Healthcare Leadership During Times Of Change: An Interview with Jeff Souza

Jeff Souza, BSN, Chief Operating Officer at Leaders For Today, speaks about the role of interim executives in today’s healthcare organizations, and in particular, how those entities can gain most value from this resource.

To begin, what exactly is an interim executive?

An interim executive is a management professional who joins an organization to fill a particular role, with the understanding that he or she will be there for a short, predefined period of time. Typically, these executives arrive on very short notice – within a week or two – and as a result, take the pressure off a hospital as it searches for an executive who will take over the position on a permanent basis.

Can you describe the conditions under which a hospital should hire an interim?

Well, there are several. First, there may be a regulatory man¬date that a particular position remain filled at all times. It may come from Medicare/Medicaid, a state-level Department of Health, or even a voluntary accrediting agency like a Joint Commission. Bringing an interim in will satisfy that requirement.

Second, there may be a knowledge deficit within the hospital. It might be preferable to fill a newly opened slot with an insider, in smaller hospitals in particular. However, there are often no other individuals in the organization – at any level – who have the skills necessary for filling in when a specific position becomes available.

And third, there may be internal candidates who, while promising, are not quite ready to step up into the newly opened position. In this case, an interim executive may assume the role temporarily, and mentor the internal candidate until he/she is ready to take on a permanent role.

We had exactly this situation recently with a New England hospital in need of an Emergency Department Director. They had a Nurse Manager as an internal candidate, but she needed more development time. We brought an interim executive in, and in a short amount of time the Nurse Manager was able to step up to the Director position.

Of course in a perfect world, your most-senior, most-critical staff members would give six months notice before they left. This would give you time to find a qualified candidate or develop internal executives for the new role. Unfortunately, that’s not the way it usually works.

What’s the risk of simply “doing without” for a little while, until a permanent person can be found?

The biggest risk is probably maintaining service quality. A hospital operates in “real time” – you can’t inventory services and save them for a rainy day the way you can a product. And in many respects, you can’t control demand either.

For example, your Emergency Room and your OR are functions that must run smoothly and efficiently at all times. If you lose a key executive in one of these areas, you risk creating disgruntled physicians, unhappy staff and dissatisfied patients, all of which can do serious harm to the reputation you’ve built up over time, not to mention your profitability.

When you bring an in interim executive to fill these critical roles you ensure that things continue to run as they should.

So it’s just about plugging the holes?

Actually no, it’s more than that. Interim executives are exceedingly well-qualified for the positions they fill. By definition, they are professionals who have vast experience and are ready to hit the ground running on day one. That means that when they arrive, they do much more than simply plug holes.

As I mentioned earlier, their work may involve mentoring less experienced staff. Or, it may involve working on projects that require a particular experience or expertise. For instance, we recently oversaw an assignment in which one of our interim executives managed the implementation of a new payroll system.

The thing to keep in mind is that in addition to meeting an immediate need of “plugging a hole,” interim executives arrive with a fresh set of eyes and, in some cases, decades of perspective and experience. Many organizations find that bringing an interim on board leads to an improvement in results, not simply a maintenance of the status quo.

You mentioned “a week or two” to bring an interim executive on board. Is it really that fast?

I was working with a hospital in New Hampshire that needed a Manager of Perioperative Services. At the conclusion of our first discussion, the Chief Nursing Officer asked me, “So, does this process take a couple of months?” I said, “No, our goal is to have somebody on site in about two weeks.” She was flabbergasted. I believe we had someone in there 13 days later.

Naturally, it’s going to depend on the particular situation, but part of the reason you look to hire an interim executive is because you have an immediate need. That’s days or weeks, not months.

In general, you can expect qualified resumes in 3-5 days. Our statistics show that one out of every two resumes sent to our clients is chosen for an assignment.

Wouldn’t it be better to just hire someone permanent, full time?

In most cases, absolutely. I think it’s safe to say that in general, if hospitals could fill all their critical openings with leaders who were as good, as experienced and as readily available, there would be no such thing as interim executives. The reality, however, is that in today’s environment, that’s just not the case; the interim industry has come about as a direct result of this reality.

Historically, 14% of our interims do eventually convert to full time with our clients, when the skill set and chemistry is a good fit.

What’s the cost of an interim executive?

The rule of thumb in the industry is that the daily rate for an interim leader is billed out at approximately one percent of the gross annual salary. So if you have a person being reimbursed a hundred thousand dollars a year, that one percent is approximately one thousand dollars a day.

