128_Succession Planning Done Right: Culture, Continuity, and the CEO Transition at TriHealth

Speaker A: Welcome to the HEALTHCARE plus podcast hosted by Quint Studer and Dan Coller. I'm Nicole Webbody, partner at Healthcare Plus Solutions Group. Thank you for joining us as we bring together leaders and change makers from across the healthcare industry. In each high impact segment, you'll hear about the latest challenges organizations are facing and learn how guests are rewiring solutions to drive real change. Plus, you'll walk away from each episode with practical tools, techniques and best practices to implement in your own role and in your organization. For more information on your host or to listen to recent episodes of the podcast, please visit www.healthcareplussg.com podcast. Now here's your host, Quint Studer, who will introduce you to our next guest.

Speaker B: Well, welcome to Healthcare plus podcast and I'm really excited to have Mark Clement with me, the President and CEO of TRI Health out of Cincinnati, Ohio and Dr. Chris Reill. Dr. Riley's uh, a psychologist, industrial psychologist out of Atlanta, Georgia. So the topic today is succession planning. And I've been around long enough to know how tricky this is because when you think about culture, and that's what really comes down to any group organization comes down to culture. Succession planning is so important. Yet I bet you those of you listening have, uh, stories of when it went well, when it didn't go well. Sometimes it can go well because you bring in the right external candidate. Sometimes it cannot go well because you didn't bring in the right external candidate. Sometimes it goes well because you got the right internal candidate. Sometimes it doesn't go well because it's not the right internal candidate. So there isn't one size fits all. When I travel the country, when people ask me who is a best practice in secession planning, I always mention Tri Health. And I think Tri Health, again, there's no perfection, there's no 99% assurance. But I think Tri Health did everything they should have done and wanted to do to make sure they were positioned to continue their culture, which is really a high performing culture. So, secession planning at a high level. Mark, you and I have talked about, I learned about secession planning a lot from you as you talked about how important was. So when you arrived at Tri Health, one of the first things, um, I don't know if you thought of this right away and I don't think it has to be a person has to be a certain phase. With a hospital co today lasting 4.84 years and 8 months, you should almost think about secession planning when you start any job. It doesn't just mean CEOs either. But I know this has been really important to you because you have some of the same observations I have. So walk us through when you first got to Tri Health, when you first started thinking about secession planning.

Speaker C: Well, Quint, as you know, um, because we actually talked about it. Uh, but you know, I began thinking about succession planning even before I started here at Tri Health. Um, um, I started here at Tri Health in uh, my early 60s. I was actually 61 and uh, uh, uh, had served as CEO, president and CEO at three other organizations before returning to my hometown of Cincinnati, uh, in 2015. And I had observed, um, in my career, uh, both outside of my organizations as well as organizations that I had led. Um, I had observed, um, kind of failed succession. CEO succession. And we're talking about actually CEO succession because your audience may not be aware of this. Uh, Quint, I shared with my board, uh, and you're a member of that board, uh, about, uh, a month ago, after 11amazing years here at trial, my plan, uh, to step uh, down as president and chief executive officer, retire from my role here, here and open another chapter in my life. Um, and so I really did begin thinking about this the day that I arrived here because uh, you know, the important work that we've done. And you touched on this in your opening. Important work that we've done here together, you know, our 14,000 team members, uh, has been extraordinarily rewarding. We built a high performing culture. We've emerged as you know, one of the, you know, the leading healthcare, um, you know, organizations from a, um, uh, you know, from the, from the standpoint of consumer trust and preference, uh, in the country. Uh, and uh, I, uh, was hoping that that would be the case when I started here 11 years ago. And it was important to me that the work that uh, we would do in the time that I was here, that it would continue. And sadly, you know, and you touched on this in your opening remarks. Uh, you know, sometimes organizations, uh, don't get succession, CEO succession right, uh, either because they brought the wrong external candidate in or they promoted the wrong intern candidate. And uh, I've seen that in my own, um, you know, personal experience after having left organizations that I, I let lead and I was um, I was, I was um, committed to m m. Do everything in my power to ensure that that wouldn't occur here. So I actually promised the board the day that I arrived here, or you know, metaphorically the day I arrived here, certainly the first year, that I would do everything in my power, uh, to leave this organization a Better organization, um, as a result of, you know, the time that I had the privilege of. And I would do everything in my power to ensure that the board, uh, had, uh, internal candidates to consider, um, if they believed that that work should continue, uh, that they could consider, uh, as my successor when it came time for me to open the next chapter in my life and in my career. Um, and uh, uh, I began those conversations with our board, uh, literally, uh, my first year here. And it really fell into, uh, you know, uh, three phases. You know, the first was just talking about and creating board awareness, uh, of the importance of very intentional, deliberate, um, approaches to CEO succession. Um, then we moved to a more formalized approach. Uh, we'll talk more about that in this podcast. Uh, and then it moved to really identifying a potential successor and putting that individual in a role that would really give that person an opportunity to continue to grow and the board to evaluate and assess whether that was the right individual to, uh, lead the organization. I shared with our board early on, uh, you and I have talked about this, Quint. I read a Harvard Business Review article, um, probably 25 years ago, and it was on the role of a board. Uh, and uh, the takeaway from that article was that the two most important roles of a board are to hire the right CEO and, uh, when it was time, uh, um, to make a change, uh, with that CEO, the two most important roles. And you know, my. My goal in coming here was to first prove that they hired the right CEO and second, uh, provide the board with the opportunity to hire the next, um, the next right CEO for the organization through internal succession planning.

