Prepping for the Future: Succession Planning in Health Care

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Tom Haederle
Succession planning can feel like a luxury even in the best of times. As hospitals continue to face workforce challenges, it's become more important than ever that we invest time and resources into developing and growing the next generation of leaders.

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Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haerderle with AHA communications. In this episode at Lisa Arespachochaga, AHA's vice president of Clinical Affairs and Workforce, sits down with Brian Junker, managing partner of SDS Consulting, and Frank Venuto, Chief Human Capital Officer at Nebraska Medicine, to discuss succession planning. They review challenges, lessons learned, and share advice for developing and supporting a robust and comprehensive succession planning program at your organization.

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Elisa Arespacochaga
Thanks, Tom. I'm Elisa Arespacochaga, vice president of Clinical Affairs and Workforce, and I'm joined today by Brian Junker managing partner of Estes Consulting. And Frank Venuto, Chief Human Capital Officer of Nebraska Medicine. And today we're telling you about succession planning and some of the lessons learned of the work they've been able to do. To get us started, 

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Elisa Arespacochaga
Frank, I’ll start with you. Tell me just a little bit about yourself and your role, and then I'll toss to Brian.

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Frank Venuto
So I'm Frank and I'm the chief human capital officer at Nebraska Medicine. Primarily, my role is all things human resources, D.I. And I oversee the succession planning process in the organization.

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Elisa Arespacochaga
Brian.

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Brian Junker
Brian Junker managing partner of STS. And we're firm based here in Chicago that specializes in talent management, basically leadership team and organizational effectiveness. We do quite a bit of succession planning generally in academic medicine in particular.

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Elisa Arespacochaga
Wonderful. And I've had the opportunity to work with Brian over the last few years, in particular on some of our work with physician leaders and helping them develop and also on a guide that we worked on last year together on succession planning. And he was kind enough to introduce me to Franks so I could hear a little bit more about some of the work at Nebraska Medicine.

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Elisa Arespacochaga
So, Brian, let's start with the first question with you. When you get to see this across industries and across fields and you get to see what happens in health care broadly across the country as well as other industries. What do you see as some of the biggest challenges, particularly for health care organizations as they think about succession planning and and really building that long term trajectory for their leadership?

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Brian Junker
You bet. You know, often is, you know, in thinking about the stuff to think about in terms of like, you know, barriers to jumping into and maintaining a focus on succession planning. And, you know, one thing that is it like to note about just the industry generally is that there's a large need for strong leadership within the industry right now, in particular given just the myriad of just big at times, if not existential challenges facing organizations, you know, and they just really need strong leadership to help basically navigate and work their way through those.

00;03;21;23 - 00;03;52;11
Brian Junker
But in terms of the factors that often get in the way? In truth, because of the challenges that so many health care organizations leaders are facing, a giant one is bandwidth, you know, tax leaders, tax workforce. And you know what? They're really strong commitment to mission and mission is patients first. And and as a result, the focus on leadership and, you know, developing their capabilities and those of their teams like often can come at their distant second, both in terms of time and resource.

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Brian Junker
And I think one of the things to note about academic medicine in particular is that there are some pretty strong traditions in academic medicine that are often driven by physician culture. And what I might say is professional upbringing. And as a result, even though, you know, you've got in academic medicine, the sort of tripartite tripartite mission of, you know, the clinical, you know, patient care research and academic...research and academic traditions often went out and and kind of guide how people think about succession planning, which is I know Frank, and I've had times kind of chuckling about this, but sort of the idea of like, you know, let's do a search.

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Brian Junker
It's a common practice for filling leadership roles. And it's it is an easy go to when a critical role comes open and that needs to be filled.

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Elisa Arespacochaga
Well, and I know we've talked about this as we were developing the guide that that's one of the the challenges in particular is if you do bring someone in from the outside, which may be the right choice, but really accommodating for that, that learning curve and that culture fit that, that can take a lot more effort than maybe originally thought.

