Healing Our Future: Leadership for a Changing Health System

Praise for Healing Our Future

"The American healthcare system of the future will be built increasingly on the strengths of teams, not individuals—an environment where everyone will be a leader. Healing Our Future will be useful for clinicians and others working in teams, as well as individuals considering the pursuit of their first formal leadership role. The book also contains valuable content and reminders for seasoned executives."

—Thomas M. Priselac, President and CEO, Cedars-Sinai Health System

I have used this amazing leadership model successfully with my leadership team, resulting in a stronger team and excellent individual development and improvement. This comprehensive leadership model will support the success of individual leaders and organizations alike.

—Cynthia Barginere, COO, Institute for Healthcare Improvement

Garman embraces the importance of developing leadership skills in everyone, not just those in leadership positions. He offers a crucial overview of healthcare fundamentals, along with practical guidance and resources. This is a must-have book.

—Jeanne Armentrout, Executive Vice President and Chief Administrative Officer, Carilion Clinic

"Healing Our Future is a transformative must-read for next-generation healthcare organization and system leaders. Dr. Garman offers a superbly crafted research-based leadership road map, and he delivers it in a clear, accessible, and compelling voice."

—Annie Tobias, former Vice President, Learning and Engagement, Ontario Hospital Association, Canada

"Healing Our Future is what we need for today and to help us achieve a better tomorrow. The book provides important information in an accessible format that will appeal to leaders at every career stage."

—Christy Harris Lemak, PhD, FACHE, Chair, Department of Health Services Administration, University of Alabama at Birmingham

"Sustainable healthcare delivery is a global challenge, and success increasingly requires leadership at all levels. Although written in the US context, Healing Our Future offers practical, evidence-based advice that can empower all aspiring leaders to help the health systems they work in to build a healthier future."

—Ronald Lavater, CEO, International Hospital Federation

"Leadership is like a fine wine, often taking time and experiences to develop. The development journey in Healing Our Future is structured in a way that ensures readers have practical and achievable solutions to evolve their thinking and leadership style, turning challenges into opportunities."

—Joseph Moscola, Executive Vice President, Enterprise Management, Northwell Health

"Healing Our Future captures the essence of what is required for our leaders as they prepare for the healthcare challenges of the future. The seven disciplines elegantly capture and detail what should be the learning path for our leaders."

—Chris Newell, Senior Director of Learning and Development, Boston Children’s Hospital

Andy Garman explores the frailties of healthcare with insight earned from the intellectual rigor of thoughtful research tempered with the scars and bruises from resolute practice. His book presents readers with a blueprint for recognizing their purpose, strengthening competencies, and, lastly but most importantly, being value-driven passionate advocates for health in the community.

—Anthony Stanowski, President and CEO, Commission on Accreditation of Healthcare Management Education

Healing Our Future

Healing Our Future

Copyright © 2021 by Andrew N. Garman

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law. For permission requests, write to the publisher, addressed Attention: Permissions Coordinator, at the address below.

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First Edition

Hardcover print edition ISBN 978-1-5230-9010-5

PDF e-book ISBN 978-1-5230-9011-2

IDPF e-book ISBN 978-1-5230-9012-9

Digital audio ISBN 978-1-5230-9013-6

2021-1

Book producer: Westchester Publishing Services

Text designer: Westchester Publishing Services

Cover designer: Adam Johnson

Illustrator: Emily Garman

To our kids, their generation, and the next two they will look after

Contents

Introduction

SECTION I  LEADERSHIP IN THE CHANGING HEALTH SYSTEM

CHAPTER 1  The Changing Health System

CHAPTER 2  Accelerating Your Development as a Leader

SECTION II THE SEVEN DISCIPLINES

CHAPTER 3  Values

CHAPTER 4  Health System Literacy

CHAPTER 5  Self-Development

CHAPTER 6  Relations

CHAPTER 7  Execution

CHAPTER 8  Boundary-Spanning

CHAPTER 9  Transformation

Conclusion

Appendix 1: Developing Mentoring Relationships

Appendix 2: Developing a Longer-Term Mindset

Bibliography

Acknowledgments

Index

About the Author

Healing Our Future

Introduction

Every time history repeats itself, the price goes up.

