Could Outsiders Represent an Inside Track for Health Care Leaders

The March 16 issue of Business Week features a profile of Ford’s CEO. Alan Mulally: The Outsider at Ford, At a time when there is plenty to say about the auto industry and its executives, the author, David Kiley, instead focuses this piece on the risks and benefits of bringing an outsider into a position of substantial responsibility. In December of 2006, when Mulally was brought from Boeing to lead Ford, the company was already on the ropes. A risky time for a controversial choice. It’s also a familiar dilemma for healthcare leaders when considering a critical recruitment.

The Value of Turning Things Inside Out

Mulally was an outsider to the company and the industry. Kiley, therefore, focuses on the combined technical and cultural barriers to Mulally’s acceptance at Ford and on the unique opportunity to reject ingrained and outmoded thinking, processes, and people that the situation created for Mulally – and for the company. He was hired by none other than Ford’s Chairman, William Clay Ford Jr. “No one understood the travails of running the automaker better than Henry Ford’s great-grandson. The company was bureaucratic and hostile to new ideas. And below the C-suite, it hadn’t yet sunk in that Ford was fighting for its life. The chairman also knew his company had a history of “organ rejection,” or spurning outsiders.” Nothing like this ever happens in health care, right?

Safe Isn’t Always Safe (or Smart)

I’ve been involved in countless strategy sessions with senior healthcare leaders about filling high-level hospital, academic, or medical group vacancies. I can’t think of many that didn’t begin with the presumption that local roots, a narrowly defined specialty range, and “having done something just like this before,” were critical selection factors. Both physician and executive healthcare leaders tend to be remarkably parochial when recruiting – tending to refer to a relatively small universe of institutions and backgrounds they view as “good fits.” But is a good fit the best approach to creating or sustaining a vibrant organization? If new leadership represents an opportunity to get to the next organizational step, or out of a currently failing step, could an uneasy fit (with the status quo) actually be a better bet?

Being from “away” as we term it here in Maine, can be an invaluable tool for appreciating the need for change. The Kiley article points out the numerous areas that Mulally was able to see differently as an outsider. So he made initially unpopular changes at Ford. Rather than cycle executives through the organization, he instituted area leadership continuity to foster long-term accountability. He changed Ford from a culture of measuring end results in an organization that leveraged internally transparent “real-time” process measures to monitor (and correct) performance status. He introduced a long view, environmental and brand-oriented strategy for auto design. The result? Ford is the only American automaker not requiring emergency government rescue today.

Peeking Outside the Box

One need not necessarily go outside the industry or even outside the organization to get out of the box a little. While there are certainly sound technical, academic, and professional reasons for a Chief of Cardiology, for instance, to be a cardiologist it is much less clear that the physician head of a Cardiac and Vascular Service Line needs to be a cardiologist or cardiac surgeon. Why not an internist or family physician or hospitalist who understands cardiology but looks at things from a different perspective? Since a service line is an essentially horizontal entity, why not someone whose clinical expertise is integration of services, processes, and professionals across disciplines rather than depth in one of them.

This holds more true the higher you go in a health care organization. Vice Presidents (Medical Affairs, Clinical Operations, Quality, Physician Practice, etc. ) in clinically related areas could have a wide range of training and background. And any reason a medical school Dean couldn’t be a dentist or a Ph.D. scientist with the skills to develop and nurture an academic environment? Could this approach bring the needed leadership skills with more independence from specialty related politics, culture, and perspective?

Going outside the discipline or the institution or the state isn’t right for all situations. But based on what I’ve seen out there, it is probably worth considering more frequently than it is. Perhaps at least peeking outside of the box should become a learned reflex for health care leaders.