The case for seriously optimistic healthcare leaders

"Every meeting I have, I talk about optimism," says Michael Dowling, CEO of New Hyde Park, N.Y.-based Northwell Health. "I've probably given four talks in the last two days on that theme, including a meeting with my physician leadership team 15 minutes ago." 

Mr. Dowling's faith in a better future is particularly timely. In April 2022, we seem to need true-blue optimists more than ever. 

These individuals aren't necessarily the walking smiley faces, zealous fun-lovers or big laughers (although we need them, too). I'm talking about staunch optimism that is felt to the core. The courage to persistently believe tomorrow will be better. Resolving to beat the odds. Hope that is not bashful, conditional or manufactured. 

Writing this, I anticipate some may read the above as naive, trite — even delusional. The pandemic rattled every person in shared and unique ways, testing even the most optimistic and leaving many more reluctant to get their hopes up. By now, most of us have earned unofficial degrees in scenario-based disaster planning. It can feel foolish to insist brighter days are ahead as so many things worsen, making the first part of the mantra "plan for the worst, hope for the best" feel safer. 

This collective mood isn't new. Americans, who have the reputation of being eternal optimists, began 2022 less optimistic than the year before. Two weeks into 2022, The Atlantic published an examination of why this new year felt different, dubbing it the year of practical thinking. "After nearly two years of uncertainty, struggle, and loss due to the coronavirus pandemic, the future has many of us feeling more apprehensive than excited," author Maggie Mertens noted. 

Even those who have come this far with largely intact optimism may feel awkward in expressing it to others. Cynicism is easy. That's why I sought out Mr. Dowling, who is never reluctant to choose hope. 

'Give oxygen to hope'

Mr. Dowling has led Northwell since 2002, consistently earning recognition for his employee approval rating and helping the integrated health system build a reputation as one of the industry's best places to work

He has been a vocal advocate for the prevention of gun violence for years, a cause where the risk of demoralization runs high. Northwell created the Center for Gun Violence Prevention in 2020, and Mr. Dowling has called on other health systems to join Northwell in treating gun violence as a public health crisis, and work with their local communities to identify solutions. "Where are healthcare CEOs in the fight against gun violence?" he asked in a column with Becker's

In summer 2021, Mr. Dowling reached out to several dozen health system CEOs, asking them to sign a letter urging Congress to support funding for violence intervention programs. Seventeen other systems, or 3 percent of the nation's medical centers, joined. "We can do better," Mr. Dowling said of the showing. 

Mr. Dowling is deeply hopeful, but not in the rah-rah performative way that some executives try on like formalwear to signal a certain outlook when the stakes are high. He confronts problems and loathes navel-gazing. 

"You have to be realistic," Mr. Dowling tells me. "You don't go around with religious fervor. You have to balance reality with optimism. Yes, today's tough but tomorrow will be better.

"You don't give oxygen to despair. Who wants to follow someone like that?"

Realistic optimism 

The New Yorker published a series of illustrations in August 2020 that haunt me. While humorous, they serve as a reminder of how attempts to convey optimism can fall utterly flat. "Just focus on the things you can control," someone shouts to a person about to be hit by a semi-truck. "You need to speak goodness into existence," someone says to a person falling off a cliff. 

This risk of tone-deafness seems especially high when leaders try to convey optimism to large groups of people and don't quite meet many of them where they are. (That's where toxic positivity comes in.) For all the emphasis placed on positive thinking throughout the pandemic, the misconception that optimists are cousins to smiley emojis still prevails. Many people have the misconception that to be optimistic is to deny that a problem exists. 

Suresh Gunasekaran, MBA, president and CEO of UCSF Health, sees it differently. He believes true optimists are actually the first to point out the problems in the current system. At the same time, he's wary of pity parties — endless problem-spotting and lamenting that goes nowhere good. 

"Optimism is not simply a positive attitude or the hope that the future is better. It is not simply faith, or a belief in something we can't see or understand," Mr. Gunasekaran said. "Optimism is the belief that we can overcome these challenges grounded in a plan to reach that brighter future, because the constraints that we presently live with can be removed and that there are solutions to the problems we face."

Perhaps the best predictor of an individual's success is whether they believe they will succeed. That's what Albert Bandura, PhD, a pioneering social cognitive psychologist, discovered in 1977 and coined self-efficacy. 

"But there is an important caveat: to be successful, you need to understand the vital difference between believing you will succeed, and believing you will succeed easily," Heidi Grant, PhD, wrote for Harvard Business Review. "Put another way, it's the difference between being a realistic optimist and an unrealistic optimist."

These days, very little about healthcare is easy, and progress is hardly moving in a straight line. New policies can intensify political partisanship. Innovations can solve problems while causing new complications. Even diseases we all but eliminated as a nation return. Healthcare takes steps forward, backward and sideways. Its leaders must embrace reality today and help people see that while backward and sideways steps occur, healthcare is still moving forward in its collective dance. 

"Keep your head up," Mr. Dowling tells his colleagues in leadership. "Look forward. You have the ability to do something special. You have influence. You can inspire. You can go to work today and either inspire people or deflate people. If you don't get anything wrong, you'll never get anything right. Manage toughness today and deal optimism for tomorrow."

"In the end, there will be two kinds of optimists," Mr. Gunasekaran forecasts. "One set of optimists will be bold enough to find the solutions to many of the industry's challenges. Other optimists will be bold enough to follow the lead of those that have found solutions and bring them to bear in their local community."

Healthcare needs plenty of both.

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