Thoughts on Moving from an Assistant to CEO
By: Gary Boyd

I am a basketball fan and, being a Sacramento Kings fan, have seen the Head Coach’s job turnover a few times over the last few years.  One of the things I’ve heard from just about all the assistant coaches who have been promoted, if even only on an interim basis, is that the move from the assistant’s chair to the top spot is physically only 18 inches, but the job is infinitely more difficult.  Before moving, they gave input, after moving, they were responsible for all of the decisions, and the teams success or failure fell squarely on their shoulders.  There are now 30 NBA teams in two conferences, and only 8 teams from each conference make it to playoffs, therefore only 16 coaches succeed every year while 14 have only next year to look forward to.  It is to say the least a stressful job.

I’m a new rural CEO, just finishing my first year at my new job.  In many ways, I feel like the assistant coach who has moved up for the first time.  I come from a large healthcare organization in an urban/suburban area of California where I was a Senior VP.  I was responsible for more staff members and bigger budgets in my departments there than I am now in the entire Healthcare District I oversee.  Everyone said as I was leaving my previous organization that I would have no trouble assimilating to the new position and could plan on a much more stress free life. 

While I have assimilated to my role, the change from SVP to CEO is similar to what I think the Assistant Coach goes through when promoted to the top spot.  While I don’t make all of the decisions in the organization, responsibility for everything that is decided or happens is mine.  In the SVP role, I could give advice, seek counsel, and when faced with a difficult decision, could talk to my direct supervisor and get some guidance before moving forward.  Now, I can still do those things, but when it comes down to the big decisions the buck stops with me.  Likewise, If there was a failure in another division of the organization, I could put some distance between me and it.  Not any more, all divisions of the organization are my responsibility.

And coming from a large organization to a rural health system the change is even that much more magnified.  At a large organization there are generally more resources to rely on for expertise and information, from an in-house legal counsel to a Performance Improvement Department to a Facilities VP.  In a rural organization you have to combine those areas of expertise into positions with the people you have.  The state and accrediting bodies also expect the same level of performance as any other hospital, including some the marvelous teaching organizations we have in our state. 

Working as a Rural CEO takes patience, the ability to learn, the ability to accept responsibility, and thick skin when the going gets rough.  But it is also a great opportunity to have an impact on the community in which we live and really make a difference in an organization.  It is a great job and I am glad I’ve accepted the challenge and am working hard to live up to the bar set by many of my colleagues who have been successful rural CEO’s for many years. 

Gary D. Boyd, CEO
Southern Mono Healthcare District
Mammoth Lakes, California
gary.boyd@mammothhospital.com