implications of health reform for healthcare executive...

Career implications - 1

Implications of Health Reform for

Healthcare Executive Positions: A

National Study of Senior Leadership

Teams in Freestanding Hospitals

Final Report: Oct. 24, 2014

Prepared for the American College of Healthcare Executives by

Andrew N. Garman, PsyD, MS

Professor, health systems management, Rush University

Cassia Carter, MS

Research Assistant, Rush University &

Doctoral student, industrial/organizational psychology, Illinois Institute of Technology


Introduction The evolution of the U.S. healthcare environment is bringing with it unprecedented changes to

the healthcare management profession. This evolution is likely to yield many opportunities for

career-minded healthcare managers, but can also make career planning more confusing. With

new titles featuring phrases such as “experience officer” and “population health” appearing on

the horizon, as well as more titles beginning with “chief,” sorting out which of these represent

robust career paths, and which may be temporary phenomena, can seem daunting.

To help shed light on the changing nature of healthcare executive career paths, the American

College of Healthcare Executives partnered with researchers at Rush University to develop and

implement a national survey to examine the changing nature of senior leadership teams, focusing

on freestanding community hospitals as a starting point. Prior to describing this research, some

historical context and definitions will be helpful.

Healthcare Management: A Profession in Transition

The U.S. Bureau of Labor Statistics (BLS)’s Occupational Outlook Handbook (2014) defines the

medical and health services manager’s role involving the planning, directing and coordinating of

medical and health services. This definition encompasses both executive leadership and

healthcare management at other levels. According to BLS estimates, there were approximately

315,500 people working in healthcare management in the United States in 2012.

Given the considerable volume of merger and acquisition activity in the health sector, it may

seem logical to conclude that the number of healthcare management positions will shrink.

However this conclusion does not take into account the extent to which organizational change

creates new management needs. For example, prior research from other industries suggests in

times of environmental uncertainty and sector-level change, senior leadership teams in particular

tend to expand rather than contract (Haleblian, Jerayr, & Finkelstein, 1993). Indeed, the BLS

estimates the healthcare management profession is likely to grow by about 23% between 2012

and 2022, much faster than the national average for jobs generally.

Healthcare Management in the Context of Health Reform

Regardless of this growth, the level and pace of change in healthcare is unprecedented

(American College of Healthcare Executives, 2014), which may translate into a much larger

proportion of job transitions than has historically been the case. Growth is also unlikely to be

uniform across the healthcare management profession, let alone individual organizations. Some

specialties may grow steadily in the years to come; demand for others may grow rapidly during

the height of the transition from volume to value and then halt or decline afterward. In each case,

the balance of talent supply as well as demand will influence how robust a specific career path

will become.


The present study was pursued to help shed light on some of these transitions within the

healthcare management profession. Using a survey of ACHE-affiliated CEOs from freestanding

hospitals, we sought to address three research questions in particular:

1. What job titles and roles are most frequently found within freestanding hospitals’

senior leadership teams?

2. How are these positions changing over time?

3. How often are “Chief” and “top officer” jobs within these organizations found on

senior leadership teams, vs. reporting to the CEO but not on the senior team, vs. neither?

Methods

Survey design

The survey used in this study was part of a larger project ACHE conducted on behalf of its CEO

Circle membership, to understand the changing nature of senior leadership teams (SLTs) within

freestanding hospitals (Athey & Garman, 2014). Three sections of this survey asked respondents

to systematically describe the members of their SLT, their direct reports who were not SLT

members and anyone else in their organization carrying a title containing “chief.”

Respondents were asked to provide two descriptors for each of the SLT members they identified.

First they were asked to provide a job title and next to identify one or more roles as appropriate

to that person’s responsibilities. The survey was prepopulated with 18 role codes commonly

found among senior executives. Respondents could also write in up to two “Other” codes if they

had SLT members with substantive roles that were not captured by these 18.

Survey Sample and Distribution

Our survey sample was identified by staff of the American College of Healthcare Executives,

who queried their member database to identify all members who were currently listed as CEOs

of freestanding hospitals. A total of 949 individuals with deliverable addresses were identified.

Surveys were distributed to these members via two rounds of post mail during October-

December of 2013. Completed surveys were mailed back to ACHE, who keypunched responses

into an Excel file according to a prespecified coding protocol. Individual responses that did not

readily fit into pre-existing coding categories were discussed among ACHE and Rush staff until

consensus on coding was reached.

Results A total of 479 surveys were completed and returned, representing a response rate of 49%. Of the

CEOs responding, 84% indicated they had a master’s degree in either health administration or


another administrative area, 12% had a nursing background, 2% had an MD or DO degree, 5%

had an “Other” clinical degree and 5% had a doctorate in health administration or another

administrative area (note: respondents could indicate more than one area in their educational

background).

Of the 479 responses, ten were removed from the sample because the respondents’ organizations

had been reclassified as systems since the original sample was drawn. Of the remaining

respondents, 39% worked for (non-federal) government hospitals; 59% for not-for-profit

hospitals, and 2% for investor-owned hospitals. 4% of respondents’ organizations were Council

of Teaching Hospital (COTH) members; 2% were critical access hospitals. In terms of core

based statistical area (CBSA), 10% were located in divisions, 34% were located in metropolitan

areas, 26% were located in micropolitan areas, and 29% were located in rural areas. Respondents

averaged 7.8 years in their current CEO position, with the majority (83%) having a master’s in

health administration.

Job Titles and Roles

Across the 469 respondents analyzed, a total of 2,711 unique individuals were identified as

members of a senior leadership team (SLT), of which 2,689 were assigned job roles by the

respondents. These individuals had 1025 unique job titles. In other words, each SLT contributed

an average of 2.2 unique job titles to the total.

