Succession Theatre.

Every hospital leadership team I have worked with can produce, within ten minutes, a succession slide listing named successors for three to five critical roles. The slide goes into the board book. It gets reviewed quarterly. Governance considers the matter covered. And then, when I meet those named successors individually, the pattern appears: most of them have never been formally told that they are named. Some have been hinted at in corridor conversations. A few have been approached obliquely by their own manager. A meaningful fraction have never heard anything at all. The slide describes a reality that has not been constructed.

This pattern is so common, and so often defended, that it deserves a specific name. I call it succession theatre — the production of succession documentation that satisfies governance reporting requirements without actually producing succession. The theatre is not cynical. It is almost always built in good faith, by leadership teams who believe the succession conversation has happened or will happen imminently. It is just structurally inadequate to the function it claims to perform.

The ANCHOR layer of CuraOS treats succession as an operational function, not a governance artefact. Post 1 of this series argued that staff are the hospital’s second customer. Post 2 introduced the three-number test for reading workforce condition. This post drills into what is, in my experience, the single most consequential gap in how hospitals manage their people: the structural confusion between a slide and a plan.

The observation at the foundation of this post: a succession plan is real only after the successor has been told, in a specific conversation, using explicit language. Everything before that point is theatre.

Why the theatre persists.

Three structural reasons keep succession theatre in place across almost every hospital I have audited.

The governance requirement is written in weak language. Board governance expectations for succession typically ask leadership to identify successors. They do not ask whether the successors have been informed, developed, or retained. Satisfying the requirement as written produces the slide. The slide, once produced, is treated as evidence that the underlying function exists. It does not.

The conversation is difficult. Telling a mid-career physician or nursing leader that she is named as the successor to a role creates obligations in both directions. The organisation has to commit to a development path; the successor has to commit to consideration of the role. Neither commitment is necessarily welcome. Leaders who prefer optionality — the right to change their minds about the succession, the right to hire externally, the right to reshape the role — avoid the explicit conversation precisely because the explicit conversation reduces that optionality.

The naming is sometimes aspirational. A slide that lists a successor might reflect the leadership team’s genuine belief that the person would be the right successor, without anyone having verified that the person wants it, would accept it under plausible conditions, or has the development path in place to be ready when the gap opens. Aspirational naming is psychologically easier than committed naming. It is operationally worse.

The four-question test.

When I audit a succession plan for a hospital, I work through four questions for each named successor. The test is deliberately specific: it is designed to separate theatre from a plan that actually exists operationally. The pattern of failures across the four questions tells the leadership team exactly where the plan is structurally hollow.

Why the first question is the one that usually fails.

The audit finding that reappears most often across hospitals is the same: the named successor has not been told. The leadership team genuinely believes the conversation has happened, because some version of it has happened — a mentor has suggested the potential career path, a prior Chefarzt has implied the successor is on the trajectory, a Geschäftsführer has hinted at leadership potential in an annual review. None of these constitutes naming.

Naming, operationally, is a specific act. It is a conversation that uses explicit language: you are the identified successor for this role; the leadership team has formally made this designation; we are asking whether you would accept the role if it opened in the foreseeable future; we are committing to a development path that prepares you for it. Without that explicit language — without the words being said — the designation does not exist in the successor’s working model of their career.

The structural reason this matters is that the successor who has not been told cannot be developed. They cannot be asked to take stretch assignments that build the relevant capability because they do not know why those assignments are being offered. They cannot be asked to accept short-term career sacrifices that position them for the role because the role has not been made visible. They cannot be retained against competing offers because they do not know what is being implicitly promised. The succession plan that has not been communicated to the successor is inoperative on exactly the dimensions that make succession planning valuable.

The second question — and why silence is not consent.

Even when the first question passes — when the successor has been formally told — the second question often reveals further theatre. The named successor has been told. They have not been asked whether they want the role. The hospital has assumed that because the role is senior, because the compensation is higher, because the career step is conventionally regarded as upward, the answer must be yes.

In my experience, the answer is genuinely yes in perhaps half the cases. In the other half, the named successor has a career trajectory in mind that does not point toward the role being offered — a research direction, a clinical specialisation, an external move, a shift toward part-time work, an early retirement window. None of these possibilities is considered by leadership teams who have not asked. The named successor goes along with the theatre because declining the theatre is politically costly, and the organisation proceeds on a succession plan that will collapse the moment the role actually opens and the successor declines to move into it.

