(August 2022) – Hospital executives face significant leadership challenges including financial shortfalls, constant vigilance in improving quality and service excellence, recruiting and retaining a strong workforce, and understanding and meeting changing consumer preferences. Years before the COVID-19 pandemic, it was recognized that health care was a complex and challenging environment, which required resiliency from hospital leaders. "Resilience is being able to deal with adversity," explained Michael Dowling, the president and CEO of Northwell Health, when interviewed by Mike Kearney, for the Deloitte Resilient podcast Health Care: Responding and Recovering with Resilience. Dowling told Kearney that he believed in the adage, "You don't fail when you lose. You fail when you quit." Dowling said while it is difficult to work through unprecedented challenges, building resilience throughout the enterprise enables an organization to get up after being knocked down and muster the strength to keep moving forward.

Author Angela Duckworth, who has studied both resilience and "grit" explains it this way. "Grit is your ability to pursue your goals with passion and perseverance as if they are a marathon, not a sprint." "Likewise, the qualities of resilience and patience are essential contributors to success, especially in the face of adversity."
Health care leaders do not become resilient or develop grit by chance. They build their capacity for overcoming challenges and leading with vision by purposefully practicing key leadership habits that work together to ensure long-term effectiveness. Resilience is key to enhancing the quality of care, quality of caring and sustainability of the health care workforce according to studies published in Academic Medicine.

Developing Leadership Resilience

How do hospital CEOs and health care leaders develop resilience? In many ways, the techniques are similar to, if not the same as, those used to reduce physician burnout and increase employee well-being. A poll conducted by the Medical Group Management Association in April 2021, asked health care leaders, "Have you invested in your own leadership resiliency training in the past year?" Nearly half said "yes." The biggest takeaways or lessons learned among those who responded "yes," included:

• Recognizing self-care as being essential to take care of and lead others.
• Being protective of your time.
• Leading with compassion and remembering that people are an organization's most valuable asset.
• Investing in oneself and focusing learning on helping others achieve success.
• Acknowledging that taking it slow at times is important to avoid being burned out. As another health care leader noted, "Respect, kindness, compassion and humility are key factors in the success of well-run health care organizations."

The Institute for Healthcare Improvement believes an important way to counteract burnout and build resilience is to focus on restoring joy to the health care workforce. Burnout leads to lower levels of staff engagement, patient experience and productivity, as well as an increased risk of workplace accidents. Lower levels of staff engagement are linked with lower-quality patient care including safety, and burnout limits providers' empathy — a crucial component of effective and person-centered care.

IHI makes available to all hospitals videos and resources like a quick reference guide on "psychological PPE" and case examples. All are intended to serve as a guide for health care organizations to engage in a participative process where leaders ask colleagues at all levels of the organization, "What matters to you?" — enabling them to better understand the barriers to joy in work and co-create meaningful, high-leverage strategies to address burnout and resilience.

Additional insights into ways in which leaders and individuals in health care can increase their resilience come from an in-depth study reported on in Academic Medicine. This study showed that individual factors of resilience include the capacity for mindfulness, self-monitoring, limit setting and attitudes promoting constructive and healthy engagement with (rather than withdrawal from) the often-difficult challenges at work. Cultivating these specific skills, habits and attitudes to promote resilience is possible not only for medical students and practicing clinicians but also for all health care workers and hospital leaders. The study noted it is in the self-interest of health care institutions to support the efforts of all members of the health care workforce to enhance their capacity for resilience. It increases the quality of care while reducing errors, burnout and attrition.

The Role of Boards of Trustees in Supporting Resilient Organizations

Boards of trustees will be successful in supporting the critical issues that must be addressed if they understand the resilience component of leadership effectiveness. Boards paying close attention to practicing leadership habits based on best practices will find their governance processes will improve, their leadership skills will be enhanced, and the quality of their governance decision-making and strategic focus will be sharpened. One of the most important leadership habits is to be a board actively dedicated to supporting the efforts of hospital leaders as they work to enhance their personal capacity for resilience, as well as enhance the capacity of everyone working together to provide high-quality and compassionate care.

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