Looking Back to Look Ahead: CFAR’s Healthcare Reflections on 2022 and Opportunities for 2023

Each year, flipping the calendar from December to January brings an opportunity to reflect on what we learned in the prior year and what we aspire to in the year ahead. The healthcare world sustained a brutal 2022—financially, emotionally, and interpersonally. CFAR joined many healthcare leaders and organizations along their challenging journeys. This article takes stock of what we observed from partnering with healthcare clients in 2022 and shares some ideas about what we anticipate will be needed to address these challenges and opportunities in the year to come.

Last month, CFAR’s healthcare team met to identify learnings from the field over the past year. A few takeaways of our observations working with clients in healthcare—largely health system and academic medicine leaders, medical professional societies and certifying boards, and other healthcare organizations focused on access and health equity—centered both on dynamics within their organizations and the context of the healthcare landscape itself, such as:

• Adapting to uncertainty and extraordinary financial pressures: The feelings of stress and pressures of crisis among our healthcare clients ebbed and flowed rapidly last year—as they did over the past few years. Notably, this sense was related to how much the strain and uncertainty of Covid-19 was impacting the industry—that is, whether the organization was simultaneously dealing with another wave of hospitalizations like the Omicron variant in early 2022 or later in the year with stresses further exacerbated by the respiratory syncytial virus (RSV) and influenza. Others struggled to adjust to the impact of the Supreme Court’s overturning of Roe v. Wade and the impact on women’s reproductive health. The financial impact and toll on patient access have been staggering, with most organizations facing steep losses (including many of the most profitable systems in the country mounting billions in losses). Many leaders grappled with how much attention they could place on broader priorities like organizational change initiatives in the context of feeling the pressure to put out the next fire; others doubled down on significant efforts to integrate, align, and restructure to be more financially and operationally competitive.
• Confluence of burnout and leadership transition: Entering 2022, healthcare organizations were faced with workforce shortages primarily of key patient-facing roles, notably bedside nurses and respiratory therapists, among others. As the year continued, we noticed that the hit on people’s mental health and burnout extended through many other frontline roles as well as administrative leadership. Turnover among hospital CEOs and other senior leaders added to an impressive progression of the “workforce crisis” that has plagued the healthcare industry since the pandemic began, revealing a pressing urgency for leadership transition support.
• Advancing inclusive practices and health equity: Concepts of diversity, equity, inclusion, health equity, and belongingness were lifted to the forefront for many healthcare organizations. As we noted at the 2022 AAMC Learn, Serve, Lead conference, these themes matured from impassioned frustrations in the wake of the 2020 murders of George Floyd, Breonna Taylor, and others, to strategic priorities for organizations dealing with an embattled healthcare workforce. We noticed that more organizations are pushing forward, moving from a philosophical commitment to meaningful actions that are starting to make a difference in this important work.
• Redesigning governance for the future, not the past: As senior leaders transitioned in and out of organizations and the strategic and financial pressures across healthcare increased, the boards of hospitals, health systems, professional societies, and certifying boards were also faced with questions about their own composition and ways of working. Boards, too, needed to examine their role in guiding their organizations to act on priorities of growing importance like health equity, access to quality care, DEI, and even climate change. The question they face is—how do we redesign our governance for the future?
• Do the work, build the team: We also encountered many leaders contemplating explicitly how to build more connection and alignment among the members of their teams. As healthcare organizations grappled with shortages in patient-facing workers, administrative leaders identified a need for their teams to build trust, psychological safety, and accountability to accomplish their organizational goals and continue to deliver high-quality care to patients.

Although many health systems sustained significant financial losses in 2022, we identified several concrete examples of the ways our clients addressed some of the acute stresses they faced with tighter-than-usual budgets:

• Aligning hospital leaders across geographic and sociopolitical settings in an established academic health system to act in unison on ways to reduce inefficiencies and improve value for the entire system—when previously these leaders were accustomed to pursuing growth opportunities independently and at will, without worrying as much about the system as a whole and the impact their actions might have.
• Helping senior leaders and middle managers in a new, growing health system reexamine how they work together to recognize that “business as usual” would no longer be enough to reduce process inefficiencies and improve the experience for patients and providers.
• Enlisting support for the transition of a long-time, beloved CEO, moving from the mindset of a transaction (conducting a search to find a new leader) to a process (preparing the board and the entire organization to welcome a new leader and set them and the organization up for success).
• With a certifying board, developing and implementing their strategy and redesigning their governance to meet the demands of a changing future.
• Building trust for a system-wide initiative to identify an organization’s core values and behaviors between corporate leaders, department leaders, and frontline employees—in a year when the Great Resignation hit an already strained healthcare industry. This question of trust in an organization’s leaders made us think about the lessons learned from the Mann Gulch fires, where a forest firefighting crew lost many lives related to a lack of trust in their leader’s plan.

Learning from our client relationships, moving forward, we recognized the increasing importance of partnering with our clients to:

• Communicate, communicate, communicate—Partnering with marketing/communications teams to ensure that people can connect the dots between problems and efforts to address them—with an eye on successful implementation when all corners of an organization can feel connected to critical initiatives.
• The power of stakeholder engagement—We appreciate the risks that our clients take when they invite us to help redevelop their strategy and align a more complex set of stakeholders than existed during their previous strategic planning process. The more people play a role in contributing to and shaping strategy, the more able they are to commit to and implement it.
• The value of executive and team coaching—The field of leadership has advanced, and we have been cognizant of what our role is as trusted advisors in elevating the performance of individual leaders with whom we work—beyond advancing an organization-wide initiative. We see the importance of coaching, for individuals and for teams, as they work together to take on new challenges in an increasingly turbulent and uncertain environment.

In the year ahead, we look forward to partnering with healthcare organizations to help them recover from an extremely challenging past several years. Our goal is to support leaders through complex strategic and organizational challenges in ways that enable them to rebound from this acute crisis and sustain and thrive longitudinally. We are committed to helping leaders maximize the impact of their people and enhance organizational performance through the alignment of their strategy, culture, governance, and leadership team efforts.