Asking the question explicitly, with the successor knowing that a “no” or “not yet” or “only under the following conditions” is a valid answer, transforms the plan. The leadership team discovers which successions are actually in place and which are notional. The named successors who say yes are genuinely committed, not merely passive. The named successors who say no free the organisation to pursue alternative succession paths before the role opens.

The third question — the development gap.

Hospitals that pass the first two questions still typically fail the third. The named successor has been told; they have indicated they want the role; but no deliberate development path is in place. The successor continues in their current role, accumulating experience that is relevant but not specifically targeted. When the succession window opens, the successor is roughly where they were when they were first named, two or three years earlier. The organisation acts surprised that they are “not quite ready.”

Development for succession is specific. It typically includes exposure to the role — shadowing, deputation during vacation periods, attendance at leadership forums the current role-holder attends. It includes stretch assignments that build the capabilities the role requires, which may be capabilities the successor has not yet had reason to develop in their current role — budget management, external stakeholder relationships, political navigation of the hospital’s committee structure. It includes visible mentorship from the role-holder, the board, and sometimes external coaching. Each of these is specific. None of them happens by default. A succession plan without a development plan is a succession plan in name only.

The fourth question — and the silent failure.

The fourth question is the one leadership teams almost never ask and almost never track: are the named successors still here in eighteen months? The turnover rate specifically for the named-successor population is the single most diagnostic metric in the ANCHOR layer, and almost no hospital tracks it separately from general turnover.

The reason it matters is that the named-successor population is structurally the most exposed to external offers. They are, by definition, the people the hospital has identified as the highest-capability operators in their cohort. External recruiters identify the same population. A named successor who has been told, who wants the role, and whose development path has not been built, is precisely the profile most likely to accept an external offer that offers more visible development and faster advancement. The hospital loses the succession not at the point the role opens, but years earlier, when the successor quietly leaves.

Measuring this attrition separately requires a specific operational discipline: the named-successor list is a tracked cohort in the HR reporting system, and the cohort’s retention is reviewed quarterly. Most hospitals cannot tell you, without looking it up, what fraction of the successors they named two years ago are still with the organisation. The number is the single most revealing data point in the whole ANCHOR layer. It is almost always below 70%.

What the Schlüchtern ANCHOR work showed on succession.

At Main-Kinzig-Kliniken Schlüchtern, the geriatric department restructured its succession discipline in 2020 as part of the broader operational programme under the research with Prof. Dr. Rainer Sibbel at Frankfurt School [1,2]. The discipline covered three roles below the Chefarzt level and two senior nursing roles. Each named successor was formally told, asked whether they wanted the role, and offered a specific development path. One of the five, on being asked, declined — she had a research direction that did not point toward the role. The designation was revised. The other four entered structured development and, as of 2025, four of the five original designations remain in place with the named successor still in the organisation.

The hospital did not install a new methodology. It installed the discipline of treating succession as a set of conversations rather than a set of slides. The conversations took, in aggregate, perhaps twelve hours of senior leadership time across a year. The operational return — successors who are actually developing, whose retention is tracked, whose readiness can be sensibly assessed — is disproportionate to that cost.

What to do on Monday.

Take your current succession slide into a meeting with each named successor, individually. The meeting does not require a formal agenda; it requires a specific conversation. You tell them they are named. You explain what that means in concrete terms. You ask whether they want the role. You describe, in first-draft form, the development path you would propose. You invite them to respond honestly, including with a decline or a conditional acceptance.

The meetings will take about an hour each. Plan for three or four separate conversations spread across two weeks rather than a marathon afternoon. The spacing gives each successor time to respond thoughtfully and gives you time to adjust your understanding of the succession landscape as the conversations proceed.

At the end of the cycle, revise the slide. Some names will remain; some will be removed and replaced; some roles will no longer have a clear successor and will need a separate process. The revised slide is, for the first time, a document that describes something operational rather than aspirational.

Install the four-question discipline as part of the quarterly succession review. At each review, for each named successor, the leadership team answers: have they been told; do they want it; are they being developed; are they still here. The reviews that were formerly ritual become operational. The theatre ends. The plan begins.

Succession theatre is not a failure of governance. It is a failure to distinguish governance artefacts from operational reality. The gap is bridgeable in weeks, not years. It requires only the willingness to have the four conversations the theatre has been substituting for.