The 7 Step Program: A Health Care Leader’s Little Guide to Recruiting

In addition to my day job advising healthcare leaders, I have a shadow life recruiting senior physician leaders (in addition to blogging here). So you can imagine the delight when my favorite source of blog content (the Harvard Business Review) published The Definitive Guide to Recruiting in Good Times and Bad with tips and principles for filling senior-level positions – aimed squarely at the global corporate market. Reading the original will be very useful for you. And by applying standard Health Care Leadership Blog wizardry, this well-written piece can be transformed into a sensible set of (albeit scaled down) insights for healthcare leaders to consider when on the prowl for talent.

The authors of this article, Claudio Fernandez-Araoz (a retained international executive recruiter) and Boris Groysberg and Nitin Nohria (both faculties at Harvard Business School) have clearly done their homework by surveying both CEOs of global companies and executive search consultants about hiring practices and strategy. They found plenty of deficiencies which led them to identify “7 Steps” to enhance effective leadership recruiting. For each of the steps, they further outlined “poor practices,” “best practices,” and “implementation challenges” in a table worth cutting out and posting. I’ll consider the steps to as “7 Principles for Health Care Leadership Recruiting” and comment on my experience with them in health care:

Principle 1 – Anticipate Requirements: The author’s counsel that recruitment should be anticipatory and strategic rather than simply opportunistic or reactive. When was the last time you sat down with colleagues to examine leadership requirements going forward in the absence of a current or clearly anticipated vacancy? Leadership succession is a well-known challenge for many of my clients but I rarely see proactive plans and resources deployed to truly develop junior professionals in the absence of a known need. Inadequate internal pipelines inevitably lead to recruitment emergencies and, in many cases, a less than optimal set of choices to fill critical vacancies that occur unexpectedly. A strategic leadership development, mentoring, and skill development approach is highly recommended.

Principle 2 – Define the Job: When I have my recruiting hat on, the first thing I look for is whether the position for a healthcare leader is well defined structurally and in terms of expectations. And usually, I find that senior physician leadership positions (other than academic Department Chairs) are poorly designed (if they were designed at all) and need a structural remake before we can speak seriously with candidates. I frequently find arcane reporting structures that relate more to history and internal politics that what it takes to get the job done. And, by the way, the job to be done is frequently vague, and success immeasurable. All of which translates into substantial limitations in precisely defining the skill set and background required for success. To make matters worse, the best candidates – those who understand the job and what it will take even if the employer does not – will flee these “opportunities.”

Principle 3 – Look in all the (un)Usual Places: There’s a tendency among healthcare organizations to go to the “usual suspects” in an effort to rapidly fill a vacancy. This compounds the problems identified in Principles 1 and 2 above. The authors of this HBR article usefully define three categories of candidates: “insiders,” “outsiders,” and “outside-insiders.” The first two are obvious – the choice between internal and external candidates is often controversial and make the work of search committees dicey. One wise piece of advice from the authors is to use “word of mouth” leads in addition to advertising and posting. I’ve found many candidates this way who just didn’t surface as a result of general announcements.

The third category is intriguing and often undervalued in health care. This consists of competitors, external collaborators, users, vendors, customers, or consultants, who have a relationship to the organization without being inside it. These individuals know your organization well, blemishes and all, from unique perspectives and warrant inclusion in the candidate pool – as well as careful scrutiny. So consider physicians in competing practices, scientists from competing investigator groups, faculty from the competitor across town, etc., even though these might be risky conversations.

The authors found, in their research, that organizations are not particularly good at developing sufficiently large candidate pools (25% of the time senior executives selected were the only candidate interviewed for their positions) or at identifying and promoting internal talent. I’ve found the same tendencies in healthcare where “candidates of convenience” often rise quickly to the top without thorough comparative scrutiny. You just don’t know what you are missing if you look at too small a pool.

Principle 4 – Evaluate the Candidates: This is all about the process of interviewing and rating candidates. Again, particularly for clinical leadership positions, this tends to be haphazard at best. It necessarily follows that decisions will be less than cogent. The HBR authors define “the right stuff” for candidate evaluation in four dimensions: the right interviewers, the right number of interviewers, the right techniques, and the right organizational support.

You can (and should) read the details but it’s all about the following: using interviewers who deeply understand the work to be done (not just those who will be colleagues); getting the number of screening interviewers (those who really determine the small number of candidates who will be left standing for final decision) right so that the proper candidates are screened in and out by experts rather than judged by devolution to the lowest common denominator; using techniques (such as “behavioral event interviewing”) that yield depth in understanding how a potential leader handles real problems and opportunities; and leveraging the most senior organizational resources to buy in, sign off, or raise red flags to ensure the final choice will work.

It’s also critically important to properly balance “skill assets” with “people assets” to be sure you are getting a candidate with not only the skills to do the job but the interpersonal qualities that will enable him or her to thrive in your organizational culture.

Principle 5 – Make a Deal: How many times has a key position been offered or filled only for the candidate (or for you as the leader-employer) to find out that there was inadequate organizational commitment to make it possible.- either in the employment terms, job scope, or inadequate buy-in from co-workers or more senior executives, or an unrealistic understanding of the job? The closing means getting it all right and realistic to maximize the potential that the relationship will be durable.

Principle 6 – Onboard Effectively: In my own experience, the failure to “onboard” is an egregious mistake – often made unwittingly – that deprives organizations and new leaders of the maximum trajectory to success. For most leadership placements, it is unrealistic to expect success without transitional support as newly placed executives adjust to the role and organization. Leaders who are ‘stepping up” into new positions will benefit greatly from coaching and mentoring from seasoned senior leaders who can serve as guides as the new leader “steps in.” Lateral movers benefit from these resources as well – the focus being more on matching established leadership style to new settings and assessing/adapting to the organizational culture. In provider or academic settings, the elevation of clinicians and clinical leaders to executive or academic leaders is especially tricky – as we have noted in prior blog postings, (Is Mentoring Optional for Health Care Leaders?) the skills that got them there are not likely to be the ones that make them successful.

Principle 7 – Measure and Evaluate Results: You value what you measure, and all that. Measurement in this context comes in two flavors – of recruiting competency and of the leader’s job performance. Well in recruitment it’s no different. Without regular reviews, relevant and realistic metrics upon which to base efficacy assessments, new leaders are forced to navigate uncharted waters and the organization doesn’t know when to throw more resources in or when to fold. Similarly, without good measures of success, the recruitment process itself can’t be evaluated and the organization that failed to produce a great hire is at risk of doing it the same way all over again. Healthcare organizations such as those I work with are coming late – but progressively – towards objectively measuring personal, clinical, and organizational performance. The new leaders you hire can help you get there.