Speaker B: Some, Some big systems sort of have this in place, Mark. They've got, um, you know, big systems, big giant system sort of, first of all, the board's way here, so they're hiring people in a city they're not in. But is there any reluctance? And I think there is to sometimes a CEO maybe talking about a younger age of you, because I think we should all be talking about a secession for every position consistently. But do you think there's any reluctance from, uh, how would a CEO go about explaining this to the board? So the board doesn't think either the person's thinking of bailing or they're thinking they get too focused on the secession. Because that's a tricky, tricky step here.

Speaker C: Yeah, well, you know, I think it was made a little easier just given where I was in my career when I started earquint, uh, and I'd made clear to the board that this would likely be My uh, final CEO role, um, um. As well, uh, in those conversations. And I would tell you that the board welcomed this discussion uh, in those uh because the board, they uh, brought me in from outside because there really wasn't uh a viable internal succession plan succession candidate rather 11 years ago when they recruited uh, into you know, recruited me into this position. So they really welcomed the conversation uh, and did not really see it as a lack of commitment to the organization but just the opposite. A commitment to ensure that the work that we were going to do moving forward would, would continue. And it was all really conditioned on that. You know, um, we, we, we talked at length about what you know, when, when a board would want to look externally for uh a ah, CEO succession candidate and when they would want to look internally. And there's a lot of you know, evidence. And I did, I did bring an expert in to work with me on this succession planning uh process. The succession planning work that really um, was, was very helpful and he said going to be introduced uh, to your listeners in just a moment but was very helpful in educating our board. So they really welcomed this uh, is an opportunity to continue the important work. You know, one of the things I, I learned early on uh, in my career is that as, as leaders we are given a finite opportunity to lead an organization continuing uh, the work of those that have preceded us, oftentimes standing on the shoulders of giants. Um, and that was certainly the case with me when I came to Tri Health. And we're given uh, that opportunity to prepare uh the next leader for our organization, uh that will continue the work beyond us. And if the organization is performing well and a board wants to stay the course and continue the important work that's been underway. That's when a board looks internally when things are not going well and there's a need for renewal and a, and a change in course or direction, then frankly that's, that's a time when the board should look outside the organization. And you know, as I look out my window here, Quint, uh, I'm in Cincinnati, Ohio and I see uh, I see the Procter and Gamble twin towers. There are two towers, uh, in downtown Cincinnati, the corporate headquarters, the inner, the global headquarters for Procter and Gamble. And you know, the Procter and Gamble board has never hired a CEO from outside of Procter and Gamble because that, that board um, is committed to continuing the great culture that has been built over 170 years and is committed to continuing the strategy and the vision and the course that uh, has really made that One of the most admired companies, uh, in the world. And so when I came to TriHealth, my goal was to put our board in the same position where they would want to continue this work. Uh, and, and in doing so, uh, the best, um, leadership option moving forward was internal succession, uh, selection.

