As 2021 draws to a close, Advisory Board's international research team looks at some of the things they were surprised by after a year of conducting research.

Covid-19 changed leadership in health care forever—and for the better

Alex Polyak, Consultant

One of the biggest surprises for me was how much leadership in health care has changed over the last two years. Since the outbreak of the Covid-19 pandemic, health care leaders have had to respond to the greatest period of transformation in the history of health care—and there are profound lessons to be recognized in how leaders have navigated this unprecedented era of stress and uncertainty.

Global ‘systemness’ case study compendium and discussion guide

It's important that we acknowledge these changes and celebrate the headway we have made towards truly adaptable, resilient, and engaging leadership. To do so, here are 10 questions that can help you take stock of how your own approach to health care leadership has changed since the pandemic.

1. What new relationships with other leaders have you developed?
   • How has the experience of cultivating these relationships helped you develop a system focus?
2. What tasks did you delegate to others that you would never have thought to do so previously?
   • How can you further delegate operational responsibilities to help you focus on strategic responsibilities?
3. What tasks did you de-prioritize or stop doing altogether, and what was the impact?
   • How can you take time to routinely de-prioritize/re-prioritize work in a way that enables you to focus on strategic responsibilities?
4. What new communication styles did you or your organization adopt?
   • How can you embed more transparent communication into your leadership style to boost employee engagement?
5. In what ways did you demonstrate vulnerability in the workplace that you would not have shown previously?
   • How can you incorporate vulnerable authenticity into your leadership style to boost employee well-being and engagement?

New risk calculations underpinning site of care shifts are pushing the boundaries of care delivery

Isis Monteiro, Senior Analyst

One thing that surprised me from our team's latest research on site of care shifts is the level of care that providers are moving out of the hospital campus. Conditions we previously thought impossible to manage without face-to-face interactions in an acute environment are increasingly being monitored or treated virtually or in community settings.

Emerging idea: Informal caregiver flexible working arrangement

Providers' and patients' willingness to experiment with where and how they deliver and receive care also hints at a recalculation of risk—and services previously considered too risky to move out of the hospital are now opportunities and are the new frontiers of health care delivery. Two examples that illustrate this are remote monitoring programs/apps for patients with high-risk pregnancies and at-home cancer care models.

Examples of the former include Mater Health's gestational diabetes management app—which enabled the system to shift a large cohort of patients entirely to virtual—and the pilot studies underway at Sheba Medical Center's Women's Health Innovation Center that aim to keep patients with high-risk pregnancies out of the hospital until delivery.  

And as for cancer, in our 2021 oncology global market trends webinar we examined the barriers and risks to delivering cancer care in patients' homes, and provided examples of organizations that successfully mitigated these barriers. Among them include Australian start-up Chemo@Home, which provides home infusion services (including chemotherapy, immunotherapy, and other intravenous treatments) and Penn Medicine's oncology-at-home model.

As we look ahead to the next few years of health service redesign, I am curious to learn what services or cohorts of patients represent health care's next "impossible" feat.

The Hippocratic Oath stops at climate change

Miles Cottier, Analyst

When I first started researching the relationship between climate change and health care, I was both surprised and disheartened to see how significantly the sector's emissions impact climate change.

Bushfires, burnt homes, black skies—how one hospital helped staff emotionally recover from a climate disaster

The global health sector's carbon emissions account for 4.4% of the world's total emissions. As Health Care Without Harm put it, "if the global health sector were a country, it would be the fifth-largest emitter on the planet." Health care is an active enabler of climate change, not merely a passive bystander. And climate change makes people sicker. This means greater usage of health care which at existing emissions rates, means greater emissions and sicker people. That is the cyclical nature of the problem.

This, for me, goes against the very principles that health care is grounded on. "First, do no harm" are the words spoken by clinicians the world over that form the foundation of modern bioethics. Health care practitioners are bound by this commitment, even at those difficult moments when the only way to honor the oath is through doing nothing. But when it comes to climate change, it is precisely health care's inaction that is causing it to break this golden principle. 

Health care must break out of the cycle—and soon. In the last year alone, health systems across Germany, Belgium, Canada, and Spain have had to respond to unprecedented natural disasters. Health care organizations need to find ways to reduce emissions and waste, build partnerships that enable both national and community-led sustainability efforts, and develop a culture that incentivizes and encourages sustainability from the ground up. If we don't become part of the solution, inevitably, we will end up as victims to the problem.

Long Covid has the potential to change how we treat and talk about chronic illness

Paul Trigonoplos, Director

What continues to surprise me is that the emergence of long Covid may push our industry closer to truly treating the whole patient, even if that push is only incremental.  

11 surprising ways the pandemic changed health care, according to Advisory Board experts

Our societies have long relegated chronic autoimmune diseases as unlucky problems that pharmaceutical companies or grant-funded researchers will have to solve. Chronic illnesses such as lupus, rheumatoid arthritis, and Lyme disease are poorly understood, expensive to manage, can involve dozens of specialists, and often do not have standard care pathways.

These inefficiencies are a consequence of how our health systems are set up. In a world where we are largely paid for productivity, these types of autoimmune issues are too often seen as a cost to avoid, and thus would never get the incentives they need from to bring them out of the shadows of medicine.

But I think that is changing, in part due to the emergence of long Covid. We are seeing a global surge in spending to help former Covid-19 patients manage and recover from its long-term effects, and that attention is paying dividends to other autoimmune diseases as well. And in the zeitgeist, a new chronic disease narrative—one that says "this could happen to anyone"—is waking up society to care more about chronic and autoimmune illnesses.

With it has come a new language that better communicates the minutiae of what a chronic illness patient experiences day-to-day, which helps society better empathize with those patients. And for providers specifically—we are seeing a surge in provider-owned long Covid clinics that may serve as test beds for how other autoimmune disease care models and clinics can succeed in the future.

Covid-19 was the ultimate stress test for international health systems, and they performed as they were designed to

Vidal Seegobin, Managing Director

The insight in global health care that surprised me the most in 2021 was that, while it might not feel this way, health systems rose to the challenge of a pandemic and performed exactly as they were designed to.

Covid-19 tested national health systems—and they responded largely as designed

There's a lot of hand-wringing both politically and in health care on what should be done to improve health care performance. But looking at Covid-19 as a universal stress test, we can say that each health system clearly had their own strengths and drawbacks when it came to managing infection and rolling out vaccinations.

What's even more striking is that these strengths and drawbacks are often connected. Market-based systems did a better job at finding and using care capacity individually but struggled to cooperate as a continuum. Centrally managed systems moved in lock step through unified decisions but struggled to diversify their solutions.

On the balance Covid-19 showed that there is no perfect health system. Instead, our health systems are designed around tradeoffs. We can make changes and adjustments on where we want to excel at, but we must also be cognizant that excelling at one element will mean we're less strong on another.