To show my lack of attention to executive management phenomena the title of this post could have been written 30 years ago. What provoked me to write now was reading an interview with Dr Toby Cosgrove who is CEO of the Cleveland clinic. The article is very short and thus not very in depth about the specifics of the job.
My reaction was to respond to something that was said in context of this current period of tremendous push for change in how health care is administered. As a concerned citizen and a concerned consumer of health care and insurance, I want to contribute to the discussion of the changes that are occurring.
The problem is that I’m responding indirectly to someone holds the title CEO. Moreover, this is a person whose credentials include a distinguished career as a surgeon. Because of these facts, it is somehow out of place for me to address his statements as if he were just another citizen and consumer who had an opinion.
The words from a CEO of his organization are inherently more valuable than the words from a common citizen. If I have an objection to what he says, I should not speak up until after studying the words deeply to explore their inner meaning in light of his authority and experience. There is a lot between the lines that need to be uncovered before I can reasonably address them. Until I fully appreciate the wisdom of the words, I should show respect with comment that shows gratitude of enlightenment.
In this particular case, I had an observation that started with some words that he said. This is my comment as I posted it:
Mentioned as a contrast to modern team approaches is a direction to an individual that ” if anything comes up that you can’t handle—handle it.” But then the team approach is ” the average cardiac surgical patient, they see 130 people, and any one of them can screw up the deal.” Isn’t this reverting back to the original advice that each is expected to handle it? Do medical teams cross-train to assist each other or do they subdivide the work into every smaller but more manageable parts that when their time comes, they have to handle it alone?
This was met with a response from the sponsor of the interview (I assume) but that response has since been deleted so I can’t copy it here. As I recall the response spoke to me respectfully but I also got the impression that the message was that I should show more respect to the esteemed CEO. Without the actual quoted response, I have no evidence that this was in fact in that message.
For the purposes of this post, I’ll assume it is was purely in my own imagination that I was being criticized for being disrespectful to a CEO. The important point is that I personally do feel a need to show respect and deference to a CEO even of an organization that wholly irrelevant to my life.
A CEO of an irrelevant organization should be a peer. What he said in the interview touched a topic that I think is very important. The topic is of the culture of medical practice that places on expectation of physicians to be a fully independent and self-equipped actor when performing his specialty. The measure of health care performance was measured by the performance of the practitioners. The culture of health care was about developing better performing practitioners.
My observation is that this culture may be at the root of the problem of poor control of health care expenses. Patients are opportunities for health providers to practice their independent skills. Management of health care was focused largely on management of the development of practitioners. The consequence that a patient who needed to return for more treatment benefited this culture because it provided another subject of practice with the added benefit of learning how to deal with complications from the botched earlier practice.
This observation raises a more direct complaint of why are we hiring into CEO positions people who have lived through that culture. That culture encouraged something we are trying to reduce. Specifically, one of the goals of reforming health care is to reduce the number of ineffective treatments and the number of patients requiring return visits either for more effective treatment or to treat the side effects of the original treatment. Perhaps one way to describe the reform of health care to reduce expenses is to reduce the number of opportunities for practitioners to practice. We want most effective treatments with the least chance of needing follow-up care.
The focus needs to be changed from developing practitioners to treating patients.
The comments by the above CEO indicated to me an ingrained culture that persists. Undoubtedly he recognizes the changes occurring. He notes that there is now much more of team approach to health care such as having 130 people participate in what once was done by a single doctor (with some exaggeration).
But I wonder about the definition of these teams. One idea of a team is to divide up a task into smaller units so that each participant can concentrate on his very specific skill set when that skill is needed. In this specific instance, when it is his turn to apply his very narrow skill, he’s alone again in doing that task. He alone is responsible and eligible to apply this specific skill. This interpretation would be consistent with the old culture. Chances of error are being not being reduced but instead the opportunities for error by any particular practitioner is reduced because of the reduced scope of skills requested.
A different idea of a team is that everyone is cross trained to help each other out. There may be designated lead for a particular procedure. But others are there watching and ready to offer assistance, advice, or warnings when they observe something that is mistaken or neglected. The lead would be obligated to accept assistance when it is offered. The goal is to get the best possible outcome for the patient at the expense of opportunities to develop better individual practitioners.
As I read the interview, I wonder whether this CEO really gets this key point. He mentions he serves at the pleasure of the board. This is a great attitude but it also points to the real audience I should be addressing: the board.
In the current health care crisis, is the board best served by a CEO that has a distinguished medical career well trained in the older culture of medical practice? I assume the board reviewed the qualifications of many candidates in light of current challenges and did make the right choice. But I also imagine that they could have chosen a younger CEO who has less applied experience with health care but is well skilled at optimizing teams to meet corporate goals.