To better identify meaningful patterns across these positions, we needed to reduce title variance

by grouping titles into broader categories. With the assistance of an executive with expertise in

healthcare leadership position design, a coding scheme containing 81 categories was developed

and then used to group all job titles. The full title coding sheet can be found in Appendix A.

Current Composition of Job Titles on Hospital Senior Leadership Teams

To address our first research question, we analyzed all of the titles of individuals that

respondents identified as members of SLTs. The three job title categories most frequently present

on SLTs were CFO/VP Finance (16.8% of all job titles for positions included in SLTs), Chief

Nursing/CNO (12.1%) and Human Resources (HR) (10.0%).

Of the 2711 total SLT jobs, 8% had two or more job titles assigned to them (e.g. “SVP, COO &

CNE”). Table 1 provides the job titles with the highest frequency of occurrence on SLTs;

complete results can be seen in Appendix B.


Table 1. Job title categories comprising at least 1% of the total job titles senior leadership

teams (SLTs) of freestanding hospitals

Job Title Count

% of all Job Titles

on SLTs

CFO/VP Finance 455 16.8%

Chief Nursing/CNO 327 12.1%

Sr HR/ Personnel 271 10.0%

Dual Titles 217 8.0%

COO/Hospital Operations 193 7.1%

Chief Medical Officer 131 4.8%

IT Director/CIO 129 4.8%

Chief Quality Officer/Risk 108 4.0%

VP Patient Care 60 2.2%

Physician Services/ Medical Staff/Medical Services 59 2.2%

Ancillary Director/Support Services 58 2.1%

Medical Group / Physician Networks / Physician Group

/Practice Manager/ PHO / Clinic 52 1.9%

Philanthropy/Foundation Director/ Fund

Development/Endowment 49 1.8%

Chief Admin Officer/CAO/Administrator 45 1.7%

Business Development/Growth 43 1.6%

CEO/President 37 1.4%

Legal/General Counsel 35 1.3%

Clinical Services VP/ Chief Clinical Officer 34 1.3%

Marketing/PR 34 1.3%

Compliance/Integrity 28 1.0%

Medical Affairs 27 1.0%

Strategy/Strategic Planning 26 1.0%

How SLT Jobs Are Changing

Survey respondents were asked to identify changes to their SLTs over the past two years, as well

as the planned additions or subtractions of SLT members during the course of the next two years.

Table 2 reports the largest net changes in job titles associated with SLTs over the past two years;

Table 3 describes the largest changes anticipated to SLTs in the coming two years. (Full results

are provided in Appendix B.)

Responses suggest that, in general, SLTs in freestanding hospitals are expanding rather than

contracting, with respondents reporting they added 1.6 positions for every one they removed in

the past two years, and on average planning to add 2.8 positions for every position being

removed in the coming two years. As illustrated by Table 4, which aggregates the results of the

prior and coming two years, recent and anticipated changes reflect an increasing emphasis on


both information technology and medical leadership in the ongoing strategic decision-making

within these organizations. The coming years look like they will also add an emphasis on

networks, quality, hospital operations, and public health.

Table 2. Job title categories most frequently added or removed over the past two years

Job Title

Number

added

% of All

Titles

Added

Number

removed

% of All

Titles

Removed

Net

Gain/(Loss)

IT Director/CIO 32 12.1% 7 4.3% 25

Chief Medical Officer 24 9.1% 3 1.9% 21

Physician Services/ Medical

Staff/Medical Services 18 6.8% 2 1.2% 16

Chief Quality Officer/Risk 18 6.8% 5 3.1% 13

Medical Group / Physician

Networks / Physician Group

/Practice Manager/ PHO / Clinic 13 4.9% 4 2.5% 9

…

COO/Hospital Operations 19 7.2% 21 13.0%

(2)

CFO/VP Finance 10 3.8% 12 7.5% (2)

Business Development/Growth 6 2.3% 8 5.0% (2)

Community Outreach/ SVP

External Affairs/

Liaison/Networking 1 0.4% 3 1.9% (2)

Facilities/Maintenance/Materials/

Engineering/Plant Operations 0 0.0% 3 1.9% (3)

HIM/Health Info Mgmt/Medical

Records 1 0.4% 6 3.7% (5)

Marketing/PR 7 2.6% 13 8.1% (6)

Sr HR/ Personnel 18 6.8% 25 15.5% (7)


Table 3. Job title categories most frequently planned for addition or removal in the coming

two years

Job Title

Numbe

r being

added

% of

All

Titles

Added

Number

being

remove

d

% of All

Titles

Remove

d

Net

Gain/(Loss

)

Chief Medical Officer 18

12.1

% 1 1.9% 17

IT Director/CIO 17

11.4

% 1 1.9% 16

COO/Hospital Operations 20

13.4

% 6 11.3% 14

Medical Group / Physician Networks / Physician

Group /Practice Manager/ PHO / Clinic 12 8.1% 0 0.0% 12

Physician Services/ Medical Staff/Medical

Services 8 5.4% 2 3.8% 6

Business Development/Growth 7 4.7% 1 1.9% 6

Population Health 4 2.7% 0 0.0% 4

Medical Director 4 2.7% 0 0.0% 4

Chief Experience Officer/Patient Experience

Officer 4 2.7% 0 0.0% 4

CFO/VP Finance 4 2.7% 5 9.4% (1)

Ancillary Director/Support Services 1 0.7% 2 3.8% (1)

Strategy/Strategic Planning 0 0.0% 1 1.9% (1)

Facilities/Maintenance/Materials/Engineering/Pla

nt Operations 0 0.0% 2 3.8% (2)

