Some of the best leaders I know run community hospitals…

This is going to be good year and it is going to be a hard year.

Regulatory and market uncertainty will be a fact of life for the foreseeable future.

That from a very talented consultant who said that Thursday was a whiplash day — deals that had been confirmed were cancelled, projects postponed were suddenly reaffirmed and consulting engagements that were nearing completion were suspended.

uncertaintyOn the provider side, hospital executives have, and will continue to experience, their own version of this whiplash experience.

Uncertainty is a fact of life that will reshape how executives do their jobs.

That there is uncertainty in the air should not be a surprise to anyone.  There is nothing that fuels uncertainty more than a real threat of transformative change to a business model and a rambunctious presidential primary election cycle.  I will not comment on the elections except to say that I think we are witnessing a slow moving, very big train wreck.

Uncertainty.   It destabilizes markets and slows down the entire marketing/sales/business cycle.  Executives hate trying to make bets on costly initiatives when the future is muddled by regulatory, market and political uncertainty.

In healthcare, the challenges of the post great recession economy are more acute given the impact of the Affordable Care Act and the decision by many states not to accept expanded Medicaid coverage.  If that was not enough, ACA’s new reimbursement incentives are pushing hospitals away from their bread and butter revenue —  volume-based inpatient care. More than a few hospitals are struggling to adjust to this shift.  This is all complicated by the bigger social phenomenon of large numbers of Baby Boomer executives who are moving — in some cases running — to retirement at a time when some experts say there is a leadership shortage.  This will, no doubt, escalate the number of health system/hospital mergers — some smart, many not — which will only hinder the effort to achieve the important goal of lowering costs, improving the quality of care, enhancing patient satisfaction and improving safety, since mergers rarely, if ever, accomplish any of these objectives.  (If anything, studies show, that mergers result in not only loss of local control over a valued institution, but in higher costs for consumers.)

For those healthcare executives with 10 or more years to work, the certainty of uncertainty is a daunting challenge for effective career management.  Careers will no longer happen, they will have to be made using a combination of savvy career strategies and tools, a relentless focus on enhancing your brand and a consistent record of exemplary performance. That said, beware there are some potholes to avoid.

Some executives confuse the commonly used term “laser focus on results” as an authorization for a “take no prisoners, my way or the highway” leadership style.  My view is that this approach to survival — keeping one’s job — would be a huge mistake unless you work for a company that places financial performance ahead of quality of care, safety and satisfaction.  Yes, companies with these upside down values exist and executives should tread carefully when considering an offer for employment. Working for a values challenged company, regardless of their tax status, size or financial success can be a real setback. Sacrificing your own values for the sake of a paycheck and job security is a bad place to be — personally and professionally.

When you are thinking about your career, I encourage you to think about adopting this approach: yes, healthcare is a business but it should be, it must be, a business with a conscience that puts the needs of the community first.

There are going to be plenty of hard times ahead but with the focus on being good stewards of our resources and keeping our eye on the real prize, this will serve all of us well.