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By Kenneth Kaufman
In the roughly 19 months since the COVID-19 pandemic emerged, America’s hospitals have borne a huge amount of the pressure and accountability for managing the effects of an unknown and unpredictable virus, and more recently for the complex process of disseminating vaccines. Our nation’s hospitals are doing all of this with relatively little public or political credit, and at great expense to overworked staffs and organizational financial health. And now perhaps, if we are fortunate, we may be starting to come out of the worst of COVID. However, for hospital executives and their boards the question is: coming out into what? How will post-COVID America, its economy, and its culture affect the relative strengths of traditional healthcare provider organizations? And, with COVID having greatly accelerated the growth of virtual business models, how will COVID affect basic patient care delivery and the encroachment of non-traditional competitors on that traditional delivery system? In the absence of clear answers to questions such as these, hospitals and health systems need to prepare for many paths to many alternate strategic scenarios. This preparation will require sophisticated analyses and high level discussion at both the management and board levels. The overall strategic considerations are likely to be the most complex and intricate that healthcare providers have wrestled with in contemporary times. To assist with this strategic re-consideration, I offer the following post-pandemic preparation checklist. Costs. Every hospital and health system has come through COVID differently. Depending on the speed and absolute degree of the return of volumes and revenues, the pre-COVID cost structure still in place at many hospitals may require significant reductions. Given the general economic insecurity in towns and cities across America, any such cost reductions will need to be accomplished in a most thoughtful way. Strategic Repositioning. What does the local and regional market now look like? What about new competitors from national companies? What does your health system portfolio now look like? Are there specific assets within the portfolio that have been damaged? Has overall competition changed? Have direct competitors been weakened or become more aggressive? Are non-traditional competitors making moves into your marketplace? Organic Growth. Do opportunities for organic growth remain in your market? How might COVID have created new opportunities? Inorganic Growth. A competitive marketplace damaged by COVID may offer new and real opportunities for inorganic growth. Inorganic growth, however, always requires unusual levels of both preparation and organizational aggressiveness. Partnerships. The post-COVID environment may create and era of transformative partnerships. Last month, 14 large health systems announced a partnership to create a large-scale database to revolutionize disease prevention and treatment. Just a few days ago, Amazon Care, Ascension, and Intermountain Healthcare announced a coalition to promote care in the home through telehealth, digital therapeutics, and provider home visiting. Hospital and health system executives will need to be attentive and alert to such innovative partnership opportunities and their potential competitive impacts. Telehealth. What is the position of telehealth in your market post-COVID? What is your own level of telehealth capability? How will telehealth impact your overall delivery system and possibly the competitive balance in your marketplace? Importantly, what is your organizational point of view relative to the role of telehealth in your post-pandemic delivery system? For some time we may be in an economic, cultural, and clinical condition where we have many more questions than answers about organizational direction in the post-COVID environment. This suggests that any generic roadmap to the future remains unlikely to impossible. Preparation, though, is both possible and essential. Only with precise and well-thought-out strategic and financial assessment and direction can complex healthcare organizations reasonably expect to navigate the post-pandemic fog. Planning your next event? Get in touch with us at the Capitol City Speakers Bureau today to schedule your ideal speaker and make your event a success!
