Elizabeth Kolbert, author of The Sixth Extinction: An Unnatural History, wrote, “The history of life ... consists of ‘long periods of boredom’ interrupted occasionally by panic.” But a hugely disproportionate amount of change happens during those brief moments of panic.
The COVID-19 pandemic was a black swan event that, combined with other global issues, warrants organizational self-examination, re-thinking and re-alignment of local strategy, partnerships and operations in concert with the global agenda—sustainable development goals. Among the many lessons to harvest from the confluence of global health challenges is the fundamental premise that we—our local communities—are part of one global community.
The top challenges cited by hospital CEOs—workforce, value (margin plus performance) and behavioral health—all have deep global connections. Worldwide digital communication and learning technology, supply chains, war and viruses (both disease and cyber) all intimately connect us and health in ways that were previously not as apparent, impactful or urgent. Our organizations’ connections to global issues transcend traditional health dimensions of space/geography, time/generations, industry sectors and cultures/norms. The veil over the line-of-sight connection between local health decisions and global health security has been lifted.
In short, health is global—and so is healthcare.
So what’s a CEO of a healthcare organization to do differently? A short list of leader actions for adapting locally to align globally includes demonstrating the humility to reset our mindset and the courage to question assumptions. Regarding our perspective on key global issues, what questions should health leaders be asking of their board, team and community members?
Questions for our boards
Most key measures of U.S. health performance are in a worse quartile compared to that of other high-income countries in such areas as rates for maternal mortality, obesity and suicide despite double the investment in healthcare. The U.S. healthcare industry’s chronic symptoms around labor, margin and health performance are reflected in escalating challenges to the not-for-profit charitable status of hospitals.
Contrary to the lack of federal standards for hospital community benefit, the “B corps”—the Sustainability Accounting Standards Board (SASB), in complement to the Financial Accounting Standards Board (FASB), and the International Sustainability Standards Board (ISSB)—have matured environmental, social and governance accountability to balance profit and purpose more in line with the global agenda. This warrants revisiting the hospital governance model and our definition of “value” or “bottom line.”
Here are questions to ask our boards:
- How can we stimulate generative board dialogue for a dramatically different global context?
- What is our role and responsibility in improving health and preventing disease in our community? How do we collaborate with city/county/state health planners to achieve that?
- How do our annual goals and strategic plan align with the United Nations’ sustainable development goal of health for all? How do they advance at least one of that goal’s 13 targets and 27 indicators. And how do they embrace the UN Global Compact?
Questions for our teams
Employee stress globally remains at a historic high. The majority of the world’s workforce has reported some level of intent to quit, according to Gallup’s 2023 State of the Global Workplace report. Calls for justice, diversity, equity and inclusion reflect calls for global awareness and cultural understanding.
With that, here are questions to ask our teams of providers, employees and managers:
- How can we support self-empowerment to align and unleash human energy?
- How proud and personally engaged are our team members in our organization’s effort to lead by example to “lean green” and advance health for all?
- To fulfill our role, what capabilities need to be developed and/or strengthened?
Questions for our community
Climate change is a health emergency, and health needs to be the center of climate action. “The 2020 report of the Lancet Countdown on health and climate change” (log-in required) and the 2022 Nature Medicine article, “Putting health at the center of climate action,” make this clear. Contrary to the mission of health providers, if healthcare were a country, it would be the fifth-largest contributor to climate pollution, nearly 1/20th of global emissions.
Here are questions to ask our communities:
- How can we help inspire trust and engage in collective impact with “glocal” health thinking?
- If all organizations were moving at the same pace as ours, would the world achieve net zero emissions by 2050?
- With whom in our communities should we partner differently to realize our role in health improvement, for example, to develop a collective community needs health assessment and mobilize stakeholders on shared priority health matters?
According to polio vaccine developer Jonas Salk (who never patented his discovery to assure wide access), the most important question we can ask ourselves is, “Are we good ancestors?” The questions above are intended to catalyze local actions for global solutions around owning your organization’s role in broader health performance, aligning for local-to-global outcomes and executing with a global mindset culturally and operationally. By thinking globally while working locally, we can help forge a societal path to protect the health of people, public and planet.
Rob Thames, LFACHE, FHFMA, is president of RTAdvisors, a global health consultancy with a mission to advance the United Nations’ sustainable development goals, particularly health for all. He has led hospitals and healthcare systems as CEO/COO, consulted nationally and most recently led the consulting arm of a global health nongovernmental organization to improve health in low-resource countries.