At the outset of the COVID-19 pandemic, leaders of health systems guided their organizations through an acute crisis, when an “all-hands-on-deck” approach was prominent and there was broad awareness of the collaboration and urgency needed in the moment. Today, however, CEOs face a steady accumulation of pressures that require a different kind of leadership: one built on endurance when declines come in small, continuous and gradual increments, as well as sustained communication.
The pandemic “was an all-at-once situation. It was pretty easy — at least in the first year — to rally everyone together because we were all facing the same thing at the same time,” Steve Davis, MD, president and CEO of Cincinnati Children’s, told Becker’s. “We’re now seeing both a ‘drip, drip’ of ongoing pressure and acute issues that come at us suddenly. There’s a constant background urgency we’re all dealing with, but also specific events — like changes to National Institutes of Health funding…or workforce challenges.”
This trickle of pressures is compounded by the looming effects of the One Big Beautiful Bill Act, which is expected to reduce federal Medicaid spending by $911 billion and leave an estimated 10 million more Americans uninsured by 2034.
Health systems will not face the headwinds in the same way; effects of the federal legislation will vary based on factors such as state policy, payment models, market dynamics, population needs, specialty mix, payer relationships and timelines. But one thing is clear: CEOs recognize that their organizations will be affected, requiring them to rally their teams around a strain that is expected but not yet experienced, while engaging their workforces and communicating clearly, often and effectively.
“We have monthly leadership meetings to make sure we are consistently updating our leaders on what we’re doing and how we’ll work together to address the challenges we’re facing,” Andre Boyd Sr., regional president and CEO of Trinity Health Mid-Atlantic based in Philadelphia and Holy Cross Health in Maryland, told Becker’s. “I also provide monthly updates to my board to keep them abreast of operational challenges or any changes we may need to make, whether those are financial, reimbursement related or regulatory.”
In addition to these updates, Mr. Boyd holds biweekly meetings with the board chair and vice chair. As CEO of six hospitals — two in Maryland, three in Pennsylvania and one in Delaware — he also rounds at each site as often as possible and hosts quarterly town halls to keep members of the community and employees informed and engaged.
At Cincinnati Children’s, patient stories are part of important meetings, including board meetings and patient care committee meetings.
“Our marketing and communications team puts together videos that often leave people in tears,” Dr. Davis said. “It helps ground everyone in why we do what we do — yes, there are challenges, but we’re doing incredible work every day.
“The challenge with board members is that they meet quarterly. … Now there’s so much going on that we send regular updates every couple of weeks, and we occasionally hold executive sessions between meetings.”
Dr. Davis also blocks out time every Wednesday to have breakfast with board members to keep them updated on areas they care about.
“It’s not perfect, but we’ve found it’s hard to overcommunicate and very easy to undercommunicate,” he said. “So we aim to communicate clearly, consistently and frequently.”
Michael Dandorph, president and CEO of Burlington, Mass.-based Tufts Medicine, told Becker’s his organization also prioritizes transparency and has found success by communicating with intentionality.
“You can’t act urgently 100% of the time; we’ll just burn our people out. We’ll burn our leaders out,” Mr. Dandorph said. “We already have physician burnout and care team burnout, so we have to be cognizant of that.”
“What we try to do, particularly with leaders, is to be intentional about taking time to step back and think — not just constantly react — so we can act more intentionally. We also encourage leaders to step back and communicate with their teams. I’m a big believer in transparency.”
Mr. Dandorph also encourages leaders and teams to focus on “no-regret moves.”
“For example, access is a big challenge right now in Massachusetts, and for us, too,” he said. “Making inroads there is a ‘no-regret move.’ Improving efficiency is another. These are efforts that remain valuable no matter what else happens. It’s important to engage people around these priorities, so we don’t always feel like this endless change means everything has to be an emergency.”
Additionally, he described communication at Tufts as “bidirectional” involving diverse teams.
“We also talk a lot about opportunities,” Mr. Dandorph said. “Healthcare has been broken for a while — even before the pandemic. … But there’s an opportunity here. What role can we play in solving broader systemic problems that might create a better environment for our care teams?
“We shouldn’t just be reactive to external changes, we should use those challenges to drive meaningful change. … This is the time to bring those leadership skills forward, so we’re not just playing whack-a-mole, but strategically thinking about how these market changes can help strengthen our organization and the industry.”
While leaders are focused on communicating with staff, they are also focused on supporting them. At Cincinnati Children’s, Dr. Davis said the change management model is outdated, because change is constant.
“At Cincinnati Children’s, we focus on being the best at getting better,” Dr. Davis said. “We don’t claim to be the best, but we work to be better tomorrow than we are today. We build agility and resilience into the team.
“We reframe change management as building capacity in the workforce. That means providing clarity under complex conditions. We follow key metrics, and we’re good at interpreting them.
“Take our safety event data: If we had two [serious patient safety events] next week, we’d be disappointed, but we wouldn’t overreact. Over the last three years, our average is less than one a year. We’d review the events thoroughly, and if they were unrelated, we’d consider it common cause variation, not a trend.”
His strategy also includes protecting time for workers to focus on deep work. Dr. Davis hosts a book club with his leadership team and employees, and they recently discussed “Deep Work” by Cal Newport.
“It emphasizes setting aside time for uninterrupted, focused thinking, both individually and as teams,” Dr. Davis said. “When we do that, we see better results and more engaged employees.”
Last year, he also set aside two months as a time for no new projects to allow teams to focus.
As leaders mold strategies to adapt to the “drip, drip” of pressures, they acknowledge that a new type of muscle is required. That said, certain practices have proved effective.
Mr. Boyd encourages his team to focus on energy and enthusiasm.
“That mindset helps us get through the day and the challenges ahead,” he said. “Without that energy, you’re not going to be an effective leader.
“I also remind them that we’re not the first to face tough times. Previous generations of healthcare leaders navigated their own big challenges — like the Balanced Budget Act of 1997 or the introduction of diagnosis-related groups. Every challenge is also an opportunity to rise as a leader.
“I try to build a safe space where my team feels comfortable sharing how they’re doing, emotionally and professionally. The slow-drip nature of today’s challenges can be draining, and I want my team to feel supported.”
Mr. Dandorph emphasizes empowering local problem-solving, active listening and creating a resilient environment for teams.
“There’s still a lot of good happening in our organizations,” Mr. Dandorph said. “We need to focus on successes, learn from mistakes, acknowledge the challenges — and also highlight the impact we’re having on the people we care for. That’s a privilege and a responsibility.”
