Healthcare Needs Leadership Now More Than Ever
2020 will be a year infamously remembered for the rest of our lives. An optimistic view is that 2020 will become a catalyst for constructive change on multiple fronts: socially, economically, politically, and in my industry of healthcare.
Healthcare is more than an industry; it is the foundational pillar to a civil, productive, and progressive society. If our nation is to advance on any of the aforementioned fronts, healthcare must be marching lockstep with them. To do so, the industry will require a modern and dynamic brand of leadership.
This year, we have witnessed a virus, that initially besieged a small city in China, become a global pandemic that has wreaked havoc on every continent. At the time this article is being written, the pandemic has killed over half a million people globally, including nearly 140,000 in the United States. The novel nature of the virus and the consequently increasing number of cases have overloaded our emergency rooms, shell-shocked our medical providers and clinicians, and placed severe strain on medical supply chains.
In the midst of the pandemic, business closures, layoffs and furloughs have resulted in unemployment percentages not seen since The Great Depression. The police murder of an unarmed black man, George Floyd, in Minneapolis became a powder keg in an inevitable episode of nationwide civil unrest. Thousands have hit the streets in protest to march for racial equality, justice, and police reform. The long-term implications of this tragic episode and the resulting backlash from society are yet to be fully understood.
The protests remind us that we still have work to do in our country and that generations of inequality and discrimination have produced an environment where the status quo is simply not good enough for the future. This statement rings ever true in healthcare; some of the most prestigious medical schools and healthcare institutions in the world reside in the United States, yet deep gaps of health outcome disparities still plague our communities, particularly on racial fronts.
Nearly six decades following Martin Luther King’s “I Have a Dream” speech, executive teams and boards of directors of healthcare organizations across the country still do not accurately depict the diverse communities they serve in terms of representing people of color.
I recall some of the events of 2020 not to simply remind you, but to illustrate the point that any major issue that confronts any of us, confronts all of us, especially in healthcare. The events of this year have stretched our healthcare industry to unprecedented lengths, resulting in hospital and health system bankruptcies, clinician burnout, and even heartbreaking stories of clinician suicide.
Even prior to this unusual year, the US healthcare industry was in an increasing state of fragility. The rising cost of providing care has resulted in the industry consuming nearly 20% of GDP, meaning that 20 cents out of every dollar spent is done so on healthcare in some way — an unsustainable economic trend.
…any major issue that confronts any of us, confronts all of us, especially in healthcare.
As government and health insurance reimbursement methodologies shift in an effort to produce value over volume, so too does the financial risk of population health outcomes to providers. The result is that costs have reached unsustainable levels for many health systems and physician groups, resulting in closures and bankruptcies.
Rural community hospitals not financially insulated by the scale of large health systems are becoming endangered species as nearly 1 in 4 are in danger of closing today. A natural consequence is consolidation of hospital and medical groups and the formation of vertically-integrated “mega-mergers” between provider groups, insurance, and pharmaceutical companies, resulting in limited competition. The jury is still out on whether these deals will truly benefit consumers.
The paradigm shift of fee-for-service (providers being paid for each service they do) to value-based care (payment based on clinical outcomes) is intended to serve as a driver for reducing costs, improving quality, and promoting collaboration between provider groups and insurance companies.
Early data shows mixed results, but nonetheless, value-based care cannot be ignored by health leaders or medical providers as fee-for-service reimbursement shrinks each year.
The events of 2020 (and even prior) have led to rising numbers of uninsured Americans, while the health insurance exchanges created by way of the Affordable Care Act are under fire with an upcoming US Supreme Court case. Even those with health insurance are facing ever-increasing costs due to shifts of reimbursement from insurance companies to consumers with the advent of consumer-directed health plans (also known as high-deductible plans).
The rising number of patient bankruptcies due to medical and health insurance costs have created a political movement for increased government involvement in the industry. All Democratic presidential candidates this year support some variant of a “Medicare-for-all” plan, theoretically replacing private health insurance altogether or at least providing a public option for tax-payer subsidized coverage.
This is not an indictment of the US Healthcare system, nor is it a partisan or ideological discussion on the merits of an institutionalized system vs a free-market system. At least for the foreseeable future, we will continue with a hybrid of the two. As leaders, we aren’t in the business of speculation, therefore this is simply an evaluation of the facts and an honest assessment of what the industry needs.
