Research Paper: What is the role of a manager in succession planning in a healthcare organization

FORMAL SUCCESSION PLANNING IN HEALTHCARE ORGANIZATIONS: MEETING LEADERSHIP N EEDS IN A CHANGING AMERICAN WORKFORCE A DISSERTATION SUBMITTED TO THE FACULTY OF THE SCHOOL OF EDUCATION SPALDING UNIVERSITY LOUISVILLE, KENTUCKY BY FREDA BAILEY SHIPMAN IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF EDUCATON LOUISVILLE, KENTUCKY MAY 3, 2007 UMI Number: 3263463 3263463 2007Copyright 2007 by Shipman, Freda Bailey UMI Microform Copyright All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code.

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by ProQuest Information and Learning Company. iii Copyright 2007 by Freda Bailey Shipman iv ACKNOWLEDGMENTS “No Matter what accomplishments you make, somebody helps you,” Althea Gibson I would like to thank my dissertati on committee members for their support and assistance in completing my study. Their input and comments helped guide me and maintain my focus. Special thanks to Dr. Mary Angela Shaughnessy who encouraged me to pursue the doctoral program of studies at Spalding University. I wish to thank Dr.

Marie Sanders for her willingness to serve as my committee chair and her time and patience while working with me, as well as the committee members; Dr. Erlene Grise- Owens and Dr. Hope Zoller Stith. To my frie nd and colleague, Mrs. Gabrielle T. Ingram who initially informed me about the Spalding doctoral program I extend my gratitude, and to Mrs. Jo Russell, Mrs. Jaymne Hamner , Mrs. Sharon Jarnagin Ivey Patterson, Ms.

Sheila Stuckey, Ms. Deborah Tazewell for thei r time, patience and technical expertise.

I would like to thank my husband, Keith, Sr. and to my sons, Keith, Jr. and Thomas for their support during the past three years for often making sacrifices in order for me to be able to attend and participate in the doctoral program. To my parents, Thomas Edward Bailey and Bermadean Wyche Bailey who encouraged me to complete this degree and gave me my strong value fo r education and continued lifelong learning.

To my grandparents who early in my childhood made their own sacrifices to ensure my success. To my sister, Dr. Paron T. Bailey who has been my inspiration and has been supportive through the years, and to my frie nd, Dr. Linda Larkin-Scott who provided me with encouragement and support in the comp letion of this dissertation and to my references: Mrs. L. Sue Stevens, Mrs. Be tty B. Parham and Dr. Terri Moore Brown for their belief in me. To my supervisor, Dr. James A. Flueck, my co-worker, Mrs. Deidre v K. Garrett. To my cohort, particularly Peg Ehlers, Tim Crook, Nick Gargala, Dr. Connie Hayes, Dr. Kevin Hubb, Dr. Larry Owens, Dr. Keith Newman, D’Artagnan Ramsey, Loretta Shake, Chad Wallace, and Deborah Wallace who were supportive and assisted me on my journey; it is to these especial people I dedicate this dissertation.

vi ABSTRACT This research is a qualitative study that investigates succession planning management in four (4) Kentucky healthcare organizations as it relates to the changing workforce demographics. In planning for the 21 st Century workforce, organizations are becoming increasingly aware of the aging workforce a nd implementing strategies to develop career development programs to identify and devel op employees for middle and upper levels of leadership. America’s workforce is aging w ith large numbers of employees eligible for retirement. The supply of future workers a nd leaders within healthcare organizations is dangerously reduced if health care organizations do not plan for the large numbers of employees eligible for retirement. This st udy analyzed the trends expected to impact healthcare organizations as leadership tran sitions occur among an aging population and workforce. This research study examined how four (4) Kentucky healthcare organizations identify potential leaders; use mentoring to address succession plans; retain employees and prepare for workforce dive rsity; and develops leaders within the organization. A major finding of this study was the consistency among all four participant organizations. The findings reflec t the need for healthcare organizations to create formal succession plans to address work force and leadership shortages. The study reveals that none of the participant organi zations have formal succession plans, and leadership development training is in the infa ncy stage of development. The implications for healthcare organizations are signifi cant and demand action now. A crisis in healthcare and related or ganizations can be alleviated if leaders take action to address the aging and shrinking workforce and plan fo r leaders using mentoring and formal succession planning. vii TABLE OF CONTENTS ACKNOWLEDGMENTS………………………………………………………………\ ……………………. iv ABSTRACT………………………………………………………………\ ……………………………………….. vi CHAPTER I: INTRODUCTION ………………………………………………………………\ …………….1 Significance of the Problem/Research Questions ……………………………………………………7 Research Questions………………………………………………………………\ ……………………… 11 Purpose of the Study ………………………………………………………………\ …………………………12 Assumptions and Limitations ………………………………………………………………\ …………….14 Definitions of Terms………………………………………………………………\ …………………………15 CHAPTER II: REVIEW OF THE LITERATURE ………………………………………………….19 Effective Succession Planning ………………………………………………………………\ ……………21 Table 1: Characteristics of and Ba rriers to Effective Succession Planning …………. 25 Benefits and Challenges of Succession Planning …………………………………………….. 27 Leadership Development in Healthcare Organizations ………………………………………….28 Workforce Retention………………………………………………………………\ ……………………. 29 Table 2: Recommendations for Identify ing Leaders within an Organization………. 30 Table 3: Recommendations for Hiring Leaders in Organizations ……………………… 30 Leadership Shortage………………………………………………………………\ ……………………. 34 360 Degree Feedback ………………………………………………………………\ ………………….. 36 Mentoring to Develop Succession Plans in Healthcare ………………………………………….37 Succession Planning and Mentoring………………………………………………………………\ 40 Readiness for Leadership………………………………………………………………\ ……………… 41 Workforce Diversity and Mentoring ………………………………………………………………\ ……42 viii Challenges of Mentoring………………………………………………………………\ ………………. 47 Employee Retention in Healthcare ………………………………………………………………\ ……..48 Workforce Diversity in Healthcare Organization ………………………………………………….50 Generational Diversity………………………………………………………………\ …………………. 53 CHAPTER III: METHODOLOGY ………………………………………………………………\ ………..56 Introduction………………………………………………………………\ ……………………………………..56 Purpose of the Study ………………………………………………………………\ …………………………56 Research Design………………………………………………………………\ ……………………………….57 Populations and Sett ings/Data Collection …………………………………………………………….59\ Limitations and Summary ………………………………………………………………\ ………………….60 CHAPTER IV: RESULTS ………………………………………………………………\ ……………………62 Data Analysis………………………………………………………………\ …………………………………..63 Edited Participant Organization Responses ………………………………………………………….63 Question #1………………………………………………………………\ ………………………………… 64 Figure 1: Formal Succession Planning ………………………………………………………….. 65 Participant Organization A………………………………………………………………\ ……. 65 Participant Organization B………………………………………………………………\ …….. 65 Participant Organization C………………………………………………………………\ …….. 66 Participant Organization D ………………………………………………………………\ ……. 67 Question #2………………………………………………………………\ ………………………………… 68 Figure 2: Define Key Positions ………………………………………………………………\ …….. 69 Participant Organization A………………………………………………………………\ ……. 69 Participant Organization B………………………………………………………………\ …….. 69 ix Participant Organization C………………………………………………………………\ …….. 71 Participant Organization D ………………………………………………………………\ ……. 72 Question #3………………………………………………………………\ ………………………………… 74 Figure 3: Performance Management ………………………………………………………………\ 75 Participant Organization A………………………………………………………………\ ……. 75 Participant Organization B………………………………………………………………\ …….. 76 Participant Organization C………………………………………………………………\ …….. 77 Participant Organization D ………………………………………………………………\ ……. 77 Question # 4………………………………………………………………\ ……………………………….. 78 Figure 4: Identifying Successors for Key Positions …………………………………………. 79 Participant Organization A………………………………………………………………\ ……. 79 Participant Organization B………………………………………………………………\ …….. 79 Participant Organization C………………………………………………………………\ …….. 81 Participant Organization D ………………………………………………………………\ ……. 81 Question #5………………………………………………………………\ ………………………………… 81 Figure 5: Identifying High Potential Employees …………………………………………….. 82 Participant Organization A………………………………………………………………\ ……. 82 Participant Organization B………………………………………………………………\ …….. 83 Participant Organization C………………………………………………………………\ …….. 85 Participant Organization D ………………………………………………………………\ ……. 85 Question #6………………………………………………………………\ …………………………….. 86 Figure 6: Individual Development Plans ………………………………………………………. 87 Participant Organization A………………………………………………………………\ ……. 87 x Participant Organization B………………………………………………………………\ …….. 87 Participant Organization C………………………………………………………………\ …….. 88 Participant Organization D ………………………………………………………………\ ……. 88 Question #7………………………………………………………………\ ………………………………… 89 Participant Organization A ………………………………………………………………\ ……. 90 Participant Organization B………………………………………………………………\ …….. 90 Participant Organization C………………………………………………………………\ …….. 90 Participant Organization D ………………………………………………………………\ ……. 90 Question #8………………………………………………………………\ ………………………………… 91 Figure 8: Healthcare Organization Special Programs ………………………………………. 91 Participant Organization A………………………………………………………………\ ……. 91 Participant Organization B………………………………………………………………\ …….. 92 Participant Organization C………………………………………………………………\ …….. 93 Participant Organization D ………………………………………………………………\ ……. 93 Question # 9………………………………………………………………\ ……………………………….. 93 Figure 9: Succession Planning Evaluation Activities ………………………………………. 94 Participant Organization A………………………………………………………………\ ……. 94 Participant Organization B………………………………………………………………\ …….. 94 Participant Organization C………………………………………………………………\ …….. 95 Participant Organization D ………………………………………………………………\ ……. 95 Question # 10………………………………………………………………\ ……………………………… 95 Figure 10: Special Challe nges with Succession Planning ………………………………… 97 Participant Organization A………………………………………………………………\ ……. 97 xi Participant Organization B………………………………………………………………\ …….. 98 Participant Organization C………………………………………………………………\ …….. 98 Participant Organization D ………………………………………………………………\ ……. 99 Patterns and Themes………………………………………………………………\ ……………………….100 Table 5: Patterns and Themes of Survey Responses ……………………………………… 100 Research Questions and Summary of Responses ………………………………………………..101 Summary………………………………………………………………\ ……………………………………….105 CHAPTER V: ………………………………………………………………\ ……………………………………106 DISCUSSIONS, IMPLICAT IONS AND RECOMMENDATIONS …………………………106 Introduction………………………………………………………………\ ……………………………………106 Discussion of Results ………………………………………………………………\ ………………………109 Implications………………………………………………………………\ ……………………………………110 Recommendations for Further Research …………………………………………………………….11\ 2 Conclusion………………………………………………………………\ …………………………………….113 APPENDICES ………………………………………………………………\ …………………………………..125 Appendix A. Research Ethics Approval Letter …………………………………………………..125 Appendix B. Spalding University Research Ethics Proposal ……………………………….126 Appendix C. Letter to Survey Participants………………………………………………………..129 Appendix D. Informed Consent………………………………………………………………\ ……….131 Appendix E. Interview Guide Questionnaire ………………………………………………………133 Appendix F. Doctoral Dissertation Proposal Acceptance Form ……………………………135 BIOGRAPHY………………………………………………………………\ ………………………………..136 xii LIST OF TABLES Table 1: Characteristics of and Barriers to Effective Succession Planning ………………… 25 Table 2: Recommendations for Identify ing Leaders within an Organization……………… 30 Table 3: Recommendations for Hiring Leaders in Organizations …………………………….. 30 Table 4: Benefits and Challenges of Workforce Diversity ………………………………………. 44 Table 5: Patterns and Themes of Survey Responses…………………………………………….. 100 xiii LIST OF FIGURES Figure 1: Formal Succession Planning………………………………………………………………\ …. 65 Figure 2: Define Key Positions………………………………………………………………\ ……………. 69 Figure 3: Performance Management ………………………………………………………………\ …….. 75 Figure 4: Identifying Successors for Key Positions ………………………………………………… 79 Figure 5: Identifying High Potential Employees……………………………………………………. 82 Figure 6: Individual Development Plans………………………………………………………………\ 87 Figure 7: Replacement Charts………………………………………………………………\ ……………… 89 Figure 8: Healthcare Organization Special Programs ……………………………………………… 91 Figure 9: Succession Planning Evaluation Activities……………………………………………… 94 Figure 10: Special Challenges with Succession Planning ……………………………………….. 97 1 CHAPTER I: INTRODUCTION Because of the aging workforce, healthcare organizations are facing a leadership and workforce crisis. Today’s employees are working in an information age and knowledge-based economy. Baby boomers are often seasoned professional employees with a wealth of information, knowledge and experience regarding technical and program skills, and are considered the historians for the organizations of which they are employed (Schiller, 2005). Younger employers (generat ion Xers) often lack the experience, work ethic and life experiences of their predecessors. It is critical for healthcare organizations to position themselves for success and focus on the fundamentals that will help healthcare organizations sustain themselves in the 21 st Century. This is a qualitative study that investigates the characteristics of a formal succession plan and identifies ways healthcare organizations can make succession planning mo st effective to ensure organizational success over time. The past decade of downsizing and reorganization has robbed organizations of developing leadership talent waiting in the wings to step into leadership roles. Additionally, an increasing numb er of employees are retiring with fewer years of service and at younger ages, fewer are entering th e workforce and more employees desire flexible work schedules (GAO-01-241, 2001). These trends have reduced America’s 2 workforce and limited the job opportunities for workers with the potential, energy and innovative ideas needed for today’s knowledge-based workplace (Rothwell, 2001). The supply of future workers and leaders within healthcare organizations is dangerously reduced if healthcare organi zations do not plan for the large numbers of employees eligible for retirement and the large number of senior employees leaving organizations (Camden, 2005; Goddard, 1989; Schiller, 2005). According to the Bureau of Labor Statistics, healthcare is one of the fastest growing occupational areas. Fourteen of the 30 fastest growing occupations are related to healthcare. “Employment of medical and hea lth service managers is expected to grow faster than the average for all occupations through 2012, as the health services industry continues to expand and di versify” (Braddock, 1999, p. 55). Mentoring and succession planning are leadership development models that contain aspects for identifying and retaining talent for future leadership roles within an organization. Soonhee (2003) defines succes sion planning as an ongoing process of systematically identifying, a ssessing and developing organiza tional leadership to enhance performance. Similarly, Rothwell (2001) defi nes succession planning as a deliberate and systematic effort by an organization to ensu re leadership continuity in key positions, retain and develop intellectual knowledge cap ital for the future, as well as encourage individual advancement. Succession planning presents a paradigm shift for human resource management to help organizational l eadership identify, recruit, train and retain a pool of employees who demonstrate high poten tial for leadership development. To ensure leadership progression for the next ge neration of leaders, succession planning is a 3 model that involves strategic planning within organizations with the purpose of mentoring and grooming younger employees for pos itions of leadership (Rollins, 2003). As reflected in much of the literature, mentoring is a recurring trend supporting succession planning. Mentoring is not a new conc ept and dates back thousands of years. According to Greek Mythology, in 800 B. C. Od ysseus, the king of Ithaca was headed off to fight in the Trojan War and left his s on Telemachus at home in the care of a friend, Mentor. In many ways, the defi nition of mentor relates to this Greek Myth, as mentoring is a form of supporting and teaching others who have a desire to learn (Leahy, 1996). Mentoring is an exchange of learning. According to Dolan (1996), healthcare management has a great tradition of mentor ing. Studies confirm what many intuitively know – the single most important influence in a person’s life is the relationship with a caring adult, which is the cornerstone of mentoring (Coughlin, Wingard, & Hollihan, 2005). There are many definitions of mentoring; however, the literature reveals several common themes. A mentor is typically an experienced, high ranking organizational member who assists in the career development of the person being mentored (mentee) by serving as a coach, sponsor and advocate (Kram, 1985; Noe, 1988). The person being mentored is a new or less experienced orga nizational member. Mentors are defined as those who help to shape the professiona l identity (Javidan, Bemmels, Devine, & Dastmalchian, 1995), model appropriate profes sional behaviors (Ragins, 1989), render guidance and support (Burke, 1984), teach the in tricacies of the work environment (Kram & Isabella, 1985), provide political sponsorship (Kanter, 1997), and facilitate entry into organizational and professional networks (Ibarra, 1993). Leahy, (1996) defines 4 mentoring as a “mutually agreed-upon relationship between an experienced company veteran or industry veteran and a less experi enced worker who’s eager to learn” (p.1). Kibby (1997) defines a mentor as one who brin gs in a rich history of experience and wisdom learned in the school of life–an inva luable asset to any organization that can reveal hidden opportunities and help the company avoid pitfalls and mistakes. Succession planning and mentoring are hum an resource tools that compliment each other. Organizations ar e realizing the benefits of mentoring as a strategy for succession planning and are investing in formal programs to serve as career development and management training tools (Burke , McKeen, & McKenna, 1993). Succession planning is a tool that ensures that the right people with the right skills are in the right place at the right time to meet the orga nization need over time (Rothwell, 2005). Labor market trends and the demand for critical skills dictate that organizations can no longer neglect the critical task of pla nning their future workforce. According to Rothwell, Prescott, and Taylor (1998) some of the trends in the workplace and workforce include: 1. Changing technology 2. Increasing globalization 3. Continuing cost containment 4. Increased speed in the market place 5. The growing importance of knowledge capital 6. An increasing rate and magnitude of change Competitive organizations know that investing in their workforce through career development opportunities pays off in multiple ways. Benefits of career development 5 include attracting, retaining and developing employees with talent and potential. Career planning gives individuals an opportunity to identify their career goals and develop themselves to achieve those goals. “Wit hout career planning, succession planning is a wish list; without succession pl anning, career planning can be a roadmap leading to an uncertain destination” (Rothwell, Ja ckson, Knight, & Lindholm, 2005, p. xv). Planning for human resources needs is one of the greatest challenges facing managers and leaders today. In order to m eet this challenge, a uniform process that provides a disciplined approach for matching human resources with the anticipated needs of the organization is essential. Formal succession planning is necessary to organizational success and long-term viability. The United States workforce is growing older in the 21 st Century. Between 1998 and 2008, several job vacancies will occur due to retirement. “Sixty-four million baby boomers (over 40% of the US Labor Force) are looking at retirement in large numbers by the end of this decade.…By 2010, the number of US workers ages 45-54 will grow by 21%, while the number of 55-64 year olds will expand by 52%. Many in the latter age group are looking ahead to re tirement” (http://www.conference-board.org, retrieved 11/14/05, pp. 10-11). According to (Rothwell et al., 2005), workforce statistics alone should motivate healthcare organizational leader s to act in thoughtful ways to ensure the long-term organizational leadership stab ility. These statistics have far-reaching implications for the United Stat es and international economies: • One in five senior executives in Fortune 500 companies is eligible for retirement within the next five years. 6 • About 80 percent of all senior ex ecutives and about 70 percent of all middle managers in the U. S. Federal governments are eligible for retirement during the current administration’s term in office.

• About 50 percent of the entire federal government workforce is eligible to retire now.