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By Kenneth Kaufman
A very interesting short article recently appeared in The New York Times that explored the COVID phenomenon of “languishing.” The author defines languishing as “the collective fog we have endured…trouble concentrating, trouble staying motivated, trouble getting excited about the future.” The author goes on to say that languishing isn’t burnout and is not depression, but instead is a sense of stagnation, a sense of just getting by. As I read the article it occurred to me that not only can individuals languish, but most certainly organizations can languish too. And if any organizations in America deserve to languish, certainly America’s healthcare providers qualify. This notion of a long-standing collective funk introduces an entirely new fiduciary responsibility for hospital boards and CEOs. The past year has been unprecedentedly difficult; every organization, especially hospital providers, is entitled to its moment of languish. But no healthcare organization can afford to languish for long. So how does the board and CEO assure that its collective organization is now moving to a path to get excited about the future. The way forward is to get aggressive about certain business tactics that assure the financial and strategic integrity of your healthcare organization. These tactical steps are as follows: Recalibrate the strategic plan. COVID has changed everything, including finances, demand for medical services, the cultural context within hospitals operate, and the immediate need for healthcare equity and social justice. Given that any hospital’s pre-COVID strategic plan is likely somewhere between partially broken and mostly irrelevant, the first critical step to recovery is to regain control of everything your board and management team needs to know. What does your marketplace now look like? How disrupted is your local demand for services? Is your clinical delivery system still intact? Has your traditional competition changed? Has your organization’s place within the competitive space changed? The questions are endless. But all of the essential questions must be posed and answered within a quantitative analytical framework. And right now, especially, that framework must be technically flawless. Reassess the organization’s financial integrity. The financial questions are going to come fast and furious. Has the basic financial integrity of your organization been damaged? If so, how damaged? How do your pre-COVID and post-COVID operating statements compare? How do your pre-COVID and post-COVID balance sheets compare? Pre-COVID, what was your estimate of capital capacity? What is your revised estimate of capital capacity? If the strategic plan is changing dramatically, are your total financial resources still sufficient to support that post-COVID strategy? Again, there are many more questions than easy answers, and, again, the financial analytics must be impeccable. Rework costs. The third tactical tool necessary to push your organization forward is bringing post-COVID costs in line with post-COVID revenue. I have written on this point previously. Let’s add to the discussion the note that your organization will languish indefinitely if the overall cost structure cannot be brought into line to assure ongoing sufficient profitability and capital capacity. The post-COVID period will demand a new sophistication in establishing a lower overall cost point for your hospital. Four key principles will support this process: recognizing that much of the low hanging costs has already been picked, approaching cost reduction as a continuous process, focusing hard on corporate overhead and shared services costs, and taking a new and fresh look at automation, outsourcing, and offshoring. The last months of the COVID pandemic have been difficult in every way one might characterize difficult. One might say that hospital providers have earned the right for some time to languish. But let’s be candid: the “languish honeymoon” has to end sometime, and from my perspective now would be that time. All hospital boards and associated CEOs need to take a good look at their post-COVID organizations and immediately step forward to assure their organizations’ strategic and financial integrity. Planning your next event? Get in touch with us at the Capitol City Speakers Bureau today to schedule your ideal speaker and make your event a success! By Kenneth Kaufman
Every healthcare organization, large or small, depends on an internal gyroscope to assure its organizational stability and maintain its administrative and clinical navigation systems. That healthcare gyroscope is a delicate combination of management, governance, and medical attitudes and processes that keeps all complex healthcare organizations functioning in a way that serves the best interests of its patients and associated communities. The COVID pandemic has impacted every aspect of our society in ways that we immediately understand and in other ways that it may take years and years to comprehend. In this regard, no institution may have been more emotionally and managerially impacted by the pandemic than the American hospital. That healthcare gyroscope in many healthcare providers has likely been knocked on its side and is now uselessly spinning sending the organization off in haphazard directions. In the post-pandemic period healthcare leaders need to locate the most necessary set of strategic and operating plans which will most immediately re-establish that internal healthcare gyroscope. Here are a handful of suggested strategies that may prove most essential.
