VUCA! VUCA! The 10-Fold Healthcare Crisis Hits Turning Point! Why Strategic Health Leaders Must Save America’s Healthcare System

Blip-Zip Summary

VUCA VUCA! Volatility, uncertainty, complexity, and ambiguity (VUCA) best describe today’s health system. America’s healthcare system is failing and has failed. Does anyone care about the healthcare crisis? Costs are skyrocketing, outcomes are poor, and the system is complex and unsustainable. We need a new breed of leaders: Strategic Health Leaders (SHELDRs) equipped with skills like navigating complexity, fostering collaboration, and prioritizing health promotion over “FIX ME NOW” healthcare. By embracing these leaders and focusing on prevention, we can create a healthier, more affordable system for all.

Blip-Zip Takeaways

1. Become a SHELDR: Develop leadership skills to tackle healthcare’s wicked problems.
2. Shift focus: Prioritize community health and prevention over costly healthcare delivery.
3. Collaborate and Transform: Knowledge sharing and open communication are key to improvement.

Key Words and Themes

VUCA or Volatility, Uncertainty, Complexity, Ambiguity (VUCA) Healthcare crisis, transformation, Strategic Health Leaders (SHELDRs), leadership development, health vs. healthcare, national health, innovation, collaboration, knowledge sharing, prevention, community health, complexity, VUCA

Introduction – The Healthcare Crisis – VUCA, VUCA!

In an earlier article, I described bold actions to save the USA’s health system.  This article explains numerous reasons WHY.  According to the Institute of Medicine, “Health care in America presents a fundamental paradox … the past 50 years have seen an explosion in biomedical knowledge, dramatic innovation in therapies and surgical procedures, and delivery of safe care was fatal”. ¹ A review of the literature indicates a contributing factor is the lack of poor readiness to assume and lead a large healthcare organization and solve or at least tame some of the “wicked” healthcare system problems.

According to several authors and futurists, transformational leadership is required to transform the US health system into the most reliable health system with the healthiest population in the world. ^{2-4 5,6 7,,8}

Further, the IOM made it clearer, “American health care is falling short on basic dimensions of quality, outcomes, costs, and equity. The “wicked” nature, unsafe, unreliable, costly, wasteful, unsustainable, and frustrating-of the US healthcare system is begging for better strategic health leadership.^1,9-11

Many believe the future of the health system is here. If unaddressed, the shortfalls in the performance of the nation’s healthcare system will deepen challenging the well-being of Americans now, and into the future.^1,9,12-15  Don Berwick, former Director of the IHI summarizes the challenge, “Health care needs major improvements to meet patients’ specific needs, to offer choice, to adapt, to become more affordable, and to improve—in short, to learn.”

Americans should demand a health care system to consistently deliver reliable performance and constantly improves and innovates systematically and seamlessly, with each patient experience and transition.”^1,14,16

Current State: A VUCA-Driven Healthcare System

The health system can be described in extreme terms: volatility, uncertainty, complexity, ambiguity (VUCA) ^17,18 in all sectors. Experts go further to describe the US health system as a “wicked” or persistent chronic untamable problem.^9,15  The 100-year-old paradigm of delivery of care and education is outdated.  It was established in the 1900s or the industrial era of public health, sanitation, and safety crisis followed by the creation of an insurance-driven health insurance system as a wage ceiling workaround during World War II.

Coupled with the implementation of Medicare and Medicaid this dated paradigm is giving way to a better focus on health, wellness, and resilience as a national strategic imperative. ^19-22

The report card––cost, quality, safety, access, integration, preventive health, productivity, and outcomes (evidence gaps)––reflects an unsustainable system weakening the nation’s economic, security, and global standing. This problem requires a transformation of the healthcare model from a purely biomedical focus to a psychosocial and epidemiological ecosystem focus–creating better health, wellness, and resilience for the nation’s communities and citizens.^2,21

The US health system has been unreliable for decades. Domestically and globally, safety and clinical outcomes have not changed over the past 20 years. Recent estimates indicate they may have gotten worse and a culture of industrial-minded leadership is a contributing factor. In 2001, the Institute of Medicine (IOM) report stated, “as many as 98,000 patient deaths per year are preventable.”^{13 23} Ten years later, IOM reports the number of preventable deaths has not changed.¹

Unfortunately, these are not the features describing safe, quality, and accessible healthcare in America today. Also, the health services industry lags behind many sectors in the ability to meet patients’ specific needs (e.g., access, choice, affordability) or to learn how to deliver better care, better health, and reduce per capita costs.¹    

The Outcome – VUCA VUCA! A Healthcare Crisis of Epic Proportions!

