Why an Executive Search Firm Cares About the First 90 Days
And Why Boards Should Too
By Neill Marshall, Chairman, HealthSearch Partners, and Ivan Bartolome, President/CEO, HealthSearch Partners.
Key Takeaways
- Executive search success is measured by leadership longevity, not just a successful hire.
The true measure of a successful executive search is whether a new CEO earns trust, builds relationships, and succeeds over the long term, not simply whether the position is filled.
- The first 90 days determine a leader’s credibility.
The most effective healthcare CEOs establish influence by listening, learning, being visible, and demonstrating humility before driving major strategic change. - Small actions create lasting leadership impressions.
Simple behaviors like rounding with staff, working alongside frontline employees, solving everyday problems, and being accessible, often have a greater impact on trust than early strategic initiatives. - Boards share responsibility for CEO transition success.
Effective governance includes preparing the organization, clarifying expectations, addressing cultural realities, and actively supporting a new leader during the critical transition period.
After posting many articles in our Earned Authority: The First 90 Days series over the past several months, people have been asking us,
"Why is an executive search firm spending so much time talking about the first 90 days? Once the CEO is hired, isn't your job finished?"
For many years, that was exactly how our profession operated. The search committee selected a candidate, the offer was accepted, contracts were signed, congratulations were exchanged, and the search firm moved on to its next assignment. Success was measured by filling the position.
But, after more than three decades in healthcare executive search we’ve come to believe that’s an incomplete definition of success. Finding the right leader is only half the challenge. Helping that leader succeed is the other half. That realization fundamentally changed the way we think about executive search.
The Conversation That Changed Everything
Our First 90 Days series began with a single conversation.
Several years ago, we interviewed veteran healthcare CEO Richard Parks. During the discussion, he casually mentioned that, during his first 90 days as CEO, he spent one or two nights each week sleeping in the hospital. He lived in the physicians’ call rooms, ate his meals in the doctors’ lounge, and immersed himself in the daily rhythm of the organization.
That one comment caused us to pause and contemplate.
Over the course of our careers, we have interviewed thousands of healthcare executives. We’ve discussed strategy, finance, physician alignment, quality, governance, mergers, acquisitions, and every imaginable leadership topic. Yet, almost no one had ever talked about what they intentionally did during those first few months to establish credibility and earn trust.
Why are the first 90 days so important for a new CEO?
We began wondering whether Richard’s approach was unique or whether other successful CEOs had similar stories. So, we asked. One interview became five. Five became twenty. Eventually, we interviewed more than thirty accomplished healthcare CEOs, asking one simple question:
"What did you intentionally do during your first 90 days that made a lasting difference?"
The answers were remarkable. Not because they were complicated, but because they were surprisingly simple.
A Different Pattern Emerged
We expected to hear stories about strategic planning sessions, organizational restructurings, financial turnarounds, and major operational initiatives.
Instead, we heard stories about leaders sleeping in hospitals, rounding on midnight shifts, shadowing environmental services employees, changing burned-out light bulbs, answering ringing telephones, eating lunch with physicians, picking up trash in parking lots, and replacing worn-out mattresses in physician sleeping rooms.
None of these actions changed the organization overnight. What they did change was the relationship between the leader and the people they were asked to lead.
Again, and again we found the same pattern. The leaders who built lasting credibility were the leaders who spent their early days listening more than talking, learning more than directing, and earning trust before asking others to follow.
Why This Matters to an Executive Search Firm
Those interviews caused us to rethink our own profession. The traditional view has been an executive search concludes when a candidate accepts an offer. The reality is very different.
The search isn’t truly successful if the CEO leaves after eighteen months, loses the confidence of physicians, struggles with the board, or never gains the trust of employees. In healthcare, the cost of a failed leadership transition extends far beyond recruiting fees. Organizations lose momentum. Strategic initiatives stall. Physician relationships suffer. Employee confidence declines. Boards find themselves repeating an expensive and disruptive process.
Most of those failures are not caused by a lack of intelligence or experience. They’re caused by misunderstandings, unrealistic expectations, fragile relationships, cultural missteps, and avoidable mistakes that occur before the leader has truly earned the organization’s confidence. Almost all of these issues begin surfacing during the first 90 days of a new executive’s employment.
If our mission is to help healthcare organizations succeed over the long term, not simply fill executive positions, then our responsibility shouldn’t end on the day the employment agreement is signed.
The First 90 Days Are Leadership, Not Logistics
Many organizations still approach onboarding as an administrative process. The new executive’s calendar is filled with meetings. HR policies and benefits are reviewed. Organizational charts are distributed. Facilities tours are completed. Those activities are necessary. But they are not leadership.
The executives we interviewed viewed their first 90 days very differently. They understood they were operating within a brief window where every action carried unusual significance. Employees were watching. Physicians were evaluating. Boards were observing.
Small actions became symbolic statements about priorities, values, humility, accessibility, and leadership style. The most successful CEOs recognized that people would remember what they did long after they forgot what they said.
Why Boards Should Care
Perhaps the biggest lesson from this work is that a CEO’s first year is not solely the CEO’s responsibility. Boards play a critical role in determining whether a new leader succeeds. So, how can boards help a new CEO succeed during the leadership transition?
Organizations that clearly define expectations, surface historical issues early, explain political dynamics honestly, align around priorities, and actively support the transition create an environment where new leaders can build momentum. Organizations that fail to do those things often find themselves asking why a highly accomplished executive is struggling. The answer frequently lies less with the individual than with the transition itself.
A New Definition of Search Success
This project has changed the way we define success as an executive search firm.
For us, success is no longer measured simply by an accepted offer, a signed contract, or a successful press release announcing a new CEO. Real success occurs when that leader earns trust, establishes credibility, builds productive relationships, and creates the foundation for years of effective leadership. Those outcomes don’t happen automatically, they happen intentionally. And, they begin during the first 90 days.
Why should executive search firms stay involved after a CEO is hired?
If an executive search firm genuinely believes that culture, leadership, and long-term organizational success matter, then its responsibility cannot end on a leader’s first day. Hiring the right executive is the beginning of the journey, not the end. The first 90 days are when the investment made by the board, the organization, the new CEO, and the search firm either begins to pay dividends or quietly starts to unravel.
In our view, that isn’t the end of the search. It’s the moment the search finally begins to matter.
Ivan Bartolome,
President & CEO
HealthSearch Partners
Neill Marshall,
Chairman
HealthSearch Partners
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