The healthcare environment has never been static. But change has been incremental and to a great extent predictable. The COVID pandemic has brought new, unpredictable external forces to healthcare that have already begun to affect the nature of healthcare’s competitive dynamic and accelerate the pace of change. To weather this new environment, healthcare organizations need to achieve a new basis of stability. The above four strategies and their associated day-to-day tactics are just the beginning of the post-pandemic re-set for American healthcare providers. But together they can combine to set that organizational gyroscope spinning back toward governance, managerial, and clinical stability. Planning your next event? Get in touch with us at the Capitol City Speakers Bureau today to schedule your ideal speaker and make your event a success! By Kenneth Kaufman
America is changing in too many ways to count. The political and cultural ramifications of an increasingly pluralistic population are harder and harder to predict and make overall governance of complex healthcare organizations an increasing challenge. For starters, the definition of healthcare is fast changing, and it now includes not only inpatient and outpatient clinical care but also the broader demands of public health. And that public health definition gets broader and broader every day, and now encompasses the COVID-induced mental health epidemic and the nationwide accelerating gun violence. This widening definition of healthcare is demanding a new board vision of service to its community and a new associated strategic plan that re-sets the next ten years of American healthcare. In the past, the board’s job was relatively straightforward: to monitor and oversee the internal workings of its hospital and health system. That remains a key board role. But in 2021, the business externalities are in ascendancy. No hospital board can set a correct strategic direction without accurately recognizing and reacting to unprecedented external business conditions. These externalities are remarkable and at the least include:
Finally, every board must recognize the power and influence of a fast-changing stakeholder environment. In the recent past, healthcare system stakeholders included the board, management, and doctors—period. But now, the stakeholders that impinge on health system operations and policy include patients, employees, sub-groups of employees, multiple communities, local government, state government, the federal government, political movements, religious influences, other not-for-profit organizations, BIG media, and social media. It all comes together to form an essentially uncontrollable business environment that seems to change by the day and sometimes by the hour. When you add the external business conditions to the long line of activist stakeholders, you get a rather new list of board challenges and responsibilities that include:
It’s hard to be a hospital board in 2021, and it’s not likely to get easier anytime soon. Planning your next event? Get in touch with us at the Capitol City Speakers Bureau today to schedule your ideal speaker and make your event a success! By Kenneth Kaufman
After several years of research and development, the automated teller machine made its first appearance in 1967 at a branch of London’s Barclay’s Bank. Two years later, the first U.S. ATM was installed at a branch of the Chemical Bank on Long Island. However, ATMs remained a minimally used curiosity until one bank took a risk and external forces took control. In 1977, Citibank made a big bet on ATMs. (Do any of you New Yorkers remember the slogan, “The Citi that never sleeps”?) Then in January of 1978, New York City was hit with a snowstorm that closed bank branches for days, leading to a double-digit increase in ATM use. After that, other banks hurried to invest in the new technology. Over the next several decades, ATMs proliferated, climbing to a peak of 2 million worldwide. Despite the popularity of ATMs, remote banking would have fallen far short of its potential if progress had stopped there. Today’s smartphone-enabled banking capabilities—budgeting, fraud protection, loan application, funds transfer, and on and on—leave ATMs in the dust when it comes to access, convenience, and tools. In March 2020, healthcare was in roughly the same place with telehealth as banks were in 1977 with ATMs. After years of research and development, telehealth was on the radar of most healthcare provider organizations, but relatively few had extensively deployed the technology. In 2019, Kaufman Hall’s State of Consumerism report found that only 20% of organizations had widely available video visits. Then came COVID-19, and with it a 154% increase in telehealth use at the peak of the pandemic’s first wave. Organizations routinely reported accelerating their telehealth plans by years in order to accommodate the demand from patients not able to see providers in person. However, as with ATMs and banking, telehealth will be a failure if it goes no further than today’s video visits and other routine features. Siddhartha Mukherjee, MD, DPhil, Pulitzer Prize-winning author, and renowned virologist and cancer researcher, made this point forcefully in a presentation at Kaufman Hall’s Healthcare