• One million college professors will soon be eligible for retirement. Because of the aging workforce, formal succession planning and mentoring should be high on the list of human res ource goals for organizations. In the 21 st Century, turnover and change among employees and with in leadership and management staff is now a common occurrence. Leaders and employees are leaving the workforce due to retirements, disability, death, downsizing, earl y retirement, lack of commitment, natural disasters, need for flexibilit y, and an individual’s desire for entrepreneurial pursuits. America’s workforce is aging with a large number eligible for retirement, which also means that senior employees are leaving the workforce in large numbers (Braddock, 1999). In today’s workforce, many baby boomer s have numerous roles including dual career families, caring for parents, long commutes, smaller families, fast-paced lifestyles, living away from extended families, and a dditional workplace demands (Camden, 2005). The various personal roles and workplace requi rements may also be reasons why people are opting to leave the workplace when or be fore they are eligible. The mass exodus of employees exiting the workforce is presen ting challenges for organizations, while providing opportunities for those seeking employment and advancement in their careers. Additionally, the growth rate of the labor force is expected to decline secondary to a 7 decline in population growth and a reduction in overall work force participation, including women’s labor force. The Bureau of Labor Statistics (BLS) projects a slowing of growth in the labor force, from a rate of 1.7 perc ent per year between 1950 and 2000 to just under 0.8 percent per year between 2000 and 2050….In the current decade and in the years after 2030, th e 16-64 age group will grow at the same rate as the overall population. From 2010 – 2030 the increase in this group will be between 0.2 and 0.3 percent, lower than the total population growth (Schiller, 2005, p. 31). Significance of the Problem/Research Questions Succession Planning is a t ool that is synonymous with an old parable about fish: “Give people a fish and they can eat for a day; teach people how to fish and they will eat for a lifetime” (Chinese proverb). The concept of succession planning dates back to biblical wi sdom of leadership. “The leaders of the Bible, as well as today’s most astute business and civic leaders, wanted competent, mature leaders with the right priorities and values following in their shoes (or sandals)” (Wolfe, 2002, p. 196). The idea of succession planning was first introduced in the 20 th Century by Henry Fayol (1841- 1925) who claims that management has a responsibility to ensure “the stability of tenure of personnel” (Rothwell et al., 2005). Help me to develop leaders in every generation, and I will perpetuate the organization forever….The most su ccessful, long-lasting organizations make a conscious effort to devel op leaders in every generation. 8 Leadership development training programs in the 21 st century mirrors biblical leadership with succession planning. In the beginning of time, leadership development and su ccession planning were not done consciously. Much of the activ ities took place naturally and spontaneously. The organization that began in Biblical times (religion) has sustained itself for almost sixty centuries; modern corporations would do well to borrow some of its techniques (Wolfe, 2002, p. 195 – 200). Succession Planning and mentoring are to day’s human resource tools that can help organizations become “great” while focusing on future and current needs and identifying talent within an organization. Collins (2001) studied “great companies” and what makes great management and organizations. He states that organizations must have the right people on the bus, the wrong peopl e off the bus, the right people in the right seats and then figure out where to drive on the right bus at the right time. In developing disciplined people, leaders always think first about “who” and then about what (p. 13). This approach is helpful to organizations in identifying people with the right skills needed for leadership and other key positio ns within an organization. Collins (2001) wrote about building lasting or ganizational greatness; he identified this as “clock building, not time telling” (p. 199). Truly great organizations prosper through multiple generations of leaders, as opposed to an organization built around a single great leader, great idea, or specific program. Succession planning and mentoring are receiving increased attention within healthcare organizations’ strategic plans for l eadership development. With the number of employees within the workforce now eligible for retirement, organizations are quickly 9 trying to identify new talent to step into the roles of those employees slated to exit the workforce. Succession planning and mentori ng are human resource tools that assist organizations with developing strategies to prepare for workforce changes that could occur at any time, thus reducing panic w ithin an organization and providing a smooth transition when leadership changes occur. Th is strategy ensures a successful transfer of knowledge without changing the culture, sy mbols, structure and politics of an organization too drastically. This proactive approach eliminates the lag time common in the hiring process by successors when leadership positions change (Wolfe, 2002; Rothwell, 2001; Jacobs & Fraser, 1987). Succession planning and mentoring helps orga nizations identify talent within the organization, leaves a legacy and prepares those individuals for expanded roles. Mentoring helps organizations grow by planning for the future, planning for succession and transmitting knowledge. It also prom otes healthy organizational growth by establishing and strengtheni ng networks and communicati on between generations of employees. Succession planning and mentoring are altr uistic and may affect the bottom line as teaching tools that satisfy an individual’s ne ed to help others. Most people have an inner need to assist others and be instru mental in promoting individual growth and developing future leaders. The long-term positive effect of mentoring may fulfill this need and enhance leaders’ se lf-esteem. Drucker (1998) suggests that many variables create a leader which include s work experience, hardship, opportunity, education, role models, and mentors. 10 Succession planning is a tool that is synonymous with the old parable about fish, and a saying about turtles and helpin g others: Alex Haley, author of Roots, says, “Whenever you see a turtle on t op of a fence post, you know he had a lot of help getting there.” Aletha Gibson wrote, “No matte r what accomplishments you make, somebody helps you.” As Einstein observed, we all st and on the shoulders of giants who came before us. Succession planning and mentoring al lows healthcare organizations to plan for future leaders’ departures; thus becomes pr oactive in addressing the potential gaps of knowledge among essential leadership personne l and high priority occupations within healthcare (Pieper, 2004). Fulfilling the responsibility to give, most leaders want to repay an organization that has provided opportunity to them. Providing future leaders with mentors is one of the best ways to ensure the long-term su ccess of the organization. John Maxwell is known as one of America’s experts on leadersh ip and espouses a leader’s “daily dozen,” where he encourages leaders to look for potential leaders and provide leadership experiences. Maxwell (1995) writes that what leaders do best is help others succeed by “leading, empowering and then getting out of the way” (p. 308). Leaving a legacy of leadership is the responsibility of the lead er, the lasting value that will be measured by the leaders’ successors (Maxwell, 1998).

In order to be effective, succession pl anning and mentoring must have the support of human resources and top management with in an organization. Resources are needed to fund programs to develop and cultivate new l eaders. In efforts to develop a successful program, potential successors must be identifi ed early in their careers, as change in leadership is generally stressful for most or ganizations. An effective succession plan can 11 help reduce stress in the workplace among the st akeholders. A change in leadership can be a smooth process that eliminates or decreases organizational in stability and improves the organizations effectiveness when successi on planning and mentoring are part of the organizational culture (Abrams & Bevilacqua, 2006) . Research Questions This study examines the demographic predictions expected to impact healthcare organizations as leadership transitions occur due to an aging population and workforce. The following research questions guided the researcher: 1. What are the characteristics of an effective succession plan?

2. Are healthcare industries identify ing potential leaders for future organizational needs?

3. Are healthcare industries using mentoring to develop succession plans? 4. Are healthcare industries addressing employee retention? 5. Are healthcare industries preparing for the shift in workforce diversity? Succession planning is a relatively ne w concept within human resources management. The concept of succession planning has created a paradigm shift among human resource leaders. Traditionally, hum an resource managers took care of basic operations of the workforce and were more doc ile in their administrative functions within an organization .

Today’s human resources have become mo re involved with the strategic plans of an organization and have obtained a seat at the table with top management ensuring that 12 competent staff are hired to help organizations meet their objectives and achieve success. Because this is a paradigm shift for organi zations, it is expected that there is limited research on best practices in organizations with succession plans. There is competition in the workforce among organizations to be an employer of choice in efforts to attract, recruit and retain talented employees. Therefore, human resource departments in healthcare organizations are becoming more vital in their role in helping organizations to achieve success with a smoothly operated or ganization and a well-trained and competent workforce (Rebore, 2004, Goddard, 1989, Wellins and Byham 2001). Purpose of the Study This research seeks to examine how four (4) healthcare organizations identify potential leaders; use mentori ng to address succession plans; retain employees and prepare for workforce dive rsity; and develop leaders within the organization. The implications for healthcare organi zations are huge and demand action now. Preventing a crisis in healthcare and other organizations can be alleviated if leaders take action to address the aging and shrinking workforce and prepare for a new wave of unprepared workers. According to McWilliams (2005), healthcare organizations need to implement succession planning and effective mentoring programs because: • 172 corporate vice presidents were in the World Trade Center at time it collapsed. • 87% of senior managers and 78% of middle managers in the Federal government are eligible to retire. • One in seven senior executives in the Fortune 500 is eligible for retirement in the next few years. • Airline pilots, industrial engineer s, college professors, and HR practitioners are the o ccupations with the highest percentage of job incumbents age 50 or over. 13 • Government (at all levels) and li ght manufacturing industries in the US have the most aged workforces. • Right now, one million college professors and one million public school teachers are eligible fo r retirement and 50% of all community college presidents are ready for retirement.

• Nationally, half of secondary schoo l teachers are 45 years old or older, with 65% expected to retire by 2008. • 2/3rds of the increase in the “US Population between 2000 and 2050 will consist of immigrants. This means that applicants for these positions will be lacking: o English proficiency o Sufficient education and training o Citizenship” These statistics are startling and have huge implications for the 21 st Century workforce. The implications for health care organizations are critical and demand attention now. Preventing a crisis in health care and other organizations can be alleviated if leaders are proactive in th eir approaches to address the aging and shrinking workforce and prepare for a new wave of unprepared workers. An effective succession plan at a time when workforce diversity offers unique challenges regarding employee retention is e ssential to leadership identification and corporate development (Rothwell, 2001). This qualitative study will investigate the characteristics of a formal succession plan and identify ways healthcare organizations can make succession planning most effective for leadership development to ensure organizational success over time. As many organizations find themselves unprepared for leadership shifts, they must analyze changing demographics within the workforce (Rothwell, 2001). The purpose of this study is to analyze pred icted employee shortages and develop an organizational approach to address wo rkforce needs and challenges for the 21 st century.

The goal of this study is to develop strategi es for healthcare organizations designed to 14 retain knowledge of retiring or departing employees while increasing knowledge and skills among current employees and those iden tified for leadership positions. Succession planning presents a paradigm shift for human resource management in helping organizational leadership to identify, recruit, train and retain employees who demonstrate high potential for leadership development. If succession planning and mentoring are employed in healthcare organizations to addr ess workforce-planning issues, then steps are needed to develop and transfer orga nizational knowledge and power to younger and newer employees, thus the need to recruit out side of the organization is reduced when workplace vacancies occur. Assumptions and Limitations The scope of this research is limited to four (4) private and public healthcare medical centers in Lexington, and Louisville , Kentucky. Data may be limited based on the numbers of healthcare organizations choos ing to complete the research survey. The literature review is limited to the past 10 years (1996 – 2006) and the literature may reflect the changing needs of employees such as flexible work schedules, virtual work assignments, family demands, and demographic tr ends as it relates to age and retirement. Data may be limited on reasons employees le ave their organizations for other than retirement reasons. There are 95 medical/sur gical healthcare facilities in Kentucky and 40 facilities with a capac ity of 150 or more beds as iden tified in the Kentucky Hospitals 2006 Guide. This research will sample only those medical/surgical fa cilities with 150 or more beds (N=4) to get a representation of succession planning management in healthcare facilities located in Louisvill e and Lexington, Kentucky. A review of the literature reveals that there are a limited number of examples of leadership succession 15 plans related to healthcare management and few peer reviewed articles or comparative studies addressing healthcare a nd its use and practice of succession planning. However, there were articles on the skills and compet encies needed for developing leaders. Definitions of Terms For the purposes of this study, the following terms and phrases are critical to this research. Several terms and definitions have meaning within the context of the succession planning experience and among human resource professionals. 1. Succession Planning Management – an effort designed to ensure the continued effective performance of an organization, division, department, or work group by making provision for the development, replacement, and strategic application of key people over time (McWilliams, 2005).

2. Technical Succession Planning – any effort designed to ensure the continued effective performance of an organizati on, division, department, or work group by making provision for distilli ng, preserving, maintaining and communicating the fruits of the organization’s institutional memory and unique experience over time (Rothwell & Poduch, 2004).

3. Mentor – A mentor is typically an expe rienced high ranking organizational member who assists in the career deve lopment of the person being mentored (mentee) by serving as a coach, sponsor and advocate (Kram, 1985).

4. Workforce Planning – A guide for developing wo rkplace competencies to meet organizational strategic plans (opm.gov).

5. Benchmarking – The approach of establis hing operating targets and productivity programs based on industry best practices (Rothwell, 2001). 16 6. Human Capital – Professional employees with a wealth of information regarding technical and progr am skills and are considered historians for the organizations of which they are employed (opm.gov).

7. Competencies – Behavior based attributes of employees, which examines their strengths and weaknesses in leadership (Rothwell, 2001). 8. Best Practice – recommended practices by subj ect matter experts who have experience, are referred to as profes sionals, and have experience with consistent success rates.

9. Traditionalists – persons born before 1945.

10. Baby Boomers – persons born between 1946 – 1964.

11. Generation X’ers – persons born between 1965 – 1977.

12. Millennials – ( also known as Generation Y, born 1978 and after).

13. Generational Differences – A shared tradition and culture by a group of people that is lifelong (Arsenault, 2004). 14. Human Resource Management (HRM) – Also known as human resources, functions to hire, retai n, develop, and motivate personnel in order to achieve the objectives of the organization, to assist individual members of the staff to reach the highest possible levels of ac hievement, and to maximize the career development of personnel (Rebore, 2004).

15. Diversity – includes people from differing cultures, races, religions, ender, physical ability, backgrounds and va lues (Ivancevich & Gilbert, 2000).

16. Retention – the act of retaining, to hold s ecure as in retaining productive employees. 17 17. Leadership – the process of influencing lead ers and followers to achieve organizational objectives through change (Lussier, 2001). 18. Replacement planning – managers identify and help groom their replacements before moving on to another position themselves (Rollins, 2003). 19. Paradigm Shift – a framework for how one views the world that affects judgment and decision making.

20. High Potential – employees who have the poten tial to move up the career ladder in 6 months, one year, three years, five years or an adequate time frame for the organization (McWilliams, 2005). 21. Employee Improvement Plan also known as an Individual Development Plan– a means for the individual to docu ment and track progress for personal and professional development activities (McWilliams, 2005).

22. Bench Strength – the availability of strong and deep pools of talent, able to assume a number of varied leadership roles at various levels within an organization (Kesler, 2002; Rothwell, 2001). 23. 360-degree feedback instrument – a tool used to gather high-quality performance feedback from peer s, superiors and customers 2004). 24. Prejudice: The tendency to form an adve rse opinion, without just cause, about people who are different from the mainstream in gender, race, ethnicity, or any other definable charac teristic (Lussier, 2001, p 436).

25. Ethnocentrism – The belief that one’s own group or subculture is naturally superior to other groups and cultures (Lussier, 2001, p. 436). 18 26. Glass Ceiling- An invisible barrier that sepa rates women and minorities from top leadership positions (Lussier, 2001, p. 436). 27. Multiculturalism – involves increasing the consciousness and appreciation of differences associated with the heritage, characteristics, and values of many different groups, as well as respecting the uniqueness of each individual (Rothwell, 2001, p. 18). 28. Healthcare Industry: Companies that develop, ma nufacture, market, and/or distribute health-related pr oducts or provide healthcare services such as hospitals, nursing homes, HMOs, me dical product suppliers, medical equipment and medical device makers, a nd medial laboratories (Healthcare Industry. n.d.retrieved 3/12/07).

19 CHAPTER II: REVIEW OF THE LITERATURE Actuaries have predicted numerous paradigm shifts and workforce shortages that will affect the American Labor Market in th e twenty-first century. America’s workforce is aging and a large number of CEO’s, management, and employees are eligible for retirement. Succession planning management in the healthcare industry is receiving increasing attention in the lite rature. Since the 1990’s, there is some discussion about succession planning and mentoring which addresses workforce concerns for future leadership. The predicted mass exodus of employees presents challenges for the healthcare industry and crea tes opportunities for those remaining employees. This paradigm shift is expected to deeply affect the healthcare industry employees and has implications for the workplace, as we know it today. It appears that healthca re industries have not prepared well for succession planning. A survey by Richard Gifford and Nancy Davidson (April 1985) shows that only 18 percent of hospital CEOs questioned ha d identified a successor to themselves as compared to 36 percent of non- healthcare corporate CEO’s. Of those hospitals CEO’s, who had selected the persons to replace them only 51 percent helped prepare that person for a leadership role as opposed to 71 per cent in the corporate sphere. Recent studies found that the average tenure of a nonhealthcare CEO is seventeen (17) years and three 20 (3) years for a healthcare CEO (Jacobs & Fr aser, 1987). According to an October 2004 American College of Healthcare Executives (ACHE) study, many hospitals do not practice adequate succession planning (Burt, 2005). The healthcare industry has grown to a market based industry subject to the changing demands of multiple stakeholders. Swift changes in technology, delivery of services, increased demand for services and decreasing revenue require organizations to make changes in order to remain viable to move employees for the next level for leadership and other positions. The dema nd for competent healthcare workers will increase as the population ages and begins to experience age related illnesses and diseases. As the baby boomer generation ages , there will be a change in the supply and demand for workers in different industries a nd occupations leading to potential shortages of workers in healthcare a nd education (Schiller, 2005).

In reviewing the literature related to healthcare organizations, there is a limited amount of information regarding leadership succession planning related to healthcare management. There were few peer reviewed articles or comparative studies addressing healthcare and its participati on and engagement in succession planning. However, there is research defining the skills and competencies needed for developing leaders. The objective of this chapter is to review the literature relevant to the analysis and importance of addressing the following questions: 1. What are the characteristics of an effective succession plan?

2. Are healthcare industries identifying poten tial leaders for future organizational needs?

3. Are healthcare industries using mentoring to develop succession plans? 21 4. Are healthcare industries a ddressing employee retention?

5. Are healthcare organizations prepari ng for the shift in workforce diversity? Effective Succession Planning According to Wolfe (2002), the concept of succession planning dates back to biblical times and the wisdom Jesus exercised in his leadership role as he carefully picked twelve disciples, which allowed him to develop additional leaders. The transition from leader to leader was both smooth and rocky; however, the chosen future leader’s mission and vitality was kept intact. It also kept their leadership engine powerful. Today, organizations realize the value of having compet ent leaders as well as a pool of potential leaders from which to pick at any given time, leaders with the skills necessary to remain successful in today’s global economy. Smart companies and strong organizations have succession plans in place that have constantly assessed all of its “high potentials” so that if an emergency or planned move occurred, there would be people in place to accept the role of leadership. The U. S. government has a succession plan in place in case of the death, im peachment, or resignation of our top executives. We are all too familiar with this scenario through the cases of John F. Kennedy, Richard Nixon, Spiro Agnew, and Bill Clinton. However, succession planning exists for a reason, and smart companies ensure that they too have a succession plan in place that addresses all contingencies, even the “unt hinkable” (Wolfe, 2002, p. 199).

Inevitable changes and challenges occur w ithin the workforce of an organization and may include disability, death, natural di sasters, relocation, downsizing, separations, 22 terminations and retirements. A mentorship training program is one strategy in succession planning that is designed to addre ss workplace needs. Succession planning is a very important human resource model that helps with workforce planning needs and builds bench strength within an organizati on (Rothwell, 2001). It includes mentoring new leadership and developing a plan to transfer organizational power to younger employees. According to Rothwell (2001), succession planning can be help\ ful and minimize disruption when senior em ployees leave an organization. Succession planning is a proactive appro ach that helps leaders deal with unexpected changes and has been defined in many different ways. However, for the purposes of this literature review, this researcher will use the definition coined by McWilliams (2005), succession planning management is an effort designed to ensure the continued effective performance of an organi zation, division, department, or work group by making provisions for the development, repl acement, and strategic application of key people over time. Added to the vocabulary of succession planning is technical succession planning. It is defined as any effort designed to ensure the continued effective performance of an organization, divisi on, department, or work group by making provisions for distilling, pr eserving, maintaining and commu nicating the fruits of the organization’s institutional memory and unique experience over time (Rothwell & Poduch, 2004). The most popular framework for understa nding succession planning is described by William Rothwell, Ph.D. Rothwell (2005) defines succession planning as an effort designed to ensure the conti nued effective performance of an organization, division, department, or work group by making provision for the development, replacement and 23 strategic application of key people over time in efforts to preserve, maintain and communicate the institutional memory and unique experience over time.

