Hospital in Crisis? Call an On-Demand Health Care Exec

Unlike many health care experts with three decades of experience, Patrick McDermott isn’t looking for stability.

McDermott is an on-demand executive leader specializing in health care finance. In 2019, he left his full-time role overseeing revenue cycle for a California health system and began taking temporary gigs, parachuting into different organizations to oversee special projects or fill sudden vacancies. His flexible career has taken him from Southern California to Ohio to Massachusetts—but he never stays with one health system for long.

“I might only be there six months, 12 months…the longest this has occurred for me is 18 months,” McDermott told Newsweek. “I just don’t worry about having a long-term job, because I know there’ll be another crisis around the corner.”

At his first hospital job in 1992, McDermott began picking up on the industry’s struggles: inefficiencies, cultural dysfunction, a divide between clinical and business operations. The laundry list has only grown longer with time. Mergers and electronic health record conversions intensified, budgets tightened, cyberattacks loomed—all as health care C-suites experienced record-breaking executive turnover, finding themselves increasingly destabilized.

Amid the noise and turbulence, on-demand executives can provide expert direction without permanently permeating an organization. McDermott considers his role somewhat of a “force multiplier,” he said. At one Ohio hospital, he worked alongside existing financial leaders to spearhead and accelerate projects. They were able to complete twice the work in half the time with more hands on deck.

“I wasn’t filling an executive vacancy,” he said. “It was kind of like Batman and Robin—I was basically the sidekick to the CFO and the revenue cycle vice president. I wasn’t replacing them, but I was complementing them, supplementing them.”

WittKieffer, an Oak Brook, Illinois-based executive search and leadership consulting firm, has helped land roles for McDermott and other short-stay experts. Demand has shifted over the past two years, according to Adam Burns, principal of the firm’s interim leadership practice. Historically, health systems reached out for traditional interim arrangements to fill vacancies on their organizational charts. But now, they’re looking for senior leaders to solve specific problems rather than to hold specific titles.

“[On-demand leadership] is really taking off,” Burns told Newsweek. “I think it’s something that’s going to be permanent in the industry. Once [health systems] start to think about all the different ways they could use somebody—when you take the org chart out of it and just think about the lists of challenges and projects and opportunities they have—it’s endless.”

There are numerous factors fueling demand for on-demand, according to Burns. Baby boomers are aging out of senior leadership roles and into retirement, leaving experience gaps in their wake. But after a year of vacationing and pursuing hobbies, many health care executives start itching for a new challenge. They become strong candidates for on-demand roles, which allow them to contribute their extensive knowledge without committing to an indefinite seat.

Health care is also facing specific challenges that call for a specialized eye. For example, most health systems could benefit from a chief information security officer, but not all can afford to fund the role indefinitely. A former CISO can serve the system in an on-demand capacity, setting up an infrastructure that outstays them.

“[Hiring an on-demand leader is] the most cost-effective option,” Burns said. “Organizations compare it to the cost of consulting firms, and when you compare hiring a senior leader in an on-demand capacity to hiring a consulting firm, many times it’s a third or half of the expense.”

Financial aftershocks from COVID-19 are still affecting health care organizations—and sometimes show up in unexpected places, Burns said. Prior to 2020, national health systems tended to focus on internal promotion. But leadership teams were consolidated during the pandemic to cut costs, and now, systems lack the “bench strength” to source special projects from within.

Health systems always assume some level of risk when hiring an on-demand leader. Usually, that person has a surface-level familiarity with the organization and must balance relationship building with fast-paced output.

But there are benefits to the model, too. When health systems reflexively look inward for new projects, they can unconsciously build their tolerance for the status quo. On the other hand, a fresh, unbiased perspective can open new doors for the organization. On-demand leaders can make honest recommendations about what is best for the health system, free from internal politics or preexisting expectations, Burns said.

When McDermott takes a new role, he tries to strike a balance between building trust and making quick decisions. In some positions, a common enemy—like an outside cyber actor that committed an attack—has helped him hit a stride with his temporary team.

“The trust-building process in this case has to be accelerated because we don’t have time for a honeymoon together,” McDermott said. “In some ways, the heaviness of crisis stimulates faster team building.”

There are so many issues in the health care industry that it can be hard to prioritize them, McDermott said. Tasks mount—all labeled “urgent”—and nothing actually gets done.

New approaches like on-demand leadership can help lighten (and reassess) the load, McDermott and Burns agreed.

“With the challenges in health care right now,” Burns said, “running the same playbook is really not a recipe for success for the future.”