Spe­cial re­port: COOS take on more re­spon­si­bil­i­ties, ca­reer risks

COOS have seen their re­spon­si­bil­i­ties shift and ex­pand with changes in health­care and grow­ing de­mands on the chief ex­ec­u­tive

Modern Healthcare - - FRONT PAGE -

Added re­spon­si­bil­i­ties may al­low chief op­er­at­ing of­fi­cers to right­fully as­sume part of the glory when their hos­pi­tal or health net­work flour­ishes. But as the job con­tin­ues to ex­pand and evolve, the role also leaves the COO more vul­ner­a­ble in case of fail­ure. They’re the ones in­creas­ingly be­ing held ac­count­able for over­all out­comes at their or­ga­ni­za­tions.

The level of scrutiny doesn’t sur­prise John Hau­pert, the new CEO at Grady Health Sys­tem in At­lanta. The sys­tem in­cludes 689-bed Grady Me­mo­rial Hos­pi­tal and six neigh­bor­hood health cen­ters. He says COOs re­quire the skills of a diplo­mat cou­pled with fi­nan­cial prow­ess and lead­er­ship skills as they nav­i­gate the needs of doc­tors, ad­min­is­tra­tors and board mem­bers.

“As a se­nior ex­ec­u­tive in a large or­ga­ni­za­tion, part of what you signed on for is be­ing an am­bas­sador, a mes­sen­ger for the or­ga­ni­za­tion,” says Hau­pert, who started this month as CEO. “Be­ing at that level, you take the heat as well as the ac­co­lades, if there are ac­co­lades to be taken.”

Hau­pert knows a bit about sit­ting in the cross hairs. He came from Park­land Health & Hos­pi­tal Sys­tem in Dal­las where, since 2006, he worked as COO. The CMS threat­ened to ter­mi­nate Park­land from the Medi­care pro­gram ear­lier this year, and the 672-bed pub­lic hos­pi­tal reached a $50,000 set­tle­ment with HHS’ in­spec­tor gen­eral’s of­fice for al­legedly vi­o­lat­ing the Emer­gency Med­i­cal Treat­ment and Ac­tive La­bor Act (Sept. 5, p. 16). Hau­pert’s men­tor, Dr. Ron An­der­son, will step down from his role as Park­land’s pres­i­dent and CEO at year-end, a nearly 30-year ten­ure.

There’s a varied set of ex­pec­ta­tions for COOs. Some de­pend on the CEO’s work­load, while other fac­tors in­clude the size of the or­ga­ni­za­tion and the area it serves. “It’s dif­fer­ent at ev­ery hos­pi­tal,” Hau­pert says.

Hau­pert says he knew An­der­son for 15 years be­fore he be­gan with Park­land, as they knew each other pro­fes­sion­ally while Hau­pert worked as ex­ec­u­tive vice pres­i­dent for the four-hos­pi­tal Methodist Health Sys­tem, also in Dal­las.

When An­der­son sought Hau­pert out for Park­land’s COO post, he says he was the only can­di­date. Park­land went through a man­age­ment reshuf­fling, Hau­pert says, with An­der­son need­ing to fill sev­eral va­can­cies in the C-suite.

The es­tab­lished re­la­tion­ship proved crit­i­cal as An­der­son and Hau­pert made sure their roles were well-de­fined, Hau­pert says.

“I read a long time ago about how con­flict­ing the COO can be if there isn’t a clear un­der­stand­ing be­tween the CEO and COO about the role he wants you to play,” says Hau­pert, who was tasked with fo­cus­ing on cer­tain ar­eas of op­er­a­tions, both clin­i­cal and non­clin­i­cal, of­ten act­ing as a bridge be­tween the two. “He wanted an op­er­a­tor.”

To head off any po­ten­tial con­flict in his new role at Grady, Hau­pert says he plans to meet soon with his COO to out­line his ex­pec­ta­tions for the job.

Hau­pert’s days solv­ing fi­nan­cial chal­lenges at Park­land may pre­pare him for sim­i­lar sit­u­a­tions at his new job. Grady re­lies on county fund­ing, which has dipped in re­cent years, lead­ing to staff re­duc­tions. The last time Grady turned a profit was fis­cal 2009. Former CEO Michael Young ar­rived in 2008, and for that fis­cal year, the hos­pi­tal posted a loss of $35.1 mil­lion, ac­cord­ing to its fi­nan­cial re­ports, com­pared with a $33.3 mil­lion deficit in fis­cal 2007. Grady has again bud­geted for a deficit for fis­cal 2011, ac­cord­ing to the sys­tem.

New de­mands on the CEO

The ex­ec­u­tives in­ter­viewed for this ar­ti­cle all agreed that changes in the CEO po­si­tion also dic­tate the COO’s role, and much of that is be­ing buoyed by health­care re­form.

The new em­pha­sis on hold­ing providers ac­count­able for qual­ity and safety is re­quir­ing CEOs to spend more of their time in­ter­act­ing with of­fi­cials out­side the hos­pi­tal set­ting. That might mean deal­ing with leg­isla­tive pres­sures that re­quire them to spend more time on ad­vo­cacy. It’s also han­dling more outreach; re­spon­si­bil­i­ties in­clude at­tend­ing com­mu­nity events, fundrais­ing and forg­ing part­ner­ships.

Con­sol­i­dat­ing re­sources to save money has also in­creased shar­ing of du­ties be­tween the CEO and COO, such as man­ag­ing the in­creased num­ber of doc­tors em­ployed at hos­pi­tals and over­see­ing im­ple­men­ta­tion of pricey in­for­ma­tion sys­tems.

CEOs were al­ready con­sid­ered too busy re­view­ing day-to-day op­er­a­tions, but these added bur­dens of­ten mean the COO has to take a much more vis­i­ble role with staff. At many or­ga­ni­za­tions, the COO is now the C-suite


John Hau­pert, the new CEO at Grady Health Sys­tem in At­lanta, had been COO at Park­land Health & Hos­pi­tal Sys­tem, Dal­las, since 2006.

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