Speaker B: Get to Dr. Riley. I'm going to team up also here. Um, I just got a call from a CEO the last week to tell me he had resigned from his position because they had done an internal search and he was one of the candidates and somebody else got the job and it just didn't work out well. And so I think when you have an external candidate, it works, but the internal people get real anxious and real nervous and they start positioning for what happens to the external candidate. Well, it's also difficult on the internal candidate because in his situation there was four or five internal candidates and he was one of the final two. And then you possibly get some politics, you might get some anxiety, you might get some how they making this decision. You might even get into camps, people supporting people. So when you decided to go internally, tell me about how you managed that. And maybe that's where, uh, who knows, Maybe that's where Dr. Reilly came in. Because again, I recommend. I've worked with Dr. Riley since 1996 and the joke was when I heard I was going to go through this assessment for my job at Baptist, I didn't think I'd like it because I thought I'd fail. And once they told me I passed, I thought it was a valid, reliable process. But um, I've worked with Dr. Riley and other people at Sproduto and Associates for a long time. So walk me through the process that you thought of because you were going to have this internal stuff because you have five or six people and how do you handle this type stuff? Because it can be tricky.

Speaker C: Well, you know, you're absolutely right, Quint. Well, first of all, it was not uh, an open or you know, publicly uh, talked about process. Uh, I identified, um, and actually would share with our board during executive sessions on a periodic basis early in this process. I've been here at 11 years and this process really began, um, um, you know, probably 10 years ago. I identified potential successors, uh, and um, put them into a development process, uh, each of the candidates and I engaged Chris Riley, a PhD industrial psychologist, to assist in the assessment process. The good news is that, uh, I'd work closely with each and every one of these individuals. So had a pretty good assessment of them and uh, their potential, uh, for um, Career advancement in growth. When we think about succession planning, we look at current performance. But we also try to assess potential for continued growth, uh in role and the opportunity to potentially grow into uh, a larger, more complex role. And so we identified candidates um, throughout this process, largely at the senior level role, um, um. And uh. Uh, engaged uh, our industrial psychologist Chris Riley, who you'll be. You'll be bringing into this conversation shortly to help. To help to further assess their uh. Strength, their capabilities. Uh, and then with that to prepare a development plan for them that could prepare them to be considered as a succession candidate for my role. Um, and um. I made it clear to each and every one of those individuals and there were about five in total, uh over the course of this process that uh. The uh. The single uh, fastest way to be to disqualify yourself uh from uh consideration was to make this a competitive process. They all heard me loud and clear. Uh, and uh. It never really became a competitive process. I didn't disclose to others who might be in this process. Um, and that in that um. That. That um. You know, development process uh spanned probably five years. Um, you know, I, when I came here, I intended to stay probably six or seven years. And then we had this uh. This global pandemic that none of us anticipated. And then the aftermath of dealing with you know, workforce challenges and financial challenges. M. You know, kept me here uh a little longer than I would anticipate, which gave us even that much more time and opportunity to develop candidates for consideration. Um, but. But you know, internal competition really didn't become an issue because I made it very clear that that that was not acceptable. Not okay. Uh, and uh, it would um. It would result uh, in. In kind of immediate disqualification from consideration as a. As a succession candidate. Um, and I will tell you that as we narrowed the. The um. The field from you know, four. It went from five to four and then four to one. Um, I shared with each of those individuals, uh, um. You know, the decision that I had made that was supported by our board. And um, there was understanding, um, and frankly broad support for that. I can tell you a little bit about that process if you'd like now or we can come back to it after you bring Dr. Riley into the conversation.

Speaker B: I'll come back to it because I think it's really important because you mentioned something. Just cause somebody's very successful on the current role might not mean they got the ability to step it up to the next level. In fact, I remember somebody said some people are like a duck. They look real smooth on the water, but their feet are just pedaling like crazy. And my story with Chris and the group is I was president of a hospital and I had a manager that was really good and another manager quit. And I thought, well, this is great. I'll promote this person into that role. Cause they're doing so good on their current role. And it was a disaster. And when I called up Chris and the group, they said, gosh, I wish you would have told us that. Because this person we could have told you, probably couldn't have, didn't have the ability at this time to take it to the next level. So I think you just can't assume because somebody's a successful internal in their role that they're going to have the power to go to a whole nother level. So. Dr. Riley, um, welcome. Appreciate you being here. So when Mark, tell us from your perspective. Um, and again, I think the other thing I want to know is, well, you're an outsider per se. How do you get to know the inside of the culture as you're going through this process? And maybe you can tell a little bit about, um. Walk me through the process.