At first glance that may seem expensive. However as I mentioned earlier, the real cost to consider is the cost of not having your hospital fully functional for a considerable period of time. During this time, the risk to your entire operation and its profitability is huge – interim executives ensure that you continue to operate as necessary, until a qualified, permanent candidate can come on board.

Why are interim executives more expensive to hire than permanent employees?

It’s simply supply and demand. If these positions were easy to fill, you wouldn’t need to hire an interim to begin with. The folks who work as interim leaders realize that there is a shortage of their particular expertise and there’s a cost to obtaining that.

Second, you’re paying for people who hit the ground running. I often say to our clients, “Give this person the first half of the first day for some form of orientation to your practices, your systems, and your institution. They’ll be productive by that afternoon.”

You’re obtaining an experienced, credentialed, well-trained individual who can get the job done from day one. In most cases, there literally is no learning curve.

How long should a client expect the interim executive to be in place?

We begin with a seventeen-week engagement, which is four months. In the course of that engagement, our clients constantly keep us abreast of how their recruitment process for a permanent executive is proceeding. If it looks like there’s a need for an extension, we work that out with our client.

Is the interim leader on the hospital’s payroll?

It depends on the interim firm you’re working with. In our firm, interim executives are all on our payroll, not yours.

The advantage of that arrangement is that if the interim doesn’t work out, for whatever reason, you’re not responsible for their benefits, Workers’ Compensation, etc. We simply move that person out and find you another.

Is this a new concept for hospitals?

Not exactly. Hospitals are quite familiar with traveling nurses for staff nurse positions and traveling radiology staff for radiology tech and radiology therapy positions. So in one sense, it’s a common practice. What’s different is that many hospitals are not well versed yet on the concept of deploying interim executives in business-critical positions.

Is an interim leader different than a consultant?

Very different. A consultant will come through your organization, assess your systems and deliver a report telling you how things need to get done. They leave the report on your desk and walk out the door.

The interim executive also assesses your organization’s performance. However, the big difference is that he or she will then develop a plan for improvement, and implement the plan.

So, rather than simply offering advice as a consultant does, the interim actually works the situation through to reach a posi¬tive resolution with you and your staff.

Where do the interim executives come from?

We separate our interims into three classifications: local, quasi-local and national. The best situation from the perspective of the hospital is to find someone in the immediate area – because it’s more cost-effective; not only in terms of their day rate, but in terms of the expense-related costs of bringing them on board. A local person costs you nothing beyond their day rate.

A quasi-local person, on the other hand, is someone who lives within about a three hour drive of the hospital. The typical arrangement is to drive to work Monday morning, work through the week, and drive home Friday night. There’s no need in this case for a rental car or airfare, however, housing and other expenses during the work week come into play.

National interim executives are the most expensive option for obvious reasons. The need to search nationally is mostly a function of supply and demand for a particular type of expertise. For example, at the moment there is an acute short¬age of individuals who can step in as a Director of Women’s Maternal Health or Director of Child Health Services. We almost always search nationally when filling these roles.

The need to go national may also relate to the location of your specific hospital, with more rural locations tending to have fewer interim options nearby.

One last question. What happens if I like the interim executive and I want to hire him or her?

Here as well, it depends on the interim placement firm you work with. At Leaders For Today, we build a buyout directly into our client contracts. So while our business model is not converting our interim placements into permanent placements, we won’t stand in the way of a ‘marriage,’ if you will, either. Sometimes the chemistry is just so perfect that everyone involved decides to make it permanent.


About Jeff Souza

Jeff Souza brings to Leaders For Today a 28-year track record of leadership with successful start-ups. His experience covers both healthcare and life sciences, across roles that include medical, clinical, nursing, laboratory science, human resources/staffing and consulting.

Jeff has a Bachelor of Science in Nursing, as well as training in executive management and quality service. In addition, he is a Panel Member at the Massachusetts General Hospital Institute and Public Relations Chair for the New England Chapter of the Association for Clinical Research Professionals.

About Leaders For Today

Leaders For Today (www.LeadersForToday.com) is a leader in healthcare interim executive management. The Company works with top hospitals and healthcare institutions across the country to find, place, and support healthcare executives and directors on an interim basis. These organizations hire interim executives from Leaders For Today to provide leadership during times of transition, help improve current operations, deliver superior expertise, and mentor junior staff.