Stratlin Memorial Hospital is located in Keen, Kansas, a small rural town in the Midwest. The county seat of Markley County, Keen has a population of 6,128, not including cows. Markley County is an area of 1,856 square miles that consists of farming and agriculture, which are also the main sources of jobs for the county residents, specifically corn, wheat, soybeans, and alfalfa. There are also numerous livestock farms. The town of Keen is unique in its geographic positioning and unique attractions. Keen lies along Interstate 35, 49 miles south and 37 miles east of the next largest urban cities. A major attraction for visitors to Keen is the Toy & Action Figure Museum and a well known chocolate factory. If you ask residents why they live in Keen, they reply by telling you that the community is family oriented, peaceful, traffic-free, and has plentiful parks and recreation activities and abundant grocery stores, including local farmers’ markets. Of course, Keen comes with its challenges that are standard in small rural towns, including residents that are older and have lower education levels, lower income status, and less healthy lifestyles. The area is also characterized by occasional droughts, lack of seat belt use, farming accidents, large numbers of residents who are uninsured and underinsured, limited business growth, and high incidences of kidney disease and chronic obstructive pulmonary disease (COPD). Stratlin Memorial Hospital opened its doors in 1970, but has a long-standing history dating back to 1905 when Drs. Calhoun and Lewis partnered to form the first 5-bed hospital, known as the Keen Sanitarium. The current hospital has 45 set-up and staffed beds, and offers services in acute care, emergency care, home health services, diagnostic testing, surgical services, laboratory services, hospice care, and therapy services. There are 130 full-time equivalent (FTE) staff and 145 employees working at the hospital, including 8 active staff physicians, 1 certified registered nurse anesthetist (CRNA), 1 full-time surgeon, and 1 full-time physician assistant (PA). Stratlin Memorial Hospital is one of the three base sites for the county-wide emergency medical service (EMS). The hospital averages 180 admissions and 147 emergency room visits per month, and approximately 7,300 outpatient visits per year. There are on average 45 babies born at Stratlin Memorial Hospital each year. Additionally, in 2007, an independent and assisted living center, The Willows, was built directly east of the hospital’s parking lot. There are four senior administrators including an interim CEO, a CFO, a part-time interim CNO, and an Ancillary Service Director. There are 16 managers within the hospital for the varying departments and service areas. The average tenure for the hospital managers is 14.25 years. Up until two years ago, the hospital had a very stable senior administrative staff. The CEO had 21-year tenure, the CFO 19-year tenure, and the CNO 33-year tenure. Due to unexpected health conditions, the CEO was forced into immediate retirement. Since his retirement, Stratlin Memorial Hospital has had two CEOs, neither lasting more than nine months. This situation mimicked a domino effect where the first quit because his wife did not like the rural lifestyle, and the second was fired due to shady dealings within the hospital. The two other members of the senior management team voluntarily quit and retired. Plans are currently underway to promote the interim CNO to full-time status. Stratlin did not have a succession or mentoring plan in place. It had never seemed necessary, as it was assumed that longevity within a job (clinical and administrative) had worked in the past and would continue. In fact, hospital cofounder Dr. Calhoun’s great-great-grandson recently retired as a general surgeon, ending a 100 year family legacy of physicians at Stratlin Memorial Hospital. The Stratlin Board of Trustees, which has always been comprised of five community leaders and volunteers, never thought succession issues of the administrative and clinical staff would become a problem. Currently, the Board is comprised of four males and one female. The men range in age from 55 to 74, and the female board member is 31 years old. Occupationally, the board members come with a range of career experiences. However, only one board member has any clinical background. The others are community members, including a high school teacher, an attorney, the city art director, and the local grocery store owner. Obviously, many things had changed for everyone involved. The aim of succession planning is to ensure there is an appropriate training and development program for junior employees as a method to prepare them to assume increasingly higher level positions of leadership throughout their tenure. Stratlin Memorial Hospital has learned its lesson. Although not initially prepared to address resignations and retirements, the Board has hired you as its consultant to create a succession plan with the focus on their troubled senior administrative staff. In order to make consultative recommendations, what are the next steps you must complete to prepare for this role?

Discussion Questions

1. What is the current situation at the hospital?

2. What are three organizational issues going on in this case? Which organizational theories do you think best apply to this situation?

3. What are Stratlin’s areas of strengths? What are its weaknesses?

4. What should a short-term plan to immediately handle the management situation include? Should they consider promoting from within to help alleviate the immediate situation, such as appointing an interim administrator; utilizing a temporary “on-loan” executive; or developing alternative strategies?

5. What role might hospital politics have played in the rapid turnover of CEOs?

6. How will you educate the Board of Trustees about succession planning? What role should they play in this process?

7. How would you introduce the concept of succession planning to the staff of Stratlin Memorial Hospital? Should workshops be used to familiarize the management staff with the succession issues? Should you include all managers in the process?

8. What recommendations and steps are needed in order to establish a long-term plan for continued succession planning? Who should be involved and lead this process?

9. Should the institution adopt a succession plan for clinical staff members?