Succession planning is an evolving human resource model that cannot be a one-time activity. It is an ongoing examination of what the organization should stop, start and continue (McWilliams, 2005). Organizations should examine themselves to identify potential leadership candidates. Kesler (2002) cal ls this analyzing leadership “bench strength” and consulted with 25 major companies observing various approaches to succession planning. He concluded that replacement planning was obsolete in today’s workforce and that succession planning includes a comprehensiv e set of assessment and development practices that support the entire workforce fo r identifying talent at all levels of the organization while nurturing talent and potential at all levels. He found that leadership development has been observed for more than 25 years in Fortune 500 companies such as GE, Exxon and a few others as they devel oped best practices for developing future leaders. In 1973, Walter Mahler wrote Executi ve Continuity, one of the first reports detailing reports of how l eading corporations planned for the replacement of key executives and found succession planning to be an important complement to executive leadership (Kesler, 2002).

In the mid 1980s, many Fortune 500 companies adopted General Electrics (GE) approach; however, by the 1990s, succession planning was lost in organizational bureaucracy. McKinsey and Company (1997) completed a study on the “war on talent” and found many succession planning practices unsuccessful; they concluded that executive leadership had been an und er-utilized asset for two decades. 24 Labor market trends and the demand for leaders with high critical thinking ability in tandem with leadership skills dictate th at organizations can no longer neglect the critical task of planning thei r future workforce. Labor market trends and the demand for essential skills dictate that organizations can no longer ne glect the essential task of planning their future workforce. According to Rothwell et al. (1998), some of the trends in the workplace and workforce include:

1. Changing technology 2. Increasing globalization 3. Continuing cost containment 4. Increased speed in market place 5. The growing importance of knowledge capital 6. An increasing rate and magnitude of change Competitive organizations know that invest ing in their workforce with career development opportunities is an investment that will pay off in multiple ways. Benefits of career development include attracting, retaining and developing employees with talent and potential. Career planni ng gives individuals an opportuni ty to identify their career goals and develop themselves to achieve those goals. “Without career planning, succession planning is a wish list; without su ccession planning, career planning can be a roadmap leading to an uncertain destination” (Rothwell et al., 2005, p. xv\ ).

Planning for human resource needs is one of the greatest challenges facing today’s managers and leaders. In order to meet this challenge, a uniform process that provides a disciplined approach for matching human resources with the anticipated needs of the organization is essentia l. Because of the aging workforce, succession planning and 25 mentoring should be high on the list of human resource goals for organizations (Rebore, 2004, Goddard, 1989 Wellins and Byham 2001). Although the literature does not report a formal model of succession planning, its influence appears to be borrowed from busin esses and organizations that have achieved success in identifying, developing and selecting new leaders for their organizations. The succession planning procedures differ from or ganization to organization and the political climate of the organization influences how it is implemented. The literature review yielded a number of important traits for organizations to consider in relation to best practices and reveals that ther e is no one approach that can be used for all healthcare systems. Leaders and HR personnel will need to design their succession plan based on their organizational mission, strategic goals, and workforce needs of their respective organizations. The following ta ble summarizes best practices from the literature. The table includes variables that s hould be included to develop a succession plan as well as barriers associated with strategic planning. Utilizing th is systems approach may address the predicted shortages of l eaders, which include: (The results are in Table 1) Characteristics and B Table 1: Characteristics of and Barri ers to Effective Succession Planning Characteristics of Effective Succession Planning Barriers to Effective Succession Planning • Be proactive • Communicate with all stakeholders • Identify talent at all levels of the organization • Promote from within the organization • Lack of vision • Lack of leadership support • Inertia among employees and leadership • Fear of change • Underestimating the importance of succession 26 • Embrace diversity • Flexibility within strategic planning • Create learning and performance opportunities designed to develop, and strengthen talents and skills • Identify individual and professional career growth needs • Modify the plan when needed • Use assessment to guide education and training • Measure performance by reporting and record results of succession planning • Report results to leadership and stakeholders • Celebrate achievements and begin again planning • Lack of creativity and problem solving skills • Failure to set aside fund for personnel development and training • Restriction of people within organizations with leadership skills • Personal bias • Favoritism and Nepotism • Choosing the wrong people for the wrong job • Procrastination • Missing a leader • Including too many non leaders • Does not relate to the organization’s strategic goals • Not letting people learn from their mistakes • Being impatient Adapted from: (Thorndyke & Grigsby, 2005; McWilliams, 2005; Rothwell, 2001; Rothwell, 2002; Rothwell et al., 2005; Tr opiano, Jr., 2004; Byham & Nelson, 1999; Yancey, 2001; Hutton, 2003; Bartling, 1997; Benchley, 2004; Byham, 2002; Walker, 2005; Kovach, 2005; Goudy, 2002) Because of the complexities of healthcare syst ems, there is no one size that fits all process or magic bullets for implementing a successful succession plan. A succession plan in healthcare must be attuned to current paradigm shifts that occur as the healthcare industry continues to evolve due to workforce trends, diversity, consumer, and community needs. 27 Benefits and Challenges of Succession Planning According to Abrams & Bevilacqua, (2006), the benefits of succession planning for healthcare organizations include the cr eation of organizational legacy to retain workplace knowledge and maintain strong leadersh ip, which in turn is a catalyst for long term high performance. The benefits are numerous which include:

1) preservation of workplace culture, norms and traditions 2) returns on investments, money savings 3) higher patient satisfaction rates 4) improved physician satisfaction and increased referrals 5) positive employee identification with the healthcare system 6) operational metrics improvement 7) financial metrics improvement 8) organizational survival 9) workforce retention Just as there are benefits, there are al so challenges associated with succession planning. For some leaders, retiring or leavi ng a leadership position compares to writing a will or planning one’s own funeral. Th is dynamic suggests that succession planning may be hard to implement as it addresses the emotional issues associated with change for retiring CEO’s, as well as the political interest of key stakeholders within and outside of an organization (Davis, 2005; Jacobs & Fraser, 1987).

Developing a succession plan for some lead ers can be difficult due to ego related concerns or an inability to relinquish power, which makes it di fficult to think of leaving. 28 Oftentimes, organizations political issues or competing priorities replace the importance of finding and mentoring a successor. Succession plans should not occur when a leader announces their departure, but as soon as they are selected for the position. Effective succession planning encourages the leader to consciously acknowledge a “life after the leadership transition” making it less difficu lt to implement the process (Davis, 2005). Succession planning is only eff ective when used well and is supported by the CEO’s who believe in and value the plan. Leadership Development in Healthcare Organizations This literature review addresses th e concerns of succession planning at all organizational levels within the healthcare industry. The healthcar e industry is in the midst of a human resource crisis. The h ealthcare industry is comprised of business organizations in a variety of settings includi ng: managed care, long-term care, hospitals, ambulatory care and home health care. The workforce crisis began in the 1990s and continues to grow. The market for healthcare workers continues to escalate as the workforce ages and there is a decline in the number of new workers. The healthcare industry did not invest in leadership development historically to the same extent as leading companies in other sectors (Abrams & Bevilacqua, 2006). According to Garman, Tyler, Darnall, and Lerner (2004), effective healthcare leadership requi res administrators to master a host of complex interpersonal skills, including persuasion, negotiation, conflict management and understanding diverse perspectives, (p. 308). In healthcare, the gap is widening be tween the supply and demand for a skilled workforce and healthcare industries are competi ng among themselves in this talent war. 29 In an effort to become an employer of choice, healthcare leaders need to identify a pool of talented employees throughout the system , provide career planning and development activities and ensure employee accountability to ensure that their organization has the leadership talent required to succeed over time (Rothwell, Jackson, Knight & Lindholm, 2005). An investment in leadership deve lopment and training programs helps the healthcare industry develop an organizational culture that maximizes its performance and is adaptive to market challeng es (Abrams & Bevilacqua, 2006).

Workforce Retention Health at Work national st udies indicates that when compared to other industries, healthcare employees are found to have the lowest level of commitment to their organization; 40% of workers in healthcare ha ve plans to leave the industry (Wilkins, 2004). The lack of employee commitment in h ealthcare industries serves as a challenge for healthcare leaders in retaining employees and empowering them with skills required to be competitive in the industry. Additionally, healthcare systems are growing in size and complexity, and the workload is beco ming more demanding, making leadership less attractive to those who mi ght be eligible or interested (Camden, 2005; D Aunno, Alexander, & Laughlin, 1996). John Maxwell (1999), one of America’s ex perts on leadership development, says that everything “rises and falls on leadership, (p.xi).” Maxwell outlines characteristics necessary to identify future leaders and te n leadership qualities one might seek when hiring new employees. Similar to Maxwell, Kouzes and Posner (2002) developed a checklist for leadership and identified the ten most mentioned characteristics for admired leaders. The following Tabl es summarize their findings. 30 12anization Table 2: Recommendations for Identifying Leaders within an Organization Recommendations for Identifying Leaders Within an Organization • Modest, conscientious, superior intellect • Visionary • Life long learner • Honesty and Integrity • Resilient • Healthy sense of ambition • Respect and genuine appreciation for others • Determination and Perseverance • Creative thinker and problem solver • Loyal • Multitalented • Reflective Table 3: Recommendations for Hi ring Leaders in Organizations Recommendations for Hiring Leaders in Organizations • Understanding the organization’s people and market • Flexibility • Transferable and diverse working skil ls including problem solving-thinking strategically 31 • Interpersonal and political skills required to interact with all levels of staff • Proven track record of success and accomplishments, drive to succeed • Visionary, forward thinking • Charismatic and influential • Positive attitude and energy • Effective communication skills and an ability to resolve conflict • Discontent with the status quo • Desire, passion, ability to lead • Self discipline and an ability to work independently Adapted from, (Maxwell, 1999; Kouzes & Posner, 2002; Bennis, 1989; Collins, 2001; Johnson, 2003; Ibrahim, Soufani, Poutziouris, & Lam, 2004) From this chart, one can deduce that ther e are leadership challenges in developing leaders. Individuals are taught to take new challenges and to do things they have not done previously which will help develop ski lls for challenge, uncertainty, turmoil and change. Maxwell, (1999) and Kouzes & Posner , (2002) feel that leaders learn lessons by doing things that they have never done. In an era when it can cost several thousand dollars to hire and train employees, it is very important that those dollars be invested wisely i.e. not multiple times for one position, which allows a good return on the company’s investment. Organizations must consider their mission, population, care, and services while ensuring the availability of co mpetent staff. Selecting leaders who meet all the criteria above may ensure the sustai nability of the organization under high quality leadership. 32 An efficient and effective Human Resour ces (HR) Department is necessary to hire, recruit, train, retain, and maintain a wo rkforce capable of leading and sustaining the ongoing achievements of management ’s objectives. An HR department can be successful in achieving these goals by keeping abreast of the current market trends in employment hiring best practices a nd being proactive in developing stra tegies that will provide for a workforce that is diverse and skilled (Rothwell, 2005).

There are paradigm shifts in healthcare that the industry must consider when identifying high potential employees for leader ship development to ensure that the right person for the right job with the right skills is present at the right time. According to Harris (1996), organizations should be aware th at job stability is no longer a guarantee. The evolving workplace calls for new thinking about relationships with employees. Research reveals that workers need to be life long learners as pay is now dependent on job performance and accountabi lity. Technology is playing a critical role in the change of how, when and where organizations and em ployees do business. Organizational work is taking on a new look as employees integrat e work, community environments, roles and responsibilities of families, and personal life (Harris, 1996; Collins, 2001).

Supporting the knowledge and skills need ed for healthcare leadership, Morgan Executive Development Institute (2004) identif ied five (5) performance competencies among hospitals’ and health systems’ leaders. The behavioral competencies are collaboration, innovation, continuous l earning, risk taking, work/life balance (Anonymous, 2004). Likewise, Leck and Wang (2004) identif ied five (5) core strategies that organizations use to develop effective lead ers. Organizations rely on leadership 33 development programs that develop potential le aders and maintain or improve the quality of the existing leadership in conjunction with the leadership competencies needed to create meaningful business results. A recent survey by the Council for Adult and Experiential Learning (CAEL, 2002), noted grow ing interest in “soft,” interpersonal skills to complement traditional and analyti cal business skills,” such as adaptability, agility, and the ability to view and evaluate the “big picture.” Creative problem solving, team building, communications skills, and broad social influence have been cited as key leadership competencies (Huy, 2001).

Maccoby (2004) discusses the importan ce of organizations finding the right leaders. Organizations must maintain that leadership selection and development from a systems approach. For example, having a sy stematic understanding of the organizational needs helps to determine the type of lead er needed. Using the systems approach, leadership selection is based on the organizatio nal needs vs. an ideal leader who fits the mold but has no understanding of the organiza tion and its interconnecting parts, and how they influence one another (Dillon, 1998). As healthcare systems change, the requirements for leadership also changes. Byham, Nelson, and Paese (2000) suggest when de veloping criteria to select a leadership candidate, an organization may use an a ssessment center to determine targeted competencies, classify skills, and behaviors, and identify development needs; these tools can be used for organizations within and outsi de of healthcare. Leadership development from within the organization can be advant ageous for healthcare systems. Having a group of competent, highly trained individuals eliminates high cost, uncertainty and time commitments associated with recruiting fr om outside sources (Byham et al., 2000). 34 Accountability is a driving force in today’s leadership circles. Increased publicity about poor leadership decisions and attempte d cover-ups may have forced the issue of accountability to the forefront of discussion ab out responsible ethical leadership (Hocker 2003, Abrams and Bevilacqua, 2006). This para digm shift is reflected across disciplines including education, government, and busin ess organizations. The challenge for organizations is to give more reflective thought to the competencies desired for their future leadership vacancies (Rothwell, 2005). There are growing tensions among generations in the workplace and age is an important leadership considera tion. Thirty-five to forty-five years of age may be the ideal range for leaders to be taken serious ly, and a college education and professional business experience are necessary credentials to positions of leadership. It is expected that individuals between the ag es of 35-45 years have some youth, vitality, vigor, drive, and energy; they are gaining maturity and life experience (Hocker, 2003). Maturity and life experience are necessary trai ts for leadership selection. Leadership Shortage The leadership shortage presents a leadership challenge for the healthcare industry. According to the literature (B urt 2005, Rothwell, 2005), a viable solution appears to be identifying internal candidates for promotion from within the organization.

This strategy provides a win- win situation for key stakeholders by increasing employee retention and thus eliminati ng the high cost and time commitments associated with recruiting and hiring leaders from outside sources. This strategy allows employees to add value to the organization by giving them rec ognition and considerations for opportunities for advancement. In attracting future leader s, Wellins and Byham (2001) report that “the 35 key is to integrate selection, retention and succession management systems thereby ensuring that the organizati on brings in the best people, keeps them around and adequately prepares them to assume future leadership roles,” (p. 06). Once individuals with leadership poten tial are identified, Leck and Wang (2004) suggest they are given assignments that stretch their areas of expert ise. Leaders should be mentored and coached by senior level st aff and finally, these leaders need guided exposure to learn about the organizational cu ltures, politics and the way things are done in the organization. The challenge for the hea lthcare industry is to identify high potential individuals early in their car eers when long-term developm ent can have the greatest impact. Leadership plans and succession planning provides healthcare systems an opportunity to develop a pool of top candidates with demonstrated leadership skills from within the organization, when an urgent need for new leadership is not needed. Historically, healthcare relied on replacement planning, an outdated HR strategy where managers were solely responsible for singling out and grooming their replacement.

(Abrams and Bevilacqua, 2006). Leadership de velopment uses a broader scope to assess those with leadership potential without atte mpting to isolate single individuals to fill certain positions (Burt, 2005). From this pool, top candidates can be selected to step in when leadership positions become available.

The selection process of new leaders often involves pol itics. Favoritism also influences decisions about people selected for leadership development within or outside an organization. People are often promoted becau se of their family ties or status within the organization rather than their abilities and contributions. Nepotism is practiced in 36 many businesses. Tragically, these practices erode self-esteem and potential (Hutcheson, 2003). Unfortunately when organizations a llow politics and personal preference to influence the selection process, often less talented individuals are selected wasting organizational resources (Kovach, 2005) According to Johnson (2004) and Kovach (2005), politics are played out as individuals from outside of an organization are being selected for leadership. This practice often contaminates th e selection process and creates a divide among individuals who are committed to the organization and the community it serves. The greatest mistakes the new leader often makes is coming into an organization with the intention of fixing the past mistakes of management before evaluating the people, policies and, procedures for the organization or unit (Johnson, 2004, p. 137). Persons with high levels of leadership are often selected; the challenge is to prepare them for future, larger roles and re sponsibilities. A well-designed, well-executed development program, tailored to the need s of high potential managers, can offer organizations a competitive edge by growing thoughtful, flexible leaders for the future within the organization (Kovach, 2005). However, being selected for leadership development does not guarantee a new job or promotion. 360 Degree Feedback Maccoby (2004) reports that when organi zations are understood as a system, the needs for leadership will be determined on how the system is structured with an additional challenge of fitting the leader into the leadership roles that are needed. The 360-degree feedback is a tool widely used in leadership development programs. Aspiring leaders receive anonymous feedback from peer s, subordinates, supervisors, and have 37 effective means to meet or exceed individua l and professional goals. Research shows that effective leadership development is en hanced by feedback from others (Brutus, London, & Martineau, 1999; Hazucha, Hezlet t, & Schneider, 1993; Walker & Smither, 1999). Although not foolproof, the 360-degree tool is effective in the business sector; however, the tool was not developed specificall y for healthcare administrators. In fact, prior research concluded that content from 360’s developed in one sector may not be generalized readily to other settings such as health care (Walker & Smither, 1999; Brutus et al., 1999). Another barrier to using the device is the cost of implementation and the cost for initial software setup. Fried ( 1997) reports the option of developing 360-degree assessment surveys in-house is not readily available to many healthcare organizations because of the specialized knowledge required to avoid common errors in design and delivery, an accessibility issue for some healthcar e settings. In summary, the validity of the 360-degree instrument for healthcare admi nistrators appears questionable compared to its usage in other private sector cor porate spheres (Fletcher, Baldry, & Cunningham- Shell, 1998; Lepsinger & Lucia, 1997; Garman et al., 2004). Mentoring to Develop Succession Plans in Healthcare A ream of literature has been written on mentoring, however, not much has been written specific to healthcare. Most info rmation focuses on business and organizations, therefore in this section of the literature review, the words healthcare industry and organizations will be used interchangeably to address this human resource tool. Healthcare organizations provide healthcare service such as hospitals, nursing homes, health maintenance organizations, etc. wh ereas healthcare industries refers to the 38 companies that develop, manufacture, market and/or distribute health-related products (Healthcare Industry n.d. retrieved 3/12/07). Interest in mentoring relati onships as a vehicle to guide career advancement has grown considerably in recent years and eviden ce indicates that mentees accrue substantial benefits from mentoring relationships. Thes e benefits include higher promotion rates, greater career satisfaction, a nd higher overall compensation than those who have not been mentored. Mentoring relations hips contribute to the knowledge of corporate culture for career progression, grows leaders internally, prov ides action learning activities and is cost effective (Dreher & Ash, 1990; Fagenson, 1989; Scandura, 1992; Turban & Dougherty, 1994; Whitely, & Dougherty, 1991). Mentoring has a record of accomplishment for success and is a way for leaders to create a legacy. “Everyone who succeeds has ha d a mentor,” said Donald S. Perkins, former Chairman and CEO of Jewel Companies (Roach, 1979). Mentorship training programs have increased as the demand for mentoring as an empl oyment strategy has risen in the last decade. Corporate organizations reali ze the value and benefit of mentoring in the workplace. Benefits for healthcare organizations include having a competent workforce for leadership selection thus reducing employment cost associated with recruitment, along with the uncertainty a nd the time associated with recruiting from outside sources (Byham et al., 2000). There is a mentoring crisis in the workplace, even though many organizations have developed formal mentoring programs. Recent employment trends may have a grave impact on succession planning and stride s taken to compensate for the predicted 39 shortage of labor. As companies continue to merge and diversity impacts the workforce demographics, the demand for mentoring has never been higher (Zey 1988). There have been discussions about the importance of leadership development in healthcare management and th e role mentoring plays in leadership development. According to the American Council of Hea lthcare Executives (ACHE), there has been a rebirth of formal mentoring programs in hea lthcare since 2001. However, little is known regarding the effects of mentoring in health care organizations. Mentoring is employed to improve retention and leadership developmen t. Mentoring programs, however, are not considered an automatic guarantee for upward mobility for all individuals selected to participate in such programs (Pieper, 2004). There is a recent trend toward developi ng formal workplace mentorship training programs to nurture employee learning and de velopment. The healthcare industry is being challenged to create a learning environment and develop life long learning programs for employees. Implementing mentoring programs is one method of encouraging career development across all leve ls and in particular as preparation for leadership. Mentorship traini ng programs are utilized in every arena of employment to some degree to include business, healthcare, education, government and non-profit organizations (Murray, 1991).