Home Health 0 0.0% 2 3.8% (2)


Table 4. Net gains/losses of job titles over last two years and in the coming two years

Job Title

Net gains/(losses)

over last two

years

Net gains/(losses )

over next two

years

Net

gains/(losses)

over four years

IT Director/CIO 25 16 41

Chief Medical Officer 21 17 38

Physician Services/ Medical Staff/

Medical Services 16 6 22

Medical Group / Physician Networks /

Physician Group /Practice Manager/ PHO /

Clinic 9 12 21

Chief Quality Officer 15 2 17

COO/Hospital Operations (2) 14 12

Population Health 3 4 7

---

CFO/ VP Finance (2) (1) (3)

Health Info. Mgmt/ Medical Records (5) 1 (4)

Sr HR/ Personnel (7) 2 (5)

Facilities/ Maintenance/ Materials/

Engineering/ Plant Operations (3) (2) (5)

Marketing/ PR (6) 1 (5)


Co-occurrence of Job Roles Within SLT Members

Although senior leadership teams are expanding, so too is the complexity of the environment in

which they are managing. As a result, many senior leaders have more than one top management

role for which they are responsible. In the present study, the average SLT had 10.4 top executive

roles spread across 6.8 positions, or an average of about 1.5 roles per senior leader.

Approximately 70% of senior leaders held a single top executive role; 19% held two roles, and

11% held between three and nine roles. The most frequent combinations of roles can be seen in

Table 5; roles that were most strongly associated with each other are shown in Table 6.

Table 5. Top combinations of executive roles most frequently held by individual executives

on the SLT

Role Combination

Frequency

Percent of all

jobs with

combined roles

Financial + Information Systems 32 1.3%

Medical + Quality 32 1.3%

Nursing + Patient Experience 32 1.3%

Human Resources + Learning 29 1.2%

Community Relations + Public Relations/ Communications 22 0.9%

Nursing + Quality 21 0.8%

Medical + Physician Group 20 0.8%

Community Relations + P.R./Communications +

Philanthropy

19 0.8%

Financial + Compliance 18 0.7%

Operations + Nursing 17 0.7%

Nursing + Quality + Patient Experience 16 0.6%

Quality + Compliance 15 0.6%

Legal + Compliance 14 0.6%

Operations + Physician Group 12 0.5%

Quality + Organizational Performance 12 0.5%

Operations + Human Resources 10 0.4%

Financial + Information Systems + Compliance 10 0.4%

Table 6. Roles most frequently held by the same individual on the SLT

Job Roles Correlations

Community Relations + Public Relations/Communications .69**

Public Relations/Communications + Philanthropy .46**

Financial + Information Systems .46**

Nursing + Patient Experience .45**

Human Resources + Learning .44**

Community Relations + Philanthropy .43**

Strategy + Innovation .38**


Medical + Physician Group .31** N=815 positions, only taking into account SLT members with more than one role assignment. ** p <.01.

Frequency and Positioning of Top Officer Roles

To examine the relative composition of executive jobs as a function of the roles played by these

jobs, we next analyzed how the 18 “top executive” roles were assigned by survey respondents.

Table 7 summarizes the results of this analysis for single-role jobs, including the percentage

breakdown of each role in the SLTs (SLT), the non-SLT direct reports of the CEOs (DR), and

the “chief” job titles that were neither SLT members nor direct reports of the CEOs (Chief).

Table 7. Composition of senior leadership teams (SLTs), non-SLT CEO direct reports

(DR), and others with “Chief” titles (Chief), by top executive role, for positions with single-

role assignments.

Role

Total

Number

of

Executives

with this

Role

% of

All SLT

Roles

% of All

non-SLT

Direct

Report

(DR)

Roles

% of All

Other

(Chief)

Roles

Where

Role most

frequently

Appears:

Financial 340 20.7 1.3 3.9 SLT

Nursing 293 17.7 1.5 5.2 SLT

Human Resources 272 13.1 12.7 3.9 SLT

Operations 179 10.8 1.3 1.3 SLT

Information Systems 206 7.7 10.1 45.5 Chief

Physician Group 160 7.6 6.6 9.1 Chief

Medical 144 7.3 4.7 7.8 Chief

Quality 87 3.6 5.3 5.2 DR

Philanthropy 139 3.4 18.0 0.0 DR

Compliance 97 1.6 13.5 9.1 DR

Strategy 28 1.5 0.8 0.0 SLT

Legal 41 1.3 4.0 1.3 DR

Marketing/PR 60 1.0 8.5 5.2 DR

Community 41 0.7 6.1 1.3 DR

Patient Experience 27 0.7 3.2 1.3 DR

Organizational Performance 15 0.6 1.1 0.0 DR

Innovation 7 0.4 0.2 0.0 SLT

Learning 10 0.3 1.3 0.0 DR

N=2146


Lastly, we examined the extent to which new and emerging “Chief” job titles appeared to

suggest robust new career paths for healthcare managers. Table 8 summarizes the prevalence of

these new titles in the freestanding hospitals participating in this study. As this analysis reflects,

most of these new “Chief” titles are relatively organization-specific.

Table 8. New / emerging “Chief” titles out of all job titles recorded in the SLTs

Emerging "Chief" Titles Number

Chief Quality Officer 22

Chief Clinical Officer 17

Chief Administrative Officer 12

Chief Compliance Officer 11

Chief Strategy Officer 11

Chief Development Officer 7

Chief Ancillary Officer 5

Chief Communications Officer 4

Chief Innovation Officer 4

Chief Legal Officer 4

Chief Patient Care Officer 4

Chief Experience Officer 3

Chief Learning Officer 3

Chief Medical Informatics Officer 3

Chief Counsel 2

Chief Analytics Officer 1

Chief Market Development Officer 1

Chief of Professional Service 1

Chief of Support Services 1

Chief Performance Officer 1

Chief Personnel Officer 1

Chief Philanthropic Officer 1

Chief Physician Services 1

Chief Regulatory Officer 1

Chief Services Officer 1

Chief Technical Officer 1 Note. N = 123. “Chief” titles remaining after exclusion of all CEO, COO, CMO, CNO, CIO, CFO, CHRO, and

Chief of Staff titles.

