization C has 500 employ ees in leadership positions and defined key positions as anyone in management or a bove. They hope to eventually design their succession planning program to include all 500 of those individuals. Participant 72 Organization C focuses on those employees beca use they provide the leadership in the organization. They consider these employees as the link pins to their staff and employees and instrumental to the day-to-day accomplishment of all of the organizations initiatives: employee satisfaction, patient satisfaction, rete ntion and employee turnover. Participant Organization C has not defined the positions fo r formal succession planning. They report that in 2007, the VP of HR, Chief Operat ing Officer, and Chief Executive Officer will meet to define positions in need of succession planning. Participant Organization D Participant Organization D reported that th e nursing shortage is expected to hit its peak between 2012 – 2015 where double digit retirements are expected nationwide. Participant Organization D’s data for nursing shortage includes projections up to 2016 the year retirements in nursing will impact their facility. To backfill those positions, they have developed a Knowledge Program that lo ans money for nursing school. Participant Organization D will loan employees $15,000 in return for a 6 month commitment of employment for each $2500 they give employees to complete school. If an employee is in an accelerated RN program, they receive $15,000 and owe three years of employment when they graduate. Participant Organi zation D provides tuition reimbursement for radiology, respiratory, medical laboratory technology and physical therapy degree programs. They loan employees tuition in the form of salary in advance for a commitment of employment after graduation. Participant Organization D’s program is very popular and they have 34 RN student employees expected to graduate in May 2007. Many of their employees in the accelerated degree program have a Bachelors Degree. 73 Participant Organization D reports the followi ng outcomes since the inception of their Leadership College in 2001: 1) Vacancy rates in nursing were 12% and today are 4%. 2) Six director positions were filled with one internal promotion and five external hires. 3) Six manager positions were filled with five internal promotions and one external hire. 4) Six nurse managers’ positions were v acated; there were three internal promotions and three external hires. 5) 71 supervisory positions were filled with 42 internal promotions and 29 external hires. 6) 89 positions were vacant. They were f illed by 38 were external hires, and 51 internal promotion. 57% of promotions came from w ithin the organizations compared to 43% external hires. Participant Organization D has 300 employees who have gone through the Leadership College since its inception. Participant Orga nization D reported that they have created the right environment for employees to grow within the organization. Many internal promotions have been awarded as positions became available. They report being pleased with improvement efforts that have resulted in a trend of developing individuals for internal hiring. They are beginning to educat e entry level supervisors and managers and are giving opportunities to new employees to gr ow in the organization, a practice that is more prevalent since the Leadership College was established five years ago. With regard to leadership with their managers , they report the following outcomes: 74 Participant Organization D has experienced fewer job vacancies and significantly reduced turnover and improved employee produc tivity evidenced by bottom line figures. Participant Organization D repor ted their outcomes reveal that they not only grow people internally but also grow the right kinds of people ba sed on employee feedback. Participant Organization D investigates shortages based on national data as well as local data. They receive data from th e Kentucky Hospital Association (KHA), which publishes workforce shortage survey results on an annual basis. Data is reported out by market, which helps Participant Organization D identify areas slated for predicted shortages. If they see the vacancy rates for RNs go up on national or statewide basis, they invest more money or sit down schools of nursing to plan and meet the challenge. If they see the vacancy rates for medical technology increa sing, they develop strategic plans. They also belong to local workforce consortium where hospitals come together to work on issues regarding the workforce shortage in healthcare. The KHA is a local corporation that works with local hospitals and come together to offer solutions to problems of recruitment and re tention in key positions in healthcare organizations. KHA received a grant from the National Department of Labor to help with training of managers throughout the state and healthcare and to deal with the shortage of certain occupations in healthcare. Participant Orga nization D takes advantage of their opportunities for the prescriptive treatment of critic al employment issues that directly impact its success. Question #3 How does your organization assess curre nt job performance for succession planning and management purposes? (Do you use the organization’s ex isting performance appraisal system – or something else?) 75% of survey participant organizations use the 360-degree self-assessment and share results with top management at their facilities. Performance measures are used to include accreditation scores, quality improvement , satisfaction scores. The 360 is used for self-development. 25% of survey participant organizations plan to implement an assessment used in healthcare called Test Sour ce that has behaviorally based questions to determine if the prospective employee will be a good fit for the organization. There is a distortion score built into the questions to ensu re reliability and validity of test results. Figure 3: Performance Management Pe rformance Manage me nt Us ing 360-degree self -assessment 75% Planning to us e 360 – degree s elf- assessment 25% Participant Organization A The interviewee representing Participant A was the Director of Education. Participant Organization A uses a combin ation of tools including the 360-degree assessment, which is a contracted by an outside company. A separate appraisal tool is completed for mangers. There are critical success factors wired into management that leadership addresses at the executive level with front line level and with management level employees. 75 76 The tools address competencies including turnover, accreditation, satisfaction scores and quality improvement initiatives. The leaders submit goals that are related to the strategic plan. They evaluate critical success, submit quarterly reports, 90 day action plans and are rewarded at the end of th e year up to 10% of their pay based on performance. There is a threshold, target and maximum level for job performance. There is a financial reward, public recognition ceremony and a congratulatory letter, and the majority of leaders receive feedback. This process allows Participant Organization A to identify problems and take corrective actions. Participant Organization B Participant Organization B uses the traditional tool based on job competencies; however, they also have othe r assessment tools. They use a 360-evaluation tool for employees’ individual’s self-development. The education director is trained to administer the 360 through the Center for Creative Leadership in Greensboro, NC, from that; they address specific goals to address. They also use the Myers Briggs personality inventory. Participant Organization B gets feedback from mentors who have mentored individuals in the Evolving Lead ers Program to identify shinning stars and future leaders. Organizational leaders communi cate regularly with the mentors about mentees who do not know they are identified as rising star s and potential leaders. Once employees complete leadership training, there is a littl e ambiguity about corporate expectations and employees are motivated to continue work ing toward positions of management and leadership. They have a low tu rnover at the director level. When they lose an employee, it is usually due to an opportunity for an em ployee to relocate closer to family. This 77 participant organization reported that for an employee to be successful in a leadership position, they have to be a “good fit” which is more than job skills; they must exhibit competencies that are difficult to rate in a typical rating skill. They know when somebody fits the organizational culture or the culture they are trying to build and they know when someone does not. Their leadersh ip training allows them an opportunity for them to look at the pool of employees and to experience them as learners which gives them an idea of who fits and who can lead within the organization. They also identify some people who have good skills; however, they will never be in a key leadership position because they do not have the behavior al competencies needed in healthcare. They often role model desired behavioral co mpetencies in the curriculum for leadership development: personal discipline, emotional intelligence, an d team leadership skills. They reported struggling to get the behavioral components aligned with organizational values. Currently, the organization looks at the individual and thei r relationships with others. Participant Organizati on B reports they sometimes rely on their “gut feelings for identifying future leaders” as well as their behavior in the organization. Participant Organization C Participant Organization C reports that th ey use all kinds of subjective measures. Their current management system is based on performance. They hope to add some additional evaluation tools such as the 360-degree instrument along with additional testing instruments. Participant Organization D Participant Organization D evaluates every employee annually. They look at the key accountabilities of the job and there are the core competencies and employee 78 performance standards. They have a pay for performance system at 0-4% on an annual basis. There is a section in the evaluation tool for reco rding developmental needs or goals discussed with management and line staff employees. Their goal is to have employees grow and develop in the organiza tion so they behave more like an “owner than a renter.” They desire employees to view ownership as part of the overall culture of service excellence. They plan to introduce the 360 assessment and implement a more formalized employee evaluation program. They are planning to implement an assessment tool in their hiring process before employees are interv iewed. This pre-employment assessment will tell them the degree of fit pr ospective employees would have within the organizational culture and help them to iden tify people who can grow with them in the future. They plan to use an assessment va lidated for healthcare called Test Source. There are 111 questions and an outside company scores the responses. This tool will give them a fit analysis based on behavioral ques tions designed to solicit information from the candidate to determine if they are a fit. Many organizations that have used this have seen a significant decrease in tur nover. It is expected that a significant decrease in turnover will occur once this test is in place. Pa rticipant Organization D believes that a good indicator of how people will do things in the fu ture is how they have done things in the past. Question # 4 How does your organization identify successors for key positions? 100% of the survey participant organi zations report they do not identify successors; however, 75% of the survey participant organizati ons report that they observe employees in stretch assignments i.e. committee assignments and mentoring experiences, and through their leadership development training. Figure 4: Identifying Successors for Key Positions IdentifyingSuccessors for Key Positions Do Not Identify Successors, 100% Participant Organization A When a vacancy occurs, Participant Organi zation A selects the next in line leader to move into an interim position of leadershi p, sometimes serving in that capacity for one year as a trial run to observe their degrees of success. Participant Organization A is not a private hospital and promotes from within. For high levels and unique positions, a national search is conducted to find a lead er who has proven leadership abilities. Participant Organization A hire d a new Vice President of HR in January 2007. Typically, individuals selected for key positions, are graduates of their leadership development classes. Participant Organization B 79 80 Participant Organization B does not identify successors. They employ a leadership coach who is instrumental in giving feedback on performance of employees working on level three project teams. Leader ship coaches identify people for leadership assignments by creating a nurturing environm ent and investing in the leadership development of employees. Participant Or ganization B reports that observations and experience allows them to identify some peopl e who are cut out for leadership and others who are not. They report that they have leadership team members who nurture and mentor people. Participant Organization B does not have a formal committee to discuss who is ready for leadership; however, they report they watch employees diligently. A formal report is written addressing the l eaders’ process and the mentor submits a summary report to the mentees’supervisor, so th ere is a formal process attached to the mentees’ progress in leadership training. Participant Organization B reports ther e are times when mentoring includes sharing knowledge about operations, politics and managing. When vacancies occur, management is given the opportunity to look at combining departments and making other administrative changes for efficiency, as we ll as looking to see who can take on more responsibility. They have a good feel for that and they report using an evaluation process that is built into the mentoring program. Re portedly, they have few obstacles with their training program; however, some employees fall through the program and they know who those people are. Participant Organizati on D trains a pool of mentors and provides them with forums during the year and individual training, and along with the mentees’they learn the values and responsibil ities of mentoring. Mentors and mentees’ are in the room together on the kickoff da y and they hear the same information. 81 Participant Organization B feels it is important for the mentee to know the expectations of the mentors. Both are mutually accountable. Participant Organization C Participant Organization C uses a s ubjective measure based on opinions and observations, which they re port is not a good system. Participant Organization D Participant Organization D has a Leadership College and they use various ways to identify potential leaders in the organiza tion. They have numerous employee driven committees in the organization. In addition, many of those committees are not facilitated by managers and directors but by staff line em ployees with direction or guidance from mangers and directors on the committee. Within the Leadership College, there are employee driven committees such as awards and recognition, standards of conduct team, and an inpatient and outpatient satisfacti on team. All groups are all made up of a combination of managers, directors and line st aff employees. There are more line staff employees on those committees than there are ma nagers and directors. They feel that employees know best about how to do the work that needs to be done, and by involving them in the problem solving process employees provide input rega rding the rising stars who emerge from those committees. Particip ant Organization D reports that employees who get involved and give of their time and talent take ownership and behave like “owners rather than renters.” Question #5 How does your organization identify hi gh potential employees (who are capable of advancing two or more levels beyond their current placement)? 