The Future of Healthcare Administration: Leading in Uncertain Times

Few professions are growing at the same pace as healthcare administration. Between 1975 and 2010, the number of healthcare administrators grew by 3,200 percent. And, according to the Bureau of Labor Statistics, there’s still room for more: it projects the need for healthcare administrators to grow another 18 percent between 2018 and 2028, adding some 71,600 jobs. Those numbers are staggeringly large, even for the US healthcare system, which is the nation’s largest employer. With all that growth comes massive change—and the future of healthcare administration will depend upon leaders who are capable of navigating through it.

“Healthcare, ever since I’ve been involved in it, as a practitioner, or now as an academic, has always changed in big ways and small ways,” says Robert Malte, a clinical associate professor in the University of Washington’s Department of Health Services and practitioner in residence for the school’s MHA program. He’s a 40-year veteran of the healthcare administration industry, and, over the years, he’s been on the front lines of numerous tectonic shifts in the healthcare landscape: the Medicare DRG payment wave, the managed care wave, the wave of mergers and consolidation, the “Triple Aim” wave, the wave of value-based payment, and the wave of different types of competing healthcare entities.

“In my various healthcare leadership roles across the country, I can’t ever remember a decade where there wasn’t some form of change,” Malte says.

Robert (Bob) Malte is a clinical associate professor in the Department of Health Services and practitioner-in-residence for the MHA program at the University of Washington. His academic interests include strategy, leadership organizational systems, and governance. He retired in 2018 as the CEO of EvergreenHealth, a top-ranked healthcare system, capping a 40-year management career to help teach the next generation of healthcare leaders. He previously served as president and CEO of Exempla Lutheran Medical Center in Denver and also held senior leadership positions with ThedaCare, Penn State Hershey Medical Center, Loyola University Medical Center, and Illinois Masonic Medical Center. Bob served on multiple boards, including the Washington State Hospital Association, where he is past chair. He currently serves on the Board of Trustees of the Lake Washington Institute of Technology in Kirkland. Malte holds an MBA from the University of Chicago.

Today, healthcare and healthcare administration have grown to become big business, and that’s led to more challenges and more complexity. Some of the added complexity has contributed to a wastefulness in the payment system, but it’s also created a more sophisticated industry: one where healthcare administrators work in a variety of subdisciplines, like health informatics, healthcare IT, practice management, or marketing and communications, to mention a few.

“Back in 1975, we had relatively few people doing that kind of work,” Malte says. “It’s grown as a byproduct of becoming a mature industry, as opposed to a cottage industry.”

The healthcare system in the US is at least mature enough to be asking itself some very existential questions. A heated national debate about how to structure that system suggests several alternate futures. Expanding the Affordable Care Act (ACA), or introducing Medicare for All, could upend the way healthcare, and healthcare administrators, conduct business.

“No matter what scenario might play out—if we ever have a single-payer system, or whether the ACA gets advanced further through a stronger public option, or even if it’s more of the status quo—we’re still going to need healthcare administrators,” Malte says. “They are still going to play a significant and transformative role. If there’s a single-payer system, and it replaces traditional commercial insurance, there’s still going to be needs for leaders, managers, administrators to run those complex businesses.”

Every healthcare organization has a set of possible scenarios that they prepare for. Every academic journal has predictions and advice on how to pivot or adjust to numerous potentialities. And every one of them has changed and will continue to change, with the times. Most pressingly, the COVID-19 pandemic is forcing healthcare systems all over the world to put once-hypothetical contingency plans into immediate action.

“Our current healthcare leaders or administrators are being challenged right now on how to lead in the face of crisis,” Malte says. “This is going to re-anchor what normal means, and what challenging means.”

Healthcare organizations, such as those that Malte has led over the course of his career, have disaster-readiness plans for situations like this. Preparing for these black swan scenarios is a collaborative effort between healthcare administrators, physicians, nurses, board members, and partner organizations. Executing them properly takes strong leadership.

“No two disasters are ever going to be the same,” Malte says. “Really good leaders lead change and help adapt to new situations.”

To prepare his students for a dynamic and uncertain future, Malte and his UW MHA colleagues advocate for adaptive leadership and principle-centered leadership. The former allows for agility and initiative in solving complex problems, while the latter provides stability, a true-north, across the wide variety of different organizations and settings in which leaders may find themselves.

“You need a full toolkit to be able to lead,” Malte says. “You need an understanding of every aspect of leadership and management, the hard skills and the soft skills. But if you don’t build a strong culture in your teams, an enduring culture embedded with really strong values, it will always be carrying a rock uphill.”

Malte encourages his students to look at complex problems through three lenses: the lens of people, the lens of process, and the lens of structure. These tools, combined with a strong curiosity, can help future healthcare leaders work across a variety of settings, and navigate through major institutional changes.

“Leaders, administrators, managers, when they’re doing their best work, are helping to support the people they lead and manage,” Malte says. “It’s not a top-down approach, but a bottom-up approach.”

Joining the faculty at the University of Washington has been the fulfillment of a longtime dream for Malte. It’s here that he’ll help prepare the next generation of healthcare administrators for the future, whatever it brings.

“My hope for the future of healthcare administration is that the skills we’re teaching our students, these future leaders, will help lead to a healthcare world where there is greater equity, fewer disparities, and continued pursuit of better outcomes,” Malte says.

Despite spending more than any other country on its healthcare system, the US ranks 27th when it comes to healthcare delivery, with major failings in access, efficiency, equity, and outcomes. It’s the only wealthy nation to not offer universal healthcare.

According to a report by The Commonwealth Fund, 44 percent of low-income Americans have trouble gaining access to coverage, compared with 26 percent of high-income Americans. At the same time, healthcare costs in the US are projected to rise by an average of 5.5 percent per year over the coming decade, growing from $3.5 trillion in 2017 to $6 trillion by 2027.

“We have too many disparities in healthcare that just aren’t right,” Malte says. “Healthcare is not affordable equally by all. And so our leaders’ roles are not only to just lead their organizations, but to be advocates for change. Now and in the future, they need to play an active role in shaping policy, and not just managing for the day-to-day, but managing for a better world.”