An Uncommon Staffing Strategy for Community Hospitals

Executives and other senior leaders with decades of first-hand healthcare experience can be available to your organization on a fractional basis.  HealthTechS3 integrates a fractional executive into your organization at the time you need it most based on strong knowledge of our team and a rigorous matching process.

Contact Michael Lieb on for fractional leadership support.

Many smaller hospitals, including critical access and sole community facilities, often run into difficulty staffing key leadership roles.  Those most impacted are in rural or frontier areas where there are simply not enough qualified local people to fill needed positions. According to a recent article published in Becker’s Hospital Review, twenty percent of the country’s population live in rural areas, so the absence of one key person can impact up to 2,500 patients.

As an example, it is often difficult to recruit well-qualified CFOs willing to also take on the routine journal entries and straight accounting functions typically completed by staff accountants and controllers in larger facilities or those in a network or health system.  While many of these small hospitals have strong accounting services, they quite often miss out on the analytic expertise of a highly-qualified CFO.   Further, the absence of a skilled strategic financial sounding board for the CEO makes administrative decision making more difficult.  Add to this the expense of multiple employees in a small location — Controllers, A/P, plus a CFO – and it is hard to justify.

How Can A Hospital Use A Fractional Executive?

Perhaps instead, a community hospital should consider a fractional leadership role.  We envision this – not as an interim – rather, a permanent executive who can support up to 2-3 client hospitals based on their needs.  Keeping with the CFO example, the fractional leader would be charged with setting the priorities of the financial projects, working with banks, investors, department operations and strategic oversight of the finance services.  He or she would be onsite every month for several consecutive days, coinciding with the hospital board and finance committee meetings.  Simultaneously, the fractional CFO would spend time with direct reports and the CEO.  During offsite times, the CFO would have direct access to the hospital’s financial systems for day-to-day operations and interact with staff via Skype or phone.  As this is a permanent role, there is continuity, and the ability to establish (and maintain) good relationships with the board, CEO, and staff.  Timekeeping is simple and can be allocated to the client hospitals on an hourly basis; much like attorneys, accountants and other outsourced service firms.

Who Makes A Strong Fractional Executive?

So, what kind of person can be a successful fractional executive?  First, he/she will need to manage time appropriately.  In a multi-tasking role such as this, there will be priorities that shift rapidly, often between projects – and even client hospitals.  Second, the successful fractional executive will need to be able to create and maintain trusted relationships with the remainder of the local administrative team, the onsite financial staff – in the case of a CFO, and the CEO.  To do this, the fractional executive will need to have frequent communications with the client hospital on progress of weekly and monthly projects, decision making as it relates to major hospital initiatives, and staff management.  Finally, the fractional executive will need to respond to the client hospital quickly, and as needed by circumstances.

This type of role will initially require a fairly significant investment of time onsite.  This will establish the working relationships and trust required to manage staff remotely later on.  The fractional executive will need to make certain that he/she is seen as a true member of the leadership team, and a daily participant in the operations of the hospital regardless of the physical work location.  For this reason, we see no more than 2-3 hospitals at a time falling under the purview of the fractional executive.  Otherwise, the role becomes more like a consultant and less an operational member of the team who can (and will) devote the time, concentration, and expertise needed to provide leadership to the hospital.  As staff relationships mature, the amount of time required to be onsite would likely decrease.

The development of secure telecommunications, VPN’s, Skype, GoToMeeting, Google Docs, and many other networking tools have made the implementation of a fractional executive  a feasible, cost-effective possibility for a community hospital.  It can be accomplished at less than half (or even a third) the expense of a fulltime, high-level person, all while reducing the difficulties associated with recruiting and retaining such expertise.  Large systems with centralized home office support often use this model.  Now those same economies of scale are available to the rural facility without giving up its autonomy and local control.

It is worth, then, considering whether such a cost-effective role would fit the culture of your organization when you next need to fill a C-suite or senior executive position.  HealthTechS3 can help fit the right permanent fractional role in your organization when you need it.