100% of the respondents report no formal process. However, they do acknowledge several ways of identifying high potentials by their willingness to relocate within the organization, observing employees who use critical thinking skills and plan strategically; those w ho mentor and nurture employees ; employees seeking continual development and current leaders who identify internal interim successors should they be out of work for any given period to time. Figure 5: Identifying High Potential Employees Ide ntifying High Pote ntia l Employe e s No Formal Proc ess to Identif y High Potential Employ ees , 100% Participant Organization A Participant Organization A reports that the Corporate Vice President of Talent Search will look at grooming the next execu tive level of leadership for the entire organization. The position is newly developed. If employees are willing to relocate, it’s a win-win for all parties. Positions are avai lable in 60 different hospitals. Positions are advertised on the website and some are terr itorial. Individuals have to search for positions. Diversity is being encouraged and supported; the CEO is African American, and a young African American is serving in an executive fellowship. They also have a diversity fellow expert team to ensure mi norities are reflected in the CEO and other 82 83 positions of leadership to balance the high number traditionally hired for nutrition and housekeeping positions. More diversity is reflected among Licensed Practical Nurses (LPN’s) or Nursing Assistants (NA’s) than among Registered Nurse (RN) positions. For nursing leadership positions, Part icipant Organization A prefers to hire applicants with a Masters in Nursing (MSN); how ever, Participant Organization A reports that most of their nurses are RN’s with an Associates Degree in nursing. Reportedly, there is no distinction in pay between the RN with a B accalaureate Degree versus an Associate’s Degree in nursing, except for tenure. Partic ipant Organization A reports two or three people of color have moved to management who were employed at their facility for a while. Employees want to know how the outco mes of their participation in leadership development will enhance their careers. Participant Organization B Participant Organization B reports that there are employees who are good at their jobs and task oriented, and then there are people who are good at seeing the big picture and understanding that their role is managing relationships and resources, not the task. They consider this the difference between ma nagement and leadership in healthcare and this varies in terms of the expectations from discipline to discipline. As employees move up and within the organization, they have to become strategic in their thinking and less task oriented. Participant Organization B looks for employees who understand their role and responsibility in the mission of the organi zation and those who are more strategically oriented and less task orie nted in their thinking. Consideration is also given to the leader’s role in the organization, the department and the level of professional accountability required for the position. Participant 84 Organization B maintains that employees sel ected for leadership must be political, strategic, visionary, have good leadership a nd problem solving skills in negotiating across multiple departments, and be knowledgeable of the mission and programs of the organization. They report st rategic and political skills are needed to negotiate resources across multiple environments with peers. Participant Organization B stated that healthcare has been notorious for promoting people because they were good at the task they did, but did not realize that promotion also demands a different set of skills and performance requirements. Participant Orga nization B asserts that a poor assumption is made when employees are selected who perform a task well; he or she may not be good at managing. Participant Organization B main tains that those employees must have the right support to develop the skills and support them and nurture them in that process of growth. They are trying to address compet encies necessary for effective leadership programs before employees are moved into l eadership responsibilities. Participant Organization B views leadership development as an opportunity to start exploring and developing those skills. Participant Organization B identifies employees with high potential through the mentoring and training programs within their leadership development program. They try to ensure that the employee’s goals are being met. Participant Or ganization B plans to add competencies to their training program to include organizational managerial ethics, emotional intelligence, the politics within an organization, and the use and misuse of power. They report that ther e is a time when leaders must maneuvers and use earned power and influence to positively impact the or ganization, and there is a time where that can become toxic or dangerous to the organization. 85 According to Participant Organization B, hidden bias is an area they have not tapped. Participant Organization B reports that prejudice many not be openly evident in the organization, but there are hidden biases and other issues such as professionalism self discipline, race, culture, socioeconomic status , age and gender, etc. that have a powerful impact on organizational effectiveness. Participant Organization C Participant Organization C identifies high potential employees subjectively. Previously, they had a Fellows Program that had a strategic leadership group that included the vice presidents and above. Thos e “fellows” selected individuals from their departments to participate in the program with the intent to advance selected employees one to two positions. Previously, there was no written criterion and decisions were subjective with who they thought had potential within the organization. Promotions were used in some instances as rewards for so me of their favorite people. Participant Organization C put that program on hold until criteria is developed and a new leadership development program is fully implemented. Th ey realize they have the need for a high level program and they are going to evaluate th e course next year (2007) to develop goals and objectives. They plan to have criteria for completion of the programs and link it to the succession planning system; whereas, th e previous program was not linked to succession planning. Participant Organization D Participant Organization D does not have a formalized process or structure in place other than the Leadership College and some leaders who identify people who appear to have leadership tale nt. They report that some employees have jumped one or 86 two levels in the organization, but they coul d not provide an example. They report that anyone in the organization can recomme nd someone for promotion–from a vice president to a director or manager who identifies people as future leaders. Participant Organization D reports that they have depart ment leaders to identify one or two key people to serve in an interi m role should they experience a leadership vacancy, whether long or short term, so operations can continue in that department. One of the questions the CEO asks lead ers is; “If you were not here tomorrow, who would either succeed you or maintain the service in your departments until such time a replacement was found?” This provides an opportunity for employees to discuss possible recruits for leadership development. There is no guarantee that the employee would be selected if a permanent repla cement is needed; however, should a vacancy occur it would allow for leader ship continuity. Succession planning is not a formalized process that guarantees that the employee selected a guaranteed placement in the vacancy. Some leaders do not want to release control and power in their areas. Participant Organization D reports they have come to understand that it “takes a village and not an individual” to make their organization a success. Question #6 How does your organization establish I ndividual Development Plans (IDP’s) to accelerate the development of high potential employees? 75% of the survey participant organiza tions have Individual Development Plans and 25% are in the process of implementing IDP’s into their leadership development training plan. The IDP’s are shared with top management and with the mentors at another healthcare facility. 25% of the survey participant organizations include it as part of the leader’s annual performance plan so that goals are measured and the leaders are held accountable. Their IDP’s are always evolving and updated based on the based on the personal and professional needs. Figure 6: Individual Development Plans Establishing Individual Development Plans Use IDP’s 75% In the process of developing IDP’s 25% Participant Organization A Participant Organization A reports using the 360 degree assessment for implementing goals and creating 90-day reports for managers; it serves as a feedback tool. Directors and executives complete the 360 individualized plans. Managers that have not completed the 360-degree assessment create individualized goals, plans and objectives that are aligned with organizational strategi c goals, which are reported quarterly. The 360 keeps mangers accountable . They report that accountability is becoming more prevalent in healthcare leadership. Participant Organization B Participant Organization B expects everyone in their leadership program to develop a personal development plan that includes personal goals and objectives. Employees evaluated their persona l development plan with their mentor if they are in a 87 88 mentoring relationship. Expectations for me ntor/mentees in level three and four are move complex than levels one and two. Level two employees have a mentor, but they found that asking mentees to write measurable goals is difficult if it is their first experience. In levels three-fi ve, they expect employees to be able to write measurable goals and share them with their mentor. The goals and objectives are submitted to the Leadership Program and are used to appropriately assign a mentor to them. Mentors are selected based on what they have to offer mentees and together they work on goals and objectives throughout the year. Progress reports are provided to the Education Director indicating the mentees progress on those goals. Participant Organization C Participant Organization C has a semiformal approach to succession planning but is currently developing a more structured approach in terms of how to implement it through career planning. With the 360-degree f eedback, they plan to be able to develop individual development plans for those they see as high potential employees. They plan for employees to be involved in other deve lopmental activities, which will replace their Fellows and Honors Program. Their plan s are in the developmental stages. Participant Organization D Participant Organization D uses the a nnual performance appraisal to evaluate employee performance, to identify opportunities for improvement, and to develop goals to stretch employees in the or ganization. The plans are review ed every 90 days to review the progress of employees in le adership positions to evaluate their progress in achieving measurable goals. Participant Organization D reports that the goals are in line with their Service Excellence Initiative and the managers are held accountable. Every key manager 89 or director has measurable goals that are developed around industry pillars, to help employees grow and ultimately impact the success of the organization. The industry pillars are people, quality, service, finance and growth. They report that Individual Development Plans are implement ed at the senior level and report that accountability has helped to reduce turnover and vacancies, and improved engagement and productivity over the last five years. Th eir productivity has improved and is reflected in the numbers; a windfall of $8.2 million dollars was added to their profit in the last four years. Reportedly, their managers are always working on their skills and are not getting stagnant in their positions. Their senior executive team sits down each year and identifies the goals that fall under each of thes e pillars, some are required for every director, and some are left to the optional discre tion of selection along with th eir director’s assistance to determine areas in greatest need of improvement. Question #7 Does your organization use replacement c harts based on the current organization chart? (If not, why)? None of the participant organizations surveyed used replacement charts. However, a goal within their leadership de velopment training programs was to develop employees with the skills and competencies needed for healthcare leadership as vacancies occur. They match the needs of the vacancies to the skills and strengths of those in the applicant pool. RFigure 7: Use Replacement Charts Use Replacement Charts Do Not Use Replacement Charts, 100% Participant Organization A Participant Organization A does not use re placement charts. They hired a new Talent Manager effective 8/7/06. They were uncertain how the position would be developed but it was expected that th ere would be a lot of new programming. Participant Organization B Participant Organization B does not use replacement charts. They report that measures previously used were subjective. Participant Organization C Participant Organization C does not use re placement charts. They report that no one has taken the leadership to develop a structured succession planning system. Participant Organization D Participant Organization D does not formally identify individuals for positions that become available and there is not a repl acement chart. They report that they do not want to set people up for failure. Instead, they report developing people with the right skill sets to be in the right place at the righ t time. When positions become available there is a pool from which to select candidates for positions of leadership. Informally they 90 make sure that if a leadership position were vacated, life could go on for a short period until the leader returned or the position was filled. Reportedly, their culture permeates from the top corporate level down. They own fi ve hospitals in the state of Kentucky with 3400 employees locally and 9500 in the organization. Question #8 What special programs, if any , has your organization established to accelerate the development of high potentials? 75% of the survey participant organiza tions’ use their leadership development- training program as a mechanism to accelerat e the development of high potentials while equipping them with the competencies needed for healthcare leadership. 