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Eight healthcare CEO insights: How to lead through immeasurable stress and change management

In a recent NRC Health CEO interview series, we asked how top leaders adjusted and adapted—both personally and professionally—during COVID-19.

Learning more about the role of the CEO and how it has shifted, and what it’s like leading a system of care during immeasurable stress and constant change, revealed overlapping areas of concern and unique challenges. Many CEOs spoke about care deferment, telehealth engagement, and vaccination opportunities, all of which are highlighted in our 2021 Mid-Year Healthcare Consumer Trends Report.  Here are eight confessional trends among healthcare CEOs.

  1. We Created Numerous Strategies to Survive
    Amid constant change and conflicting guidance, CEOs navigated the COVID-19 epidemic with a variety of strategies to steer everyone through the darkness. As one CEO mentioned, “Incident command usually lasts 12 to 36 hours—it’s been a year.” Another leader focused on running their command center with a militaristic feel, viewing the virus as their enemy. Another explained that their success began when they looked at what they didn’t know as a strategic threat, and worked to fill the knowledge gaps.Additionally, COVID-19 reminded leaders whom they serve and why they serve them. Leaders found that people can handle the truth and appreciate the reality. Some focused on employee engagement and unity to survive; others sent laptops to employees in need so they could work from home.
  1. We Boosted Board Interaction, and Some of Us Trashed Five-year Plans
    Engaging a board of directors is always a top priority, but COVID-19 challenged CEOs to get creative. Our interviews revealed that nearly all CEOs met with their boards more frequently during the pandemic. Many canceled regularly scheduled meetings, then used virtual tools to replace physical conversations.CEOs reported “emailing with the board more than ever before” and “establishing a new weekly email conversation.” Some CEOs emphasized that they had to grow in their digital communication prowess and established weekly columns, digital newsletters, and even virtual town halls to share updates with their organizations. Many were pleased by the high attendance.Many five-year strategic plans were delayed or reimagined within shorter timeframes with virus-oriented goals, though a few CEOs forged ahead to finish their 2020 strategies in an attempt to keep up momentum post-pandemic.“The idea of five-year plans seems irresponsible, so we will be doing a three-year plan,” one CEO said. “It’s much tougher to predict forward.”Said another: “We shelved our five-year plan and went all hands on deck!”
  1. We Collaborated in New and Exciting Ways
    If the pandemic provides us with any silver linings, one may be the collaborations that sprang up while we fought the virus. Most CEOs reflected on a shared purpose among typical competitors. Everyone learned together, and when one organization needed help, others typically stepped in.Some collaborations were more formal, like Minnesota’s “Fight COVID MN” partnership, which shared updates and advice among providers and pushed information and updates out to state residents. Others were handled day by day. “We were in a better position to collaborate than the politicians,” was the common message among many CEOs. Everything from oxygen tanks to surgical masks was passed from one organization to another as the virus became a shared threat to all.According to NRC Health’s Market Insights survey, the vast majority of consumers want their local hospitals and health systems to collaborate. But will it continue? “Competition will return, but we hope to compete more healthily as we try to improve the lives of the community,” said one leader.
  1. We Helped Shift Visits to Telemedicine—and Believe It Will Continue to Trend
    Among the beneficiaries of COVID-19, telemedicine advocates were undoubtedly near the top. After merely dabbling in virtual experiences, hospitals, health systems, and primary-care outfits were immediately faced with a crisis: how do we serve patients if they can’t walk through our doors?Screens became the new doors. “We went from 50 visits a day to 5,000 visits a day,” explained one CEO, while another recalled, “We saw five years of growth in five weeks.” The implications go beyond appointments as, according to a third, “[telemedicine] greatly accelerated our focus on the hospital-at-home model of care.”So what about digital inequities? While they certainly exist, it seems all income brackets had virtual appointments, and “there was less concern about reaching the poor—it seems nearly everyone has a cell phone.”NRC Health’s Market Insights has documented the astronomical growth of virtual health: 15% reported telemedicine (virtual and phone-only) experience in 2019, which more than doubled to 35% in 2020. Now in 2021, according to the NRC Health study, 44.8% of consumers report having had a telemedicine experience in their lifetime. And of the group forced into virtual care in 2020, 74% were satisfied with their visit.Consumers favor more virtual healthcare, but will providers oblige them after the pandemic ends? All CEOs interviewed believe that they will. “We’ll never go back to pre-pandemic usage; the genie is out of the bottle,” one remarked. Another shared, “we have a new goal to make post-pandemic telehealth 20% of all experiences we provide.”
  1. We Juggled Care Deferment and Watched Financial Burdens Wreak Havoc
    Perhaps the only number that wasn’t being tracked on a dashboard in 2020 was the number of people delaying medical treatment. These “deferrers” have been around for some time; NRC Health began tracking healthcare deferment during the throes of the Great Recession.Between 2009 and 2014, the number of healthcare consumers delaying treatment dropped each year. Then, starting in 2015 as out-of-pocket costs continued to climb, more consumers chose to put off care. In 2019, nearly a quarter of consumers deferred care. In 2020, that number skyrocketed: at one point, half the country was putting off care, and over the year, a record 33% of Americans delayed care.“Patients vote with their feet,” pointed out one CEO. “The financial burden has been placed on the back of individuals,” described another, pointing out that COVID-19 had wreaked havoc on personal finances. And while some consumers are returning to standard care patterns, many are not. The risks of having so many opt out of care are yet untallied. “The problem with delayed care is, the diagnosis doesn’t take a day off,” one CEO said.
  1. We Met the Needs of the Re-emerging Patient
    As consumers return to traditional care patterns, what, if anything, will have changed? Many CEOs wondered about the mindset of future patients as they emerged from the pandemic. One went so far as to say, “Mental health will become our great unifier—no one organization can solve that puzzle.”And as for traditional patient experiences, NRC Health has already documented a sizeable number of consumers who lack any stated preference for their future care. Even when this number is broken out—and including Emergency Department preference—there are sizeable gray areas as consumers try to decide where they’ll go on their next journey of care—a path both physical and mental.
  1. We Bolstered Efficiency on the Vaccination Battleground
    Organizational energy has shifted to vaccination deployment and the return to physical healthcare experiences. Vaccines have divided the country, with hospitals stuck in the middle.Most CEOs have seen positive experiences within their vaccine rollouts: “We do 2,000 folks a day and have had nothing but great feedback,” one reported. “We are so efficient, we had a patient compare us to a Chick-Fil-A drive-through.”Some CEOs viewed vaccine hesitancy as an essential opportunity to rise to the occasion. “We saw the need for proactivity—to go where consumers live and work,” said one CEO, adding that their organization has partnered with churches. Just as healthcare organizations collaborated to fight COVID-19, they’re now banding together to spread the vaccine as far and wide as possible. One CEO shared that “a local Native American community finally let us in to vaccinate, and it has opened up a relationship with the tribe to serve more of their healthcare needs.”When was the last time so many Americans had such a shared healthcare experience? As such, there is now an industry-wide opportunity to reimagine the healthcare experience—starting with the vaccine—and to spread the word about healthcare organizations. As one CEO mentioned, “[The vaccine] is an opportunity to engage if you use it—why not put your brand on the Band-Aid they’ll wear out the door?”
  1. We Began to Redesign Care in Our Communities
    Beyond the vaccine, we asked CEOs how they feel the future of care will materialize in their communities. There was no shortage of enthusiasm. “We look at the need to co-design care with the community,” explained one CEO. Others argued that there is a need to entirely shift from sick-care positioning to well-care positioning. “We want to transition from the healthcare provider you need when you or a loved one is sick, to being the [healthcare provider] that is a part of your daily life,” said one leader.Healthcare organizations have long sought consumer loyalty. Still, it typically falls off the strategic map, because loyalty requires a long view and unwavering focus to ensure consumers feel engaged, both when they are patients and when they aren’t.One CEO cited the rise of virtual care as an essential sea change for healthcare, arguing that “we need more creativity in healthcare delivery.” And CEOs share a thought with consumers that if we could adapt our systems so drastically during the pandemic, we might be able to change faster than we think.“The future got here ten years early,” one CEO remarked on innovation. Another pointed to a less noticeable change: the rise in sharing information. “Transparency was critical to keeping everyone engaged,” that leader noted. A few CEOs felt that price transparency might be the next crisis facing the industry—and it’s certainly a topic consumers are passionate about.

