Provider organizations are grappling with a surge in executive turnover. With a 66% increase in hospital CEO exits during the first eight months of 2023, as compared to the same period in 2022, this trend is expected to continue well into 2024. AMN Healthcare, a staffing firm, reported that 62% of directors and managers from provider organizations are actively seeking new positions. As a result, organizations are looking to hire interim leaders to help guide them through these transitions.

We spoke with Sue Schade, a principal at StarBridge Advisors, about her extensive knowledge of interim leadership and how organizations should leverage them to support their organizations during executive transitions.

StarBridge Advisors is a health IT advisory firm with three primary services: interim management, consulting/high level advisory services, and leadership coaching. We’re a national firm, founded in late 2016. David Muntz and I are the two principals, and we have over 40 senior-level health IT advisors on the team.

I have 40 years of experience in health IT management and have been at the CIO level since 2000 as part of Mass General Brigham and later at Michigan Medicine. In early 2016, I moved back to New England to be closer to family and to have more flexibility in my career by doing interims, consulting, and leadership coaching. 

There’s still a lot of movement among leaders who have decided to retire, meaning that the need for interim leadership has increased overall. Sometimes organizations fill an interim internally instead of hiring externally, especially if that individual is interested as a permanent candidate and the organization wants to try them out. If organizations are looking for more radical or transformative change during this period, they’re more likely to hire an external candidate. It really depends on the situation, the organization, and the individuals.

Right now, more organizations are requiring their executives to work onsite, especially coming off the pandemic, where there were a lot of remote or hybrid options. That onsite requirement is lengthening searches for permanent positions, which also creates opportunity for more interims.

Interim leaders do everything that the employed or permanent person would do. Oftentimes they need to steer the ship, get things back on track, and make assessments.

The typical duration of an interim is about six months, so they need to be a quick study and hit the ground running. They need to establish a good rapport with people and quickly determine what’s most important to focus on. They also need to make objective assessments of the current state and issues, and they need to be honest and direct about what’s working and what’s not.

The expectations are very high early on. If an organization is paying for an external interim, they’re looking for someone who can deliver tangible results quickly. I think that, for interim leaders, it’s a combination of operations and consulting. As an interim leader coming in, you can give an honest opinion early on, as compared to a permanent employee who may need 6-12 months before they have all the right relationships and have built up the credibility. I think if you’re a quick study, you can see what's going on within a matter of weeks. You can have some honest conversations with the person you're reporting to and the rest of the executive team.

Interim leaders also keep the hiring process moving. The best situation is when the organization lets the interim help with the search to find the permanent person. The interim can help screen resumes, help with interviews, or even sit on the search committee. Once they're on the job, the interim knows better than anybody what’s needed for the position. What's the skill set needed? What are the challenges and issues? They’re in a very good position to help find the right permanent person.

It’s critical that they widely and clearly communicate the role, responsibilities, and authority the interim will have. The organization needs to highlight the interim’s background and experience, as well as why they're right for the organization, which you would do with a permanent hire too. But interims are unique because their responsibilities may be different than the responsibilities of the person who left, and may also be different than the permanent person that’s going to be hired. For example, in one of my interim positions, I focused more from a strategic perspective and was expected to have my “number two” in IT deal with the operational work and issues.

I think this really depends on the circumstances of the previous person's departure. Did they retire? Did they resign? Were they on good terms? Or were they walked out the door?

For some of those later scenarios, it’s important that there’s a very calm, stable message from the executive that the interim reports to. If someone was exited, staff may be very nervous about what happened and how it will affect them. It’s critical that the person that the interim reports to is visible and helping with that communication.

Another thing I would suggest is what I call a briefing book. When I've taken over interim roles, I've always asked my leaders reporting to me to pull together a list of key documents that I can review in advance. I also ask for a profile and background on each of my direct reports. I want to understand their key projects, concerns, and what support they need.

The other thing I would recommend is scheduling a townhall with your staff within the first week or two. Use the initial townhall to introduce yourself, review what's important to you, what you’re going to focus on, and your leadership style. It’s an opportunity for people to ask questions and get to know you.

Learning the organization’s politics and culture is probably the hardest. Every organization has its politics and, as an interim, you don't have to get involved or own them the same way you would if you were the permanent employed person, but you need to understand them.

You also need to know logistics like understanding what meetings you need to attend and get on all the right email distribution lists.

To avoid these pitfalls, leaning on the support and accessibility of the hiring executive, or whoever you're reporting to, is critical. They need to be available to you and very supportive in the early weeks. Something that I've always done is schedule meet and greets with all the key leaders that I'm going to be working with and my direct reports within the first several weeks. Who you know within the organization is priceless.

The interim and who they're reporting to need to agree on what their focus areas are going to be. I don't typically call them goals because, to me, a goal is something that you know you can complete. I call them focus areas because you don't know how long the interim will be there. So, there will be some focus areas that you get as far as you can while you're there, some that you’ll actually complete, and others that you tee up for the permanent person.

I always encourage our clients to do a 1–2-week handoff period. You must have things well documented to hand off to the permanent person, like what I talked about with the briefing book. Additionally, you’ll need time to have a lot of one-on-one discussions, as you can only impart so much in the written form. This allows you to provide more background and insight and answer any questions that the permanent person has. Bottom line, make yourself available to them.

The other thing that I feel very strongly about is that the new person is in charge on day one. We have a handoff period, but they are now the focal point. I, as the interim, go into the background and my role is to make sure that the permanent person is successful. You're there to support them so that they can be successful.

Listen to the interim leader, in terms of what they have to say, their observations, and their opinion on permanent candidates.