25% of the survey participant organizations plan to use leadership development training to accelerate the development of employees with high potential. Figure 8: Healthcare Organization Special Programs He a lthc a r e Or ga niza tion Spe c ia l Pr ogr a m s Us e Leaders hip Dev elopment Training Program 75% In the proc es s of dev eloping leaders hip dev elopment plan 25% Participant Organization A 91 92 Participant Organization A reports that they are a large organization that has followed the model by General Electric – th e change agent model and workout session models. They report that leaders are tapped to participate in the National Leadership Training Programs, which is a great opportunity for leadership development. They have five healthcare facilities and some are located in small and rural areas. Their flagship institution is expected to lead the way for other healthcare facilities in their system. The have 42 directors, the vast majority w ho were tapped within the organization for leadership positions. The next level down may be tapped for leadership positions based on the organizational need. Participant Orga nization A reports many baby boomers at the Directors level and they antic ipate a high number of retiremen ts in the next 10-15 years from among those eligible for retirement. They report that they are affected minimally in other areas. They are acquiring other small hospitals, which mean that they will consolidate resources among leadership positions and reorganize to eliminate overlapping high profile positions. Participant Organization A reports that this merger caused people to lose their prestige resu lting in a decrease in employee sati sfaction. Change is not painless for those individuals involved repo rts Participant Organization A. Retainment is based on performance. Pa rticipant Organization A desires to work with people who want to come onboard. They are a faith based organization and have found that employees respond in a passive aggressive way to change. Participant Organization B Participant Organization B reports that the Evolving Leaders Program has had about 100 participants. All of their leadership development participants completed level 93 one of instruction. Twenty four employees have completed level two, fourteen employees completed level three, twenty employees level four. Two employees have completed level five for executive level leadership positions. Participant Organization C Participant Organization C reports th at the Fellows and Honors Program was initially established to accelerate the devel opment of high potentials. Their new program will start the fall of 2007. Participant Organization D Participant Organization D reports that the Leadership College develops high potential employees. Reportedly their serv ice excellence philosophy of cultural pride, personal responsibility and de livering excellence motivates their employees to take ownership in the organization, and for their ow n their behaviors and performance. As a key development tool, the subcommittee that su pports each of these endeavors creates an “ownership rather than rentorship” philos ophy that is shared among leaders and staff members. Question # 9 How does your organization evaluate succession planning and management activities? 75 % of the participant organizations use data to evaluate their leadership development-training program and a manage ment activity, which is tracked through employee productivity, performance and patient sa tisfaction scores as well as evaluations from leadership development training. 25% of the survey participant organizations are in the development stages of leadership deve lopment and acknowledged that there were no evaluation processes in place, thus making it hard to fill vacancies. Figure 9: Succession Planning Evaluation Activities Succe ssion Pla nning Eva lua tion Activitie s Tr a c k Da t a 75% Do No t Tr a c k Da t a 25% Participant Organization A Participant Organization A r ecognizes the need for data driven assessment with public forums to validate results. New unit mangers and their successors are evaluated by patient satisfaction, which is web-based and tracked daily to create a balanced look at the employee patient satisfaction scores. Participant Organization B Participant Organization B completes a year-end summary and evaluation with the coordinating team in the Evolving Leaders Program and the Mentorship Training Program. They constantly evaluate the cu rriculum based on participant feedback and their learning needs. Courses are added or deleted based on this feedback. When they evaluate the Leadership Development Program, they track the progress of a participant’s movement in the organization, whether it is a vertical move or a move outside the organization. They also recognize that they may lose staff to other healthcare 94 95 organizations and they view this as preparing employees to become stronger healthcare providers to serve their community a nd to take care of someone else. Participant Organization C Participant Organization C is in the early stages for leadership development and acknowledges they have no evaluation process in place which makes it difficult to fill vacancies from a pool of 10,000 employees. Participant Organization D Participant Organization D participated in Kentucky’s Best Places to Work Program the last two years, and finished in the top 20. In 2005, they were # 3 in the large employee category. They were named one of the top 100 hospitals (by an organization called Soluceint), for two years and won the consumer choice award for the Louisville Market of Healthcare Organi zations. Participant Organization D views employment satisfaction as a key indicator to gauge su ccess in growing and developing leaders. Employee turnover has been reduced to 14% from 22%; they have seen job vacancies drop 3-4% in all areas, and an increase in pr oductivity as a result profits have been added to the bottom line which are shared with em ployees. When they meet or exceed their quality goals and/or financial goals, they share up to 2% of the ex cess each year, which is outside of any market adjustments. Productivity and quality are measured by patient satisfaction which allows employees to earn an ywhere from ½ to 2% increase in salary. They were recognized by a research organiza tion at the University of Kentucky for their Leadership College and their Knowledge Program both of which were evaluated based on the implementation of best practices among healthcare organizations. Question # 10 96 What special challenges has your organiza tion encountered with succession planning and management? In the area of diversity? How have those been solved? 100% of the survey participant organi zations acknowledged challenges with succession planning and management. They include challenges in recruiting in healthcare personnel to Kentucky, diversity am ong leadership teams was not reflective of the client population served by the health care organization or the fabric of the community, and an applicant pool with low num bers reflecting diversity. All healthcare organizations interviewed had a different view of diversity. 75% of participant organizations have developed measures to address diversity which include: (a) developing a Diversity Fellows Program to attr act more diversity to attract more people form diverse backgrounds to leadership positi ons; (b) requiring all employees to attend four hours of diversity traini ng; (c) educating staff about issues and complexity associated with diversity; (d) implementing a national search for diversity recruitment purposes; (e) creating a partners hips with an area high school Health Careers Program to develop interest and attract healthcare workers from a di verse student populations. Efforts are being made among healthcare organi zations to include a more diverse group of employees. They are recruiting hea lthcare workers from areas with a high concentration of minorities’ i.e. environmental management and food and nutrition service. Those with an interest and a de sire to learn are tagged for upward mobility programs. Tuition reimbursement incentives ar e offered to employees who wish to climb the organizational ladder. Figure 10: Special Challenges with Succession Planning Acknowledge Special Challenges with Succession Planning Including Diversity 100% Participant Organization A 97 Participant Organization A reports havi ng a leadership position vacant for two years even though the position has been offered two or three times. Participant Organization A has vacancies for a director and vice president. Several shinning stars have been tapped to work at the corporat e headquarters, which is a challenge for a flagship institution. They report obstacles hi ring operating room and surgical nurses and the average age of these speci alized personnel is between 47 and 50. For hard to fill positions, such as a director of surgery a na tional search is conducted and a recruiter is used in the hiring process. Participant Or ganization A has a Diversity Fellows Program, which is a corporate program for leadership development. Two people from diverse backgrounds are selected each year for this paid internship. The Diversity Fellow is placed on the executive team and works with th e Director of the Medical Center. Their emphasis is on building diversity within the executive level and building strong executives and creating strong leaders. 98 Participant Organization B Participant Organization B does not have a leadership team that reflects the community they serve. The nurse demogra phic reports did not reflect the community they serve. They report gi ven thought to and taken an active role in and building partnerships with academic institutions for recruitment purpose. Reportedly, they are willing to hire a diverse workforce but ha ve few candidates and low enrollments in programs designed to fill the need for diversity. When they examine the pool of applicants, there is little diversity repres ented, including ethnicity and gender. They recently promoted an African American in the Cardiac Cath Lab. Currently, three African Americans are in the leadership pool of sixty directors. They have partnerships with an area high school’s Healthcare Careers Program where efforts have been developed to nurture and recru it minority students to healthcare careers. They also have high school students who volunteer for communi ty-based experiences to learn about healthcare jobs. They attempt to recruit from environmental and nutrition services within the organization–areas that have the larg est number of minority employees and entry- level jobs. Participant Organi zation B reports there is little interest in scholarship and continuing education opportunities among thes e employees. Participant Organization B is aware of the need to recruit and hire minorities for high level healthcare positions and state this as an area in which they need improvement. Participant Organization C Participant Organization C does not reflect a high level of diversity in the area of management. Organizational makeup is 85% female, 84% white, and the median age is 40. 12.3% of females are salaried employees (exempt status) and 25.3 % of males are in 99 exempt positions. African Americans make up 4.9 % of exempt employees. Of the top 800 people in management, 43 are minorities whic h represents 5% of those employed at a supervisory level or above. The professiona l group direct caregiver, physicians, nurses and allied health minorities represent 8% of the total numbers or 284 of 3640 employees. The statistics are not in proportion to the patient population they served. They have a Division Director of divers ity who is rolling out a diversity wide initiative. Four (4) hours of diversity tr aining will be required for every employee in 2007. They hired an outside consultant to tr ain key employees within the organization to serve as facilitators for employee sessions. Topics will include personality, internal dimensions, external dimensions and organiza tional dimensions related to diversity. Participant Organization D Participant Organization D has taken steps to send an employee for training and certification as a Diversity Trainer. They are moving towards a culture that reflects diversity even though they do not have a pool of diverse backgrounds. Reportedly, they do not have a pool of candidates from divers e backgrounds. Demographically, their staff is 90% Caucasian and 10% of the staff reflects people of color. They have no diversity in upper level leadership among the vice presidents , directors, or manager; however, they do employ several minority supervisors. The Bo ard of Directors reflects some diversity. Future diversity plans may address this and include cultural sensitivity training for nurses and caregivers i.e. to include culture, religion and sensitivity awareness. Reportedly, they embrace diversity. 100 Patterns and Themes Although leadership development training programs varied from organization to organization, the following patterns and them es were identified among these four (4) Kentucky healthcare particip ant organizations. The results are shown in Table 5. Table 5: Patterns and Themes of Survey Responses Patterns and of Themes of Survey Responses • Accountability: Healthcare organizations app ear to be holding leadership accountable for their leadership performance agreements. • Focus on Workforce Retention: A trend to promote from within the organization is emerging. • Leadership Development: Leadership Tr aining is open to all levels of the organization with emphasis on top management . Healthcare organizations appear to recruit leadership within every level of the organization. • Leadership Competencies: Negotiation skills, behavior management, budgeting, finance, collaboration and continuous learning appear to be the competencies required for healthcare leadership. • Performance Management: All employees ar e expected to perform at high levels within the organization, whic h supports the need to reassign poor performers for improved efficiency and improved staff morale. Leadership Development Programs in Hea lthcare organizations surveyed do not use formal succession planning as practiced in business organizations. Leadership 101 Development Programs of those surveyed vari ed from organization to organization and was not linked to succession plans. Research Questions and Summary of Responses Research Question #1: Are healthcare organizations us ing recommended best practices in succession planning? Succession planning is a proactive appr oach that helps leaders deal with unexpected changes and has been defined in many different ways. However, for the purposes of this research, the definition co ined by McWilliams (2005) defined succession planning management as an effort designed to ensure the continued effective performance of an organization, divisi on, department, or work group by making provision for the development, replacement, a nd strategic application of key people over time. Added to the vocabulary of successi on planning is technical succession planning. It is defined as any effort designed to ensure the continue d effective performance of an organization, division, department, or wo rk group by making provision for distilling, preserving, maintaining and communicating the fruits of the organization’s institutional memory and unique experience over time (Rothwell & Poduch, 2004). All of the survey participant organizati ons acknowledged that they did not have a formal succession plan. They all acknowle dged that the concept was new to their organizations but two healthcare organizations filled positions at their respective facilities in 2006 with the intent to develop a succession plan for their facility. Either the Human Resources Department or Education and Development Department coordinated the succession planning /leadership development in itiatives, which involved top management at each of the selected healthcare organiza tions. Succession planning procedures differed 102 from organization to organization and appeared to be based on the political climate for the organization with regard to how leader ship development training was implemented. The survey participant organizations were keep ing abreast of the current market trends in healthcare as well as human resource trends in the industry. Some were partnered with associations that evaluated marketing trends in healthcare, which assisted with their strategic planning. The present findings support the need for succession planning to preserve workplace culture, norms, traditions, returns on investments, money savings, higher patient satisfactions rates, employee satisfaction and organizational survival resulting in long-term high performan ce (Abrams & Bevilacqua, 2006). Survey participant organizations acknow ledged challenges associated with succession planning. Participant Organizations acknowledged some resistance to the succession planning process but were rethinking how the healthcare organizations would benefit from their succession planning and leadership devel opment training program efforts, and acknowledged need for further study. Research Question # 2: Are healthcare industries identifyi ng potential leaders for future organizational needs? Responses