Our industry has reached a critical crossroad; how do we address health disparities, improve affordability of care, and retain and engage our clinician talent all while improving health outcomes? Some of the modern challenges of healthcare can be addressed through the appropriate use of automation, artificial intelligence, and advanced analytics. However, even more important than the integration of technology is the ingredient that has proven itself as invaluable and timeless throughout history, even in the era of advanced innovation and information-sharing. This ingredient is leadership.
Our industry has reached a critical crossroad; how do we address health disparities, improve affordability of care, and retain and engage our clinician talent all while improving health outcomes?
Healthcare leaders, current and emerging, are facing an unprecedented time in the industry. The social, economic, and political considerations of today and beyond will continue to challenge the industry and thrust its performance into the public spotlight. We as leaders must be prepared for the pressures that tomorrow will place on our teams and ourselves. We must be willing to accept that many of the preconceived notions of “right and wrong” or “what works and doesn’t work” must be challenged as this is the only way that progress and innovation are created.
In my years of working in the industry, I have found there to be a core group of key characteristics that exceptional leaders have, and when missing, nearly always result in incompetence, poor organizational results, and eventually turnover among their most talented employees. A leader that lacks these ingredients will alienate the two most important stakeholders in healthcare: patients and medical providers. Without them, success in healthcare is impossible.
The key ingredients for modern exceptional leadership are:
- Humility
- Introspection
- Learning
- Creativity
- Respect for People
Humility
For years, charisma has often taken the cake as the most valuable trait of a leader. While charisma can certainly attract followers, humility keeps them. Humility as a leader is the awareness that you have influence on every person that follows you and with that, comes immense responsibility. It is the willingness to admit when you’re wrong, to accept that you may not be an expert in a particular subject matter, or that others are better at something than you are. Humility is adherence to the principle that you never ask a follower to do something you would not do yourself. Ultimately, humility as an executive is the ownership of decisions and results, even when others in their area of responsibility commit mistakes.
For years, charisma has often taken the cake as the most valuable trait of a leader. While charisma can certainly attract followers, humility keeps them.
Humble leaders in organizations are perceived by their employees as human and relatable. In my experience, employees in organizations led by humble leaders are more likely to be flexible in their roles, will treat customers better, and will be more willing to improve their performance with proper coaching. These are all traits that healthcare will require going forward.
Humility is a foundational requirement to collaboration in organizations. In healthcare, clinical and non-clinical leaders at every level need to collaborate to lead their respective areas. I have witnessed highly-effective tandems of administrative and physician leaders work together well because they understand the boundary of where their expertise and knowledge area ends and where their partners’ begin. In order for this partnership to truly coalesce, humility from both leaders is a requirement.
Introspection
The French philosopher Blaise Pascal has an impactful quote that sums up the value of introspection nicely:
“All of humanity’s problems come from man’s inability to sit quietly in a room alone.”- Blaise Pascal
Leaders are often caught in a cycle of crisis and reactivity, which leads to brash decision-making. The further a leader advances in their career, the more responsibility and less available time they have for reflection. One of the most valuable habits I picked up in my career is routine journaling. By doing so, I have built a strong sense of what motivates me, what I need to improve at, and an overall stronger sense of self-awareness.
Another aspect of introspection is proper time management. A consequence to becoming a rising leader is the demand for time and attention. Often, decisions and issues do not require a senior leader’s intervention and can be resolved through the development of standard policy and procedures or the empowerment of front-line leaders and employees. In the busy, fast-paced life of an executive, we often admire those that can make decisions quickly, but in reality, a sound decision that is made slower is often more valuable. The key to this principle is introspection.
Introspection is especially relevant in today’s world as leaders across the healthcare industry take a hard look at the practices and cultures of their organizations in terms of diversity and inclusion. As protests remind us of work to be done on all fronts, businesses must lead. This process begins with individuals reflecting on times in their lives and careers where they may have personally held an implicit bias or perhaps did not provide the level of support to individuals from marginalized backgrounds as they could have.
In this regard, journaling and routine reflection has had a profound impact on me this year.
