Executive leadership appointments are high stakes yet can be built on weak foundations. Many are shaped informally through familiarity, prior relationships, and instinct built over time. That isn’t a lack of intent. It reflects how decisions are made under pressure, particularly when the outcomes are pivotal, and time feels limited.
Healthcare intensifies this dynamic. We expect a leader to move quickly, manage risk, and maintain confidence in complex stakeholder environments. In that context, known quantities feel safer, and decision-making narrows.
Research supports this reality. A significant proportion of executive appointments are made through referrals or internal networks rather than via an open-market process. Decisions get made before options are known. At the same time, failure rates for executive hires remain high, with a meaningful number not lasting beyond the first 18 months.
These patterns sit alongside one another for a reason. Familiarity reduces uncertainty. It shortens conversations and reassures stakeholders. Over time, it can influence judgment in subtle ways. Candidates are assessed more on proximity and past exposure than on future context and requirements.
Strong organisations never remove judgment from senior hiring decisions. They recognise when it’s compromised, creating space for perspective before commitment, scrutinising assumptions and clarifying future needs.
Independent input plays a role here, not because it is superior, but because it introduces distance. Distance allows clearer thinking about what an organisation needs next, rather than what feels comfortable now.
Executive appointments shape organisations for years. In healthcare, they influence culture, leadership dynamics, and service resilience in ways that are not always immediately visible.
At Marsh Farmer, we work alongside leaders at these moments. Not simply to present candidates, but to support more transparent decision-making when it matters most.
Handled well, senior appointments set direction. That responsibility deserves attention.