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From one battlefield to another: How to foster leadership and retain top performers

This is the second post of a four-part series on applying military lessons to the healthcare workforce. 

Blog #1: From one battlefield to another: Improving caregiver well-being in the face of COVID-19 


Most soldiers join the army out of a sense of patriotic duty. But during combat deployments, a soldier’s purpose quickly shifts from their duty to country to the people around them. They don’t fight for patriotism; they fight for the members of their team.  

During the pandemic, we also saw what truly motivated the healthcare workforce: their colleagues in the trenches with them. For example, a nurse doesn’t show up for their ninth 12-hour shift in 10 days out of a commitment to the organization or its mission. They show up because they don’t want to let their teammates down. Therefore, the strongest interventions will be the ones that directly impact the organization at the team or unit level. 

High reliability organizing principles are designed to strengthen teams by providing a platform of safety and confidence to do the right thing every time and empower individuals to speak up when they see something wrong. These aren’t philosophical concepts. We aren’t simply asking people to “be engaged.” Much like soldiers, healthcare workers demand authentic and honest dialogue, action plans, and resources. That’s why Press Ganey’s high reliability toolkit is filled with resources that real people can use in the real world to get real results—when it really matters. 

Similarly, generals don’t win battles—captains and sergeants do. A general develops strategies and provides resources to “shape the battlefield”—i.e., to change circumstances into your advantage. Only leaders on the front lines can assess and react fast enough to win. In healthcare, these core leaders are the managers and directors who run things like the ICU or the clinical laboratory. Unfortunately, no one wants to take these jobs anymore. Today, it’s especially hard to get people to volunteer to be nursing leaders because they can see how stressful the job is and how little preparation and support they can expect. 

So how can we turn this around? 

5 lessons from the military to attract, grow, and retain healthcare talent

The military recognizes that it is critical to invest in strong leadership. A key part of my job as an officer in the U.S. Army was to develop the junior talent around me. Supporting the next generation of healthcare leaders—and reinforcing key best practices among them—has a ripple effect across an organization that will drive the results you want. 

1. Train core leaders for the job. In the military, your schooling prepares you for the level of leadership expected at your next rank. But we tend to do the exact opposite in healthcare. For example, we might promote a high-performing X-ray technician into a position of leadership over a complicated department without adequate leadership training. This sets promising leaders up for failure when, in reality, we owe them formal instruction on how to read a budget, use scheduling software, coach their team members, and other valuable skillsets. 

2. Remove some of the burden from these positions. Our administrative processes can be highly inefficient from the core leader’s point of view. For example, some of my clients tell me it takes a full day to process their timecards. But those kinds of tasks shouldn’t require that much time or effort! What if we used lean principles to streamline the process? What if we hired a scheduling clerk that coordinated timecards for the entire hospital? What could our leaders do with that time? 

3. Set better expectations for our core leaders. New leaders often think they need to sacrifice themselves to support their team members—and they wear themselves out doing so. Let’s not forget the lieutenant who used all of his energy preparing for battle that he slept through it. We can help our core leaders understand just how physically demanding good leadership is. They also need to understand to prioritize their well-being first before they take care of others, because we need them for the long term.  

4. Give leaders the time, space, and support to rest. Some have been working without a meaningful break for the last two years. Even the military doesn’t expect that level of around-the-clock focus! Meaningful breaks are built into the job: Every soldier gets two weeks of leave halfway through each combat deployment. We need to facilitate similar periods of respite for our core leaders. One solution: Create a hospital-wide calendar that allows everyone to take time off over the next year. 

5. Help core leaders regain their “calm.” During my time in the army, I ran several deployable medical units under very stressful conditions. And 50% of my role in those situations was to appear calm. Whenever tensions among my soldiers started running high, they would look at me and think, “Well, the captain isn’t worried. We must be fine.” But you can’t just tell someone to be calm. You must provide the proper training and support to help them build the skills to find their inner strength and project their calm, even in the face of great adversity or uncertainty. 

For more information on high reliability organizing and leader coaching and support, connect with an expert.

About the author

Mike Hall is a Senior Associate at Press Ganey HPI, a firm that specializes in improving human performance in complex systems using evidence-based methods derived from high-risk industries. He brings over 23 years of experience transforming healthcare operations by creating tightly knit and successful teams through direct leadership or influence. He has successfully partnered with leaders at all levels to design and implement large-scale, complex change initiatives. Mike spent 10 years at Providence Health & Services, culminating in his recruitment by the President of Operations to synchronize systemwide and corporate operations and improve hospital operations in a $22B fully integrated health system with 100,000+ employees, 829 clinics, and 52 hospitals in 6 states. Mike led the provider contracting team at Kaiser Permanente in Hawaii and has provided consulting services to healthcare organizations. Prior to his civilian healthcare career, Mike spent 10 years as a Medical Service Corps officer in the U.S. Army, providing integrated medical support to combat and humanitarian operations, including deployments to Afghanistan and the Demilitarized Zone in the Republic of Korea. ​

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