Speaker D: Yeah. Well, in this case we had a lot of luck because I was already working with some people in the organization. So being able to see what the culture's like, being on site, meeting leaders, seeing what they go through, was really important because it gave me an understanding of what would a future candidate actually look like in terms of, um, getting along with others, leading others, what would they, the challenges they would be faced with. And typically an industrial psychologist does have a long term relationship. So that allows you. Right, to work with people, to be an outsider, but still not to be disconnected. Right. You understand the culture, the processes, et cetera. So I had that going into it, which was a real benefit.

Speaker B: No, I think that's wonderful. So what do you do? Um, I mean, tell me the process works. Like Mark identifies five people. Maybe you helped him identify the five people. I don't know. So what is the process? I mean, is the board involved? I mean, tell me what you do to see, to sort of evaluate or assess these individuals.

Speaker D: Yeah, let me tell you my side of that, Mark, you can handle the other side since I'm not exactly sure. So we believe in using empirical means of looking at people, not just going with kind of an intuitive feel or how they do overall in an assessment. And the very first thing we have to do is really understand the role. And Mark and I, this is no exaggeration, we probably spent Three months on a draft of what is the CEO role do here? Um, what does the Tri Health weigh? What are the competencies associated with it? So just on the front end alone, we had a great idea about what we were looking for. And that's kind of the beginning thing. If you understand the job, then we go to understand the person. So then we talked about, um, you know, based on that, what would we need to do to look at that person's ability? And we decided a few things. We would want to look at their performance ratings over the, the past few years, how they did on their LEMs or their evaluations. Um, we would want to go through and rate them on the competencies, how well they fit into the culture, the Tri Health way. But we'd also want to do this psychological component. And that's kind of an, it's an interesting process. We do a lot of different things. The first one is a structured interview. And the idea there, if you've been through it, you know how extensive it is. We start with educational background really looking for, um, patterns going all the way back. Did people hold leadership roles in school? Were they involved in extracurricular activities? What was their social confidence like? To really get a feel for the pace of that person's development? Um, we then go through a work history where we're really looking at work dynamics. How well have they worked at different places before? If they left, why did they leave? What motivated them while we were there? Um, we even look at developmental history going back at some things that only psychologists look like, like birth order, values in the family and values you learned growing up. To look at the consistency with the Tri Health way, um, the last part of the interview we actually asked them what are their own strengths, weaknesses, what are their goals? Because self awareness is typically one of the biggest issues in whether people are promoted or not. People who do not have a good self awareness, it's impossible for them to learn and grow. So we go through all of that and then we combine that with different kinds of testing data. We look at preferences, how people like to work, how they like to make decisions, the kind of information they use. Um, we look at another instrument that looks at behavioral characteristics. How do they like to come across to people? What is their executive presence like, their interpersonal skills. So all of that and then we look at problem solving, which is critical. And the final one we look at is basic personality. And when we look at preferences and behavioral characteristics, if something needs to change, we're hoping that they fall in those two realms right because those are changeable with discipline and training and support. Um, we use the basic psychology, um, profile, basic personality to really get a feel for what is natural to that person. Are they going to be a natural fit? Or will they spend their career fighting against something that's naturally them? So we kind of put all that together and then come up with our judgment on readiness and fit.

Speaker B: So mark, Chris, um, Dr. Riley, I call him Chris. Dr. Riley, um, um, goes through this. You gave him candidates. And I've seen it. And it's like, basically, I would call it if you're a patient having a diagnosis, but not more of an assessment, I mean, but really a report on what you've got here and how to work with them. So what was the step? Did you and Chris meet and go over, um, some of his perceptions of the candidates and match them with, of course, yours that were already done?