Leadership Conference last month. Mukherjee noted, first, that too often video visits are isolated encounters rather than part of a care plan with measurable goals and steps. Worse still, Mukherjee said, is when a video visit concludes simply by scheduling an in-person visit, essentially making the health system bear the cost of two visits instead of one. But, Mukherjee said, the true failure would be if telehealth does not take advantage of the clinical and cost breakthroughs possible through increasingly advanced technology leading to a fully integrated digital health platform. COVID has been to telehealth what the 1978 New York City blizzard was to ATMs. For banking, ATMs were just a first step in greater efficiency, convenience, and use of technology. The responsibility of healthcare providers now is to keep telehealth momentum going. That means continuing to promote telehealth to consumers and clinicians. It means improving the execution and efficiency of current practices. It means advocating for fair payment for telehealth services. And most of all, it means developing, investing in, partnering for, and promulgating sophisticated new digital technology that can bring about major advances in outcomes, convenience, and affordability. COVID has had a devastating impact on the U.S. healthcare system, and we don’t yet know the intensity or duration of that impact. One positive glimmer that has come from COVID is the rapid adoption of telehealth. It is up to healthcare provider organizations to turn that glimmer into the bright light of progress. To fail in that effort would be to add yet another blow to the long list that COVID has delivered. Planning your virtual event? Get in touch with us at the Capitol City Speakers Bureau today to book your healthcare speaker! By Kenneth Kaufman
I have given a number of talks over the past few months, and despite the fact that all of those presentations have been delivered virtually, the question-and-answer sessions have remained interesting and robust. The most frequent question asked has been about possible consolidation of the provider space post-COVID. Most of these questions start from the perspective that another round of significant consolidation is coming. That perspective seems to rest on two key assumptions:
What is clear is that every hospital organization must have a well-held point of view about its own role in the next phase of healthcare mergers, acquisitions, divestitures, and partnerships. That point of view will pivot around three significant strategic questions:
First, COVID has catalyzed a major shift in economic and competitive dynamics. Few organizations of any kind can expect pre-COVID strategy to be unaffected. Hospital and health system executives need to carefully and thoroughly assess their organizations’ capabilities, their competitive environment, and their path forward. Second, as Jim Collins notes, a most important corporate character trait is preparedness and readiness. There is no way to anticipate the pace of post-COVID change. Now is the time to prepare, to be ready, and to consider your organization’s options. Later, in fact, could be too late. Planning your virtual event? Get in touch with us at the Capitol City Speakers Bureau today to book your healthcare speaker! By Kenneth Kaufman
One hallmark of the rapidly changing COVID-19 crisis is that any statement about the situation one day is likely to be incorrect the next day. However, after more than eight months of battling the virus, we have enough data to make several important observations about the state of play that are highly relevant for the strategy—and indeed the very thought processes—of healthcare organizations. When the pandemic hit in the early spring of 2020, the most hopeful scenario was a steady decline in number of new cases, with the virus at very low levels by late summer or early fall. Less hopeful scenarios suggested a series of subsequent surges of gradually decreasing intensity. The reality, of course, has been very different. As of early November, almost every day brings a record high in the number of new cases. The graph on the far left above illustrates the story extremely well: New cases are coming in waves, and the waves are getting larger. As of this writing, the number of daily new COVID-19 cases in the U.S. is more than 50% higher than the number of new cases during the previous spike in mid-July, and it is an increase of more than 200% over the number of new cases in the mid-September trough. As we have learned more about how to treat patients, and as we have identified cases earlier, the number of deaths from COVID has declined since April. However, as shown in the graph at the far right, that number also has been trending higher during October and November. Very concerning for hospital executives is the center graph, showing the number of people hospitalized for COVID each day over the course of the pandemic. As of early November, the number of hospitalized COVID patients is back to very near the peaks we experienced in April and July. And the number has been rising daily. Thus, fighting the virus for most of 2020, we are at the greatest level of uncertainty yet. Far from the temporary pandemic many of us expected, the virus is moving from pandemic to endemic and back to pandemic, with the intensity and duration of the crisis impossible to predict. Further, every hospital and health system is experiencing its own version of the pandemic, with its own short-term and long-term consequences. The ongoing pandemic has challenged our most basic assumptions about organizations and organizational decision making, about organizational strategy, and about the organizational thinking process itself. Let’s summarize these assumptions through a series of questions... 