Discussion

Before forming conclusions from this research, several important limitations are important to

note that may affect generalizability of the results. First is the focus on freestanding short-term,


nonfederal general medical/surgical hospitals. According to the American Hospital Association’s

2011 survey of U.S hospitals—the most recent data available at the time of this research—these

hospitals comprised 32% of the total hospital population in the United States (American Hospital

Association, 2013). Additionally, the 469 ACHE-affiliated CEOs responding to this research

survey oversaw approximately 23% of the total number of freestanding short-term, nonfederal,

medical/surgical hospitals, and their organizational and leadership structures could differ from

those run by non-ACHE affiliates.

While not a limitation per se, an additional challenge to the research related to the very large

number of unique job titles across the positions represented. Clearly, there is currently very little

standardization of job titles across the healthcare management profession. Some of this

heterogeneity may reflect the reality that many SLT members are tasked with more than one top-

level role, and titles could in part reflect these varied role combinations. Title variations may also

reflect positions being designed around the talents specific individuals bring to them. However,

the downsides of this heterogeneity may be considerable. For working and aspiring healthcare

managers, the lack of title standardization can make it very difficult to make sense of potential

career paths. For our colleagues in other disciplines, the level of heterogeneity represented here

poses a formidable barrier to maintaining a coherent professional identity.

These limitations notwithstanding, the present results point to some important trends in the areas

of expertise senior leadership teams are seeking to expand. The overall picture appears to reflect

efforts to effectively manage the level of complexity and environmental uncertainties in which

the sector currently finds itself. Teams are diversifying to include more functional experts,

including more clinically trained leaders. Information technology expertise in particular is clearly

increasing as a core component of many senior leadership teams. Demand for expertise in

productively evolving physician relationships also appears to be growing.

In terms of the CEO role itself, the masters of health administration and related degrees continue

to be the most prominent educational credential, comprising 84% of the total respondents. Even

among the 19% of CEOs with an MD or other clinical degree, 74% reported also having an

administrative master’s degree. This dual-credential finding suggests that recent research

dichotomizing CEOs into doctors vs. managers (e.g. Goodall, 2011) may have inaccurately

minimized or obscured the true importance of professional education in healthcare management

for these roles.

Although the net overall picture for senior leadership teams is one of growth, results still point to

substantial changes at the individual position level, with roughly three positions being removed

for every five that were added. Although current and future leaders can be optimistic about job

prospects, they also need to be mindful of the transitions that may be necessary, and should plan

accordingly.


In conclusion, while this research suggests that healthcare management will remain a vibrant

career in the years to come, it also identified better standardization of job titles and roles as an

important opportunity for establishing a stronger professional identity. In our future work, we

hope to provide greater clarity on common themes that might point in the direction of clearer

descriptions of positions and roles, to the benefit of career minded healthcare managers as well

as the profession itself.

References American College of Healthcare Executives (2014). “Career resources.” Available:

http://www.ache.org/carsvcs/ycareer.cfm. Accessed October 9, 2014.

American Hospital Association (2012). AHA Annual Survey Database Fiscal Year 2011. Health

Forum, LLC, an American Hospital Association Company, Chicago, IL.

Athey, L. & Garman, A. N. (2014). “Health Reform and the Evolving Senior Leadership Team:

A Survey of Freestanding Hospital CEOs.” White paper published by the American

College of Healthcare Executives’ CEO Circle, Chicago, IL.

Bureau of Labor Statistics, U.S. Department of Labor (2014). “Medical and Health Services

Managers.” Occupational Outlook Handbook, 2014-15 Edition. Available:

http://www.bls.gov/ooh/management/medical-and-health-services-managers.htm.

Accessed October 9, 2014.

Goodall, A. (2011). Physician-leaders and hospital performance: Is there an association? Social

Science & Medicine, 73, 535-539.

Haleblian, J., & Finkelstein, S. (1993). Top management team size, CEO dominance, and firm

performance: The moderating roles of environmental turbulence and discretion. Academy

of Management Journal, 36, 844-886.

http://www.ache.org/carsvcs/ycareer.cfm

http://www.bls.gov/ooh/management/medical-and-health-services-managers.htm


Acknowledgments The work described in this research report was made possible through support from the

American College of Healthcare Executives. We wish to thank Leslie Athey, ACHE’s Director

of Research, as well as her staff for their support and expert advice throughout this project. We

would also like to thank Megan Butler for her subject-matter-expert review of the classification

system we developed for this survey, and W. Jeffrey Canar and Ron Landis for their statistical

consultations.