The concept of mentoring is touted in the literature as a way to develop high potential employees and is proving advantageous for men, women and minority groups (Murray, 1991). Mentorship training program s are considered a means to develop young and high potential employees with leader ship potential by giving them impact assignments, mentoring, formal career development programs and formal education. 40 Mentorship training programs offer employees the opportunity to be involved in special projects with high visibility, targeted organizational assignments, assignments with cross functional teams and interagency groups, developmental assignments, rotational assignments and details involving other organizations or other agencies (McWilliams, 2005, p. 7). McWilliams (2005) defines mentoring as the cheapest, easiest, most effective and most fulfilling means of ‘closing your gaps’ in the succession planning process.

Mentoring is a cost effective tool that supports succession planning and serves as an effective way of helping employees ac quire the necessary skills, organizational knowledge, culture, and confidence to progress into more upward mobility positions within the workplace (Rothwell, 200 5, McWilliams 2005). Mentoring works simultaneously with succession planning to help with workforce retention of high performers, and aids in conflict resoluti on, enhances an individual’s confidence, reinforces cultural change and diversity, a nd supports the retention of organizational technical knowledge and culture (The Taylor Clark Partnership LTD, 2005).

Succession Planning and Mentoring Mentoring is an essential factor in developing a successful succession plan. Succession planning and mentoring are human resource tools that complement each other. Organizations are real izing the benefits of mentoring as a strategy for succession planning and are investing in formal progr ams to serve as career development and management training tools (Burke et al., 1993) . A mentorship training program is one strategy in succession planning designed to address workplace needs. Thorndyke and Grigsby (2005) reiterate the need for succes sion planning and describe it as a “specific 41 type of mentoring designed to build legacy within the organization while mentoring for succession provides the retention of the knowle dge assets of the leader and leaves a continuing imprint upon the organization” (p.2) . Succession planning is a very important human resource model that helps with workfor ce planning needs. It includes mentoring new leadership and developing a plan to transfer organizational power to younger and newer employees. Succession planning can mi nimize disruption when senior employees leave an organization. Purposeful and inte ntional succession planning is a systematic process of identifying, asse ssing, retaining, developing a nd replacing organizational leadership in efforts to ensure leadership cont inuity in key positions for the future and for advancement over time (Rothwell, 2001; McWilliams, 2005; Soonhee, 2003). Healthcare organizations should ask three questions as they develop succession planning and mentoring programs: 1) What do we have? 2) What do we need, and 3) How are we going to design and implement plans? (McWilliams 2005, p. 4).

Readiness for Leadership Organizations are experiencing age gaps in the workplace because of retirements, separations, downsizing, hiring freezes, buyouts and layoffs. In efforts to ensure leadership progression, succession planning has become a model for strategic planning for healthcare systems. Organizations are realizing the benefits of mentoring as a strategy for succession planning and are investin g in formal programs to serve as career development and management training t ools (Burke et al., 1993). In the 21 st Century, it is imperative that organizations make strate gic plans to address globalization, increased technology in the workplace, changing demographics in the workforce, security threats and quality of life issues (Jor gensen, 2005). It is critical to apply succession planning and 42 formal mentoring programs to healthcare in e fforts to remain competitive. Knowledge of demographic trends within the workforce and knowledge of future leadership needs will help sustain organizations for the future. Discussions among leaders in healthcare about the importanc e of leadership development and the role mentoring plays in l eadership development are on the table. In efforts to get the most out of healthcare re lations (Pieper, 2004) identifies a six-phase mentoring cycle that may help potential ment ees and mentors gain a better understanding of what to expect and to maximize the success of a mentorship. The six phases consist of 1) choosing a mentor/mentee, 2) getting ac quainted 3) setting goals, 4) growing the relationship, 5) ending the relationship, and 6) evaluati ng the relationship’s success.

In healthcare, there appears to be a lack of individuals ready for leadership.

Perhaps those with potential are not identified or developed which results in a shortage of new leadership (Coonan, 2005). To address the need the American College of Healthcare Executives (ACHE) chartered a Leadership Mentoring Network in 2001 to develop quality health care leaders while improving the future of leadership in the healthcare industry. Recommendations include expandi ng networking and mentoring opportunities with other healthcare executiv es, cultivating good relationships with stakeholders, creating career development opportunities , and developing guidelines for ethical decision-making. Workforce Diversity and Mentoring Healthcare organizations are providing care to a wider variety of patients as American society becomes more diverse. Acco rding to a recent report by the Institute of Medicine (2002), the healthcare needs of pa tients from minority groups are not always 43 being met. There is a lack of communication that acts as a barrier between patients and healthcare workers and can negatively affect the quality of healthcare received by minorities (Lien, 2004). In contrast, failure to achieve workforce diversity can affect patient satisfaction, public relations, staff morale, employee retention and result in financial cost to the orga nization due to discriminati on complaints (Jackson, 1992).

According to Guillory, (2004), workfo rce diversity should reflect one’s community. He maintains society plays a role in correcting the existing gap among ethnic groups’, representation in healthcare organizations, which has resulted in a polarization of cultures within the community and the workplace. To realize the value of diversity in the workforce, healthcare leaders must understand the principles of diversity:

value, trust, respect, excellence, comp assion, and commitment. Diversity in the workforce encompasses more than external or visible features such as age, gender, race, ethnicity, religion, disability, re ligious beliefs, and sexual orientation. Diversity also extends professions, level of education, life experiences, and even financial status thus resulting in culture or divers ity barriers that make it difficult to see beyond the surface yet, each begging for mutual respect. Two trends have given rise to th e importance of workforce diversity:

demographic changes show an increased minority population in the workplace and globalization of industry and economics, thus, multiculturalism has become a way of life in the United States (Lussier, 2001). By 2008, the U. S. Census Bureau census data reveals that nearly half of all of the nation’ s new workers will be classified as minorities, i.e. women, people of color and ethnic minorities (US Census Bureau, 2001). This cultural shift changes the fabric of the workforce. As diversity increases within the 44 workforce and a growing global economy for ces organizations to rethink models of business success, healthcare organizations must decide how they will ensure organizational readiness. Aligning busine ss strategies with current and future demographic and market realities may help organizations achieve growth, profitability, and sustainability (Martino, 1999; Wh eeler, 2001; Fitzpatrick, 1997). Rothwell (2001) suggests promoting multic ulturalism in the workplace helps create opportunities for diverse groups and reflects the nation’s population. While one recognizes the strides society has made to improve under representation of ethnic and minority groups at various levels in the workfo rce, factors still exist that substantiate the continued inequality and inequity for oppor tunities among minorities. Differences of opinions about progress of minorities and the existence of prejudice and discrimination continue to vary among cultures, so much so that these differences suggest that minorities and non-minorities have problems understanding, let alone accepting, the other person’s perspective or perception on any given situ ation (Deidre K. Garrett, EEO Manager, Lexington VA Medical Center, February 13, 2007). Such awareness allows one to acknowledge that obtaining and retaining a diverse workforce will not be accomplished without challenges. Benefits and challenges of multiculturalism as it impacts organizations are outlined below in Table 4.

Table 4: Benefits and Challenges of Workforce Diversity Benefits of Workforce Diversity Ch allenges of Workforce Diversity Profit, performance and talent Leadership Improved bottom line and marketing advantage Stereotypes and Prejudice Competitive advantage – can be cost effective Ethnocentrism Superior business performance Unfriendly work environment 45 Attract the best and the brightest Policies and practices that work against diversity Employee satisfaction, loyalty and organizational strength Glass Ceiling- an invisible barrier that separates women and minorities from top leadership positions Creative problem solving and decision making The cost of ignoring diversity Adapted from (McCuiston, Ross Woolridge, & Pierce, 2004, p. 74-77); (Lepsinger & Lucia, 1997).

Any organization that wants to be su ccessful in the 21st Century and beyond should continue efforts that build upon the prin ciples of diversity to improve in all areas of performance including problem solving and customer service. Employing principles of diversity principles to cr eate effective work groups may improve work relationships within and among diverse culture s and decrease the number of discrimination complaints.

Using the principles of diversity as cornerstones for improved employee relations underscores the importance of having and ma intaining a diverse workforce and defines the direction for the organization (Deidre K. Garrett, EEO Manager, Lexington VA Medical Center February 13, 2007). On the other hand, ignoring this need places the organization at risk for stagnation and ultim ate dissolution in an ever-changing business environment. According to Messa (1998), a diverse workforce gives organizations a competitive advantage by enabling them to be tter meet the needs of their customers, successfully compete in the global marketplace, and hire from an expanded labor pool. Mentoring is a venue that most organizations utilize in the current work environment. The question must be asked: How diverse ARE those who mentor and those WHO are being mentored? Ambrose (2003) reminds us that mentors tend to mentor someone who is “like them.” “The y often do not think about reaching out to 46 those who are different in race, culture or ge nder because they are either unaware of the need for the unknown” (p. 60). When diversity is added to the equation and design of an organization’s mentoring program, the focus can help leadership understand the value of having culturally diverse indi viduals providing input in deci sion-making processes. This mindset is especially important today as healthcare managers interact with an increasing diverse patient population (Ambrose, 2003). Effec tive leaders in healthcare must develop and carryout mentoring programs that support diversity, increase the number of minorities in the managerial and leadership ranks and strategically prepare them for upward mobility (Ambrose, 2003). Some c onsiderations for planning a successful diversity driven mentoring program include understanding differences, defining program goals, involving top leadership and soliciting input from participants (McCuiston et al., 2004). Hill (2004) studied the relationship of mentoring and race and found that mentoring programs can benefit most race gr oups typically excluded from the informal mentoring relationships includ ing women and minority groups . His study suggests that minorities are frequently left out of mentoring relationships with the dominant members of an organization’s leadership team those w ho could provide needed career advice (Hill, 2004). Both cross race and same race mentori ng relationships provide career support in terms of trust and attainment. According to Hill, same-race relationships have shorter and easier periods of initiation, provide a greate r sense of identification, increase levels of intimacy, enhance balance in work life and soci al development, and aid in grappling with issues of inclusion and professional id entity in early career phases. 47 (Rothwell et al., 2005) identifies nine commandments of a successful mentoring relationship: 1. “Be proactive: Don’t wait for your mentor or protégé to contact you.

2. Negotiate a commitment: Agree to have regular contact at predefined intervals.

3. Establish rapport: Learn as much as you can about one another.

4. Be confident: Each of you has something important to offer the other.

5. Communicate: Share your knowledge and experience openly.

6. Be a good listener: Hear what your mentor or protégé is saying to you.

7. Be responsive: Act on what you have planned.

8. Be accessible: Have an open-door or open-phone policy.

9. Take responsibility: It takes two to crea te a successful mentoring relationship.” (p. 164-165) Mentoring is necessary to nurture employee learning and development. Healthcare systems are challenged to devel op life long learning programs for employees and are implementing mentoring programs as one method of encouraging career development in preparation for future leadership. Mentoring bene fits the organization and employees by providing a cost effective wa y of developing leaders internally because those individuals are knowle dgeable of the healthcare system for which they are employed (Allen & Poteet, 1999).

Challenges of Mentoring There are benefits as well as cha llenges to developing mentoring training programs for succession planning. Compared to non-mentored employees, those who are mentored often receive greater organizatio nal reward (promotions), reach financial prosperity sooner, and enjoy increased job satisfaction and commitment (Chao, Walz, & Gardner, 1992; Mobley, Jaret, Mars h, & Lynn, 1994; Roach, 1979). The positive 48 outcomes of mentoring often enhance the car eers of the mentor and the mentee. The literature supports that mentoring can help to expedite leadership development, increase job satisfaction, and influence promotional opportunities. With benefits come challenges. Ment orship training programs can fail if not supported by organizational leadership and if mentors themselves have not had training in their career development (Fracari, 2006) . Other challenges may come from selecting the wrong person as the mentor due to a mis understanding of the purpose or a lack of willingness to share helpful information with the mentee. Additionally, some mentors lack the ability to teach others or have no interest in sharing their organizational knowledge. As stated earlier Leahy (1996) found that there is a natural tendency to share one’s knowledge about the workplace; howev er, not all employees embrace the concept of mentoring and some do not feel a need or desire to share their knowledge base. He also found that some lack the ability to te ach others. The body of knowledge is limited for training the mentor and the mentee. (Rot hwell et al., 2005) discusses how mentoring contributes to career development and succession planning, citing that the organization benefits most from mentoring. The cha llenge for organizations lies in evaluating mentoring relationships including the positiv e and negative outcomes of mentoring as well as how to encourage these relationships for effectiv e leadership transition. Employee Retention in Healthcare Employees having various careers in various occupations and workplaces during their working years charact erize today’s workforce (Goddard, 1989). Given the projections for workforce shortages, employees in retirement may be asked to return to the workforce. Having a skilled workforce adds to the viability of any organization and 49 contributes to the success of healthcare systems. Replacing employees is expensive to the organization and underscor es the importance of retaining valuable employees (Rothwell, 2005). A motivated workforce is needed for excellent customer service. In healthcare, major changes are occurring: the industry is becoming more consumer driven, employs an aging popul ation, and the work is becoming more specialized due to increasing technological demands. Decisi on-making is data driven and an emphasis is placed on teamwork. There is a growing consensus that multiskilled health care employees can contribute to exte nding professional roles, reducing shortages of personnel, and reducing costs (Hyde & Fo ttler, 1995). The trend of outsourcing is occurring in positions for which recruitment is considered difficult. Other sources of labor are utilized for healthcare shortage s including volunteers, older workers, the disabled and immigrants (Mateo and Smith, 2001).

To meet the workforce needs of the futu re now, healthcare organizations must understand the competencies necessary for positi ons that need to be filled; more concise job descriptions will allow for more cri tical thinking, decision-making when hiring, developing, and evaluating employees. The American workforce is becoming smaller and less sufficiently skilled; more global, vi rtual, diverse, autonomous, and empowered (Tucker, Kao, & Verma, 2005). The outlook for the American workforce is faced with enormous challenges as predictions for a gene ration of workers are expected to retire in mass numbers. The challenges signal an alert for healthcare organizations to think about expected outcomes and to examine their process in workforce development to effectively address these trends. 50 The era of downsizing has diminished the talent supply and created a new workforce of free agents, employees who work as consultants and want flexible work schedules in addition to time and an opportunity to balanc e relationships and lifestyle choices plus independence and an element of co ntrol over their work environment. Free agents are usually highly skilled employees who no longer have a desire to work in a traditional work setting (Byham & Nelson, 1999; Kennedy, 1996). If this trend is influencing healthcare organizations and is re flected in the available selection pool of prospective employees, then organizations wi ll need to validate these assumptions and make new arrangements to remain competitive in the workforce. Workforce Diversity in Healthcare Organization The United States is becoming more diverse resulting in demographic changes in the workforce. These two trends have made it imperative for organizations to address workforce diversity in ways th at create win-win situations for all parties. Another trend creating diversity among workers is globali zation; organizations are marketing their products and services worldwide (Lussier, 2001). The workforce is better educated and refl ects more diversity in their beliefs and lifestyles (Coates, Jarratt, Mahaffie 1991). Th e census data reveals that by 2008, nearly half of all of the nation’s new workers will be individuals traditionally classified as minorities; i.e. women, people of color, and ethnic minorities (US Census Bureau, 2001). Representation of minorities in top management is not a common occurrence in healthcare. Moore and Jaspen (1997) repor t that only 1% of presidents and chief executive officers were minorities from among the 5 million hospital workers in the US in 1996. This data offers an incentive to encourage organizations to prepare their 51 workforce for success by rethinking their models of business success and how they ensure organizational readine ss by effectively aligning busine ss strategies with current and future market realities to achieve growth, profitability and sustainability (Martino, 1999; Wheeler, 2001; Fitzpatrick, 1997; McBride & Bostian, 1998). Developing a multicultural leadership team remains a challenge for most healthcare organizations. The literature gives attention to the need and the challenge for leaders to understand organizational culture and the populations they serve (Washington, Erickson, & Ditomassi, 2004; Lussier, 2001). H ealthcare organizations treat patients holistically; therefore, the culture, beliefs, cust oms and traditions of their consumer base are important. Today, diversity is consider ed an advantage to an innovative employer actively engaged in maximizing hiring opportun ities. Thus, a more diverse workforce may improve the organization’s ability to comm unicate with its increasing diverse clients (Jackson, 1992). This perspect ive is especially true in the world of healthcare. In the business of health and the health of any business, the advantages of a multicultural workforce have been analyzed, pondered, examined, studied and surveyed (Washington et al., 2004). The statistics are startling and include the following: almost 30% of the US population is from ethnic or racial minority groups, 12.8% are African American, 11.9% are Hispanics, 41% are As ian and Pacific, and 1% represent other groups. Patients and healthcare workers likewi se are increasingly reflecting the ethnicity and diversity of the country. The call ha s never been louder for organizations to strengthen and encourage cultural awareness and implement organizational training in the area of multiculturalism (Mateo, & Smith, 2001). 52 Diversity in healthcare, seen at all or ganizational levels, includes people from differing cultures, races, re ligions, genders, physical abili ties, backgrounds, and values (Ivancevich & Gilbert, 2000). Four fundamental competencies of effective leadership in a culturally diverse society include: 1) A knowledge base with increased sens itivity to and an awareness of the diversities in the workforce, 2) Identification of resources, which can stre ngthen and improve the quality of life for all individuals, 3) Open communications with others about cultural differences, 4) Strategies that will enable leaders to serve as change agents to maximize the benefits of a cultural diversity workfor ce (Kappa Omicron Nu Honor Society, 2002). The benefits of cultural diversity can occur when leaders and employees accept responsibility for understanding differences and develop strategies for inclusion. Rothwell (2001) reports that encouraging diversity and multiculturalism avoids ‘homosocial reproduction’ by managers, (p. 30). Diversity must be supported from the leadership of the organization, which will support a work culture of openness, equity, tolerance and inclusion. This is a counter point to homosocial reproductions where everyone in the organization re presents the mainstream culture. Measurable benefits include improved bottom line, competitive a dvantages, superior business performance, employee satisfaction and loyalty, strengt hened relationship with multicultural communities, and attracting the best and the brightest candidates (Guillory, 2004).

