Chapter 6 of your textbook opens with a reminder that healthcare systems are built by the unique talents, aims, and complex relationships of the humans comprising them (p. 105). The relationships healthcare systems are built on are as complex as the individuals in them, making the quality and strength of these relationships especially important. Trust, the relational state this chapter primarily focuses on, is actively built over time through experiences that require risk, openness, vulnerability, and reliability (p. 110).
This week’s assignment demonstrates our trust in you, as a future leader in healthcare provision. Choose an area of your current or future work in healthcare leadership and a particular point made in this week’s readings that impacted you to build an assignment on. At this point in your program, you are familiar with a variety of assignment formats such as:
Topical research paper
Analytical paper
1500 Words minimum for a paper, submitted as a Word document, please use the APA 7th Essay Template
5-7 minutes for a narrated PPT presentation, submit slides with presenter notes and link to presentation uploaded to Youtube (See below for PPT narration tutorials)
The assignment must include a statement explaining what it is intending to analyze, demonstrate, discuss, or explain
Explain who they are and what they are doing. Which of the three critical elements of disruptive innovation (p. 99) are present in your example? Based on your research, share what you discover about their process and challenges to bring this innovation to market or implement it.
Chapter 5
Healthcare Entrepreneurship
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Learning Objectives
• Discuss the significance of entrepreneurship
in the delivery of healthcare services
• Define the concept of innovation in the
context of healthcare delivery
• Describe the types of entrepreneurs that
have emerged in healthcare services
• Understand where entrepreneurship can
occur in the current healthcare environment
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
What Is Entrepreneurship?
• Entrepreneurship is a way of creating wealth with a new
business innovation.
• In a more general sense, entrepreneurial activity
involves innovation to create some new factor or exploit
some perceived opportunity in the economy.
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Opportunities for Entrepreneurs
in Healthcare
The seven windows of entrepreneurial activity include:
• Growth in new knowledge
• Consumer desires
• Changes in the industry structure
• Aging of the population
• Process improvement
• Shortcomings in service delivery
• The uncertain nature of the healthcare system
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Who Are Entrepreneurs in Healthcare?
• Behavioral traits
• Tendency to seek opportunities for personal
achievement
• Inherent management or leadership skills
• Ability to facilitate idea generation
• Ability to sell
• Ability to demonstrate, or designate, responsibility to
someone who has demonstrated sound financial
management practices
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Innovation and Entrepreneurship
• Innovation starts when someone creates an idea that
brings value or perceived benefit either to the
stakeholder(s) or customers.
• Innovation in healthcare has never been easy.
• There are obstacles causing a very real need for
innovation and entrepreneurship in healthcare delivery.
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Design Thinking
The process of design thinking involves the
following stages:
• Inspiration
• Goal or problem clarification
• Interviewing or data collection
• Concept generation
• Result synthesis
• Iterative prototyping with feedback
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Challenges to Entrepreneurship and
Innovation in Healthcare
• The fragmentation found in healthcare
• Resistance to change
• The prevalence of healthcare regulations
• Under the current system, new
technologies must gain regulatory
approval prior to being reimbursed by
insurers.
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Phase Gate Process
• The phase gate process is a way to divide a
process into steps that move from idea to
implementation.
• Typically, the phases include:
• Ideation
• Scoping
• Building a business case with risk analysis
• Development
• Testing
• Validation
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Idea Generation
• Questions to be asked
Is the idea consistent with the mission, vision,
and goals of the organization?
Is the idea aimed at the existing or a new client
base?
Does the idea confer revenue generation or
cost savings?
Is the idea unique?
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Price Sensitivity
• Price sensitivity represents an estimate of
how much a consumer will change the
quantity purchased of a good or service
based on a change in price for that good
or service.
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Disruptive Innovation
• Much of the entrepreneurial innovation in
healthcare has sought ways to earn additional
income from the existing healthcare system.
• As this push for income from investors and
healthcare business ventures continues, the
actual services to address illness and injury—
the essence of healthcare delivery—becomes
less affordable.
