Lessons for Health Care Leaders in Times of Crisis

The March 15 issue of The Wall Street Journal carried another one of those "business" articles that health care leaders could easily overlook as too corporate. But Seven Lessons for Leading in Crisis, written by Bill George, former CEO of Medtronic and a member of several mega corporation Boards, is important reading for both physician leaders and executive health care leaders - especially these days which are anything but crisis-free. It's quick and easy to digest so please click and read it.

And to make the point, George dismisses the technical causes of the current economic crisis (poor regulation, bad investment decisions, risky investment vehicles) and lays the blame squarely on people just like us: "The root cause is failed leadership....[It] can only be solved by new leaders with the wisdom and skill to put their organizations on the right long-term course." While he doesn't offer the advice we really want - how to avoid getting into crises - he fortunately provides a methodology to prevent us from getting in deeper once the trouble is upon us.

Consider organizational, Departmental, practice, or community health crises. The high profile crises such as preventable deaths or toxicities, allegations of ethical lapses in research, or epidemics are easy to recognize and raise red flags to most leaders. But the reality for most health care leaders is crises, and potential crises, come every day in relatively smaller scale events or situations such as physician or executive misbehavior, billing and coding irregularities, abusive relationships between staff and subordinates or faculty and trainees, etc.

When not full blown at the time of discovery, these are the crises waiting to happen. All it takes is a little leadership lapse and you have a mess on your hands. And even if it's not a highly visible mess, the insidious result of poorly managed "situations" can actually be worse - leading to defections, underperformance, and cynicism that can be as paralytic to a health care organization as any front page story.

Let's examine how each of Bill George's lessons applies to these less dramatic events that constitute potential health care crises.

1. Leaders must face reality: When it was first evident to you or your peers that the behavior of a physician or administrator was near the line or over the line, did the responsible leader(s) step up, articulate, and "own the problem" promptly? Or was there a period (perhaps a continuing period) of winking, ignoring, avoiding, or misgauging the problem? How long did it take to "get real?" Did the leader(s) believe nobody else knew about this? What opportunities or people were lost as a result? How did leadership action or inaction impact their credibility and stature as a leaders?
2. No matter how bad things are, they will get worse : It's hard to step up as a leader when you see the first signs of trouble - especially if it involves individuals of stature or high economic value to the organization. But the alternative can be a real disaster. Does leadership at your organization recognize exactly how things that start small with these individuals can get worse? Has your organization gone beyond policy development and done scenario planning or role playing for the interventions that may be required for the common "crises in waiting?" Beyond policy, have you developed the leadership collegiality and culture that ensures early and strategic action?
3. Build a mountain of cash, and get to the highest hill: George says "cash, " I say "cachet" for this one. Leaders in health care often can't have a lot of cash stuffed away for crises - although for managing a crisis that results in lost revenues you will need it. So a contingency fund is always nice. But what is really in shortest supply, in most crises, is leadership reputation and credibility - the loss of which lead health care organizations or their subunits to go into free fall. So the importance of having accumulated relationships and having nurtured a reputation for trustworthiness, fairness, approachability, candor, and accessibility as a leader within the organization represent the "mountain of cachet" for health care leaders.
4. Get the world off your shoulders: Leaders can't fully assess, much less solve, serious and potentially serious problems on their own. Physician leaders, having developed as clinicians with a high degree of personal accountability for patient outcomes, are particularly susceptible to the sense that they need to solve problems in splendid isolation. As George puts it: "...leaders must have the help of all their people to devise solutions and to implement them. This means bringing people into their confidence, asking them for help and ideas, and gaining their commitment to painful corrective actions." Not to mention the value of obtaining the personal support and encouragement necessary to manage effectively in a time of stress.
5. Before asking others to sacrifice, first volunteer yourself: What you are visibly willing to do yourself sends the critical leadership message about what is expected in the organization. This does not preclude enlisting others (as above) but it does mean personally stepping up to any unpleasant parts of the leadership job that you expect others to join in.
6. Never waste a good crisis: This has been said many times by many people. In times of perceived crisis people take notice and are able to call upon hidden capabilities, strengths, and enthusiasm. If the problem can be elevated to a positive and culture-shaking organizational (or Departmental or local) change it can actually bring positive value.
7. Be aggressive in the marketplace: Bill George counsels: "This may sound counter-intuitive, but a crisis offers the best opportunity to change the game in your favor..." and it's been proven many times. Fixing problems in innovative and public ways can open market and reputational opportunities. Leadership's response to the 1995 chemotherapy overdose accident at Dana Farber Cancer Institute referenced above is an example. DFCI subsequently developed a national reputation for chemotherapy safety and the use of computerized chemotherapy ordering systems early in the "patient safety revolution."