I suspect many boards of health care organizations are also dominated by industry insiders who had been trained in the same culture of practitioner development and independence. They may be biasing their decisions to think that the CEO position is a career capstone event for a special subset of medical practitioner who has good business skills. The CEO is one of the possible pinnacles of a career. This is in contrast to viewing a CEO as distinct specialty task that may be best performed mid-career.
CEOs have that “C” in front of the acronym. It is a position instead of a task. It is a position that warrants deference and appreciation for the back story that got him to that point. It has become one of many such top positions as chief officers. These often appear to be presented as a semi god like position. And like the gods of yore, the minimal words spoken must be interpreted carefully to fully appreciate the inherent and inevitable wisdom the contain.
There was a second article that motivated me to write this post. That article was the advocacy of a new denizen of the ever increasing size of the “c-suite”. This was an advocacy of the essential importance of organizations to establish chief data officers (CDOs) to handle all aspects of the challenges of proper handling and governance of data within their organization.
I fully agree that the challenges posed by data are huge and deserve positions within the organizations specifically tasks to manage these challenges properly. I object that this necessarily needs to be a C-something.
Over the years, I have observed with increasing annoyance an explosion of chief positions that organizations must fill. From my biased perspective, the idea of a CEO chief executive officer introduced me to the concept of a corporate chief officer position. I then learned of the necessity of a tier of chiefs to provide checks and balances in the form of CFO (chief financial officer) and COO (chief operating officer). Again I’m not being a student of executive management, but instead I’m just describing my perspective of the introduction of these concepts. The need for checks and balances justified the need for more than one chief-officer. However that same need argues that there should be a small number of these officers.
My annoyance came when gradually (to my untrained eyes) I became aware of lots of other chief officers: information, technology, marketing, etc. I’m very aware organizations are complex with components that need their own hierarchy of management. There must be some top to these hierarchies. We may even use the word chief to name these top positions.
But do we really need to give them the title of officer? Does it really make sense to have so many CxOs (x is some letter)?
As I suggested with the CEO position, there is a danger of presuming the officer position as status position of a capstone of a career. The CEO position may be seen as an achievement rather than a task. Similar tendencies may occur with other chief officers by selecting accomplished individuals in the field they are chiefs in to be the officers of that field.
A CxO is a task or a set of responsibilities about competent operation of a certain branch of a business. A CxO is an official with responsibilities to administer policies appropriate for that x. A CxO is not tasked to practice that x.
Another concern I have with the CDO concept is that it conflicts with the CIO. How is data different from information? I realize that the CIO is much more focused on information technologies, of the actual infrastructure to handle information flow within an organization. But the concept still is focused on information. Aren’t matter of data handling and governance already within the purview of the CIO? If there are two separate positions, then there will be a need for a position above both to mediate their differences: a chief officer of data and information technology. Creating such a position is an admission that the CDO and CIO are not chief officers.
I have another complaint about the justification for a chief officer role for data being that data is central the needs of an organization. This has always been true. Going back to a original chief officer role, the CEO’s primary focus is on data about his organization. At that level data has always defined the organization, and the CEO has always demanded good data for him to make decisions. From my limited perspective, I recall seeing many CEO-signed decisions about how data will be handled within an organization. Data is one of the tasks of the CEO.
The CEO may need help to understand the increasing complexity of data. However, he doesn’t need another c-suite position to be filled with a bias of rewarding someone for lifetime achievement. He needs someone to do a very specific job about staying on top of the various issues surrounding data. He probably needs someone who is quite bit younger.
This turned out to be a rambling post that ultimately didn’t really address the central point about the analogy of the growing c-suite with the Olympian gods. There are many high level positions within an organization that are tasked with broad levels of responsibility whether it is data, information technology, security, etc. These positions need to be filled with accessible individuals who can engage in the daily details of very specific issues with an openness to learn from the people below them. These are highly demanding positions that require a lot of work in staying current and maintaining communications with his area of responsibility. I believe these are best served by mid-career level positions because their assignment demands a lot of energy and willingness to adapt.
Elevating these positions to c-suite positions, making them chief officers, runs the risk of overlooking the best talents for these roles in favor of using the positions as career capstones where the eligibility requirements are biased toward lifetime achievements in being practitioners in that field. This expectation complicates the delivery of value from the positions because it elevates the holders to be beyond criticism of those beneath them, and the holders do not have the requisite motivation and energy to actively keep up with very dynamic changes.
If I were on a board of directors, I would question the need for so many different chief officers. There should only be a couple. I would also question the qualifications in terms of their presently assigned duties instead of their history as practitioners in a field. The job of being an officer is very different from being a practitioner.