One of the outgrowths of transformational change in health care has been a significantly expanded workload for CEOs. Everything important seems to flow through the chief executive, who is expected to steer the ship while scanning the horizon for threats and opportunities. He or she is responsible for quality, culture, structure, finance (with the chief financial officer), vision and strategy, community relations, and more, and must be able to draw upon a broad and diverse set of skills

In addition, the CEO has many constituents to serve, including the board of directors, whose expectations and responsibilities for strategic input and engagement have increased in recent years. Meanwhile, the stakes in health care have risen, the pace of change has quickened, organizations have grown, and new competitors are emerging. Can one person realistically be expected to capably handle so many things?

The answer is no, at least not without help. One solution is a chief of staff. The chief of staff position has long been a fixture in the political arena as well as in the corporate world. It is fairly new but gaining favor in health care.

Making connections

Not to be confused with a medical chief of staff, the organization’s chief of staff serves as the right hand of the CEO.

What a health care chief of staff does depends on the CEO’s needs and what the organization demands of the chief executive. The role's duties can encompass supporting internal operations and day-to-day management, as well as representing and even speaking for the organization in public and with external constituents. The chief of staff should fulfill high-level responsibilities befitting an executive.

At WellStar Health System in Georgia, the chief of staff position was instituted in 2014 to support the transition of then-President/Chief Operating Officer Candice Saunders into the CEO role, and it has continued into Saunders’ tenure as chief executive. At WellStar and other organizations that are experimenting with the position, the chief of staff is often a connector — someone who helps to join the CEO with individuals and ideas across the system and, literally, enables integration and communication among the system's different parts (including hospitals, urgent care centers, specialty facilities, medical group practices and insurance entities, to name a few).

Potential key responsibilities of the chief of staff include:

  • Anticipating and addressing the immediate needs of the CEO.
  • Overseeing the staff and budget of the executive office; managing logistical details.
  • Overseeing procedural and decision-making protocols.
  • Preparing and facilitating communication to and from the executive office.
  • Serving as an organizational spokesperson; liaising with key internal and external constituents.
  • Serving as a key liaison with advisers to the CEO from outside the organization.

Of course, there will be “other duties as assigned.” Chief of staff is a new role that will become better defined over time.

Board considerations

A boards that entertains the idea of a chief of staff to support its CEO should do so with realistic expectations. Several considerations should be factored in when planning for the position; here are some starting points:

Shape the position around the CEO. Each CEO in each organization has different needs. The chief of staff role should be defined by the type of assistance that is most needed. What skill areas need shoring up, or what time and resource limitations does the CEO have? 

Consider hiring an insider. The ability of a chief of staff to support the CEO is related to the chief of staff's overall appreciation of the organization and its culture. For this reason, a chief of staff typically will come from within the organization and have strong familiarity and pre-existing relationships with its executives, physicians, staff, constituents and sometimes board members.

Seize an opportunity to support a CEO transition. A chief of staff can significantly aid a CEO who is new or relatively new to the organization. This is the case, for example, with chiefs of staff Debra Plousha Moore at Carolinas HealthCare System and Nancy Ban at Central Maine Healthcare.

Consider candidates from different backgrounds. Ideally, a chief of staff would be a person with expertise in human resources and/or corporate communications. But because the role is still developing in health care, no typical or standard prerequisites exist.

Don’t necessarily view the role as a stepping stone. In the corporate world, a chief of staff is often a developmental or transitional position. Though this can be the case in health care, it is not imperative that the chief of staff be groomed to eventually assume, for example, the role of COO or president.

Don’t expect the chief of staff to directly serve the board. The chief of staff does not always have to engage directly with trustees. That responsibility is better left to designated governance support staff, such as (at WellStar) a director of board activities who then collaborates with the chief of staff.

One question for organizations and boards to consider is whether the chief of staff will be inextricably linked to a given CEO. If the CEO departs, for example, must the chief of staff follow? A situation-by-situation assessment will probably best serve most organizations.

A good chief of staff and the CEO should be closely connected. Effective chiefs of staff, though, also are likely to become increasingly valuable resources for their organization in the long term.

Andrew Cox (Andrew.Cox@wellstar.org) is chief of staff at WellStar Health System, headquartered in Marietta, Ga. Andrew Chastain (AndrewC@wittkieffer.com) is managing partner and chair of the health care practice at the executive search firm Witt/Kieffer and is based in Atlanta.