Speaker C: Yeah. Uh, so Chris, uh, I think explained the assessment process that he took each of our candidates through. Then, uh, with. With the insights gleaned from that assessment or the assessment process, we would meet, we would talk through strengths, weaknesses, development opportunities. And then the three of us would, meaning Chris and myself, as well as the candidates, succession candidates, uh, to uh, talk about development opportunities, uh, um, that would prepare that individual for a higher level, ah, role within the organization, in this case the CEO role. Um, and we tasked each of the candidates individually, um, with Tate, uh, taking the discussion that we had with them, the insights from the assessment, the feedback that I provided around performance, uh, and then uh, assign them with the responsibility to prepare and then bring back to me and Chris a development plan. And uh, we would agree on two or three key objectives, uh, or three, four or five objectives that would really help that leader to grow and to prepare that leader for a larger role within the organization. And it varied from executive to executive. Uh, but we would use that development plan on a periodic basis every three months, uh, to assess progress. And uh, the three of us would meet, review progress. And part of that was a360, um, survey. A360, um, where there was, uh, feedback on that executive's performance from direct reports from peers and from one up. And that was, uh, an important part of this, uh, this, um, these development plans, um, and so that process, you know, those quarterly, you know, review sessions and uh, then annual updates that span probably three or four years.

Speaker B: Wow. Well, you know what? I just.

Speaker C: And I will, if I can, Quint, if I can, I will tell you that every one of those leaders is a better leader today. Even those that did, didn't advance, uh, to the, to this, to the, to the CEO role, which ultimately was, uh, was appointed by our board, uh, just a month ago to succeed me when I, When I stepped down and retired from my role. So every one of those, those leaders would tell you that they are better because of this process they went through.

Speaker B: Well, no surprise we were on the same page right then because what I was going to say was this person I got a call from, who I think is a very. He was a CEO of one of the regions, didn't get the corporate job, and called me to tell me he decided it wasn't a good fit with the new CEO. Um, so they lost. But I just thought of that right now. Every one of the internal candidates is still there. Yes, they're very loyal and it's really cool to see how that worked. The other thing you did, and I know we got. I want to get into one other topic is you had Chris sort of meet with the board too, to help walk the process, didn't you?

Speaker C: Yeah, Let me, let me talk to you about that process. Chris talked about his part. Let me talk about how we engage the board in this process. Um, you know, it started, and I touched on this earlier, there are really three kind of three phases to this. The first was just awareness, you know, making the board aware that this is an important role, uh, that I felt like I had a responsibility for, meaning preparing potential success successors, uh, and a role that the board needed to be fully informed about. Um, uh, and that was followed by a more formalized approach where I really, you know, where we put in place a lot of the structures that Chris talked about and that I talked about as well. You know, development plans. Uh, I would use executive sessions of our board when all, uh, the staff were excused. And um, I would update the board periodically on how each of these succession candidates was performing. Um, we, um, uh, and as we got further into that second formalized approach, uh, I, uh, I asked our board chairman to create, with the support of the board, a, uh, special committee, an ad hoc committee on CEO succession, uh, planning and oversight. And that committee, uh, worked for two years after, after I had worked with these individuals for two to three years before that. Uh, and we had, we had good data to be able to report back on how each candidate was doing. Uh, we uh, convened a, um, again a committee of the board, the special, uh, CEO succession committee. That was in 2021. And that committee met probably two or three or four times. Uh, and um, we used that both to Report those meetings to report on the progress of each of the candidates uh in achieving their development goals and how they were evolving and growing and developing as executive um um as well as my assessment of their readiness for um a next larger position within the organization. But we also use that to build consensus and we run it back to the larger board. Build consensus on the role. Chris touched on this. The role of the CEO at Tri Health in continuing uh the work that has been underway uh as well as core competencies. What for our board became ah non negotiable uh in this succession planning process was uh really three things. One is um ah a demonstrated uh competency as a servant leader. Able to really uh effectively uh uh lead and achieve top decile performance and results as a servant leader. So uh real competency as a leader. The second was um unwavering commitment to people and culture. You know we'd work really hard to build a great culture here and you know top decile engagement uh nationally recognized um for um ah you know consumer trust and preference. Number one in Cincinnati, number one in Ohio among the top 10 in the country uh based upon Monogle which is a national brand consultancy firm rating and ranking of healthcare organizations. So we've made a, A lot of progress. The board did not want to see that uh erode so strong commitment to our culture and our people and servant leadership. And then the third was um an unwavering commitment to continuing our vision and strategy of transforming healthcare for the better, uh embracing population uh health and value based care financing and care delivery models. And uh. So um, um the special committee really endorsed um core competencies, the role of the CEO and those things that were going to be critical in the next CEO of the organization. And then we brought that back to the larger board and um the larger board embraced that as well. And then that brought us to the third phase. Quint. Uh the third phase was uh when I went to the board three years ago and um shared the results of each of these candidates performance, the progress that they made against their development plans and recommended, not recommended, let me say it a little differently and shared with the board that I was going to promote uh one of those candidates Terry Hanlon Bremer uh into the chief operating officer role because I felt that she really met those three criteria. Strong servant leadership, uh unwavering commitment to culture and people and a commitment to staying the course in transforming healthcare for the better. Getting healthcare right. I asked the board to endorse that as part of our. That that appointment is coo. I uh didn't need their approval for this. Um, uh, but I asked them to endorse it as, um, as the final phase of our succession planning process. And, uh, and that would give the, uh, board an opportunity to watch her performance. Uh, she attends board meetings. I, uh, gave her opportunities to present at each of our board meetings, um, to watch her performance and watch her grow. Continue to grow into the role. So when. When it. When. When I made the decision that it was time for me to, um, you know, open the next chapter of my life. And uh, it was an easy decision. Uh, you were at that board meeting. Your Quint is a. Is a member of our board. And I think that, uh, discussion took about 15 minutes.