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Review Article
Page 1 of 5
A One-Team approach to crisis management: a hospital success
story during the COVID-19 pandemic
Tracy H. Porter1, Cheryl Rathert2, Sabry Ayad3, Nicholas Messina1
1
Department of Management, Cleveland State University, Cleveland, OH, USA; 2Department of Public Health, St. Louis University, St. Louis, MO,
USA; 3Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
Contributions: (I) Conception and design: TH Porter, C Rathert, S Ayad; (II) Administrative support: N Messina; (III) Provision of study materials or
patients: TH Porter, C Rathert, S Ayad; (IV) Collection and assembly of data: TH Porter, C Rathert, S Ayad; (V) Data analysis and interpretation:
TH Porter, C Rathert, S Ayad; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
Correspondence to: Tracy H. Porter. Cleveland State University, 2121 Euclid Avenue, BU 428, Cleveland, OH 44115, USA. Email: t.h.porter@csuohio.edu.
Abstract: In the later months of 2019, coronavirus disease of 2019 (COVID-19) began to spread across the
globe. The pandemic quickly became a challenge for healthcare facilities to respond to and hospitals were
expected to lose billions. Subsequently, many hospitals implemented mandatory furloughs, layoffs or pay cuts
amongst their clinical staffs. Previous research has demonstrated it is important for organizational members
to pull together and act as a team during a crisis situation. A team approach offers a number of organizational
benefits however; most of the literature on teamwork is focused at the micro level (e.g., unit level) and does
not address the importance of an organizational level team. We propose the importance of creating an
organizational level team (e.g., one, which spans throughout the organization) as being key to successfully
mitigating organizational crises. We offer an applied social identity approach as a theoretical lens to
understand this phenomenon. We offer insight into one hospital, which dealt with the COVID-19 pandemic
based on an organizational wide team. We explain the steps the Cleveland Clinic took in preparation for
and during the pandemic. These steps allowed the Clinic to avoid many of the negative consequences other
hospitals suffered, such layoffs, furloughs, and potential long-term organizational workforce problems.
Keywords: Coronavirus disease of 2019 (COVID-19); Cleveland Clinic; pandemic; leadership; One-Team
Received: 21 October 2020; Accepted: 05 February 2021; Published: 25 June 2021.
doi: 10.21037/jhmhp-21-9
View this article at: http://dx.doi.org/10.21037/jhmhp-21-9
Introduction
In November/December 2019 the coronavirus disease of
2019 (COVID-19) was identified and began to spread.
The virus spread quickly across the globe and began to
challenge governments and healthcare facilities to respond
appropriately (1). On March 11, 2020 the World Health
Organization (WHO) formally declared COVID-19 a
pandemic. Normally, health care organizations (HCOs) are
prepared for typical disease levels in their populations (1).
However, COVID-19 tested traditional epidemic protocols
as the disease surpassed the scope of previous pandemics.
U.S. hospitals were expected to lose $323.1 billion in
2020 due to the COVID-19 pandemic, according to a
© Journal of Hospital Management and Health Policy. All rights reserved.
report from the American Hospital Association (1). The
total includes $120.5 billion in financial losses from July
through December, as well as $202.6 billion in losses
that were projected between March and June. The losses
are largely due to a lower patient volume after canceling
elective procedures (2). Although Congress allocated $175
billion to help hospitals offset some of the revenue losses,
hospital leaders have said it is not enough (2).
To address the financial fallout from COVID-19,
hospitals across the nation implemented mandatory
furloughs, layoffs or pay cuts amongst their clinical staffs (3).
Nearly 270 hospitals and health systems enacted such cost
cutting strategies with potential long-term consequences.
Health care workers who have been laid off tend to have
J Hosp Manag Health Policy 2021;5:18 | http://dx.doi.org/10.21037/jhmhp-21-9
Page 2 of 5
decreased feelings of job security, increased anxiety levels,
and increased diagnoses of depression (4,5). Laying off
health care workers will also have a negative impact on
the health of the community, as there will be less access
to medical care (6). Therefore, it is imperative healthcare
system leaders recognize the costs to health care workers
who find themselves unemployed and seek creative ways to
avoid such decisions.
