Because Life Happens: 8 Succession Planning Best Practices for Medical Groups

Succession planning should be based on a well-thought-out strategy to identify, recruit, and develop leaders at all levels of an organization. Medical groups often neglect succession planning, procrastinate working on it, or, worse, allow some of their members to actively sabotage it. The result is key positions are filled on an ad-hoc basis, which produces a leader who is poorly prepared for the job, or reluctant to assume it. 

The following are eight succession planning best practices, specifically catered to medical groups.

It can take between six months to a year to identify and recruit talented people, especially in select advanced medical specialties and subspecialties. Seek out leaders who shine beyond their technical knowledge and demonstrate capacity for the following: good communication, teamwork, strategic thinking, multi-tasking, empathy, adaptability, and ability to bridge business concepts with excellent delivery of care.

Define critical competencies needed for each position, and mindfully keep the overall diversity of your staff in mind. Identify mission-critical positions, not only positions near or at the top of the pyramid. Include service lines, critical department sections, key administrative and operational positions, as well as medical staff committees that are structural to the group’s success.

Succession planning should not be a one-person task, although it is often treated as such in groups where the original founder is still solely in charge. Include key physicians and managers and seek input from various other interest groups, including HR, other physicians and staff, and key external stakeholders. Give preference to internal candidates if continuity is desired and to external ones if transformation and a fresh perspective are top priority. Consider appointing a standing succession committee to ensure that succession planning is further incorporated into the company’s culture and processes.

Retiring leaders often want/need to remain engaged and relevant; they can be superb mentors to younger colleagues. When possible, don’t discard their years of accumulated experience, corporate memory, and established networks. To attract retiring physicians, most of whom care about finding a balance between slowing down and staying involved, consider implementing part-time or job-sharing policies.

Establish a written succession plan document and update it at regular intervals (at least every two years) and communicate it internally and externally with key stakeholders, including: internal staff, clients, hospital administrators, and relevant professional organizations. Consider posting the succession plan online (for example, on your organization’s intranet) to make it accessible to individuals in need-to-know positions, ensuring that appropriate access security and authorization are in place.

Support promising future leaders with a curriculum encompassing a broad range of management and leadership topics. Build an administrative framework that will allow them to thrive in their upcoming role as leaders. The goal, obviously, is to set them up for great success, not failure or burnout.

Test your plan more than once, before needing to implement it. Share the helm on a regular basis: 

• Delegate progressively more complex tasks (short-term vacations are ideal for regular testing). 
• Debrief with your protégé/second-in-command upon your return. 
• Share successes and, just as important, failures. They are both rich in learning opportunities and leadership growth.

Practice the plan whenever possible and re-evaluate as needed. As Ann Mulcahy, the former CEO and chairwoman of Xerox, once stated, “One of the things we often miss in succession planning is that it should be gradual and thoughtful, with lots of sharing of information and knowledge and perspective, so that it's almost a non-event when it happens.”

The line of succession, and therefore the line of authority, must be crystal clear to all, especially to the principal parties assuming these roles. Once a leader is replaced, the successor must clearly assume the helm and the predecessor must unequivocally step out of the way.

An organization should only have one leader at a time. During World War I, Lloyd George, the former prime minister of the United Kingdom, said, “It is not a question of one general being better than another, but of one general being better than two.” I have visited groups of physicians where multiple individuals were in charge, which really meant nobody was. I have also visited groups where one person was in charge by title only, but in reality, the decision-making processes were vague at best, non-existent, or, at worst, not applied. This is a sure recipe for confusion and stress for all involved in the organization. 

In addition to the best practices suggested above, it is important to avoid potential traps such as the following on the journey of designing an organizational succession plan: 

• Trying to make it perfect. 
• Looking for clones of one’s own leadership style. 
• Not accepting that “things have changed.” 
• Being too dogmatic about expectations. 
• Being unaware or disrespectful of generational variations. 
• Not paying attention to diversity. 
• Ignoring work-life balance.

A well-designed succession plan can be the source of many positive impacts for a medical group. It emphasizes leadership’s long-term commitment to continuity of services and excellence; it can be a great tool for recruitment and job enrichment; it helps decrease the probability of burnout; and it enhances the likelihood of physician and staff engagement.

It is incumbent on leaders of medical groups to plant the seeds of leadership and nurture them well in advance of such seedlings coming due for harvesting. Similarly, it takes time to see the effects of such labor. Stanislav Shekshnia, a professor at INSEAD, has stated the following: “You cannot evaluate a leader or CEO’s performance until at least 10 years after the person has left the company. It will take that long for the company’s performance to reflect the quality of the CEO’s succession planning.” Ten years! Your goal—long after retiring from your group and initiating and implementing its succession plan—should be for somebody to bless your memory, not curse it, while you relax on a remote white sand beach, pina colada in hand.

Karim E. Sirgi, MD, MBA, FCAP, owns Sirgi Consulting LLC and offers expertise to medical groups in various aspects of practice management and leadership. Dr. Sirgi is board-certified in anatomic, clinical and cytopathology with additional surgical pathology fellowship training, he also holds an MBA and has 30 plus years of practice and leadership experience in private, academic, and hospital-based pathology and medical staff settings. Among his previously held positions, Dr. Sirgi served as president of the largest multi-specialty pathology group in the Rocky Mountain region and chair of the regional medical staff council for the largest hospital organization in the US. Dr. Sirgi is the immediate past-president of the American Pathology Foundation, the chair of the CAP Practice Management Committee, and the Chief Science Officer of Breath Tech.