of those surveyed revealed that the healthcare organizations in Kentucky have only recently begun to devel op and institute succession planning. The participant organizations’ surveyed were al l in the cultivation phase of leadership development planning within their organization. Two were in the development stages of planning with new positions created and filled in 2006 and two had leadership development programs launched and implemente d in 2000. All of the survey participant organizations had invested in leadership development and training programs, and were 103 trying to develop an organizational culture to maximize its performance and adapt to market changes in diversity. By creating leadership development programs, those survey participant organizations whose programs had been launched within the last six years believed they were beginning to see the fruits of their labor–a pool of individuals trained to fill vacant positions when needed. Because of this training, most positions were being filled from within with a smaller percentage being selected from outside of the healthcare organization. Outcomes from leadership development training programs affected the bottom line due to increased employee sati sfaction. All participant organizations surveyed acknowledged the need for having a sk illed workforce in efforts to become an employer of choice. Question # 3: Are healthcare industries using me ntoring to develop succession plans? Of the survey participant organizations responding, 25% of population studied acknowledged having a strong mentoring program linked to their leadership development/succession planning initiatives. Th e survey participant organizations agreed that the mentoring programs were not cons idered an automatic guarantee for upward mobility for all individuals sel ected to participate in such programs. All four survey participant organizations agreed that they were creating a learning environment to help employees develop life-long learning skills. Question#4: Are healthcare industries addressing employee retention? Survey participant organizations with leadership development programs in existence since the year 2000 saw positive resu lts with regard to employee retention which resulted in improved employee sati sfaction, improved manager effectiveness, increased promotions from within, reduced turnover, increased retention, increased 104 productivity, personnel cost savings, awards and recognition of employees. Within a short period in tracking data, th e novelty of the program makes it difficult to determine its long term effectiveness for one organization; however, the leadership staff reported they had developed a better understanding of th eir employees’ strengths and weaknesses. Furthermore, they reported having a keener in sight to those employees who were ready to assume additional responsibilities and move to the next level, as well as those who needed additional time or would not be a candidate for increasing responsibilities. Question #5: Are healthcare organizations preparing for the shift in workforce diversity? The survey results indicated that although the workforce is better educated and reflects more diversity, divers ity in top management is not a common occurrence in the four (4) Kentucky healthcare organizations interviewed. All survey participant organizations acknowledged workforce diversity as a challenge for their organizations in the area of attracting minorities and others to the CEO level of administration. All survey participant organizations noted that they could do a better job with diversity, but cited the following reasons for low numbers: few applic ants, few diversity enrollees in university healthcare professions, little di versity within the community. While partnership with institutions of learning were cited as a means of generating a more diverse pool of applicants in healthcare, no Kentucky healthcare organization acknowledged a relationship with the Commonwealth’s only Historically Black College and University (HBCU) – Kentucky State University. 105 Summary The literature review provided a solid basis for the need for this study: While many corporations utilized formal succession planning, many healthcare organizations have not or are slow to follow. The research findings have been presen ted in this chapter. The researcher addressed five research ques tions through a literature revi ew and a survey of Kentucky healthcare facilities. The research data indi cates that if healthcare organizations are to remain viable and competitive, then they have no choice but to develop and implement a formal succession planning program. A va riety of themes emerged from the study indicating that an approach to formal su ccession planning is beginning to evolve in Kentucky healthcare organizations; however, th e healthcare organizations surveyed are in the early stages of development making it diffi cult to determine the effectiveness of their programs. The following chapter will offer recommendations to guide healthcare organizations toward implementing succession planning programs in the future. 106 CHAPTER V: DISCUSSIONS, IMPLICATIONS AND RECOMMENDATIONS “The Chinese philosopher Lao Tzu wrote a descri ption that is as close to an ideal leader: The best of all leaders is the one who helps people so eventually they don’t need him. Then comes the one they fear. The worst is the one who lets people push him around. People don’t trust a leader who doesn’t trust them. The best leader says little, but when he speaks, people listen and when he is finished With his work, the people say we did it ourselves” Maccoby (2004). Introduction Because of the aging workforce, health care organizations are facing a leadership and workforce crises. Today’s employees are working in an information age and knowledge based economy in a global so ciety (GAO-01-241, 2001). Baby boomers are often seasoned professional employees w ith a wealth of information, knowledge and experience regarding technical and program skill s, and are considered the historians for the organizations in which they are empl oyed. Younger employers (generation Xers) often lack the experience, work ethic and lif e experiences of their predecessors. (GA0-01- 241, 2001). After the September 11, 2001 bette r known as the 911 tragedy, a day where the United States was attacked by terrorists , perhaps many employees reprioritized their 107 values regarding career and family, and imp acted workforce demographic trends that point to the necessity to better prepare for an uncertain future. It is critical for healthcare organizations to position themselves for great ness and focus on the fundamentals that will help sustain themselves in the 21 st Century (Collins, 2001). This study analyzed the trends expected to impact healthcare organi zations as leadership transitions occur among an aging population and workforce. This qua litative study investigated the effectiveness of an ideal formal succession plan and wa ys healthcare organizations can make succession planning a priority to ensure organizational success over time. A major finding of this study was the consistency among all four participant organizations. The findings reflect the need fo r healthcare organizations to create formal succession plans to address workforce and leader ship shortages. Using best practices in succession planning are more prevalent in non -healthcare organizations but healthcare organizations must adapt this strategic plan in efforts to remain viable for the 21 st Century. This study examined four (4) major hea lthcare organizations to determine how they identify potential leaders; use mentor ing to address succession plans; retain employees and prepare for workforce dive rsity; and develop leaders within the organization. Succession planning in healthcare must be attuned to current paradigm shifts as the health care industry continues to respond to workforce trends, diversity, consumer and community needs. Healthcare in dustries must prepare well for the future via succession planning and defi ning the skills and competencies needed for developing leaders. Succession planning provides an opportunity for healthcare organizations to develop a strategic plan to ensure a high quality workforce. 108 Critical issues face healthcare organizations including budget challenges, quality improvement initiatives, patient safety, patient satisfaction surveys, technology, malpractice, workforce shortages and governmental mandates which add to the complexity for developing an effective succession plan (Top Issues Confronting Hospitals: 2005). While th ese issues are viable, the need for developing and implementing an industry standards based succe ssion plan is critical. While management talent is selected and groomed to be effective leaders in healthcare organizations, other grave issues such as diversity, and workforce retention may receive little or no attention without a competent leadership team and workforce. Rothwell (1999) offers a step-by step guide for implementing a succession planning model: • Clarify leadership expectations and preferences • Establish competencies by hierar chical level or departments • Implement a 360 degree assessment • Establish an organizational performance management system • Assess employees for advancement • Establish ongoing individual development plans with in-house leadership development training • Establish a competency inventory • Establish individual and organizational accountability for succession planning efforts • Evaluate the results 109 Succession planning has implications for th e healthcare industry. Expertise may be lost often along with retirement trends ; there is a need to have employees and leadership with a vision to anticipate the next healthcare crises. For example, the Center for Medicare Service is evaluating the incidenc e and cost of hospital-acquired infections. In 2007, they will begin to pilot the collection of data. In 2008, Medicare may no longer pay for hospital acquired infections. This is an example of one of many policies and procedural changes that health care organizations are facing that requires them to have a well trained workforce. This has large impli cations for large teaching facilities that see more complicated patients who are high risk fo r infections. Another implication is third party payers may choose hospitals with lower ri sk of infection thus resulting in decreased admissions. Additionally, recent legislature ma ndate public disclosure of data as it relates to complications and errors (Mary Oden, RN, MHS, Op erations Director, Infection Control and Epidemiology, Duke Un iversity Medical Center, March 18, 2007). Discussion of Results The world of work is changing and orga nizations no longer offer job security; however, many organizations offer training skills for professional development to employees. This study represents the findings, conclusions and recommendations of the leadership needs in a changing American wo rkforce as well as challenges in developing and retaining a qualified diverse workforce to provide quality healthcare to an aging population. This researcher gath ered invaluable ideas from the literature and the study that have direct implications for healthcar e organizations in developing formal succession planning. The study reveals that the four (4) participant healthcare organizations 110 surveyed in Kentucky are planning for future leadership; however, this planning remains in the infancy stage of development. Succession planning and leadership devel opment training at all levels of the organization improves their day to day opera tions and is the hallmark of successful organizations and allows them to become great, improve in their operations, and become high performing organizations. Planning and implementing succession planning prevents a crisis from occurring in an organization and is a mean s to prepare for changes and vacancies in key positions that often occur without notice. Formal succession planning allows healthcare organizations to be prepared for changes that can occur at any time. As organizations develop individua ls organizationally, they develop their human capital and increase the behavioral skills that help strengthen the organization. Implications Results of this study indicate important implications for succession planning in healthcare organizations. Survey findings indi cate that there is a need for improvement in the implementation of formal succession pl anning in healthcare. While it appears that succession planning and leadership development are important tools for healthcare organizations, none of the healthcare fac ilities interviewed had formal succession planning programs in place. Succession planni ng can be difficult when organizations do not know the skills required for various positi ons and when position descriptions have not been updated to reflect the skill sets required for the vacant position. Healthcare organizations need to understand what ski lls are needed for every position and update position descriptions prior to the recruitment pr ocess to ensure an individual is hired who 111 has the right skills. Additionally, interview questions for prospective employees designed to reveal the talent and skills of job applicants. There are differences in practices among th e healthcare organizations surveyed in developing the process of succe ssion planning practices. Becaus e of the complexities of healthcare systems, there is no one size th at fits all process or magic bullet for implementing a succession plan. However, orga nizations achieving success with some of their initiatives should share th eir success with other healthcare organizations in efforts to create a best practice model that could be used among healthcare organizations. The research findings indicate that lead ership training, mentoring and stretch assignments appear to be important developm ental assignments for employees identified with leadership potential. Th e data suggest that the more opportunity for developmental activities, the higher perceived effectiven ess of the training program. Healthcare organizations would benefit from devel oping a formal succession planning program. Succession planning is a way of preparing healthcare organizations to achieve the goal of having employees prepared for promotion at each level of the organization. There needs to be more partnering, collaboration and join t ventures among healthcare organizations to develop comparable standards-based programs to identify talent within the organization for promotion and leadership roles. Mentor ing needs to be embraced in the development of succession planning with specific roles and responsibilities of each partner clearly delineated. Additionally, leadership development programs need to be formalized to succession plans and linked to organizatio nal strategic plans that are based on organizational needs. A tracking process needs to be in place to determine the effectiveness of each program. Active recr uitment, attention and a commitment among 112 organizational leaders must be made to encour age and promote diversity at all levels of leadership. Healthcare organizations need to keep abreast of current trends in healthcare and remain current with liter ature in business practices. Recommendations for Further Research This research suggests several directi ons for future research in terms of succession planning. 1) A comparative study on the effectiveness of succession planning and its impact on leadership stability. As formal su ccession planning is not a model endorsed in health care settings, additional research would provide more information on outcomes associated with succession planning. 2) Further research is needed about th e relationship of employee development and organizational commitment for workforce planning. If succession planning is used as an effective tool in healthcare organizations, an evaluation of outcomes of those employees who have participated in leadership development training programs must be co mpleted to solidify the process and generate standards for h ealthcare organizations fo r identifying and grooming leadership at all levels of the organization. 