The Stew BLOG

Preparing for Leadership Transitions to Sustain Regional Health Transformation Efforts

Ruth Wageman, Senior Scholar & Advisor and Nina Burke, Senior Project Associate | 01/29/2019

Nearly everyone has been a part of a leadership transition—either as a leader themselves or as a team member acclimating to the change. You’ve almost certainly heard a story about a founding leader who was so central to the organizational culture that the team lost its rudder for a while when that leader left. It turns out that leadership transitions are unusually common in health industries. Some estimates say the average tenure of a hospital CEO, for example, is less than 40 months. This is less than the average tenure in the private sector overall (roughly four years) and especially low compared to the public sector overall (roughly seven years).

Leadership transitions are particularly challenging for any regional transformation effort (especially in the early stages, when leadership is not well distributed) because departures of key individuals can mean the loss of a partner organization and its resources, erosion of shared vision, and disruption of shared initiatives. In addition to the obvious loss of the particular individual or, worse, of leadership itself, a leadership transition can lead to loss of momentum for the work; eliminate key relationships; and reduce money, political support, and institutional memory. Often the leader who departed held critical knowledge and skills that are not widely shared by the rest of the group.

On the other hand, when transitions are managed well, they can spark new innovation and creativity. They can create opportunities, including new distributed leadership structures, increased momentum around the work and broad-based ownership of it, new financial assets, new political support, interest from a wider group of stewards, fresh thinking, and more.

The question is: how can regional stewards anticipate and better manage team members’ reactions to these inevitable transitions, gleaning more of their potential benefits and minimizing negative outcomes?

Anticipating leadership transitions

When a leadership change occurs, stewards can minimize the potential for negative outcomes with proven strategies such as developing a distributed leadership structure, a shared vision, and a transition plan. A distributed leadership structure can help ambitious, long-term transformation efforts stay on track and not stall or derail each time a key leader leaves. As we saw in a blog post earlier in this series on stewardship, in this structure, key leadership functions—such as sustaining a vision, leading strategic initiatives, redesigning parts of the system—are distributed across groups and institutions, and each participating organization has many people involved somewhere in the effort. A distributed leadership structure is more resilient and less likely to be affected by the departures of individuals.

Another important strategy for increasing the chances of the transformation effort outlasting the tenures of individuals or institutions is to ensure that all the stewards involved in the effort have a shared vision. The ultimate vision for the effort should be its guiding force, and if many people are involved in creating and working toward the shared vision, then they can sustain and share it with newcomers as the composition of the group shifts over time.

A third strategy is to identify a leadership pipeline—you can think of this as your second string—with rising leaders who are ready to be starting players when you need them. The ARCHI Collaborative in Atlanta, for example, has prepared for successors to take over by taking the time to create job descriptions for stewards that outline key capacities and expectations. ARCHI actively engages its partner organizations in the use of these documents to identify successors to their leadership groups. This approach ensures that ARCHI and its partner organizations are seeking highly collaborative people who are passionate about the vision and want to lead on behalf of the effort, not just their own institutions.

Managing leadership transitions

In addition to strategies for anticipating leadership transitions, there are strategies for managing transitions as they occur. For example, you could create an onboarding process that includes a package of materials to help potential new leaders know exactly what they’re joining, step into their role, and take up the norms and practices of the team they have joined. Good materials describe the history, purpose, strategy, and governance of your effort. When the Upper Connecticut River Valley collaborative recruited new members, such as representatives from local government and healthcare, it created a set of videos and graphics to help get them up to speed. Onboarding processes take many forms, and the best ones include using mentors or buddies that a new member can shadow as they integrate.

Some other useful strategies for dealing with transitions well—including sustaining the learning, connection, and coherence of an effort—include:

  • Conducting an intentional hand-off, in which a departing leader is celebrated and also carefully interviewed to understand the key roles and key knowledge she has held, both formal and informal
  • Maintaining clarity of shared purpose, including celebrating and welcoming stewards in group events and scheduling annual retreats to help teams realign around purposes, norms, and strategies
  • Doing an annual “leadership assessment,” reflecting together on how well leaders are being onboarded and how successful the effort has been at broadening participation and sustaining member commitment

Consider the threats and opportunities that the regional transformation efforts you are involved with face related to leadership transitions. What strategies do you employ for anticipating and managing transitions? What might you add to the mix moving forward? Please share your insights and experiences with these challenges, and how you have worked through them. Comment below, use #ThinkWithUs on social media, or email us at [email protected].