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Succession Planning and the Delivery of Care
Lanetta Lashawn Muhammad
Liberty University Online
BUSI 646: Managing Human Capital in Healthcare
Respectfully submitted to Dr. Terrance Duncan
February 27, 2022
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Abstract
Succession planning has become increasingly popular in the healthcare delivery system. It is
often explained as a specific business strategy often used by hospitals to help improve staffing
issues and increase quality performance and better health outcomes (Desarno et al., 2021). This
research paper will attempt to define succession planning, its function in the delivery of care,
metrics necessary for designing the program, and the building blocks of succession planning.
Also, to be considered are the specific traits associated with creating a successful succession
plan, challenges associated with succession planning, and how human resource leaders can
ensure succession planning is effective within their organization. Overall, an effective and
efficient succession plan should produce capable leaders that can transition smoothly into the
leadership role so that the organization does not suffer and quality care is maintained throughout
the process.
Keywords: succession planning, quality improvement, organizational performance, leadership
succession, delivery of care, staffing shortages
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Succession Planning
It is often thought that succession planning is a means of replacing one leader with
another at the executive level but it is much more concrete and delicate than this. Staffing
shortages and healthcare outcomes are rectifiable issues within healthcare that can drastically
lead to the collapse of the healthcare delivery system (Graystone, 2019). It involves nurturing
future leaders, sustaining organizational leadership, knowledge, and experience, and aligning
succession strategies with objectives that can provide significant quality outcomes necessary for
delivering care. The goal is to ensure that the mission and vision of the healthcare organization
never falter in the event of an expected or unexpected change in leadership or power. Succession
planning can be achieved if leaders shift their focus and attention on recognizing any deterrents
that may arise. Overall, succession planning should not just be approached from an upper
management concern but all areas of leadership to avoid critical disruptions in the delivery of
care and everyday functions of governing an organization whether they be big or small.
Areas that can directly impact succession planning are generally centered around
recruitment, investing, identifying quality candidates, and the hiring and selection process which
can all be extremely complex (Koppolu et al., 2021). One of the best examples of these particular
determinants that leads to unsuccessful succession is leaders that do not familiarize themselves
with the individuals they lead. This is common especially in the healthcare industry as it hires
thousands of employees from the executive level to lower levels of employment. This is often
recognized in executive leadership as many of them for whatever reason do not take the time to
familiarize themselves with the roles, workflows, and experiences of those they lead. An astute
and mindful leader should pay close attention to the necessary skills and experiences that are
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needed to perform the task and most importantly have a general idea of the individuals who work
for them and why they take on those roles.
Principles of Succession
Succession planning is generally made of up five unique principles. These principles
center around collaboration, a continuation of organizational processes, competencies, recruiting
the right leader for the organization, and post succession. To successfully ensure the organization
has a well-thought-out and detailed succession plan all these factors must be considered. The
governing board, CEO, successor, and human resources leaders play a vital role in properly
implementing a successful succession plan (McConnell, 2021). With the help and collaboration
of all parties working together the organization should be able to develop strategies that will help
avoid vacancies. Isiah 32:8 teaches, “But he who is noble plans things, and on noble things he
stands” (English Standard Version). This demonstrates that planning is indeed essential
especially in healthcare because prolonged staffing shortages and vacancies have a direct impact
on the delivery of care which in the long term affects performance metrics and patient
satisfaction.
The first principle of succession planning focuses on the collaboration process of all
parties involved. This simply implies that the board and all other involved members are working
together in cohesion to generate a sound transition of power from one leader to another. With
hospital turnover rates on a continuous rise, healthcare leaders need to collaborate on a
succession plan that provides feasible solutions to the deficit being witnessed (Moore et al.,
2021). This first starts with selecting suitable candidates or in some instances grooming
candidates from within. This can only be achieved if all parties are collectively communicating
their needs, goals, objectives, and desired outcomes for the organization as well as their specific
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departments. If there is a breakdown in communication amongst these parties the succession plan
will ultimately fail from the start.