53 Generational Diversity Another type of diversity is generational differences. The 21 st Century has produced a melting pot of generations that now work together in healthcare settings. Eyerman and Turner (1998) define generation as people passing through time together that come to share a common habitus, hexis a nd culture, a function of which is to provide them with collective memory that serves to in tegrate the generation over a finite period of time, (p. 93). Generational diversity is an important leadership issue and can affect how generations view leadership. The four generations are: Traditionalist (born before 1945); Baby Boomers (born 1946 – 1964); Generati on X (born 1965 – 1977); Millennials (also known as Generation Y, born 1978 and after). Raines (2002) recommends that leadership development training programs in clude generational differences to encourage conversations and avoid judging other’s percep tions. Martin and Tulgan (2002) suggest holding a diversity summit that promotes the strengths of generations. Zemke, Raines, and Filipczak (2000) recommends that leaders need to develop listening and questioning skills to offset potential conflicts before they happen. Healthcare organizations need to integrate generational differences in leader ship development training programs and be mindful of the tendency to highl ight leadership styles of past generations and incorporate action learning for younger generations. Today’s leaders need to be mindful a nd knowledgeable of the generations which they serve and examine this when selecting the individuals in terms of compatibility within the organization. Add itionally, leaders may have to consider meeting the needs and desires of employees as different generatio ns and cultures bring different values and 54 work ethics to the workplace (Arsenault, 2004) . For example, supporting generational differences can cause differences of opinions and conflict due to differing work ethics and views of relationships, authority a nd workforce expectations (Anonymous, 2006; Arsenault, 2004). Summary Dwight D. Eisenhower once said, “In preparing for battle, I have always found that plans are useless, bu t planning is indispensable.” While it is understood that plans do not always work out, having a plan help s leaders and organizations cope with unexpected changes when they occur as well as sustain themselves for the future. A review of the literature shows that healthcare industr y leaders have a tenure of three years and indicates that the healthcare industry is behind in their efforts to develop succession planning for leadership development, stability and sustainability (Jacobs and Fraser 1987). Implementing succession pl anning and purposeful mentoring programs may help healthcare systems to better develop se lection criteria for effective leadership as well as prepare for strong leadership by th eir successor and succession planning efforts (Abrams and Bevilacqua, 2006). This study explores the perceived benef its of the succession planning model with mentoring. This study also explores the limitations and challenges perceived by the healthcare industry in their organizational effo rts to remain competitive, an employer of choice and a responder to consumer dema nds. Succession planning and mentoring complement each other and some of the same characteristics for successful implementation may benefit the healthcare indus try as it grapples with the context of today’s workforce. The concepts of su ccession planning and mentoring address more 55 than the statistics of those eligible for retirement. Succession planning is about the preservation versus the potential loss of organizational knowledge, experience and expertise, continuation of effective serv ices, healthy work relationships, and the preservation of a productive and healthy workplace culture (Kouzes and Posner, 2002). While the workforce statistics are predictions of anticipated labor shortages, this study may reveal how these predictions can be used as a positive force even as it provides a major challenge for the hea lthcare industry to respond to rapid changes in workforce demographics as they impact leadership in healthcare organizations. Although the healthcare industry may be severely challenge d, and it may take years to implement and perfect a formal succession plan, the steps taken now may provide greater opportunities for future workforce generations and ensure the long term success of the organization.

“While it is better to be gone and not for gotten than forgotten but not gone, it is even greater to be remembered and re vered than only remembered” (Wharton, 2005, p 278). Succession planning is a proactive approach that provides a tool for organizations to identify, develop and select employees who ar e the right people, with the right skills, at the right time for leadership and other key positions while focusing on current and future needs of the organization. When impl emented successfully a positive outcome for succession planning can reduce the high cost and time commitments associated with recruiting and hiring from outside sources. Succession pl anning also enhances the organization’s ability to maintain continuity of services as quality care and performance remains stellar qualities for th e organization (Rothwell, 2005). 56 CHAPTER III: METHODOLOGY Introduction Planning for the 21 st Century workforce is becoming increasingly difficult due to an aging workforce and issues of diversit y. Developing strategies to foster career development programs to identify and devel op employees for middle and upper levels of management is critical to th e survival of healthcare orga nizations. Within the last decade, organizations have reduced their workforce by rightsizing, downsizing, and not hiring staff for extended periods . This process has reduced America’s workforce while at the same time excluding a new generation of wo rkers with the vitality and ideas needed in today’s workplace. This trend has subseque ntly reduced the reservoir of future leaders within an organization. As diversity becomes more reflective of the nation’s populations, organizations have a responsibil ity to pursue and embrace diversity at all levels (Rothwell, 2001). Purpose of the Study This is a qualitative study to inves tigate formal succession planning management in four (4) healthcare organiza tions as it relates to meeting leadership needs in a changing American workforce. Qualitative research is used to describe problems and thus when implemented effectively can bring meaning to problems and answer questions. 57 Qualitative research is characterized by a descri ption and requires the researcher to access and gather data in natural settings under inve stigation. Thus, a qualitative analysis helps the researcher to understand a problem with a focus on process where the researcher attempts to explain why something is taking place (Denzin & Lincoln, 2000; Creswell, 2005). The objectives of this chapter are: 1) to an alyze findings in the research relative to the healthcare industry and 2) compare a select number of Ke ntucky healthcare facilities to the national trends in the workforce. Me dical facilities in Kentucky were identified from the Kentucky 2006 Hospitals Guide. A review of the literature was conducted to obtain information as to previous research on th is topic. The researcher sought to answer the following questions: 1. Are healthcare organizations usi ng recommended best practices in succession planning? 2. Are healthcare organizations identi fying potential leaders for future organizational needs?

3. Are healthcare organizations usi ng mentoring to develop succession plans?

4. Are healthcare organizations addressing employee retention?

5. Are healthcare industries preparing fo r the shift in workforce diversity? Research Design According to (Creswell, 2005), qualitativ e research studies are designed to provide information data that represent word s rather than statistics. In qualitative 58 approaches, there are no guidelines on how to analyze the data; therefore, the researcher develops their own design. This study and research design was m odeled after an interview guide for Benchmarking Succession Planning and Manage ment developed by Rothwell (2001). Dr Rothwell grants permission to use the interv iew guide in his book (p. 110). This study will use recommendations from research based best practices for succession planning and provide recommendations to sel ected healthcare organizations to develop a personalized formal process for succession planning.

There are 95 medical/surgical healthcare facilities in Kentucky and 40 facilities with a capacity of 150 or more beds, as iden tified in the Kentucky Hospitals 2006 Guide. This research will sample only those medical/s urgical facilities with 150 or more beds (N=4) to get a representation of successi on planning management in healthcare.

Four (4) healthcare facilities were randomly selected to participate. Each subject was mailed a questionnaire. A follow-up phone call to schedule a face-to-face interview was scheduled. Data from the oral and writt en questionnaire was aggregated to compare with recommended best practices for successi on planning. A letter of thanks to each survey participant followed the interview. An invitation to review the results of the study and recommendations for implementing formal succession planning based on best practices culled from leading businesses as they apply to healthcare organizations as identified in the literature review. The investigator took every precauti on to minimize the physical and/or psychological risk associated with completing the questionnaire. Each healthcare facility selected was named Participant Organizat ion A, B, C, and D in the order the 59 questionnaire was returned to the researcher. Only the researcher knows the letter that corresponds with each healthcare facility. The interview questionnaire consisted of ten (10) open-ended questions. Completing the survey took 45- 60 minutes (See Appendix E). Each question was open ended. The researcher identified and compared common characteristics of selected healthcare organizations succession plans to determine the degree to which four (4) Kentucky healthcare organizations use formal succession planning to develop organizational effectiveness. This resear ch builds on Rothwell’s work by adapting the model to healthcare organiza tions to examine succession pla nning in its current state of practice. Populations and Sett ings/Data Collection This qualitative study gathered da ta through a mailed questionnaire and a recorded follow-up interview with four (4) healthcare organizations in Kentucky. These face-to-face interviews provided informati on regarding the succession planning programs in place at the identified healthcare organizations. A copy of Kentucky Hospital Guide 2006 was obtained from the Medical Pub lishing Company and a random sample population of healthcare systems partic ipated in the study from within the Commonwealth of Kentucky. Informed Consent Each health care administrator who agreed to participate in the study signed an informed consent form (Appendix D) indicatin g agreement to participate in the study. 60 The researcher took every precaution to ensure confidentiality of those willing to participate. Approval to conduct this research wa s granted from the Research Ethics Committee at Spalding University (Appendi x A). The survey respondents signed a written consent form for the data they shared with the researcher, as the information was used to determine whether their healthcare organization was currently using succession planning tools and to what degree for leader ship development. The recommendations will be based on information obtained from individual healthcare organizations and included in Chapter 5. Limitations and Summary Due to many factors such as time, availabi lity, willingness to participate, etc., this study is limited to four medical/surgical heal thcare organizations with a capacity of 150 or more beds. The study’s findings may not be generalized to other populations or to other healthcare organizations due to the co mplexity of each institution as well as differences in organizational structure at each facility. In this study, the researcher chose to use four (4) healthcare organizations w ith 150 beds, which is indicative of a large healthcare facility that would benefit fr om a succession plan for leadership and continuous service. This chapter describes in detail the st eps involved in the study. This yielded important information regarding formal su ccession planning management of healthcare facilities in four (4) Kentuc ky healthcare organizations and the impact on leadership development in healthcare. Participants w ill have access to the results of the study and recommendations based on the research to cr eate or improve their efforts in formal 61 succession planning. These findings may have implications for all healthcare organizations that need to develop and implement succession planning. This study used the predicted employment tre nds affecting the healthcare industry. As the healthcare industry prepares for the 21 st century workforce to addre ss the projected employment deficit with a thoughtful process for change rather than a magic bullet approach to address the magnitude and complexity of th e problem. The following chapter will offer the results of the study.

62 CHAPTER IV: RESULTS This chapter focuses on the findings of the interviews conducted with four health care medical/surgical facilities in Kentucky with 150 or more beds. The facilities were randomly selected to particip ate in the study. Four (4) participating organizations in Kentucky were surveyed to determine the de gree to which they use formal succession planning management as part of their orga nizational planning. The purpose of this research was to examine how four (4) healthca re organizations identify potential leaders; use mentoring to address succession plans; retain employees and prepare for workforce diversity; and develop leaders w ithin the organization. This chapter discusses the results of the study based on the research questions posed to each randomly selected healthcare organization. The sample size was representational of 10% of the medical/surgical healthcare facilities in Kentucky with a capacity of 150 or more beds, as identified in the Kentucky Hospitals 2006 Guide. This research sample d only those medical/surgical facilities with 150 or more beds (N=4) to obtain a sample representation of formal succession planning management as utilized in Kentucky healthcare organizations.

63 Data Analysis Data analysis for each participating organization interviewed consisted of transcribing and classifying the audiotape in terview questions and field notes collected from the four participant organization interv iews. The audiotapes were transcribed in narrative text, and the transcribed interviews formed the database for the researcher’s content analysis literature. Based on the res ponses from each participant, the researcher utilized the content method of data analysis to analyze the tran scripts in order to look for emerging themes among the partic ipants’ responses. Later, the researcher reviewed each of the responses in order to synthesize the themes. Qualitative interviewing is utilized to understand the central phenomenon of the probl em studied and to analyze the data for themes and provide an interpretation of the meaning of the information gleaned from the study (Creswell, 2005). Edited Participant Organization Responses The following section provides edited participant organization responses to the survey questions from the participating orga nization audiotape interviews. In reporting the results of the study, the healthcare organi zations are referred to by an alphabetical letter to ensure confidentia lity. A summary of all respons es are introduced prior to individual participating organization responses to the intervie w questionnaire guide. This is done for the convenience of the reader to gain an overview of their responses as well as a full report of individual or ganizational responses. The following key medical center personnel were interviewed and reported the following participant organization responses: • Participant Organization A: Director of Education 64 • Participant Organization B: Vice Pres ident of the Medical Center and the Director of Educational Development • Participant Organization C: Vice Pres ident of Education and Development • Participant Organization D: Vice Pr esident of Human Resources and the Manager of Recruitment and Retention Question #1 What goals and objectives have been established for succession planning and management in your organizations?

100% of the participant organizations surveyed had established no formal succession planning and management program in their organization. 50% of the survey participant organizations had recruited and hi red an individual responsible for developing goals and objectives for succession planning in their organization through education and training departments, which appeared to be closely aligned with human resources. 100% of the survey participant organizations had established leadership development training programs in efforts to develop an internal pool of leadership talent. 25% of the participant organizations were developing a leadership development training program to create a more equitable process for their empl oyees to access higher levels of leadership within multiple levels of the organization. The leadership development training programs are designed to include competencies needed in healthcare as identified by their respective organizations and the Healthcare Advisory Board, a national organization that benchmarks core leadership competen cies for healthcare organizations.

Figure 1: Formal Succession Planning r= Formal Succession Planning No Fo r ma l Succesison Plan, 100% Participant Organization A In the interview, Participant Organizati on A noted that healthcare has not kept pace in response to strategic planning to th e degree of business corporations. In August 2006, Participant Organization A hired a talent manager to further define goals and objectives as the position develops. New initiatives and programs are planned for leadership development. The leadership track included modules for frontline managers in performance management, behavioral manageme nt, strategic planning, diversity, conflict resolution, leadership et hics and leading from the heart, and the mission and values of the organization. Modules on quality improvement, budget and finance are slated for 2007. The core program has been running for 4 y ears and the programs are designed for people already in management and for low-level supervisors. Participant Organization B The interviewee reported that Participan t Organization B does not use succession planning geared toward specific job and pos ition placement. They do not identify employees to move into roles as successors for leadership positions. Participant 65 66 Organization B has a model for creating and de veloping a pool of employees for a variety of positions as vacancies occur. Their prim ary goal and objective is to have a pool of internal candidates; however, they do not always recruit from th at pool of internal candidates for every position, but wherever possible they try to provide the first opportunity for internal applican ts. Most senior team members have been promoted from within the facility and have worked in othe r assignments prior to their current roles. Although no formal program is in place, prom otions from within are evident with the following positions: vice president, vice president for cardiac, chief financial officer, chief nurse for clinical services and the e ducation director. Participant Organization B reports a good retention rate with low turnover and provi des opportunities for employees to develop themselves th rough education and training. Participant Organization C The senior leadership team for Participan t Organization C sensed the need to have a greater focus on leadership development and succession planning, and created the position Vice President for Education and De velopment in March 2006. Their goals are 1) to improve the current level of performan ce 2) to prepare employees interested in leadership for greater responsib ilities within the organization. Participant Organization C organized their leadership group into three groups: 1) Emerging Leaders – clinical and non-clinical staff that do not cu rrently have supervisory responsibilities; 2) Operational Leadership – a core middle management group that currently manages a department or a group of departments; 3) Strategic Leader s – current leadership made up of vice presidents, senior vice presidents, executive vice presidents and presidents of the hospitals. Each level is de signing a model to develop em ployees, which includes career 67 planning as well as individual and professional development. Participant Organization C plans to use some components of the 360-degree instrument to measure the skill set of the directors and executives in the organization. Succession planning appears to fit into the organizations’ development model. Participant Organization C will implement career planning and individual development planning, to create a succession plan. Participant Organization D Participant Organization D reported an in formal process was in place and had completed an analysis of their leadership gaps. They are knowledgeable of the retirement dates of the leaders in high profile positio ns. In 2001, they developed an internal Leadership College. Initially, they provided training to their directors and managers in the Leadership College. Subsequently, the Leadership College was opened\ to new leaders i.e. supervisors, managers, or director positions, during the first year of employment. New leaders are taught the cu lture of the organization, philosophy and the service excellence model, employment law, service requisition, and the Continuous Quality Improvement (CQI) process. After completing the core phase of the college, they began the developmental phase. The Leadership College is open to any employee with their supervisor’s concurrence. Partic ipant Organization D uses an informal process to create a pool of leadership talent. They use an informal process so that employees are not setup for disappointment or failure in the event that they are not successful. Participant Organization D does not have a formalized process to test or identify individuals who may have certain skills and observed leadership behaviors. When employees have been in their role less than two years, goals are developed from their performance appraisal. Based on the developm ental needs of new leaders, their manager 68 may assign certain levels of classes to address the developmental skills model identified by the performance appraisal. Participant Or ganization D uses the MBTI – Myers Briggs for their training instrument. They also o ffer virtual learning and some classes with learning labs to simulate the work envir onment for making patient rounds, employment interviews or making tough decisions, which offers an opportunity for role-playing in any of these training areas. Question #2 How does your organization define key positions? What positions, if any, are given special attention in your succession-pl anning program? Why are they given that attention?

