HIT THE GROUND RUNNING One reason to promote from within: Insiders know the ropes and the culture of the organization.

A management position opens at your facility. Do you fill it by hiring an outsider or by promoting from within? You may be tempted by a fresh face or an impressive résumé, but don't underestimate how hard it is to integrate new people into your facility — and don't overlook the loyal talent already working for you.

Comfort of familiarity
The main reason I consider promoting from within? You already know how hard current employees work and how their personalities mesh with staff and surgeons. You're also familiar with their clinical or business skills and how those skill sets match the qualifications you've established for the open position.

The same can't be said for outside hires. No matter how many candidates you interview, how impressive their résumés and how extensive your vetting process, trying to figure out how a new person will do is largely a crapshoot. What's more, an outsider might cost you more. "Paying More to Get Less: The Effects of External Hiring versus Internal Mobility," a recent study by Matthew Bidwell, an assistant professor at the University of Pennsylvania's Wharton School, found that external hires get paid 18% to 20% more than internal employees do for the same job, but they get lower marks in performance reviews during their first 2 years on the job. Mr. Bidwell's study, published in the journal Administrative Sciences Quarterly, also found that because everyone had to pitch in to bring the new hire up to speed, the performance of the whole unit declined.

Current staff members have a working knowledge of your center's operations and culture. They might have to acclimate themselves to the new position, but the adjustment period won't be as difficult or as long as it would be for an outsider. The in-house candidate might not have every trait you're looking for, but consider her length of service, loyalty to the facility, relationships with physicians and staff, and motivation to succeed in the new position.

From friend to manager
The insider you promote will have to move beyond her current responsibilities and form new working relationships with former peers that she'll have to manage. Communicate how the staff dynamics will change, that her former peers won't treat her the same and that she can't maintain close friendships with the employees she'll be overseeing.

Let the promoted manager shadow you or the person being replaced (as long as the departing employee is leaving on good terms) for a day or two to get a feel for the new position. The new manager won't have basic tasks on autopilot, so emphasize that the role may involve a significant time commitment, including nights and weekends, during the first few months of orientation. Stress that she'll soon establish a routine, and the day-to-day won't seem so daunting. Don't let early difficulties scare off potentially excellent managers.

Just because someone has been in your organization for years doesn't mean you can shortcut training. Doing so would set the employee up for failure. Employees with strong clinical backgrounds must be schooled on the financial side of surgery. A business wiz will need a primer on clinical issues.

How computer-literate is the employee? To begin with, she should already be proficient with Microsoft Office. However, she might not be as comfortable with every module of your computer software. A nurse, for example, might have mastered the scheduling, supply inventory and reporting programs, but not the billing module.

Employees who cut their teeth in the business office must learn how to schedule cases and order surgical supplies. Start computer training as soon as possible and provide examples of case reports and business documents for reference. Provide bookmark links to valuable resources such as industry websites and educational resources. Don't forget to address practical items such as check-signing privileges, bank access and how to submit survey notifications to accreditation agencies.

Document her progress
Outline the new job's requirements in a logical, progressive timeline. Excel is a great tool for this. List the knowledge requirements from basic to complex in one column. In the next column, note how often the task must be performed (daily, weekly, monthly or annually). Create a second spreadsheet with the same requirements, this time listed by how often they must be completed. The promoted employee can use both charts to cross-reference her new responsibilities so nothing slips through the cracks.

Make note of what the promoted employee does well and areas in which you need to see improvement. Those notes will be valuable references during the first performance review after her promotion. Above all, encourage the newly promoted employee to assume responsibility for improving her skill set. Tell her to identify what she doesn't know and own it. Empower her to continue learning and network with leaders at other facilities for tips on becoming a better manager.

At some point, the promoted employee needs to fly solo. Let her take on the new position's responsibilities in full, even if she stumbles out of the gate. Instead of shielding her from difficult tasks, let her give them a try. If she struggles, offer insights so she can improve the next time.

The ultimate success of a manager promoted from within depends on the guidance you provide, available training tools and support from staff who want to see one of their own further her career. Your ability to foster such an environment will create a well-trained, loyal manager who's happy she was given an opportunity and determined to reach her potential in the new role.

One final note: Even if you think you'll ultimately select a current staffer, advertise the open position. A qualified in-house candidate may not apply at first, so you have to cast a wide net. Besides, someone on the staff whom you assumed was uninterested or unqualified may apply and turn out to be the ideal choice.