Speaker B: Well, I think you prepared them so well, Mark. It was like, oh, we thought we'd already done this, but it was just so. Well, no, they were so excited because you prepared them so well. But let's talk now. Not everybody has three years, five years. So I think sometimes it happens quickly. Sometimes you gotta have a depth. And the one thing I think you've done, and it's interesting. Cause I talk to people. We use Chris personally for my companies. And I'll say to people, um, how much is a bad hire worth? Because some people say, well, gee, isn't it expensive to bring in an industrial psychologist? And I'll say, it's more expensive not to bring in an industrial psychologist and make the wrong move, because we all. And you can't. There's no perfection here. There's no perfection here. But, um, you've also really done a great job in two ways. One, the whole pipeline. Cause I think we create pipelines. And you've created a big pipeline we're gonna end this with. But the other pipeline is you've used Chris and your methodology quite a bit for internal promotions, positioning people. Right. Can you talk a little bit about using, uh, beyond the CEO search? Really?

Speaker C: Yeah.

Speaker B: I think you've been the most sophisticated organization I've ever seen on looking at talent, assessing talent and deciding what's the right role and how to develop once they're in it.

Speaker C: What a great question, Quint. Uh, you know, uh, succession planning is not limited to the CEO role within our organization. Uh, we have a very robust approach to succession planning for really all of our leadership positions. We have 900 leaders, uh, in our organization. We're a pretty large organization. We're the largest, uh, health care system, um, in Greater Cincinnati, uh, actually the second largest employer. And we began investing in our people. Um, as you know, um, we had. Began Investing in our people, our leaders, in our culture. Really almost the day that I arrived here at Tri Health, um, I mean we all know that healthcare is a service uh, industry and we deliver service through people and we deliver great service and clinical outcomes by having highly engaged doctors and nurses and allied health professionals and other team members and we have highly engaged um, people, um, by uh, creating a great culture that supports those people in doing their best and being their best. So we went to work on um, investing in our leaders and investing in our people and culture day one and we've made enormous progress. I think our team member engagement 11 years ago when I arrived was at the 26th percentile. We're at the 97th percentile today and have been there for the last five years. Years, um, you know, patient experience, uh, top decile or approaching top decile. So we've made enormous progress. Um, and uh, you know, about three or four years, about three years into my tenure here, um, we, I became really, really kind of concerned about you know, the external uh, searches and external hires. Those, those people that we were bringing into the organization. Um, more often than not, uh, we're not succeeding. Uh, you know, Tri Health is a unique organization and a unique culture. Chris talked a little bit about it. Uh, to be successful as a leader in this organization you have to be highly collaborative and assertive leaders. Uh, you have to be secondly self aware and invite feedback, uh, and recognize that healthcare is a team sport and you're going to get feedback. And it's really aimed at making the team stronger and better like all great teams. The third thing is critical thinking. Being able to think through complex issues and problems, uh, and really understand um, the vital few and what's important. The fourth is, uh, you have to be able to get results in our organization. And then fifth, um, we are a somewhat prescriptive organization. We believe that there are best and right ways to lead. So we have, as Chris indicated, we've developed a very formalized uh, approach uh, to how we lead as servant leaders. Ah, we refer to it as the trial way of leading. And the trial way of leading practices are based on evidence. Um, and um, so three or four years into this, uh, you and I had a conversation about how do you get hiring. Right. Because we haven't been getting it all out right here. And you suggested I meet this gentleman by the name of Chris Riley. And Chris has really helped us to elevate, uh, uh, and dramatically improved. You're right, there is no perfection but dramatically improve success rate from, with external hires. Uh, and just as importantly, to improve, uh, success rate with internal promotion. And so whenever possible, we promote from within Quint based upon the investments that we are making through quarterly LDIs, precision leadership development plans, and uh, you know, um, monthly operations reviews and all the things that we are doing to help our leaders to become better leaders. Uh, whenever we have the opportunity to promote from within, we promote from within. And the vast majority of our leadership, probably well over 80% of our leadership, um, you know, appointments are promotions from within. But um, we do recruit from outside. We recruit from outside when we don't have a bench internally because it's, it's a, it's a kind of a one off position. Uh, or when we feel like we need a fresh set of eyes. Um, and when we do that, we bring, you know, Chris Riley to the table and we um, in addition to the normal interview process, uh, we asked each of these candidates. It's mandatory in our organization. No one gets promoted or hired without, uh, being assessed by Chris and his team. And um, um, no one will be hired from outside or promoted unless, uh, they are judged to be a strong fit within our organization. Um, we actually, in the past long it passed, uh, we have occasionally deviated from that thinking that we could help somebody be successful. And we have always regretted it.

