Not your father's COO

The lines on the organizational chart used to be pretty clear. CEOs were responsible for strategy, external issues and dealing with the board, COOs rode herd on internal operations and day-to-day management, and CFOs managed the money to make it all happen. But as with so many other areas of health care, those roles have blurred. While the chief operating officer's job description hasn't been dramatically rewritten, the pressures facing hospitals today--physician relations: an increased focus on quality, safety and patient satisfaction; reimbursement changes such as Medicare's policies concerning payment for so-called never events; and a continually evolving competitive environment--are radically changing the demands on hospital COOs. The four COOs profiled here have embraced their expanded roles. Whether helping create and implement a rural organization's strategic plan, translating corporate policy to the front-line troops, leading a big regional system in a time of market crisis, or balancing the goals of the parent system with those of dozens of local hospitals, these COOs are performing jobs their predecessors a generation ago might not recognize.