1. In a pandemic of uncertain intensity and duration, what is now the appropriate direction for a complex healthcare organization? 2. In such an environment, how is capable leadership defined, and what does competent management look like? 3. In the fog of one of the worst public health crises in American history, what tasks and strategies must be attended to and which can be left undone? These questions are in no way theoretical, nor are their answers. Rather, these questions and their answers are as real as it gets. Given this state of play, it is not possible, nor is it useful, to define a so-called pandemic roadmap at this time. What is more helpful is to call out a series of strategic observations and identify a series of management thought processes that can act as an organizational gyroscope in times of unprecedented macroeconomic turbulence. Planning your virtual event? Get in touch with us at the Capitol City Speakers Bureau today to book your healthcare speaker! By Kenneth Kaufman
With the end of the Cold War, the U.S. Department of Defense faced a new geo-political reality. The Berlin Wall came down. The Soviet Union was dismantled. Communist regimes fell out of power in many parts of Eastern Europe. The Iron Curtain was lifted. As promising as this new reality was for global politics, it was a problem for the U.S. military. For almost five decades, the military had been structured to provide defense based on the global structure of a Cold War world. Military personnel, capabilities, weaponry, and installations all were informed by the reality of the Cold War. Now that the reality had changed, the U.S. military was structured for a geo-political map that no longer existed. At the broadest level, this structural mismatch resulted in three serious problems. First, the U.S. was not ready for potential new defense needs. Second, the outdated structure was highly inefficient, spending huge amounts of resources on assets that were no longer required. Third, this waste meant that funds were not available to invest in post-Cold War defense. The most significant source of waste was the outdated physical structure of the military—installations that were located in areas that no longer needed military bases, or that needed different types of military facilities. To realign the military’s physical presence with the new reality, the U.S. Department of Defense began a process of base closures that continues today. The process involves a systematic and continuous comparison of military needs with the military’s physical presence, and engages the many groups affected by these decisions. The result has been new rounds of recommended base closures or repurposing initiatives every several years. Recently, a healthcare executive I have worked with for many years pointed out to me how apt base-closure is as an analogy for the situation faced by hospital-based health systems, and as a way to make difficult but positive changes. Over the past 10 years, we have seen a major migration in healthcare demand from inpatient to outpatient settings. Surgeries that 10 years ago were almost exclusively inpatient-based are now routinely performed in outpatient settings. The length of inpatient stays for other procedures and conditions has dramatically reduced. Payment rules increasingly create incentives for care to be performed in outpatient rather than inpatient settings. And advances in telehealth are moving care encounters out of healthcare facilities altogether, and into patients’ homes. Over the past 10 years, MedPAC reports a 43% growth in outpatient visits, compared with a 20% decline in inpatient discharges. The American Hospital Association reports that inpatient and outpatient revenue for hospitals is nearly equal, whereas in 1995, inpatient revenue made up 70% of total operating revenue. Hospitals’ traditional facility footprint simply is no longer aligned with the realities of how healthcare is being delivered today, or how it will be delivered in the future. This misalignment has a similar effect on the U.S. healthcare system as the post-Cold War military base misalignment had on U.S. defense. An enormous amount of healthcare spending goes to facilities that are underused or mis-matched to community healthcare needs, and that waste prevents investment in healthcare resources that can advance the quality, efficiency, and experience of healthcare for a new era. As I wrote last year in the blog post Getting Serious about Costs, hospitals have long struggled to manage their high fixed and operating costs. Traditionally, hospitals have focused their cost-reduction efforts on labor and supplies—high-cost areas that continue to warrant attention. However, the basic mismatch between U.S. healthcare facilities and healthcare