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Elisa Arespacochaga
So, Frank, I know you have a robust program and I got to hear a little bit about it when we spoke earlier for succession planning within your organization on the administrative side. And you spent a lot of time and effort there and you're really working now on strengthening that at the clinic on the clinical side and then at the leadership level.

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Elisa Arespacochaga
What are a couple of really key success factors for the work you've done that you're now trying to translate into the work you're doing?

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Frank Venuto
Yeah, One of the things we were able to do early on is really engage the operational and support leaders. So we try to understand what their problems were, what they were faced with. And we looked at developing a talent system and a talent review system. So I think, one, it's really important to engage the leaders and make developing people a part of your management culture and your leadership culture. Two, 

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Frank Venuto
we developed what we called Leadership Essentials, which were really guidelines that we discussed with leaders about what are the essential qualities and capabilities that leaders need now and into the future. So irrespective of your strategic direction, you can create agility within your leadership system and leadership teams to manage the future. And so we created these leadership essentials, which really served as our North Star, as we thought about talent review, talent development and ultimately succession planning, which which all kind of filled together.

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Frank Venuto
So I think that's another important factor that contributed to the success of what we've done. And really about building a system of talent development, not think about this in terms of just training and training programs. So I thought that was important, which naturally led us into the succession planning conversations and then really transitioning up, transitioning the ownership from human resources, launching and leading this system to now we facilitate the process, but the operational leaders really own the development plans.

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Frank Venuto
They own the talent reviews with our assistance and guidance, and then we help them build those development plans with these leaders. And I think that's really critical and that's really a really important if you don't build it and think about it in a systemic from a systemic point of view. And then really moving from now, what we're working on is moving from I own my talent as an individual, say, vice president level to talent is owned by the institution, and we start to think more globally of of where the talent needs to be placed for either development purposes or in fact, we have a strategic initiative that we need somebody with a certain skill set

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Frank Venuto
and we need to move people around a little bit more strategically. The analogy I use is we need to play chess now with where we really making our strategic investments in the people and what locations do they need to be in our organization. So that's what I think those are the things that really have helped us be successful.

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Frank Venuto
And as we look at moving into the clinical side, those are some of the principles we're going to take along with us.

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Elisa Arespacochaga
No, absolutely. I think the chess analogy is a really good one because you need to be thinking not who's going to take this next step, but who's going to be in line to take this chief role in ten years or the third person who's going to take this role? And I think that's a place where we struggle. And I think the pandemic to some extent, is going to have an impact on that.

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Elisa Arespacochaga
I remain very concerned that the number of women who have stepped back or left the workforce as a result of COVID and the pressures that still disproportionately fall on them. Will they be ready for those leadership roles that may be open in ten or 15 years? So not to put that put either of you on the spot on that, but if you have thoughts, I'm sure you're also concerned about those issues.

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Frank Venuto
Absolutely. When we think about the future and this is really, I think also some of the barriers that that Brian mentioned at the beginning is you have to think of succession planning as a long run activity. It's a strategic investment and you have to make decisions on where you're going to put your dollars and develop that. We're making a very concerted effort to begin to identify DEI level individuals that need to be built into our pipelines, which we all can agree needs improvement and start to think about them for ten years from today.

00;09;28;20 - 00;09;51;20
Frank Venuto
And the same with with our with our female leaders know, I'm pretty happy to say right now I would say we are now have a preponderance of female leaders in our institutions and they're all going to get built into talent development, individual development plans and succession plans. And until you really get intentional about those issues, it's going to be difficult for organizations to shift and change.

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Brian Junker
I think that's an excellent point. A giant piece of internal just the overall philosophy of building a a diverse pipeline is that you have to start early to your point. It is pretty much a hire a great search firm and or have a great talent acquisition team to fill more senior roles of today with diverse talent.

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Brian Junker
And if you are if you really want to build that bench long term, it is you've got to invest and develop. Otherwise, you're just going to be scrambling for and competing for the for the talent that's available today. And it will be expensive, frustrating and and perhaps not especially fruitful journey.

