Healthcare leadership is evolving. As systems grow more complex, the expectations placed on executives — especially clinician leaders stepping into enterprise roles — are changing just as quickly.
Those changes were the focus of the recent American College of Healthcare Executives webinar, “Leading at Scale: Executive Leadership in an Era of Expanded Span of Control.” The panel discussion, which included leaders from Jackson Healthcare, University of Michigan Health-Sparrow, Kirby Bates Associates, and Jackson Physician Search, offered important guidance for executive recruiters tasked with placing physician leaders into increasingly complex roles.
Here are the key takeaways and what they mean for recruiting executive-level physicians and nurses today.
Leadership at Scale Is Not Just More of the Same
One of the most important insights from the discussion is that enterprise leadership is fundamentally different from hospital-level leadership, so one’s success in a department-level or even hospital-level leadership role is not necessarily predictive of success in an enterprise-level leadership role.
Mergers and acquisitions continue to reshape organizations, and matrixed reporting relationships are replacing traditional hierarchies. As a result, leaders are expected to operate across multiple facilities, consult different groups of stakeholders, and juggle competing priorities.
That shift requires a change of mindset. Success depends less on individual expertise and more on the ability to integrate teams, influence stakeholders, identify patterns, and think strategically.
Start with Role Clarity
A consistent theme throughout the webinar was the need to define the role before the search for candidates begins. Are decision rights clearly defined? Are success metrics established for enterprise performance, not just hospital or department outcomes? Where does authority actually reside when hospital and system leadership priorities are at odds?
Without answers, organizations risk hiring talented people into structurally ambiguous roles — setting them up for burnout, diminished decision quality, and turnover that damages morale beyond the executive suite. From a recruitment standpoint, that often leads to repeat searches and damaged credibility in the candidate market.
Enterprise roles also carry a layer of governance complexity that site-level roles rarely do: multiple board relationships, community-facing communication demands, and the ever-present tension between local performance and system-wide strategy. For recruiters, this means the process doesn’t begin with defining the ideal candidate. It starts with tough questions about the role itself and ensuring it has been designed for scale.
Evolving Candidate Assessment
As roles become more complex, the assessment of candidates must evolve. Enterprise-level positions often require a broader lens than internal teams alone can provide. The panel identified several capabilities that deserve elevated weight in any assessment of enterprise-level candidates:
- Analytical fluency across multiple sites: Enterprise leaders must synthesize data from diverse settings to identify patterns and make strategic decisions for the organization rather than for a single patient population or department.
- Comfort with ambiguity: The ability to lead effectively through rapid organizational change, without clear hierarchy and without the proximity that once made communication straightforward, is now a core executive function, not a nice-to-have.
- Influence over authority: At scale, leaders rarely have direct control over the outcomes they’re accountable for. The ability to build trust, align stakeholders, and drive results through relationships is critical for obtaining any objective.
For physician executives, these questions are especially important. Clinical credibility still matters, but enterprise roles increasingly demand giving up individual practice to focus on system-level performance and avoid conflicts. In these situations where leaders continue to practice in some capacity, expectations must be clearly defined.
The Executive Triad
The webinar also touched on the increased adoption of the executive triad model, typically composed of a CEO or President, a Chief Medical Officer, and a Chief Nursing Executive. New research from Jackson Physician Search and Kirby Bates Associates, published in our joint report “Stronger Together: Leveraging Triad Leadership for Healthcare’s Biggest Challenges,” reinforces the value of this structure. The report emphasizes that organizations with well-functioning triads are better positioned to navigate complexity because they bring clinical, operational, and financial perspectives into alignment at the highest level.
However, the benefits are not automatic. Both the report and the webinar panel emphasized that clarity and cohesion are what make the model work. When roles are poorly defined or accountability is diffused, the triad can create confusion instead of alignment. When it is functioning well, however, there is a visible sense of unity — what panelists described as “no daylight” between leaders.
That alignment builds trust with boards, strengthens communication across the organization, and leads to more consistent decision-making. For recruiters, this means evaluating not just individual candidates, but how they will operate within a shared leadership structure. Collaboration, mutual respect, and the ability to navigate healthy tension are essential.
Competencies for Today’s Leaders
As healthcare continues to evolve, a few capabilities are emerging as non-negotiable for enterprise leaders.
Flexibility is at the top of the list. Organizational structures, priorities, and market conditions are all in flux, and leaders must be able to adapt without losing momentum. Just as important is the ability to build relationships across functions and geographies. Silos are no longer sustainable at scale.
Communication, while always important, must be intentional. Leading teams at multiple sites requires clarity, consistency, and the ability to build trust without proximity. Leaders who cannot connect across distance will struggle to create alignment.
These are not secondary traits. They are central to performance in modern executive roles, more so than clinical capabilities or departmental expertise, and they should be weighted accordingly.
Closing the Gap
What the ACHE panel described is, ultimately, a gap between the complexity of leadership roles and the process organizations use to fill them. Executive search partners with a national market perspective, access to passive candidates, and experience in complex C-suite placements are positioned to close that gap. However, the conversation must begin in the right place: with a clearly defined role and governance structure, as well as the organizational readiness to support an enterprise-level leader.
The talent is most certainly out there. The question is whether organizations are designing roles and creating environments that are worthy of it.
Is your organization recruiting physician executives? Contact Jackson Physician Search to learn how our Physician Executive Search team can help you build an efficient process that attracts and secures physician leaders who are ready to lead at scale.