Speaker B: I'm zero for that too. When Chris and I first started working, he'd do a recommend with reservation. And I thought, okay, well I can outdo the reservation. Uh, and uh, I was zero for all of them. So now unless you're a strong recommend, let's not go to the party here together. And I think, and you and I have talked over this for many years with Chris. He really prevents us and also what people miss is he prevents somebody else from accepting a job they might not be successful. So I remember Mark, you and I talking one day and person was interviewing with you. Uh, everybody, very charismatic, all the staff loved him, your team loved him. Yet Chris can identify real challenges with, let's say, problem solving. I've learned if you're not above average in problem solving at certain roles, you're going to really, really struggle because you want to prevent someone from taking a job and them not so them not being successful because it's not going to work. So Chris, uh, what I think, and I think no one does it better. And I think you've saved yourself. And even though they say it's expensive, you've saved people from taking a job they won't be successful in. And you've also helped people get promoted that will be successful. And I think it's really, as you were sitting here, I'm thinking numbers, because I am on your board. And I bet you you're exactly right. I bet you it's 80 to 85% of your promotions are from within. And I bet you there's about 15%. And what I've noticed, Mark, is the better you do this, the less external there are because you're doing such a better job on the internal. So, Chris, walk through outside the co, some of the things that you do to help candidates get developed. And look, is this the right role for them in internal promotion?

Speaker D: Absolutely. So, um, we've got a process here where we look at different leaders, those who have potential or those who are in positions where there's likely to be some turnover. And we want to have them proactively go through the assessment, look at their skills and abilities. So when that role actually opens, they will have had more experiences and more training and support to be ready for that. So we have, I'm guessing, maybe about 40 to 50 different leaders, um, that go through the developmental process here, which is the full assessment, the interview, um, a360 as well. Right. Because we want to round out our data that we have. And then we have them sit down and we sit down with their boss and we talk about what are the, the three things that if you do better, you'll advance in your career and do better on your job. It's not here are the 50 things or here are the 20 things. It's what are the three things? And then we work throughout the year on developmental plans to help them develop them. At the end of a year, we assess, have they actually made progress? Does their performance review show that they've made progress? Right. It's not just the feeling. You want to see different results. So we look at all that and every year we go through it and make sure that we're out there in the organization looking at talent, identifying it and getting it in to take an empirical look.

Speaker B: Well, you do a great job as we wrap up. And I'm going to throw a curveball at you, Mark. Um, and, um, again, I don't want people sitting here thinking, you've got to have five years, three years, all this, because sometimes you have to. What you've done is prepare that next level. So if you, if something happens quickly, you have somebody ready to go in there, you know, the next person. But Mark, you've done something else. Um, you've created this new tool, which I don't Know if you know what I'm talking about. But it's the new tool, which I've never seen anything like it out there, um, to help people sort of say, are we doing what we say we're doing? Do you know what tool I'm talking about, Mark?

