My first year as chief of staff

Physician Executive, Jan-Feb, 2005 by Marc Wooten

April 20, 2003.

I arrived for my first day on the job as chief of staff at a new hospital in a new city. I was coming from the Department of Veterans Affairs (VA) and thought I was familiar with the system. Or was I? Who knew what challenges awaited me as the new chief of staff? I certainly had no idea of what all lay ahead ...

Figuring things out

My first month on the job consisted of a wide variety of "how-do-you-do's" with staff who were supposed to tell me about their jobs. It truly takes a community to run a medical center. This was my chance not only to learn the formal organizational structure but also the informal structure.

Not only did I get to know the true power brokers, but also whom to go to with a problem, or to whom I needed to apologize for making yet another mistake. After a while, I lost all sense of self-consciousness for asking questions. I was slowly being absorbed into the culture of the organization, an important transitional step for any new executive. And all the while I knew that people were thinking, "He sure isn't like ... [my predecessor]."

Yet it is people who make things happen. Having gone from a few people working for me to knowing everyone in the whole hospital system that our two campuses encompass was a baptism for me. What was being chief of staff after all?

First, it means serving as the liaison for the medical staff with the rest of the staff. This included talking up the chain, talking down the chain and talking all around the chain of command. It includes serving as the listening ear for all kinds of people, many who really didn't know where to go with their problems.

I also learned how far a smile and a kind word go. Most people are longing for encouragement and an expression of commendation that says they have been noticed. I'm still working on how to best give people the praise and affirmation they deserve, but I wanted to be remembered for the positive after I left, not the negative.

It also helped to have other chiefs of staff as friends to go to, particularly when I had questions about what I ought to do. Their mentorship helped me through some really difficult situations.

My secretary leaves

I had been at my new job for just a month when my secretary popped in with news. She had accepted another position in Florida! I tactfully asked if she was sure that this was something she wanted to do. She reassured me that it was.

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With only a month until her actual departure, we set about trying to put her house in order. A good secretary, I found out, is only a heartbeat away from a health care executive and I really needed someone to keep me on task to know where to be and when to be there.

Suddenly, we needed to plan for her successor. While no one is truly indispensable, sometimes his or her knowledge is. Unfortunately, we lost a lot of information when she left, like several of the electronic files that we later needed. (One year later, for example, my new secretary was finally able to come up with a file plan based on her predecessor's filing and all the files I brought with me from my old job.)

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Other questions I faced: When did I have to be somewhere? Where was it? Where were the minutes from the last meeting?

On the other hand, we were able to come up with a reasonable plan to keep the office in business until we could hire a replacement, something that took three months. I learned that hiring (like firing) in the federal government is extremely slow (it took us roughly a month to advertise the position the first time).

With a lot of flexibility and people chipping in, we were able to make things happen. In addition, I wouldn't trade my current secretary for any in the world! The keys are staying on focus, knowing what the most important things in the day are and having a healthy sense of humor.

Recruiting 101--Two vacancies and a stroke

A special challenge awaiting me was recruiting. No one had prepared me for this difficult task. I arrived finding the chief of surgery position vacant, so getting a new qualified applicant was going to be a challenge.

Add that my chief of geriatrics and extended care resigned for personal reasons at the end of July. Now I was in the middle of a full blown recruiting war for chiefs (not to mention providers!)

My first experience interviewing candidates for chief of surgery taught me that I needed to be a bit more inquisitive. The first candidate brought an impressive dossier, and it wasn't until he arrived for his personal interview that we found out he had been forced to resign his hospital privileges at two previous hospitals.

What would I find out about the rest? Even as I write, this position remains vacant, silent testimony to the fact that qualified chiefs of surgery willing to work full time on governmental salaries are hard to find.

Searching for a chief of geriatrics and extended care was a bit less intimidating. First of all, it hadn't been vacant forever. Secondly, it seemed like we got a greater number of qualified applicants. One came to see us on the advice of the university. Golly, I thought, this was going to be easy.