Healthcare staff judge leadership values by decisions, not statements

Healthcare organizations spend a lot of time describing their values. Employees spend their working lives finding out whether those values hold up.

They learn it when a leader listens without rushing, when a concern gets a real response, and when someone takes an interest in their future. They also learn it when executive priorities make patient care harder while leadership keeps talking about putting patients first.

That tension is the core of Dr. David Schreiner's argument about leadership. Schreiner spent 36 years at a not-for-profit, independent rural hospital, including a long run as CEO of Katherine Shaw Bethea Hospital, and now leads the National Center for Healthcare Leadership, which works with health system C-suites on leadership and succession. His view is that a leader's legacy rests mostly on how people experienced working for them.

He doesn't wave off the money. "No margin. No mission. We all get it," he says. But when people talk about the leaders who came before them, he notes, "we didn't talk about whether they made budget or what the margins were or the cost cutting that they did." They talk about the ones who cared about them and helped them succeed.

The memory that outlasted the financial report

Dr. Kevin Stevenson makes the point with his longtime mentor, Russ Harrington, then president of the Baptist medical system in Arkansas that is now Baptist Health. Stevenson got his first job at Baptist Rehabilitation Institute in Little Rock, and on his 30th birthday, Harrington was at his house cooking hamburgers.

In the hospital halls, Harrington was just Russ, to physicians and floor techs alike. Stevenson says he couldn't tell you Baptist's days cash on hand from 37 years ago. He remembers the burger.

The story keeps the subject from going soft. Personal attention is a leadership choice, and people can see it. It tells employees whether their place in the organization goes beyond the work they produce.

Schreiner ties that choice directly to patient care. He doesn't think the industry has lost its way: in his words, "the magic that happens at the bedside is still happening." The caregivers people once thanked with healthcare-hero yard signs are the same people now. Leadership's job, as he describes it, is to promote that connection and take away the obstacles that get in its way. He points to structural and payment changes the system needs, but he doesn't blame the people doing the work.

That bar is higher than asking staff to stay resilient while the obstacles stay where they are.

Twenty-five priorities leave people guessing

Executives are being asked to improve quality, grow market share, recruit physicians, cut costs, adopt AI and engage staff, all at once. Schreiner thinks there's more noise now than there has ever been. His answer forces leaders to make choices.

Start with a true north, he argues, built on personal values that carry into organizational ones. Then judge every meeting request, board invitation and new initiative against it. "If it's not consistent and it doesn't move our organizations closer to that true north, then we need to say no," he says. That's hard, because leaders get rewarded for saying yes to everything on the way up.

He's specific about how much counts as too much. "It can't be 25 things or we have nothing," he says. "It needs to be three. It needs to be five." Priorities can change from quarter to quarter, often because a leader got something started and handed it to a trusted staff member to finish. The true north stays put.

This matters to employees. Every new executive initiative takes someone's time, usually from people already running daily operations. If leadership won't decide what matters most, departments end up settling the conflicts themselves, and the overload that follows can look like a failure to execute.

Clear priorities make executives own what the organization will stop doing, not just what it will take on. Schreiner applies the same discipline to boards. He never thought of it as managing his board. He thought of it as making sure board members were never surprised and that his priorities were their priorities. He borrows a line from a friend who spent his career in the Air Force: "What's interesting to my boss is fascinating to me."

Succession planning exposes how secure a leader really is

Stevenson pushes back on executives who act as if they'll hold their jobs forever and pay little attention to developing the people behind them. Schreiner agrees that succession matters more now, and says best governance practice makes it the board's job to ensure a plan exists.

The hard part is structural. Leadership teams are flattening, so there are fewer roles and fewer people to pick from. In medium and small health systems especially, the C-suite has gotten lean.

For Schreiner, that is what succession planning is: giving people chances to step outside their current level of competence and grow through new responsibilities. At his hospital, he reshuffled the organizational chart every three or four years so leaders ran departments they had never been exposed to. The previous owners stayed on the team, almost like consultants. Some leaders who came up through those rotations went on to lead other health systems.

He grants that this is easier at a small independent rural hospital, but he says it still works inside lines like finance, strategy, medical group performance and quality. Stevenson points to Texas Health Resources, which rotates hospital presidents through its hospitals so they learn different submarkets. When its system head prepared to retire, the system skipped a national search and chose from two or three executives it had been grooming. Schreiner calls that a win that also keeps culture intact, while allowing that sometimes an organization needs a new set of eyes.

For boards, this raises an uncomfortable question: if the organization leans heavily on one executive and has done little to prepare anyone else, how well has its leadership development actually worked?

Technology should help leaders show up

Schreiner says he can't remember anything in his career driving change as fast as AI. He hopes it takes away drudgery and routine work, like the family medicine physician who could stop "pajama charting" at 10 p.m. once ambient listening handles the notes.

He uses AI heavily himself. Each morning, a dashboard shows him everyone he's meeting that day and what he needs to follow up on. None of that put anyone out of work, he notes. It lets him show up more fully for the people who matter most.

That question works as a test for adoption. Time saved is worth something when it improves attention, responsiveness or the experience of delivering care. Leaders should look at where the recovered time actually goes.

The test happens on third shift

Asked what he'd tell a first-time CEO before day one, Schreiner keeps it concrete: "Lock the door. Don't go in. Get out into the hallway and see as many people as you can see." Go in on Sunday nights, on holidays, on third shift, and stay out of the office as much as possible.

The advice fits the traits he looks for when hiring: optimism and passion, in an industry he considers as complicated as any. An executive can't understand a whole organization through the people who are around during normal meeting hours. And employees can't judge a leader's commitment from statements alone.

They judge it by access, decisions, follow-through, and whether their concerns change what happens next. Over time, those experiences become the organization's culture, and the leader's reputation.