In August 1914, Sir Ernest Shackleton and a crew of 28 men set sail to Antarctica. In January 1915, the Antarctic winds shifted and Shackleton’s ship, the Endurance, got stuck in the ice. The ship had been built to cut through that ice, but after a while, its timbers crushed and it sank, leaving Shackleton and his crew stranded on the ice floes.
The Endurance expedition’s mission changed in the most profound way. Once about glory back in London, it was now about keeping everyone alive.
What are the shifting winds in health care that face us? asks Marc Harrison, President and CEO of Intermountain Healthcare. These probably sound familiar: legislative uncertainty, dramatic changes in patient expectations, payments going to the mean of government payments, new quality and safety expectations, and huge disruption from other industries.
“We’ve had a lot of change for a long time in health care, and that’s not a bad thing,” says Harrison. But, he adds, “the rapidity of change is unprecedented at this point in time.” For organizations that are already at sail, what will happen? What changes do we need to make to not only survive, but to thrive into the future?
1. Be relentless about getting unstuck. Think of dramatically new ways of doing things, “and do it fast, because you don’t have time and the enemy of good is better,” says Harrison. Shackleton was stuck, but he was relentless about keeping his crew alive. He kept everyone focused on that mission by applying their intelligence, skills, and fortitude to the new survival tasks at hand.
“It’s proven difficult in health care to do that,” Harrison says. In many cases, “these incredibly smart, motivated physicians have been coddled and protected from the realities of [the rapid change] happening in the industry around us.” They do not understand the economics, the risk, or the need to reorganize. Despite this, Harrison believes there is huge opportunity. “When you think about clinician leadership and you think about the process that clinicians go through to get trained, if we provide them with a respectful education of what needs to be done, I have no doubt that they will rise to the occasion and they will be superb leaders.”
2. Always be the first one on deck and the last one off. In other words, lead from the front. Shackleton knew this, and he knew that bringing everyone home alive meant more than just taking care of his crew’s bodies — it meant caring for their hearts and minds as well. He modeled positivity, creativity, resolve, and adaptability, and eventually, he and his crew escaped. They crossed 1,000 miles of ocean in three lifeboats until they reached the tip of the Antarctic Peninsula and Elephant Island, which they found deserted. There, they were stuck again. Formulating a new plan, Shackleton got back on one of the boats, with four other men, and sailed to a whaling station at South Georgia Island.
“Shackleton had taken the lead, put himself in danger, but there were more challenges out there,” says Harrison. “I believe that clinicians in leadership positions have the same ability and resolve to make that kind of change in order to lead us to success.” There are some bad physician leaders, Harrison acknowledges, and some “truly superb” non-clinician leaders, but “if you can put the package together, it’s a little bit of nirvana in terms of being able to have conversations that others just can’t have,” he says. “In the absence of that, dyads of really strong administrators and clinicians are a very powerful tool. So what we learn is, when we take on big, hairy goals, we can lead through them with the right kind of approach.”
3. Save your greatest intensity for other people — for your patients and fellow caregivers. “The money is only important as it relates to our ability to deliver on our mission for other human beings,” says Harrison. “Never let why we exist be drowned out by anything else.” Shackleton never took his eye off his goal of leading his crew to safety, even though it took multiple tries over months to obtain a ship that could cut through the ice. Finally, in August 1916, Shackleton rescued the remainder of his crew — and no lives were lost. “How many times do we need to try solutions before we actually reach success?” Harrison asks. “We cannot be stymied by the fact that when we try something in a very difficult environment like this, it doesn’t work the first time, we need to keep hammering, hammering, hammering with a big goal in mind.”
“We have these three lessons. Pretty straightforward stuff,” concludes Harrison. “If we keep them in mind, I fully believe that we can get to a place where we can lead health care that we’re not only surviving, but we’re thriving, and we create a model system that will take us to a place where we can serve with pride and with integrity.”
From the NEJM Catalyst event Physicians Leading | Leading Physicians at Intermountain Healthcare, July 12, 2017.