Eric Cecava | What the COO-to-CEO Transition Actually Reveals

Eric Cecava in the lab

The jump from running operations to running an enterprise teaches things about leadership that the job description does not capture

Most health system CEOs arrived at that title by way of a COO role, and most of them will tell you that the transition taught them something they did not expect. The work is different in ways that are not obvious from the outside. Eric Cecava of Fort Gratiot, Michigan, who served as Chief Operating Officer at Adena Health System in Ohio, then as COO and later President and CEO of McLaren Port Huron in Michigan, has a specific view of what that transition actually changes.

The COO Owns What Happens Inside. The CEO Is Accountable for Everything.

As COO, Cecava's accountability was operational. He was responsible for how the hospital functioned, how the skilled nursing facility performed, how the medical group was managed, and how quality and financial metrics tracked against targets. Those are significant responsibilities, but they are bounded. The operational accountability has a fence around it.

The CEO accountability does not have that fence. The CEO is accountable for the organization's relationship with the board, with the community, with payers, with the regulatory environment, and with the media. Those relationships are connected to operational performance, but they are not the same as operational performance. A CEO who manages them as though they are will eventually discover that relationship problems have a different timeline and a different set of consequences than operational problems.

The External Work Is Not Optional, and It Is Not a Distraction

One of the adjustments Cecava made in the CEO role was the scope of engagement outside the organization. The YMCA involvement, the economic development work in St. Clair County, the community visibility that comes with the CEO title at a regional health system: these are not ancillary activities. A community that trusts the health system's leadership is more likely to use the system, to support its development, and to advocate for it when political or regulatory decisions affect its future.

Regional health systems are woven into their communities in ways that urban academic medical centers are not. McLaren Port Huron is one of the larger employers in St. Clair County. Its decisions about programs, facilities, and services affect the county's health and its economic structure. The CEO who understands those stakes has a different relationship to community engagement than the one who treats it as a schedule obligation.

The Internal Work Does Not Get Smaller

The CEO transition adds external accountability. It does not remove internal accountability. The CEO who becomes primarily external-facing and delegates the operational work entirely will find that the internal problems that develop in the absence of active executive engagement eventually surface in the external relationships. Payers notice quality metric trends. Boards notice workforce culture signals. Communities notice when a health system's staff is unhappy.

Cecava's approach to the CEO role at McLaren Port Huron maintained the operational visibility he had developed as COO. That meant being present in the organization, understanding what the leadership team was dealing with, and staying connected to the front-line operational realities rather than managing exclusively through reporting systems.

The Board Relationship Requires Its Own Development

The COO typically has a relationship with the board that is primarily informational: presenting operational results, answering questions, providing context for the CEO's strategic framing. The CEO relationship with the board is different. The CEO is accountable to the board in a direct way, and the board relationship requires ongoing investment in trust, transparency, and alignment on the organization's direction.

Building that relationship requires clear and honest communication about organizational performance, including the problems and the plan for addressing them. Boards that receive consistently positive presentations from their CEOs tend to be less effective governors than boards that are trusted with the real picture. Cecava's experience at McLaren Port Huron shaped a clear view on this: the board relationship is an asset when it is built on transparency and a liability when it is managed as a performance.

The Transition Is a Leadership Development Moment

The COO-to-CEO transition is also, in a practical sense, the moment when a leader discovers which parts of their leadership model hold and which parts need to change. The instincts that worked well at the COO level, the operational focus, the process discipline, the direct management of problems, all carry forward. The CEO role requires additional range: the ability to hold strategic direction and operational accountability simultaneously, the patience to manage relationships that operate on a longer timeline than operational problems, and the judgment to know which of the two to prioritize when they compete.

The executives who navigate this transition well tend to be the ones who were already thinking about the enterprise while they were running the operations. Cecava's progression through the VP and COO roles at Adena Health System before moving to McLaren Port Huron provided that preparation. The CEO title was a formalization of accountability that the operational work had already been building toward.

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