A Presidents’ Day Dilemma – The Audacity of (Health Care) Leadership

The Wall Street Journal of Friday, February 13 described President Obama’s balancing act when engaging the Congress and the American public about the current economic crisis. In After Curbing Enthusiasm, Obama Must Ease Anxiety writer and commentator Gerald F. Seib describes the delicate leadership dance between the Scylla of raising expectations and the Charybdis of lowering them. As the candidate of hope on the campaign trail, and the inspirational leader a country needs to combat adversity, Obama has been required to audaciously raise the hopes of legislators and a citizenry that have become cynical about the possibility of change and despondent about their future. As President, he has also been required to “right size” expectations for the trajectory of economic improvement while setting a tone of urgency in order to achieve legislative responsiveness. Which task he undertook beginning with a sober inaugural address.

The result must be a bit of a psychological roller coaster for both the President and the public. So Mr. Obama also needs to be a psychiatrist, managing the anxiety of his patients – the public and Congress – sufficiently to keep them in the game going forward. Neither hoping for too much too soon nor for too little too late. The President must alleviate the anxiety that comes from spending vast sums of money in pursuit of a hoped for, right-sized, economic recovery. Without hope, there is no future. With unrealistic expectations comes anger and more cynicism. “The biggest economic danger lying ahead is a vicious downward spiral in which Americans stop spending, prompting more layoffs, depressing spending further….” What special skill set and audacity is required of a leader who must communicate both sides under these circumstances? It’s enough to make any anyone lose his or her marbles.

Don’t healthcare leaders face similar challenges and responsibilities? On the one hand, they are driven by the promise that scientific and medical advances can fundamentally decrease our vulnerability to disease, aging, and injury. And that healthcare organizations can be run well and somewhat profitable. On the other hand, they live in an environment of constrained resources and an uncertain economic future. They must convince Boards and financial fiduciaries to make critical and sometimes controversial investments (in infrastructure, technology, human resources, facilities) for which payback is uncertain and regulatory oversight constantly shifting. So as they encounter these challenges they are also faced with a need to be inspirational, sober, and therapeutic. Take, for instance, the task of convincing physicians and nurses that implementation of a costly EMR that has a potentially spectacular – but still speculative in the minds of some – upside for patient care and safety while simultaneously sending a sober message about near time loss of productivity is a good example. Or the “selling” of horizontal service line reorganization to nurses and managers when it carries a similar spectrum of theoretically high potential, as yet unproven large-scale benefit, and requires significant revision of operations and reporting.

Yes we must hope that the vision of improved health and safety will be met; and yes we must make uncertain investments to make these achievements possible; and yes we must have realistic expectations and time trajectories; and yes it could all fall apart; and yes, yes, yes, everyone is anxious about the situation and the conflicting messages. So in addition to running hospitals, health systems, practices, programs, academic Departments, etc., healthcare leaders must pay close attention to being great communicators of multiple conflicting and simultaneous messages – and then to be the therapists that make it possible for colleagues and staffs to get through another day productively. Now that’s really audacious.