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Frank Venuto
Yeah, And I think as we look at the lack of talent, the search, the outside searchers are going to be infinitely more complex and infinitely more competitive as well.

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Frank Venuto
So you might as well start to build and grow from within. And I think that's the bet we're making that overall our leader development and our succession planning will ultimately pay off long term dividends for us.

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Elisa Arespacochaga
Yeah. So to this point, Brian, what are some of the I mean, we just talked about a couple of the common pitfalls that you see leaders make as they start to do this, which is, okay, well, we need people now, so we're going to do a search, we're going to do these things and and maybe then think, okay, we're okay now.

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Elisa Arespacochaga
We aren't going to focus on this as much as we should because there are all of these very large competing priorities. But what are some of the other things you're seeing as there's true pitfalls that catch people when they start to do these succession planning efforts?

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Brian Junker
Well, to the conversation we had earlier about, you know, perhaps organizational barriers are, you know, that we typically see,  you know, to the comment you just made. There's so much competing for the attention and resource of today's leaders that this often gets pushed off in terms of like until it gets to the point of going, oh, my God, we can't push this off anymore

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Brian Junker
we have to take action. So and at that point, there's a it's starting too late and rushing the process in terms of, you know, really doing a quality job of making sure you're identifying the right candidates and actually truly getting alignment of the most senior leaders and decision makers and and, you know, sponsors of this work and, you know, rushing the process itself in terms of the quality on that part. But in particular, the quality time allotted for internal candidates to actually use the insights generated from the from the succession process and develop. The whole idea is that you're making and investment that they really should allow people to truly upskill and they need time to

00;12;31;20 - 00;12;58;22
Brian Junker
be able to do that. There are a host, a litany of of common pitfalls. I know that, you know, Frank could also attest to as well. But one of the things we do see a lot is, you know, trying to build trying to do too much too quickly. And this is complicated. It's well, it doesn't require, you know, significant IQ points to design and execute a robust succession planning process.

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Brian Junker
But it gets complicated quick. In particular when it comes to, you know, all the stakeholders involved and in essence, the elements of like organizational change associated with like bringing something like this in. And so if you try to get work in too many components too quickly, it just gets complicated. And if you don't have the mindset, the skills, the foundation laid it, it may not be successful.

00;13;19;14 - 00;13;40;09
Frank Venuto
Yeah, I would just want to accent that point, Brian, I think it was really important. Part of our success was we started where there was a need and we built out, we built up and down. So we actually started with our management level, which is where we saw A) the greatest opportunity and B) the biggest need. And I and I think that that's really important what Brian just said.

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Elisa Arespacochaga
Well, Frank, to that point, I mean, as you said, you sort of started with your need. You started with the administrative side. And, you know, I know you said you had told me you had worked a lot on team development and how that that can help support this work. How are you starting to pull the work that you've done into that clinical space in terms of developing the team up and down the entire team, not just the leadership level and what's different about now working with your clinical leadership?

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Brian Junker
Yeah, I think one of the things we were very fortunate about is that both our CEO and the dean of the College of Medicine recognize there is a need for physician leadership development as opposed to clinical leadership development. So one, we're very fortunate that we have physician sponsorship and then we have an individual physician who's really taking on the task.

00;14;32;07 - 00;14;56;05
Frank Venuto
And again, we're starting very small. So we're using a similar process where we're really finding and asking what what do physicians need, what's important, where are the gaps? And we operate Nebraska medicine very much in a dyad model. So we're able to take the foundations of what we built on the non-clinical side and now start to begin to apply it to the physician side.

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Frank Venuto
And we're doing that. We're starting with very small steps. In fact, we're we're going to run a pilot program with just simply eight physicians. So that's number one. I think we were able to build confidence and earn trust on the non-clinical side, such that the physician observation and the development of the leaders that they worked in was noticeable and the change was noticeable to them.

