I remember standing on the battlefield at Gettysburg, on a rainy, cold day, a Marine Colonel (turned professor) yelled at us, “If it ain’t raining, it ain’t training” followed by an old Marine Corp adage, “Embrace the suck!” Now, we weren’t heading into battle, merely experiencing an educational tour, but his message was clear: choose to overcome the difficulties or be overcome by them.
Many leaders disproportionately focus (by habit) on the problems right in front of them and ignore the opportunities beyond those challenges; this is often the least productive use of their focus. Peter Drucker, whose leadership and organizational wisdom has aged well, penned “the purpose of strategy is to enable an organization to achieve its desired results in an unpredictable environment.”
The pandemic has changed much of what we think of as normal, has accelerated trends already underway, and added a new level of uncertainty to the healthcare ecosystem. Faced with these external realities - and the challenges they create, every leader has a choice to make – overcome, or be overcome. Three mindset shifts offer a pathway to refocus leaders and help them produce sustained success in today's unpredictable environment.
1 - Begin strategy development with the end in mind and work backwards (not how most strategic planning happens)
The most common method of strategic planning is to define objectives, create strategies to achieve them, and then marshal resources (although in healthcare this last step is often neglected by simply reallocating existing resources). Several challenges arise from this widely practiced methodology:
- First, objectives are too short-term in place of long-term aims, making it almost impossible to achieve a real competitive advantage. It’s reminiscent of watching an America’s Cup match (sailing race). If two competitors simply copy each other in short-term tactical movements, there will never be much separation. It takes bold, well-executed maneuvers, to win.
- The second problem is it encourages episodic thinking that is often more tactical than a continuous building of a consistent, coherent, and context-relevant strategy. This episodic approach often leads to unending compromises, unsustainable processes and a loss of focus and commitment to the original business intentions.
- Lastly, it tends to lead to quantitative only objectives and drives non-quantitative goals out. I wrote about this at some length in my book, Lead With Imagination. In essence, we have given our left brains a more favored place in our organizations, at the steep cost of innovation, inspiration, and resiliency.
Our objective setting is articulated only in the language of executives, but it rarely translates to the ground teams charged to achieve them and leaves the power of the rest (or right side) of our brains untapped. Perhaps in visual terms we are leading “half-brained”. Few people are inspired by a return on investment or EBITA target. In the end, we rarely calibrate for the single most important inputs into the ‘do-ability’ of any strategy, our organization’s culture, capabilities, and capacity. Stephen Covey reveals in his writings, “If you want to have a successful enterprise, clearly define what you’re trying to accomplish…the extent to which you begin with the end in mind often determines whether or not you are able to create a successful enterprise.” This is not how most organizations approach strategic planning.
Most strategic planning today culminates in a flat surface map of the road ahead. While this sounds reasonable on its face, it is of limited use. It assumes a known terrain and a very specific set of directions, with limited problem solving or contingency planning incorporated. In stark contrast, the environment in which we function is much more like a swamp and lends itself better to possessing a compass rather than a map. We know the end point we are moving toward, but the pathway to get there will likely not be the route we envisioned, much less a straight line or a journey along an existing road. There is little doubt that we will need to navigate several unforeseen obstacles and fight through real dangers. This is also why cultural context matters so much to the development of strategy. As my military friends have taught me, no plan (even one from the corporate office) survives contact with reality.
2 - Leverage the discipline of design in planning
Noah Waxman from consumer experience design firm, Cactus, states, “For decades, the interests of hospitals, networks, insurance companies, pharmaceutical companies, large employers, and the Electronic Health Records (EHR) software providers have been elevated above the interests of the actual patients and caregivers who use the spaces, places, technologies, and equipment. This has meant that engineers, accountants, lawyers, and business people have been put in charge and designers have not had a seat at the table where decisions are made. I see today’s low patient satisfaction and dangerously high doctor (and staff) burnout rates as direct results.”
I found this statement difficult to come to terms with but am slowly coming to the realization of its truth. I remember a time when a very insightful colleague sat in my office and posed one of those stop-you-in-your-tracks questions. He described how he had recently sat near the front of his busy hospital entrance and observed. That led to the question he posed. “Is this what we intended to design?” His question was rhetorical because we both knew the answer. We didn’t really understand the discipline and distinctions good design brings. We spend most of our executive time choosing what problem to solve or opportunity to pursue and limited time framing the problem - or opportunity - and rigorously and creatively solving it.
