All over the country—in rural hospitals and big-city health systems, in clinics and corner offices—the people in charge of delivering excellent healthcare find that task increasingly difficult.
The numbers paint a horrifying picture of a U.S. medical system in crisis. Today, 4 in 10 patients face significant healthcare debt. And they wait an average of 26 days to see a doctor in larger cities while those in rural settings face even greater barriers to accessing care. Clinicians, meanwhile, seem to have hit rock bottom with nearly two-thirds reporting symptoms of burnout, leading to “higher rates of alcohol abuse and suicidal ideation, as well as increased medical errors and worse patient outcomes,” according to the U.S. Surgeon General.
The macro view of American healthcare is equally distressing. The United States spends twice as much as other wealthy nations on per-person medical care, yet clinical performance in the U.S. lags all 10 of its closest peer countries. In addition to these troubles, a perfect storm looms. Soaring healthcare inflation, a widespread nursing shortage and the influx of private equity in medicine are poised to create all-out chaos.
Why fix what’s broken?
In a moment that begs for bold leadership, no one is answering the call.
Instead, most healthcare professionals, administrators and executives have embraced a middleman mindset. It’s an outlook bent on delivering point solutions for narrowly defined problems while ignoring the deeper, systemic issues that plague the whole of healthcare.
Though this band-aid mentality may be lucrative, it won’t fix a broken system. While the status quo remains tempting for many, here are three reasons leaders will choose to step up and take on the Herculean task of transforming healthcare:
Point solutions are profitable in healthcare (an industry with over 80 unicorns), but a far bigger prize awaits those who can solve the manifold issues of healthcare delivery and insurance. Contenders include medical groups, hospital systems and big corporations like Amazon, CVS and Walmart. Right now, these retail giants are furiously acquiring pharmacies, physicians and insurance partners—pieces they’ll need to dominate the industry.
Some of healthcare’s biggest players are struggling mightily. Hospital margins have eroded under the weight of inflation and the shift to outpatient care. Medical groups, having suffered financial losses throughout the Covid-19 pandemic, now face declining Medicare reimbursements in 2023. Community doctors, meanwhile, are experiencing both declining revenues and diminishing workplace satisfaction. For some, a radical pivot may be their best (and only) chance to stop the bleeding.
Though many healthcare players are driven by financial gain, medicine has long attracted individuals motivated by the desire to help others and save lives. A case in point came during the earliest days of the pandemic, when doctors and nurses selflessly put the health of patients ahead of their own lives. For many clinicians, a sense of purpose may drive them to lead the process of change and inspire likeminded individuals to join the cause.
Regardless of their motivations, all potential leaders face the challenge of where to begin. My suggestion: reframe the problem.
Redefining healthcare leadership
In 1998, shortly after I was named CEO in Kaiser Permanente, I visited the Oregon Health Sciences center to keynote a conference on healthcare in the coming century. As I wandered the halls after my talk, a sign caught my attention.
In bold letters across the top, it read: “Cost. Access. Quality.”
And below, in tiny font: “pick any two.”
I found the message appropriate for the time, even if a bit sardonic. Back then, most administrators believed it was possible to improve in two of these areas but only at the expense of the third. Unfortunately, they were right. Even in the 1990s, medical practice lacked the knowledge, technology and processes required to achieve excellence in all three.
Almost three decades later, this outdated mentality persists—despite radical scientific and technological advances such as evidence-based practices, deep data analytics, smartphones, telemedicine and artificial intelligence.
To healthcare’s current leaders, the quandary of cost, quality and access goes something like this: Sure, it’s possible to enhance the quality of (and access to) care by hiring a lot more nurses to assist patients with chronic conditions. But doing so always leads to unsustainably higher costs. Likewise, it is possible to stem financial losses by shutting down poor-performing hospitals. And it might even be possible to boost quality of care by replacing those facilities with a single center of excellence in a nearby community. But doing that would limit access for people with multiple jobs or those without reliable transportation.
That is why leadership in the 21st century will be defined as the desire and ability to improve quality, access and affordability—simultaneously. In this quest, leaders will encounter major challenges.
For one, they’ll have difficulty winning over the people who deliver care. Doctors dislike authority and prefer a flat, collegial structure. Anyone who seeks to wield command over clinicians will find the effort similar to herding cats. And, unlike in process-driven industries where decisions hinge on data and collaborative thinking, physicians value their independence. They resist any attempts to standardize care, often dismissing evidence-based approaches as “cookbook medicine.” Furthermore, physicians are trained to challenge data and resist centralized power. To embrace change, they’ll need to be thoroughly convinced of the benefits.
Still, despite these obstacles, success is possible.
The anatomy of healthcare leadership
To achieve excellence in healthcare, leaders must possess the ability to change people’s minds, generate emotion and passion and maintain courage in the face of adversity. Putting the anatomic pieces together, success will be determined by how leaders use their brains, hearts and spines:
Medical students are selected based on standardized tests, which aim to measure intelligence and problem-solving abilities. Therefore, leaders who wish to drive change in medical practice must lead with logic—presenting a clear vision, offering sound arguments and engaging in intellectual debate. In addition, they must listen to and work alongside clinicians, helping them weigh the pros and cons of change before mandating it. And, finally, they must avoid the mistake of thinking the brain is the only (or even most important) anatomic structure necessary to connect with others.
The mind is compelled by logic, but the heart is moved by emotion, passion and the power of story. Leaders who convey powerful narratives and patient testimonies are more successful in reaching others and helping people overcome the fear of change. Passion is equally important because no one will care how much a leader knows unless they know how much the leader cares. When leaders express a sincere desire to help others and save lives, they can form a powerful bond with clinicians. Reconnecting doctors and nurses with a higher sense of purpose has the power to touch the heart in ways no logical argument could.
Even when people are convinced that change is important, they still need the courage to act. Leaders must demonstrate both resolve and resilience during the painful transition process. Not surprisingly, the most common question I get from future leaders is, “What do I do if I get pushback?” I tell them, “If you’re not encountering resistance, you’re not leading.” Helping people move forward in the face uncertainty is a key leadership skill. A strong spine supports the leader in hard times and gives followers greater confidence that the future will be better than the present.
Leadership: from theory to practice
Future articles in this series will focus on how the anatomy of leadership—the brain, heart and spine—can transform American healthcare and improve professional satisfaction.
On November 14, look for my next piece: “A Mind For Technology.” I’ve chosen this topic because technology offers the greatest opportunity for radical and transformational change. After all, healthcare remains one of the only U.S. industries that hasn’t yet figured out how to use 21st century innovations to increase quality and lower costs. But healthcare technology also can be used to better support clinicians and increase their professional satisfaction.
Subsequent articles will examine other supportive changes leaders must make, including how medicine is organized, paid for and delivered. Combined, these articles will demonstrate that—contrary to what healthcare leaders have always assumed—it is possible to improve quality, access and cost all at once. Without tradeoffs.
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