Appendix A: Job Title Coding Sheet

1 COO/Hospital Operations 42 LEAN coordinator/ PI/ Process/ Clinical

Effectiveness/ Performance Improvement Director

2 CFO/VP Finance 43 OB-GYN

3 CEO/President 44 College President

4 Sr HR/ Personnel 45 Credentialing

5 Chief Nursing/CNO 46 Dietary/Nutrition

6 Chief Medical Officer 47 Home Health

7 Clinical Services VP/ Chief Clinical Officer 48 Accreditation

8 IT Director/CIO 49 Dual Titles

9 Chief Quality Officer 50 Environmental Services / Housekeeping

10 VP Patient Care 51 Cardiopulmonary/Cardiology

11 Chief Admin Officer/CAO/Administrator 52 Board secretary/Board Relations

12 Executive VP 53 Surgery / Perioperative

13 Chief of Staff/COS 54 Mission Services/Mission Integration/Mission

Advancement/Mission Effectiveness

14 Legal/General Counsel 55 Mental Health / Psych/ Behavioral Health

15 Facilities/Maintenance/Materials/Engineering/Plant

Operations 56 Emergency Services/ ER

16 Pharmacist/Pharmacy Director 57 Respiratory

17 Marketing/PR 58 Social Services

18 Ancillary Director/Support Services 59 Clinical Integration

19 Strategy/Strategic Planning 60 Anesthesia

20 HIM/Health Info Mgmt/Medical Records 61 Business Manager / BO

21 Physician Services/ Medical Staff/Medical

Services 62 Billing / Accounts Receivable / AR

22 Philanthropy/Foundation Director/ Fund

Development/Endowment 63


Group /Practice Manager/ PHO / Clinic

23 Business Development/Growth 64 Insurance / Managed Care

24 Population Health 65 Controller

25 Executive Assistant 66 Executive Director

26 Ambulatory Services/Outpatient 67 Employee Services

27 Lab Director 68 Medical Director

28 Infection Prevention 69 Informatics/Clinical Decision

29 Elder Care/ Senior Services/Nursing Home/

Hospice/ Long Term Care/LTC 70 Risk/Compliance/Integrity

30 Community Outreach/ SVP External Affairs/

Liaison/Networking 71 Chief Experience Officer/Patient Experience Officer

31 Internal Auditor 72 Assistant Administrator

32 Learning / Education 73 Supply Chain/Purchasing

33 Access Health 74 Professional Staff/Professional Support/Professional

Services

34 Post-Acute/ Acute Care 75 General Services

35 Govt Relations 76 Wellness Officer

36 Revenue Cycle 77 Department-level Manager

37 Medical Affairs 78 Utilization Review

38 Rehab/Physical Therapy/PT 79 Poison Control

39 Radiology/Imaging/ Diagnostics 80 Project Management

40 Volunteer Director 81 HIPAA/Privacy


41 Chaplain/Spiritual Services

Appendix B: Complete Results Tables

Table B1. Job titles in the senior leadership teams (SLTs) of freestanding hospitals

Job Title Count

% of all job titles

on SLTs

CFO/VP Finance 455 16.8%

Chief Nursing/CNO 327 12.1%

Sr HR/ Personnel 271 10.0%

Dual/Multiple Titles 217 8.0%

COO/Hospital Operations 193 7.1%

Chief Medical Officer 131 4.8%

IT Director/CIO 129 4.8%

Chief Quality Officer/Risk 108 4.0%

VP Patient Care 60 2.2%

Physician Services/ Medical Staff/Medical Services 59 2.2%

Ancillary Director/Support Services 58 2.1%

Medical Group / Physician Networks / Physician Group /Practice

Manager/ PHO / Clinic 52 1.9%


Development/Endowment 49 1.8%

Chief Admin Officer/CAO/Administrator 45 1.7%

Business Development/Growth 43 1.6%

CEO/President 37 1.4%

Legal/General Counsel 35 1.3%

Clinical Services VP/ Chief Clinical Officer 34 1.3%

Marketing/PR 34 1.3%

Compliance/Integrity 28 1.0%

Medical Affairs 27 1.0%

Strategy/Strategic Planning 26 1.0%

Elder Care/ Senior Services/Nursing Home/ Hospice/ Long Term

Care/LTC 25 0.9%

Facilities/Maintenance/Materials/Engineering/Plant Operations 24 0.9%

Community Outreach/ SVP External Affairs/ Liaison/Networking 23 0.8%

Medical Director 20 0.7%

Executive VP 15 0.6%

LEAN coordinator/ PI/ Process/ Clinical Effectiveness/

Performance Improvement Director 15 0.6%

Ambulatory Services/Outpatient 14 0.5%

Professional Staff/Professional Support/Professional Services 12 0.4%

Assistant Administrator 11 0.4%

Post-Acute/ Acute Care 9 0.3%


Job Title Count

% of all job titles

on SLTs

Revenue Cycle 9 0.3%

HIM/Health Info Mgmt/Medical Records 8 0.3%

Controller 8 0.3%

Chief of Staff/COS 7 0.3%

Executive Assistant 7 0.3%

Learning / Education 7 0.3%

Rehab/Physical Therapy/PT 5 0.2%

Radiology/Imaging/ Diagnostics 5 0.2%

Home Health 5 0.2%

Surgery / Perioperative 5 0.2%

Environmental Services / Housekeeping 4 0.1%

Mental Health / Psych/ Behavioral Health 4 0.1%

Executive Director 4 0.1%

Chief Experience Officer/Patient Experience Officer 4 0.1%

Pharmacist/Pharmacy Director 3 0.1%

Govt Relations 3 0.1%

OB-GYN 3 0.1%

College President 3 0.1%

Mission Services/Mission Integration/Mission

Advancement/Mission Effectiveness 3 0.1%

Clinical Integration 3 0.1%

Billing / Accounts Receivable / AR 3 0.1%

Lab Director 2 0.1%

Cardiopulmonary/Cardiology 2 0.1%

Board secretary/Board Relations 2 0.1%

Employee Services 2 0.1%

Informatics/Clinical Decision 2 0.1%

Project Management 2 0.1%

Population Health 1 0.0%

Accreditation 1 0.0%

Emergency Services/ ER 1 0.0%

Respiratory 1 0.0%

Social Services 1 0.0%

Business Manager / BO 1 0.0%

Insurance / Managed Care 1 0.0%

General Services 1 0.0%

Infection Prevention 0 0.0%

Internal Auditor 0 0.0%

Access Health 0 0.0%

Volunteer Director 0 0.0%

Chaplain/Spiritual Services 0 0.0%


Job Title Count

% of all job titles

on SLTs

Credentialing 0 0.0%

Dietary/Nutrition 0 0.0%

Anesthesia 0 0.0%

Supply Chain/Purchasing 0 0.0%

Wellness Officer 0 0.0%

Department Manager 0 0.0%

Utilization Review 0 0.0%

Poison Control 0 0.0%

HIPAA/Privacy 0 0.0%


Table B2. Job titles added to and removed from SLT in the last two years.

