The authors of a recent Harvard Business Review article postulated that the circumstances in which we find ourselves are going to be with us for a long time. In “Leadership in a (Permanent) Crisis” they discuss the current economic chaos and give us a sobering message: this is “not just another rough spell” and the “mix of urgency, high stakes, and uncertainty will continue even after the recession ends” (Heifitz, Grashow, and Linsky 2009). This new age, they advise, calls for “adaptive leadership” in which disequilibrium must be embraced, turbulence becomes an opportunity, and strong leaders will search out skills that reside deep in their organizations. Our lead author, Stephanie McCutcheon, captures this mindset in her observation that “leading change in a challenging healthcare environment may be more difficult than leading change during good economic times, but it does offer certain opportunities….During tough times, choosing to be highly efficient is easy.”

The HBR authors speak of chaos in the world of general business. We in healthcare face a double dose of chaos. Not only has the economic downturn taken its toll, but now health reform is upon us, lending a whole new dimension to our chaos. Whatever design health reform ultimately takes, it will unleash ongoing and deeper demand for change. As Debra Sukin writes in her feature article, “any aspect of the changes proposed (within healthcare reform) will be monumental.”

Healthcare administrators are accustomed to change. Healthcare delivery has morphed over decades. New technologies have disrupted procedures (consider the HER), public policy and financing mechanisms have evolved, consumer expectations have increased, the environment has demanded the greening of our organizations and processes--you could name many more changes. You have had to morph as well. However, today’s chaos “takes it up a notch” as Emeril would say.

So it’s a good time to consider which leadership ideas and strategies we need to hold on to, and which we need to change in order to continue to lead successfully. The deepest characteristics of the truly successful leader have not morphed, and they must not. Vision, a sense of mission, and shared values provide the underpinning for successful strategic thinking, problem solving, and leading into and through change. Each of the authors in this issue affirms the fundamental importance of these characteristics. They have held firmly to their vision and values no matter the buffeting of the surrounding storm.

Debra Sukin discusses leadership success through the prism of these core and enduring characteristics. She says decision making is easy when she approaches problems and opportunities with a strong vision. It leads to competitive advantage. Stephanie McCutcheon brings another perspective. Starting from the point of values and vision, leadership to her is about planning well and executing that plan effectively – with the involvement of one of the organization’s most important assets: its people. Some years ago I served on the board of an equestrian therapy non-profit organization. One day its founder, one of the most genuine and generous leaders I have ever met, handed me a small rectangular metal bar with the inscription “what would you do if you knew you could not fail?” That little bar sits on my desk and has “spoken” to me and to many who stop by to talk. It speaks of another characteristic that we need in the midst of chaos: courage, the willingness to step out of the proverbial box and into unknowns, to take risks. There are many unknowns in our future in healthcare, and it is going to take courageous, smart, generous leaders to guide us into and through them. Hopefully, this issue of Frontiers will provide a bit of the wisdom that you will need to take the paths that we, your consumers, need you to take. Reference: Heifetz, R., A. Grashow, and M. Linsky. 2009. Harvard Business Review, 87(7/8), p. 62-69.