One key to success during any organizational crisis is for
all caregivers to pull together and act as a team (7). A team
approach to crisis management brings benefits for caregivers
such as increased positive affect, crisis resilience, creativity,
and agreement on important decisions (7,8). However, most
of the literature on teamwork is focused at the micro level
(e.g., unit level) and does not address the importance of an
organizational level team. The rational for the focus on the
micro level is an important consideration for future research
but, could be as simplistic as size (7). perspective could
be based on a number of reasons. In addition, healthcare
systems might examine the methods implemented by other
hospitals and especially those, which successfully mitigated
the pandemic.
We therefore propose the importance of creating an
organizational level team (e.g., one, which spans throughout
the organization) as being key to successfully mitigating
organizational crises. An organizational level team would
offer the organization consistency with regard to messaging,
processes, evaluation criteria, and offers the “team” level
benefits noted earlier to the organization as a whole.
Certainly, this would need to be empirically evaluated. We
offer an applied social identity approach as a theoretical
lens to understand this phenomenon (9). Through the
following case presentation, we offer insight into one such
organization, which dealt with the COVID-19 pandemic
based on an organizational wide team. We explain the steps
the Cleveland Clinic took in preparation for and during
the pandemic. These steps allowed the health system to
avoid many of the negative consequences other hospitals
suffered, such as layoffs, furloughs, and potential long-term
organizational workforce problems (10).
Case presentation
In January 2020, the Cleveland Clinic system leadership
recognized the impending challenges approaching the
United States as the COVID-19 pandemic began to surge.
Leadership began to organize resources and ready the
organization based on the knowledge of how the pandemic
© Journal of Hospital Management and Health Policy. All rights reserved.
Journal of Hospital Management and Health Policy, 2021
impacted hospitals elsewhere. The following discussion
demonstrates the key steps and action areas addressed by
this HCO to proactively prepare for the pandemic. We
build on the work of Paavola [2020] who noted the steps
the Cleveland Clinic took to maximize the potential in
its workforce. We interviewed Dr. Mark Taylor, Chair of
Surgical Operations for the Cleveland Clinic, who offered
first-hand accounts of his experiences during the pandemic
and was a key architect of the Cleveland Clinic COVID-19
response.
Engage key stakeholders
According to Dr. Taylor, the Cleveland Clinic successfully
responded to the pandemic for a number of reasons. First,
the health system deployed excess caregivers to assist
other hospital surges in the early stages of the pandemic.
Frontline providers were able to witness what others
were doing. Leaders made a number of strategic moves
proactively and were committed to transparency with the
full organization. They developed an Incident Command
Center (ICC) to serve as the central hub for information
and delegation. The ICC developed several working groups
at both the system and sub-system levels. System-wide
groups focused on communication and collaboration while
the sub-system groups focused on more specific localized
issues and challenges.
Physical space/bed capacity
Next, the ICC groups assessed the availability of beds
throughout the system and examined the potential of
converting some beds to additional ICU capacity. Cleveland
Clinic converted the main atrium of its Health Education
Campus into a 327-bed surge hospital to be used for lowacuity COVID-19 patients. In addition to repurposing
non-medical spaces for patient beds, the State of Ohio
temporarily canceled elective surgeries to allow additional
bed space. Many HCOs responded to this mandate by
laying off or furloughing caregivers assigned to these units.
However, the health system redeployed the caregivers
associated with these units to the pandemic front lines
rather than laying them off.
Re-deployment of workforce
Re-deployment of its clinical workforce to the front lines
from other areas of the system required some planning,
J Hosp Manag Health Policy 2021;5:18 | http://dx.doi.org/10.21037/jhmhp-21-9
Journal of Hospital Management and Health Policy, 2021
training, and understanding. New protocols needed to be
developed quickly (within weeks) and training programs
established. Since non-essential units were shut down, many
clinical caregivers were available to assist with COVID-19.
Each of these individuals was assigned to a “team group”
to support the front line. Though these caregivers had
the basic medical knowledge and skills needed to care for
COVID-19 patients, many needed additional training to
address the unique needs of COVID-19 patients. The
hospital first assessed the learning needs for the redeployed
caregivers and then began to develop “crash courses” to
get them prepared. These courses focused on areas such
as appropriate personal protective equipment (PPE) use,
isolation precaution, ventilator use, and medications.
