In a landscape saturated with billion-dollar technology investments and ceaseless waves of innovation, U.S. healthcare organizations still grapple with a stubborn, costly paradox: some of the biggest improvements in safety, quality, and cost effectiveness don’t come from cutting-edge tools or shiny new robots. They come from the less glamorous, but far more impactful, art of leadership and organizational coordination.
That’s not just consultant-speak. In this episode of the American Journal of Healthcare Strategy podcast, Christopher Myers, PhD—Professor of Management, Medicine, and Public Health at Johns Hopkins University—cuts through the hype, showing why improving how people lead, coordinate, and communicate can outperform investments in new devices or drugs. If you’re an executive, physician leader, or system-level decision-maker, understanding why “who is in the room, and how they work together” matters more than the gear in the room is foundational to your next major improvement.
This conversation is a rare deep-dive into the tangible, often overlooked levers of performance hiding in plain sight. Myers offers not just analysis but practical ways to bridge the infamous gaps between clinicians and administrators, highlighting opportunities for leaders to create value—without hiring, buying, or building a thing.
Short answer: Leadership isn’t “owned” by anyone—it’s diffused, often invisible, and usually falls between the cracks of busy clinical and administrative roles. The result? It’s rarely a line item or a focus of structured training.
“Leadership is sort of implied or expected by everybody, but it's not anybody's one focus or job... it's something that spans all of those different domains, but it isn't anybody's core focus or responsibility, so it gets left as kind of this, well, we'll learn that on the job,” Dr. Myers explains.
Healthcare has evolved as a technical field, with each discipline—physicians, nurses, pharmacists—training to be “deep” in their own specialty. “We know that it's an incredibly complex endeavor... but we don't often devote as much time to thinking about the impact of leadership as we do to, say, the impact of technologies or new drug developments,” says Myers. The temptation to throw money at new tools persists because it’s tangible and “belongs” to a department, while leadership training is either siloed or, worse, viewed as soft.
Key drivers behind the leadership training gap:
No “home” for leadership: Neither strictly clinical nor purely administrative.
Overloaded curricula: Clinicians already face packed schedules and endless requirements for continuing education.
Visibility bias: It’s easier to justify and market investments in technology than in leadership or team dynamics.
Direct answer: Leadership failures, not technical gaps, are often the root cause of medical errors and poor outcomes.
Dr. Myers points to root cause analyses that repeatedly find the same culprits: “It's not that we don't know what to do or we don't have a medication... it's that information got lost, we dropped a ball, there was a bad handoff. Those are a function of how we lead and coordinate within our organizations.”
In fact, research shows that investing in leadership and coordination can drive 15-20% improvements in performance or quality of care—a figure that dwarfs the marginal 1-2% gains often seen from new technologies after the low-hanging fruit has been picked. He frames this as a modern-day “sterilization moment”: “We're still in the sterilization days. In randomized control trials of different behaviors, we see things like 15-20% changes in performance or quality of care delivered. Those are huge compared to a one or two percent gain from a new treatment or procedure.”
How does this show up in real life?
Handoffs and communication breakdowns—still among the most common causes of preventable harm.
Operational drag—suboptimal team configurations or processes leading to delays, waste, and burnout.
Failure to maximize existing resources—underutilized talent or tools simply due to poor coordination.
Short answer: Leadership training in healthcare is fragmented because information is siloed—physicians read clinical journals, administrators read management publications, and rarely do both audiences overlap.
Dr. Myers observes, “A lot of this translational science... is either very tailored to the physician or tailored to the administrator. It’s siloed. There’s little information where both people read it and get something out of it. That’s one of the biggest problems.” This creates “echo chambers” where each group validates its own worldview but rarely shares actionable insights across boundaries.
What can be done?
Translation of organizational research: Myers’ Center for Innovative Leadership works to “create accessible translations of organizational research... that have really good practical insights about how we might lead in complex organizations, making those as easily accessible as an online article or an airport book.”
Joint forums and facilitated meetings: At Johns Hopkins, Myers brings together department chairs and leaders to share “experiences and expertise with one another... but I join those meetings as a facilitator to bring evidence base on a particular topic, maybe it's burnout for leaders.”
Leverage local expertise: Every major health system is adjacent to academic programs—business schools, public health, social science departments—that can serve as partners or resources for evidence-based leadership initiatives.
Practical steps for organizations:
Establish recurring joint sessions for clinicians and administrators to review both case studies and operational data.
Engage local academic resources—most universities are eager for collaborative projects that provide research opportunities and real-world impact.
Create plain-language summaries of key leadership research and distribute them through internal communications, grand rounds, or digital channels.
Direct answer: Effective leadership training for clinicians isn’t about overwhelming new content—it’s about leveraging evidence-based, practical strategies and making time to apply them in daily work.
