When hospitals select an executive search firm, there are a handful of things they almost always look at.
- Who has the biggest name?
- Who has worked with similar hospitals?
- What does the process look like?
- What is the fee?
All fair questions.
But there is one question I think hospitals should be asking much earlier in the conversation:
Who can you not recruit for us?
That question becomes especially important when you are considering one of the very large search firms.
And let me be clear: large search firms can do very good work. They have resources, recognizable brands, and relationships with a lot of healthcare organizations.
But those relationships can also create a problem that hospitals don’t always think about.
The more clients a search firm has, the more organizations may potentially be off-limits to that firm for recruiting purposes, depending on its agreements and policies.
Think about what that means.
You hire a firm partly because they work with everybody.
But because they work with everybody, there may be a number of places where they can’t recruit.
That is worth understanding before the search starts.
Healthcare executive recruiting is already a pretty narrow market.
If I’m looking for a CNO for a hospital, the client usually isn’t saying, “Find me anybody who has ever been a CNO.”
They want somebody who has managed comparable scale, dealt with nursing shortages, worked effectively with physicians, improved quality, and maybe has experience in a particular type of market or hospital.
Every requirement makes that pool smaller.
The same thing happens with a CEO.
Maybe the board wants rural experience, strong physician recruitment, financial turnaround capability and somebody comfortable working with a community board.
Okay.
There may only be so many people who really fit that profile.
Now take a portion of those candidates away because their organizations are off-limits to the search firm.
That matters.
And here is the part that would bother me if I were the hospital: you may never know who you didn’t get to meet.
The search can still produce a good slate.
Everybody can be happy with the candidates.
But was the best candidate on the slate?
That is a different question.
Most of the best executive candidates we deal with are not sitting around applying to jobs all day.
They have jobs and they are usually doing pretty well.
You have to identify them, call them, and give them a reason to have a conversation.
If your search firm cannot call them, then for purposes of your search, they effectively aren’t in the market.
So when a firm tells you it has 50,000 executives in a database, I’m not sure that is the number I would care about most.
I would ask:
Of the people who are actually qualified for this job, how many are you able to approach?
That tells me a lot more.
The other question I think hospitals should be asking is even simpler:
How long are you willing to stand behind the person you place?
This has always been interesting to me.
Hospitals are hiring people they hope will lead the organization for years.
A CEO may shape strategy, physician relationships, culture and capital decisions.
A CNO can have enormous influence over quality, workforce and patient care.
A CFO or COO can fundamentally change financial and operational performance.
Yet sometimes the search firm’s responsibility for that hire ends after a relatively short guarantee period.
Why?
If I were sitting on the hospital side of the table, I would want to understand that.
Because a failed executive placement costs a lot more than another recruiting fee.
- You lose momentum.
- Projects stall.
- Employees start asking questions.
- Physicians notice.
- The board gets involved.
- You may need an interim executive.
And then you get to start the entire search over again.
That is why I think a five-year placement guarantee says something important.
It means the recruiting firm has a reason to care about whether this person is going to work long term, not simply whether the candidate accepts the offer.
Now, obviously hospitals should read the details. What does the guarantee cover? Under what circumstances does it apply? What happens if the person leaves?
Those things matter.
But the broader question remains: if this is supposed to be a long-term leadership hire, why wouldn’t you want the search firm thinking long term too?
To me, hospitals evaluating search firms should really look at three things together:
Who can the firm reach?
How well do they evaluate those people?
And how long are they willing to stand behind the result?
Price matters.
Brand matters.
Process matters.
But none of those things matter as much as getting the right executive.
Hospitals aren’t buying résumés when they retain an executive search firm.
They are buying access to the talent market, judgment about who fits their organization, and some level of confidence that the person sitting in that chair a year from now, hopefully several years from now, was the right hire.
So before automatically selecting the largest firm in the proposal process, I would ask two questions.
Who can’t you recruit for us?
And then:
If we hire the person you recommend, how long are you willing to stand behind them?
I think the answers to those two questions may tell you more about the search firm than the size of its logo ever will.
