Outdated Mindsets

Many Health Systems will cease to exist in the next ten years.  Geographic barriers are breaking down, which ratchets up competition and drives consolidation. As described in the previous article, Jumpstart is optimistic about the future of health. The health industry will prosper but consolidate into a small number of brands in the next 10 years. By 2033, these successful health brands will have established systems to deliver better care at lower costs. The new health providers will not be geographically limited and will leverage competitive advantages to win market share nationwide.

The most important factor determining success and failure in the coming health renaissance is leadership’s ability to evolve and grow their mindset. Mindsets are heuristics or shortcuts that help us distill massive ongoing streams of data into digestible insights. These belief systems help leaders set expectations, plan for the future, make decisions, and take decisive action. Mindsets help us to make sense of the world. However, when the world changes, our mindsets can become outdated and lead us to incorrect expectations, poorly designed plans, and unwise decisions. Unfortunately, two of the most common mindsets relied on by healthcare leadership teams for 40 years are no longer beneficial. 

Credential Culture Mindset

To support and enable patient safety, many health systems developed a culture ranking caregivers in a hierarchy based on credentials. This credential culture positioned those with the most education, certifications, experience, and training as leaders in the organization.  It fostered trust with patients who believed credentials resulted in high-quality decisions.

When it began in the 1980s, the credential culture mindset was the best method for a health system to signal its attention to patient safety and treatment quality. However, in the last four decades, our ability to use technology to gather and process information have massively advanced. Today, we can measure patient outcomes and healthcare quality directly. This new capacity often renders credential culture, the original proxy for healthcare quality, obsolete. Credentials remain requirements, but they are insufficient to ensure high-quality patient outcomes.

This should not be surprising. We would not expect every restaurant to be of equal quality because they have the needed credential from the health department to serve food. The credential sets the floor for entry, but it’s insufficient to signal high quality. For this reason, holding up credentials as an important part of the culture puts the emphasis on the wrong area. 

There are two reasons credentials need to be deprioritized in health system culture. First, table stakes such as credentials serve as a foundation on which culture is built but never differentiate one health system from another. Second, stressing credentials undervalues the important work of low-credentialed caregivers. This leads to a workforce divided into classes resulting in unhappy caregivers and sub-optimal patient outcomes. Post-pandemic, healthcare is a team activity. 

We need compassionate caregivers at all levels of licensure to deliver consistently high-quality patient care. No question, surgeons are valuable members of the care team. However, so are the nurses, nurse assistants, dietary counselors, home health caregivers, and every other healthcare provider in the system. Each role is essential.  Leadership teams must update the credential culture mindset to emphasize holistic care teams.

Castle Mindset

The second outdated mindset relates to capital assets such as buildings, equipment, and financial endowment.  Again, leadership teams have for decades used capital assets as a signal to gain competitive advantage and attract patients. Large buildings, advanced diagnostic equipment, and robotic surgical tools communicated both financial strength and the willingness of leadership to bring the best available healthcare to patients.

Jumpstart refers to this mindset as the Castle Mindset. The castle image is illustrative because hospital buildings were once a symbol of hope and a source of strength. However, as time passes, leaders holding onto this mindset are anchored in the past and will lose influence.. 

Complex procedures will continue to be administered in the in-patient setting.  However, every year technology advancements enable more care to be safely moved out of the hospital to the community and the home. This transition increases patient compliance, improves outcomes, and shifts the competitive landscape. As care migrates out of the hospital, the traditional geographic oligarchies enjoyed by health systems disappear. When all care was delivered “in the castle,” competition was limited because patients would only travel 1-2 hours for healthcare. Thus, every large metropolitan area needed local health systems and trended toward an oligarchy with 2-3 health systems holding stable market share.

With continued advancements in health care, the Castle Mindset is quickly becoming obsolete and should be abandoned.  We need buildings, equipment, and capital assets, but leading systems want as few as possible. This is because they inhibit scale and inconvenience patients. Furthermore, all nationwide competitors have sufficient capital assets. Thus as consolidation occurs, these assets will be table stakes. Necessary but insufficient to convey a competitive advantage.

Bottom line:

CEOs and leadership teams must consider how long their geographic barriers will last and assess their mindsets. If there are outdated mindsets in the organization, recognition is the initial step. The good news is education and updating mindsets are free.  Leadership teams from any health system can come up the learning curve and improve. The time is now, and Jumpstart is here to offer help and guidance.