00;15;19;21 - 00;15;41;11
Frank Venuto
So I think that was an important that's an important component of this. And then we focus on trying to transition the physician from being the leader of medical care to a leader of people. And those are fundamentally different and we want to acknowledge and honor their leadership of medical care while saying this is different now that you're talking about leading people.

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Frank Venuto
So we're moving that forward and we're in the process of really developing a very clear goal and a vision for what this program can and should look like. So very much the same kinds of things that we're that we did in the beginning. I think the other thing that we're working very hard on is really honest feedback and communication, which I think is really one of the more difficult things about going through succession planning processes, because maybe, just maybe, Frank isn't the right person for the role in which he is wishing to succeed too.

00;16;13;10 - 00;16;45;27
Frank Venuto
And either there may be another different opportunity for me or you have honest conversations and dialog that maybe leadership isn't your thing. Let's go be the best individual contributor you can have. And I think that's another thing that health care has to kind of come to terms with and grips, particularly on the clinical side. We're used to giving patients feedback, but when it comes to individuals in their careers and where they want to go, because in academic medicine you have multiple avenues you can pursue academics, you can pursue research, or you can pursue clinical care or now clinical leadership.

00;16;45;29 - 00;17;05;09
Frank Venuto
So it's really helping also discover for the individual what they want to do and where they want to go. And so we want to we want to work with the willing. I have a lot, too, to be a leader and understand the complexities of what that means, which are similar and different from what it means to take care of a patient.

00;17;05;11 - 00;17;08;24
Frank Venuto
So I think those are those are the places we're starting right now.

00;17;08;26 - 00;17;26;22
Elisa Arespacochaga
Absolutely. I couldn't agree more. I think you really are looking at where the opportunities are to to bring people to the myriad of things they could be doing and then help them see you know, this is what it actually is to lead people. This is not you didn't show up for a meeting. So now you're the department chair.

00;17;26;25 - 00;17;39;10
Elisa Arespacochaga
This is we've moved beyond that. And there really is some some role there. And and when you have someone who is engaged in it, the difference it can make to the ability of the team to move forward is just exponential.

00;17;39;12 - 00;18;09;14
Frank Venuto
I will also say it's inspiring to watch these physicians that really want to move and are very interested in becoming better leaders. So it's not like we have to go out there and and drum up business for somebody to come into leadership. They're there, they're hungry for it. They want to understand this. And again, I think if you look at this from a human capital investment perspective, this is going to pay big dividends, particularly for Nebraska medicine, which we believe is going to be more physician-led in the future.

00;18;09;14 - 00;18;25;17
Frank Venuto
It's physiciasn-led right now, but even more so in the future. So we want to do a good job preparing these physicians to make this transition and become leaders of two, three, $4 billion companies now, which is decidedly different than running a practice.

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Elisa Arespacochaga
All right. Well, Brian, I'm going to start this question with you, but then I am going to ask you as well, Frank, this question I like to ask everyone. But, you know, what advice would you give, Brian? Obviously, you do this literally for a living, but what advice would you give for those starting on a succession planning journey to say: this is how I'm going to make it a priority in my organization?

00;18;47;27 - 00;19;16;16
Brian Junker
How much time do we have left Elisa? So I would say playing off of a couple of comments I made earlier, I would say, you know, it's start early, start early, start early. Start before there's a need so that you can now the process itself can be quite high quality. And then the investments that you're making in your leaders internally, you know, they can really benefit from those and, and develop the skills and capabilities that you need them to have for the roles for which you're developing them.

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Brian Junker
Relatedly, you know, in terms of the advice piece, this is yes, this is about succession planning. This is about, you know, the health of your talent pipeline. But a big piece of this, too, is about, I think, something that can get missed in this is that this is also about helping shepherd in a culture of learning and development.

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Brian Junker
You know, in in health care, it's not just about the provision of medicine. It's also about the management of the complexity of this system. And one of the lovely benefits you get from a succession planning process is you just get those who may not be in an actual, you know, in an actual succession plan, you know, an uptick in terms of their overall like organizational leadership capability and acumen. And kind of appreciating this - I guess I wouldn't call it a twofer, but it's there's a lot more benefit to it than that.

