It is stating the obvious to say that the situation confronting healthcare leaders is as challenging, if not more challenging, than any time in our history.  After surviving the ravages of the emergent stage of the COVID pandemic, we find ourselves facing a landscape which has been dramatically, and permanently, changed. We not only face workforce shortages but workforce weariness given the emotional and physical toll of the last two years. Labor costs have skyrocketed as a result of the shortages and the stopgap measure of using travelers has proven to be unsustainable both financially and culturally, and it fails to address the underlying reality that the supply of qualified staff is inadequate. Beyond labor cost increases, the resurgence of inflation has put significant upward pressure on costs with limited latitude for health systems to find offsetting increases in their revenue streams. The magnitude of the financial decline has created the need for dramatic and urgent change in order to restore financial stability amid the ongoing volatility of the healthcare marketplace.

Given the need for an urgent and dramatic change, the understandable inclination is to look at first order change, cutting costs within the current organizational and operating configuration of the enterprise. Given that those levers have been pulled repeatedly through the years, the danger is that there are not adequate opportunities to take out cost without adversely impacting other key performance metrics.

The path back to thriving for most organizations will require second order change, change which involves redesign of the basic design of the enterprise to create new value and eliminate inherent waste. There are numerous opportunities for second order change in operating models, service line configurations, clinical processes, administrative processes, technology deployment, nursing models, even payment and incentive models. The challenge of second order change, though, is that it takes time and is fraught with complexity and the predictable risk of disruptive change.  

There is no manual for leadership in such circumstances but there are some important reminders which can serve as guideposts to leaders as they navigate the turbulence which lies ahead:

Make self-care a priority.

Given the pace and pressure of leadership in challenging circumstances like the present, it is easy for leaders to de-prioritize self-care, working long hours, sacrificing sleep and exercise, eating poorly and generally neglecting their well-being.  That response reflects a mindset that the most effective response to a challenge is to outwork it despite overwhelming evidence that the quality and creativity of a leader’s thinking declines dramatically when physically or emotionally depleted. As counter intuitive as it may seem, investing in self-care is of the utmost importance when leading in crisis so that the leader is able to perform at their best.

Let go of the role of “expert” and embrace the role of “chief learning officer.”

One of the most unsettling things for leaders in a period of turbulence and volatility is not having an “answer” on how best to resolve the situation.  Recognize that in this environment there are no clear answers. Become comfortable operating with uncertainty, willing to try new approaches, learn from what transpires, and adjust based on what you learn in an ongoing journey of learning and improvement. In the absence of having clarity about “what” to do, trust that if you follow the right approach, engage the right people, focus on the mission, and remain faithful to your values, you will find the path forward.

Accept that first order change is necessary.

With the magnitude of the financial challenge many organizations are facing, relying on second order change, which necessarily takes time, may not be feasible. But having focused on first order change repeatedly in the past, it is fair to assume that for many organizations additional savings from such efforts will not be possible without slowing down or adversely impacting certain aspects of organizational performance.

It is important to be deliberate about the criteria which will guide your organization in making those decisions. Be clear to prioritize what is most important to protect. Define criteria to guide decisions around the short term “pain” you are willing to endure in the interest of shoring up short term financial performance as you work through second order change. For each proposed change, identify its direct impact and any steps which can be taken to mitigate that impact if possible.

Recognize the critical role of leaders to frame and lead the process of second order change.

The process of reimagining and redesigning is one which must be fed with the ingredients which foster creativity and innovation. Leaders often get frustrated at the lack of transformational ideas coming from people down in the organization. It is easy, but incomplete, to assume that the scarcity of new ideas is resistance to change. The science of innovation tells us that the longer and closer one is to a certain way of doing things, the harder it is to recognize ways in which it might be done differently and better. It is less a matter of defending “sacred cows” and more a matter of “invisible cows.”

Leaders play a critical role in providing organization and focus to the pursuit of transformational change, supporting and guiding those closest to the process to see something familiar with fresh eyes. 

  • Leaders energize the creative process by personally “staying open,” being relentlessly curious, engaging in various forms of learning and networking to stimulate creative idea for application or adaptation in their organizations.
  • Leaders support the creative process by asking provocative questions which help members of their teams see opportunities which are in front of them but which they no longer recognize.
  • Leaders provide resources to support the creative process, bringing together key influencers in identified areas of opportunity with the tools and information needed for design, experimentation, and development.
  • Leaders bring purpose, urgency and clarity to the process with timetables and accountability which keeps the process moving deliberately from concept to action.
  • Leaders encourage and nurture a generative culture which values vigorous dialogue, challenges to conventional thinking, and experimentation.
  • Leaders demonstrate courage to take action in the face of uncertainty and a willingness to risk and fail and learn.
Intensify your efforts to be present and communicate, communicate, communicate.

In the midst of uncertainty and the absence of clear and risk-free answers to the organization’s challenges, it can be tempting for leaders to pull back and communicate less. It is important to resist that temptation and lean into being even more present and communicative.  Otherwise, stakeholders are left to make up their own stories about the organization’s intentions and efforts, and those stories almost always skew to the negative. 

What anchors people in the midst of uncertainty is trust in the people leading the effort, the process by which the effort is being carried out and the values which are guiding the effort.  Authentic, timely and consistent communication of the nature of the challenges and the efforts being made to address those challenges can help sustain trust and credibility despite not having definitive answers.

It is important to communicate with “realistic optimism,” acknowledging the nature of the challenge but communicating confidence in the ability of the organization to find the way forward through the support and commitment of everyone.

  • Keep the organization’s mission at the center of all communications as the shared purpose toward which the combined efforts of the team are directed.
  • Share the criteria and process guiding the first order decisions and the process through which second order change is being explored and designed.
  • Acknowledge the reality that there are likely to be individuals who are personally impacted by the changes which lie ahead while sharing the organization’s commitment to and plans for helping those affected through their transition.

While the journey will not be easy, the best chance of bringing the organization forward on the journey is through honest, timely, authentic and forward-looking communication. 

Leading through the post-COVID landscape can be a daunting, lonely and confusing challenge. You may find it helpful to have the support of a coach who can help you step out of the turbulence and sort out your most authentic and effective path forward. If you would like to learn more about how MEDI Leadership can support in this vital work, please visit our website at MEDI Leadership or call and talk to one of our coaches at 904-543-0235.

 

Robert Porter
About the author

Robert (Bob) Porter is an accomplished organizational leader with over 30 years’ experience in health system leadership.
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