3) Employee skill gaps in terms of l eadership development and meeting the leadership competencies needed for healthcare leadership needs investigation. 4) Healthcare organizations need to continue to expand leadership development and need guidance in how to develop formal succession plans. 5) Hidden biases are involved with lead ership selection and identifying employees who could be groomed for leadership in all areas of the organization. 113 Information is needed on how successors are identified and prepared for leadership roles. 6) The integration of diversity in succession planning programs needs to be studied in terms of effec tiveness. Information is needed on the importance of leadership diversity and the development of multicultural leaders. 7) Further research is needed in terms of effectiveness to determine the effects of mentoring in healthcare to include cro ss race and same race relationships and the impact on career success. 8) Another question remains open for rese arch: How can leaders/managers build competence on a daily basis through mentoring feedback? More partnering, collaborations and joint ventures among healthcare organizations is necessary to develop compar able programs and set industry standards. Conclusion Formal succession planning provides an opportunity for healthcare organizations to successfully position themselves for greatness by designing and implementing a formal succession-planning program with commitment from leadership to create a workplace culture of leaders across all levels. This message must be imparted in their daily operations if they are to sustain themselves over time. Embracing this leadership concept can lead to developing and ensuring a divers e high quality workforce, thus allowing healthcare organization to thrive in the 21 st Century. This can be done by: 1) analyzing healthcare workforce trends and projections; 2) being proactive in embracing a formal succession planning model of development; 114 3) assessing skill gaps and needs; 4) creating a workplace climate that supports continuous learning and development; 5) developing a diverse workforce that repr esents the fabric of the community, customers and stakeholders; 6) widely publicizing developmental opportunities for employees interested in higher level positions; 7) holding managers and leaders a ccountable for achieving results; 8) monitoring the results of the effectiv eness of formal succession planning initiatives and making informed adjustments when needed; and 9) implementing training to address the competencies needed for healthcare leaders at all level of the organization. The above guidelines serves as a roadmap for healthcare organizations to position themselves for success in their efforts to ensure leadership continuity, retain critical staff in critical positions, promote diversity, encourage individual and personal and professional development. These are necessary to sustain healthcare organizations in a competitive and global economy. 115 REFERENCES Abrams, M., & Bevilacqua, L. (2006). Buildi ng a Leadership Infrastructure: The Next Step in the Evolution of Hospital Systems. Healthcare Strategic Management, 24(4), 13-16. Allen, T. D., & Poteet, M. L. (1999). Deve loping Effective Mentoring Relationships: Strategies From the Mentor’s Viewpoint. The Career Development Quarterly, 48, 59-73. Ambrose, L. (2003). Mentoring Diversity. Healthcare Executive, 18(5), 60-62. Anonymous. (2006). Workforce Trends, Workplace Issues. Growth Strategies, 1-3. Anonymous. (2004). Competencies You Can’t Afford to Ignore. Healthcare Executive, 19(6), 28. Arsenault, P. M. (2004). Validating Genera tional Differences: A Legitimate Diversity and Leadership Issue. Leadership & Organization Development Journal, 25 (1/2), 124-141. Bartling, A. C. (1997). 25 Pitf alls of Strategic Planning. Healthcare Executive, 12(5), 20- 23. Benchley, R. S. (Ed.). (2004). The 6 Don’ts of Succession Management. CEO Insights. Bennis, W. (1989). On Becoming a Leader (Massachusetts). Welsley Publishing Company. Braddock, D. (1999). Occupational Employment Projections to 2008. Monthly Labor Review, 122 (11), 51-77. Brutus, S., London, M., & Martineau, J. (1999). The Impact of a 360-Degree Feedback on Planning for Career Development. Personnel Psychology, 18(8), 676-693. 116 Burke, R. (1984). Mentors in Organizations. Group and Organizational Studies, 9(3), 352-373. Burke, R. J., McKeen, C. A., & McKenna, C. (1993). The Mentor’s Perspective. Psychological Reports, 72 , 883-896. Burt, T. (2005). Leadership Development as Corporate Strategy: Using Talent Reviews to Improve Senior Management. Healthcare Executive, 20(6), 14-18. Byham, W. C. (2002). 14 Leadership Traps. Training and Development, 56(3), 56-63. Byham, W. C., & Nelson, G. (1999). RX Succession Planning. Health Forum Journal. Byham, W. C., Nelson, G., & Paese, M. (2000). Cultivating Leaders With an Acceleration Pool. Health Forum Journal, 43 (4), 28-30. Camden, C. 2005). Workplace and Workforce Trends. Vital Speeches of the Day, 71(21), 648-652. Chao, Walz, & Gardner. (1992). Formal and Informal Mentorship’s: A Comparison on Mentoring Functions and Contrast with Non-Mentored Counterparts. Personnel Psychology, 45 (3), 619-636. Coates, J., Jarrett, J., Mahaffi e, J., (1991) Future Work. The Futurist, 25(3), p. 9-14. Collins, J. (2001). Good to Great. New York: Harper Business. Coonan, P. R. (2005). Succession Planning: Aligning Strategic Goals and Leadership Behaviors. Nursing Leadership Forum, 9(3), 92-97. Coughlin, L., Wingard, E., & Hollihan, K. (Eds.). (2005). Enlightened Power: How Women are Transforming the Practice of Leadership. San Francisco: Jossey Bass. Creswell, J. W. (2005). Educational Research (Second). Upper Saddle River, New Jersey: Pearson Education, Inc. 117 D Aunno, T., Alexander, J. A., & Laughlin, C. (1996). Business as Usual? Changes in Healthcare’s Workforce and Organization of Work. Hospital & Health Services Administration, 41 (1), 3-18. Davis, J. (2005). Changes at the Top: Are you Ready? Behavioral Health Management, 25(6), 23-28. Denzin, N. K., & Lincoln, Y. V. (Eds.). (2000). Handbook of Qualitative Research (Second). Thousand Oaks, California: Sage Publications, Inc. Dillion, Jr., PhD., J. A. (1998). Syst ems Theory. Spalding University. Dolan, T. C. (1996). Developing Human Resources. Healthcare Executive, 11(6), 5. Dreher, G., & Ash, R. (1990). A Compara tive Study of Mentoring Among Men and Women in Managerial, Professi onal, and Technical Positions. Journal of Applied Psychology, 75 , 525-535. Drucker, P. F. (1998). Ma nagements New Paradigms. Forbes Magazine,162(7), 152-163. Eyerman, R., & Turner, B. S. (1998). Outline of a Theory of Generations. Euperopean of Journal of Social Theory, 1 , 91-106. Fagenson, E. (1989). The Mentor Advantage: Perceived Career/Job Experiences of Protégés versus Non-Protégés. Journal of Organizational Behavior, 10 , 309-320. Fitzpatrick, B. (1997). Make the Business Case for Diversity. HR Magazine, 42(5), 118- 122. Fletcher, C., Baldry, C., & Cunningham-She ll, N. (1998). 360 Degree Feedback: An Empirical Study and Cautionary Tale. International Journal of Selection and Assessment, 19(34), 19-34. Fracari, K. (2006). Mentoring for Career Guidance. Supervision Burlington, 67(6), 13-16. 118 Fried, N. E. (1997). 360 Degree Feedback Ve ndor Comparison [Online Information]. Message posted to http://nefried.com/360/360goldshootout.html Government Account Office -GAO in “Major Management challenges and Program Risks,” GAO-01-241, January 2001 Garman, A. N., Tyler, J. L., Darnall, J. S., & Lerner, W. (Sept/Oct 2004). Development and Validation of a 360-Degree Feedb ack Instrument for Healthcare Administrators. Journal of Healthcare Management, 49 (5), 307-322. Goddard, R. W. (1989). Workforce 2000. Personnel Journal, 65-71. Goudy, K. (2002). Passing the Torch. Journal of Property Management, 67(5), 24-26. Guillory, W. A. (2004). The Roadmap to Di versity, Inclusion, and High Performance. Healthcare Executive, 19 (4), 24-30. Harris, R. L. (1996). Developing Leaders in an Era of Change. Executive Speeches, 10(5), 8-10. Hazucha, J. E., Hezlett, S. A., & Schneider , R. J. (1993). The Impact of 360 -Degree Feedback on Management Skills Development. Human Resources Management, 32(2), 325-351. Healthcare Industry. (n.d.). Retrieved March 12, 2007, from http://www.bitpipe.com/tlis t/Health-Care-Industry.html Hill, G. (2004). Mentoring by Minorities for Minorities: The Organizational Communications Support Program. Review of Business, 21, 53-58. Hocker, C. (2003). The Next Generation. Black Enterprise, 20-21. Hutcheson, J. (2003). Esteemed Leaders. Executive Excellence, 20(1), 15-16. Hutton, D. H. (2003). Succession Planning: Dress Rehearsal for the Understudies. Trustee, 56(10), 14-22. 119 Huy, Q. (2001). In Praise of Middle Manager. Harvard Business Review, 79 (8), 72-79. Hyde, J. C., & Fottler, M. D. (1995). Determinants of Rural Hospital Utilization of Multisided Health Practitioners. Health Services Management Review, 8 (1), 64- 72. Ibarra, H. (1993). Personal Networks of Women and Minorities in Management. Academy of Management Review, 18 , 56-88. Ibrahim, A. B., Soufani, K., Poutziouris, P., & Lam, J. (2004). Qualities of an Effective Successor: The Role of Education and Training. Education and Training, 46(8/9), 474-480. Ivancevich, J. M., & Gilbert, J. A. (2000). Diversity Management: Time for a New Approach. Public Personnel Management, 29 (75), 75-92. Jackson, S., (Ed.). (1992). Diversity in the Workplace; Human Resource Initiatives. New York: Guilford Press. Jacobs, B., & Fraser, L. (1987). CEO Succession: Who will Lead? Healthcare Forum Journal, 25(6), 39-52. Javidan, Bemmels, Devine, & Dastmalchian. (1 995). Superior and Subordinate Gender and the Acceptance of Superiors as Role Models. Human Relations, 48, 127-184. Johnson, D. (2003). Why There is no CEO Shortage in Healthcare. Health Care Strategic Management, 21(3), 2-3. Johnson, G. (2004). Follow the Leader. Fire Chief, 48(8), 136-138. Jorgensen, B. (2005). The Aging Populati on and Knowledge Work: A Context for Action. Foresight: The Journal of Future Stud ies, Strategic Thinking and Policy, 7(1), 61-76. Kanter, R. (1997). Men and Women of the Cooperation. New York: Basic Books. 120 Kennedy, M. (1996). Defining Career Success: Title and Salary are not the only Indicators of Success in Today’s Marketplace. Healthcare Executive, 11(6), 6-11. Kesler, G. C. (2002). Why the Leadership Bench Never Gets Deeper: Ten Insights about Executive Talent Development. Human Resource Planning, 25(1), 32-43. Kibby, L. (1997). Making Mentoring Work – Using the Corporate Tool of 2021. Retrieved December 13, 2004, from http://k inematic.com.au/fta/emwork20/htm Kouzes, J. M., & Posner, B. Z. (2002). The Leadership Challenge. San Francisco: Jossey- Bass. Kovach, R. (2005). Cultivating the Next Generation of Leaders. The British Journal of Administrative Management, 22-24. Kram, K. E. (1985). Mentoring at Work: Developmental Relationships in Organizational Life. Glenview, IL: Scott Foresman. Kram, K., & Isabella, L. (1985). Mentoring Alte rnatives: The Role of Peer Relationships in Career Development. Academy of Management Journal, 28(1), 110-132. Leahy, T. (1996). Building Win-Win Relationships. Controller Magazine. Retrieved from http://businessfinacemag.com/m ag/archieves/article.html Lepsinger, R., & Lucia, A. D. (1997). The Art and Science of 360 Feedback. San Francisco: Jossey-Bass. Lien, M. (2004). Opportunities in Workforce. Occupational Outlook Quarterly, 48(2), 28-37. Lussier, R. N. (2001). Leadership: Theory, Applic ation, Skill Development. Cincinnati, Ohio: South-Western College Publishing. Maccoby, M. (2004). Finding the Right Leader. Research Technology Management, 47(2), 60-61. 121 Martin, C., & Tulgan, B. (2002). Managing the Generation Mix. New York: HRD Press. Martino, J. (1999). Diversity: An Imperative for Business Success. New York: NY: The Conference Board. Mateo, M. A., & Smith, S. P. (Summer 2001) . Workforce Diversity: Challenges and Strategies. Journal of Multicultura l Nursing & Health, 7(2), 8-12. Maxwell, J. (1995). Developing the Leaders Around You. Nashville: Thomas Nelson. Maxwell, J. (1998). The 21 Irrefutable Laws of Leadership. Nashville: Thomas Nelson, Inc. Maxwell, J. (1999). The 21 Indispensable Qualities of a Leader. Nashville: Thomas Nelson. McBride, M., & Bostian, B. (1998). Managing Diversity. St. Petersburg, Florida: Human Resource Institute. McCuiston, V., Ross Woolridge, B., & Pierce, C. (2004). Leading the Diverse Workforce: Profit, Prospects and Progress. Leadership & Organization Development Journal, 25 (1/2), 73-92. McWilliams, A. (2005). Mentoring for Succession: Countering Aging Work Force [Paper presented at 2005 Oakland, California IMA Conference]. Retrieved November 14, 2005, from http://www.mentoring-association.org Messa, C. (1998). Workforce Diversity. Ability Magazine, 98 (4), 38-40. Mobley, G. M., Jaret, C., Marsh, K., & Lynn, Y. Y. (1994). Mentoring, Job Satisfaction, Gender and the Legal Profession. Sex Roles, 31(1), 79-98. Moore, J. D., & Jaspen, B. (1997). Diversity Still Hard to Find in Top Executive Rank. Modern Healthcare, 27(50), 30-34. Morrison, Ann. (1992). The New Leaders: Guidelines on Leadership Diversity in 122 America. San Francisco: Jossey Bass. Murray, M. (1991). Beyond the Myths and Magic of Mentoring. San Francisco: Jossey- Bass. Noe, R. A. (1988). Women and Mentori ng: A Review and Research Agenda. Academy of Management Review, 13 (1), 65-78. Pieper, S. K. (2004). The Mentoring Cycl e: A Six Phase Process for Success. Health Care Executives, 19 , 16-22. Raines, C. (2002). Managing the Generational Mix. 9. Retrieved from www.generations.org: Rebore, R. (2004). Human Resources Administration in Education: A Management Approach. Boston: Pearson. Roach, G. R. (1979). Much ado about Mentors. Harvard Business Review, 57(1), 14-28. Rollins, G. (2003). Succession Planning: Laying the Foundation for Smooth Transitions and Effective Leaders. Healthcare Executive, 18 (6), 14-21. Rothwell, W. J. (2005). Effective Succession Planning (3 rd). New York: Amacon. Rothwell, W. J. (2001). Effective Succession Planning (2nd). New York: Amacon. Rothwell, W. J. (2002). Putting Success Into Your Succession Planning. The Journal of Business Strategy, 23 (3), 32-37. Rothwell, W. J., & Poduch, S. (2004). In troducing Technical (Not Managerial) Succession Planning. Public Personnel Management, 33 (4), 405-419. Rothwell, W. J., Jackson, R. D., Kn ight, S., & Lindholm, J. E. (2005). Career Planning and Succession Management: Developing Your Organizations Talent – for Today and Tomorrow. Westport, Connecticut: Praegar. 123 Rothwell, W. J., Prescott, R. K., & Taylor, M. (1998). Strategic Human Resource Leader: How to Help Your Organization Manage the 6 Trends Affecting the Workforce. Palo Alto, California: Davies-Black Publishing. Scandura, T. A. (1992). Mentorship and Car eer Mobility: An Empirical Investigation. Journal of Organizational Behavior, 13 , 169-174. Schiller, T. (2005). After the Baby Boom: Popul ation Trends and the Labor Force of the Future. Business Review, 30-43. Soonhee, K. (2003). Linking Employee Assessments to Succession Planning. Public Personnel Management, 32 , 533 – 543. The Taylor Clark Partnershi p LTD. (2005). Helping Organiza tions Lead: Mentoring. In. Retrieved November 14, 2005, from http://www.taylorclark. co.uk/successionplanning.htm Thorndyke, L., & Grigsby, K. R. (2005). Academic Physicians & Scientist, 1-2. Top Issues Confronting Hospitals: 2005. (9/13/2005). In. Retrieved January 4, 2007, from American College of Healthcare Executives: http://www.ache.org/PUBS/Research/ceoissues.cfm Tropiano, Jr., M. (2004). Effective Succession Planning. Defense AT&L. Tucker, E., Kao, T., & Verma, N. (2005). Ne xt-Generation Talent Management: Insights on how Workforce Trends are Changing the Face of Talent Management. Business Credit, 107 (7), 20-27. Turban, D. B., & Dougherty, T. W. (1994). Role of Protégé Personality in Receipt of Mentoring and Career Success. Academy of Management Journal, 37 , 688-702. US Census Bureau. (2001). Retrieved from www.census.gov/dmd/www/products.html Walker, A. G., & Smither, J. W. (1999). A Five-Year Study of Upward Feedback: What Managers do with Their Results Matters? Personnel Psychology, 52(2), 393-423. 