Job Title

Count

Added in

Last Two

Years

% of All

Titles

Added

Count

Removed

In Last

Two

Years

% of All

Titles

Removed

Net Gain/

(Loss)

over last 2

years

IT Director/CIO 32 12.1% 7 4.3% 25


Physician Services/ Medical Staff/Medical Services 18 6.8% 2 1.2% 16

Chief Quality Officer/Risk 18 6.8% 5 3.1% 13 Medical Group / Physician Networks / Physician


Dual Titles 18 6.8% 13 8.1% 5 LEAN coordinator/ PI/ Process/ Clinical

Effectiveness/ Performance Improvement Director 4 1.5% 0 0.0% 4

CEO/President 3 1.1% 0 0.0% 3

Clinical Services VP/ Chief Clinical Officer 3 1.1% 0 0.0% 3

Ancillary Director/Support Services 11 4.2% 8 5.0% 3

Strategy/Strategic Planning 6 2.3% 3 1.9% 3


Revenue Cycle 3 1.1% 0 0.0% 3

Clinical Integration 3 1.1% 0 0.0% 3

Chief Experience Officer/Patient Experience Officer 3 1.1% 0 0.0% 3

Chief of Staff/COS 2 0.8% 0 0.0% 2

Legal/General Counsel 3 1.1% 1 0.6% 2

Ambulatory Services/Outpatient 3 1.1% 1 0.6% 2

Govt Relations 2 0.8% 0 0.0% 2

Medical Affairs 2 0.8% 0 0.0% 2


Compliance/Integrity 5 1.9% 3 1.9% 2

Assistant Administrator 2 0.8% 0 0.0% 2

Executive VP 1 0.4% 0 0.0% 1 Philanthropy/Foundation Director/ Fund

Development/Endowment 3 1.1% 2 1.2% 1

Cardiopulmonary/Cardiology 1 0.4% 0 0.0% 1

Mental Health / Psych/ Behavioral Health 1 0.4% 0 0.0% 1

Emergency Services/ ER 1 0.4% 0 0.0% 1

VP Patient Care 1 0.4% 1 0.6% 0

Pharmacist/Pharmacy Director 1 0.4% 1 0.6% 0

Executive Assistant 0 0.0% 0 0.0% 0

Lab Director 0 0.0% 0 0.0% 0

Infection Prevention 0 0.0% 0 0.0% 0 Elder Care/ Senior Services/Nursing Home/

Hospice/ Long Term Care/LTC 1 0.4% 1 0.6% 0

Internal Auditor 0 0.0% 0 0.0% 0


Job Title

Count

Added in

Last Two

Years

% of All

Titles

Added

Count

Removed

In Last

Two

Years

% of All

Titles

Removed

Net Gain/

(Loss)

over last 2

years

Learning / Education 0 0.0% 0 0.0% 0

Access Health 0 0.0% 0 0.0% 0

Post-Acute/ Acute Care 0 0.0% 0 0.0% 0

Rehab/Physical Therapy/PT 0 0.0% 0 0.0% 0

Radiology/Imaging/ Diagnostics 0 0.0% 0 0.0% 0

Volunteer Director 0 0.0% 0 0.0% 0

Chaplain/Spiritual Services 0 0.0% 0 0.0% 0

OB-GYN 0 0.0% 0 0.0% 0

College President 0 0.0% 0 0.0% 0

Credentialing 0 0.0% 0 0.0% 0

Dietary/Nutrition 0 0.0% 0 0.0% 0

Home Health 0 0.0% 0 0.0% 0

Accreditation 0 0.0% 0 0.0% 0

Environmental Services / Housekeeping 0 0.0% 0 0.0% 0

Board secretary/Board Relations 0 0.0% 0 0.0% 0

Surgery / Perioperative 0 0.0% 0 0.0% 0 Mission Services/Mission Integration/Mission

Advancement/Mission Effectiveness 0 0.0% 0 0.0% 0

Respiratory 0 0.0% 0 0.0% 0

Social Services 0 0.0% 0 0.0% 0

Anesthesia 0 0.0% 0 0.0% 0

Billing / Accounts Receivable / AR 0 0.0% 0 0.0% 0

Insurance / Managed Care 0 0.0% 0 0.0% 0

Controller 0 0.0% 0 0.0% 0

Executive Director 0 0.0% 0 0.0% 0

Employee Services 0 0.0% 0 0.0% 0

Informatics/Clinical Decision 0 0.0% 0 0.0% 0

Supply Chain/Purchasing 0 0.0% 0 0.0% 0

Wellness Officer 0 0.0% 0 0.0% 0

Department Manager 0 0.0% 0 0.0% 0

Utilization Review 0 0.0% 0 0.0% 0

Poison Control 0 0.0% 0 0.0% 0

Project Management 0 0.0% 0 0.0% 0

HIPAA/Privacy 0 0.0% 0 0.0% 0

Chief Nursing/CNO 6 2.3% 7 4.3% (1)

