Over the last four decades, healthcare has faced one disruption after another. Hospitals fundamentally changed how they were paid. Managed care altered relationships among payers, providers and patients. The patient safety and quality efforts changed how we measure and improve care. Electronic health records transformed clinical workflows and patient engagement. A global pandemic disrupted every aspect of healthcare delivery and life. And through each of these transformations, healthcare adapted, improved and continued to deliver on its mission. Now comes artificial intelligence.
AI may prove to be different from the disruptions that preceded it by speed, scale and its potential to transform clinical care, knowledge and the healthcare workforce. But while change is constant, history suggests something else is constant as well — our ability to execute.
We don’t talk much about execution being a core proficiency of healthcare organizations. Major transformations require vision and strategy. The quote “vision without execution is hallucination” has been attributed to many people from Einstein to Edison to a Japanese proverb and is a perfect fit for this narrative. Execution is essential. Execution means setting clear and meaningful goals, developing people, redesigning work, measuring results, fixing problems and continuously improving. Healthcare organizations have demonstrated that capability repeatedly over the last 40 years. The disruptions may be new, but the ability to execute is old.
40 years of healthcare disruption
Consider just some of what health systems have faced since the 1980s. This is not intended to be an exhaustive history of major disruptions. Rather, it illustrates the frequency, breadth and increasing complexity of the changes healthcare organizations have been asked to navigate.
| Time | Major disruption | How healthcare organizations executed |
| 1980s | Diagnosis Related Groups and prospective payment | Hospitals developed new capabilities to manage length of stay and utilization of resources. |
| 1990s | Expansion of managed care | Health systems built provider networks, developed contracting capabilities and increased their focus on utilization management. |
| 2000s | Patient safety, quality measurement and public reporting | Health systems built measurement and improvement infrastructure and implemented event reporting, root-cause analysis, infection prevention, safety culture and multiple high-reliability practices. |
| 2010s | Electronic health records | Health systems converted much of the clinical enterprise from paper to digital, requiring enormous investments in workflow redesign, training and change management. |
| 2020s | COVID-19 pandemic | Health systems simultaneously managed personal protective equipment, infection prevention, clinical capacity, workforce shortages, supply chains, testing, vaccines, telehealth and rapidly changing clinical protocols. |
| 2020s | Workforce crisis | Health systems have responded to clinician burnout, workforce shortages, agency labor, compensation pressures and the need for new models of care; all of which will continue for several years. |
| 2020s | Cybersecurity | Health systems increasingly protect digital environments from evolving threats while maintaining continuous clinical operations. |
| 2020s | Precision medicine and genomics | Health systems are beginning to translate advances in genomics and precision medicine from science and research into clinical practice and improved outcomes. |
| Now | Artificial intelligence | Health systems are beginning to redesign clinical and administrative work, governance and decision-making around a technology that may ultimately change fundamental models of management and care. |
Three lessons emerge from this history.
First, disruption in healthcare is not new. What is changing is its speed, complexity and reach. Second, healthcare organizations are remarkably resilient. Despite enormous external pressures, they continue to care for patients 24 hours a day, 365 days a year while simultaneously changing how that care is delivered. Third, execution has been a critical part of that resilience. Strategies and resources matter, but none of them produces results without the organizational ability to execute.
It is reasonable to argue that the disruptions in this history are not comparable in magnitude. They aren’t. It is also reasonable to argue that execution alone did not determine whether organizations successfully navigated them. It didn’t. But each disruption required healthcare organizations to do something extraordinarily difficult — change while continuing to operate.
Hospitals did not close for several years while they installed electronic health records. They did not stop caring for patients while they developed and implemented new patient safety practices. And during COVID-19, healthcare organizations changed staffing models, clinical protocols, supply chains and physical capacity, often daily, while caring for unprecedented numbers of patients.
That is execution.
My view of AI may be quite naïve as I often consider it a tool at this stage. Though ultimately it may be more transformative than anything in recent memory. However, AI will still require strong execution to make it effective and efficient.
How health systems sustain execution
If execution has helped healthcare navigate the last 40 years, then how do we sustain that capability for the next 40. Four practical to do’s are important to consider:
1. Continue to invest in people who can lead change. Leadership is critical during changes. Organizations should purposefully develop leaders who can set direction, communicate clearly, build teams, manage projects, solve problems and move from decision to implementation swiftly. Leadership development for the execution muscle is a foundation.
2. Be relentless about the outcomes that matter. Disruption creates activity, and activity can easily be mistaken for progress. Mission and a small number of clear strategic goals are still the focus.
3. Do not get distracted or waver from the core work. Healthcare organizations must simultaneously run today’s operation and build tomorrow’s. New technologies and opportunities will require experimentation and rapid pivots, but organizations cannot allow every new idea to become a new priority. The main thing must remain the main thing. You should review your strategic plan and goals frequently, but that doesn’t mean they have to change with the same cadence.
4. Build improvement into execution. Execution does not mean getting everything right the first time. It means learning quickly when we don’t. Organizations need disciplined systems and processes to test changes, measure results, identify gaps, adjust, and standardize what works. Improvement is not separate from execution; improvement is what makes execution sustainable.
The next several years will bring more changes. The organizations that succeed will not necessarily be the largest, or the ones with the most resources, or the first ones to adopt new innovations, or the ones that can best predict the emerging trends and changes. They will be the organizations capable of executing on changes by setting bold goals, developing human capital, and implementing and improving constantly. History has shown that healthcare has been doing that for decades.
Change is constant. So is execution. And our history of execution will be one of our greatest assets in building the future of healthcare.
Dr. Joshi is the president and CEO of Meritus Health in Hagerstown, Md., and president and professor of the Meritus School of Osteopathic Medicine.
