Stay Aligned, or at Least Know You Are Headed for the Ground
The CEO's vision may have been genuine. It may even have had merit on its own terms. But a strategic pivot of this magnitude — executed as an announcement, not a process — told every physician leader in the room something important about how decisions were actually made in that system.
The cardiology chief had every reason to be confident.
Two new satellite clinics. An advanced heart failure program. Improved cath lab turnaround. Volumes surging. A local paper ran a feature with his photo. Things were going well — visibly, undeniably well.
He asked the CEO for a standing 20-minute monthly check-in.
Not to report successes. Not to make requests. To synchronize.
Each session, he would present two or three planned moves — an outreach effort to underserved ZIP codes, an equipment request, a joint recruitment with CT surgery — and ask one question: "Where does this sit against your top institutional priorities right now?"
The CEO would tell him which growth bets were confirmed, which were flexible, and what stories she was sharing with donors and trustees.
Midyear, finance proposed pausing the second hybrid OR to fund a system IT upgrade.
Because of those sessions, the CEO could walk into the boardroom and explain the downstream revenue at risk, the referral patterns already shifting, and precisely why the cardiac timeline protected the hospital's five-year plan.
The capital remained unchanged.
From the outside, it appeared to be an aggressive service line charging ahead on its own momentum.
From the inside, it was two leaders moving in such close sync that neither was ever surprised in front of a board, a reporter, or a town hall meeting.
High performance without alignment is fragile. It can be paused, defunded, or redirected the moment it inconveniences a larger institutional priority.
How synchronized are you with how your CEO is actually thinking right now?