Chief Admin Officer/CAO/Administrator 4 1.5% 5 3.1% (1)

Business Manager / BO 0 0.0% 1 0.6% (1) Professional Staff/Professional Support/Professional

Services 0 0.0% 1 0.6% (1)

General Services 0 0.0% 1 0.6% (1)


Job Title

Count

Added in

Last Two

Years

% of All

Titles

Added

Count

Removed

In Last

Two

Years

% of All

Titles

Removed

Net Gain/

(Loss)

over last 2

years

COO/Hospital Operations 19 7.2% 21 13.0% (2)

CFO/VP Finance 10 3.8% 12 7.5% (2)

Business Development/Growth 6 2.3% 8 5.0% (2) Community Outreach/ SVP External Affairs/

Liaison/Networking 1 0.4% 3 1.9% (2) Facilities/Maintenance/Materials/Engineering/Plant

Operations 0 0.0% 3 1.9% (3)

HIM/Health Info Mgmt/Medical Records 1 0.4% 6 3.7% (5)

Marketing/PR 7 2.6% 13 8.1% (6)

Sr HR/ Personnel 18 6.8% 25 15.5% (7)


Table B3. Job titles CEOs plan to add to and remove from the SLT in the next two years.

Job Title

Number

Planned to

Add In

Next Two

Years

% of

All

Titles

Added

Count

Planned to

Remove

In Next

Two

Years

% of All

Titles to

Remove

Net Gain/

(Loss)

Over Last

Two Years


IT Director/CIO 17 11.4% 1 1.9% 16

COO/Hospital Operations 20 13.4% 6 11.3% 14



Physician Services/ Medical Staff/Medical

Services 8 5.4% 2 3.8% 6

Business Development/Growth 7 4.7% 1 1.9% 6



Chief Experience Officer/Patient Experience

Officer 4 2.7% 0 0.0% 4

Sr HR/ Personnel 8 5.4% 6 11.3% 2

Wellness Officer 2 1.3% 0 0.0% 2

CEO/President 2 1.3% 1 1.9% 1

Chief Quality Officer/Risk 7 4.7% 6 11.3% 1

VP Patient Care 1 0.7% 0 0.0% 1

Chief of Staff/COS 1 0.7% 0 0.0% 1

Legal/General Counsel 1 0.7% 0 0.0% 1

Marketing/PR 2 1.3% 1 1.9% 1

HIM/Health Info Mgmt/Medical Records 1 0.7% 0 0.0% 1

Ambulatory Services/Outpatient 2 1.3% 1 1.9% 1

Elder Care/ Senior Services/Nursing Home/

Hospice/ Long Term Care/LTC 1 0.7% 0 0.0% 1

Internal Auditor 1 0.7% 0 0.0% 1

Medical Affairs 1 0.7% 0 0.0% 1

LEAN coordinator/ PI/ Process/ Clinical

Effectiveness/ Performance Improvement Director 1 0.7% 0 0.0% 1

Dual Titles 10 6.7% 9 17.0% 1

Surgery / Perioperative 1 0.7% 0 0.0% 1

Compliance/Integrity 1 0.7% 0 0.0% 1

Professional Staff/Professional

Support/Professional Services 2 1.3% 1 1.9% 1

Chief Nursing/CNO 1 0.7% 1 1.9% 0

Clinical Services VP/ Chief Clinical Officer 0 0.0% 0 0.0% 0

Chief Admin Officer/CAO/Administrator 0 0.0% 0 0.0% 0

Executive VP 0 0.0% 0 0.0% 0


Job Title

Number

Planned to

Add In

Next Two

Years

% of

All

Titles

Added

Count

Planned to

Remove

In Next

Two

Years

% of All

Titles to

Remove

Net Gain/

(Loss)

Over Last

Two Years

Pharmacist/Pharmacy Director 0 0.0% 0 0.0% 0


Development/Endowment 1 0.7% 1 1.9% 0

Executive Assistant 0 0.0% 0 0.0% 0

Lab Director 0 0.0% 0 0.0% 0

Infection Prevention 0 0.0% 0 0.0% 0

Community Outreach/ SVP External Affairs/

Liaison/Networking 2 1.3% 2 3.8% 0

Learning / Education 1 0.7% 1 1.9% 0

Access Health 0 0.0% 0 0.0% 0

Post-Acute/ Acute Care 0 0.0% 0 0.0% 0

Govt Relations 0 0.0% 0 0.0% 0

Revenue Cycle 0 0.0% 0 0.0% 0

Rehab/Physical Therapy/PT 0 0.0% 0 0.0% 0

Radiology/Imaging/ Diagnostics 0 0.0% 0 0.0% 0

Volunteer Director 0 0.0% 0 0.0% 0

Chaplain/Spiritual Services 0 0.0% 0 0.0% 0

OB-GYN 0 0.0% 0 0.0% 0

College President 0 0.0% 0 0.0% 0

Credentialing 0 0.0% 0 0.0% 0

Dietary/Nutrition 0 0.0% 0 0.0% 0

Accreditation 0 0.0% 0 0.0% 0

Environmental Services / Housekeeping 0 0.0% 0 0.0% 0

Cardiopulmonary/Cardiology 0 0.0% 0 0.0% 0

Board secretary/Board Relations 0 0.0% 0 0.0% 0


Advancement/Mission Effectiveness 0 0.0% 0 0.0% 0

Mental Health / Psych/ Behavioral Health 0 0.0% 0 0.0% 0

Emergency Services/ ER 0 0.0% 0 0.0% 0

Respiratory 0 0.0% 0 0.0% 0

Social Services 0 0.0% 0 0.0% 0

Clinical Integration 0 0.0% 0 0.0% 0

Anesthesia 0 0.0% 0 0.0% 0

Business Manager / BO 0 0.0% 0 0.0% 0

Billing / Accounts Receivable / AR 0 0.0% 0 0.0% 0

Insurance / Managed Care 0 0.0% 0 0.0% 0

Controller 0 0.0% 0 0.0% 0

Executive Director 0 0.0% 0 0.0% 0


Job Title

Number

Planned to

Add In

Next Two

Years

% of

All

Titles

Added

Count

Planned to

Remove

In Next

Two

Years

% of All

Titles to

Remove

Net Gain/

(Loss)

