What 21st century hospitals can learn from one of the 20th century’s greatest generals

Originally published Presidents’ Day 2020, The Year of the Nurse
y Arup Roy-Burman

“You don’t lead by hitting people over the head-that’s assault, not leadership.”
– Dwight D. Eisenhower, 5-Star General & 34th President

The greatest challenge of the 20th century was World War II. Nearly 10% of the US population was on active duty— every individual had a personal stake. Our nation rose to meet this challenge—and we succeeded.

While we in the US are fortunate to now be living in an era of relative peace and prosperity, we are faced with an aging population and soaring healthcare costs, with spending approaching 20% of GDP— every individual has a personal stake.  Economically sustainable healthcare is the greatest challenge of the 21st century— can we succeed?

Gen. Eisenhower led what has been described as the greatest team in the history of military battle. As D-Day approached, he warned his troops, “Your task will not be an easy one… your enemy is well-trained, well-equipped, and battle-hardened.” Battle-hardened himself in the frontlines of World War I, he approached leadership with empathy.

“Leadership is a word and a concept that has been more argued than almost any other I know. I am not one of the desk-pounding types that likes to stick out his jaw and look like he is bossing the show. I would far rather get behind and, recognizing the frailties and the requirements of human nature, would rather try to persuade a man to go along, because once I have persuaded him, he will stick. If I scare him, he will stay just as long as he is scared, and then he is gone.”

Eisenhower understood firsthand that to win, his team would need to be better trained, better equipped, and have the morale, will, and stamina to persevere.

The battle in healthcare really isn’t any different. Our “troops” of nurses are now nearly 4 million strong. Add ancillary staff, and the numbers are well over 5 million. However, training costs are exploding, turnover is rampant, and morale is falling. Leadership’s priorities are often focused on the near-term: regulatory/compliance (insuring quality by checking the boxes for standards) or financial (billing, collections, or staff reductions). Frontline “failures” evoke leadership response; day to day successes often go unrecognized. Many of our healthcare leaders have not personally felt the pains of the frontlines.  For those who have risen from the ranks, some follow the beaten path and simply-maintain the status quo; true leadership is driving change to help the team win.

The US healthcare workforce has grown dramatically, yet outcomes are lagging. In contrast, the military Eisenhower left behind has decreased in numbers (from 12 million in WWII to 1.3 million today) and is still the strongest in the world. While equipment, tactics, and adversaries are constantly changing, leadership has kept a laser-focus on incorporating new technologies and practices to constantly train and equip their troops, keeping them engaged and at peak performance. They are doing more— with less.

It is time for our healthcare leaders to rise to today’s challenge. Sustainable high-quality healthcare is within our reach. However, this will not happen with the status quo. Success will require a team effort, and our frontline staff must be equipped with the tools they need to give effective, efficient care. Let’s start the journey with empathy, and continually ask ourselves: “How can we better support our troops?”