Leadership Transitions: Considerations for the Last 90 Days as an Ontario Hospital CEO

In his book The First 90 Days, Harvard Business School Professor Michael Watkins presents a roadmap for taking charge of the first 90 days of a new executive position. A transition he describes as “a critical time for leaders” (Watkins, 2003). There is little written, however, on planning the last 90 days when a leader is preparing to depart an organization. A review by Proximity Institute suggests the last 90 days may be as important for a leader as the first 90.

Ontario hospital CEO turnover was 19.7% in 2021 and 16.6% in 2022

Proximity spoke with nine Ontario hospital CEOs in the midst of their last 90 days in the role to understand their considerations and approaches in planning their departures. Three themes emerged from these conversations: degree of preparation, extensiveness of stakeholder management and care of handover.

Within each theme, vital considerations are outlined for the outgoing CEO to ensure a thoughtful transition and provide assurance to the Board until their last day in the role. The nine departing CEOs welcomed the opportunity to share this learning.

Careful preparation minimizes surprises and disruption

Timing the Departure

The CEOs we spoke with had notice periods ranging from 60 to 548 days (1.5 years). Leadership transitions can be destabilizing for an organization. A sixty-day notice period may create a succession scramble, while 548 days may prolong a period of instability and contribute to unnecessary confusion. There is, however, no right or wrong duration.

Is there an optimal time to leave an organization that minimizes strategic and cultural disruption while accounting for one’s own personal and professional considerations? An equally important question is whether a period of overlap with an incoming CEO, once identified, is desirable or dysfunctional?

Communicating the News

Most of the CEOs we spoke with proactively prepared a communications plan for when they announced their departure to the Board. They mapped out vital stakeholder groups within the organization and externally with appropriate messaging and timing for each.

Their definition of “vital stakeholders” was inclusive and exhaustive. One CEO noted the importance of personally informing major donors so that the announcement in the local media would not be a surprise. The aim is to minimize surprises.

Consideration of stakeholder prioritization and the planned and deliberate sequencing of communications proved to be a key success factor in contributing to a smooth transition overall.

Effective stakeholder management provides assurance and stability

Supporting the Board Through the Succession Process

Once a CEO informs the Board of their decision to leave the hospital, the Board assumes the responsibility of activating a CEO succession plan. CEO succession sits squarely as a Board mandate.

The CEOs we spoke with had varying levels of involvement in the CEO succession process. There were those who had given thought and time to develop and ready one or more potential successors for the permanent CEO role, providing an internal pipeline of potential candidates. In addition, some CEOs provided best practice resources on CEO succession (found at proximityinstitute.com) to ensure the Board was well-informed and could approach its mandate with utmost effectiveness.

Other CEOs admitted they may have overstepped best in class practice by exerting undue influence with their Board during the succession process including influencing the final CEO succession choice.

Alleviating Anxiety of the Senior Leadership Team

When a CEO informs senior leadership of their intention to leave the organization, it is not uncommon for teams to experience some anxiety. The CEO’s role in alleviating that anxiety should not be underestimated.

The CEOs we spoke with paid special attention to supporting their senior leaders through the transition and communicating even more than they normally would to set the team and the organization up for success.

One way to support the senior leadership team is to reinforce strategic focus and ensure momentum. One departing CEO exhibited foresight by establishing performance plans for their senior leadership team to stay the course in the months ahead and provide a more seamless entry experience for the incoming CEO.

Another CEO ensured each member of their senior leadership team had access to an independent professional coach to surface and speak to concerns, fears and opportunities that a transition often brings.

Saying Goodbye to the Organization and Community

Over their leadership tenure, the CEOs we spoke with emphasized the many important trust-based relationships they had developed over the years. They were sensitive to the lasting impact on the people, culture and community in which they have been an integral force, often beloved. They acknowledged that it wasn’t only a question of looking forward to their own next move, but balancing this sensitively with how they said goodbye to the organization.

One CEO stepped down from committees immediately after their departure was announced to free up their own time during the transition. Another CEO dedicated their entire final week to simply walk the halls, have meaningful conversations and be present and available to the organization.

A thoughtful handover supports strategic momentum

Clarifying Decision-making Accountability

Some CEOs chose not to relinquish authority until the date of their departure, while others began delegating to trusted members of the team as a deliberate act of letting go. There was consensus overall that when the timing and manner of the handover of authority was ambiguous, the transition became unnecessarily uncomfortable and confusing for everyone.

Acknowledging Organizational Memory and Culture

Some CEOs spoke about the importance of sharing historical knowledge with the incoming CEO including transformations, breakpoints, cultural shifts and other organizational milestones that likely left an imprint on the hospital’s culture.

In one case, a departing CEO had assumed the role after a period of government supervision and was understandably motivated to ensure this history was known by the incoming leader and part of the organizational memory.

Through Proximity’s conversations with outgoing CEOs, it became increasingly apparent that an awareness by CEOs of the importance of their leadership and the impending absence of their leadership presence in an organization cannot be underestimated. This summary of learning reinforces the significance of thoughtful planning for a departure and the potential risks of a less structured approach.

Works Cited

“The Conference Board – CEO Dashboard,” The Conference Board, January 2023,


Watkins, Michael “The first 90 days.” Harvard Business Review Press, 2013.


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