—Anonymous

This is a leadership book for people who are more interested in making change happen than in formal leadership roles or titles. In health systems, as in other organizations, leadership has been evolving into a team sport: our environment has simply become too complex to be understood, let alone managed, by a small group at the top of a hierarchy. Regardless of whether leader is part of your title, or even in your job description, in the years ahead you will have increasing opportunities to lead. I’d like to help you prepare for these roles as they appear before you, so that you can pursue them with a greater sense of confidence and purpose.

This is also a book about the changing role of health systems in our society. If you are working in a health system, you are working with colleagues who care deeply and inclusively about the health and well-being of others. You are also part of the largest corner of our economy, a sector with both the potential and the responsibility to become a powerful vehicle for pursuing the healthier futures that we know are possible but not certain.

I started my own career as a clinical psychologist, focused mainly on helping individuals in distress find better ways to get their needs met. I did not plan to become a leader, or even to study leadership. Over time, I was doing more and more things that were leadership-like, and then studying leadership to figure out how to do them better. This eventually led to my being asked to run programs, then departments, and then, ultimately, an organization: the National Center for Healthcare Leadership. Over the course of nine years, I had the opportunity to lead numerous research studies examining excellence in healthcare leadership, and analyze the approaches of hundreds of health systems in developing their leaders. The more individuals and organizations I studied, the clearer the commonalities across them became. Cut through all the chaos of personalities and secret recipes, and every leadership model can be mapped to seven universal disciplines. Similarly, every successful leadership development activity involves a finite set of universal learning principles.

In this book, I provide approaches to help you develop into a more effective leader. I do not assume you are currently in a formal leadership role, or even that you aspire to be—only that you will periodically find yourself with the desire to pursue a greater good in the world, and you will need other people’s help along the way. The seven disciplines described in this book form an evidence-based common language of leadership—one that you should be able to easily map to any local language model your organization or profession may be working with, and in doing so provide a stronger scientific foundation.

The first section begins with a glimpse into our more distant future, and how our health systems could evolve to help us navigate this future more successfully. I then describe how people become more effective leaders over time, and what the research has to say about what works best in making this happen. In section two, I introduce the seven disciplines. The first three—the enabling disciplines—relate to the inner game of leadership:

• Values– clarifying the greater goods you want to serve.

• Health system literacy– understanding how healthcare organizations work.

• Self-development– developing and maintaining yourself for success in the challenges leadership often entails.

The next four—the action disciplines—focus on leadership in action:

• Relations– understanding and supporting the individual needs of the people you work with.

• Execution– clarifying and monitoring the shared direction for action.

• Boundary-spanning– managing relationships between your collaborators and the outside world.

• Transformation– creating the urgency, vision, and trust needed for more fundamental changes of direction.

Each chapter in the section provides a description of the discipline, illustrates why it is important, and provides specific advice on how to raise your proficiency. In each case, I describe many free and low-cost resources—online articles, videos, and courses—available to help you along the way. I also suggest places you can find good mentors to learn from, as well as additional tools, resources, and background that may be of more specific help, depending on what brought you to this book in the first place. The book concludes with two appendices. The first offers step-by-step advice on recruiting and engaging good mentors. The second provides more in-depth guidance on how to develop your skills in long-term thinking and foresight.

In the coming years, we will likely participate in some of the biggest social changes many of us have seen in our lifetimes. Our health systems stand to play a significant role in the many adaptive changes we need to make to heal our future. I hope you take this book as an invitation to help lead us there.

SECTION I

Leadership in the Changing Health System

Before diving into the nuts and bolts of effective leadership, I provide some context on why the subject is so important, and how it will become even more so in the years to come. In the first chapter of this section, I share some perspectives on how healthcare is likely to evolve in the decade ahead, based on trends that are already in motion today. With this background, you will be better prepared to identify areas that may be helpful for you to learn more about, and prepare to contribute to. In the second chapter, I summarize the factors that have the greatest influence on how leadership develops over time. With this context, you will be better prepared to put the concepts and recommendations in the later chapters into immediate action.

