What are the major leadership issues facing you? What decisions need to be made? How would you make them?

You have been promoted to be the CEO of a 312-bed hospital that is the second largest facility in your healthcare system. The prior two CEOs were from the Deep South and were not great cultural fits for this medical center. Financially the hospital is doing well, but the attitudes and actions of the former CEOs have divided the staff, physicians, and community, and there is a lot of latent anger. You know you will have to address this quickly. In addition, the medical staff pride themselves on their independence.

The president of the medical staff accosted you on your third day on the job and told you, “You have about six months to clean up the mess here or I will make certain we are looking for another CEO.”

The winter can get very cold and windy at the hospital, and the former CEOs had special parking near the entrance for themselves and all department heads; everyone else parked over 200 yards away and slogged through the snowdrifts. Furthermore, those CEOs almost always ate for free in the physician’s lounge and were rarely seen in the general cafeteria, even though it is just across from the executive office. Then there are the potential clinical problems.

A year before your arrival, the previous CEO brought in a cardiac surgeon and began a cardiac surgery program. He made three-year guarantees and anticipated great success. However, after reviewing the figures for the first year, you wonder if the clinical and financial outcomes justify the program. Only 47 adult open heart surgeries were conducted last year, and only 55 are projected this year. The vast majority have been Medicare patients and maybe—if only marginal costs are factored in—the service has been breakeven. Clinically, however, the American College of Surgeons recommends that an adult open heart surgery program have an annual volume of at least 100 to 125 open heart procedures per hospital from a quality standpoint; at least 200 procedures per year are necessary for a program to function efficiently.