124 Walker, T. (2005). Succession Success. Managed Healthcare Executive, 28-32. Washington, D., Erickson, J. I., & Ditomassi, M. (Jul-Sept 2004). Mentoring the Minority Nurse Leader of Tomorrow. Nursing Administration Quarterly, 29 (2), 165-169. Wellins, R., & Byham, W. (2001). The Leadership Gap. Training, 38(3), 98-106. Wharton, Jr., C. R. (Feb 15, 2005). Personal Reflections On Leadership . Vital Speeches of the Day, 71 (9), 270-278. Wheeler, M. (2001). The Diversity Executive: Tasks, Competencies, and Strategies for Effective Leadership. New York: NY: The Conference Board. Whitely, W., & Dougherty, T. W. (1991). Relationship of Career Mentoring and Socioeconomic Origin to Managers’ and Professionals’ Early Career Progress. Academy of Manage ment Journal, 34, 331-351. Wilkins, E. (2004). Healthcare Employee Commitment Rises Among Strong Leaders. Healthcare Executive, 14 (6). Wolfe, L. (2002). Leadership Secrets from the Bible. New York: MJF Books. Yancey, G. B. (Nov/Dec 2001). Succession Planning Creates Quality Leadership. Credit Union Executive Journal, 41 (6), 24-27. Zemke, R., Raines, C., & Filipczak, B. (2000). Generations at Work: Managing the Clash of Veterans, Boomers, Xers, and Nexters in Your Workplace. New York: AMACOM. Zey, Michael. (1988). A Mentor for All. Personnel Journal, 67, 46-51. APPENDICES Appendix A. Research Ethics Approval Letter 125 126 Appendix B. Spalding University Research Ethics Proposal 1. Title of the Study Succession Planning in Healthcare Organizations: Meeting the Leadership Needs in a Changing American Workforce 2. Faculty Research Advisor Dr. Marie M. Sanders, Associate Professor Spaulding University 3. Investigator Contact Information Freda Bailey Shipman 770 Stoneleigh Drive Frankfort, Kentucky 502-848-9882 home; 859-281-3916 work; 859-221-4677 cellular [email protected] 4. Estimated starting date and duration of the study October 20, 2006 – November 30, 2006 5. Purpose of the study The purpose of this research is to investigate the correlation between succession planning management of healthcare organizations in Kentucky and its impact on leadership development in healthcare as it relates to the changing workforce demographics as reported in the Bureau of Labor Statistics. 6. Name of the sponsor [if any] There are no sponsors or agencies sponsoring this research. 7. A brief description of the study a. Survey instrument b. Demogra phics/subject recruitment c. Subject participation requirements a. Survey Instrument – An interview questionnaire developed by Dr. William Rothwell, author of Effective Succession Planning (2001), will be adapted to reflect Kentucky Healthcare Organization’s needs. Some questions have been deleted to reflect the literature review and current trends in the healthcar e industry. There are 10 questions. Completing the survey can be expected to take about 30-45 minutes. Each question is open ended. b. Demographics/subject recruitment – There are 95 medical/surgical healthcare facilities in Kentucky and 40 facilities with a capacity of 150 or more beds as identified in the Kentucky Hospitals 2006 Guide. This research will sample only those medical/surgical facilities with 150 or more beds (N=4) to get a representation of 127 succession planning management in healthcare. c. Subject participation requirements – Four (4) healthcare facilities will be randomly selected to participate. Each subject will be mailed a questionnaire. A follow-up phone call to schedule a face to face interview will be scheduled. Data from the oral and written questionnaire will be aggregated to compare with recommended best practices for succession planning. A letter of thanks to each survey participant with an invitation to review the results of the study and recommendations for implementation. 8. Risks to the study participants (Minimal Risk) Survey Respondent – The investigator will take every precaution to minimize the physical and/or psychological risk resulting from answering the questionnaire. Each healthcare facility selected will be named A, B, C, and D in the order the questionnai re is returned to the researcher. Only the researcher will know the letter that corresponds with each healthcare facility. 9. Benefits to the participants and others Th is research is expected to yield important knowledge regarding the correlation between succession planning management of healthcare facilities in Kentucky and the impact on leadership development in healthcare. Participants will have access to their results and recommendations from the research to create or improve their efforts in succession planning. 10. Protection of Subjects’ Rights All info rmation gathered in this research will remain confidential. Specific individual survey data will not be disclosed to anyone and only the investigator will have access to the research materials. 11. Informed Consent Agreement The survey respondents need to sign a written consent form for the data they are sharing with the researcher as the information will be used to determine 128 whether their healthcare organization are currently using succession planning tools and to what degree for leadership development. The recommendations will be based on that information and each individual healthcare organization. The questionnaire on succession planning should provide valuable information about the needs a healthcare organization should meet. 13. Purpose of Survey Instrument The purpose of this qualitative study is to analyze the characteristics of succession plans and develop ways healthcare systems can utilize best practices to create mentoring succession planning as a most effective means to address predicted employee shortages to develop an organizational approach that addresses the workforce, needs and challenges of the 21 st century. 14. Signatures __________________________________ Freda Bailey Shipman, Investigator/Date _________________________________ Dr. Marie M. Sanders, Dissertation Chair/Date Dr. Veda P. McClain, Dean, College of Education/Date 129 Appendix C. Letter to Survey Participants Freda Bailey Shipman 770 Stoneleigh Drive Frankfort, Kentucky 40601 502-848-9882 home; 859-221-4677 cellular [email protected] November 21, 2006 Dear Survey Participant, I am currently a doctoral candidate at Spalding University’s School of Education in Louisville, Kentucky pursuing doctoral degree in Leadership Education. I am conducting research on Succession Planning in Healthcare Organizations that involves general medicine and surgical healthcare facilities around the state of Kentucky. The purpose of the study is to analyze the charac teristics of succession planning and develop ways healthcare systems can utilize best practices to create mentoring succession planning as a most effective means to addre ss predicted employee shortages as leadership transitions occur among an aging population and workforce. Your participation in this study will assist me in examining current succession planning practices that prepare leaders for healthcare leadership. I wr ite today to request your assistance. To participate in this study, I will ne ed to receive a copy of your institutions succession plan. You may be assured that no re ference will be given to the name of your healthcare facility in the reporting of this research. I will be happy to pick up the materials if necessary. In addition, I would like to meet w ith you for no more than hour at your convenience. Your efforts will help me in compiling the needed data for my research design. Please use the enclos ed self-addressed stamped envelope to confirm an appointment, or you may contact me at (859) 221-4677 cellular or (502)848-9882 home. Your time, participation and support are gr eatly appreciated and necessary to this research project. The information you provide can assist me in identifying themes, patterns, and trends in today’s healthcare workforce. 130 You may request information regarding results, implications and recommendations from this study. Thanking you in advance for your assistance. I look forward to hearing from you. Sincerely, Freda Bailey Shipman Enclosure: Succession Planning Management Interview Guide Informed Consent 131 Appendix D. Informed Consent Informed Consent – Survey Respondent (Succession Planning) 1. Title of the Research Study: Succession Planning in Healthcare Organizations: Meeting the Leadership Needs in a Changing American Workforce. 2. Purpose of the Research Study: The purpose of this research is to investigate the correlation between succession planning management of healthcare facilities in Kentucky and the impact on lead ership development in healthcare. 3. Estimated Duration of the Research Study: October 20– November 30, 2006 4. Research procedures: An interview questionnai re guide adapted from Dr. William Rothwell author of Effective Succession Planning (2001). Completing the survey can be expected to take 30-45 minutes. 5. Description of Potential Risks: (Minimal Risk) The investigator will take every precaution to minimize the physical and/or psychological risks resulting from answering the questionnaire. Data from indi vidual healthcare facilities will not be released. 6. Description of Potential benefits: This research is expected to yield important knowledge regarding the correlation between succession planning management of healthcare facilities in Kentucky and th e impact on leadership development in healthcare. Participants will have access to their results and recommendations to create or improve their e fforts in succession planning. 7. Alternate Research Procedures: No alternate research procedures have been established. 8. Confidentiality: All information gathered in this research will remain confidential. Specific indivi dual survey data will not be disclosed to anyone and only the investigator will have access to the research materials. 9. Contact Information: Freda Bailey Shipman 502-848-9882 or 770 Stoneleigh Drive 859-221-4677 Frankfort, Kentucky 40601 [email protected] 10. Voluntary Participation: Your participation is voluntary, refusal to participate will involve no penalty or loss of bene fits to which you would otherwise be entitled, and you may discontinue participa tion at any time without penalty or loss of benefits. 132 I have received a complete explanation of the study and I agree to participate. ______________________________________________ 133 Appendix E. Interview Guide Questionnaire Succession Planning Management Interview Guide Questionnaire Survey Instructions: Please answer all of the questions. I will call you to schedule a face to face interview where we will discuss the ques tions below. Interviews will be recorded and later transcribed to examine written and verbal responses for additional information and clarification purposes. 1. What goals and objectives have been established for succession planning and management in your organization? 2. How does your organization define key positions? What positions, if any, are given special attention in your succession planning program? Why are they given that attention? 3. How does your organization assess current job performance for succession planning and management purposes? (Do you use the organization’s existing performance appraisal system – or something else? 4. How does your organization identify successors for key positions? 5. How does your organization identify high-potential employees (who are capable of advancing two or more levels beyond their current placement)? 6. How does your organization establis h Individual Development Plans (IDP’s) to accelerate the devel opment of high-potential employees? 7. Does your organization use replaceme nt charts based on the current organization chart? (If not, why?) 134 8. What special programs, if any, ha s your organization established to accelerate the development of high-potentials? 9. How does your organization evaluate succession planning and management activities? 10. What special challenges has your organization encountered with succession planning and management? In the area of diversity? How have those been solved? Appendix F. Doctoral Dissertation Proposal Acceptance Form 135 136 BIOGRAPHY Freda Bailey Shipman earned her Bachel or of Arts Degree in Sociology with a concentration in Social Work from North Carolina Central University in 1983 and her Masters of Social Work Degree with a concen tration in Health from the University of North Carolina School of Social Work at Chapel Hill in 1985. She has served as a Clinical Social Worker at the VA Medical Center in Mountain Home, TN and Durham, NC and currently is employed as a Program Director for one of the VA’s special emphasis programs (Visual Impairment Serv ices) at the Lexington VA Medical Center culminating in 21 years of service in healthcare. A So cial Worker by training, her professional career has been committed and dedicated to helping others, providing clinical services and program administration to veterans who are disabled. Committed to Social Work Education and the life long learni ng of others, she has served as an agency field instructor to twelve undergraduate and graduate Social Work Students at various Schools of Social Work in Tennessee, North Carolina and Kentucky. During her tenure with the Veterans Affairs Medical Center, she has been recognized for exceptional performance and received numerous awards for her humanitarian outreach to the veteran population and their families. She is a 2005 graduate of the VA’s Vetera ns Integrated Services Network (VISN) Leadership Institute and a past participant of the Allied Health Clinical Mentorship Training Program (2000). Mrs. Shipman entere d the Spalding Doctoral Program in the fall of 2004 and this dissertation is the culmination of her work and reflects her lifelong career and joy of helping others. A public se rvant, she is a member at large of the 137 Lexington Lions Club, serves as a board member to Kentucky Office for the Blind State Rehabilitation Council (Governor Appoint ed), Special Olympics of Kentucky, Independence Place Board Member, Frankfort- Lexington Chapter of the Links, Inc. and Alpha Kappa Alpha Sorority, Inc. A native of Raleigh, North Carolina, she has been married for 18 years and has two sons, 12 and 7.
Research Paper: What is the role of a manager in succession planning in a healthcare organization? To achieve a successful assignment, you are expected to meet the following requirements. Scholarly Ex