CHAPTER 1

The Changing Health System

Say what you will about the year 2020. It was undeniably the gateway to a new decade and a glimpse of the road ahead. It is hard not to equate the whole year with the COVID-19 pandemic, and all of the changes that followed in its wake. For many people working within health systems, these changes meant working under conditions they were never trained for, and learning new skills on the fly. In many cases, it involved developing entirely new approaches to the delivery of care, and learning as quickly as possible from the experiences of peers across the country and the world.

As hard as people worked to mitigate the pandemic, they could only do so much within what their contexts allowed—and that context was a health sector already facing significant challenges. We had just begun to understand the severity of healthcare inequalities when COVID-19 began making them much worse. At a time when we needed resilience more than ever, the sector was already facing problems with clinician burnout and wellbeing. And our planet’s climate, our most important determinant of human health, was about to clock its hottest year on record. COVID-19 did not create these challenges; what it did, more than anything, is reveal how deeply intertwined they are, and how critical it will be to address them simultaneously.

How are our health systems likely to continue evolving in the decades to come? The answer depends partly on trends taking place outside these organizations’ direct control, and partly on how well we understand these trends and the opportunities they can create.

In a recent foresight study for the National Center for Healthcare Leadership, our research team identified four macro-level trends that are particularly likely to shape the future of healthcare and have specific implications for leadership within our health systems. All of this work took place before the onset of the COVID-19 pandemic and the civil unrest that reemerged in its wake. It even predated the climate strikes Greta Thunberg led. None of these events were predicted by our modeling, and no one expected them to be. They are the types of emergent events that, in the moment, can seem quite random. Events of this type—sudden, unexpected, dramatic—can lead people to feel very powerless about the future. Attempting to predict a specific event or a specific timeline not only is impossible but also misses the real value of foresight work. The futurist Bob Johansen (2017) makes this point very well in distinguishing certainty, an assumption that we know what is coming, from clarity, a deeper sense of multiple potential future states, some more likely than others.

For example, although no one predicted a novel coronavirus would begin to spread among humans in late 2019, many public health experts had said they believed a pandemic was likely to happen sometime during their lifetimes. (One of the most colorful and compelling examples was Bill Gates’s excellent TED talk from 2015: The next outbreak? We’re not ready. Worth a watch if you haven’t seen it.) And although no one could have predicted beforehand that the events surrounding George Floyd, Breonna Taylor, Ahmaud Arbery, and others would galvanize action the way that they did, understanding the underlying forces at work—heightening awareness of racism within the context of growing structural inequality—makes clear their eventual inevitability.

Forces such as the cyclical nature of human social and economic history, the patterns through which new technologies find acceptance and are spread, the influences of demography, and the root causes of attraction and disgust each offer specific clues about the robust trends and the interplays between them, providing greater clarity about these longer-term trends. With practice, these trends can be analyzed to develop a clearer sense of the directions the future is likely to take us, and the inflection points that decide which paths will prevail. For the interested reader, I provide greater detail on sources of data and foresight methods in appendix 2. In the meantime, the four trends we identified for health system leadership in the decade to come are given below. As you look at these health system trends, I invite you to consider whether the events of 2020 truly changed their course, or just accelerated us toward them.

Trend #1: From Expertise to Relationships

If you have ever taken a course on research methods, or conducted some research yourself, you may have run across the idea that good experiments often raise more questions than they answer. As health professions mature, the volume of research relevant to their work also tends to grow very rapidly, quickly outpacing the capacity of practitioners to keep up. Although technologies such as better search tools can assist caregivers in identifying the most important studies related to specific health problems, we only have so much time in a day we can spend in search of better methods. This can result in very long delays—decades, according to some research—before research advances become standard clinical practice (Morris, Wooding, and Grant 2011).

In