There are too many chiefs and not enough Indians. I have heard that phrase for as long as I can remember. My dad, the owner of a successful retail bakery, was fond of the phrase, especially when his business partner, my mother, began to micromanage his day.

chiefIn healthcare, doctors, skeptical employees, and union members use it to describe what they feel are bloated executive staffs. Now, to make things more interesting, we have seen an explosion of new “chief” titles. Here are a few that are becoming more popular. They include:

  • Chief Talent Officer
  • Chief Engagement Officer
  • Chief Service Officer
  • Chief Managed Care Officer
  • Chief Care Management Officer
  • Chief Analytics Officer
  • Chief Risk Officer
  • Chief Growth Officer
  • Chief Innovation Officer

You get the picture. It is clear that some of these titles were created to salvage good executives who were interested in more responsibility, money, and prestige, so they got a “chief” title. To be fair, there are many more organizations that have created “chief” titles to demonstrate to the rank and file the importance of specific initiatives such as growth and innovation or to highlight a chronic challenge as in Chief Quality and/or Chief Safety Officer.

As a general rule I am not wild about expanding the C-suite because it represents more, not less, overhead and higher, not lower, costs. However, I realize that as far as some bureaucratic health systems go, I am swimming against the tide. That is precisely why I believe that so many expanding health systems are going to run into a cost, quality and satisfaction problem. Bigger is not necessarily better. There are exceptions to the rule, but they are very rare. The only thing bigger gives you is more clout against the payers, to hold the line against reductions in reimbursement so that we can sustain a business model that we understand and, more or less, works for us now.

Let’s not make the mistake of equating the complexity of our organizations with the need to load up on Chiefs with the mistaken belief that somehow they will enable us to deliver better, safer and lower cost care.

Yes, hospitals are amazingly complex businesses but I remain a devout believer that the hospitals which will excel in a post reform environment will be those which create and sustain a culture that emphasizes what I call personal healthcare, that is to say, focusing on all patients with the same level of care and compassion that we normally reserve for family members and close friends.

We already have a title for the person who is responsible for that: Chief Executive Officer.