March 25, 2025: Kate Gamble and Sarah Richardson discuss how fear-based leadership impacts healthcare organizations. They explore how fear stifles innovation, paralyzes decision-making, erodes trust, and contributes to burnout. Key takeaways include strategies to foster psychological safety, implement data-driven decision-making, and promote cross-functional collaboration to overcome fear-based leadership challenges in healthcare IT.
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Today in Health IT, we're discussing the consequences of fear in healthcare leadership. My name is Kate Gamble, and I'm Managing Editor at This Week Health, where we host a set of channels and events dedicated to transforming healthcare, one connection at a time.
And I'm joined by Sarah Richardson, President of Community Development. Sarah, welcome to the show. Hi, Kate. How are you? I am good, and I'm anxious to get into this discussion. So today we are delving into the consequences of fear in healthcare leadership. In the article, Dr. Michael Wagner, President and CEO of Care New England, suggests that we don't talk enough about fear, despite the fact that it directly impacts decision making, innovation, security, and ultimately patient care.
So we're going to break that down and give you some key takeaways that you can bring back to your team, board, or peers. Let's start with innovation because one of the biggest consequences of fear based leadership is that it shuts down creativity leaders often operate from fear to avoid risks, which means new ideas get dismissed before they even have a chance. So if you're a healthcare it leader, this is especially critical because healthcare is moving so quickly that if we're not continuously experimenting with the hottest topics like AI.
Automation and cyber security advancements, we are likely going to fall behind. Yeah, that's a good point. So let's put this into perspective. Why do so many health care organizations struggle with ER optimization? There's a lot of reasons, but we know that leaders fear disrupting current workflows. They worry about downtime, user pushback, and unintended consequences.
All valid concerns, but avoiding change is not a solution. And what happens is that teams are going to go ahead and stick with these inefficient processes and clinicians become frustrated and patients don't get the best experience possible. And if we zoom out, we see this in cybersecurity as well, because CISOs know that implementing zero trust security models is crucial and leadership will often delay action because of fear of the cost, fear of the workflow impact, or resistance from staff.
However, what is worse than all of that is the short term discomfort that could also lead to a major data breach. Exactly. So that's the question leaders need to ask. If you're listening to this, here's something to consider. Are there ideas or innovations in your organization that have been rejected out of fear rather than true feasibility concerns?
And if the answer is yes, it's probably time to revisit those conversations. And also throw out there, if it is specific to something like EHR optimization or workflow optimization, that is not something you just decide to do and then start it on a Monday kind of a conversation. It is massive planning that goes into whether you're switching out your EHR or doing these optimization workflow efforts.
They can take weeks or months of planning to effectively put them into production. And what I will share is that. If you're scared of what the outcomes might be, start with organizational change management, because we have talked about this time. And again, if you do not have good OCM in place, 70 to 80 percent of your initiatives will fail out of the and it's so easy to miss that part because it seems too routine. So fear and poor decision making, it's not going to just stifle innovation. It's also going to impact your decision making. So leaders that are driven by fear either freeze up and delay decisions to make rash self preserving choices that may not be best for the organization, you heard me laugh because it's back to the analysis paralysis or letting good get in the way of good enough and being able to launch something that is ready for your organization.
Yeah, it's no wonder that's the topic of so many books because it's just such a, it's such a huge topic for all of us, but it really does make you think. And so let's talk about cybersecurity again. If an organization experiences a ransomware attack. A fear driven leader might immediately pay the ransom without considering other options.
And conversely, an overly fearful leader might avoid making any decision at all, leaving the organization paralyzed and vulnerable to more damage. So there's that paralysis analysis you were talking about. It absolutely is because it is a real problem in health it and beyond when we roll out projects.
Have you ever seen a hospital delay a system upgrade for years because leaders kept second guessing themselves, been in that boat and it gets worse the longer you wait. So here's a practical exercise. Think about the last major decision your organization faced. Was fear a factor
and did it lead to delay, avoidance, or an overly conservative approach? And if so, how can your team move toward evidence based decision making rather than fear based decision making? So here's where trust is going to come into play, because when Fear dictates leadership. Employees are not going to feel safe speaking up.
They're going to hide any mistakes that happen, they're going to avoid difficult conversations, and they will stop contributing ideas. This all is a massive disaster, especially in healthcare, because that always on environment in which we live is not something that's going to get diminished because you are waiting to make any of these Yeah, and even patient safety could be affected. So for example, if a nurse is afraid of being blamed for reporting a near miss medication error, they might stay silent. And that silence could lead to a serious patient harm event later. And if you're on the cybersecurity team, What if a staff member accidentally clicks a phishing link? Do they feel comfortable reporting it right away? Or are they going to hesitate because they fear punishment? When you have high trust in your environment, then you can report things immediately, and this allows security teams to respond before damage is done.