00;20;03;24 - 00;20;31;07
Brian Junker
And relatedly, to, you know, comment made earlier to I think there is an important element of, you know, not trying to boil the ocean. Start small, start where there's a need today, start where you've got, you know, clarity of purpose, strong stakeholder engagement. And you can really make a difference by bringing in a quality succession process in practice around a key role or key roles and then build from there, you know, work in additional complexity.

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Brian Junker
And I think you alluded to this earlier, but one of the biggest pieces is also making sure that this is led by the leadership of the organization, and it's not something that's delegated to the human capital or human resources functions. Human capital, human resources functions have really important roles to play, but they are really important, vital support and expertise to consult with and and advise the senior leadership as they do over the senior leadership is in the equation to really advise them as they truly lead this.

00;21;07;12 - 00;21;45;06
Brian Junker
Because what really makes this impactful is when this is leaders developing leaders for the health and, you know, benefit of the of the organization long term, not when it's a well funded human capital human resources activity that you know that we've all been there seen it executive leaders sort of tolerate and or support. But I will say one of the other fundamental pieces here is if you want to make this important, you ground it in the organizational strategy and you really appeal to the mission minded element of like you, as Frank alluded to earlier, it's like you don't have to do a lot to drum up enthusiasm in health care leaders.

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Brian Junker
They have devoted their lives, you know, to this mission that they believe wholeheartedly in. And so rather than make it a practice or something that, you know, that someone brought in because it's what you're supposed to do, make it about the health and performance of the organization and your ability to serve, you know, your patient population amazingly well, you know, tomorrow and for years to come.

00;22;10;03 - 00;22;24;09
Brian Junker
So in truth, there are a host of other what I might say is more some will say small strategic and some big tactical advice and counsel I could provide, but I'd call those the big ones. But I will say I'd love to hear Frank's take on this one as well.

00;22;24;12 - 00;22;26;26
Frank Venuto
Agree with everything Brian said. Here's what I would say.

00;22;26;26 - 00;22;44;29
Frank Venuto
You have to fund this. This is not a side of the desk activity and you have to be very, very intentional about what you are trying to accomplish and what you want to do. I think you have to understand why as an organization, you're going to do it. And I think as Brian alluded to here, you have to build this into your human capital strategy.

00;22;45;01 - 00;23;06;10
Frank Venuto
I think that is really critical. Much like academic medicine is about preparing the next generation of providers to carry on health care. I think we as leaders have a responsibility of developing the next generation of leaders, and particularly in this time when we know for the next probably 15 years, 20 years, we're going to have a labor shortage issue.

00;23;06;13 - 00;23;30;15
Frank Venuto
And so it's important that we invest in this generation and grow and develop them. As Brian alluded to, start, start small, build the confidence and trust and develop disciples, because I think what happens is and Brian made an important point here at the end, our operations teams and our operations leaders have now owned this process. They have they have actually graduated from it.

00;23;30;21 - 00;23;51;23
Frank Venuto
Some of our vice presidents were in our development programs and we we were able to identify our top leaders. And so now that they're essentially graduates of our development programs and so they bought in now. They understand the importance of this not only to the organization, but what it did to them personally in terms of their own growth and development.

00;23;51;26 - 00;24;07;12
Frank Venuto
And then you got to build it into your management culture and then recognize and realize this is a journey. It's not a destination. It's a long game play that you have to continually make investments in. And it will fundamentally, I think, help reshape and change your organization for the good.

00;24;07;14 - 00;24;30;07
Elisa Arespacochaga
Well, I have to thank you both so much for your advice and insights. As I said, this is work that I think is so important but ends up falling off the urgency list sometimes. And I think just really underscoring the importance and the value that it can bring in, even handling that urgency list is is key to this.

00;24;30;07 - 00;24;34;29
Elisa Arespacochaga
So thank you both so much for joining me and I really appreciate all your thoughts.