Learning
The pace of information sharing and the evolution of how business is conducted in the 21st century has forced leaders to be more nimble than ever before. A truly effective executive must commit themselves to become life-long students of their industry and even leadership and management itself.
Maintaining an awareness of market conditions and government regulations in the healthcare industry is the baseline requirement. In an increasingly diverse workforce, leaders will need to have an evolving understanding of cultural norms, the drivers to health disparities in their communities, the importance of sponsorship for groups often underrepresented at the executive level, and an appreciation of the expectations of the patient populations they serve.
A learning possibility for today’s leaders is surrounding generational diversity. With every new generation that enters the workforce, comes a new learning opportunity for leaders. Currently, many organizations have 4, possibly 5, different generations in their workplace. With each generation, comes a different set of values, behaviors, and expectations for leadership. This level of diversity can be challenging to lead, but if done correctly, can produce immense value by maximizing the experience and skill set that each generation provides.
Creativity
Leaders today are often praised for their “left-brained” abilities: analytical skills, process improvement, logic, and an attention to detail. These are the skills often taught in business schools in order to drive evidence-based decision-making. There’s certainly enormous value in a leader who can do these things well.
However, the future will demand a more dynamic leader who can utilize their “right-brain”: creativity, free-thinking, strategic, and sometimes unorthodox. As automation, artificial intelligence, and outsourcing replaces many of the left-brained activities in organizations such as analytics, manual tasks, and other process-driven activities, leaders will be freed up (and expected) to be creative. In business terms, creativity typically means innovation and strategy.
In order for the future of healthcare to be one in which delivery systems are improved, efficient, and equitable, creative solutions will be necessary. An example that we’re witnessing right now is creativity in the form of business model innovation around telehealth. In rural critical access hospitals that suffer from a major shortage of physician specialists needed for acute care, some academic medical centers have begun outsourcing virtual medicine services to hospitals in need in order for in-demand physician talent to be shared with under-served communities without regard to geography. One such case in Mississippi is often cited an excellent example of how telehealth can potentially transform care delivery in the US.
Today, some of the creative ideas for implementing telehealth developed over the last few years have been vital as in-person care deemed as “non-essential” was put on hold. Care providers across various specialties have been able to provide consultations to patients with chronic illnesses and diseases virtually, minimizing the risk of spreading COVID-19, while ensuring access to care. Creative methods for delivering lower-cost, high-quality care such as these will be needed in our value-based world moving forward.
Respect for People
The Center for Creative Leadership states that respect is not the absence of disrespect. Simply eliminating disrespect in the workplace does not ensure an environment of respect. Respect is conveyed by leaders when active listening, empathy, empowerment, sponsorship, coaching, and development takes place (among other behaviors).
One of the core principles taught by the Toyota Production System, one of the most efficient and productive management systems in the world that revolutionized the world of manufacturing and other process-driven industries, was the principle of “going to the Gemba,” which in Japanese translates to “going to where the work is being done.” Essentially this means that leaders should always be in-tune with the issues and problems being faced by front-line employees and to always be connected to the operations that drive value for the organization.
Respect for people is closely tied to humility in that it involves the appreciation by leaders that every person employed by the organization is a unique individual with values, goals, beliefs, strengths, weaknesses, and likely families to support. The most effective and innovative organizations in the world are the ones that respect people by providing development and educational opportunities, livable compensation and benefits, work-life balance, and an appreciation for the diversity that their workforce provides.
Development is especially important; it is no longer just a fringe benefit for organizations to develop their employees — it is a requirement. As new generations enter the workforce, they do with a desire to grow, improve, and perform work they deem meaningful. With the average tenure with organizations shrinking for the typical employee, a major opportunity has presented itself in the labor market: retain your employees and you will have a major advantage over competitors as they increasingly devote resources to hiring, training, on-boarding new ones. A classic management parable sums it up nicely:
A CFO asks the CEO: “What happens if we invest in developing our people and then they leave us?”
CEO: “ What happens if we don’t, and they stay?”
-Unknown
Healthcare is an industry that is “for the people and by the people.” The events of 2020 have reminded us of this crucial principle and the ongoing changes in the industry have and will continue to challenge us as leaders to ensure that our employees and patients are served in the most effective way possible. A particular and dynamic brand of leadership will be necessary to carry us forward into the future.