needs, and the unsustainability of healthcare spending to the U.S. economy, requires that legacy hospitals and health systems take on costs at a greater magnitude and with more permanence. That means taking a very hard look at the value being provided by each asset of the facility portfolio. Where assets are not contributing sufficiently to the healthcare needs of the community, and not meeting the strategic or financial needs of the organization, some very tough decisions are in order. Repurposing or closing a hospital is one of the most difficult decisions healthcare leaders can make. The decision involves a major change to a trusted community presence. It can bring community outcry, political scrutiny, and unfavorable press. At the least, it involves helping community members transition to a new approach to care. Yet, in an environment that is rapidly transitioning from an inpatient to outpatient focus, some hospitals are no longer serving a relevant purpose in the U.S. healthcare system. A 2018 study identified 13 states in which average hospital occupancy rates for urban hospitals were 50-60%, and 28 states in which average occupancy rates for rural hospitals were 40% or less. These averages mask even greater variation from facility to facility within smaller areas. Dealing with hospitals and other high-cost assets that no longer provide necessary value in the healthcare system of today is among the toughest and most important steps in managing healthcare costs. Today, hospitals are at a “base closing” moment. In order to be competitive and relevant, hospitals will need a structured, continuous process that results in informed decisions about their facility and real estate portfolios. These decisions may be challenging in the short term. However, in the long term, a base-closure approach can improve care, improve the viability of healthcare organizations, and create a healthcare system that is more sustainable, more cost effective, and better able to meet the health needs of our nation. Planning your virtual event? Get in touch with us at the Capitol City Speakers Bureau today to book your healthcare speaker! By Kenneth Kaufman
For five months, hospital leaders have been responding to what will likely be the biggest challenge of their careers: managing the operational and financial threats from the COVID-19 pandemic. An already difficult environment is likely to become even more challenging this fall and into 2021. Surges and resurges of infection, ongoing macroeconomic threats, and widespread uncertainty about the stability of regained volumes and revenue are likely to persist for some time to come. Against this backdrop, achieving credit and rating “success” will require significant performance improvement. Given revenue uncertainty and potential volatility, the focus must be on expense containment and careful capital and resource allocation. More than ever before, this will emerge as a rating differentiator. Preparing for these realities starts with critically assessing every aspect of an organization’s toolkit—from financial resources to decision-support infrastructure to management capabilities. This preparation itself will yield clarity, which can be used to guide a more proactive and productive next conversation with rating agencies, investors, and other external constituents. The difference in outcomes from doing this well or doing this poorly will be material. The ability of executive teams to successfully multitask will be a core driver of success. In this context, multitasking refers to the ability to both confront the myriad of new pressures COVID-19 is producing right now and reposition the risk profile of the organization to be prepared for what is coming next. Organizations have no choice but to address these two priorities simultaneously. And their success will heavily influence whether they thrive or struggle in a post-COVID-19 environment. Different leaders and organizations possess a wide range of needed multitasking capabilities, which leave them in relatively better or worse position to succeed in the current and emerging environment. As a result, CEOs and hospital boards should be critically assessing right now where their organization finds itself on this key skill continuum, and how to improve its performance. Enterprise-oriented frameworks that bring analytics and decision-support under a common umbrella are another critical element of improving multitasking. These frameworks—ideally limited to just a few critical needs—can create clarity around resource utilization and risk management, offering senior executives the greatest amount of management leverage. Ultimately, CEOs should be then able to create a “multitasking enterprise,” where downstream activities roll up to a manageable and common number of resource deployment and risk management decisions. As part of this approach, organizations that embrace predictive methodologies can begin to better understand the potential long-term impact of various externalities. At the same time, such methodologies can help identify internal actions to mitigate those external risks. For example, through careful financial planning, organizations might realize the need to move swiftly on securing financing for the next 18 months, or address looming