Therefore, the leadership and leader development strategy must change–a new brand of Strategic Health Leadership (SHELDR) is needed to deal with the quantum transformation and complexity of healthcare delivery and the need for improving the nation’s health, wellness, and resilience or prevention focus as a national strategic imperative.^5,24-26 Before the Patient Protection and Affordability Care Act (PPACA), globalization, advances in technology, demand for high reliable care, need for a common information infrastructure, and value-based care have had grave implications in all health sectors–commercial, federal, and military for decades.^2,3,10  Now, it’s more imperative than ever.

SHELDR-Transformational Leadership is Imperative

Transforming the health system is a daunting challenge for leaders. Based on VUCA and the degree of wickedness, healthcare organizations, and their leaders can no longer afford to allow health system processes to work in isolation systems, engage in linear thinking, and rely on centralized control to “fix” the healthcare system. SHELDRs must begin to reframe the conversation to create a culture of health, wellness, and resilience before the system collapses.

According to the Centers for Disease Control and Prevention (CDC), “researchers identified at seven chronic conditions where a comprehensive preventive health approach could save tremendous health care costs and reduce premature disability and death.” These preventable chronic diseases include heart disease, stroke, some cancers, diabetes, arthritis, and asthma.^{27 28}

If the US continues on the current trajectory, spending more than any other nation in the world and enjoying unsafe, unreliable, and mediocre health outcomes, the system will implode and national security will be impacted.^29-31  The impact on the US economy for these seven preventable chronic diseases is estimated to be $1.3 trillion annually.³²  Individual responsibility for personal health and life style have gone on unaddressed at the expense of a “fix me now” attitude. 

Lost productive time due to health-related issues closely linked to chronic illnesses costs employers $225.8 billion per year ($1685/employee per year). ^33,34  Twenty-seven percent of the population is too heavy to join the military.^35-37

From a comparative global health perspective, the Commonwealth Fund ranked the U.S. health system last amongst seven developed nations.³⁸

The average life expectancy in the US is far below many countries that spend less on health care.27 By most comparisons, the US healthcare system ranked 37th in the world for quality and outcomes.³⁹

Numerous studies cite a lack of medication adherence, limited health literacy, and the challenges of communication before, during, and after visits or admissions as key factors driving the high cost of healthcare. For example, a survey found only 23 percent of respondents adopted new behaviors or followed through on their treatment plans.⁴⁰  

Complicating communication, and poor health literacy contribute to less compliance and motivation. According to the Department of Health and Human Services (DHHS), most Americans are not health literate41, and 50% of the two billion prescriptions issued are taken incorrectly or not at all.⁴² In continuous quality improvement (CQI) parlance this is wasteful.

Employers, stakeholders, and providers are beginning to develop a culture of health. However, the incentives are not there.  Even when offered economic incentives, people do not always make healthy choices.  More than 500 US companies responded to a study on health plan costs. 58% cited the lack of employee engagement as the largest obstacle to changing behavior about health and medical conditions. Two-thirds said employees’ poor health habits are the most significant challenges to keeping affordable health coverage .⁴³

Providers often cite patients as not as engaged as they should be. Most providers make sincere attempts to encourage patients during their visits. However, sustaining motivation is difficult. For example, a patient sees his or her physician about four times per year.⁴⁴

A medical practitioner’s lack of time and communication skills or barriers may manifest themselves in counterproductive behaviors such as not reviewing a patient’s chart, interruptions, and forgetting to get the patient’s input.45 For example, the average visit duration for family practitioners was 20 minutes.⁴⁶  Many patients with chronic conditions report they do not understand the symptoms they should be monitoring.⁴³