For example, today doctors and nurses are overwhelmed by their technologies. It weighs them down, because it’s not designed with their goals in mind - or the patients, for that matter. Often, it’s designed for the operations of the hospital and their billing requirements. Doctors spend an average of 16 minutes and 14 seconds of active time - per patient encounter - doing data entry in an antiquated EHR interface. Technology should have the exact opposite role. When a doctor or nurse arrives in a treatment room, there should be technologies in place to help them tell the story of the customer’s health and compelling distillations of how (and why) this is the case. We should be building up doctors and caregivers to be able to better connect on a human-to-human level about what is going on with their body and what they think needs to happen next (Kervin, 2021).
Design affects nearly everything, but as my friend Noah suggests, rarely do you find designers around the table. And for me, perhaps they play the role of voice of the customer and then translator to best design the experience customers (and so often caregivers for that matter) desire.
3 - Plan for a complex landscape not just a complicated one
What exactly is the difference between a complicated and complex system anyway? Aren't they essentially the same thing? No, they are not. The main difference is a complicated system can usually predict outcomes by knowing the starting conditions. In a complex system, the same starting conditions can produce different outcomes, depending on the interactions of the elements in the system (Harvard Business Review, 2011). In other words, complex systems have multiple parts that are interacting in which each can be difficult to predict. They are difficult to model due to the dependencies, competitions, relationships, or other types of interactions between their parts and the Environment.
I find it helpful to think of a complicated system as an oil refinery. It requires tight processes and controls, and if you do that well it will always give you exactly what you expected, various refined products like gasoline. A hospital or health system is not like an oil refinery. Once you mix in everything from flu season to days of the week, to independent and employed physicians, to individual humans and whatever else, you have a complex system. And further considering this complex system now operates in an increasingly unpredictable environment, we have ourselves quite the leadership and strategy challenge.
Complex systems (like the healthcare industry) demand that leaders possess a different skill set to manage than complicated ones. It’s harder to make sense of things because the degree of complexity and lack of right information may lie beyond quick conclusions. And it’s harder to place bets, because the past behavior of a complex system may not predict its future behavior. To make matters worse, as the environment becomes more chaotic, we tend to manage it as a complicated system, using leadership approaches and control mechanisms that make things worse over time.
Conclusion
Leadership has never been easy. Within healthcare there are forces in play, and more coming, that will make the challenge of leading in uncertainty even more difficult. In the next normal, we have a choice to reimagine the way we strategize, plan, and lead. Armed with an agile mindset and improved methods of collaboration, these three mindsets will strengthen your systems and processes giving your organization a fighting chance to win and serve you well now and in the future.
Brian Paradis is the CEO and Founder of Csuite Growth Advisors, a healthcare advisory firm specialized in customer-valued growth, focused innovation, and sustained high performance. Previously, he was the President of Advent Health’s Central Florida Division - a $4 billion enterprise with more than 25,000 employees and 2,000 physicians. Under his leadership, Florida Hospital was ranked #1 hospital in Florida by U.S. News & World Report for three consecutive years, was one of the largest hospitals to become ISO certified and was a 2014 finalist for the prestigious Malcolm Baldridge National Quality Award. He is a proven creative strategist and operator, and known for his imaginative leadership, collaborative nature, and growth orientation.
Scott Perryman is a Senior Advisor and leads our Growth Design & Opportunity Mapping at Csuite Growth Advisors. His professional journey has often found him at the nexus of healthcare, sports, and higher education. He has a strong history of leading teams who achieve high-level financial, quality, and operational performance in the for-profit, not-for-profit, and academic hospitals and medical practice sectors of healthcare. His teams’ accomplishments include recognition as a Leapfrog Group national top children’s hospital four times and recognition as a magnet hospital.
References
Harvard Business Review. (2011, September). Retrieved from Learning to Live with Complexity: https://hbr.org/2011/09/learning-to-live-with-complexity
Inside Small Business. (2014, July 14). Begin with the end in mind. Retrieved from https://insidesmallbusiness.com.au/management/planning-management/begin-end-mind
Kervin, L. (2021, July 26). Noah Waxman of Cactus: In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System. Retrieved from https://medium.com/authority-magazine/noah-waxman-of-cactus-in-light-of-the-pandemic-here-are-the-5-things-we-need-to-do-to-improve-the-752884e63e90
William Cohen, P. (2014, August 9). Business Strategy: Drucker's "New Certainties" and why when all else fails, think! Retrieved from https://www.processexcellencenetwork.com/business-transformation/columns/business-strategy-drucker-s-new-certainties-and-wh
Hess, Edward; Liedtka, Jeanne. The Physics of Business Growth (Stanford Briefs) (p. 13). Stanford University Press.