The courses were offered online so that caregivers could
complete them remotely.
Equipment challenges
Caregivers all over the nation expressed concern about
shortages of PPE. Sometimes this fear led to hoarding of
equipment, or personally purchasing inferior equipment.
To mitigate these challenges, Cleveland Clinic took an
accounting of all key equipment needed for COVID-19
patients. An online dashboard was established on the
organization’s intranet to show real-time information.
All caregivers were able to access the dashboard to see
the numbers and location of PPE, ventilators, and other
materials. The goals of this step were to be fully transparent
with caregivers in order to mitigate possible hoarding, to
show caregivers there were adequate resources, and to keep
them from purchasing materials elsewhere. Dr. Taylor felt
the dashboards were very successful and assured caregivers
the health system cared about their wellbeing, and did not
want them to worry about resources. Dr. Taylor also felt
this approach worked because Cleveland Clinic had a longstanding culture of transparency, and therefore they trusted
the information was correct.
Communication strategy
From the beginning of the pandemic Cleveland Clinic
leadership incorporated transparent communication into
every step of the response plan. First, they developed
content on COVID-19 policies, procedures, training
resources, and webinars. Next, they established daily
organization-wide webinars led by top executives, which
anyone in the hospital system could join. During these
© Journal of Hospital Management and Health Policy. All rights reserved.
Page 3 of 5
calls, leaders shared information, discussed challenges,
brainstormed solutions, and clarified misinformation. After
the updates, there was an “open mic” portion of the call
where caregivers were able to ask questions, share concerns,
or simply gain clarity on COVID-19 topics. According to
Dr. Taylor, caregivers would often share stories of hope,
inspiration, and encouragement. “Within a high stress
environment such stories offered caregivers a sense of pride,
motivation, and camaraderie,” Dr. Taylor stated.
Discussion
A One-Team approach
Teamwork is considered the number one global workforce
development trend (11). Working collaboratively has
become an imperative for contemporary organizations and
“collaboration is taking over the workplace” (12). Effective
teams have demonstrated a number of organizational benefits
including, outcomes that are greater than the sum of individual
contributions (13,14). This includes improved decisionmaking, increased commitment, increased collaboration,
and improved development opportunities (15). As teamoriented work increases, organizations are “implementing
networks of teams, whereby projects are assigned to groups of
individuals who work interdependently, employ high levels of
empowerment, communication freely” (16). The One-Team
(organizational level team) approach is somewhat unique given
that most of the teamwork literature focuses at the unit level.
Central to the Cleveland Clinic’s mission is the culture of
acting as One-Team, even though it has 18 locations across
the globe. Dr. Taylor explains that the “One-Team approach
is built on full transparency of information regardless
of employee status.” This approach is a long-standing
pillar within the Cleveland Clinic. Thus, a level of trust
between caregivers and the system leadership allowed the
organization to pivot quickly when the pandemic became
a global crisis. As other hospital systems seek ways to
ensure they can adapt to disruptive external environmental
changes, such as pandemics, they might consider the OneTeam approach and examine the Cleveland Clinic culture.
The redeployment of clinical staff during the pandemic
brought a number of benefits to the Cleveland Clinic. The
redeployment allowed the Cleveland Clinic to avoid having
to implement furloughs, layoffs, or pay cuts among clinical
staff. In addition, the training protocols employed as part
of the redeployment process offered their clinical staff
new skills and knowledge, which would be of value in the
J Hosp Manag Health Policy 2021;5:18 | http://dx.doi.org/10.21037/jhmhp-21-9
Page 4 of 5
prevention and treatment of future pandemics.
Applied social identity approach to organizational crisis
One theoretical lens which applies to the Cleveland
Clinic One-Team culture is the applied social identity
approach (ASIA) (9), which sprang from social identity
theory (SIT) (17) and self-categorization theory (SCT) (18);
two related but distinct social psychological theories. SIT
focuses on intergroup relationships and SCT focuses on the
role of social categorization processes in group formation
and coordinated action (9). The focus of this framework is
to understand how social behavior is influenced beyond the
individual’s viewpoint but is also influenced by the individual’s
sense of being a member of a larger social group (9). The
ASIA has been applied to a wide variety of fields and continues
to be very effective.
