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After COVID-19: Hitting Reset on Criteria for Hospital Leaders’ Performance

By Rulon Stacey, PhD, FACHE, and Wayne F. Cascio, PhD

COVID-19 brought out the best in many healthcare leadership teams. They ramped up telehealth services in record time, erected field hospitals to care for a surge of patients and moved non-clinical staff into remote settings. They became master innovators, partnering with engineers to create personal protective equipment when supplies were scarce and crowdsourcing solutions to detect disease hotspots.

However, in our discussions with dozens of hospital and health system CEOs across the country, we were surprised to find that many CEOs were very open in expressing their frustration with the performance of their senior-leader peers. When rapidly evolving business conditions required a quick shift in priorities, some leaders faltered.

Now, the uncertainties of a post-COVID environment present hospital CEOs with two critical questions: “What do we do with senior leaders who did not rise to the occasion during COVID-19?” and “How can we more effectively evaluate candidates for leadership positions to avoid such scenarios in the future?”

A Time for Reflection—and Action

The need for hospital CEOs to evaluate the performance of their senior leadership team during the pandemic is critical. The stakes are high: A Guidehouse analysis shows 89% of healthcare leaders believe 2020 revenues will not match 2019 performance, and two-thirds believe revenue losses will total more than 15% year over year.

Hospital CEOs do not have the luxury of waiting three to five years to see if a leader’s ability to perform under pressure can improve with coaching and development—not when their viability may depend on having the right executives in the right roles at the right time. CEOs must ensure that senior leaders know: Leading through any crisis effectively—including a crisis as sudden and far-reaching as the coronavirus pandemic—is essential to their roles.

There are three actions hospital CEOs should take after reflecting on the performance of senior leaders during the first months of the pandemic.

Speed up the timeline for senior-leader performance reviews. Leaders must respond with resilience and agility as business conditions change, whether due to the evolving threat of COVID-19, marketplace disruption or forces yet unseen. Consider moving to monthly or quarterly check-ins rather than annual performance reviews, similar to companies such as Adobe, GE, Gap and Facebook. In instances where leaders did not meet expectations during the pandemic, explore why leaders were unable to respond to the crisis of the moment. Then, set goals for changes in behavior.

Determine whether to expand evaluation criteria for senior leaders. The entire healthcare environment has changed—and so has the yardstick for performance measurement. Now, whether a candidate will operate effectively under pressure is an integral component that must be assessed in current senior leaders and actively sought in evaluating new hires and promoting within. In assessing leaders’ performance during the pandemic, consider factors such as:

  • How does the leader perform under pressure?
  • Is the executive emotionally stable in the face of extreme job demands?
  • Does the leader have a deep understanding of how the coronavirus pandemic is affecting team dynamics, cross-functional teamwork, and the effectiveness of the organization?
  • Does the executive know what type of support direct reports need to maintain their well-being?

Establish increased opportunities for performance follow-up and feedback. Set bi-weekly meetings to review progress toward behavior change goals and keep a record of effective and ineffective behaviors. This cadence provides hospital CEOs with one or two quarters to observe how senior leaders are performing and to determine: “Is this leader in the right position?” and, more importantly, “Can I continue to work with this leader?” If CEOs are not seeing the desired level of behavior change, these meetings provide a record to support reassignment or another course of action.

By revamping the way in which senior leaders’ performance is evaluated following the pandemic, hospital CEOs will be better positioned to initiate tough conversations with their team members and bring discipline to their organizations’ recovery efforts.


Rulon Stacey, PhD, FACHE, is director of graduate programs in health administration for the University of Colorado Denver, a partner in the healthcare strategy division of Guidehouse, and a former hospital CEO (rstacey@guidehouse.com).

Wayne F. Cascio, PhD, is a Distinguished Professor at the University of Colorado, and he holds the Robert H. Reynolds Chair in Global Leadership at the University of Colorado Denver (wayne.cascio@ucdenver.edu).

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