50% of the participant organizations repor ted their process was confidential and monitored behind closed doors where decisi on making was subjective. 25% of the participant organizations made their decisi ons based on data obtained from the Kentucky Hospital Association (KHA), which tracks and predicts employment trends to compare their expected shortages with national data. A tuition reimbursement program is developed for those occupations with exp ected workforce shortages. 25% of the participant organizations identified one successor to promote for a key position. Figure 2: Define Key Positions De fine Ke y Positions Subjec tive dec s ion making50% Dat a Driven 25% Management Selection 25% Participant Organization A Participant Organization A practices th e Jack Welch Succession Planning GE Model, which is monitored behind closed doors and the process is confidential. The 360- degree assessment is a learning contract that is shared with the executive team and a strategic program is incorporated. The 360 is the instrument used to identify the “shinning stars” in the orga nization. In 2007, executives an d directors will use the 360 degree assessment for front line managers, thos e who have a staff of 75 people or more. The CEO has access of all cumulative summary reports for the 360-degree assessment. Participant Organization A uses the 360 to determine the shinning stars for future leadership opportunities w ithin their organization. Participant Organization B Participant Organization B reported that th eir education director was selected and developed for that position. The education di rector holds a Masters Degree and replaced the leadership coach who was on the verge of retirement after 48 years of service. 69 70 Participant Organization B retained the leadership coach as a board member and transitioned her as a mentor to nurture new leadership directors. This gave the new director an opportunity to learn the job. They report that the selection was based on observations and the potential they saw in the individual as a clinicia n, the quality of her relationships with employees and her abil ity to get people together to get work assignments completed. The new education dire ctor received training at the Centers for Creative Leadership and was certified in ad ministering the 360 assessment and the Myers Briggs. Participant Organization B reported that this was the only position for which they had developed or groomed an employee. They reported that they provide employees with leadership, skill sets, competencies which they listed as critical to performing well in healthcare as a leader. Once their employees participate in the leadership development program, they are assigned a mentor. Participant Organization B has looked at many different models and collaborated with the Healthcare Advisory Board, a national group in Washington, D.C. that identifies best practices within healthcare (www.advisory.com). The Healthcare Advisory Board identifie d 56 different competencies required for healthcare. They looked at in ternal needs in the hospital as well as skills needed for vacant positions. They tapped several sources in their organization and worked collectively to agree on the core sk ills needed at their facility. Those competencies are targeted in thei r Evolving Leaders Training Program. The following competencies are targeted: budgeting, finance, emotional intelligence, personal intelligence, human resources, me ntoring, and coaching. The leadership curriculum matches the mission and values of their decisions based on an organization’s 71 needs assessment tool. They benchmark the core competencies with the Healthcare Advisory Board then match them to the organizations needs. Employees are identified for the Evolving Leaders Training Program by their supervisor and based on their inte rest in leadership. There are three levels of leadership training. The introductory leve l of leadership training allows employees who wish to explore opportunities in leadership decide if they want to enga ge in level one curriculum. Employees can self-select up to level five (t he executive leadership program) which is a fellowship — a graduate program for those who have completed graduate school or are in a graduate degree program and have comp leted all the other executive leadership curriculum requirements. The Master’s Degree is not discipline specific for the executive leadership program. They have a committee that matches the mentees with the mentors based on individual developmental goals. Participant Organization B has 2300 employees and all employees have the opportunity to participate in leadership training with approval from their manager who offers mutual support as employees begin taking level one classes. Employees can determ ine their own pace in the developmental program. Participant Organization B does not typica lly define key positions. They plan a general leadership development program that teaches people the skills and competencies identified by the National Think Tank as skills needed among desired employees. Participant Organization C Participant Organization C has 500 employ ees in leadership positions and defined key positions as anyone in management or a bove. They hope to eventually design their succession planning program to include all 500 of those individuals. Participant 72 Organization C focuses on those employees beca use they provide the leadership in the organization. They consider these employees as the link pins to their staff and employees and instrumental to the day-to-day accomplishment of all of the organizations initiatives:

employee satisfaction, patient satisfaction, rete ntion and employee turnover. Participant Organization C has not defined the positions fo r formal succession planning. They report that in 2007, the VP of HR, Chief Operat ing Officer, and Chief Executive Officer will meet to define positions in need of succession planning. Participant Organization D Participant Organization D reported that th e nursing shortage is expected to hit its peak between 2012 – 2015 where double digit retirements are expected nationwide. Participant Organization D’s data for nursing shortage includes projections up to 2016 the year retirements in nursing will impact their facility. To backfill those positions, they have developed a Knowledge Program that lo ans money for nursing school. Participant Organization D will loan employees $15,000 in return for a 6 month commitment of employment for each $2500 they give employees to complete school. If an employee is in an accelerated RN program, they receive $15,000 and owe three years of employment when they graduate. Participant Organi zation D provides tuition reimbursement for radiology, respiratory, medical laboratory technology and physical therapy degree programs. They loan employees tuition in the form of salary in advance for a commitment of employment after graduation. Participant Organization D’s program is very popular and they have 34 RN student employees expected to graduate in May 2007. Many of their employees in the accelerated degree program have a Bachelors Degree. 73 Participant Organization D reports the followi ng outcomes since the inception of their Leadership College in 2001: 1) Vacancy rates in nursing were 12% and today are 4%.

2) Six director positions were filled with one internal promotion and five external hires. 3) Six manager positions were filled with five internal promotions and one external hire. 4) Six nurse managers’ positions were v acated; there were three internal promotions and three external hires.

5) 71 supervisory positions were filled with 42 internal promotions and 29 external hires.

6) 89 positions were vacant. They were f illed by 38 were external hires, and 51 internal promotion. 57% of promotions came from w ithin the organizations compared to 43% external hires. Participant Organization D has 300 employees who have gone through the Leadership College since its inception. Participant Orga nization D reported that they have created the right environment for employees to grow within the organization. Many internal promotions have been awarded as positions became available. They report being pleased with improvement efforts that have resulted in a trend of developing individuals for internal hiring. They are beginning to educat e entry level supervisors and managers and are giving opportunities to new employees to gr ow in the organization, a practice that is more prevalent since the Leadership College was established five years ago. With regard to leadership with their managers , they report the following outcomes: 74 Participant Organization D has experienced fewer job vacancies and significantly reduced turnover and improved employee produc tivity evidenced by bottom line figures. Participant Organization D repor ted their outcomes reveal that they not only grow people internally but also grow the right kinds of people ba sed on employee feedback. Participant Organization D investigates shortages based on national data as well as local data. They receive data from th e Kentucky Hospital Association (KHA), which publishes workforce shortage survey results on an annual basis. Data is reported out by market, which helps Participant Organization D identify areas slated for predicted shortages. If they see the vacancy rates for RNs go up on national or statewide basis, they invest more money or sit down schools of nursing to plan and meet the challenge. If they see the vacancy rates for medical technology increa sing, they develop strategic plans. They also belong to local workforce consortium where hospitals come together to work on issues regarding the workforce shortage in healthcare. The KHA is a local corporation that works with local hospitals and come together to offer solutions to problems of recruitment and re tention in key positions in healthcare organizations. KHA received a grant from the National Department of Labor to help with training of managers throughout the state and healthcare and to deal with the shortage of certain occupations in healthcare. Participant Orga nization D takes advantage of their opportunities for the prescriptive treatment of critic al employment issues that directly impact its success. Question #3 How does your organization assess curre nt job performance for succession planning and management purposes? (Do you use the organization’s ex\ isting performance appraisal system – or something else?) 75% of survey participant organizations use the 360-degree self-assessment and share results with top management at their facilities. Performance measures are used to include accreditation scores, quality improvement , satisfaction scores. The 360 is used for self-development. 25% of survey participant organizations plan to implement an assessment used in healthcare called Test Sour ce that has behaviorally based questions to determine if the prospective employee will be a good fit for the organization. There is a distortion score built into the questions to ensu re reliability and validity of test results. Figure 3: Performance Management Pe rformance Manage me nt Us ing 360-degree self -assessment 75% Planning to us e 360 – degree s elf- assessment 25% Participant Organization A The interviewee representing Participant A was the Director of Education.

Participant Organization A uses a combin ation of tools including the 360-degree assessment, which is a contracted by an outside company. A separate appraisal tool is completed for mangers. There are critical success factors wired into management that leadership addresses at the executive level with front line level and with management level employees. 75 76 The tools address competencies including turnover, accreditation, satisfaction scores and quality improvement initiatives. The leaders submit goals that are related to the strategic plan. They evaluate critical success, submit quarterly reports, 90 day action plans and are rewarded at the end of th e year up to 10% of their pay based on performance. There is a threshold, target and maximum level for job performance. There is a financial reward, public recognition ceremony and a congratulatory letter, and the majority of leaders receive feedback. This process allows Participant Organization A to identify problems and take corrective actions. Participant Organization B Participant Organization B uses the traditional tool based on job competencies; however, they also have othe r assessment tools. They use a 360-evaluation tool for employees’ individual’s self-development. The education director is trained to administer the 360 through the Center for Creative Leadership in Greensboro, NC, from that; they address specific goals to address. They also use the Myers Briggs personality inventory. Participant Organization B gets feedback from mentors who have mentored individuals in the Evolving Lead ers Program to identify shinning stars and future leaders. Organizational leaders communi cate regularly with the mentors about mentees who do not know they are identified as rising star s and potential leaders. Once employees complete leadership training, there is a littl e ambiguity about corporate expectations and employees are motivated to continue work ing toward positions of management and leadership. They have a low tu rnover at the director level. When they lose an employee, it is usually due to an opportunity for an em ployee to relocate closer to family. This 77 participant organization reported that for an employee to be successful in a leadership position, they have to be a “good fit” which is more than job skills; they must exhibit competencies that are difficult to rate in a typical rating skill. They know when somebody fits the organizational culture or the culture they are trying to build and they know when someone does not. Their leadersh ip training allows them an opportunity for them to look at the pool of employees and to experience them as learners which gives them an idea of who fits and who can lead within the organization. They also identify some people who have good skills; however, they will never be in a key leadership position because they do not have the behavior al competencies needed in healthcare. They often role model desired behavioral co mpetencies in the curriculum for leadership development: personal discipline, emotional intelligence, an d team leadership skills. They reported struggling to get the behavioral components aligned with organizational values. Currently, the organization looks at the individual and thei r relationships with others. Participant Organizati on B reports they sometimes rely on their “gut feelings for identifying future leaders” as well as their behavior in the organization. Participant Organization C Participant Organization C reports that th ey use all kinds of subjective measures. Their current management system is based on performance. They hope to add some additional evaluation tools such as the 360-degree instrument along with additional testing instruments. Participant Organization D Participant Organization D evaluates every employee annually. They look at the key accountabilities of the job and there are the core competencies and employee 78 performance standards. They have a pay for performance system at 0-4% on an annual basis. There is a section in the evaluation tool for reco rding developmental needs or goals discussed with management and line staff employees. Their goal is to have employees grow and develop in the organiza tion so they behave more like an “owner than a renter.” They desire employees to view ownership as part of the overall culture of service excellence. They plan to introduce the 360 assessment and implement a more formalized employee evaluation program. They are planning to implement an assessment tool in their hiring process before employees are interv iewed. This pre-employment assessment will tell them the degree of fit pr ospective employees would have within the organizational culture and help them to iden tify people who can grow with them in the future. They plan to use an assessment va lidated for healthcare called Test Source. There are 111 questions and an outside company scores the responses. This tool will give them a fit analysis based on behavioral ques tions designed to solicit information from the candidate to determine if they are a fit. Many organizations that have used this have seen a significant decrease in tur nover. It is expected that a significant decrease in turnover will occur once this test is in place. Pa rticipant Organization D believes that a good indicator of how people will do things in the fu ture is how they have done things in the past. Question # 4 How does your organization identify successors for key positions? 100% of the survey participant organi zations report they do not identify successors; however, 75% of the survey participant organizati ons report that they observe employees in stretch assignments i.e. committee assignments and mentoring experiences, and through their leadership development training.

Figure 4: Identifying Successors for Key Positions IdentifyingSuccessors for Key Positions Do Not Identify Successors, 100% Participant Organization A When a vacancy occurs, Participant Organi zation A selects the next in line leader to move into an interim position of leadershi p, sometimes serving in that capacity for one year as a trial run to observe their degrees of success. Participant Organization A is not a private hospital and promotes from within. For high levels and unique positions, a national search is conducted to find a lead er who has proven leadership abilities. Participant Organization A hire d a new Vice President of HR in January 2007. Typically, individuals selected for key positions, are graduates of their leadership development classes. Participant Organization B 79 80 Participant Organization B does not identify successors. They employ a leadership coach who is instrumental in giving feedback on performance of employees working on level three project teams. Leader ship coaches identify people for leadership assignments by creating a nurturing environm ent and investing in the leadership development of employees. Participant Or ganization B reports that observations and experience allows them to identify some peopl e who are cut out for leadership and others who are not. They report that they have leadership team members who nurture and mentor people. Participant Organization B does not have a formal committee to discuss who is ready for leadership; however, they report they watch employees diligently. A formal report is written addressing the l eaders’ process and the mentor submits a summary report to the mentees’supervisor, so th ere is a formal process attached to the mentees’ progress in leadership training. Participant Organization B reports ther e are times when mentoring includes sharing knowledge about operations, politics and managing. When vacancies occur, management is given the opportunity to look at combining departments and making other administrative changes for efficiency, as we ll as looking to see who can take on more responsibility. They have a good feel for that and they report using an evaluation process that is built into the mentoring program. Re portedly, they have few obstacles with their training program; however, some employees fall through the program and they know who those people are. Participant Organizati on D trains a pool of mentors and provides them with forums during the year and individual training, and along with the mentees’they learn the values and responsibil ities of mentoring. Mentors and mentees’ are in the room together on the kickoff da y and they hear the same information. 81 Participant Organization B feels it is important for the mentee to know the expectations of the mentors. Both are mutually accountable. Participant Organization C Participant Organization C uses a s ubjective measure based on opinions and observations, which they re port is not a good system. Participant Organization D Participant Organization D has a Leadership College and they use various ways to identify potential leaders in the organiza tion. They have numerous employee driven committees in the organization. In addition, many of those committees are not facilitated by managers and directors but by staff line em ployees with direction or guidance from mangers and directors on the committee. Within the Leadership College, there are employee driven committees such as awards and recognition, standards of conduct team, and an inpatient and outpatient satisfacti on team. All groups are all made up of a combination of managers, directors and line st aff employees. There are more line staff employees on those committees than there are ma nagers and directors. They feel that employees know best about how to do the work that needs to be done, and by involving them in the problem solving process employees provide input rega rding the rising stars who emerge from those committees. Particip ant Organization D reports that employees who get involved and give of their time and talent take ownership and behave like “owners rather than renters.” Question #5 How does your organization identify hi gh potential employees (who are capable of advancing two or more levels beyond their current placement)? 100% of the respondents report no formal process. However, they do acknowledge several ways of identifying high potentials by their willingness to relocate within the organization, observing employees who use critical thinking skills and plan strategically; those w ho mentor and nurture employees ; employees seeking continual development and current leaders who identify internal interim successors should they be out of work for any given period to time.

Figure 5: Identifying High Potential Employees Ide ntifying High Pote ntia l Employe e s No Formal Proc ess to Identif y High Potential Employ ees , 100% Participant Organization A Participant Organization A reports that the Corporate Vice President of Talent Search will look at grooming the next execu tive level of leadership for the entire organization. The position is newly developed. If employees are willing to relocate, it’s a win-win for all parties. Positions are avai lable in 60 different hospitals. Positions are advertised on the website and some are terr itorial. Individuals have to search for positions. Diversity is being encouraged and supported; the CEO is African American, and a young African American is serving in an executive fellowship. They also have a diversity fellow expert team to ensure mi norities are reflected in the CEO and other 82 83 positions of leadership to balance the high number traditionally hired for nutrition and housekeeping positions. More diversity is reflected among Licensed Practical Nurses (LPN’s) or Nursing Assistants (NA’s) than among Registered Nurse (RN) positions. For nursing leadership positions, Part icipant Organization A prefers to hire applicants with a Masters in Nursing (MSN); how ever, Participant Organization A reports that most of their nurses are RN’s with an Associates Degree in nursing. Reportedly, there is no distinction in pay between the RN with a B accalaureate Degree versus an Associate’s Degree in nursing, except for tenure. Partic ipant Organization A reports two or three people of color have moved to management who were employed at their facility for a while. Employees want to know how the outco mes of their participation in leadership development will enhance their careers. Participant Organization B Participant Organization B reports that there are employees who are good at their jobs and task oriented, and then there are people who are good at seeing the big picture and understanding that their role is managing relationships and resources, not the task. They consider this the difference between ma nagement and leadership in healthcare and this varies in terms of the expectations from discipline to discipline. As employees move up and within the organization, they have to become strategic in their thinking and less task oriented. Participant Organization B looks for employees who understand their role and responsibility in the mission of the organi zation and those who are more strategically oriented and less task orie nted in their thinking. Consideration is also given to the leader’s role in the organization, the department and the level of professional accountability required for the position. Participant 84 Organization B maintains that employees sel ected for leadership must be political, strategic, visionary, have good leadership a nd problem solving skills in negotiating across multiple departments, and be knowledgeable of the mission and programs of the organization. They report st rategic and political skills are needed to negotiate resources across multiple environments with peers. Participant Organization B stated that healthcare has been notorious for promoting people because they were good at the task they did, but did not realize that promotion also demands a different set of skills and performance requirements. Participant Orga nization B asserts that a poor assumption is made when employees are selected who perform a task well; he or she may not be good at managing. Participant Organization B main tains that those employees must have the right support to develop the skills and support them and nurture them in that process of growth. They are trying to address compet encies necessary for effective leadership programs before employees are moved into l eadership responsibilities. Participant Organization B views leadership development as an opportunity to start exploring and developing those skills. Participant Organization B identifies employees with high potential through the mentoring and training programs within their leadership development program. They try to ensure that the employee’s goals are being met. Participant Or ganization B plans to add competencies to their training program to include organizational managerial ethics, emotional intelligence, the politics within an organization, and the use and misuse of power. They report that ther e is a time when leaders must maneuvers and use earned power and influence to positively impact the or ganization, and there is a time where that can become toxic or dangerous to the organization. 85 According to Participant Organization B, hidden bias is an area they have not tapped. Participant Organization B reports that prejudice many not be openly evident in the organization, but there are hidden biases and other issues such as professionalism self discipline, race, culture, socioeconomic status , age and gender, etc. that have a powerful impact on organizational effectiveness. Participant Organization C Participant Organization C identifies high potential employees subjectively. Previously, they had a Fellows Program that had a strategic leadership group that included the vice presidents and above. Thos e “fellows” selected individuals from their departments to participate in the program with the intent to advance selected employees one to two positions. Previously, there was no written criterion and decisions were subjective with who they thought had potential within the organization. Promotions were used in some instances as rewards for so me of their favorite people. Participant Organization C put that program on hold until criteria is developed and a new leadership development program is fully implemented. Th ey realize they have the need for a high level program and they are going to evaluate th e course next year (2007) to develop goals and objectives. They plan to have criteria for completion of the programs and link it to the succession planning system; whereas, th e previous program was not linked to succession planning. Participant Organization D Participant Organization D does not have a formalized process or structure in place other than the Leadership College and some leaders who identify people who appear to have leadership tale nt. They report that some employees have jumped one or 86 two levels in the organization, but they coul d not provide an example. They report that anyone in the organization can recomme nd someone for promotion–from a vice president to a director or manager who identifies people as future leaders. Participant Organization D reports that they have depart ment leaders to identify one or two key people to serve in an interi m role should they experience a leadership vacancy, whether long or short term, so operations can continue in that department. One of the questions the CEO asks lead ers is; “If you were not here tomorrow, who would either succeed you or maintain the service in your departments until such time a replacement was found?” This provides an opportunity for employees to discuss possible recruits for leadership development. There is no guarantee that the employee would be selected if a permanent repla cement is needed; however, should a vacancy occur it would allow for leader ship continuity. Succession planning is not a formalized process that guarantees that the employee selected a guaranteed placement in the vacancy. Some leaders do not want to release control and power in their areas. Participant Organization D reports they have come to understand that it “takes a village and not an individual” to make their organization a success. Question #6 How does your organization establish I ndividual Development Plans (IDP’s) to accelerate the development of high potential employees?

75% of the survey participant organiza tions have Individual Development Plans and 25% are in the process of implementing IDP’s into their leadership development training plan. The IDP’s are shared with top management and with the mentors at another healthcare facility. 25% of the survey participant organizations include it as part of the leader’s annual performance plan so that goals are measured and the leaders are held accountable. Their IDP’s are always evolving and updated based on the based on the personal and professional needs.