The ASIA approach for offers five strategies HCOs may
consider. First, groups and social identities form the basis
for social behaviors (17). In fact, when individuals define
themselves in terms of their social identity, they will make
important decisions to ensure the group is successful (9).
Second, self-categorization (how one views oneself) offers
a reason for group membership (19). For example, selfcategorization impacts the way an individual dresses, speaks
(jargon), and their interests. Third, the real power of the
group is found through working with social identities and
not against them (9). Specifically, the shared identities
foster collaborative environments. Fourth, social identities
need to be “made to matter” (9). Which means, the groups
procedures, rules, and formal procedures need to be used
as a means of promoting well-being and constructive
engagement (20). Finally, psychological intervention is
political because it involves social identity management (9).
The Cleveland Clinic culture is one very much built
on the concept of “we” as opposed to “I” where caregivers
flourish when they understand and work as a team based
on “we”. According to Dr. Taylor, the inherent autonomy
of some medical disciplines (e.g., surgeons) makes this
shift difficult for some individuals. In addition, some
medical disciplines work in satellite locations or may not
interact with other departments on a regular basis. Such
arrangements further isolate those in specific disciplines.
But because Cleveland Clinic had been focusing for years
on its “we” identity, the quick shift necessary during the
COVID-19 surge was a lot more manageable. The lesson
here is for hospital’s to start building their One-Team
cultures now.
© Journal of Hospital Management and Health Policy. All rights reserved.
Journal of Hospital Management and Health Policy, 2021
Conclusions
The COVID-19 pandemic placed a tremendous burden
on the global health care community and many medical
systems still struggle with the financial impact. Cleveland
Clinic, however, seemed to avoid many of the difficult
outcomes other systems experienced (e.g., layoffs,
furloughs). The key to these successes lies in Cleveland
Clinic’s unique One-Team organizational culture. Other
systems might learn from the Cleveland Clinic approach,
disruptive environmental events are inevitable. This article
offers insight into why Cleveland Clinic might have been
successful and how other health care systems might develop
a One-Team culture themselves.
Acknowledgments
The authors would like to acknowledge Dr. Mark Taylor,
Chair of Surgical Operations for the Cleveland Clinic, for
his gracious contribution to this article.
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned
by the Guest Editors (Erick Guerrero and Jemima A.
Frimpong) for the series “Organizational Approaches to
Implement Rapid Change in Hospitals to Respond to
Public Health Emergencies” published in Journal of Hospital
Management and Health Policy. The article has undergone
external peer review.
Conflict of Interest: The authors have completed the ICMJE
uniform disclosure forms (available at http://dx.doi.
org/10.21037/jhmhp-21-9). The series “Organizational
Approaches to Implement Rapid Change in Hospitals to
Respond to Public Health Emergencies” was commissioned
by the editorial office without any funding or sponsorship.
The authors have no other conflicts of interest to declare.
Ethical Statement: The authors are accountable for all
aspects of the work in ensuring that questions related
to the accuracy or integrity of any part of the work are
appropriately investigated and resolved.
Open Access Statement: This is an Open Access article
distributed in accordance with the Creative Commons
Attribution-NonCommercial-NoDerivs 4.0 International
J Hosp Manag Health Policy 2021;5:18 | http://dx.doi.org/10.21037/jhmhp-21-9
Journal of Hospital Management and Health Policy, 2021
License (CC BY-NC-ND 4.0), which permits the noncommercial replication and distribution of the article with
the strict proviso that no changes or edits are made and the
original work is properly cited (including links to both the
formal publication through the relevant DOI and the license).
See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
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doi: 10.21037/jhmhp-21-9
Cite this article as: Porter TH, Rathert C, Ayad S, Messina N.
A One-Team approach to crisis management: a hospital success
story during the COVID-19 pandemic. J Hosp Manag Health
Policy 2021;5:18.
© Journal of Hospital Management and Health Policy. All rights reserved.
J Hosp Manag Health Policy 2021;5:18 | http://dx.doi.org/10.21037/jhmhp-21-9
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