Healthcare Leadership 5 min read

Why I Believe in the CEO "Extender" Model

There's a stigma around bringing in outside help that I think actively hurts CEOs, and I want to name it directly.

Somewhere along the way, calling in interim leadership got coded as an admission of failure — as if a CEO who needs an "extender" must not be able to handle their own organization. In my experience, it's almost always the opposite. The CEOs who ask for help early are usually the ones who understand their own bandwidth most clearly. The ones who wait too long are the ones who eventually get replaced.

Every CEO I know is dealing with what I've started calling "the flood in the basement" — the urgent, unglamorous operational fire that has to be handled today, on top of the strategic work the board actually hired them to do. Something has to give, and it's usually the strategic work, because the flood doesn't wait.

"An extender's only job is the thing you don't have time to finish. That's not a weakness in your leadership team. That's math."

An "extender" — someone who steps in as a CEO, CFO, or COO's dedicated partner on a specific turnaround, project, or performance goal — isn't there to replace your judgment. They're there to make sure the initiative that can't afford to stall doesn't stall, while you keep running the organization. The best engagements I've been part of, on either side of that relationship, worked because the scope was narrow, the accountability was clear, and the extender left once the goal was actually met — not when the invoice ran out.

If there's one thing I'd want a sitting CEO to take from this: needing bandwidth isn't the same as needing to be replaced. The leaders who last are the ones who know the difference, and act on it before the board makes the decision for them.