To understand, leaders must actively listen, communicate proactively, and take a closer look at the potential of behavioral health economics.47 The question of whether a policy approach can be effectively applied to alter personal choices and behaviors requires tough love and visionary strategic health leadership (SHELDR).⁴⁷

DEVELOP THESE 5 COMPETENCIES FOR SENIOR HEALTH LEADERSHIP SUCCESS: TRANSFORM YOUR JOURNEY WITH THE STRATEGIC HEALTH LEADERSHIP (SHELDR) FRAMEWORK

The Federal Health System is not immune

The Veterans Affairs (VA) and the Military Health System (MHS) face similar challenges. According to the RAND study and Congressional Budget Office (CBO) estimates, “The VA’s 2013 budget request represents an 11-percent ($13 billion) increase over estimated 2012 spending and a 72-percent increase from 2007 spending despite a 10-percent decrease in the number of veterans between 2007 and 2013.”^{48 49} Spending on medical programs grew 42 percent between 2007 and 2011.⁵⁰ 

While the MHS has supported multiple contingencies since 1989 with publically heralded success to include the lowest died of wound (DOW) rates in the history of warfare, the MHS is not immune from the “systemic wickedness” of the overall healthcare system.

For a variety of reasons, healthcare costs topped $50B last year, almost 10% of the DOD budget, and is starting to squeeze out other parts of defense-related spending.⁵⁰ The cost of providing care has increased rapidly as a share of the defense budget over the past decade. This trend has outpaced the growth of the economy, growth in per capita healthcare spending in the United States, and growth in DoD’s budget.⁵¹

The CBO also went on to state, “Between 2000 and 2012, funding for military health care increased by 130 percent, over and above the effects of overall inflation in the economy. In 2000, funding for health care accounted for about 6 percent of DOD’s base budget; by 2012, the share had reached nearly 10 percent. By 2028, health care would claim 11 percent.⁵¹

A recent Department of Defense (DOD) report summarized the quality of healthcare at many medical treatment facilities (MTF) as inadequate citing leadership as one of the contributing factors.  Also, the Chairman of the Joint Chiefs of Staff (CCJS) cited gaps in senior leader development in the areas of critical and agile thinking signaling a need to better train and develop senior military leaders (including health leaders) to deal with VUCA environments.^52,53

Emergency Preparedness Continues to Be Disconnected

Health emergency preparedness still lacks integration and confidence since 911, 2001. While progress on emergency preparedness has been made, many challenges remain for leaders who must know how to collaborate across organizational boundaries. Emergency response efforts are sometimes disparate; and efficient coordination is often lacking across governmental jurisdictions, communities, and the health and emergency response systems.⁵⁴

Even more distressing, the nation faces many transnational threats of health incidents with the potential for large-scale health consequences, including disease outbreaks, natural disasters, and terrorist-induced health-related attacks. National health security is a state in which the Nation and its people are prepared for, protected from, and resilient in the face of health threats or incidents with potentially negative health consequences.^{55 56}

While built on a foundation of community resilience, securing the nation’s health is a formidable task and requires partnering and coordination among virtually all segments of society. Highly publicized virulent infectious diseases—including HIV/AIDS, a potential influenza pandemic, and “mystery” illnesses such as the 2003 outbreak of severe acute respiratory syndrome (SARS)—remain the most direct health-related threats to the United States but are not the only health indicators with strategic significance.