JONAVolume 39, Number 12, pp 548-555Copyright B2009 Wolters Kluwer Health | Lippincott Williams & Wilkins THE JOURNAL OF NURSING ADMINISTRATION Healthcare Succession Planning An Integrative Review Brian K. Carriere, MN, RN Melanie Muise, BA, MA Greta Cummings, PhD, RN Chris Newburn-Cook, PhD, RN Succession planning is a business strategy that has recently gained attention in the healthcare litera- ture, primarily because of nursing shortage con- cerns and the demand for retaining knowledgeable personnel to meet organizational needs. Little re- search has been conducted in healthcare settings that clearly defines best practices for succession planning frameworks. To effectively carry out such organizational strategies during these challenging times, an integrative review of succession planning in healthcare was performed to identify consisten- cies in theoretical approaches and strategies for chief nursing officers and healthcare managers to initiate. Selected articles were compared with busi- ness succession planning to determine whether health- care strategies were similar to best practices already established in business contexts. The results of this integrative review will aid leaders and managers to use succession planning as a tool in their recruit- ment,retention,mentoring,andadministrationactiv- ities and also provide insights for future development of healthcare succession planning frameworks. Succession planning is an essential proactive busi- ness strategy to ensure that internal, qualified can- didates are continuously identified and available to take up leadership positions when vacancies occur. 1,2 It is a process that allows retention of intellectual and knowledge capital by identifying and prepar- ing potential successors to assume new roles, thus encouraging individual advancement. 3-5 Succession planning is a topic that has recently moved to the forefront of healthcare planning because of current and forthcoming nursing shortages. 6The number of entry-level nurses is already not keeping pace with those leaving the profession. 7If qualified per- sonnel are not retained and prepared to assume leadership roles, facilities c ould find themselves lack- ing experienced personnel when most needed. 8This situation adds to the importance of succession plan- ning within healthcare organizational practices. Be- fore losing this wealth of knowledge and expertise, healthcare leaders and managers should be practis- ing succession planning now to meet future orga- nizational needs. Within the business community, succession plan- ning historically began with family-owned busi- nesses 3but is now integrated into frameworks with common strategies and practices. 4,5,9-12 In contrast, chief nursing officers (CNOs) and healthcare man- agers have been slower to recognize the need for suc- cession planning in general, and there is little research regarding recommended best practices among suc- cession planning frameworks within the healthcare 548 JONA Vol. 39, No. 12 December 2009 Authors’ Affiliations: Captain (Mr Carriere), Canadian Forces, Edmonton, Alberta; PhD Candidate, Faculty of Physical Educationand Recreation, and Research Assistant (Ms Muise); AssociateProfessor and Principal Investigator, CLEAR (Connecting Leader-ship Education and Research) Outcomes Research Program(Dr Cummings); Associate Pro fessor and Associate Dean (Dr Newburn-Cook), Faculty of Nursing, University of Alberta,Edmonton, Alberta, Canada. Corresponding author: Dr Cummings, Faculty of Nursing, CSB 5-125, University of Alberta, Edmonton, AB, Canada T6G2G3 ( [email protected] ). Funding: Dr Greta Cummings is supported by a New Investigator Award, Canadian Institutes of Health Research,and a Population Health Investigator award, Alberta HeritageFoundation for Medical Research. 9 Copyright @ 200 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. literature. With recent increases in marketplace and financial pressures in healthcare management, concerns for more resources and attention are be- ing devoted to its business operations. 13 This has led to a shift in focus toward a more business- oriented approach to healthcare decision making, placing the need for succession planning at the forefront of healthcare organizational planning by managers and leaders. Nevertheless, nursing short- ages remain a current and complex challenge faced by those who manage healthcare environments. To assist healthcare leaders in dealing with workforce challenges, an integrative review was performed to determine whether findings among available re- search in healthcare literature reveal best practices. The purpose of this article is to present findings from the integrative review of healthcare succession plan- ning to identify similarities and differences among the theoretical frameworks in business and com- bine these into a common strategy for healthcare managers. The authors believe that a precise succession planning framework that includes strategies from best business practices can guide and promote suc- cession planning within healthcare organizations. Three questions guided the integrative review: (1) How are healthcare succession planning frame- works similar or different? (2) Are these frameworks similar to business literature examples? (3) What are the strategies implied by these frameworks for healthcare organization? Articles were reviewed and analyzed based on type of literature (theoretical, research, other), framework congruency and differ- ences, and similarities with business models. The Review Method Before conducting the integrative review, ‘‘succession planning’’ was differentiated from similar and com- monly used terminology. Online database searches of career development ,career planning ,retention , career ladder , and mentoring confirmed that each had different definitions, meanings, and uses when compared with succession planning in both busi- ness and healthcare literature. Succession planning is a structured process involving the identification and preparation of a potential successor to assume a new role within an organization. 3In the liter- ature, there are also similar strategies to succession planning. Succession management is a formalized process of role planning and leadership develop- ment to ensure that the leadership pipeline is filled and the right talent is available when required. 14 Career planning is the process of outlining future career developments, thereafter setting and pursu- ing career goals, 15 focused at the individual level. Career development is focused at an organizational level 16 to meet employee needs through their career stages to reduce turnover, increase professional knowl- edge, and improve service quality. 17 Although ca- reer planning and career development were defined differently in the literature, several authors used them interchangeably. 18,19 Career development has been mistaken for succession planning, despite being identified as only part of the process in both business and healthcare succession planning liter- ature. 3,9,11,12 Career ladders are a way of providing status and economic incentives, often professional development, to workers who stay within an organi- zation. 20 Mentorship is a distinct type of relation- ship where mentors provide professional or personal guidance to a prote ´ge´.21 Identifying ambiguity in these terms is important to distinguish contrasts in healthcare succession planning frameworks. The integrative review, based on restructured methodology recommended by Whittemore and Knafl, 22 began with a preliminary literature search using the following keywords: succession planning and succession management individually, each com- bined with nurse ,nursing ,or healthcare . The results identified that enough pertinent literature was pre- sent in various databases using the term succession planning , a term historically important to business planning. 3Succession management , a synonymic equivalent, was used to capture all seminal articles. Twelve online databases were searched using the keywords succession planning and succession man- agement in separate searches for the time period of 1998-2008. These databases are recorded as an initial search in Table 1. Those meeting the follow- ing inclusion criteria were retained for screening: all articles relating to healthcare succession planning, for either the chief executive officer (CEO) or the CNO position, with a framework, template, or ap- proach to implement best practices as the article’s focus. Articles that specifically focused on research of succession planning were not chosen because of their limited number, and commentaries, editorials, and articles that did not present a complete succes- sion planning framework were excluded. For arti- cles with business succession planning frameworks, Business Source Complete, ABI Inform Global, Academic Search Complete, PsycInfo, and Social Sciences Full Text were searched. To ensure that the most relevant articles were chosen, the primary author reviewed titles and ab- stracts using the inclusion criteria, and the selected articles were then agreed upon through consensus with a second reader to reduce bias. The theoretical JONA Vol. 39, No. 12 December 2009 549 9 Copyright @ 200 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. frameworks and critical elements of the retained articles were described, and specific strategies for effective succession planning were extracted. Arti- cles were analyzed using the questions guiding the integrative review to determine congruence, differ- ence, and comparison with business succession plan- ning frameworks. Results A total of 1,419 titles and abstracts were reviewed, with 122 meeting the inclusion criteria for health- care succession planning. These were retrieved and rescreened, and duplicates were removed, leaving 8 retained from all databases (see Table 2 for the characteristics of the included studies). Eighteen arti- cles specific to business succession planning were selected separately, with 5 used for comparison with healthcare succession planning frameworks. 4,5,9-12 The healthcare succession planning models were comparable with the selected business succession planning models, which all recommended planning, recognizing the importance of clarifying expectations and future needs, and identifying future leaders as imperative steps in succession planning. Further- more, all selected business articles stressed having a candidacy development plan and an evaluation pro- cess to ensure that the succession planning frame- work performed as expected. Theoretical Frameworks and Strategies Of the 8 healthcare articles that discussed succes- sion planning frameworks, 4 articles 7,23-25 predom- inantly described the critical elements of effective succession planning strategies. Describing addi- tional features of a succession planning framework, Collins and Collins 8reviewed the succession plan- ning process as a systematic preparation of the next generation, whereas Rollins 26 examined the success of implementing a succession planning conceptual framework through a case study. Two remaining articles 1,27 illustrated how to follow a succession planning process. From all articles, 8 common strat- egies were identified, using a qualitative content analysis, and are discussed in relationship to their application to succession planning in healthcare organizations (Table 3). These succession planning strategies are strategic planning, identifying desired skills and needs, identifying key positions, detect- ing possible succession candidates, mentoring and coaching, further developmental processes, resource allocation, and evaluation. Table 1. Search Strategy Database 1998-2008 Search Terms Returned Selected Included CINAHL Succession Planning 106 7 1 Succession Management 6 1 0 Medline Succession Planning 620 26 6 Succession Management 321 1 0 Health Source Nursing Succession Planning 48 7 1Academic Edition Succession Management 1 1 0HealthSTAR Succession Planning 593 12 6 Succession Management 431 0 0 EMBASE Succession Planning 2,292 8 4 Succession Management 523 0 0 ERIC Succession Planning 510 0 0 Succession Management 71 0 0 Global Health Succession Planning 546 1 0 Succession Management 79 0 0 Business Source Complete Succession Planning 2,294 8 1 Succession Management 122 0 0 ABI Inform Global Succession Planning 4,285 2 0 Succession Management 99 0 0 Academic Search Complete Succession Planning 601 7 1 Succession Management 24 0 0 PsycINFO Succession Planning 1,441 1 0 Succession Management 216 0 0 Social Sciences Full Text Succession Planning 546 0 0 Succession Management 967 0 0 Total manuscripts after removal of duplicates 9Final included manuscripts 8 Abbreviations: CINAHL, Cumulative Index to Nursing and Allied Health Literature; EMBASE, Excerpta Medica Database; ERIC, EducationResources information Center.The ‘‘Selected’’ column numbers are associated with advanced searches, where articles were limited to those with full text and abstracts. 550 JONA Vol. 39, No. 12 December 2009 9 Copyright @ 200 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Strategic Planning An integral part of succession planning is strategic planning, which was identified by several authors as a key and primary component within healthcare organizations. 1,8,24,27 For instance, Bonczek and Woodward 1suggested defining the strategic imper- atives as the first action for succession planning, along with identifying skills required to meet the organization’s objectives, and before identifying tal- ent from within. Collins and Collins 8also proposed accurately evaluating short- and long-term organiza- tional goals to ensure that they are consistent with existing candidates. While Husting and Alderman 24 recommended that strategic planning be part of suc- cession planning, Noyes et al 27 indicated the im- portance of obtaining clarity on the organization’s purpose and vision through strategic planning be- fore understanding the necessary skills and people talent to develop. Although the strategic planning components differed slightly across articles, the main focus was ensuring that organizational goals were realized by current leaders as part of succession planning for future leadership. Strategic planning also distinguishes succession planning from career planning. 1,8 Desired Skills and Needs The goal of succession planning is to identify cur- rent talent in the organization for future leadership, and to do so, desired skills and needs for succession candidates are identified as a key process by several writers. 1,8,24,25 Husting and Alderman 24 contend that administrators must asses current and future work details for future competency requirements, and Collins and Collins 8suggest that examining gaps between existing skills and core competencies of the position to be filled should be completed at organizational levels. Redman 25 identified both of these strategies, supporting the notion that neither concept should be excluded, given their apparent importance in ensuring that succession candidates are successful. The need for desired skills and suc- cession candidates is clear. Thus, the next strategy Table 2. Characteristics of Included Manuscripts Author (Year) Journal Country Design Purpose/Objective Setting Blouin andMcDonagh(2006) NursingManagement UnitedStates Theory Discusses how healthcare lags behind other corporateorganizations in creating asuccession plan and providespractical approaches forsuccession planning, identifyingkey elements Hospitals andhealth systems Bolton andRoy (2006) Journal ofNursingAdministration UnitedStates Theoreticalinstruction Describes the critical elements ofa succession plan and suggestsways to implement them Healthcareorganizations Bonczek andWoodward(2004) Journal ofNursingAdministration UnitedStates Theoreticalinstruction Describes steps for successionplanning, stating its importance Healthcareorganizations Collins andCollins(2007) The Health CareManager UnitedStates Theoreticalanalysis Provides a framework for improvingthe systematic preparation of thenext generation of managersby analyzing the successionplanning process Healthcareorganizations Husting andAlderman(2001) NursingManagement UnitedStates Theoreticalinstruction Describes required steps forsuccession planning and howto phase it in Healthcare facilities Noyes et al(2002) Seminars forNurseManagers UnitedStates Theory Identifies how critical succession planning can be to anorganization and discussessuccession planning steps Hospitals Redman(2006) Journal ofNursingAdministration UnitedStates Theoreticalinstruction Identifies the essential needs thatindividuals face when developinga cadre of available leadersthrough succession planning Healthcare industry Rollins (2003) HealthcareExecutive UnitedStates Qualitativeanalysis andtheoreticalinstruction Identifies the benefits of successionplanning and describes thenecessary steps using a specificorganization as an example Multi-institutionalhealthcaresystem JONA Vol. 39, No. 12 December 2009 551 9 Copyright @ 200 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Table 3. Common Succession Planning Framework Strategies in the Healthcare Literature Author (Year) Strategic Planning Identificationof Desired Needs and Skills Identification ofKey Positions Detection ofCandidates Mentoring andCoaching Other Developmental Processes ResourceAllocation Evaluation Blouin andMcDonagh(2006) Demand forecastingand gap analysisfor key positions Early and frequentdetection Formal and informal Exposure to developmentcompetencyopportunities