When was the last time you thought, "If I quit today, this program would fold"? You would be surprised at the number of people we've talked to during the course of this project who conveyed that sentiment in one form or another. Actually, maybe you wouldn't be surprised at all. Because we've all heard the stories of people who haven't taken a vacation in years because there's no one else to cover the pager. People who spend more time at their agencies than in their homes because they're the only ones regularly available to see patients and do the administrative tasks that keep the program going. Or worse, people who just don't trust that anyone else could manage the program the way they do. I hate to break it to you, but this is simply not a sustainable way to do business.
As program directors, we are keenly aware of how much the unexpected life issues impact our programs--family illnesses and injuries, personal crises, changes in job status, pregnancy. All of these things can take a prospective or working member of our team off the roster at a moment's notice. So why do we imagine the same thing couldn't happen to us? This is where the concept of succession planning comes in to play.
Succession planning isn't just a luxury for wealthy, well-staffed SANE programs. It's an essential activity (or should be an essential activity) for every program. And it's not something to consider only when you're thinking about leaving your position. Succession planning should be be about contingencies for the unexpected, not just the planned departures. Having a plan in place means that a program, at least in it's most basic form, can keep providing care for patients, even if it can't do all of the extras, like community awareness events or professional education. So ask yourself the question--if I left today, do I know who would take over? Is there someone to take over?
I became part of the management team at the DOVE Program in 2000 and took over running all patient care services 2 years later. At the time I transitioned to running the program, however, I knew that at some point I would move on. I like starting and growing programs; I don't necessarily like maintaining them (short-attention span). So when we had the funding to hire a PT staff person, I recruited with the idea of eventually grooming that person to replace me. I hired someone smart and savvy, with a skill set that complimented, but didn't duplicate my own. And when I decided the time was right to start implementing my exit strategy, we spent a full year transitioning her into her new leadership position. No trial by fire and no hiring in desperation.
There is no manual for succession planning in SANE programs, but there are strategies that can be adapted from the non-profit literature. The Annie E. Casey Foundation , for instance, has published quite a bit on leadership development, and they have a monograph  on succession planning that is worth checking out.
Even if you have no extra staff position, no money to fund much beyond the bare bones of a program, look around your pool of SANEs and consider who might be interested and effective in running your program when you step down. Don't see the answer you're looking for? Consider how and where you're recruiting for your program and start prioritizing leadership qualities in your candidates, and not just clinical skills or a willingness to take call. Share how things get done in your program, like billing for cases, scheduling staff, or ordering supplies. Delegate an administrative task or two, which has the dual benefit of teaching someone else how to do a part of the job and relieves you from having to do said task yourself. And for those of you who feel just a little bit threatened by an up-and-comer, keep in mind that surrounding yourself with quality people makes you a better, smarter and more effective manager. And that is a sustainable way to do business.