The next principle focuses on the continuations of the organization's processes,
productivity, and mission. This ensures that if something unexpected happens the organization
will continue to run without incident. In any business, anything can happen unexpectedly and for
that matter, healthcare is no different. From untimely departures to resignations and firings to
death succession plans must be in place in these instances. If any of these were to occur the
organization nor the consumer should notice this from operations, productivity, or workflow
standpoint. Many organizations find succession planning especially in advance helps mitigate
turnover and cut recruitment costs drastically (Phillips et al., 2018). Recruitment especially at the
highest level of leadership is not a simple task. It is unlike hiring for lower-level management
positions as this individual must be thoroughly vetted by all stakeholders. An effective
succession plan should at least have an individual prepared to step into the role immediately or in
the interim until a permanent leader has been appointed. Without a formal leader appointed
cracks in the organization's production, delivery, and framework will quickly be noticed.
Competencies are essential in developing a successful succession plan thus making it the
third principle. Finding or grooming individuals who possess the necessary education, skill sets,
organizational skills, and leadership qualities should begin even before a current leader leaves.
Simply put this individual should always be ready and prepared to take the role without
hesitation. Competencies must be established as a protocol for recruiting a leader who provides
the leadership qualities and abilities the organization desires (Anderson, 2018). This means
organizational leaders and human resource leaders must work in direct unison to build and
establish competencies that can be used to measure a potential candidate's ability to lead.
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The fourth and one of the most important principles happen to be timing. When and how
a leader leaves or comes into an organization is equally as important as their ability to lead. This
step in the succession plan is primarily overseen by human resource managers. When an
organization's leader notifies them of their departure they should already be working to put the
succession plan in place (Chakraborty & Biswas, 2020). This is where areas related to exit plans
and contracts come into play. As the human resource manager, one would be responsible for
timing the exit of the current CEO and the appropriate timing in bringing in the new CEO.
Lastly, the final principle in the succession plan is a post succession assessment. After all
the parties have uniformly chosen a candidate and that individual has accepted the role human
resources is now tasked with reviewing the overall process to ensure its effectiveness and
efficiency but also they are tasked with discovering areas where changes could be made to better
assist in the development of future succession planning strategies.
Barriers Associated with Succession Planning
Succession planning although a fairly new concept in healthcare has its fair share of
barriers The most common areas of conflict within succession planning is associated with
diversity, funding, hiring inaccuracies, training/professional development programs, clear
understanding of roles and functions, ability to pay candidates, aging workforce, and retention
rates which all directly impact the delivery of care (Bleich, 2019). It has been established that
succession planning helps facilitate quality candidates but that does not mean there are no
challenges along the way. Diversity is one of the most common barriers that need to be addressed
in the succession planning process. Jones et al. (2017) conclude that many organizations put
leaders in place that are not a direct reflection of their diverse workforce which often has a direct
impact on the delivery of care. Healthcare institutions that focus on overcoming diversity-related
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issues will also strengthen their competitive edge not only in the workforce but also in their
patient populations.
Funding in healthcare is often controversial. The majority of healthcare institutions'
funding comes from government-funded programs or private investors. Issues related to funding
or lack thereof impact the delivery of care because it cuts away from valuable training resources.
Although employees may be trained in certain areas they still require specific training, skills,
experience, and education especially if they want to excel in their organization (Moore, 2018).
Succession plans that lack structured training, on-the-job training, and professional development
opportunities will not foster growth but will often lead to higher retention rates. Another
component of this is the aging workforce. One of the biggest concerns of succession planning is
planning for this. The workforce globally is coping with an aging workforce that is working
longer but not seeking to go into leadership positions leaving positions such as upper
management harder to fill (Foster, 2019). This impacts the healthcare delivery system as it puts
more strain on paying the aging workforce and little investing in leadership development
programs and grooming potential candidates that will take over leadership roles once the aging
group retires.
