Which is harder to lead: a turnaround or a high-performing hospital?
I’ve had the opportunity to lead organizations in both circumstances, and the answer is less obvious than it sounds.
A turnaround is difficult because the problems are real and the consequences are immediate. Quality may be slipping. Financial performance may be deteriorating. Physician relationships may be strained. Employees may have lost confidence that the organization can succeed.
But a turnaround also gives a leader something valuable: urgency.
When performance is clearly unacceptable, people understand that the status quo cannot continue. The organization has permission to question long-standing assumptions, change leadership structures, redesign processes, establish new expectations and move quickly. The case for change has already been made.
At Adventist Health Bakersfield, the organization had experienced serious regulatory and performance challenges before I became Market President and CEO. Rebuilding required much more than correcting individual metrics. We had to restore confidence, strengthen accountability and create a shared belief that the organization could become exceptional. Over time, patient safety improved from a Leapfrog C to an A, the hospital achieved Top 5% national quality recognition, physician engagement reached the 90th percentile, and financial performance strengthened substantially.
Success creates a different leadership problem.
In a high-performing organization, there may be no obvious crisis demanding action. The metrics are good. The team is proud of what it has built. Physicians and employees may be understandably protective of practices that helped produce success.
That is precisely when leadership judgment becomes more difficult.
The leader has to distinguish between what should be protected and what must continue to evolve. Change too aggressively and you can damage the culture, relationships and operating disciplines that created strong performance. Change too cautiously and yesterday’s strengths can quietly become tomorrow’s constraints.
That requires curiosity rather than complacency. Where is performance beginning to plateau? What are patients and physicians going to expect three years from now? Which service lines need to be strengthened before competitors expose the weakness? What capabilities will the organization need that it does not have today? Which processes worked at the current scale but will not work at the next one?
It also requires humility. A new leader entering a strong organization should not assume that visible change is evidence of leadership. Sometimes the most important decision is to leave something alone, understand why it works, and protect it.
But stewardship is not preservation for its own sake.
High performance has to be renewed. Markets change. Clinical practice changes. Technology changes. Workforce expectations change. Organizations that wait for declining results to justify adaptation have often waited too long.
So which is harder?
A turnaround demands courage, urgency and disciplined execution. A high-performing organization demands restraint, foresight and the willingness to create constructive urgency before a crisis creates it for you.
The leadership challenge is different. The obligation is the same: understand what the organization needs now, see what it will need next, and help people move from one to the other without losing what made them successful in the first place.