expense problems before they wreak havoc. In the early days of the COVID-19 pandemic, many disciplined, resilient organizations quickly and simultaneously tackled a wide range of unexpected clinical needs. At the same time, these organizations addressed a rapidly deteriorating financial picture and crafted strategies for the post-COVID-19 world. As the external environment grows even more uncertain, hospitals will need to take their multitasking to an even more sophisticated, enterprise-wide level. Moving forward, success will require continuous and coordinated monitoring of the external environment, timely evaluation of the associated implications, and proactive steps to mitigate the many, varied, and unpredictable risks of a world that is more volatile than any we have ever experienced. Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success! By Kenneth Kaufman
There is an old saying in sports: “We’re looking for character, not characters.” Sam Walker found that this old saying doesn’t lead to the most winning teams. For many years, Walker was a sportswriter and he is now the leadership columnist at The Wall Street Journal. When researching his excellent book The Captain Class, Walker found that captains of the most successful teams in sports history had very little in common with the Hollywood version of a leader and a captain. They did not have superstar talent. They were not the best-known or the most individually successful players. Surprisingly, they weren't fond of the spotlight. They often played subservient roles to others on the team. They were not angels. Sometimes they were divisive. Carla Overbeck, the largely unknown captain of the 1996 gold medal–winning U.S. women's soccer team, was “average at best” as a defender, and her offensive totals were “anemic.” She was so selfless that she often carried teammates’ bags to their hotel rooms. However, her humility created trust among team members and lent power to her relentless pushing of teammates during training and games. Richie McCaw, captain of the New Zealand All-Blacks rugby team, talked with referees before each game to find out how tightly they would enforce the rules so he could play up to the very edge of what was permissible—and frequently over the edge. However, his rule-pushing created an atmosphere of assertiveness that was a large part of his team’s success. New York Yankees captain Yogi Berra could barely put sentences together. However, his constant one-on-one communication helped him understand each player’s strengths and helped bring out the best in his teammates. And Valeri Vasiliev, captain of the Soviet Union Olympic hockey team, once threatened to throw his coach out of an airplane. However, this was in response to the coach breaking a promise and calling out individual team members after the team, favored to win the gold medal in the 1980 Olympics, fell apart. Vasiliev's act, which was unimaginable for a Soviet player, galvanized the team and contributed to a stretch of great success. Longstanding organizations—such as hospitals—typically have strong, highly valued cultures. The potential problem is when an organization begins to play to that culture to the point that human resources decisions, especially for leadership positions, are constrained by culture. People hired tend to fit within that predetermined cultural mold. Given that view of culture, many people who would make great leaders in our organizations—like the captains that Sam Walker profiles—may never get hired, much less placed in leadership positions. Walker found, at least in sports, that teams benefited from putting people in leadership roles who did not fit the mold. Each of the captains that Walker profiled was a “character.” Each person behaved differently from the norm, pursued leadership in nontraditional ways, and in general looked at the world differently than most people. Yet those were the very characteristics that separated those people from their peers in terms of their ability to motivate, push, and lead their teams to levels of performance few teams can match. Walker found that these captains were dogged and focused to an almost unnatural degree. They played aggressively. Many projected humility and gained respect through their willingness to do thankless jobs and to stay in the shadows. Many communicated in a low-keyed, one-on-one manner. And despite their intensity—or perhaps because of it—these captains displayed ironclad control of their emotions. Hospitals and health systems are facing a time of basic business model change. That means not only a new way of doing business, but an entirely new breed of highly aggressive competitors. To face this challenge, we need leaders who look at the world in new ways. Those leaders may seem different from those that the current culture deems “a good fit.” The captains in Walker’s book lead from a very different direction from our usual expectations. Success is very personal to these people, and their leadership styles come from that personal drive and their very personal traits. Therefore, these leaders can’t be screened by measuring their relationship to the existing culture. These leaders don’t fit a pre-existing culture; they are the culture. |
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