Another fascinating barrier that impacts succession planning is pay scales and the
inability to effectively train future leaders. A successful succession plan strives to address
financial needs as this topic will arise during the negotiation process when seeking out potential
candidates. Succession management practices and human resource leaders must evaluate
financial restraints, operational constructs, hospital performance metrics, including patient
satisfaction when evaluating pay scales (Groves, 2019). Positive examples of succession
planning can be implemented by hospital organizations related to pay scales, professional
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development, and training needed for those who either serve or want to serve in an executive
capacity. In hindsight, individuals want to be paid what they believe they are worth based on
their job functions and responsibilities set forth by human resources. If employees believe the
pay scale does not justify their responsibilities it will have a direct impact on any future
succession planning. Hospital organizations that focus on addressing their pay scales, providing
adequate development, and training programs will produce more diverse and qualified candidates
to essentially choose from or even choose from within their organization. Promoting within is
not an uncommon practice, especially in healthcare but to do so leaders along with HRM must
ensure they are addressing barriers that may prevent them from actively recruiting the finest
candidates, especially those who already have a personal stake in the institution of delivering
quality care.
Leaders Role in Succession Planning
Leaders at the executive, administrative, and mid-level all have a direct impact on
developing a successful succession plan for their respective organizations. It takes detailed
planning and resolute individuals working together to successfully see the process through.
Talent management is a relatively new concept that represents a shift in human resources
management from a reactive position to a more initiative-taking position when it comes to
vacancies within the organization (Nowak & Scanlan, 2021). The goal of leaders is to stay ahead
of vacancies by identifying and developing talent as a means of preparing individuals and the
organization for the future. By doing so human resource management is ensuring successful
transitions that build successful leaders and the continuity of the organization's culture, success,
financial stability, mission, goals, and vision and delivery of care.
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In today’s unique society the role of leaders has become more dynamic than ever before.
It is nothing short of demanding, time-consuming, and overtly complex so choosing the right
person for one’s organization must be done delicately and strategically as to not interrupt the
delivery of care. Leaders play a pivotal role in identifying the specific talents, skill sets, tools,
qualities, knowledge, attributes, education, and experiences their peers bring to the organization
to potentially lead the entire organization or departments there within. It is estimated for instance
that 75% of nurse leaders will leave the workforce in the next five years, which will generate
about 67,000 leadership vacancies in healthcare (Pedersen et al., 2018). When human resource
leaders and department leaders see numbers like this, it supports the need for strong succession
planning strategies that can develop future-readiness programs and an adequate supply of willing
and ready leaders so there is no disruption in organizational operations. For many leaders, this
starts internally by seeking out skilled employees within because the ultimate success of an
organization's succession plan is recruiting within before ever having to seek candidates
externally for leadership roles.
The executive leaders or Chief Executive Officers along with the board of directors are
arguably the most influential members of a well-developed and executed succession plan.
Today’s executive leaders must focus on continuous improvements, team and relationship
building, balancing financial crises, and utilizing an unstable marketplace with limited to no
resources (Wainright et al., 2021). The board of directors plays one of the most intricate roles in
succession planning as they are the determining factor in deciding who a healthcare
organization's next CEO will be. Data suggest that the number of hospital CEO turnovers have
increased over the past 10-15 years leaving many healthcare institutions without a solid structure
in leadership (Wainright et al., 2021). Results such as these can have many interpretations such
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as the lack or inability of the organization to develop talent or the need for individuals with
higher skill sets needing to be searched for outside of the organization which indicates an even
more daunting succession planning process and the timeline for finding a new leader.
Advantages of Succession Planning
Although clear barriers exist in succession planning there are also very defined
advantages as well. If done effectively and cohesively a succession plan should produce better-
recruiting outcomes, retention of well-qualified employees, employee commitment, add value to
the organization's mission, cost reduction in the hiring and recruiting process, and most
importantly reduce delays in the delivery of care to the patient population (Stevens et al., 2018).
Hospitals and other healthcare institutions who actively use succession planning platforms use
them as a means of recruiting the most desirable and qualified individuals and seek to place them
in higher positions of power within the organization which ultimately reduces an organization's
rate of retention. As employees see opportunities to gain experience and growth within their
respective careers and organizations as feasible they will dedicate more time and energy to
accomplishing goals. On the other spectrum with the job market being very much competitive
and employers offering flexibility, negotiable pay, and work-life balance many employees will
leave their jobs for what is considered better opportunities or options. Strong leaders will apply
this concept to their succession plans as a means of retaining and recruiting younger employees
for longer terms of employment.
