We Become Who We Hire

In healthcare, where trust and mission alignment are critical, the effects of each hiring decision extend far beyond the interview room. Common pitfalls in healthcare hiring can quietly undermine fairness, stifle diverse thinking and erode trust—even when processes meet technical requirements and intentions are good. However, they are avoidable with thoughtful design, reflection and intent.

Many healthcare organizations get it right. Strong, principled hiring processes have brought forward leaders who elevate culture, improve systems and inspire teams. What follows below are examples of when that doesn’t happen. These scenarios, drawn from lived experience across clinical environments, show how even well-intended processes can drift—often quietly—from fairness and impact.

 The Illusion of Objectivity

In one hiring process for a management position in a clinical service, the selected candidate had previously worked in the facility. The panel chair, who also reported to the incoming role, participated in the interview panel. Résumés weren’t scored side by side, and there was no shared rubric tied to the role’s key experiences or competencies. While the process met basic procedural standards, it lacked the structure needed to elevate the most relevant qualifications. Without clear safeguards, it risked allowing familiarity or hierarchy to outweigh merit.

How to avoid it:

• Exclude the role’s direct reports from chairing or leading interview panels.
• If direct reports are included to promote perspective and inclusion, ensure their input is balanced and not given extra influence.
• Use measurable evaluation criteria for candidates.
• Review scoring distributions to flag inconsistencies or dominant influences.
• Debrief after interviews to capture insights and improve future integrity.

Objectivity doesn’t result from structure alone. It demands safeguards that account for power dynamics, process transparency and equity in evaluation.

 Familiarity Isn’t Fairness

Many organizations tend to favor internal candidates, which is a wonderful way to develop leaders from within. However, the rationale for selecting them can sometimes be less about exceptional readiness and more because they’re familiar. In one case, at a large healthcare system, a finalist with strong qualifications and experience leading system-level improvements was quietly passed over. Instead, the role went to someone viewed as a more natural “cultural fit” and comfortable choice. It echoed the old saying: better the devil you know than the one you don’t.

It’s worth considering whether an understandable preference for familiarity led panelists to undervalue a candidate who not only brought fresh ideas but also had a track record of delivering results. Sometimes, in seeking alignment with existing dynamics, organizations miss the chance to bring in someone who could elevate performance in ways that matter most.

How to avoid it:

• Define “fit” through documented leadership competencies—not alignment with current norms.
• Include diverse, cross-functional voices on panels to widen perspective and reduce echo chambers.
• Use structured interview prompts that uncover candidates’ ability to challenge and grow the system.

Familiarity offers comfort, but progress often requires the courage to choose growth over ease.

 Safe Over Strong—Failing to Raise the Standard

In another key selection process for a front-line supervisor role, panelists leaned toward a polished candidate who spoke well and presented confidently. But strong delivery can sometimes edge out a potentially better-qualified finalist who may not have articulated their strengths as clearly in a single interview. When final scores are close, it becomes harder to distinguish who is most prepared to lead. Without a structured approach, there’s a real risk of rewarding style over substance.

How to avoid it:

• Incorporate simulations, case-based discussions or stakeholder presentations to reveal leadership depth beyond verbal polish.
• When résumé and interview scores are close, conduct a second round to clearly differentiate the most qualified candidate.
• Debrief the panel afterward to evaluate whether substance—not style—ultimately shaped the outcome.

Safe hires may stabilize the present but might not always transform the future.

 Underestimating Hiring as a Culture Signal

When a healthcare leader is chosen who visibly embodies commitments to equity, patient-centeredness or innovation, that decision reinforces belief in the organization’s mission. When a hire contradicts those values, through a track record of exclusionary leadership or resistance to change, it sends a different message entirely.

In one clinical system, a key leadership position was quickly filled by a candidate who formally met qualifications but had limited experience aligned with the strategic needs of the role. No structured review of résumés was conducted, and interview questions failed to probe operational readiness or cultural alignment. Panelists later acknowledged that while nothing overtly unfair occurred, there had been no deliberate effort to ensure the most qualified candidate was truly recognized. The appointment was swift, but staff perceived the process as arbitrary and confidence in future selections eroded.

How to avoid it:

• Define and communicate clear selection criteria up front.
• Evaluate candidates not just on baseline qualifications but also alignment with the organization’s future needs.
• Encourage panelists to speak up when critical elements, such as operational track record or leadership impact, are missing from the process.
• Treat excellence not just as a requirement, but as a reflection of organizational integrity.

Many teams uphold strong, principled hiring practices. When they do, the impact is unmistakable: trust takes root, teams thrive and leadership becomes a standard others rise to meet.

Owais A. Farooqi, DDS, FACHE, is a healthcare executive and clinician with experience in both public and private sectors. He currently leads a multi-site clinical service in the public sector. The opinions expressed are solely of the author.

The American College of Healthcare Executives (ACHE) is a network of leaders committed to excellence in healthcare and achieving their personal best.

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