Chronic, non-communicable diseases; neglected tropical diseases; maternal and child mortality; malnutrition; sanitation and access to clean water; and availability of essential health-care services also affect the US national interest through their impacts on the economies, governments, and militaries of key countries and regions.^{54 57 55}

The complexity of the health system transformation is the new normal. Couple the above with health system waste, the impact of poor health on the nation’s economy, and improve disaster preparedness, and the need for a national strategic imperative is evident. The US healthcare system is undergoing massive implementation of the Patient Protection Affordable Care Act (PPACA). The exact effects of the 2,800 pages of legislation are a highly debated narrative today with unintended second and third-order effects for years to come.⁵⁸

Lack of Leader Development is a Major Factor

Senior health leaders responsible for leading complex or multi-health facility systems with many interdependent parts and organizations know about the “wicked’ or ongoing chronic nature of the healthcare system. However, many leaders admit they are paralyzed by the sheer dynamics and quantum changes in the health system and underestimate their own development to lead complex healthcare systems.^9,15,59

These strategic health leaders (SHELDR) readily admit, that they struggle with the sheer complexity and need for sustainable change is daunting.60,61  These comments are underscored by researchers, associations, organizations, and advisors who cite chronic health leader development gaps associated with individual performance at higher levels of progression and complexity. Yet, approaches to improving leader development appear to be sporadic and based on old models and levels of leadership at best.

Summary: Future State — Call to Action

Americans deserve a health system capable of delivering innovative and reliable performance constantly. The system must be seamless, transparent, and integrated.⁶² A new breed of leadership must be developed to meet these challenges. All Americans must begin working toward becoming the healthiest nation in the world.  Complicating the reality is the lack of health leader development and a diverse set of stakeholders with divergent interests.

Leaders at all levels must catalyze communities of solutions and agencies across the nation. The communities of solutions must design and implement a multi-dimensional strategy – an epic campaign – to transform the healthcare system to a model of health wellness, and resilience. This transformational effort can be accomplished within a generation of strategic-minded leaders with a passion for making the effort a national strategic imperative of the highest order.⁵⁹

Comments?

Deep Dive Discussion Questions

1. The article highlights the need for SHELDRs. Do you believe current healthcare leaders possess the necessary skills to tackle the complex challenges outlined? Why or why not? What specific skills or experiences do you think are most crucial for SHELDRs?
2. The article emphasizes the importance of shifting focus from healthcare to health. How can we, as individuals and communities, contribute to this shift? What are some practical steps we can take to prioritize preventive measures and promote overall well-being?
3. Collaboration and knowledge sharing are identified as key drivers for improvement. How can we foster a more collaborative culture within the healthcare system? What are some existing initiatives or strategies that you find particularly promising?
4. The article mentions the “wicked” nature of the healthcare system. What are some of the biggest obstacles to achieving sustainable transformation? How can we overcome these challenges and ensure continuous progress?
5. The article calls for a new generation of strategic leaders. What are your thoughts on the role of leadership development in addressing the healthcare crisis? What are some effective ways to equip future leaders with the necessary skills and mindsets? Reflect on the “wicked” nature of the healthcare system. What personal experiences or observations have you had that exemplify its complexity and interconnectedness?
6. The article emphasizes the need for Strategic Health Leaders (SHELDRs). What skills and qualities do you believe are essential for SHELDRs to be successful in navigating the VUCA healthcare landscape?
7. The Blip-Zip Takeaways mention shifting focus from healthcare to health. How can individuals and communities contribute to this shift, promoting prevention and well-being over reactive care?
8. Imagine you are a SHELDR leading a team. How would you foster a culture of collaboration, knowledge sharing, and continuous learning within your organization?
9. The text highlights the challenges faced by the federal health system (VA and MHS). What are some potential solutions to improve leadership development and preparedness in these critical sectors?

Professional Development and Learning Activities

1. Identify a specific problem or challenge within your own healthcare community. Collaborate with colleagues or community members to develop and implement a solution. This hands-on experience can help you hone your collaboration, problem-solving, and leadership skills
2. Conduct a personal leadership assessment using a tool like the Leadership Circle Profile or Myers-Briggs Type Indicator. Identify your strengths and areas for development as a leader, particularly in the context of healthcare.
3. Participate in leadership development programs or workshops focused on complex systems, collaboration, and population health
4. Research and learn about the core competencies and skills of SHELDRs, and identify areas for personal development.
5. Participate in online or in-person courses or workshops focused on strategic leadership, healthcare transformation, or population health.
6. Join a professional organization or community of practice for healthcare leaders. This can provide valuable networking opportunities, mentorship, and access to best practices.
7. Shadow a successful healthcare leader or conduct informational interviews to learn from their experiences and insights.
8. Read books, articles, and blogs on current trends and challenges in healthcare leadership. Regularly engage in thought leadership activities like writing articles, giving presentations, or participating in industry discussions.

