Interim Interview: A Talk With Rosemary Ciotoli

A Seasoned Interim Shares Her Experiences.

Whitman Partners: What were the challenges you faced in transitioning from permanent to interim?

Rosemary Ciotoli: I think the biggest challenge is that it’s like starting a new job each time. You don’t know the organizational culture, you don’t know the players or the politics. You also don’t know the nuts and bolts—the building, the computer systems, the phone systems, where to park. All those things that you have to acclimate yourself to in any new position. So while sometimes it feels a little bit overwhelming, I always enjoy the challenge of meeting new people and figuring out the organization, and what the politics are or the hot spots.

WP: Still there were differences between being a permanent and an interim employee. What did you find in terms of being effective within those differences?

RC: To be honest, I don’t see a big difference. I felt very effective in all of my permanent roles. I went into the interim role with the same leadership style and was able to be effective.

WP: Did you get pushback? Did you feel like surgeons or staff or any peers saw you as an interloper?

RC: Well, every organization is different. Probably the most common scene that I’d see as far as pushback would be what we see on a permanent basis as well. And by that I mean people are resistant to change, so you’re gonna hear the old, “We’ve always done it that way.” But I think it works best if you have that sense of confidence, without being a know-it-all. What’s worked best for me is to engage those that are closest to the problem or the issue that we’re having and have them be a part of designing the solution.

WP: I remember as you were transitioning, you were very deliberate and thoughtful, but you couldn’t have known all the things that you should’ve done to prepare. What do you wish you had done to prepare for the transition beforehand?

RC: Honestly, I worked in multiple different leadership positions, and had experiences in different health care systems. To me, that was the best preparation. I found the interim role to be all about leadership. You have to have that surgical services foundation, but it’s more about being a real leader. I’ve had great role models and opportunities that have influenced my leadership skills and style. And, I have to say, really no matter how prepared you are and you think you’ve seen it all, you probably should be prepared to be surprised. You’re always gonna see something that you thought would never happen.

WP: How about nuts and bolts: did you incorporate? Did you visit with a CPA or an attorney?

RC: I do have an accountant that helps with taxes, especially working in different states. There are different rules and regs, so I would say it’s a good idea to have somebody that’s helping you with that.

WP: And how your family deals with your presence or lack thereof?

RC: Well, my children are grown, they live a few hours away, and we do see each other frequently, but I find, even when I’m on assignment, we’re still able to visit them with the same frequency. You do take routine visits home. My husband’s retired and enjoys golfing and hunting. Those are activities that I don’t engage in, so he does sometimes come for a visit while I’m on assignment or just looks forward to my weekends home. The assignments do go by quickly, and I always take a significant amount of time between assignments. It seems to work for us.

WP: What would you advise a person in your shoes to do to prepare for the conversion from permanent to interim?

RC: I think the best thing they can do is to beef up their leadership skills. I’d say take on new assignments, find people in positions that you aspire to, study what makes them successful, help your boss succeed. Seize any leadership opportunity, no matter how small it is, and look for opportunities to demonstrate your leadership potential, both at work and outside. I think the more well-rounded you are and the more experiences you have, the better you’re gonna be in the interim role. Also you need to be comfortable with change. There are certainly common threads, but every organization has their own culture, so people skills are extremely important, and being able to read people when you’re first meeting them is a huge plus.

WP: To what do you attribute the scarcity of Director of Surgical Services talent?

RC: These are very demanding and stressful jobs. I don’t think we have done a good job in succession planning in most health care organizations, and I think the people that are in those roles were all baby boomers. And the younger people coming up, they’re not as inclined to want these positions, so you need to do a better job of making them attractive because they certainly can be very rewarding careers. But the biggest thing that’s happening right now is people are retiring and we haven’t done succession planning to tap talent internally and try to mentor people better.

WP: What did you see in hospitals that waited too long to get an interim? What was breaking down?

RC: The easier question would be, what wasn’t breaking down? I’ve been in a few hospitals where the position was vacant for at least a year and you end up with high turnover, staff vacancies, poor morale, and a huge lack of trust—it becomes very much an “us and them” mentality where they feel the organization is against them. Operational issues, broken processes, physician dissatisfaction, and most concerning for me are some very real patient safety issues. If that position of key leader for surgical services is vacant for more than just a couple of months, you’re setting yourself up for failure. You’re gonna lose whatever ground you had prior to that.

WP: What are some common misconceptions about the interim world?

RC: There are two that stand out for me: “Well, you’re only here because you can’t get a real job.” The other staff issue was that they thought I was just going to come in and change everything and fire people. So I think organizations could help themselves out if they would explain the role to their people before the person does come in. I think these staffers were out of the loop and just had no idea, just one day, “Here’s this interim person from a different state.” And they don’t know why you’re here. So they had their own nightmare going on.

WP: So a simple introduction would have been helpful.

RC: Right.

WP: What are some of the immediate actions that you took, or an interim can take, to boost revenue or otherwise have a successful contract?

RC: Some common things that I’ve seen, if they have a high cancellation rate, how are we preparing patients? You have to look at the whole gamut of surgical services and it starts with pre-admission testing, making sure patients are prepared, looking at throughput, how rooms are set up, turnaround times, all of the basic things that we look at. Usually, when you go into an organization that’s got issues or problems, some of those basic nuts and bolt surgical services are the things that have gone awry. Also, how they are staffing and how they schedule cases. Those are some issues where we’ve had some good turnaround as far as financial improvements.

