How important is accountability in the senior executive suite? Not much gets done without it. 


Most hospital’s profit margins are small; around 4% with about 30% of hospitals overall operating in the red. Administrative costs are excessive, and to a large extent, the waste and inefficiencies can be traced to leadership. The reason is that many leaders are unwilling to proactively make hard choices to curb excessive expenditures. They don’t hold one another accountable, put a stop to underperformance, or acknowledge their own conflict avoidance.

One CEO, recently promoted to run a larger hospital, told me that in bringing the right talent on board, his presence at the hospital wasn’t always needed. With his eyes already on another promotion, he promised not one but two VPs his job if they hit their year-end targets.

The VPs met their goals but at the expense of not developing their people. In essence, they emulated their CEO’s beliefs and behaviors: “Hire good people, and let them do their job. There’s no need to spend time with them.”

The CEO got his next promotion. Much to the chagrin of the two VPs, neither was selected to take over. Enter the new CEO, forced to deal with the aftermath of broken promises (and the pursuit of short-term gains), a couple of miffed VPs, and no real bench depth on his senior team or in the pipeline. Fortunately, the CEO got up to speed quickly. He took smart, sweeping actions centered on patient care. His first steps:

• Make a personal visit to every area of the hospital, presenting a one-page strategic plan that everyone could understand and support

• Address the most pressing inconsistent practices within leadership—announcing corrective actions, discussing consequences up front, and following through

• Increase visibility of leadership hospital-wide

Within a few months, energy and productivity began to shift. Now leadership had to put skin in the game and raise the accountability bar within the team and, ultimately, throughout the organization.



The reality is that in poor performing or failing hospitals the executives rarely hold one another accountable. There are few, if any, open, honest, and direct conversations about the lack of accountability. When someone messes up, the leadership team often waits to see what the CEO will do. Usually it’s nothing and the unspoken message is clear: “Accountability is not one of our core values. We choose to gloss over missed expectations and move on.”



Recently I was on the receiving end of a rant by an aggravated CEO after a critical leadership meeting with the hospital board: “Three of my VPs failed to come through. They knew exactly what I expected from them, but in our run-through the day before, their presentations fell short. I worked through the night to make everything right. Clearly, they weren’t up to the job, and I had to do it myself.”

If he’s doing the job of his VPs, when does this CEO have time to do his job—the one he’s being paid to do? The answer is, he doesn’t.

He blames his team, but he couldn’t be more wrong. Until he faces his own choices and confronts his team, he’s in for more of the same. Five key questions he should ask his VPs as he debriefs and deals with the board meeting debacle:

1. Was I clear about my expectations?
2. Did you take ownership and feel supported in achieving success?
3. Were there regular checkpoints, and was I there for feedback and direction?
4. Did I send your work back—or did I “rescue, fix, and save?”
5. Am I willing to push for your best work and allow for mistakes and missteps?



I pressed another hospital CEO, the head of a 1,100-bed facility about specific lapses in holding his VPs accountable.

“They’re already working on overdrive and feeling really stressed out,” said the CEO. “I don’t want to create more pressure or make anyone feel bad.”

Fact is, the CEO chooses to avoid conflict and often fears hurting people’s feelings. Instead of confronting the truth and developing a truly effective leadership team, he opts to make nice and keep the peace. And the leadership group? They’d be relieved if he dealt with the cold hard truth: the team isn’t, well, a team.



Complex environments such as hospitals require interdependence—a competence by leaders to work with and through others. The capacity to genuinely engage with people—despite ongoing tensions—and to juggle the needs of individuals with the needs of the larger group requires a strong sense of collaboration and an ability to negotiate at a relational level. It is also the key to accountable leadership.

On an interdependent leadership team, everyone owns the bottom line. There are no sacred cows. Interdependence means committing to eliminating exceptions and inconsistencies at the top of the organization. Leadership is trusted to confront and close critical gaps and keep the direction of the hospital focused on patient care.

Holding each other accountable as executives or managers can be as uncomfortable as a 360 degree mirror when you can see the naked truth about every aspect of how you look; front, back and sideways. Absent this level of scrutiny effective leadership is unlikely.

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  1. I enjoyed the Stl Anthony Hospital managers retreat last week. Thank you for the insights and expertise you shared.
    Nice article “The Naked CEO”.

  2. I loved working with your group Lee! What a beautiful setting and great discussion. Some pretty funny moments too. Enjoy the boosters and I invite you to keep reading this blog! If there is a subject or situation of interest that I can apply The Straight Truth to, let me know!

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