Resources and References

1. The National Center for Healthcare Leadership (NCHL). (2023). https://www.nchl.org/
2. The American College of Healthcare Executives (ACHE). (2023). https://www.ache.org/
3. The Commonwealth Fund. (2023). https://www.commonwealthfund.org/
4. Institute for Healthcare Improvement (IHI): The Institute for Healthcare Improvement (IHI), an independent not-for-profit organization based in Cambridge, Massachusetts, is a leading innovator, convener, partner, and driver of results in health and healthcare improvement worldwide. At our core, we believe everyone should get the best care and health possible. This passionate belief fuels our mission to improve health and health care. http://www.ihi.org/Pages/default.aspx
5. The Advisory Board: the Advisory Board is a best practices firm that uses a combination of research, technology, and consulting to improve the performance of healthcare organizations around the world. They provide a wide variety of institutional knowledge in educational resources to its members including workshops and research. https://www.advisory.com/
6. Health Care Cost Institute (HCCI): The IFMA Health Care Institute consists of hospital administrators, facility managers, design and construction professionals, consultants, vendors and students serving academic medical centers and community hospitals, retirement facilities, and specialty hospitals and clinics. Our mission is to holistically enhance the skills of facility management professionals within the health care industry and to further the profession overall. http://www.hcinstitute.info/
7. EXAMPLE: The Strategic Planning Process: In line with the announcement of the new Director, Daniel E. Dawes, JD, the Satcher Health Leadership Institute. (SHLI) executed a strategic planning process that involved conducting an environmental scan; conducting surveys and informant interviews with funders, community representatives, alumni, policy makers, and leaders; hosting a strategic planning retreat; and developing this report. In order to most efficiently accomplish this goal, SHLI engaged Dr. Robin Hindsman Stacia of Sage Consulting Network, Inc. as a consultant for this process. After hearing directly from external stakeholders via a broadly disseminated survey and more personal interviews, as well as incorporating the thoughts, concerns, and recommendations from internal SHLI faculty and staff, this report was compiled to serve as the guiding document for the next phase of SHLI’s work.
8. Porter ME, Teisberg EE. Redefining Health Care: Creating Value-Based Competition On Results. Harvard Business Review Press; 2006.
9. Bradley EH, Sipsma H, Taylor LA. American health care paradox-high spending on health care and poor health. QJM. 2017 Feb 1;110(2):61-65. doi: 10.1093/qjmed/hcw187. PMID: 27780898.
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11. The Strategy That Will Fix Health Care, Michael E. Porter, Thomas H. Lee, HBR

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About the Author:

I am passionate about making health a national strategic imperative, transforming and integrating health and human services sectors to be more responsive, and leveraging the social drivers and determinants of health (SDOH) to create healthier, wealthier, and more resilient individuals, families, and communities. I specialize in coaching managers and leaders on initial development, continuously improving, or sustaining their Strategic Health Leadership (SHELDR) competencies to thrive in an era to solve wicked health problems and artificial intelligence (AI).

Visit https://SHELDR.COM or contact me for more BLIP-ZIP SHELDR advice, coaching, and consulting. Check out my publications: Health Systems Thinking:  A Primer and Systems Thinking for Health Organizations, Leadership, and Policy: Think Globally, Act Locally. You can follow his thoughts on LinkedIn and X Twitter: @Doug_Anderson57 and Flipboard E-Mag: Strategic Health Leadership (SHELDR)

Disclosure and Disclaimer:  Douglas E. Anderson has no relevant financial relationships with commercial interests to disclose.  The author’s opinions are his own and do not represent an official position of any organization including those he consulted.  Any publications, commercial products, or services mentioned in his publications are for recommendations only and do not indicate an endorsement. All non-disclosure agreements (NDA) apply.

References: All references or citations will be provided upon request.  Not responsible for broken or outdated links, however, report broken links to [email protected]

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