For leadershipdevelopment When desirablesuccessors leavethe organization Bolton andRoy (2006) Identify key andnew positions Identify potentialcandidates Mentoring Commit time and financialresources Bonczek andWoodward(2004) Define strategicimperative oforganization Current nurseleaders identifyleadership skillsand talents toreplace themselves Determine whopossessesnecessaryskills; possibleacceleration pool Mentor and coachaspiring leaders Develop aneducation andgrowth plan Collins andCollins(2007) Evaluate short- andlong-termgoals; matchorganizationalgoals withcandidacy pool Examine gapsbetween existingskills and corecompetencies ofproposed position Identify key areasand their corecompetencies Analyze skills/resources ofavailablecandidates Identifydevelopmentprocess ofproposedsuccessor Time, energy,and employees Extensive evaluationprogram offormalization,control andinformationsystems, politicaland technicalcriteria, staff roleand business impact Husting andAlderman(2001) Conduct strategicplanning Identify current jobrequirement andfuture positions Assess current jobrequirements,future positions,and futurecompetencyrequirements Identifyhigh-potentialcandidates Mentoring andcoaching Assess learning anddevelopmentneeds ofparticipants Part of theevaluation process Extensive evaluationof program:organization,objectives, andparticipants Noyes et al(2002) Determine purposeand vision oforganization;conduct strategicplanning Identify and assesshigh-potentialcandidates Mentorshipprogram Formalizeddevelopmentalplan involvingmultiple skill sets Redman(2006) Identify desirable skillsand qualities forsuccessors; analyzegaps comparingtalent pool Assess specificpositions(competencies,desired qualities,future needs) Assess individualsin terms ofleadershipcapabilities/potential Mentoring andcoaching Use a transparent,flexible processto develophigh-potentialemployees Assessment, periodicevaluation, andimprovement asneeded Rollins (2003) General characteristicsand requirementsof future leaders Identify the talents,skills, andcharacteristicsand assess theleadership skillsof those involved Plan describes skillsand experiencesneeded, along withtimeline to achievethese; assignmanagers newresponsibilitiesoutside areaof expertise 552 JONA Vol. 39, No. 12 December 2009 9 Copyright @ 200 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. deals with identifying key positions that require suc- cession planning. 7,8,23-25 Blouin and McDonagh 23 used this strategy to conduct demand forecasting and gap analysis by CEOs and other senior leaders; however, identification and needs of future leaders were not explicitly stated, only that identification of where, when, and what type of leader was es- sential. Distinctively, Bonczek and Woodward 1 proposed that current nurse leaders should look for future leaders by identifying talent and skills in their staff to meet future organization needs. Gen- erally, the authors 7,23-25 concurred in proposing the identification of key organizational positions as a crucial component of succession planning. Finding and Mentoring Succession Candidates Two strategies cited in 6 of the 8 frameworks were detection of possible succession candidates and mentoring/coaching of succession candidates. Detec- tion of successor candidates should be early and frequent, 23 using an acceleration pool to identify po- tential successors. 1An acceleration pool is a group from which a candidate could be selected to provide a resource when a talent gap occurs. Although Collins and Collins 8did not identify mentoring/ coaching as a strategy, the overwhelming emphasis on mentoring/coaching within healthcare makes this a necessary ingredient for a successful succes- sion planning framework. Other Development Processes Although not identified as a common strategy, many offered other development processes. Collins and Collins 8suggested that a development process needs to be identified, and Blouin and McDonagh 23 rec- ommended exposure to development competency opportunities to broaden one’s career. Bonczek and Woodward 1indicated that, generally, an educa- tional growth plan should provide opportunities for successful candidates. Husting and Alderman 24 similarly recognized that the learning and develop- ment needs of succession candidates should be assessed and implemented to closely match organi- zational growth requirements. Redman 25 was more precise in identifying alternative developmental pro- cesses to coaching/mentoring, suggesting that they be transparent, geared toward linchpin positions at all levels, flexible, and regularly measured, thus pro- posing that design and implementation of leader- ship development programs have both generic and individualized components. Noyes et al 27 approved a packaged approach to development, suggesting personal effectiveness management, financial man- agement, conflict management, human resources skills, case management, and preceptor develop- ment skills. In contrast, Rollins 26 recommended that devel- opment processes describe and include skills and experiences needed for candidates to obtain rounded- out executive competencies, carried out in a time frame dependent on succession planning require- ments. Rollins 26 suggested assigning managers to areas outside their expertise to fill gaps between desired and actual skills. The remaining recom- mendations for developmental processes were all valuable, useful for any succession planning frame- work depending on organizational and candidate needs and goals. Resource Allocation Although the importance of resource allocation is implied, only 3 articles 7,8,23 discussed it as a required strategy. While Blouin and McDonagh 23 focused resource allocation toward leadership development, Bolton and Roy 7and Collins and Collins 8both identified allocating time and energy as imperative resources for successful succession planning. Bolton and Roy 7recognized finances as key to successful succession planning. Husting and Alderman 24 ad- dressed resources only through the evaluation pro- cess by ensuring that appropriate resources were available. The other succession planning frame- works did not mention resource allocation, perhaps in oversight. This oversight, or implying of resource requirements, was also present in the business lit- erature, 4,5,9,10,12 with only Ibarra 11 implicitly stating its need. Evaluation Last, evaluation was a common strategy for succes- sion planning. Redman 25 identified that evaluation of succession planning frameworks was important for improvements to both the plan and the process. Blouin and McDonagh 23 did not identify evalua- tion as an imperative strategy but recommended that it be performed when desirable successors leave the organization. Husting and Alderman 24 identified evaluation as an important aspect, recommending that assessment processes be in-depth and programs evaluated in 3 separate ways: first, through the organization’s key positions, within 3 months of implementation and after 1 year of successor per- formance, to ensure that the program contributes to organizational goals; second, by determining whether program objectives are met, course evalu- ations are positive, and all stakeholders remain sat- isfied; third, by recognizing individual participants JONA Vol. 39, No. 12 December 2009 553 9 Copyright @ 200 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. who exhibit behaviors and values outside of the training environment. Proper regular evaluation to ensure a framework’s performance is optimal and meets the organization’s expectations is both nec- essary and feasible. Collins and Collins 8 suggested multiple ap- proaches to evaluate the succession planning process. These included evaluating policies and procedures used in the succession planning process (formal- ization), ensuring delivery of equal and appropriate use of power and attention (control systems), eval- uating how selection decisions are based (technical criteria), criteria for selection (political criteria), degree of involvement of all applicable personnel (staff role), and how data are statistically or finan- cially measured (business impact). These processes included return on investment, patient satisfaction, and evaluation of resource allocation. Only this framework identified transition issues of predeces- sor to successor, possible feelings of rejection by those not selected, and means to address them. Differentiating Frameworks Beyond these 8 strategies, the separation of succes- sion planning into 2 distinct processes differentiated the succession planning frameworks. Collins and Collins 8treated the first 5 strategies of succession planning as one process and the evaluation phase of succession planning as another. Alternatively, Noyes et al 27 separated the development of organi- zational strategies from the creation and implemen- tation of personalized plans. Redman 25 replicated this approach using Noyes et al 27 as a template for his recommended framework. Nevertheless, from the common strategies in all frameworks, a best-practices model would include the need for strategic planning before considering a succession planning process or developing a suc- cession planning framework. The desired skills of candidates need to be identified, ensuring that or- ganizational needs are met. Key positions that re- quire succession planning need to be recognized and possible succession candidates identified. Then, a development plan should be implemented to ensure that potential succession candidates acquire all skills required for the position. This includes pro- cesses that focus on both individual and generalized components; however, from the literature, it is imperative that mentoring/coaching be included. The appropriate allocation of resources is also neces- sary to ensure that the succession plan has appro- priate funding, time, and energy. Once the succession plan is implemented, evaluation is essential to ensure that the framework is on track and includes all aspects of the process. Summary In examining the current literature, we found exam- ples of approaches to succession planning in health- care contexts; however, to date, no best-practices framework for implementation has emerged. To mitigate knowledge loss, current CNOs and health- care leaders need to integrate succession planning with organizational needs by developing and pro- moting its best resources into future leadership posi- tions. Although there is a body of literature on succession planning in healthcare organizations, the lack of a best-practices succession planning frame- work may be due to inconsistently defined concepts, leading to potential confusion and lack of concept clarity. This is not conducive to best practices and may lead to inconsistent implementation of succes- sion planning. Findings from the integrative literature review suggest the need for best practices in succession planning, and 8 such strategies were identified for healthcare managers. Implementation of these strat- egies will assist CNOs to identify internal successor candidates. This will provide employees with a leadership goal to strive for and may also reduce poaching of established leaders from other orga- nizations. Furthermore, fostering mentoring/coaching relationships initiates camaraderie as staff members and leaders develop relationships, recognizing sim- ilarities in skills and aptitudes, as opposed to differences. The establishment of team building, although not specifically identified within the current literature as an outcome of the mentoring/coaching strategy, is a logical progression considering that personal interactions will occur. Encouraging both predeces- sors and successors to participate in the evaluation process will ensure that the succession plan ad- dresses stakeholder needs. More research needs to be directed toward establishing a best-practices succession planning framework for healthcare that is informed by business succession planning. This will not only provide consistency in succession plan- ning in healthcare but also establish frameworks conducive to optimal employee satisfaction, organi- zational efficiency, and better patient care. These positive responses could resonate outside the health- care facility and attract long-term employees who are looking for an enduring employer-employee relationship that will hone their skills. Implement- ing a successful succession planning framework will ensure that healthcare organizations survive leader- ship changes as effectively as possible, supporting organizational goals and the opportunity for em- ployees to develop to their potential. 554 JONA Vol. 39, No. 12 December 2009 9 Copyright @ 200 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. References 1. Bonczek ME, Woodward EK. Who’ll replace you when you’re gone? Nurs Manag . 2006;37(8):31-34. 2. Schmalzried H, Fallon F Jr. Succession planning for local health department top executives: reducing risk to commun-ities. J Community Health . 2007;32(3):169-180. 3. Garman AN, Glawe J. Succession planning. Consult Psychol J Pract Res . 2004;56(2):119-128. 4. Rothwell WJ. Succession planning for future success. Strateg HR Rev . 2002;1(3):30-33. 5. Rothwell WJ. Putting success into your succession planning. J Bus Strategy . 2002;23(3):32-37. 6. Goudreau KA, Hardy J. Succession planning and individual development. J Nurs Adm . 2006;36(6):313-318. 7. Bolton J, Roy W. Succession planning: securing the future. J Nurs Adm . 2004;34(12):589-593. 8. Collins SK, Collins KS. Changing workforce demographics necessitates succession planning in health care. Health Care Manag . 2007;26(4):318-325. 9. Aquila AJ. Key best practices for succession planning. Accounting Today . 2007;21(11):23. 10. Burns-Martin T. How to: here are 10 tips on developing a succession planning program. T&D . 2002;November:15. 11. Ibarra P. Succession planning: an idea whose time has come. Public Manag . 2005;87(January):18-24. 12. Miles SA, Dysart TL. Roadmap for successful succession planning. Directors & Boards . 2008;First Quarter:57-59. 13. Abrams MN. Succeeding at succession planning. Health Forum J . 2002;45(1):27-29. 14. Vestal K. Succession management: a key to future leadership. Nurse Lead . 2004;April:10-11. 15. Zikiz J, Klehe U. Job loss as a blessing in disguise: the role of career exploration and career planning in predictingreemployment quality. J Vocat Behav . 2006;69:391-409. 16. Gunz HP, Jalland RM, Evans MG. New strategy, wrong managers? What you need to know about career streams. Acad Manag Exec . 1998;12(2):21-37. 17. Chang P, Chou Y, Cheng F. Designing career development programs through understanding of nurses’ career needs.J Nurses Staff Dev . 2006;22(5):246-253. 18. McGillis-Hall L, Waddell J, Donner G, Wheeler MM. Outcomes of a career planning and development programfor registered nurses. Nurs Econ . 2004;22(5):231-238. 19. Umiker M. Staff career development programs: the role of supervisors. Health Care Superv . 1998;17(1):12-16. 20. Shapiro MM. A career ladder based on Benner’s model: an analysis of expected outcomes. J Nurs Adm . 1998;28(3): 13-19. 21. Murphy P. Mentors offer footsteps to follow. Men Nurs . 2006;August:50-55. 22. Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs . 2005;52(5):546-553. 23. Blouin AS, McDonagh KJ. Leading tomorrow’s healthcare organizations: strategies and tactics for effective successionplanning. J Nurs Adm . 2006;36(6):325-330. 24. Husting PM, Alderman M. Replacement ready? Succession planning tops health care administrators’ priorities. Nurs Manag . 2001;September:45-50. 25. Redman RW. Leadership succession planning: an evidence- based approach for managing the future. J Nurs Adm . 2006; 36(6):292-297. 26. Rollins G. Succession planning: laying the foundation for smooth transitions and effective succession planning. Healthc Exec . 2003;18(6):14-21. 27. Noyes BJ, McNally K, Tourville S, Robinson P. Preparing tomorrow’s leaders through succession planning from the pro-vider perspective. Semin Nurse Manag . 2002;10(4):240-243. JONA Vol. 39, No. 12 December 2009 555 9 Copyright @ 200 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.