Myers notes, “The strategies to help improve this are not rocket surgery... but there are evidence-based strategies that we know from research in the organizational sciences and social psychology and other related disciplines that we could bring to bear and apply.”
He advocates for:
Practical, scenario-based learning: Move beyond “what bad leadership looks like” (which everyone knows from experience) to “giving [clinicians] a set of tools or examples to say, well, here's what good leadership looks like.”
Offloading technical minutiae: As more information becomes available digitally, we can reduce time spent on rote learning (like memorizing drug interactions) and shift some of that effort to leadership skills.
Integration into existing workflows: Use real organizational data—such as patient satisfaction surveys or EMR audit logs—for leadership development, rather than abstract case studies.
Barriers to address:
Time constraints: Clinicians are already overloaded; solutions must be integrated, not “add-ons.”
Cultural resistance: Both clinicians and administrators may view leadership as secondary to “real work.”
Perceived relevance: Emphasize that leadership skills are directly tied to outcomes, resource allocation, and even technology ROI.
Explicit answer: You make collaboration “win-win” by offering something of value to each party—especially by leveraging data that benefits both research and operational improvement.
“If you just go to the incentives, faculty in any part of the university... are rewarded for publishing high-quality research. Being able to gather and use data for research is usually the most compelling offer. Health systems are sitting on mountains of data about how things are going within their organization... [but] most Healthcare Executives I talk to don't even have time to look at all of it.”
A successful collaboration often includes:
Shared access to real-world data (EMR, Press Ganey, operational metrics)
Rigorous, independent analysis that is not contingent on a “desired answer” (unlike some consultant arrangements)
Joint publication or reporting that supports academic goals and organizational improvement
Cost savings for both sides, since research and quality improvement can overlap
Myers highlights: “Combining forces can save money. We can eliminate cost, and then again, it proves results. We maintain honesty, and it's ethical.”
Direct answer: Real-world examples from Johns Hopkins and peer institutions show measurable improvements in outcomes—often without new hires or major investments—by simply applying a more systematic, evidence-based approach to team configuration and coordination.
“If we can give a little bit more systematic thought to [scheduling teams] without any increase in cost—not hiring anybody, not buying a new robot, not buying anything, just thinking about who do we put in which rooms for which cases—we could start improving the outcomes that we get.”
This low-hanging fruit is rarely captured in budget cycles or capital requests, but the impact is substantial:
15-20% improvement in outcomes or quality from changes in team assignments or coordination methods (vs. 1-2% from incremental tech).
Reduced burnout and turnover by focusing on leadership’s role in supporting workforce well-being (a multi-million dollar savings for large systems).
More effective utilization of high-cost investments: As Myers points out, leadership quality “increases the worth of that investment as well, because it helps the utilization of the technology.” For example, a $2M surgical robot is only as valuable as the processes, team training, and coordination behind its use.
Direct answer: Investing only in technology, without equal attention to leadership and coordination, creates risk—both operational and financial. “Shiny objects” don’t solve problems on their own.
As Myers and his colleagues have studied, implementation of technologies like robotic surgery can have negative spillover effects if leadership is not present. “With the robot, it's just binary—you’re either driving or you’re watching on TV, and there’s no in-between... We haven’t necessarily adjusted how we lead our residency programs or how we think about surgical training to accommodate that.”
This isn’t just a training challenge—it’s a system-wide leadership issue. “We take the easy shiny option, but we want to make sure that we're attending to both [technology and leadership] together.”
Risks of neglecting leadership in tech implementation:
Wasted capital investment
Process bottlenecks and safety issues
Loss of institutional knowledge during workforce transitions
Direct answer: Start by leveraging local resources, breaking down silos, and making leadership development a core operational priority—not an afterthought or “soft” skill.
Dr. Myers advises: “Look for the local resources, because... there are really talented researchers, and there's increasingly an interest in bringing these together. We've done an amazing job of improving our technologies... with each new technology, we're not seeing quite as big of a gain as we might have in the past.”
Best practices for executives:
Engage academic partners—invite organizational researchers into ongoing improvement initiatives.
Use your own data—start with what you already collect to inform, not just measure, change.
Make leadership a visible, celebrated part of the organizational culture—from orientation to ongoing education, make it clear that leadership is everyone’s job, and provide frameworks for doing it well.
“These are not new challenges,” Myers reminds us, “but hopefully finding some resources, teaming up with organizational researchers, can bring systematic attention to those in ways that make a really productive change.”
For U.S. health systems facing margin pressures, workforce shortages, and a public demanding more for less, the next leap in performance won’t come from the latest gadget—it’ll come from how leaders think, coordinate, and systematically improve the human side of care delivery.
Executives, don’t default to new purchases or outside consultants as your only answers. “Just giving a little bit more systematic thought to who is in which rooms for which cases, we could start improving outcomes... without any increase in cost.” Leadership is leverage. The smartest systems will make it their edge.
