As health systems continue to navigate prolonged financial strain, workforce fatigue and growing regulatory pressure, Airica Powell-Steed, EdD, RN, says sustainable turnarounds depend less on quick fixes and more on values-driven leadership and long-term value creation. But there are some mistakes executive teams often make.
Dr. Powell-Steed, interim executive vice president and COO of Loretto Hospital Network in Chicago and CEO of Breakthrough Innovation Partners, has spent more than 25 years leading transformations in some of healthcare’s most challenging environments, including safety-net systems, highly unionized organizations and financially distressed hospitals serving underinvested communities.
“My career has really been built in the hardest places in healthcare,” she said. “What pulls my heartstrings is safety-net health systems, highly unionized environments, financially distressed organizations, and communities that historically have been underinvested yet deeply resilient.”
That experience now shapes her work advising hospitals, health systems, payers and public-sector organizations through complex turnarounds. The focus is not incremental improvement but helping organizations fundamentally shift care delivery and health system leadership.
Dr. Powell-Steed has stepped into multiple organizations facing severe financial and operational distress, often compounded by lingering workforce exhaustion from the pandemic. The pressure pushes leaders toward short-term decisions that undermine long-term viability.
“Organizations must elevate quality performance and keep the community well and out of the hospital while also balancing the dynamic of pay-for-performance,” she said, adding that sustainable turnarounds require resisting “very quick, tempting solutions to bluntly cost cut.”
For Dr. Powell-Steed, the success or failure of a turnaround often hinges on change management, and specifically on trust.
“You know, honestly, change management at its core is all about people. It is all about culture, and is all about rebuilding a sense of trust and respect in the people-centered aspects of change management,” she said.
It’s more important for leaders to listen than speak, and bring both frontline teams and community members into the transformation process. Too often, change feels imposed rather than inclusive.
“A lot of times, the community feels like change is happening to them and not for them,” she said. “I really, pride myself in opening up seats at the table for the community to have a real voice, to unmute the muted who are often not heard or respected in the change management process.”
Looking ahead, Dr. Powell-Steed said one of the most urgent priorities for healthcare leaders is moving beyond a prolonged state of survival mode. She noted that many systems were already struggling before the pandemic, which only intensified financial, regulatory and workforce pressures.
“I think the biggest priority for leaders and organizations and communities alike, is moving beyond the survival mode that we’ve been in,” she said.
With reimbursement erosion, capital constraints and political volatility converging, she warned that some leaders are quietly shifting from asking how to thrive to questioning whether their organizations can survive at all.
“That’s really a dangerous place to lead from,” she said.
The greater risk is fear-based leadership.
“The headwinds are real, but the bigger risk is fear-based leadership,” she said. “Those that really exercise a different level of courage and won’t losing strategic nerve to execute effectively.”
That courage is especially critical as leaders face pressure to act quickly and demonstrate movement. Executives may need to slow down decision-making and challenge their assumptions about the future of healthcare delivery to protect their organizations and fragile workforce against the rapidly changing political and financial landscape.
“Speed without strategy is how organizations really create self-inflicted wounds,” Dr. Powell-Steed said, later adding, “Leadership right now in this era is not about being popular and making the popular decisions. It’s about being anchored, being disciplined, being focused, and taking the courage to slow yourself down and act more strategically. That’s going to propel us into long term success.”
When it comes to growth, Dr. Powell-Steed argued that health systems must rethink how value is defined; it’s not just by where revenue comes from, but also through workforce investment, culture and trust.
“Traditional brick-and-mortar mergers and acquisitions are not going to be the dynamic,” she said. “Strategic collaboration is really the space for growth. We have to check our titles at the door and not be competitive in that collaboration, because at the end of the day, we’re fighting for the same populations that we’re trying to drive value for. We need to truly align clinical excellence with financial stewardship instead of pitting those dynamics against each other.”
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