Figure 6: Individual Development Plans Establishing Individual Development Plans Use IDP’s 75% In the process of developing IDP’s 25% Participant Organization A Participant Organization A reports using the 360 degree assessment for implementing goals and creating 90-day reports for managers; it serves as a feedback tool. Directors and executives complete the 360 individualized plans. Managers that have not completed the 360-degree assessment create individualized goals, plans and objectives that are aligned with organizational strategi c goals, which are reported quarterly. The 360 keeps mangers accountable . They report that accountability is becoming more prevalent in healthcare leadership. Participant Organization B Participant Organization B expects everyone in their leadership program to develop a personal development plan that includes personal goals and objectives. Employees evaluated their persona l development plan with their mentor if they are in a 87 88 mentoring relationship. Expectations for me ntor/mentees in level three and four are move complex than levels one and two. Level two employees have a mentor, but they found that asking mentees to write measurable goals is difficult if it is their first experience. In levels three-fi ve, they expect employees to be able to write measurable goals and share them with their mentor. The goals and objectives are submitted to the Leadership Program and are used to appropriately assign a mentor to them. Mentors are selected based on what they have to offer mentees and together they work on goals and objectives throughout the year. Progress reports are provided to the Education Director indicating the mentees progress on those goals. Participant Organization C Participant Organization C has a semiformal approach to succession planning but is currently developing a more structured approach in terms of how to implement it through career planning. With the 360-degree f eedback, they plan to be able to develop individual development plans for those they see as high potential employees. They plan for employees to be involved in other deve lopmental activities, which will replace their Fellows and Honors Program. Their plan s are in the developmental stages. Participant Organization D Participant Organization D uses the a nnual performance appraisal to evaluate employee performance, to identify opportunities for improvement, and to develop goals to stretch employees in the or ganization. The plans are review ed every 90 days to review the progress of employees in le adership positions to evaluate their progress in achieving measurable goals. Participant Organization D reports that the goals are in line with their Service Excellence Initiative and the managers are held accountable. Every key manager 89 or director has measurable goals that are developed around industry pillars, to help employees grow and ultimately impact the success of the organization. The industry pillars are people, quality, service, finance and growth. They report that Individual Development Plans are implement ed at the senior level and report that accountability has helped to reduce turnover and vacancies, and improved engagement and productivity over the last five years. Th eir productivity has improved and is reflected in the numbers; a windfall of $8.2 million dollars was added to their profit in the last four years. Reportedly, their managers are always working on their skills and are not getting stagnant in their positions. Their senior executive team sits down each year and identifies the goals that fall under each of thes e pillars, some are required for every director, and some are left to the optional discre tion of selection along with th eir director’s assistance to determine areas in greatest need of improvement. Question #7 Does your organization use replacement c harts based on the current organization chart? (If not, why)?

None of the participant organizations surveyed used replacement charts. However, a goal within their leadership de velopment training programs was to develop employees with the skills and competencies needed for healthcare leadership as vacancies occur. They match the needs of the vacancies to the skills and strengths of those in the applicant pool. RFigure 7: Use Replacement Charts Use Replacement Charts Do Not Use Replacement Charts, 100% Participant Organization A Participant Organization A does not use re placement charts. They hired a new Talent Manager effective 8/7/06. They were uncertain how the position would be developed but it was expected that th ere would be a lot of new programming. Participant Organization B Participant Organization B does not use replacement charts. They report that measures previously used were subjective. Participant Organization C Participant Organization C does not use re placement charts. They report that no one has taken the leadership to develop a structured succession planning system. Participant Organization D Participant Organization D does not formally identify individuals for positions that become available and there is not a repl acement chart. They report that they do not want to set people up for failure. Instead, they report developing people with the right skill sets to be in the right place at the righ t time. When positions become available there is a pool from which to select candidates for positions of leadership. Informally they 90 make sure that if a leadership position were vacated, life could go on for a short period until the leader returned or the position was filled. Reportedly, their culture permeates from the top corporate level down. They own fi ve hospitals in the state of Kentucky with 3400 employees locally and 9500 in the organization. Question #8 What special programs, if any , has your organization established to accelerate the development of high potentials?

75% of the survey participant organiza tions’ use their leadership development- training program as a mechanism to accelerat e the development of high potentials while equipping them with the competencies needed for healthcare leadership. 25% of the survey participant organizations plan to use leadership development training to accelerate the development of employees with high potential.

Figure 8: Healthcare Organization Special Programs He a lthc a r e Or ga niza tion Spe c ia l Pr ogr a m s Us e Leaders hip Dev elopment Training Program 75% In the proc es s of dev eloping leaders hip dev elopment plan 25% Participant Organization A 91 92 Participant Organization A reports that they are a large organization that has followed the model by General Electric – th e change agent model and workout session models. They report that leaders are tapped to participate in the National Leadership Training Programs, which is a great opportunity for leadership development. They have five healthcare facilities and some are located in small and rural areas. Their flagship institution is expected to lead the way for other healthcare facilities in their system. The have 42 directors, the vast majority w ho were tapped within the organization for leadership positions. The next level down may be tapped for leadership positions based on the organizational need. Participant Orga nization A reports many baby boomers at the Directors level and they antic ipate a high number of retiremen ts in the next 10-15 years from among those eligible for retirement. They report that they are affected minimally in other areas. They are acquiring other small hospitals, which mean that they will consolidate resources among leadership positions and reorganize to eliminate overlapping high profile positions. Participant Organization A reports that this merger caused people to lose their prestige resu lting in a decrease in employee sati sfaction. Change is not painless for those individuals involved repo rts Participant Organization A. Retainment is based on performance. Pa rticipant Organization A desires to work with people who want to come onboard. They are a faith based organization and have found that employees respond in a passive aggressive way to change. Participant Organization B Participant Organization B reports that the Evolving Leaders Program has had about 100 participants. All of their leadership development participants completed level 93 one of instruction. Twenty four employees have completed level two, fourteen employees completed level three, twenty employees level four. Two employees have completed level five for executive level leadership positions. Participant Organization C Participant Organization C reports th at the Fellows and Honors Program was initially established to accelerate the devel opment of high potentials. Their new program will start the fall of 2007. Participant Organization D Participant Organization D reports that the Leadership College develops high potential employees. Reportedly their serv ice excellence philosophy of cultural pride, personal responsibility and de livering excellence motivates their employees to take ownership in the organization, and for their ow n their behaviors and performance. As a key development tool, the subcommittee that su pports each of these endeavors creates an “ownership rather than rentorship” philos ophy that is shared among leaders and staff members. Question # 9 How does your organization evaluate succession planning and management activities?

75 % of the participant organizations use data to evaluate their leadership development-training program and a manage ment activity, which is tracked through employee productivity, performance and patient sa tisfaction scores as well as evaluations from leadership development training. 25% of the survey participant organizations are in the development stages of leadership deve lopment and acknowledged that there were no evaluation processes in place, thus making it hard to fill vacancies. Figure 9: Succession Planning Evaluation Activities Succe ssion Pla nning Eva lua tion Activitie s Tr a c k Da t a 75% Do No t Tr a c k Da t a 25% Participant Organization A Participant Organization A r ecognizes the need for data driven assessment with public forums to validate results. New unit mangers and their successors are evaluated by patient satisfaction, which is web-based and tracked daily to create a balanced look at the employee patient satisfaction scores. Participant Organization B Participant Organization B completes a year-end summary and evaluation with the coordinating team in the Evolving Leaders Program and the Mentorship Training Program. They constantly evaluate the cu rriculum based on participant feedback and their learning needs. Courses are added or deleted based on this feedback. When they evaluate the Leadership Development Program, they track the progress of a participant’s movement in the organization, whether it is a vertical move or a move outside the organization. They also recognize that they may lose staff to other healthcare 94 95 organizations and they view this as preparing employees to become stronger healthcare providers to serve their community a nd to take care of someone else. Participant Organization C Participant Organization C is in the early stages for leadership development and acknowledges they have no evaluation process in place which makes it difficult to fill vacancies from a pool of 10,000 employees. Participant Organization D Participant Organization D participated in Kentucky’s Best Places to Work Program the last two years, and finished in the top 20. In 2005, they were # 3 in the large employee category. They were named one of the top 100 hospitals (by an organization called Soluceint), for two years and won the consumer choice award for the Louisville Market of Healthcare Organi zations. Participant Organization D views employment satisfaction as a key indicator to gauge su ccess in growing and developing leaders. Employee turnover has been reduced to 14% from 22%; they have seen job vacancies drop 3-4% in all areas, and an increase in pr oductivity as a result profits have been added to the bottom line which are shared with em ployees. When they meet or exceed their quality goals and/or financial goals, they share up to 2% of the ex cess each year, which is outside of any market adjustments. Productivity and quality are measured by patient satisfaction which allows employees to earn an ywhere from ½ to 2% increase in salary. They were recognized by a research organiza tion at the University of Kentucky for their Leadership College and their Knowledge Program both of which were evaluated based on the implementation of best practices among healthcare organizations. Question # 10 96 What special challenges has your organiza tion encountered with succession planning and management? In the area of diversity? How have those been solved?

100% of the survey participant organi zations acknowledged challenges with succession planning and management. They include challenges in recruiting in healthcare personnel to Kentucky, diversity am ong leadership teams was not reflective of the client population served by the health care organization or the fabric of the community, and an applicant pool with low num bers reflecting diversity. All healthcare organizations interviewed had a different view of diversity. 75% of participant organizations have developed measures to address diversity which include: (a) developing a Diversity Fellows Program to attr act more diversity to attract more people form diverse backgrounds to leadership positi ons; (b) requiring all employees to attend four hours of diversity traini ng; (c) educating staff about issues and complexity associated with diversity; (d) implementing a national search for diversity recruitment purposes; (e) creating a partners hips with an area high school Health Careers Program to develop interest and attract healthcare workers from a di verse student populations. Efforts are being made among healthcare organi zations to include a more diverse group of employees. They are recruiting hea lthcare workers from areas with a high concentration of minorities’ i.e. environmental management and food and nutrition service. Those with an interest and a de sire to learn are tagged for upward mobility programs. Tuition reimbursement incentives ar e offered to employees who wish to climb the organizational ladder. Figure 10: Special Challenges with Succession Planning Acknowledge Special Challenges with Succession Planning Including Diversity 100% Participant Organization A 97 Participant Organization A reports havi ng a leadership position vacant for two years even though the position has been offered two or three times. Participant Organization A has vacancies for a director and vice president. Several shinning stars have been tapped to work at the corporat e headquarters, which is a challenge for a flagship institution. They report obstacles hi ring operating room and surgical nurses and the average age of these speci alized personnel is between 47 and 50. For hard to fill positions, such as a director of surgery a na tional search is conducted and a recruiter is used in the hiring process. Participant Or ganization A has a Diversity Fellows Program, which is a corporate program for leadership development. Two people from diverse backgrounds are selected each year for this paid internship. The Diversity Fellow is placed on the executive team and works with th e Director of the Medical Center. Their emphasis is on building diversity within the executive level and building strong executives and creating strong leaders. 98 Participant Organization B Participant Organization B does not have a leadership team that reflects the community they serve. The nurse demogra phic reports did not reflect the community they serve. They report gi ven thought to and taken an active role in and building partnerships with academic institutions for recruitment purpose. Reportedly, they are willing to hire a diverse workforce but ha ve few candidates and low enrollments in programs designed to fill the need for diversity. When they examine the pool of applicants, there is little diversity repres ented, including ethnicity and gender. They recently promoted an African American in the Cardiac Cath Lab. Currently, three African Americans are in the leadership pool of sixty directors. They have partnerships with an area high school’s Healthcare Careers Program where efforts have been developed to nurture and recru it minority students to healthcare careers. They also have high school students who volunteer for communi ty-based experiences to learn about healthcare jobs. They attempt to recruit from environmental and nutrition services within the organization–areas that have the larg est number of minority employees and entry- level jobs. Participant Organi zation B reports there is little interest in scholarship and continuing education opportunities among thes e employees. Participant Organization B is aware of the need to recruit and hire minorities for high level healthcare positions and state this as an area in which they need improvement. Participant Organization C Participant Organization C does not reflect a high level of diversity in the area of management. Organizational makeup is 85% female, 84% white, and the median age is 40. 12.3% of females are salaried employees (exempt status) and 25.3 % of males are in 99 exempt positions. African Americans make up 4.9 % of exempt employees. Of the top 800 people in management, 43 are minorities whic h represents 5% of those employed at a supervisory level or above. The professiona l group direct caregiver, physicians, nurses and allied health minorities represent 8% of the total numbers or 284 of 3640 employees. The statistics are not in proportion to the patient population they served. They have a Division Director of divers ity who is rolling out a diversity wide initiative. Four (4) hours of diversity tr aining will be required for every employee in 2007. They hired an outside consultant to tr ain key employees within the organization to serve as facilitators for employee sessions. Topics will include personality, internal dimensions, external dimensions and organiza tional dimensions related to diversity. Participant Organization D Participant Organization D has taken steps to send an employee for training and certification as a Diversity Trainer. They are moving towards a culture that reflects diversity even though they do not have a pool of diverse backgrounds. Reportedly, they do not have a pool of candidates from divers e backgrounds. Demographically, their staff is 90% Caucasian and 10% of the staff reflects people of color. They have no diversity in upper level leadership among the vice presidents , directors, or manager; however, they do employ several minority supervisors. The Bo ard of Directors reflects some diversity. Future diversity plans may address this and include cultural sensitivity training for nurses and caregivers i.e. to include culture, religion and sensitivity awareness. Reportedly, they embrace diversity.

100 Patterns and Themes Although leadership development training programs varied from organization to organization, the following patterns and them es were identified among these four (4) Kentucky healthcare particip ant organizations. The results are shown in Table 5.

Table 5: Patterns and Themes of Survey Responses Patterns and of Themes of Survey Responses • Accountability: Healthcare organizations app ear to be holding leadership accountable for their leadership performance agreements. • Focus on Workforce Retention: A trend to promote from within the organization is emerging.

• Leadership Development: Leadership Tr aining is open to all levels of the organization with emphasis on top management . Healthcare organizations appear to recruit leadership within every level of the organization.

• Leadership Competencies: Negotiation skills, behavior management, budgeting, finance, collaboration and continuous learning appear to be the competencies required for healthcare leadership.

• Performance Management: All employees ar e expected to perform at high levels within the organization, whic h supports the need to reassign poor performers for improved efficiency and improved staff morale.

Leadership Development Programs in Hea lthcare organizations surveyed do not use formal succession planning as practiced in business organizations. Leadership 101 Development Programs of those surveyed vari ed from organization to organization and was not linked to succession plans. Research Questions and Summary of Responses Research Question #1: Are healthcare organizations us ing recommended best practices in succession planning?

Succession planning is a proactive appr oach that helps leaders deal with unexpected changes and has been defined in many different ways. However, for the purposes of this research, the definition co ined by McWilliams (2005) defined succession planning management as an effort designed to ensure the continued effective performance of an organization, divisi on, department, or work group by making provision for the development, replacement, a nd strategic application of key people over time. Added to the vocabulary of successi on planning is technical succession planning. It is defined as any effort designed to ensure the continue d effective performance of an organization, division, department, or wo rk group by making provision for distilling, preserving, maintaining and communicating the fruits of the organization’s institutional memory and unique experience over time (Rothwell & Poduch, 2004).

All of the survey participant organizati ons acknowledged that they did not have a formal succession plan. They all acknowle dged that the concept was new to their organizations but two healthcare organizations filled positions at their respective facilities in 2006 with the intent to develop a succession plan for their facility. Either the Human Resources Department or Education and Development Department coordinated the succession planning /leadership development in itiatives, which involved top management at each of the selected healthcare organiza tions. Succession planning procedures differed 102 from organization to organization and appeared to be based on the political climate for the organization with regard to how leader ship development training was implemented. The survey participant organizations were keep ing abreast of the current market trends in healthcare as well as human resource trends in the industry. Some were partnered with associations that evaluated marketing trends in healthcare, which assisted with their strategic planning. The present findings support the need for succession planning to preserve workplace culture, norms, traditions, returns on investments, money savings, higher patient satisfactions rates, employee satisfaction and organizational survival resulting in long-term high performan ce (Abrams & Bevilacqua, 2006). Survey participant organizations acknow ledged challenges associated with succession planning. Participant Organizations acknowledged some resistance to the succession planning process but were rethinking how the healthcare organizations would benefit from their succession planning and leadership devel opment training program efforts, and acknowledged need for further study. Research Question # 2: Are healthcare industries identifyi ng potential leaders for future organizational needs?

Responses of those surveyed revealed that the healthcare organizations in Kentucky have only recently begun to devel op and institute succession planning. The participant organizations’ surveyed were al l in the cultivation phase of leadership development planning within their organization. Two were in the development stages of planning with new positions created and filled in 2006 and two had leadership development programs launched and implemente d in 2000. All of the survey participant organizations had invested in leadership development and training programs, and were 103 trying to develop an organizational culture to maximize its performance and adapt to market changes in diversity. By creating leadership development programs, those survey participant organizations whose programs had been launched within the last six years believed they were beginning to see the fruits of their labor–a pool of individuals trained to fill vacant positions when needed. Because of this training, most positions were being filled from within with a smaller percentage being selected from outside of the healthcare organization. Outcomes from leadership development training programs affected the bottom line due to increased employee sati sfaction. All participant organizations surveyed acknowledged the need for having a sk illed workforce in efforts to become an employer of choice. Question # 3: Are healthcare industries using me ntoring to develop succession plans?

Of the survey participant organizations responding, 25% of population studied acknowledged having a strong mentoring program linked to their leadership development/succession planning initiatives. Th e survey participant organizations agreed that the mentoring programs were not cons idered an automatic guarantee for upward mobility for all individuals sel ected to participate in such programs. All four survey participant organizations agreed that they were creating a learning environment to help employees develop life-long learning skills. Question#4: Are healthcare industries addressing employee retention? Survey participant organizations with leadership development programs in existence since the year 2000 saw positive resu lts with regard to employee retention which resulted in improved employee sati sfaction, improved manager effectiveness, increased promotions from within, reduced turnover, increased retention, increased 104 productivity, personnel cost savings, awards and recognition of employees. Within a short period in tracking data, th e novelty of the program makes it difficult to determine its long term effectiveness for one organization; however, the leadership staff reported they had developed a better understanding of th eir employees’ strengths and weaknesses. Furthermore, they reported having a keener in sight to those employees who were ready to assume additional responsibilities and move to the next level, as well as those who needed additional time or would not be a candidate for increasing responsibilities.

Question #5: Are healthcare organizations preparing for the shift in workforce diversity? The survey results indicated that although the workforce is better educated and reflects more diversity, divers ity in top management is not a common occurrence in the four (4) Kentucky healthcare organizations interviewed. All survey participant organizations acknowledged workforce diversity as a challenge for their organizations in the area of attracting minorities and others to the CEO level of administration. All survey participant organizations noted that they could do a better job with diversity, but cited the following reasons for low numbers: few applic ants, few diversity enrollees in university healthcare professions, little di versity within the community. While partnership with institutions of learning were cited as a means of generating a more diverse pool of applicants in healthcare, no Kentucky healthcare organization acknowledged a relationship with the Commonwealth’s only Historically Black College and University (HBCU) – Kentucky State University. 105 Summary The literature review provided a solid basis for the need for this study: While many corporations utilized formal succession planning, many healthcare organizations have not or are slow to follow. The research findings have been presen ted in this chapter. The researcher addressed five research ques tions through a literature revi ew and a survey of Kentucky healthcare facilities. The research data indi cates that if healthcare organizations are to remain viable and competitive, then they have no choice but to develop and implement a formal succession planning program. A va riety of themes emerged from the study indicating that an approach to formal su ccession planning is beginning to evolve in Kentucky healthcare organizations; however, th e healthcare organizations surveyed are in the early stages of development making it diffi cult to determine the effectiveness of their programs. The following chapter will offer recommendations to guide healthcare organizations toward implementing succession planning programs in the future.

106 CHAPTER V: DISCUSSIONS, IMPLICATIONS AND RECOMMENDATIONS “The Chinese philosopher Lao Tzu wrote a descri ption that is as close to an ideal leader: The best of all leaders is the one who helps people so eventually they don’t need him. Then comes the one they fear.

The worst is the one who lets people push him around.

People don’t trust a leader who doesn’t trust them.

