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Column | Leadership

The evolution of integrated health system leader roles

Column | Leadership

The evolution of integrated health system leader roles


Leadership of an integrated health system has become an increasingly complex undertaking today because of the many roles a leader must assume. These roles may become even more complex and numerous in the days ahead.

The leader must at once be an executive, a business development officer, a community/state leader, a mentor, an innovation officer, a process improvement officer, a safety officer, a motivator, a chief vision officer and a chief comforter.

In response to these demands, it is common for these health system leaders to say, “This has been the most challenging year of my career.” 

To this, I and others say, “Yes, but you can’t just survive it. You have to create positive momentum.” The integrated health system has become a must have component of society.

Nearly impossible, but highly rewarding

Here are four of the ways the job of leading an integrated system is getting more demanding. 

1. The security aspects of the job are escalating. Leaders must attend to cybersecurity, to the physical security of the health system and to the personal and emotional safety of those within the system and those it cares for. The security issues are broad and often interrelated. The pandemic has compounded the challenge, as has the growing prevalence of fear, anger, political divisions, income disparities and financial insecurity.

2. As integrated systems have grown (in geography, scale and financial clout), the “decision-making distance” within the organization has become stretched. In most integrated systems, key decisions about opportunities — such as which forms of care should continue to be delivered virtually versus in-person — are made many levels down in the organization from where resource allocations and reimbursement decisions are made. The voices from below often become muffled before they reach the top. Health system leaders must establish a disciplined approach (e.g., special listening sessions, a pattern of visits by leaders or other tailored approaches) to bridge the distance between top decision-making and the patient-caregiver interactions.

3. As integrated systems become larger, they also must relate to and work closely with a larger number of local governments and community organizations. Different communities have different needs and different politics. Health systems now often have to balance, reconcile or sometimes mediate between these multiple community constituencies. Key outside relationships are both a threat and an opportunity, and they must be managed for the benefit of the health system and the community. 

4. As healthcare delivery evolves, the need for clinicians, scientists, information system professionals and business managers to work creatively together becomes greater. An integrated system is the most common convener of such cross-disciplinary work. However, it requires intention and skill to do it well.

All of these changes come at a time of incredible stress. A leader might feel overwhelmed by the feeling that the integrated system is stretched to its absolute limit, while at the same time saying, “I’m thankful to be doing something that is so important, and to be using every ounce of skill and experience that I have.” And both views are equally valid.

Opportunities to make an even greater difference

The core concept underlying integrated health systems (i.e., the related activities of ambulatory care, hospital and other forms of patient care, research and innovation, and financial transactions) is further validated every year. It is difficult to envision meeting our future healthcare needs without integrated health systems. This reality places the health system in a central role for many aspects of local communities.

Today, vaccinations are occurring particularly smoothly in states and communities where there are one or more integrated health systems, with robust electronic health records and patients that are accustomed to communicating with the systems electronically. And integrated systems can go much further in leveraging their large population databases, close bonds between physicians and patients, value-based payment approaches and financial and decision-making tools.

The opportunity for integrated systems to deliver even greater benefits to society is still evolving. They have the potential to be central building blocks to address a wide range of next-generation societal needs. 

Fortunately, integrated systems already have a rare and valuable set of tools in place that can help them achieve this purpose:

  • Communications, including personal communications, mass communications and ways to quickly integrate them
  • Science, encompassing the scientific discovery process and ways to disseminate and commercialize the results
  • Organizational change, including LEAN processes and other approaches to identify and implement large-scale change
  • Market-based discipline, including the ability to fit supply cost, demand price, marketability and growth into a strategy and action plan
  • Parallel, highly differentiated services, such as the ability to treat cancer patients with one set of skills and processes and orthopedic problems with another
  • Scope, reflected in a broad range of data, some of it protected by HIPAA and other laws, that are within their purview
  • Culture, including, for example, the belief in the admonition to do no harm

Emotion that leads to action, as evidenced, for example, in the ability to link those who are capable of philanthropy with those who deserve and need philanthropic services

During a focus group with healthcare leaders, I once asked, “Given the combination of skills required, could you lead other types of organizations?” The answer that came back was, “Yes, we could, but why would we?” As future integrated systems evolve in new areas, new roles may emerge that prompt leaders to simply answer “yes,” and welcome the new leadership opportunities.

Time to reprioritize and reorganize

The pandemic has profoundly taxed health systems’ mental, emotional and physical energy for a year. However, it’s the job of a leader to look beyond the here and now. Initiatives and work that were underway before the pandemic now deserve renewed focus. Meanwhile, new opportunities have emerged from the pandemic. All these initiatives and opportunities involve broader roles in the communities that health systems’ serve. 

There is no way a health system CEO, or even a small leadership team, can accomplish all they may be asked to do. It’s almost imperative that leaders begin to reprioritize their personal focus and time, emphasize new skills and reorganize their work. Here are a few points of departure for such an effort.

Expand skill sets. Although CEOs often begin with a focus on both clinical and business skills, they also should refine and reemphasize their political skills and spend more time both communicating to the population as a whole and building and nurturing partnerships and alliances that extend beyond healthcare. 

Create new roles in response to the evolving CEO role. Other C-suite executives will need to take on new responsibilities in response to new roles for the CEO.

Improve internal health system coordination. Health systems should seek ways to cut costs by getting mid-level clinical and payer silos to work more closely together. For example, after the pandemic, health systems may look at ways to make better long-term use of virtual visits and messaging communications tools. What they find  may lead to both staffing and incentives changes.

Explore opportunities for cooperation to address health system challenges. Health systems, the communities they serve and others may be able to work together more closely on social determinants of health. Health systems are demonstrating that they can circumvent competition in some spheres to promote cooperation. Health systems, communities and states have long cooperated on addressing selective issues, such as obesity. More recently, health leaders have become sources of authority on issues such as vaccines and masks. Next, health systems may be an important influence on the role of science in society.

Integration after COVID-19

COVID-19 put a pause on broad industry attention to the evolving role of integrated health systems. But long before the pandemic, the concept of an integrated health system was due for refinement and selective retooling. Now, as the pandemic begins to occupy less of the total attention span, we have a new opportunity to discover just how valuable a future integrated health system can become. 

Coming out of the pandemic, we are likely to add, not reduce, the forms of community and integrated health system cooperation. This trend also will likely stretch the health system leadership team even further.

About the Author

Keith D. Moore, MCP,

is CEO of McManis Consulting, Denver, and a member of HFMA's Colorado Chapter.

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