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Do you approach the recruitment of a Chief Executive Officer for a rural community hospital differently than you would for a community medical center in a metropolitan area?

Decidedly yes, and decidedly no.

ask the recruiterNo, I am not straddling the fence.  There are significant differences in how the search should be executed, but when it comes down to identifying and screening the candidates, the process is essentially the same.  Where you vary is in the due diligence site visit, and that divergent approach makes all the difference in the world — frequently between success and failure.  I know.  Early in my career at Affiliated Hospital Systems, a network of rural and community hospitals that was sponsored by Houston’s Hermann Hospital, I learned the hard way when I recommended a CEO who “did not fit” with a small Texas community.  My answer to your question reflects that lesson.

When searching for a CEO for a medical center in a metropolitan area, you focus almost completely on the enterprise, operations, finance, market challenges and opportunities and, most importantly, on the working culture to ensure there is a good fit.

When you recruit in a smaller community, you do all that and much more.  In fact, I tend to spend more time with my due diligence in smaller rural community hospitals.  A colleague once mused that my approach seemed counterintuitive.  You should be able to knock that out in a day.  He could not have been more off the mark.

Not only should you look at internal operations, finance, market conditions and the operating culture, but you must spend a significant amount of time talking to the board, medical staff leadership, community leaders, local business owners, and other stakeholders, drilling down on what it is like to live in the town, local interests, events, values — in other words, the culture of the community.

To miss the latter is as bad as missing important facets of the internal operations.

In a metropolitan area, a mismatch with the community culture typically is not as critical since the CEO can meld into the crowd, so to speak.  In a small town, there is a very bright, very hot, community spotlight that the CEO must walk within.  The CEO may be experienced and very talented but if he or she is out of step with the community culture, it will not be an effective or long-term relationship.

The community culture profile requires a recruiter who is a good listener, someone adept at picking up on, and translating into a clear written description, those core values and equally important nuances of community life.

Before we begin a CEO search in a small community, we do our research, talking to people who are familiar with the community and the hospital.  We build the framework of a comprehensive community profile that will be finalized following the due diligence visit.  We cover everything from the role of faith-based organizations, and service clubs, and the social structure.  We develop profiles on the key community civic and business leaders as well as the hospital board.

This community profile is an important chapter in our comprehensive Position Prospectus that we provide to qualified candidates.  This document outlines the selection criteria, from academic and professional credentials, to types of experience, verifiable relevant accomplishments, the performance deliverables, and challenges or hurdles to success.  Our clients and candidates say that our Prospectus is the most complete they have ever seen.  This level of disclosure — transparency — is critical to successfully matching the right candidate.

A lack of transparency about the hospital, its finances, medical staff engagement, operational challenges and the cultural values of the hospital and the community, can derail the successful recruitment of a CEO.  When clients raise concerns that our disclosure may scare off good candidates, I ask if the information is accurate and if it is, then the next question is, “Isn’t this the least embarrassing time for the candidate to learn the truth?”

Now here is the important part, it only takes one bad or mismatched CEO to send a rural community hospital down a path from which it may not be able to recover.  I have seen it dozens of time over the last 20 years.  In my case, the hospital survived and continues to this day, but I had to spend many hours there as the interim CEO calming the waters and refocusing the hospital team and the community.

Recruiters who view recruiting a CEO for a small community hospital as just another contractual transaction would be better off working other searches.  So would those communities.

The number of failed searches that lead to failed hospitals is staggering.