Healthcare is the fastest growing industry in the United States and globally. Economists forecast that as the population grows and life expectancy increases, the healthcare sector will continue expanding to meet consumer needs domestically and globally. Population aging and the emergence of global pandemics has substantially increased the demand for healthcare services and has created volatile, complex, uncertain, and ambiguous conditions that ignite social, economic, and workforce shifts within and outside the organization. While these factors require growth and agility within healthcare organizations, high turnover in the healthcare workforce threatens these organizations’ ability to effectively fulfill their mission. The high rate of chief executive turnover within large hospital systems poses particularly significant threats to the industry and national health. Therefore, this study identified strategies and organizational practices for chief executive officer transitions at large hospital systems during times of significant multidimensional change. The present study used a qualitative Delphi method. Thirty chief human resources officers from large hospital systems were recruited for the panel using a purposive sampling strategy. The initial survey was created based on a review of extant literature on chief executive transition. Panelists were asked to rate the identified organizational practices on a scale 1 (not at all important) to 7 (critically important). Items were rated iteratively until consensus and stability have been achieved or the three rounds have been completed.

Library of Congress Subject Headings

Chief executive officers—Hospitals; Hospitals—Administration; Delphi method

Date of Award


School Affiliation

Graduate School of Education and Psychology



Degree Type


Degree Name


Faculty Advisor

Farzin Madjidi