Over Last

Two Years

Employee Services 0 0.0% 0 0.0% 0

Informatics/Clinical Decision 0 0.0% 0 0.0% 0

Assistant Administrator 0 0.0% 0 0.0% 0

Supply Chain/Purchasing 0 0.0% 0 0.0% 0

General Services 0 0.0% 0 0.0% 0

Department Manager 0 0.0% 0 0.0% 0

Utilization Review 0 0.0% 0 0.0% 0

Poison Control 0 0.0% 0 0.0% 0

Project Management 0 0.0% 0 0.0% 0

HIPAA/Privacy 0 0.0% 0 0.0% 0

CFO/VP Finance 4 2.7% 5 9.4% (1)

Ancillary Director/Support Services 1 0.7% 2 3.8% (1)

Strategy/Strategic Planning 0 0.0% 1 1.9% (1)

Facilities/Maintenance/Materials/Engineering/Plant

Operations 0 0.0% 2 3.8% (2)

Home Health 0 0.0% 2 3.8% (2)


Table B4. Net change in adding and removing job titles over the last two years and in the next two

years.

Job Title

Net

change

over past

two years

Net change

over

coming

two years

Total net

change

IT Director/CIO 25 16 41

Chief Medical Officer 21 17 38

Physician Services/ Medical Staff/Medical Services 16 6 22

Medical Group / Physician Networks / Physician Group

/Practice Manager/ PHO / Clinic 9 12 21

Chief Quality Officer 15 2 17

COO/Hospital Operations (2) 14 12

Population Health 3 4 7

Dual Titles 5 1 6

Medical Director 2 4 6

Chief Experience Officer/Patient Experience Officer 3 3 6

LEAN coordinator/ PI/ Process/ Clinical Effectiveness/

Performance Improvement Director 4 1 5

Business Development/Growth (2) 6 4

CEO/President 3 0 3

Clinical Services VP/ Chief Clinical Officer 3 0 3

Chief of Staff/COS 2 1 3

Legal/General Counsel 2 1 3

Ambulatory Services/Outpatient 2 1 3

Revenue Cycle 3 0 3

Medical Affairs 2 1 3

Clinical Integration 3 0 3

Ancillary Director/Support Services 3 (1) 2

Strategy/Strategic Planning 3 (1) 2

Govt Relations 2 0 2

Assistant Administrator 2 0 2

Wellness Officer 0 2 2

VP Patient Care 0 1 1

Executive VP 1 0 1


Development/Endowment 1 0 1

Elder Care/ Senior Services/Nursing Home/ Hospice/ Long

Term Care/LTC 0 1 1

Internal Auditor 0 1 1

Cardiopulmonary/Cardiology 1 0 1

Surgery / Perioperative 0 1 1

Mental Health / Psych/ Behavioral Health 1 0 1

Emergency Services/ ER 1 0 1


Job Title

Net

change

over past

two years

Net change

over

coming

two years

Total net

change

Pharmacist/Pharmacy Director 0 0 0

Executive Assistant 0 0 0

Lab Director 0 0 0

Infection Prevention 0 0 0

Learning / Education 0 0 0

Access Health 0 0 0

Post-Acute/ Acute Care 0 0 0

Rehab/Physical Therapy/PT 0 0 0

Radiology/Imaging/ Diagnostics 0 0 0

Volunteer Director 0 0 0

Chaplain/Spiritual Services 0 0 0

OB-GYN 0 0 0

College President 0 0 0

Credentialing 0 0 0

Dietary/Nutrition 0 0 0

Accreditation 0 0 0

Environmental Services / Housekeeping 0 0 0

Board secretary/Board Relations 0 0 0


Advancement/Mission Effectiveness 0 0 0

Respiratory 0 0 0

Social Services 0 0 0

Anesthesia 0 0 0

Billing / Accounts Receivable / AR 0 0 0

Insurance / Managed Care 0 0 0

Controller 0 0 0

Executive Director 0 0 0

Employee Services 0 0 0

Informatics/Clinical Decision 0 0 0

Risk/Compliance/Integrity 0 0 0

Supply Chain/Purchasing 0 0 0

Professional Staff/Professional Support/Professional

Services (1) 1 0

Department Manager 0 0 0

Utilization Review 0 0 0

Poison Control 0 0 0

Project Management 0 0 0

HIPAA/Privacy 0 0 0

Chief Nursing/CNO (1) 0 (1)

Chief Admin Officer/CAO/Administrator (1) 0 (1)


Job Title

Net

change

over past

two years

Net change

over

coming

two years

Total net

change

Business Manager / BO (1) 0 (1)

General Services (1) 0 (1)

Community Outreach/ SVP External Affairs/

Liaison/Networking (2) 0 (2)

Home Health 0 (2) (2)

CFO/VP Finance (2) (1) (3)

HIM/Health Info Mgmt/Medical Records (5) 1 (4)

Sr HR/ Personnel (7) 2 (5)

Facilities/Maintenance/Materials/Engineering/Plant

Operations (3) (2) (5)

Marketing/PR (6) 1 (5)

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