In April, Linda Henman and Deborah Perkins published a book entitled Healthy Decisions: Critical Thinking Skills for Healthcare Executives, which challenges the status quo, arguing that the success of healthcare organizations hinges not on abstract concepts like "culture" but on the concrete decisions executives make. Drawing from real-world experience with large systems like Mercy and Banner Health, specialty hospitals like Ranken Jordan Pediatric Bridge Hospital, insurance companies like Blue Cross Blue Shield, and nonprofit elder care systems, the authors provide a practical guide to help healthcare executives make the tough decisions they can’t afford to get wrong.
When I spoke with Linda this month, I asked her: "What are the biggest mistakes healthcare executives make regarding decision-making and leadership?" Here is her complete answer:
The single most catastrophic—and astonishingly common—mistake healthcare executives make is undervaluing their workforce. Not on paper, of course. On paper, they wax poetic about people being their greatest asset. In practice, they slash staffing, ignore burnout, and treat frontline engagement as optional.
Let’s look at the wreckage.
Hahnemann University Hospital collapsed under its own weight in 2019. Leaders gutted staffing and fiddled with spreadsheets while credibility—and then patients—walked out the door. This resulted in a full shutdown in a city that needed that hospital.
Ascension Health, one of the largest systems in the country, thought it could cut its way to profitability. That meant layoffs and razor-thin staffing, even in clinical settings. They didn’t get the results they intended. Instead, the decision caused lawsuits, strikes, and a shattered reputation.
Providence faced strikes and the massive exit of nurses because executives didn’t listen. Executives suspected burnout, but they ignored the warnings for too long. Travel nurse overreliance, plummeting morale, and public embarrassment resulted.
Even public systems like NYC Health + Hospitals remain hamstrung by hiring delays and morale freefall. If you can’t staff behavioral health in New York City, you don’t have a workforce problem; you have a leadership problem.
And then there’s MetroHealth, where the headlines address lawsuits, not life-saving care. When the executive team implodes, culture does too.
Some of these organizations have changed leadership and slowly started the recovery process, but others never will. In turbulent times, no one will recover from hiring mistakes, inaccurate strategic focus, or underdeveloped succession planning.
Executives don’t create culture at a board retreat. Culture forms when executives use advanced critical thinking skills to solve problems they’ve never faced before. They must first start by seeing their workforce not as overhead but as a leverage point. Underinvest there, and you’re not saving money—you’re setting a match to your margins.
Start with the best people delivering the best care. Ignore that, and you’ll join the list above—not as a cautionary tale, but as a case study in how to lose an empire by winning a spreadsheet.
What do you think of Linda's perspective? Do you agree with her regarding the mistakes made by these health providers? Have you worked in organizations that have made these mistakes?