Fellowship Openings

Designing a Succession Planning Framework to Improve Health Care Hiring

Project: Designing a Succession Planning Framework to Improve Health Care Hiring

Agency: Los Angeles County Department of Health Services

Location: Los Angeles County


Los Angeles County Department of Health Services (DHS), which runs the second-biggest municipal health care system in the nation, employs 25,000 people to help care for over 600,000 patients annually. With an employee base whose average age is over 50 and increasing numbers of managers and supervisors in nursing and administration nearing retirement age, the County sees a clear need for system-wide succession planning to ensure leadership continuity and quality of care across its nineteen health centers and four hospitals.

These efforts are all the more urgent in light of an aging and tightening workforce nationally, which is making it harder to attract management talent from other industries. Therefore, DHS must take a more proactive and systematic approach to filling positions.  According to one estimate, the vacancy for a nurse manager can add $250,000 in operating costs because it impacts an entire unit. More importantly, an overlap between the current and future job holder is essential to pass on institutional know-how or, in the case of a specialist, very specific information known only by the person departing. Achieving this continuity is all the more challenging at DHS, a government agency whose employees are civil servants, subject to rules that can sometimes work against succession planning. For example, those rules forbid hiring for a position that is still filled, thereby impeding knowledge transfer.  Also, job specifications may end up eliminating good candidates when they are based on outdated information, which is not unusual in a field as fast-changing as health care.

Despite these challenges, DHS has taken initial steps to incorporate succession planning through the Management Development Program including: Transition, Organization and Personal Abilities (TOP) Program, which helps new supervisors and managers gain the necessary skills to prepare for new roles, and LEAP, designed to strengthen and expand the skills of existing managers. The goal is to proactively create a pipeline of well-qualified candidates for every opening, thereby reducing recruiting expenses, improving leadership continuity and easing the stress of job changes.  In addition, DHS member facility Rancho Los Amigos National Rehabilitation Center (Rancho Los Amigos) has begun to work with the kind of dataset that could help management identify and prioritize hiring needs by collecting employee information based on an anticipated vacancy assessment, uniqueness, expertise and scope of work.

Ultimately, DHS believes the economic and organizational improvements catalyzed by succession planning can contribute to the most important goal of all: providing better patient care. To support this work, Los Angeles County will partner with FUSE Corps to host an executive-level fellow for one year who will analyze the succession planning regimen at other healthcare systems as well as current hiring practices at all DHS facilities, and develop a system-wide and data-based approach to succession planning that is ready for implementation by the end of the fellowship year.


The following provides a general overview of the proposed fellowship project. This project summary and the potential deliverables that follow will be collaboratively revisited by the host agency, the fellow, and FUSE staff during the first few months of the fellowship, after which a revised scope of work will be developed and agreed upon by the FUSE Fellow and the host agency.

Starting in October, 2019 it is proposed the FUSE Fellow will analyze the recruitment needs and practices at other DHS facilities, as well as the succession planning process created at Rancho Los Amigos. This will be followed by an examination of succession planning at other large healthcare facilities around the nation. In consultation with DHS management across DHS the fellow will develop a succession planning framework for the DHS system, incorporating the most relevant data points that enable management to prioritize hiring needs. The data will include a definition of skills and competencies that can provide an objective basis for identifying potential candidates for the LEAP program. In this way, DHS will have a means to discover candidates who might otherwise remain undetected in such a large organization. The fellow will also use the data to make a compelling case for proposing changes to existing civil service regulations, as well as software and technical recommendations. By the end of the fellowship year, a fully designed succession plan will be ready for implementation. The goal of the plan is to achieve a centralized process that responds to the needs of local facilities by creating a pool of well-qualified candidates ready to assume vacancies in the DHS system.

The fellow’s success in the endeavor will be evaluated based on several factors. Solid operations management skills will be necessary from the start, both to undertake a current state analysis of DHS hiring practices and to assess the best practices in succession planning at other large healthcare facilities. Those skills will include command of information technology tools in the area of data management. Combined with significant operations management experience, the fellow will employ strong listening and communications skills to ensure buy-in around the succession plan. Working towards a consensus on the plan is unlikely to encounter resistance but will require some degree of change management, given that it involves parting with entrenched ways of doing things. A completed succession plan ready for implementation should be in hand by the end of the fellowship year.

  • Conduct a local landscape analysis and a review of best practices: Get an overview of DHS hiring needs and practices, giving particular attention to succession planning efforts at Rancho Los Amigos. Conduct a best practice review of succession planning at other large healthcare institutions.
  • Initiate stakeholder engagement and develop plan parameters: Consult with DHS management and facility CMOs to hear their ideas for the succession plan, including specific data points and expected outcomes. Those consultations, combined with a best practices overview, will provide the starting point for a system-wide succession plan.
  • Conduct technology assessment: As the plan evolves, present management with a data-backed argument in favor of making changes to existing civil service regulations. Examine software options to determine if installation of a new software system would be best, based on greater efficiency, flexibility and user-friendliness.
  • Generate stakeholder consensus and buy-in: Present succession plan and technology recommendations to stakeholders, respond to questions and concerns, and make whatever changes are necessary. Present finalized plan with recommendations for implementation.


  • Elizabeth Jacobi, Chief People Officer, Los Angeles County Department of Health Services
  • Donna Nagaoka, Performance Improvement Director, Los Angeles County Department of Health Services
  • Aries Limbaga, CEO, Rancho Los Amigos National Rehabilitation Center, Los Angeles County Department of Health Services


  • At least 15 years of professional experience in strategic planning, project management, operations and data management combined with some experience in change management,
  • Consulting experience, involving client engagement and presentations, would be beneficial but not required.
  • Superior critical thinking and analytical skills.
  • Ability to synthesize complex information into clear and concise recommendations.
  • Ability to relate to a wide variety of diverse audiences with strong emotional intelligence and empathy.
  • Excellent stakeholder engagement skills and the ability to use facilitative leadership techniques to coordinate stakeholder activities.
  • Self-motivated, goal-oriented, entrepreneurial leader who can also be an independent worker.
  • Persistent in obtaining information and creatively resourceful in identifying solutions to complex problems.
  • Ability to create direction and movement within bureaucratic environments.
  • Exceptional written and verbal communication skills with an ease in public presentations.
  • Understands the need for solutions to support all people in a community regardless of race, religion, gender, immigration status, or ethnicity.