Advice to New Leaders in Healthcare

NRC Health closed every interview by asking each CEO the same question: Imagine today is someone’s first day as a healthcare leader—knowing all you know now, what is one piece of advice you’d pass on to them?

There were many distinct answers, but the common thread was clear: listening is key. “The longer you listen, the better your decisions will be,” said one CEO. Another cautioned, “You can’t only listen forever,” but suggested it was a great start. Transparency and trust were also common themes.

Other great mentions:

“You’ve got to understand your practice as a leader and how you authentically lead. This will make or break you.”
“You need to create an environment that will challenge the status quo.”
“Never forget whom you are serving and why.”
“Understand that what we do is love—it’s one person trying to relieve the suffering of another person.”
“Resilience: do not let any of it get you. Wake up each day and figure out which way you are going.”
“No matter what you’re doing, be transparent in doing it.”
“Once you lose your integrity, you’re toast.”
“You aren’t going to make everyone happy—don’t be afraid of that.”

CEOs expressed that being flexible while managing change was the most significant factor in riding the immeasurable stress and change-management wave created by the pandemic. However, no matter what their advice, the CEOs we spoke with voiced a spirit of hope, and each one felt that brighter days were ahead for healthcare and the patients they serve.

Would you like to participate in the next CEO Interview Series? Please reach out to mcharko@nrchealth.com.