WP: There is great overlap between transitional leadership and consulting. In what ways did you feel like you were able to be consultative or the opposite? What areas of improvement should not be on an interim’s to-do list?

RC: I don’t know that there’s anything that shouldn’t be on it. If I identify something, I go back to the person I’m reporting to and we talk about it. I haven’t had anything come up that I was asked to back away from. I think in most organizations there is a sense of urgency in correcting things and process improvements. I haven’t really had anything come my way that they didn’t want me to at least start.

We did a process change in one of the hospitals where we had concurrent systems. They were previously working sequentially, so there was a lot of wait time for the patients, for staff who’d be hanging around. You’d say, “What are you doing?” “I’m waiting for…” was the typical answer for many people. So I said, “While you’re waiting, you still should be working. There’s other things that can be done.” So we made some changes, and it was, in their minds, very, very big changes. Although we’ve been doing it this way in the rest of the country for the past 20 years, they were back in the 1950s, I think. They did struggle with that, and it wasn’t totally hard-wired before my contract was up. So sometimes when you’re doing a big process change for people, you want to make sure that the plan is clearly written down so that the permanent person coming in can finish the process that you’ve made, they know right where it’s at.

WP: How did you advance yourself professionally from first assignment to the next? In other words, what did you learn after the first one that you said, “I’ll take that to my second.”?

RC: In my first interim assignment they had requested an interim after a corporate review, and they had found a lot of clinical, operational, and compliance issues. When I went to the assignment, I was given the review which was like a 12-page document. From that document, I developed an action plan, and that has worked very well for me. So when I go into an organization, I do an assessment much like the assessment that the corporation had done at that hospital, and I develop the action plan. It works well for me to keep myself organized, it’s shared with the surgical team, and it’s shared with the person that I’m reporting to so that we’re all on the same page and you can actually see progress.

WP: Is that something that you found on the internet? A template for that?

RC: No, this was a template that I developed based on the reports that had their deficiencies. I’m sure you could get the template right off the internet. My motto is, “Keep it simple.”

WP: How does having an interim prepare the hospital for a permanent hire?

RC: I think the interim can keep day-to-day operations running so that the permanent hire isn’t coming in and having to spend their first three to six months fixing things up. The permanent should be more focused on the future and not have to clean up. I’ve used that action plan so that they know right where there may still be some deficiencies, and spend time with that new person coming in. Hopefully by the time they get in you’ve improved some of the staff morale and the lack of trust that was there when you first arrivd. And I think if you have transparency in your leadership style, you can develop that trust relatively quickly.

I find most people are like sponges, they just need a little help. They want to do the right thing, they’re just not sure what the right thing is. But, when you’re interviewing and you have your staff interviewing a new candidate and they’re not in a good place, it’s not helpful. You have to remember, they’re interviewing you as well as you’re interviewing them. And if you have apathetic staff or apathetic physicians interviewing a candidate, it is a real turn-off. I think organizations definitely benefit by having staff morale turned around to help them get the right candidate.

WP: Philosophically, do you believe an interim should be integral to the hire of a permanent placement? Or do you think the interim should be removed from that interview process?

RC: I’ve always been included, and I think it is helpful because I think you’ve been there a while and have a outsider sense of what the organization is, what the culture is in that operating room. And I know my input has been valued by the organization.

WP: Something that I talk about with clients is that the benefit of getting an interim to come in is they can make difficult change without being beholden to long-term relationships.

RC: You’re absolutely right on that. I haven’t had to fire anyone, but I do get them to make the right choice and they self-select to leave. I have moved people out of positions, but I haven’t had to resort to firing them.

WP: Because you felt like you had a clean set of eyes to look at the problem, which has to be beneficial.

RC: Yes, absolutely, absolutely.

WP: Did I not ask you any questions that you wanted to mention, a piece of Rosemary’s insight?

RC: I think that interim leadership is very rewarding. I have to say that. When I go in, one of the first things I say is, “How can I help?” And you know what? People, just hearing those words… It’s just very comforting to know they’re not there alone. Whether I’m talking to the CEO or the CNO or the staff, those are usually my first things that I start with. And if you can get a couple of quick wins, you can win their trust very quickly. I’ve always enjoyed my career, so this is like a second career with a second chance to do it all over again.

WP: What type of internal leadership at the hospital is most effective when guiding you as an interim? Partnership? Strong leader? Leave you alone?

RC: Mostly partnerships work, so that we both can agree on what the route is. I want them to tell me up front if I’m doing something that they don’t want me to. I ask for that weekly, or at least every two weeks at meetings. Sometimes that’s hard to make happen. I know everybody gets busy, but I need to make sure that things are going in the direction they want, so I can self-correct or move it in a different direction. So partnerships work best. I feel like I usually do get that kind of support.

WP: Thank you for your time.

RC: Thank you. It was nice talking to you.

Credit

Rosemary Ciotoli, Interim Director of Surgical Services

Ms. Ciotoli is a seasoned administrative healthcare professional and highly motivated self-starter who is committed to patient safety and high-quality healthcare. As Director of Perioperative Services at United Health Services, Ms. Ciotoli implemented system-wide Procedural Verification processes which included components of the WHO surgical safety checklist. Ms. Ciotoli has earned a Master of Science in Heath Services Management, and is a Registered Nurse.

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Interim Interview: A Talk With Rosemary Ciotoli