Articles

Healthcare Leadership During Volatile Times: Strategies for Resilience and Impact

by Pradipta Komanduri, FACHE

With the rapid evolution of the healthcare landscape, effective leadership is more critical than ever.  The COVID-19 pandemic seemingly marked the beginning of ongoing volatility, with healthcare leaders facing pressures in the form of staffing shortages, financial instability, technological disruptions, and rapidly changing regulations.  Once thought of being temporary, these challenges have endured and are now considered ongoing trends in the industry.  To navigate these turbulent waters, healthcare leaders must be adaptive, empathetic, and strategic.  They must foster resilience in their organizations while maintaining a clear focus on high quality patient care.

While healthcare has always operated under pressure, today's environment is uniquely challenging.  According to the American Hospital Association (AHA), hospitals faced a median operating margin of just 1.4% in 2023, with many rural and community hospitals operating at a loss (AHA, 2023).  Simultaneously, a McKinsey report projects that the healthcare workforce gap could reach up to 3.2 million workers by 2026 in the U.S. alone (McKinsey & Company, 2023).  Leaders today must not only manage traditional clinical and operational challenges but also anticipate and respond to broader societal and technological shifts.  External factors like political instability, cybersecurity threats, and rapid technological advancements also contribute to a sense of constant disruption. 

With a higher demand for services, increased fragmentation, financial pressures, a smaller workforce, and intense public scrutiny, healthcare leaders are faced with significant challenges that will require broader policy-level intervention over many years.  In the meantime, they also carry the responsibility of leading teams through these challenging times in order to support local community needs.

In order to succeed in today’s unpredictable and volatile environment, healthcare leaders need to develop competencies across several key traits:

• Be adaptable and agile.  The ability to pivot quickly in response to new information is crucial. Adaptive leaders encourage innovation and are comfortable making decisions with incomplete information, a necessity when dealing with emerging crises (Heifetz & Linsky, 2017).  Consider failure modes in strategic and operational decisions to proactively develop plans that allow for rapid change in direction if needed.
• Be empathetic and use emotional intelligence.  During periods of uncertainty, staff and patients alike experience heightened stress. Leaders who demonstrate emotional intelligence by actively listening, expressing understanding, and supporting mental well-being build trust and loyalty (Goleman, 2018).  For patient care delivery, this means understanding the fear and anxiety of navigating the healthcare process and ensuring patients can maintain their dignity and agency.  For workforce wellbeing, this means considering the challenges of front-line teams in continuous improvement work.
• Communicate clearly. Transparent, consistent communication reduces fear and misinformation.  Leaders must stay informed of trends, provide timely updates, and be willing to admit when answers are not yet clear, thus fostering a culture of openness.   While leaders need to relay optimism in the organization’s ability to endure significant challenges, they should also be clear regarding the threats needing to be considered in decision-making and operational execution.
• Have a strategic vision and plan. While it can be tempting to focus on immediate crises, strong leaders balance short-term responses with long-term planning efforts.  Strategic foresight ensures that decisions made today do not compromise future stability, and leaders must be able to instill confidence that the organization will endure the challenges ahead through an effective strategy.
• Build resilience.  Resilience is cultivated intentionally. At a personal level, leaders should gain a breadth of experiences that develop decision-making instincts over time.  They should practice self-care to maintain their health and well-being.  At an organizational level, building resilience means that leaders are investing in workforce well-being to combat burnout, developing leadership at all levels through delegation of decision-making authority, enhancing technological infrastructure to combat cybersecurity threats and support automation, and supporting emergency preparedness activities that empower teams to feel better prepared in the face of imminent threat to operations and safety.

As uncertainty becomes the norm rather than the exception, the role of healthcare leaders will continue to evolve. Leadership development programs will need to prioritize adaptability, crisis communication, and systems thinking.  Moreover, leaders must advocate for systemic changes, such as policy reform and increased funding for public health infrastructure, which address the root causes of instability.

Healthcare leadership during volatile times demands a delicate balance between compassion and decisiveness, innovation and tradition, and rapid response with thoughtful strategy.  Those who succeed will not only guide their organizations through crisis but also lay the foundation for a more resilient, fair, and sustainable healthcare system.

Pradipta Komanduri, FACHE

References

• American Hospital Association (AHA). (2023). The Financial Health of U.S. Hospitals. Retrieved from aha.org
• Goleman, D. (2018). Emotional Intelligence: Why It Can Matter More Than IQ. Bantam Books.
• Heifetz, R., & Linsky, M. (2017). Leadership on the Line: Staying Alive Through the Dangers of Leading. Harvard Business Review Press.
• McKinsey & Company. (2023). The Future of Healthcare: Closing the Workforce Gap. Retrieved from mckinsey.com
• National Academy of Medicine (NAM). (2022). Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Retrieved from nam.edu

Bridging Gaps in Care

by Scott Suckow, FACHE

Imagine you are on an overseas business trip to someplace like Seoul, South Korea. In the middle of the night, you suddenly start feeling very ill. You find your way to a local hospital and check-in at the ER. The clerk doesn’t speak English, and you don’t speak Korean, so communicating the reason for your visit is difficult. The doctor who sees you seems empathetic, but only knows a few English words, like pain, and where. You can’t explain what you are feeling or give any of your health history. The doctor orders labs and an x-ray, later returns, and hands you a bottle of pills. The label is in Korean, and so is the discharge paperwork. You don’t know what the medication is, or how often to take it. You get the idea you are supposed to take two tablets, so you do. You leave and hope for the best.
This kind of scenario happens every day in hospitals across the US. Patients with language barriers often struggle to communicate with care teams, leading to 27% higher rates of readmission, 47% higher rates of returning to an ED, and inpatient stays that average 1.5 days longer. Often these patients are uninsured or under-insured, making any return ED visits and readmissions even more impactful to the hospital. 
Within Colorado and Wyoming, the percentage of individuals with Limited English Proficiency ranges from as low as 2-3% in some areas, to a high of 12-13% in Denver and Aurora, where some 150 different languages are spoken at home. These percentages have increased in recent years.

Fortunately, many hospitals invest in language access resources like video interpretation, telephonic interpretation, in-person interpreters, and bilingual staff. While not reimbursed, these services enable hospitals to comply with legal requirements and accreditation standards. More importantly, they level the playing field for these patients and allow them to fully participate in their care. Patients who are provided language assistance see shorter lengths of stay, return to the ED less, and enjoy better patient experience.
Over the past 20 years, hospitals across the US have made great progress in providing language access. It is now commonplace for care teams to be able to access telephonic or video interpreters in several hundred languages, on-demand, day or night. Many telehealth and virtual care modalities have interpretation resources built-in.
Important barriers still persist, however. The telephone remains the “front door” to hospitals and doctors’ offices for many patients, and those facing a language barrier often have trouble making appointments, canceling them, or inquiring about a family member. Medication labels and discharge instructions are commonly printed in English. Patient portals are available in English and sometimes Spanish, but not other languages. Social determinants of health like transportation, housing and insurance often block access to follow-up care and specialty services.

Recent advances in artificial intelligence bear great promise for these kinds of barriers. As AI solutions spring forward, though, it is important to keep a close eye on the accuracy, cultural context, and legal compliance of the information they provide.
With support from healthcare leaders, new and innovative solutions will emerge that close communication gaps, and enable patients with language barriers to take charge of their healthcare, and reap the benefit of all that our hospitals and clinics have to offer.

Scott Suckow, FACHE - Senior Director, UCHealth Language Services