In the fall of 2007, the California Nurses Association started a campaign for publicly funded health care by referring to Vice President Dick Cheney's medical problems. Their political ad begins like this: “The patient's history and prognosis were grim: four heart attacks, quadruple bypass surgery, angioplasty, an implanted defibrillator, and now an emergency procedure to treat irregular heartbeat.”
While the nurses were using the vice president's health issues as an argument for policy change, such a medical history raises another question for American corporations: Should executive health be considered a “risk”? If so, what kind of risk, and how should it be prepared for and managed?
We think executive health is a risk — in the case not only of the sudden death of the CEO or other important member of the management team but also, perhaps more problematically, the incapacitation or semi-incapacitation of that person.
The finality and shock of sudden death is a difficult problem; the uncertainty that comes with some incapacitating illnesses is a corrosive one. Magnifying the risk is that current approaches to dealing with an ill executive seem deeply flawed. There are few clear guidelines about procedures and actions to be taken.
While dysfunctional leadership has many causes, we are interested in the subset that is caused by, or involves, illness. In 1951, Harvard sociologist Talcott Parsons, setting parameters that serve us well today, defined the state of “being ill” as involving several elements, including:
• The sick person requires “… exemptions from normal social responsibilities (in proportion to the nature and severity of the illness …”).
• The sick person “… cannot be expected by ‘pulling himself together' to get well by an act of decision or will … He is in a condition that must be ‘taken care of.' ”
• The sick person must “… seek technically competent help, namely, in the usual case, that of a physician, and to cooperate …” in recommended treatment (emphasis in original).
Each of these points becomes hard to operationalize in actual cases, and especially difficult in the executive situation.
For one thing, there is the issue of how much exemption is to be allowed, and for how long. Second, there is the imperative for others (often the board, but other staff as well) to assist, to “take care of” the sick person and that person's responsibilities. Third, there is the issue of walking the talk in wanting to get well; most ill people say they want to get well, but many ill people act in ways contrary to that stated intention. (This may be especially true in the case of addictions.) Finally, there is often a resistance — especially with addictions and other mental illnesses — to seek competent help.
The problems illness creates
Illness in the executive suite is an important and largely unrecognized problem in government as well as in businesses and organizations of all sizes. In addition to Cheney, there was Woodrow Wilson, with his history of strokes and mental deterioration, and Ronald Reagan, who succumbed to Alzheimer's. In business, two prominent cases were Harry Helmsley's mental deterioration and James Batten's battle with cancer (see sidebar). And, of course, many executives experience problems related to alcohol and substance abuse.
In executive life, the assumption is that the executive is “healthy” or “functional.” But what if that is not the case? What if the executive is suffering from some physical or mental illness that impairs her or his functionality? How would anyone actually know this? How much impairment is “OK”? At what point does impairment require intervention by the board or senior executives (if we are talking about a member of the senior staff rather than the CEO)? Who decides, and how? This issue is a compelling one, with serious consequences for the organization if the board fails to act — which it usually does.
Because as individuals our own attitudes toward illness are mixed, we are often unsure how to proceed. Our first impulse is usually a supportive and caring one. Boards are no different in this response. The norm, at least in American society, is to provide role exemptions — excusing the executive in various ways from performing usual roles.
But at a certain point of mental or physical illness, both the executive and the organization begin to experience loss of functioning. While the individual executive goes through a period of functional effacement, within the organization decisions fail to get made — or bad decisions get made — and opportunities are missed. Coalitions of decision makers scurry for favor and influence (“succession politics”). Unscrupulous aides and other senior staff may actually exacerbate the situation.
Individual and organizational breakdown
Let's examine the fuller ramifications of how illness negatively impacts executive performance and generates unhealthy organizational behavior:
• Physical Effects — Illness depletes executive physical energy by lowering the available energy the executive has for a demanding job. Illness steals time. Especially in a global environment, that required time might often be at odd hours. Lowered energy requires more time for rest, and treatment regimens themselves require time. Illness also steals scope/scale. Because of the issues of energy and time and their interconnections, ill executives may have trouble addressing the scope and scale of their job.
• Intellectual Effects — Some illnesses (brain injury, stroke) can lower one's cognitive ability in areas of information processing and decision making. There can be a loss of previous knowledge or an altering in the way in which an individual processes incoming information. Ill persons are often disoriented in many ways by their illness. They are themselves confused about what is happening to them and why.
• Intrapersonal/Interpersonal Effects — Illness impacts self-knowledge and interaction with others in part because the ill person tends, very naturally, to focus on himself.
• Office Distraction — Illness generates succession politics. As the executive's attention wanes and her time becomes attenuated, others with an eye on the “executive prize” begin to strategize for power, influence, and possible succession. Major distractions develop as various executives and cadres strive for current influence and future power. The organization can suffer “mission attenuation,” in which employees begin to rivet their attention on who will be the ultimate “winner” rather than on the objectives of the business.
• Bad Decisions — Illness diverts decision making into backchannels or “non-responsible parties” (e.g., Woodrow Wilson's wife; a boss's support person).
• Uncertainty Reigns — Colleagues (superiors, peers, subordinates) experience problems similar to those confronted by the ill person's family. Bosses do not want to intervene too soon. Subordinates do not want to appear overreaching but also do not want to delay intervention for fear of being faulted for undue delay. Peers are not sure what their role is, or could be, or should be, especially because they might be in line for succession if the ill person cannot resume her duties. Subordinates are perhaps in the most difficult position, because they are climbing up the power grid and anything they say is suspect. Elyse Tanouye, a health and science editor at the Wall Street Journal, puts it this way: “When it becomes clear that the boss needs help, figuring out who should raise the issue can be tricky. A subordinate runs the risk of being ignored or punished for confronting the executive. Some experts say it should be a superior … or a trusted board member in the case of the CEO.”
Suggestions for action
There seem to be no accepted approaches to this problem. Upon review of the literature, it seems that proactivity and forethought is an excellent first step.
• Successful Approaches — In our view, the suggestions of the Society for Corporate Secretaries and Governance Professionals are a good place to start:
— The board should require regular physicals of the CEO and top team;
— The board should require disclosure of the physical's results to one or more board members;
— The CEO employment contract should give the board the explicit right to determine executive “disability”;
— The board should have written policies to govern the determination of long-term and short-term disability;
— The board should have a written plan for short-term succession as well as permanent replacement;
— The board should have a plan for disclosure of executive illness;
— In the case of business units, the “board” should be replaced with “superiors” in statements of policy practices regarding disability.
We would add to this list a suggestion that the executive be required to exhibit positive health behaviors. Risky health practices are personally problematic to the executive and set a bad organizational example.
• Unsuccessful Approaches —Seemingly the norm at the moment, unsuccessful approaches involve doing nothing, hoping for the best, denying anything is wrong, and actual lying about the situation.
We can do better
Executive illness is a complex and important problem in the executive suite. The idea that one can rely on the executive to take the lead in the handling of his or her own illness is problematic for many reasons, not the least of which is that denial is characteristic of many illnesses. On the other side, “governors” — whether they be board members or staff colleagues — seem woefully ill prepared to take action.
Few options have been thought through and put in place to be readily exercisable. This gap creates and supports indecision and inactivity. Hence, we are faced with inaction on more or less every side, broken only by some dramatic event that forces steps to be taken. We owe our executives, our shareholders, and our organization's stakeholders better than such stumbling. â–
The authors can be contacted at tropman@umich.edu and rwinf@umich.edu.