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A popular phrase used to illustrated a wide variety of immutable truths is, “ Too many chiefs, and not enough Indians.”

My father, a superb retail baker in the southern style, often said, especially when his business partner/wife tried to control his schedule, “Too many cooks in the kitchen is a a losing proposition.”

Now, think about the organizational structures in many hospitals in the U.S.:

  • Chief Executive
  • Chief Operating Officer
  • Chief Nursing Officer
  • Chief Medical Officer
  • Chief Financial Officer
  • Chief Human Resource Officer
  • Chief Customer Service Officer/Chief Customer Experience Officer
  • Chief Strategy Officer
  • Chief Information Officer
  • Chief Medical Informatics Officer
  • Chief Compliance Officer
  • Chief Risk Management Officer
  • Chief Quality Officer
  • Chief Talent Officer
  • Chief Innovation Officer

There are others, some surprisingly ludicrous, but you get the picture…

In healthcare, we have a reputation – a reputation for trailing other industries in terms of leadership, performance, cost control systems, innovation and then, overkill when we catch on and catch up.  Let’s take the abundance of “officer” titles.

In the “old days,” these titles actually meant something.  Their use/award in building an organizational structure was limited to certain key executives who were actually corporate officers with wide ranging responsibilities and authority.  However, based on some of the executive “chiefs” I have interviewed over the last two years, I have come to believe that “title overkill” is reaching epidemic proportions. When a COO is reporting to an executive vice president and not all operating divisions or departments report to that position, you obviously title abuse.  

In one small health system I visited this year, 12 of these 15 titles were assigned to executives.  The organization was struggling financially and operationally (quality of care, safety issues, and an escalating turnover rate) because all the Chiefs were spending entirely too much time protecting turf, trying to grab power to enhance their own fiefdom, and building reinforced concrete silos around their their own scope of responsibility territory as if to prove how valuable they were to the enterprise.

I understand that there are career/brand management implications here; executives believe the title will lead them to a better job at a higher rate of pay, but having the title is not the same thing has having the necessary experience. 

I hope they are not paying some of those executives based solely on their chief of this or that title.

What is my title?  President only because state law covering corporations requires it.  In reality I am but a mere Chief Cook and Bottle Washer.

© 2012 John Gregory Self