Speaker C: Is that our. The tool we created to really assess the um, strength of our culture, uh, to ensure that the organization is built to last. Is that what you're referring to?

Speaker B: Yeah, it's the one that says, okay, are the senior leaders walking the talk or are they remodeling? Yeah, yeah, yeah, you want to talk about that tool.

Speaker C: So, um, our board really, really is, as well as our senior leadership team and the larger organization really, really are committed to continuing the approach, the work that we've started long beyond my tenure here at Tri Health, um, the great culture that we've built. We are not only the most preferred, most trusted healthcare system in Cincinnati. We are based upon, uh, independent, uh, surveys and research, um, not conducted by us but by independent organizations. Uh, but we are really the healthcare provider of choice, uh, for uh, physicians and team members. So um, this is a great culture. We're not perfect, but it's a really great culture that supports our people. And so, uh, in doing their best and being their best for those we serve. Um, and uh. So um, we recognize a lot of research, a lot of uh, evidence that organizations that persist and survive and thrive are organizations that are really focused on preserving their core ideology, their mission, their vision, their values, their culture, while they continuously, um, stimulate progress and improvement in everything else. So we've created a tool, um, that assesses the degree to which we are um, preserving our core ideology. What we stand for, who we are, what we believe in, what we are aspiring to be, and at the same time, uh, continuously improving everything else. Processes, practices, uh, outcomes. And it's eight questions. Um, and uh, we um. Eight questions for each of those two domains. Preserving our core. And we borrowed some. Some of the science from a book written by Jerry Boris and Jim Collins called Built to Last. Uh, Built to Last of the day. Copy of it. Here it is. I just happen to have a copy of it here. Um, Built to Last Successful habits from visionary Companies. And we. We constructed this survey, eight questions for each of those two domains. Uh, we asked our 900 leaders to assess, uh, our performance in each of those, you know, the degree to which, um. You know, um. We, uh. We. We. We are making decisions based upon our values, the value of, uh, and a number of other questions and provide feedback on Each of those two. And um, we were very encouraged with the progress. With the results on a scale of 1 to 5, we were between 4.1 and 4.5 in both preserving core and stimulating progress. We've created this tool uh, because organizations have um, it's human nature. Organizations have uh, atrophy, cultures, atrophy, uh, they drift. And we wanted um, to be able to monitor real time, um, the strength of our organization around core ideology as well as our commitment to continuously improving. And we've um, not only asked uh, our leaders to provide feedback based upon those eight questions, each domain, but we've asked uh, our physicians to do the same. And um, we've just rolled out a pulse survey with team members and um, very encouraging to me, um, leaders, physicians, team members. The results are all very similar.

Speaker B: I think the other thing as we wrap up here is for a board and you and I have been situations where the board might not realize something's drifting early on or even the CEO might not realize it's drifting. People tell us what we want to hear. Big organizations, you just can't put your fingers on everything. And I love about your tool, uh, to me it creates guardrails. So instead of going off the road you hit those little bumps like we're all going to hit that get us on or you get that little beep like you get in a car if you're going out of the lane. So I like it because I think it's continuously monitoring the culture and I had not seen anything like it or anything uh, is doable of doing it and you don't have to spend hundreds of thousands of dollars. But I would think every CEO would like this. I'm sure Terry Handler, Bremmer were going to like it because it's going to tell her in the transition how things are going. I think for a board it's a great gift that they can uh, see this on a regular basis. So I really think that's another legacy that you're leaving. A tool that not only can try health use, of course you've always so generous about allowing what you do to be developed and teaching other organizations. So I'm trying to talk Mark Clement into doing a workshop in Tri Health to talk about culture and to talk about consumerism because that's really where we're going. So again, phenomenal. I always talk about succession planning because I think it's a missing link in many healthcare systems and it's hard to. Even if you do it right, you still might not get it right. But you can, uh, increase your odds of getting it right. So, Dr. Riley, thank you for being on the podcast today. Mark, thank you for being on the podcast.

Speaker C: Well, thank you, Quint. This has been a lot of fun.

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