The Healthcare COO Role

Stopping point or stepping stone?

Across industries the chief operating officer role historically has not been consistently defined. There is no well-trodden path to the position, and no standardized job description.1 This applies to healthcare COOs as well. Roles can be as varied as the organizations that create them. Operational positions are by nature organization-specific. Nevertheless, I believe that the COO role in many hospitals and health systems can be too limited and confining. It is often viewed as a terminal role, in fact, COOs are respected to be sure, but because of their operational (read: not strategic) focus they tend be undervalued. The role is not always viewed as a stepping stone to the chief executive position.

In other situations, the COO role is bigger, bolder. Especially within larger health networks, there is the realization that the COO has a unique window on the CEO’s activities and can play a pivotal role in long-term quality of care initiatives, market assessment, bottom-line planning, staffing and talent management, change management and more. Rather than playing a distant second fiddle, the COO is increasingly a trusted consultant, confidante and partner to the CEO. In such cases, these COOs become well prepared for potential CEO roles in the future should they desire them.

The COO-to-CEO transition may happen more than we think, directly or indirectly. In the healthcare CEO recruitments conducted by my firm in the past three years, approximately two-thirds of placements had previous experience as a chief operating officer or equivalent (whether with the same or another organization). Somewhat surprisingly, also over the past three years, more than one-third of the healthcare COO placements at our client firms had previous CEO experience. It is confirmation that there can be fluidity between the two roles, especially if COOs are given broad, CEO-like responsibilities by which to develop skills and expertise.

Intentionality and Potential

It is important for organizations to be very intentional about the chief operating officer role. Boards, search committees, and CEOs can ask, “What do we really want our COO to do?” Some of the core areas of oversight today include:

  • Hospital and ambulatory operations
  • Employment and staffing
  • Facilities and infrastructure planning
  • Physician relations
  •  Lean and Six Sigma; operational excellence
  • Data and analytics; modeling
  • PR/communications

Another question organizations should ask is, “What potentially can our COO do?” Can he or she have a greater impact?

The answer is usually yes. It is up to the organization to conceive of the role as broad and multidimensional. One way to gain insight into the potential of today’s healthcare Chief Operating Officer is to look at recent job specifications-what my company calls leadership profiles-coming out of respected organizations as they conduct recruitments.

Below are some key responsibilities of today’s healthcare COOs, gleaned from actual position specifications. These responsibilities indicate that organizations are thinking big, integrating the COO into their strategic and visionary leadership. There is a greater emphasis on CEO-like characteristics and activities. These include:

General leadership qualities:

  • “executive demeanor and presence”
  •  “transparent, innovative, trusted”
  •  “a preference for taking action”
  • “engaged leader who gets things done”
  • “consummate team builder”

Exercising of vision:

  •  “participates in the development of the system’s strategic plan”
  • “prepares short- and long-range capital plans and recommendations”
  • “challenges the status quo”
  •  “champions change initiatives”
  •  “assesses opportunities for new revenue streams”

Building and maintaining relationships (internally and externally):

  • “establishes relationships across the continuum of care”
  • “has superior skills in building relationships with physicians”
  •  “has a track record of relating well to all kinds of people”
  •  “uses diplomacy and tact”
  • “represents the organization before governmental, business, and citizen groups”

The phrases above demonstrate the expansiveness of some COO roles.

Combine these broad responsibilities with more traditional ones-“improving operational performance”; “championing quality and safety”; “increasing customer satisfaction”-and it is easy to see how the chief operating officer is increasingly vital to the success of organizations pursuing population health initiatives and more value-based, patient-centric care delivery models.

Advice for Would-Be Healthcare COOs

The message for those who envision themselves as COO material? Allow me to make a few brief suggestions:

  • Develop yourself broadly; build leadership and strategic capabilities as well as operational skills and competencies; don’t get pigeonholed.
  • Lobby for the COO role to be painted with broad strokes within your organization. If you land in the job, push the boundaries of what you can do.

The healthcare chief operating officer role is not going to be well-defined any time soon. It will remain largely organization-dependent. And yet most hospitals and health systems can give the role more responsibility and muscle so that the COO makes a larger contribution towards operational and strategic objectives.

Donna Padilla is a senior partner with the executive search firm Witt/Kieffer and vice chair of its Healthcare practice. She has participated in nearly 350 healthcare executive search assignments over the course of her career.


  1. Bennett, N and Miles A., S. ‘Second in Command: The Misunderstood Role of the Chief Operating Officer.’ Available at:

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