Managing through turbulence in healthcare: Tips for health execs

Since last fall’s election, the uncertainty in healthcare has grown tremendously. At first, it seemed definite that the Affordable Care Act would be repealed. But after numerous attempts in Congress, still to no avail, the “new normal” appears to be this: wake up, check Twitter to see if anything exploded, and then plan your day.

But how can we do this, day after day, without losing our sanity? Is there any “signal” we can extract from all of this noise? A path we can follow?

Fortunately, there is. There are tried and true methods to manage through turbulent times, both at the business and personal level. We can apply these methods as healthcare leaders. Below are some tips that you can use, depending on your role in the company.

Role: Responsible for business strategy

If you responsible for developing or contributing to your company’s overall business strategy, but feel overwhelmed by the uncertainty in the marketplace/political environment, you must “keep calm and carry on.” Remember that it is always possible to take a systematic approach, even if uncertainty levels are high. Here are some tips from a classic Harvard Business Review article, “Strategy Under Uncertainty.”

First, identify the level of uncertainty you are facing. Level 1 means that the potential outcome of the situation is “clear enough.” Levels 2 and 3 means that there are alternate or a range of futures. And Level 4 means there is “true ambiguity” regarding the potential outcome. About half of all strategy problems are Level 1; very few are Level 4. This means most strategy problems have a range of potential outcomes you can assess.

Second, identify the range of potential outcomes and their probabilities of happening. Try to simplify the possibilities and narrow things down.

Third, do scenario planning on how to respond to the most likely outcomes. Specifically, identify where and how to compete. You have three options for action, according to the Harvard Business Review article:

1. Make big bets (“shape the future”)

2. Hedge your bets (“adapt to the future”)

3. Wait and see (“reserve the right to play”)

For any scenario, identify the “no regrets moves,” i.e., the things that are worth doing no matter which outcome. Those could be building skills of employees, gathering competitive intelligence, and finding ways to reduce costs and run more efficiently.

For example, take the ACA repeal and replace proposals. It may feel like a lot of uncertainty, but if we analyze what’s really at stake, we can see that the potential effects fall into two main categories: the individual insurance marketplace and Medicaid. The proposals’ impacts have boundaries and are distinct. Specifically, the individual insurance market is a very small percentage of the insured population. And while Medicaid covers more people, a block grant would limit, not eliminate funding. So, for all of the “noise” around these proposals, it’s still possible to work systematically through a discrete set of options of how to respond.

Next: If you are responsible for leading a team that is stressed by uncertainty

Role: Responsible for leading a team that is stressed and distracted by uncertainty

As a leader, you need to ensure that your team can handle the stress of working in a highly uncertain environment. It requires “compassionate management," according to the Harvard Business Review article, to ensure continued productivity. Heed some expert advice: Be transparent about what’s going on, communicate early and often, and show your team what’s feasible to accomplish. Refocus on the core mission of your company, and connect that to your team’s daily work. Find a compelling narrative to keep people focused and engaged.

You then need to reinforce and strengthen the capabilities in your team that are required in an uncertain environment, including adaptation and resilience. Invest in coaching and training for these things. In the meantime, you can help your team members focus on what they can control (increasing their sense of agency can reduce their stress). Be flexible where you can be. And last, but not least, reaffirm a shared sense of purpose.

For instance, you could lead your team to focus on some of the fundamental truths in healthcare, rather than the ACA repeal proposals. Costs continue to rise at a rate greater than inflation. This is not sustainable. What can your organization be doing to lower that rate of spending growth? If you work for an insurer, can you pay for value, not volume? If you are in a provider system, can you develop an ACO? These options could fit the category of no regrets moves.

Managing your self

You cannot lead others through this level of turbulence without taking care of yourself. Here are a few tips:

• Reserve time to think strategically. Stay out of the office one morning a week so that you can read, absorb, and make sense of the information about the changing environment and develop your goals accordingly.

• Refresh yourself. Exercise, meditate.

• Control your inputs. Limit your time on news and social media, so that you can stay focused on your goals.

• Collaborate. Surround yourself with the people who energize you and work with them to solve the problems. Create a “SWOT team” to help you assess your firm’s strengths, weaknesses, opportunities and threats.

If one thing is certain, it’s that these are uncertain times. But if you take these steps to keep calm and carry on, you will find clarity and be able to focus on goals that will allow you to lead others through the turbulence.

Rosemarie Day is the president of Day Health Strategies, a consulting firm that advises healthcare organizations on transformation initiatives.  She assisted with leading health reform in Massachusetts, which served as a model for the Affordable Care Act.