Another equally important advantage is retention. Retaining quality candidates can be
challenging if the organization does not adhere to the expectations of its employees. When
organizations invest in succession planning they see their cost to recruit and retain drop
drastically. Countless data reports by the nation's top hospitals suggest financial and human
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resource departments spend on average $6,422 on a new employee notwithstanding the delay in
hiring that can take upwards of 90 days (Mianda & Voce, 2018). And of course, this price will
increase as the higher the position goes along with longer vacancy times as it takes longer to hire
at the executive level. Although many organizations seek to recruit within this is not always the
case with executive leadership positions such as CEOs or CFOs. This individual can be recruited
from countless places all over the world and for this it is extremely expensive and time-
consuming. According to van Diggele et al. (2021), the cost and resources needed to attract,
advertise, and accommodate potential executive candidates are not often cost-effective for the
organization's bottom line. This, therefore, suggest that succession plans be used as a practice of
hiring internally as it would be much less costly, the transition would be smoother and quicker,
the leader will already have knowledge of the organization and its history, and time will not be
spent taken away from key organizational resources that are already stretched thin. Looking at
succession planning in totality it will only work if leaders work collectively on strategic goals
and plans on how they can save the organization’s valuable resources. This will only be achieved
through proper recruitment, retainment strategies, and developing skilled candidates within the
organization for future promotion.
Succession Planning and the Delivery of Care
Succession planning is a key component in the success and failure of the healthcare
delivery system as it impacts the quality of care provided and the organization's ability to survive
without sustainable leadership in place. Effective and efficient methods of succession planning
are integral to the development and success of organizations across the entire healthcare system
(Sibbald et al., 2017). Healthcare institutions are tasked with the role of taking care of people at
their most vulnerable and as a result, those same people expect to receive quality care when they
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need it. Shortages even at the executive level can have a devastating impact on the delivery of
care because without strong leadership a business will eventually crumble under the pressure. By
following the guiding principles of succession planning organizations will see drastic changes in
employee shortages especially at the leadership level and their overall retention rates will decline
as the overall goal is to provide smooth almost flawless transitions of power from one leader to
another. By implementing succession planning programs, it will be as if the organization never
missed a beat.
The many advantages heavily outweigh any barriers of succession planning as all barriers
are issues that can be rectified by executive leadership, human resource management, and
department leads working together to address employee concerns. Quality improvement depends
on engaging and empowering the teams delivering the care and equipping them with the tools
and skills needed to improve patient care (Drew & Pandit, 2020). Managers working in the
capacity of HRM or executive offices should constantly consider the barriers that will stop them
from being successful and plan for the future of the institution. Succession planning is not just a
guise to replace one leader with another but an organization’s ability to adapt to changes either
expected or unexpected, have a concrete and sound business strategy, and develop leaders within
the organization that have the capacity and qualities needed to take the organization to the next
level while ensuring patients safety, security, and care is being delivered at all times.
Conclusion
Just like any other institution of business healthcare institutions will not be successful if
they don’t properly organize and plan for their future, their employee’s future, and most
importantly the patient’s future. Planning is essential because without a plan chaos will follow.
Proverbs 15:22 advises, “Without counsel plans fail, but with many advisors, they succeed”
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(English Standard Version). Succession planning involves healthcare institutions being deliberate
in their attempts to reduce employee shortages, departures, and the replacement of the
organization’s most critical employees. Following the five principles of succession planning and
addressing any barriers will help organizations find valuable solutions for the future of their
institution. There will always be a need for quality, competent, educated, and skilled
professionals to replace incumbents in the most critical areas of the delivery of care. Developing
solid, sustainable, and functional succession programs will help healthcare institutions evaluate
their current system and make informed decisions on who and what they will need to develop,
promote, recruit, and retain to fill critical leadership roles. To continue to be successful in
providing quality care and producing quality patient care and outcomes that will benefit the well-
being of the community healthcare institutions must consider succession planning as a strategy in
doing so.
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