The best leader says little, but when he speaks, people listen and when he is finished With his work, the people say we did it ourselves” Maccoby (2004). Introduction Because of the aging workforce, health care organizations are facing a leadership and workforce crises. Today’s employees are working in an information age and knowledge based economy in a global so ciety (GAO-01-241, 2001). Baby boomers are often seasoned professional employees w ith a wealth of information, knowledge and experience regarding technical and program skill s, and are considered the historians for the organizations in which they are empl oyed. Younger employers (generation Xers) often lack the experience, work ethic and lif e experiences of their predecessors. (GA0-01- 241, 2001). After the September 11, 2001 bette r known as the 911 tragedy, a day where the United States was attacked by terrorists , perhaps many employees reprioritized their 107 values regarding career and family, and imp acted workforce demographic trends that point to the necessity to better prepare for an uncertain future. It is critical for healthcare organizations to position themselves for great ness and focus on the fundamentals that will help sustain themselves in the 21 st Century (Collins, 2001). This study analyzed the trends expected to impact healthcare organi zations as leadership transitions occur among an aging population and workforce. This qua litative study investigated the effectiveness of an ideal formal succession plan and wa ys healthcare organizations can make succession planning a priority to ensure organizational success over time. A major finding of this study was the consistency among all four participant organizations. The findings reflect the need fo r healthcare organizations to create formal succession plans to address workforce and leader ship shortages. Using best practices in succession planning are more prevalent in non -healthcare organizations but healthcare organizations must adapt this strategic plan in efforts to remain viable for the 21 st Century. This study examined four (4) major hea lthcare organizations to determine how they identify potential leaders; use mentor ing to address succession plans; retain employees and prepare for workforce dive rsity; and develop leaders within the organization. Succession planning in healthcare must be attuned to current paradigm shifts as the health care industry continues to respond to workforce trends, diversity, consumer and community needs. Healthcare in dustries must prepare well for the future via succession planning and defi ning the skills and competencies needed for developing leaders. Succession planning provides an opportunity for healthcare organizations to develop a strategic plan to ensure a high quality workforce. 108 Critical issues face healthcare organizations including budget challenges, quality improvement initiatives, patient safety, patient satisfaction surveys, technology, malpractice, workforce shortages and governmental mandates which add to the complexity for developing an effective succession plan (Top Issues Confronting Hospitals: 2005). While th ese issues are viable, the need for developing and implementing an industry standards based succe ssion plan is critical. While management talent is selected and groomed to be effective leaders in healthcare organizations, other grave issues such as diversity, and workforce retention may receive little or no attention without a competent leadership team and workforce. Rothwell (1999) offers a step-by step guide for implementing a succession planning model: • Clarify leadership expectations and preferences • Establish competencies by hierar chical level or departments • Implement a 360 degree assessment • Establish an organizational performance management system • Assess employees for advancement • Establish ongoing individual development plans with in-house leadership development training • Establish a competency inventory • Establish individual and organizational accountability for succession planning efforts • Evaluate the results 109 Succession planning has implications for th e healthcare industry. Expertise may be lost often along with retirement trends ; there is a need to have employees and leadership with a vision to anticipate the next healthcare crises. For example, the Center for Medicare Service is evaluating the incidenc e and cost of hospital-acquired infections. In 2007, they will begin to pilot the collection of data. In 2008, Medicare may no longer pay for hospital acquired infections. This is an example of one of many policies and procedural changes that health care organizations are facing that requires them to have a well trained workforce. This has large impli cations for large teaching facilities that see more complicated patients who are high risk fo r infections. Another implication is third party payers may choose hospitals with lower ri sk of infection thus resulting in decreased admissions. Additionally, recent legislature ma ndate public disclosure of data as it relates to complications and errors (Mary Oden, RN, MHS, Op erations Director, Infection Control and Epidemiology, Duke Un iversity Medical Center, March 18, 2007). Discussion of Results The world of work is changing and orga nizations no longer offer job security; however, many organizations offer training skills for professional development to employees. This study represents the findings, conclusions and recommendations of the leadership needs in a changing American wo rkforce as well as challenges in developing and retaining a qualified diverse workforce to provide quality healthcare to an aging population. This researcher gath ered invaluable ideas from the literature and the study that have direct implications for healthcar e organizations in developing formal succession planning. The study reveals that the four (4) participant healthcare organizations 110 surveyed in Kentucky are planning for future leadership; however, this planning remains in the infancy stage of development. Succession planning and leadership devel opment training at all levels of the organization improves their day to day opera tions and is the hallmark of successful organizations and allows them to become great, improve in their operations, and become high performing organizations. Planning and implementing succession planning prevents a crisis from occurring in an organization and is a mean s to prepare for changes and vacancies in key positions that often occur without notice. Formal succession planning allows healthcare organizations to be prepared for changes that can occur at any time. As organizations develop individua ls organizationally, they develop their human capital and increase the behavioral skills that help strengthen the organization. Implications Results of this study indicate important implications for succession planning in healthcare organizations. Survey findings indi cate that there is a need for improvement in the implementation of formal succession pl anning in healthcare. While it appears that succession planning and leadership development are important tools for healthcare organizations, none of the healthcare fac ilities interviewed had formal succession planning programs in place. Succession planni ng can be difficult when organizations do not know the skills required for various positi ons and when position descriptions have not been updated to reflect the skill sets required for the vacant position. Healthcare organizations need to understand what ski lls are needed for every position and update position descriptions prior to the recruitment pr ocess to ensure an individual is hired who 111 has the right skills. Additionally, interview questions for prospective employees designed to reveal the talent and skills of job applicants. There are differences in practices among th e healthcare organizations surveyed in developing the process of succe ssion planning practices. Becaus e of the complexities of healthcare systems, there is no one size th at fits all process or magic bullet for implementing a succession plan. However, orga nizations achieving success with some of their initiatives should share th eir success with other healthcare organizations in efforts to create a best practice model that could be used among healthcare organizations. The research findings indicate that lead ership training, mentoring and stretch assignments appear to be important developm ental assignments for employees identified with leadership potential. Th e data suggest that the more opportunity for developmental activities, the higher perceived effectiven ess of the training program. Healthcare organizations would benefit from devel oping a formal succession planning program. Succession planning is a way of preparing healthcare organizations to achieve the goal of having employees prepared for promotion at each level of the organization. There needs to be more partnering, collaboration and join t ventures among healthcare organizations to develop comparable standards-based programs to identify talent within the organization for promotion and leadership roles. Mentor ing needs to be embraced in the development of succession planning with specific roles and responsibilities of each partner clearly delineated. Additionally, leadership development programs need to be formalized to succession plans and linked to organizatio nal strategic plans that are based on organizational needs. A tracking process needs to be in place to determine the effectiveness of each program. Active recr uitment, attention and a commitment among 112 organizational leaders must be made to encour age and promote diversity at all levels of leadership. Healthcare organizations need to keep abreast of current trends in healthcare and remain current with liter ature in business practices. Recommendations for Further Research This research suggests several directi ons for future research in terms of succession planning. 1) A comparative study on the effectiveness of succession planning and its impact on leadership stability. As formal su ccession planning is not a model endorsed in health care settings, additional research would provide more information on outcomes associated with succession planning. 2) Further research is needed about th e relationship of employee development and organizational commitment for workforce planning. If succession planning is used as an effective tool in healthcare organizations, an evaluation of outcomes of those employees who have participated in leadership development training programs must be co mpleted to solidify the process and generate standards for h ealthcare organizations fo r identifying and grooming leadership at all levels of the organization. 3) Employee skill gaps in terms of l eadership development and meeting the leadership competencies needed for healthcare leadership needs investigation. 4) Healthcare organizations need to continue to expand leadership development and need guidance in how to develop formal succession plans.

5) Hidden biases are involved with lead ership selection and identifying employees who could be groomed for leadership in all areas of the organization. 113 Information is needed on how successors are identified and prepared for leadership roles. 6) The integration of diversity in succession planning programs needs to be studied in terms of effec tiveness. Information is needed on the importance of leadership diversity and the development of multicultural leaders. 7) Further research is needed in terms of effectiveness to determine the effects of mentoring in healthcare to include cro ss race and same race relationships and the impact on career success.

8) Another question remains open for rese arch: How can leaders/managers build competence on a daily basis through mentoring feedback? More partnering, collaborations and joint ventures among healthcare organizations is necessary to develop compar able programs and set industry standards. Conclusion Formal succession planning provides an opportunity for healthcare organizations to successfully position themselves for greatness by designing and implementing a formal succession-planning program with commitment from leadership to create a workplace culture of leaders across all levels. This message must be imparted in their daily operations if they are to sustain themselves over time. Embracing this leadership concept can lead to developing and ensuring a divers e high quality workforce, thus allowing healthcare organization to thrive in the 21 st Century. This can be done by: 1) analyzing healthcare workforce trends and projections; 2) being proactive in embracing a formal succession planning model of development; 114 3) assessing skill gaps and needs; 4) creating a workplace climate that supports continuous learning and development; 5) developing a diverse workforce that repr esents the fabric of the community, customers and stakeholders; 6) widely publicizing developmental opportunities for employees interested in higher level positions; 7) holding managers and leaders a ccountable for achieving results; 8) monitoring the results of the effectiv eness of formal succession planning initiatives and making informed adjustments when needed; and 9) implementing training to address the competencies needed for healthcare leaders at all level of the organization. The above guidelines serves as a roadmap for healthcare organizations to position themselves for success in their efforts to ensure leadership continuity, retain critical staff in critical positions, promote diversity, encourage individual and personal and professional development. These are necessary to sustain healthcare organizations in a competitive and global economy. 115 REFERENCES Abrams, M., & Bevilacqua, L. (2006). Buildi ng a Leadership Infrastructure: The Next Step in the Evolution of Hospital Systems. Healthcare Strategic Management, 24(4), 13-16.

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Zey, Michael. (1988). A Mentor for All. Personnel Journal, 67, 46-51. APPENDICES Appendix A. Research Ethics Approval Letter 125 126 Appendix B. Spalding University Research Ethics Proposal 1. Title of the Study Succession Planning in Healthcare Organizations: Meeting the Leadership Needs in a Changing American Workforce 2. Faculty Research Advisor Dr. Marie M. Sanders, Associate Professor Spaulding University 3. Investigator Contact Information Freda Bailey Shipman 770 Stoneleigh Drive Frankfort, Kentucky 502-848-9882 home; 859-281-3916 work; 859-221-4677 cellular febs1@aol.com 4. Estimated starting date and duration of the study October 20, 2006 – November 30, 2006 5. Purpose of the study The purpose of this research is to investigate the correlation between succession planning management of healthcare organizations in Kentucky and its impact on leadership development in healthcare as it relates to the changing workforce demographics as reported in the Bureau of Labor Statistics. 6. Name of the sponsor [if any] There are no sponsors or agencies sponsoring this research. 7. A brief description of the study a. Survey instrument b. Demogra phics/subject recruitment c. Subject participation requirements a. Survey Instrument – An interview questionnaire developed by Dr. William Rothwell, author of Effective Succession Planning (2001), will be adapted to reflect Kentucky Healthcare Organization’s needs. Some questions have been deleted to reflect the literature review and current trends in the healthcar e industry. There are 10 questions. Completing the survey can be expected to take about 30-45 minutes. Each question is open ended. b. Demographics/subject recruitment – There are 95 medical/surgical healthcare facilities in Kentucky and 40 facilities with a capacity of 150 or more beds as identified in the Kentucky Hospitals 2006 Guide. This research will sample only those medical/surgical facilities with 150 or more beds (N=4) to get a representation of 127 succession planning management in healthcare. c. Subject participation requirements – Four (4) healthcare facilities will be randomly selected to participate. Each subject will be mailed a questionnaire. A follow-up phone call to schedule a face to face interview will be scheduled. Data from the oral and written questionnaire will be aggregated to compare with recommended best practices for succession planning. A letter of thanks to each survey participant with an invitation to review the results of the study and recommendations for implementation.

8. Risks to the study participants (Minimal Risk) Survey Respondent – The investigator will take every precaution to minimize the physical and/or psychological risk resulting from answering the questionnaire. Each healthcare facility selected will be named A, B, C, and D in the order the questionnai re is returned to the researcher. Only the researcher will know the letter that corresponds with each healthcare facility. 9. Benefits to the participants and others Th is research is expected to yield important knowledge regarding the correlation between succession planning management of healthcare facilities in Kentucky and the impact on leadership development in healthcare. Participants will have access to their results and recommendations from the research to create or improve their efforts in succession planning. 10. Protection of Subjects’ Rights All info rmation gathered in this research will remain confidential. Specific individual survey data will not be disclosed to anyone and only the investigator will have access to the research materials. 11. Informed Consent Agreement The survey respondents need to sign a written consent form for the data they are sharing with the researcher as the information will be used to determine 128 whether their healthcare organization are currently using succession planning tools and to what degree for leadership development. The recommendations will be based on that information and each individual healthcare organization. The questionnaire on succession planning should provide valuable information about the needs a healthcare organization should meet. 13. Purpose of Survey Instrument The purpose of this qualitative study is to analyze the characteristics of succession plans and develop ways healthcare systems can utilize best practices to create mentoring succession planning as a most effective means to address predicted employee shortages to develop an organizational approach that addresses the workforce, needs and challenges of the 21 st century. 14. Signatures __________________________________ Freda Bailey Shipman, Investigator/Date _________________________________ Dr. Marie M. Sanders, Dissertation Chair/Date Dr. Veda P. McClain, Dean, College of Education/Date 129 Appendix C. Letter to Survey Participants Freda Bailey Shipman 770 Stoneleigh Drive Frankfort, Kentucky 40601 502-848-9882 home; 859-221-4677 cellular febs1@aol.com November 21, 2006 Dear Survey Participant, I am currently a doctoral candidate at Spalding University’s School of Education in Louisville, Kentucky pursuing doctoral degree in Leadership Education. I am conducting research on Succession Planning in Healthcare Organizations that involves general medicine and surgical healthcare facilities around the state of Kentucky. The purpose of the study is to analyze the charac teristics of succession planning and develop ways healthcare systems can utilize best practices to create mentoring succession planning as a most effective means to addre ss predicted employee shortages as leadership transitions occur among an aging population and workforce. Your participation in this study will assist me in examining current succession planning practices that prepare leaders for healthcare leadership. I wr ite today to request your assistance.

To participate in this study, I will ne ed to receive a copy of your institutions succession plan. You may be assured that no re ference will be given to the name of your healthcare facility in the reporting of this research. I will be happy to pick up the materials if necessary.

In addition, I would like to meet w ith you for no more than hour at your convenience. Your efforts will help me in compiling the needed data for my research design. Please use the enclos ed self-addressed stamped envelope to confirm an appointment, or you may contact me at (859) 221-4677 cellular or (502)848-9882 home. Your time, participation and support are gr eatly appreciated and necessary to this research project. The information you provide can assist me in identifying themes, patterns, and trends in today’s healthcare workforce.

130 You may request information regarding results, implications and recommendations from this study. Thanking you in advance for your assistance. I look forward to hearing from you.

Sincerely, Freda Bailey Shipman Enclosure: Succession Planning Management Interview Guide Informed Consent 131 Appendix D. Informed Consent Informed Consent – Survey Respondent (Succession Planning) 1. Title of the Research Study: Succession Planning in Healthcare Organizations: Meeting the Leadership Needs in a Changing American Workforce.

2. Purpose of the Research Study: The purpose of this research is to investigate the correlation between succession planning management of healthcare facilities in Kentucky and the impact on lead ership development in healthcare.

3. Estimated Duration of the Research Study: October 20– November 30, 2006 4. Research procedures: An interview questionnai re guide adapted from Dr.

William Rothwell author of Effective Succession Planning (2001). Completing the survey can be expected to take 30-45 minutes. 5. Description of Potential Risks: (Minimal Risk) The investigator will take every precaution to minimize the physical and/or psychological risks resulting from answering the questionnaire. Data from indi vidual healthcare facilities will not be released. 6. Description of Potential benefits: This research is expected to yield important knowledge regarding the correlation between succession planning management of healthcare facilities in Kentucky and th e impact on leadership development in healthcare. Participants will have access to their results and recommendations to create or improve their e fforts in succession planning. 7. Alternate Research Procedures: No alternate research procedures have been established. 8. Confidentiality: All information gathered in this research will remain confidential. Specific indivi dual survey data will not be disclosed to anyone and only the investigator will have access to the research materials. 9. Contact Information: Freda Bailey Shipman 502-848-9882 or 770 Stoneleigh Drive 859-221-4677 Frankfort, Kentucky 40601 febs1@aol.com 10. Voluntary Participation: Your participation is voluntary, refusal to participate will involve no penalty or loss of bene fits to which you would otherwise be entitled, and you may discontinue participa tion at any time without penalty or loss of benefits. 132 I have received a complete explanation of the study and I agree to participate. ______________________________________________ 133 Appendix E. Interview Guide Questionnaire Succession Planning Management Interview Guide Questionnaire Survey Instructions: Please answer all of the questions. I will call you to schedule a face to face interview where we will discuss the ques tions below. Interviews will be recorded and later transcribed to examine written and verbal responses for additional information and clarification purposes. 1. What goals and objectives have been established for succession planning and management in your organization?

2. How does your organization define key positions? What positions, if any, are given special attention in your succession planning program? Why are they given that attention?

3. How does your organization assess current job performance for succession planning and management purposes? (Do you use the organization’s existing performance appraisal system – or something else?

4. How does your organization identify successors for key positions?

5. How does your organization identify high-potential employees (who are capable of advancing two or more levels beyond their current placement)?

6. How does your organization establis h Individual Development Plans (IDP’s) to accelerate the devel opment of high-potential employees?

7. Does your organization use replaceme nt charts based on the current organization chart? (If not, why?) 134 8. What special programs, if any, ha s your organization established to accelerate the development of high-potentials?

9. How does your organization evaluate succession planning and management activities?

10. What special challenges has your organization encountered with succession planning and management? In the area of diversity? How have those been solved? Appendix F. Doctoral Dissertation Proposal Acceptance Form 135 136 BIOGRAPHY Freda Bailey Shipman earned her Bachel or of Arts Degree in Sociology with a concentration in Social Work from North Carolina Central University in 1983 and her Masters of Social Work Degree with a concen tration in Health from the University of North Carolina School of Social Work at Chapel Hill in 1985. She has served as a Clinical Social Worker at the VA Medical Center in Mountain Home, TN and Durham, NC and currently is employed as a Program Director for one of the VA’s special emphasis programs (Visual Impairment Serv ices) at the Lexington VA Medical Center culminating in 21 years of service in healthcare. A So cial Worker by training, her professional career has been committed and dedicated to helping others, providing clinical services and program administration to veterans who are disabled. Committed to Social Work Education and the life long learni ng of others, she has served as an agency field instructor to twelve undergraduate and graduate Social Work Students at various Schools of Social Work in Tennessee, North Carolina and Kentucky. During her tenure with the Veterans Affairs Medical Center, she has been recognized for exceptional performance and received numerous awards for her humanitarian outreach to the veteran population and their families. She is a 2005 graduate of the VA’s Vetera ns Integrated Services Network (VISN) Leadership Institute and a past participant of the Allied Health Clinical Mentorship Training Program (2000). Mrs. Shipman entere d the Spalding Doctoral Program in the fall of 2004 and this dissertation is the culmination of her work and reflects her lifelong career and joy of helping others. A public se rvant, she is a member at large of the 137 Lexington Lions Club, serves as a board member to Kentucky Office for the Blind State Rehabilitation Council (Governor Appoint ed), Special Olympics of Kentucky, Independence Place Board Member, Frankfort- Lexington Chapter of the Links, Inc. and Alpha Kappa Alpha Sorority, Inc. A native of Raleigh, North Carolina, she has been married for 18 years and has two sons, 12 and 7.

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