Interim or Permanent – The First 90 Days as a Hospital Executive

Being new to any job is never an easy task.  However, when you are a member of a hospital’s C-suite, you are in the middle of a fish bowl with all eyes on you; and, you only get one chance to make a first impression.  Board members, physicians, senior leadership, staff, community members and, most important of all, patients, will be forming opinions and expectations of you or your role, judging your every move.  So, how do you make the best of it and rise to the challenge to be successful?  The first 90 days are critical and will set the stage for long term success. 

In preparing for this role, what can you do ahead of time, prior to starting?  What information should you seek, and who should you consult?  What experience in your past has prepared you for this role, and how can you draw upon it?  Do you have a mentor who has been down this road, as well, who you can use as a sounding board?  These are all great questions; and, you will likely have a million more.  Preparation and planning are key to navigating the first 90 days.

However, what if the role is interim?  Does that significantly change how you prepare, allocate your time and develop relationships?  Is it different from taking on a permanent role, and if so, how?  Success is achieved by understanding the most often required skills, experience and cultural expectations for senior leadership roles and how those are different for an interim and a permanent leader.   People already within the organization develop a variety of perceptions about those in interim and permanent roles, and how they may expect the leader to respond.  90 days may seem like a short time, but it can actually seem like an eternity if negative perceptions are formed.  Again, preparation is the key.

Often, the amount of time one has to prepare for an interim assignment is very different than the amount of time a person permanently placed may have.  Interim roles may open quite quickly and be filled even more quickly, depending on the situation.  On the other hand, once in place, an interim leader may buy an organization time, allowing for a formal search to be conducted for a permanent leader, a process that may span six months or more.  And even if an interim leader is not involved, once a candidate has accepted an offer for a permanent role, if already employed elsewhere, formal notification may need to be given, which could be anywhere from 30 to 90 days; or longer, depending on whether or not there are any contractual obligations.  This may allow a permanent candidate more time to acquire information and prepare for the role than an interim is allowed. 

In either case, the arrival of a new face in the organization will generate questions:

1) who is this new person,

2) what does his or her presence mean to my own role, and

3), what changes are forthcoming? All of these are normal, valid and require a rapid assertion of leadership and development of trust by the new leader. This is especially true if the vacancy was sudden or unexpected. Transparency and openness are critical to success during the transition period to minimize organizational fearfulness and, worse, inertia for the institution. Most often, there is an operational or strategic reason for the change in leadership, so it is essential to be well prepared and move with confidence in the initial days.

The impact of either an interim or permanent leader on the group dynamics in the C-suite can also be different.  While impacts can be lasting for either, decisions of an interim may be viewed as “quick fixes” or “low-hanging fruit,” while those of the permanent leader are often viewed as more deliberate, as the decision-maker will be around to live with the consequences of the decisions.  Learning the lay of the land during the first 90-days will be critical to getting the right amount of information, vetting the business proposition and political climate, gaining buy-in and monitoring results.  Again, an interim leader’s time frame is abbreviated as compared that of a permanent leader; however, success or failure does not come necessarily from the decision itself, but rather the buy-in and support, or lack thereof, of the decision-maker by others.  The relational and cultural foundation, otherwise known as trust, laid during the first 90 days will dictate the outcome. 

Register for our Webinar:  “The First 90 Days of a Healthcare Executive” – 12pm, June 6, by Michael Lieb, Vice President of Interim Services, HealthTechS3 and Robert Thorn, Principal, Summitt Healthcare Strategies, LLC.
We will address the pressures on today’s C-suite and how an executive new to an organization can set the tone early for strong performance, and how those approaches and the goals differ between the two types of leaders.


  1. Understand the most often required skill, experience and cultural expectations for senior leadership roles and how those are different for an interim and a permanent leader.
  2. Learn how the organization perceives that difference in roles, how it responds to each, and what the executive must do to drive the organization forward.
Register Here