Virtually everyone agrees succession management is important, but many health care organizations struggle to implement a plan that works. At Centura Health, the leadership team has built a well-established, successful succession management program for nurse leaders.

We recently spoke with Noreen Bernard, Vice President of Professional Resources at Centura, to discuss the structure of their succession management program, the results they have seen since implementation, and key insights for other organizations who may want to take a similar approach to succession planning.

Program structure

Nicole Clarke: When did succession management become an issue that kept you and other Centura leaders up at night?

Noreen Bernard: In 2009 we sensed a retention problem, so my team went out to collect some data—and learned Centura had 33% nurse leader turnover. Thinking ahead to 2011, we knew 80% of our CNOs would become eligible for retirement in 2013, and we had no succession plans in place.

Given the costs associated with executive turnover and vacancies, we began crafting a succession planning model for nursing leadership. That ultimately led to a formal nurse executive residency program.

NC: What is the structure of your residency program?

NB: The Centura Nurse Executive Residency Program was designed to do four things:

• Accelerate the development of senior nursing leadership talent
• Build a succession pipeline for nurse executive roles
• Mitigate the impending talent crisis
• Advance integrated talent management

Each year we review applications from candidates across the Centura system and welcome two to five residents—also called "fellows"—into the year-long cohort program.

In terms of structure, 70% of a resident's development comes from group projects, quarterly stretch assignments, and experiential learning opportunities.

Each fellow is assigned a CNO preceptor and a formal coach, and 20% of their development comes from this direct mentoring. The final 10% of their development comes from classroom sessions taught by current system executives.

NC: How do you source candidates who will be successful residents—and future Nurse Executives?

NB: We do our sourcing once per year after the formal organizational talent review process. We work with HR to identify nursing directors who fall in the "high potential" or "expandable" categories.

From there we have a conversation with their current CNO to ensure the candidate is in good standing, meets the program requirements, and would be a good fit for the residency program. If the CNO supports a candidate then we invite him or her to apply for the nurse executive residency program.

NC: Is there a specific profile that you look for in candidate residents?

NB: The aspiration to be a nurse executive is one of the biggest indicators of success—someone who is drawn in by the complexities of the role. That aspiration is important, but a candidate should also have at least director-level experience managing multiple units, supervising large spans of control, and interfacing with different disciplines.

One might consider nurse managers for this program, but, practically, we found that it is too difficult for someone in the nurse manager position to leapfrog into an executive role.

Results

NC: In your article about Centura's nurse residency program, you shared that 50% of the first cohort went on to CNO positions at Centura. Any updated results since 2012?

NB: As of June 2014, 9% of residents maintained their current director role, 18% were given expanded roles internally, 27% left the company for personal reasons, and 45% were internally promoted to associate CNO/CNO or Executive Director.

We are working with the finance team to calculate an ROI in terms of cost avoidance, but because of the residency program, we have certainly saved resources by not having to do an external search for executives.

NC: Were there any unexpected results?

NB: Because of the success of the nurse residency program, there was system support to blend the nurse executive residency program with a newly built executive program named "Nebula." Partnering with talent management, we've built an interprofessional model of executive preparation to develop future executives for both nursing and non-nursing specialties.

To ensure that role-specific knowledge and skills are acquired, the nurse executive residents have a learning track specific to that role. The next iteration for us is to develop tracks for other role-specific development needs, such as a finance track or a physician leader track.

Watch: How to succeed at succession management

NC: One particularly impressive result is around your talent retention. How do you keep these primed executives in your system once they have completed the residency program?

NB: Our residents stay at Centura largely because of our culture. They find their work purposeful, and they are very connected to the mission and values of our organization. Those who have left have gone on for family (i.e., spouse relocation) or other external reasons.

Another reason is because of the connections our residents make through the program. They end up on committees or having leadership roles different than what they were in before the residency program. That keeps them engaged and motivated and aligned to the values of the organization.

Implementation advice

NC: How important is executive buy-in to getting a program like this off the ground?

NB: There was a sense of urgency driving our succession management conversation. Our current CEO joined Centura right around the time we started planning our strategy, and he had a passion around developing the organization's own employee base to enable promotion from within.

Then in 2011 a new SVPHR came onboard who implemented a robust talent management and organizational talent review process, which is still the first step to identifying good candidates for our program. We didn't have to "sell" our executives on succession planning, but having that support is crucial to developing a successful succession management program.

NC: How much did you need to invest upfront to develop this program?

NB: This was a homegrown program, and while there are upfront assessments for emotional intelligence and the Hogan assessment, the cost is minimal per resident. A successful succession management program doesn't have to be expensive. The key insight from our experience is to focus instead on developing solid mentoring relationships and creating opportunities for fellows to learn from current executives.

NC: What advice would you give to other leaders looking to start a nurse executive residency program?

NB: Evaluate and assess the organizational readiness for a formal succession planning program and think critically about the broader system culture around leader development. Any organization can do a good job of educating and teaching people, but if the fabric of the organization doesn't support them, then you have not used valuable resources wisely and the residents struggle to feel successful.