Leading Health Care in Disruptive Times

Kelly Rakowski

Kelly Rakowski, MHSA ’93

President, Leadership and Search Solutions, AMN Healthcare


We are at a pivotal moment in health care as we must simultaneously find ways to reduce total health care spending while also delivering greater value and serving more citizens. These often competing pressures and lack of overall progress require new ways of delivering care and engaging health consumers. Success in this dynamic climate starts and ends with our leaders.

The rising costs of health care and size of the industry have attracted new entrants and disruptive forces. We have to drive change and be disruptors ourselves. Health care leaders have to embrace change, use all of their tools, and discover innovative talent across our health systems to stay relevant. Health systems are vulnerable right now—greater demands, fewer resources, regulatory uncertainty, and increased competition—so the pace of change is accelerated.

Technology alone will not solve issues.

Change in today's environment includes embracing technology to improve care delivery, enhance the patient experience, and engage patients in the ways they engage other parts of their lives. And, though it seems counterintuitive in this time of rapid technology innovation and growth, it is even more important to address the human side. Technology alone will not solve issues. Leaders need to help employees and caregivers adopt changes and work differently while staying empathetic to patient needs. Leaders determine who gets hired, what investments are made, and what direction their organization takes. They need to stay committed to improvement and open to new ideas.

Focused on Change Management

Transformations are challenging to any organization, even more so in health care, which is highly regulated and highly specialized. As the industry consolidates, health systems become larger and more complex operationally, making change more difficult. This is not necessarily unique to healthcare—other industries have tackled and solved complex problems. And I've seen many organizations introduce solutions from outside the health care industry. For example, Virginia Mason Health System adopted a lean production approach from the auto industry, resulting in significant quality and performance improvement.

If the banking industry could solve for this globally, why not look to them for best practices?

Health care often lags behind other industries in adopting new technological approaches, such as interoperability, where health information systems work together across organizational boundaries to provide better delivery. If the banking industry could solve for this globally, why not look to them for best practices?

On the flip side, health care organizations are really good at staying focused on the why of our work. Most people who pursue careers in health care have a passion for serving others. This passion creates purpose and provides motivation to improve. I find that staying focused on aspirations of service and transforming health care, rather than on the company's financials, often results in improved performance overall, and the company's needs follow suit.

I've worked in consulting and services to health care for 25 years now, and no two days have been the same. Change management requires empathy, patience, humility, and creativity. Networking deeply within the field and broadly across other industries has helped me support truly innovative organizational transitions. Most importantly, change management centers on the human side, especially the caregivers and employees at the center of each change. I'm so grateful that my most recent work at AMN Healthcare is focused on workforce development—identifying and matching talent to organizational needs and mentoring our young and future leaders in the industry.

The Value of a Diverse Leadership Force

The focus today on diversity in leadership is extremely encouraging—and necessary. We need leaders who can build and manage diversity of all types: experience, views, demographic, and career background. We need leaders with diverse approaches and perspectives. We need leaders from other industries to provide fresh solutions. And these leaders need to integrate with the deep expertise of our clinicians and health care operators. The workforce is changing, populations are changing. We need people in leadership positions who can understand and relate to these new dynamics so we can approach and solve problems in new and innovative ways.

This is not just about hiring that one individual who's got great ideas.

This is not just about hiring that one individual who's got great ideas. It's about the whole structure of an organization embracing diversity at all levels and in all definitions of the term diversity. Organizations have to commit to diversity for the long term, and public health as a field has to start early in the education system to recruit and develop diverse talent with the skills and training to address our current and future public health needs.

Let's also think about attracting third- and fourth-career people into health care leadership. Can we promote not only through experience but through skills? Who understands technology but not necessarily health care? These are challenging issues, but given our talent needs, determining solutions to accommodate this type of retraining will be necessary and hopefully transformational.

Recruiting Diverse Talent

Perhaps the biggest challenge in health care today is around talent. We have too many job openings and not enough quality candidates. We have serious talent shortages across the industry, especially in clinical positions—nurses, physicians, allied professionals. And the outlook five to ten years from now is more troubling. Training programs are not keeping pace with industry needs. Low unemployment rates don't favor health care—it's a complex industry, and time and cost for education can seem daunting to prospective students and young professionals considering a career in health care.

Diversity—in all definitions of the word—has to become a centerpiece of health care staffing and leadership needs.

We need to find ways of addressing this and turning these challenges into opportunities. This includes reengineering processes and staffing models to be more efficient, utilizing technology and artificial intelligence to "work smarter," and focusing on retaining talent. We need to redefine health care and how we meet the needs of the population. Housing and socioeconomic conditions have a big impact on demand for health care, yet we have trouble influencing these social determinants of health. Where are the creative spaces for alleviating social determinants of health while also recruiting new talent into the workforce? The field is adjusting to ideas around treating the whole person, so as we engage multiple partners in addressing total health needs for a single patient, perhaps we can find new talent streams as well.

Diversity—in all definitions of the word—has to become a centerpiece of health care staffing and leadership needs. Recruiting, developing, and retaining diverse workforces is imperative if we are going to continue to serve a growing and changing population.

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