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By Carson Kolb
The 90-Day Executive Integration Playbook: Setting New Leaders Up for Success When you bring a new executive on board, what happens in those early month...
When you bring a new executive on board, what happens in those early months determines whether they'll thrive or struggle for years to come. Most organizations underestimate how deliberately they need to manage this transition period. They assume talented leaders will figure it out on their own, but even the most capable executives need structured support to navigate a new culture, build relationships, and understand the unwritten rules that govern how work actually gets done.
The difference between executives who hit their stride quickly and those who flounder often comes down to how intentionally their organization approached integration.
Standard onboarding works fine for entry-level positions. Show up, learn the systems, meet your team, start executing tasks. But executive integration requires something fundamentally different because executives don't just join an organization—they reshape it.
New executives arrive with the weight of high expectations. Their board, their team, and their peers are all watching closely, forming opinions that become surprisingly hard to change. Meanwhile, these leaders are trying to decode organizational politics, understand strategic priorities, and make decisions with incomplete information.
The stakes are particularly high in healthcare, where executive decisions directly impact patient care, staff wellbeing, and community trust. A misstep during those early months doesn't just affect quarterly numbers—it can ripple through an entire organization.
The most successful executive transitions start with listening, not leading. Your new leader needs structured opportunities to understand the landscape before they start changing it.
Set up meaningful conversations with key stakeholders across the organization. Not just courtesy meet-and-greets, but substantive discussions about challenges, opportunities, and what people hope this new leader will bring. These conversations reveal the informal power structures, the sacred cows, and the initiatives that have failed before.
Your new executive should spend time understanding the work at ground level. In healthcare settings, this might mean shadowing clinical teams, sitting in on patient rounds, or observing how frontline staff experience policies that look good on paper. This builds credibility and reveals disconnects between executive decisions and operational reality.
Board relationships deserve special attention. New executives need to understand each board member's priorities, communication preferences, and hot buttons. What keeps them up at night? Where do they have patience for gradual change, and where do they expect quick wins?
Most organizations tell new executives what they want them to accomplish but don't adequately explain why things are the way they are. Your new leader needs historical context to make smart decisions.
Walk them through past strategic initiatives. What worked? What failed? Why did that restructuring happen? What's the backstory on that contentious relationship with a partner organization? This context prevents them from repeating mistakes or inadvertently stepping on landmines.
Help them understand the financial reality clearly. Not just the budget they'll manage, but the broader financial pressures facing the organization. Where are the margin constraints? What revenue streams are growing or declining? What investments are already committed?
Strategic priorities need to be explicit and prioritized. New executives often receive a list of objectives that would take a decade to accomplish, then get criticized for not moving fast enough on everything simultaneously. Be honest about what matters most right now versus what can wait.
Culture eats strategy for breakfast, and it can absolutely devour a new executive who doesn't understand it. Your role is to help them decode the unwritten rules that govern how work really happens.
Every organization has informal decision-making processes that differ from the org chart. Who actually needs to be consulted before major decisions? Whose support is essential versus nice to have? What's the difference between asking for input and asking for permission?
Communication norms vary wildly between organizations. Some cultures value direct, decisive communication. Others prefer building consensus gradually. Some expect executives to be visible and accessible. Others see that as micromanagement. Your new leader needs to understand these expectations explicitly.
Help them identify cultural landmines. What topics are sensitive? What changes have been attempted and rejected before? Where do people have change fatigue? This doesn't mean they can't address these areas eventually, but they need to approach them thoughtfully.
New executives need to demonstrate value while also setting up sustainable success. This requires balancing quick wins with foundational work that takes longer to pay off.
Help them identify opportunities for early impact. These shouldn't be superficial changes just for show, but meaningful improvements that are achievable and visible. Maybe it's solving a persistent operational problem, improving a key relationship, or launching an initiative that's been stalled.
At the same time, they need space to build the infrastructure for long-term success. This might mean restructuring their team, implementing new systems, or developing capabilities that will pay dividends later. Protect them from pressure to sacrifice these foundational investments for short-term optics.
Regular check-ins during this period are essential. Not performance reviews, but genuine conversations about what they're learning, what's working, and where they need support. These discussions help you catch problems early and adjust the integration approach as needed.
Your new executive's success depends heavily on the team they inherit and develop. This transition period is when they need to assess talent, build trust with direct reports, and potentially make difficult personnel decisions.
They need honest assessments of their team members. Not just performance ratings, but context about relationships, political capital, and development potential. Who are the trusted advisors? Who might resist their leadership? Where are the skill gaps?
Give them room to build relationships with their team individually before making major changes. Rushed personnel decisions during the transition often backfire. They need time to see people in action, understand the dynamics, and make informed choices.
At the same time, don't let necessary personnel changes drag on indefinitely. If there are performance issues that need addressing or structural changes that everyone knows are coming, prolonged uncertainty undermines the new leader's credibility and team morale.
The integration period requires a delicate balance. Your new executive needs support and guidance, but they also need autonomy to lead. Hover too much and you undermine their authority. Provide too little support and you leave them floundering.
Create structured checkpoints for feedback and guidance, but let them drive their own process between those touchpoints. They should feel like they have a partner in their success, not a babysitter watching their every move.
Be honest about challenges and mistakes you see emerging, but frame feedback as partnership rather than evaluation. The goal is helping them succeed, not catching them doing things wrong.
Remember that integration doesn't end at a specific milestone. Even after the initial transition period, your new executive will continue learning and adapting. The foundation you build together during those early months shapes their entire trajectory with your organization.
When you invest in thoughtful executive integration, you're not just helping one leader succeed. You're strengthening your entire organization's capacity to navigate change, build leadership depth, and achieve strategic goals that seemed out of reach.