This goes back to the shooting incidents that you and I covered the previous week, where if people feel safe reporting something that seems amiss, you're going to have a safer overall environment. Yeah, that in itself is such an interesting topic. And it's something we definitely hear our security leaders talk about.
When an environment is too punitive, you are going to have this effect sometimes. So leaders really do need to ask. Is our workplace psychologically safe? Do employees feel like they can report problems without fear of retaliation? And if the answer is no, that is a major cultural issue that needs to be addressed.
Fear is going to drive burnout, also going to drive higher turnover. So another major consequence of fear based leadership, burnout and turnover. So when employees are operating in a constant state of fear. Whether that's fear of their job security, fear of making mistakes, fear of leadership, it's going to take a mental and physical toll on your And when teams are experiencing high turnover, you're going to have projects that could delay security gaps, widening, and institutional knowledge is lost. So another question to ask, if your organization experiences high turnover, could fear based leadership be a contributing factor? And I'm going to lean into that whole institutional knowledge component, because every time a person walks out the door that has all that information, it's almost a guarantee it's very Rarely documented in a way that someone can just pick up that book and start flipping through the different instructions.
So be thinking about what kind of institutional knowledge gets lost, and can you do a knowledge transfer when it is inevitable that someone has resigned or is going to leave. More importantly, can you also think about what is the knowledge base look like that allows the team to keep learning in any environment?
Because Fear will prevent collaboration and integration. And these, fear based cultures tend to silo teams instead of actually fostering the collaboration that you need across the continuum. We see this with EHR interoperability all of the time. Different departments hold onto their own systems and workflows out of fear of change.
But that fear prevents seamless data exchange and better patient care. And this will rear its head. Yeah. And as. Yeah. And as. And
Yeah.
Yeah. And
You've written about this, and we have spoken to people about AppRat, and if you're not able to do that, there's so much money being left on the table.
So collaboration, though, is the foundation for digital transformation in healthcare, right? And if you don't have that, you're not going to achieve true interoperability, never mind driven diagnostics or fully integrated patient experience. So that just shows how critical that is. And you have to start thinking about how you move away from fear based leadership and create a culture of innovation, trust, and resilience.
There are three key action items. And what I will share is you may work in an organization that is fear based does not mean you cannot create your department to have those. spaces that are safe for them. So the first thing you need to do is to create psychological safety, encourage open discussions, reward honesty, and ensure employees feel safe reporting mistakes and suggesting improvements.
The second thing to do make decisions based on data. You will hear us talk about that every single time and not fear use metrics and real world. Use cases to drive decision making versus emotional or reactionary responses. And the last thing is to foster the collaboration across teams, break down silos, create cost functional teams to drive innovation and integration.
And if that does not exist in your organization, guess what? It starts with you. Those are great takeaways. And if you're going to get anything from this episode, it's this. fear is the enemy of progress in healthcare, and leaders who recognize it, confront it, and replace it with trust and action will be the ones who will drive the future of healthcare forward.
And I always like to call out the interviews that we did, and there was one that you had with Dawn Whitney who's the CEO of ElevateX Leadership Collective, and she brought up a great saying that everything we desire is on the other side of fear. And she said if you take a minute to think about that, you realize that Our own self doubts and limiting beliefs are in the way.
And that doesn't go just for individuals, but for organizations. So I thought that was very pertinent to this discussion. It is. And what she'll also share because she does a lot of executive coaching is that when you make decisions based out of fear, you will likely make the wrong decision.
And it is a spiraling effect. So great closing thought. And thank you for bringing that forward. Kate, I encourage everyone to start the conversation about how fear may be affecting decision making in your organization. Especially today when there's so much fear, uncertainty and doubt about policies and other things that may affect our health care systems going forward, and especially in the next few months as things continue to sort themselves out.
And actually tomorrow we are going to be talking about funding bill that skips measures to avert position pay cuts. So we are always right up in there with the policy discussions as that is so important to everyone. So remember to share this podcast with a friend or colleague use it as a foundation for 📍 daily discussions on the topics that are relevant to you in the industry.
They can subscribe wherever you listen to podcasts. Sarah, thank you for joining and thank you all for listening. That's a wrap.