The strategic leadership mindset required to thrive in times of resource scarcity and escalating demand.
While all industries were disrupted by Covid-19 - and with the pandemic still far from over - many healthcare leaders across the globe in particular are struggling with the ongoing aftereffects (or in healthcare speak sequalae) on the complex adaptive system that is modern healthcare delivery. The pandemic not only exposed inadequacies in operating models and ways of working but has also exacerbated the scarcity of workforce - estimated pre-pandemic by the World Health Organisation (WHO) at 15 million globally - through a combination of illness-related absences, burnout, fatigue, premature retirements, career movement or change and demanded reduction in work hours. All this is happening as demand increases. And while the pandemic has spawned a wave of innovation in such areas as the contactless delivery of healthcare services or remote patient monitoring, predicting which of the plethora of initiatives will ensure high-quality, high-value care still looks to many more a task of alchemy then organic chemistry!
What's to come?
A common strategic question pondered by healthcare leaders has been at what pace can innovation and restructuring of service delivery occur without exacerbating the strain the system - and most particularly its workforce - is already under. Or as some have put it ‘Building the boat as it sinks’. The global economic outlook is uncertain and in many countries public sector finances are under increasing pressure. And the uplift in ‘business as usual’ costs resulting from attracting - and then keeping - frontline staff engaged, happy and safe could well continue.
My view is that the years ahead are likely to see a significant re-balancing of power and influence across the healthcare ecosystem: between funders, patients, providers and staff. While innovation may offer patients increasing choice about how they access healthcare, my belief is those choices are even more likely to be predetermined by healthcare funders than in the pre-Covid world.
If true, this will not be uniformly welcomed by patients or providers. Wealthy consumers will, of course, always have the option to self-fund but I believe that for much of the population their choices will be even more determined by the drivers of funder sustainability, be it government treasuries or private health insurers.
In the government sector, budgets are likely to be squeezed with the demand to deliver more for less even more pronounced. In the private sector this financial squeeze is likely to drive significant merger and acquisition activity.
For healthcare workers the picture is a little more mixed. Ongoing competition for their labour, particularly for chronic disease and aged care service delivery, is likely to increase their ability to move freely between countries seeking better deals - and their intra-country wage bargaining power. On the other hand, change in models of care will be challenging for some – especially if associated with the movement of resources away from areas and ways of working within their comfort zone. And some countries will see increased net outflows of healthcare workers in 2023 adding further stress and workload on those who remain.
Setting a direction
Despite the scale of these challenges, I am guardedly excited about the wave of creative innovation sweeping the world of healthcare. Many problems in funding, delivery and workforce structure that should have been addressed decades ago are now being - or I believe soon will be – tackled. And the urgent need to take action on climate change has the potential to act as an additional catalyst to reduce easily identified waste and inefficiency in an industry that makes a very substantial contribution to global greenhouse gas emissions.
But there is risk - in particular, the risk that leaders and systems will be seduced into seeing these innovations as ends in themselves rather than a means to embed a long-term uplift in quality and value for patients and their organisations. The natural instinct to seek islands of certainty and hope in times of crisis can easily transmogrify into falling for a compelling narrative from ‘experts’, often seized upon by the popular media, about the need to get on board any wave of innovation lest a leader be left behind and permanently scarred for missing a once-in-a-lifetime opportunity.
Leaders in this time of great uncertainty need to bring quite a sober head to their strategic considerations and are more likely to plot a successful course for their service organisations by reminding themselves of the basics of complex adaptive system theory and research, marrying this with analysis from strategic models that have some proven ability to predict success, and then ‘plugging in’ their own assessment of the likely economic and social drivers of future sustainability in their organisation or system.
Innovation is then used to help navigate the route - not set the destination.
This is one perspective that informs the structure of the new Oxford Healthcare Leadership Programme which I have the privilege of being the Programme Director of.
Five key themes of need underpin the structure of the programme:
My strong view is that leadership success in the uncertain years ahead will predominantly accrue to those who can wisely govern the wave of disruption and innovation by applying a ‘top quartile’ value proposition lens to strategy, resources and implementation specific to their ecosystem. There will be no straight-forward, widely reproducible path to success every healthcare leader can follow. The level of complexity is too great. Each will need to discern the environment, deeply engage with the culture and expectations of their key stakeholders - be it funders, patients or workforce – then design and implement models of delivery and service that their stakeholders will identify as high value.
Healthcare is an incredibly complex cradle-to-grave human enterprise and there are no simple miracle cures for its many ailments. But it is an industry with people at its heart and to restore it to robust health its leaders also need the tools to diagnose, treat and strengthen its ecosystem.