Negotiate to Win Before You Start
By Neill Marshall, Chairman, Ivan Bartolome, President/CEO, and Kurt Mosley, Associations Practice Leader, HealthSearch Partners
Key Takeaways
- Negotiate more than compensation.
Before accepting the position, negotiate the conditions that will help you succeed: time to diagnose the current state of the organization, set realistic expectations, line up sufficient resources, and garner support from the board.
- Protect time to diagnose the current state of the organization before making major decisions.
Unless the organization faces an immediate crisis, establish that your early mandate includes listening, learning, and understanding the organization before being pressured into making major changes. - Use your pre-start leverage to create meaningful early wins.
Identify high-friction issues affecting employees, physicians, or patients and secure board support to address them when the facts justify action. - Early wins should benefit the organization, not showcase the new CEO.
The best early wins demonstrate that leadership listened and responded. They build credibility, and that credibility gives the new CEO more time and latitude for harder decisions.
There is a brief moment in almost every executive search when the balance of power changes. The board has interviewed the finalists. References have been checked. The search committee has debated the candidates. Someone has emerged as the clear choice. Then the phone rings.
“We’d like you to be our next CEO.”
Most executives immediately begin negotiating compensation, incentive opportunities, benefits, relocation, severance, and perhaps a few other provisions in the employment agreement. They should. But they are overlooking something potentially far more important — negotiating the conditions under which they will be expected to succeed.
Once you accept the position and arrive on day one, your leverage begins to change. Problems start landing on your desk. People want decisions. Board members want progress. Employees want answers. Physicians want issues resolved. Everyone has something they have been waiting for the new CEO to address. Before long, your carefully planned first 90 days can become an exercise in firefighting.
There is a better way.The period between receiving the offer and accepting it may be the best opportunity you will ever have to negotiate not simply your employment agreement, but your leadership runway.
“What should a new healthcare CEO negotiate before accepting the job?”
Negotiate the Right to Diagnose the Current State Before You Prescribe Remedies
One of the recurring lessons from our First 90 Days work is deceptively simple:
Diagnose the current state of the organization before you prescribe any remedies. That sounds obvious until you become CEO. The board may already have a list of problems it expects you to fix. Your executive team will have another list. Physicians will have theirs as will employees.
Some problems will be genuine emergencies. Others have existed for years and suddenly become urgent because a new CEO has arrived. Before accepting the position, establish an understanding with the board about what your first 90 days are actually for.
How much time should a new CEO spend evaluating and diagnosing before making major changes?
Unless the organization is facing an immediate crisis, negotiate sufficient time to listen, learn, assess the leadership team, understand the culture, study the financial and operating realities, and return to the board with a thoughtful action agenda. You aren’t asking for permission to do nothing. You are asking for the opportunity to make better decisions.
Research on executive transitions reinforces the importance of managing expectations early, resisting pressure to act before understanding the situation, and creating time for diagnosis. Our conversations with healthcare executives have repeatedly demonstrated why that matters.
Healthcare organizations are complicated places. A decision that looks obvious from the boardroom can look very different after spending several weeks with physicians, nurses, department leaders, patients, and frontline employees.
Be quick, but don’t hurry. The best time to establish that expectation of having time to diagnose before acting is before you accept the job.
How can a new healthcare CEO create early wins before Day One?
Imagine starting your first week as CEO already knowing that you have the board’s support to address something employees have wanted fixed for years. Not because you arrived as a hero with all the answers. Because you listened before you arrived.
We know of a new healthcare CEO who understood during the recruitment process that nurse compensation had become a significant issue following COVID. Nurses believed their salaries had fallen behind the competitive market. Rather than waiting until after he arrived and inheriting the problem, the incoming CEO discussed it with the board during negotiations. He asked the board to authorize a compensation study and, importantly, to commit to addressing demonstrated market deficiencies.
Think about what that accomplished. The CEO didn’t have to walk through the doors and immediately ask the board for money. He didn’t make an empty promise to nurses. He didn’t pretend to know what competitive compensation should be. He negotiated the ability to establish the facts and act on them. When the organization subsequently addressed nurse compensation based on the findings, it became an early win for nurses, the organization, the board—and the new CEO. That is the kind of early win worth pursuing.
It is a meaningful improvement that tells employees: “I heard you. We looked at the facts. And we acted.”
Our interviews with healthcare CEOs have shown repeatedly that relatively small but meaningful early wins can generate disproportionate credibility. Richard Parks heard physicians complain about terrible mattresses in their call rooms and replaced them. It was a small expenditure with an enormous symbolic return. Jay Robinson heard employees describe problems with uniforms and acted. He also responded to a lab manager’s suggestion about rearranging equipment to improve workflow. Derick Ziegler discovered needed equipment while working alongside frontline employees and approved the purchase. Wayne Sensor’s conversations with nurses exposed problems with the hospital’s admission process, eventually leading to an overhaul that improved the process for all stakeholders.
These leaders weren’t trying to manufacture victories. They found real frustrations affecting real people and removed them. Early wins buy credibility. Credibility buys time. And time gives a new CEO room to address the harder problems ahead.
In Part Two: Why incoming CEOs should document the starting line, negotiate realistic measures of success, secure resources before they need them, and make sure the board isn’t saving yesterday’s difficult decisions for the new CEO to own.
Ivan Bartolome,
President & CEO
HealthSearch Partners
Neill Marshall,
Chairman
HealthSearch Partners
Kurt Marshall,
Associations Practice Leader
HealthSearch Partners
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