The Hidden Crisis in Healthcare: Why Untrained Executives Are Stalling Transformation and Risking Quality & Safety
- EvaluCare
- May 17
- 7 min read
Updated: May 19
In a time when the U.S. healthcare system is in desperate need of transformation, from a model focused on treating illness to one that promotes and sustains health, the absence of continuous quality improvement (CQI) knowledge among healthcare executives is a major roadblock. Despite the complexity, expense, and human cost embedded in our current care systems, many of the individuals tasked with leading change lack the training and knowledge of basic tools, techniques and methodologies required to navigate this terrain effectively.
The result? A stagnant system, rife with inefficiencies and prone to failure, where innovation is too often reduced to buzzwords, strategy execution falters, and, ultimately, quality and patient safety is jeopardized.
From Sick Care to Health Care: A Stalled Mission
The ambition to shift from "sick care" to true "health care" has been a long-standing goal in the United States. The logic is simple, rather than reacting to illness, we should be preventing it. However, despite billions spent on technology, data infrastructure, and wellness initiatives, our progress has been slow and inconsistent. One could argue our care is less safe today than it was a decade ago.
A significant, yet underacknowledged, cause of this sluggish transformation lies not in clinical limitations or financial constraints, but in the lack of CQI training and basic knowledge of the tools, techniques and methodologies of healthcare quality improvement among healthcare executives and administrators. Without a deep understanding of systems thinking, process improvement, and operational excellence, leaders are left to manage the world’s most complex care delivery system with little more than intuition and trend-chasing. Trend-chasing that results in years of adoption of systems and processes that draw resources away from true systems improvement.
Fads Over Fundamentals: How Buzzwords Dilute the True North
Too many healthcare executives become attached to the latest industry buzzwords, whether it's “digital front door,” “value-based care,” “population health,” or “AI-powered healthcare,” often without a real grasp of the underlying systems required to make these initiatives successful, let along the true value for patient care. These trends, while often well-intentioned, are frequently adopted without a rigorous improvement infrastructure to support them, leading to a slow death as new prioritize move in to take the spotlight to become the new flavor of the month or year.
This creates a phenomenon where the organization’s "true north," its foundational mission and purpose, becomes watered down, replaced by vague strategies that fail to drive real results, such as improvements in quality and patient care. Worse still, these fads become distractions, redirecting resources and attention away from sustainable improvement practices, frustrating the talented “middles” charged with implementing the next new shiny industry fad.
The Training Gap: Why Lean, Six Sigma, IHI Model for Improvement, and Theory of Constraints and More Matter
Healthcare executives are typically trained in clinical disciplines or far fewer in general management, not in the structured improvement methodologies that are necessary to manage complex, adaptive systems. This gap manifests in poor decision-making, fragmented strategies, and ineffective process execution. It results in little to no takeup for the use of basic tools, like cross function workflow analysis to really understand processes.
Models such as:
Lean (for eliminating waste and enhancing value),
Six Sigma (for reducing variability and defects),
The IHI Model for Improvement (for rapid-cycle testing of changes),
Theory of Constraints (for identifying and managing bottlenecks),
are not merely academic exercises, they are essential toolkits for running high-functioning healthcare organizations. In the absence of such frameworks, many executives default to siloed thinking, reactive management, and gut-level decision-making. A select few make the decisions for the whole in a top down organizational structure.
Training in these models equips leaders with:
A shared language for improvement
A structured methodology for solving complex problems
A systems-level view of operations
Tools to align organizational strategy with frontline execution
Without these, leaders are essentially navigating a ship without a compass, particularly dangerous when that ship is carrying human lives. Not being able to consistently navigate to a true north, sets ships off in an erratic direction, without the ability to rapidly and frequently course correct.
Fragmentation and Risk: The Consequences of No Common Methodology
One of the most serious consequences of this lack of CQI training is the fragmentation it causes within healthcare systems. Without a shared improvement methodology, hospitals and health systems operate with disjointed approaches to solving problems.
One department may try Lean, another may try homegrown solutions, and another may do nothing at all. This compounds the bigger the organization or health system as differences exist between micro and macro systems. This inconsistency leads to:
Conflicting priorities
Redundant or contradictory initiatives
Wasted resources
Increased risk to patients
Inability to innovate
When improvement isn’t anchored in a shared framework, it becomes an ad hoc endeavor. That is not how you run a nuclear reactor, a commercial airline, or a hospital or health system. The stakes are too high, and the complexity too great.
Unqualified to Lead: The Myth of the Clinician-Executive
There is a common, and increasingly problematic, assumption in healthcare that clinical expertise alone qualifies someone to lead large, complex organizations. While clinical insight is invaluable, it does not inherently prepare someone to design strategy, optimize operations, or drive quality at scale.
Hospital administrators, especially those rising from clinical ranks, often lack formal education in organizational leadership, systems thinking, operations management, and CQI. This leads to:
Poorly designed business processes
Misalignment between strategic goals and daily operations
Ineffective communication across clinical and non-clinical teams
Resistance to evidence-based management practices
Loss in support for leadership among the ranks
Poor culture of quality/excellence
Until we change how we evaluate and select healthcare executives—placing weight not only on clinical pedigree but also on demonstrated operational and improvement competence—we will continue to fill C-suites with well-meaning but underqualified leaders.
Reforming the Hiring Process: A Crucial First Step
To fix this, we must first improve how we hire healthcare executives.
Hiring committees are often composed of board members and senior leaders who may not themselves have the expertise to evaluate candidates' knowledge of systems improvement, process design, or quality execution. Instead, they may rely on past titles, clinical reputation, or personality fit, none of which guarantee performance in the administrative arena.
A better hiring process would include:
Panel members trained in CQI who can evaluate operational competence
Structured assessments of a candidate’s improvement knowledge
Simulations or case studies as part of the interview process
Clear criteria related to the six aims of high-quality care: safe, timely, effective, efficient, equitable, and patient-centered
Executives should be expected to articulate a vision for improving care quality using tested methodologies, and demonstrate past results of such work.
A Dangerous Future: When Leaders Can’t Lead Safety
The risks of maintaining the status quo are enormous. Without capable, CQI-trained leadership, the future of healthcare is not one of progress, but of decline, where system errors become more common, patients face greater harm, and providers become increasingly burned out by chaotic work environments. All of this is occurring simultaneously with increases in patient complexity as many living longer with complex healtchare issues and chronic conditions.
The Institute for Healthcare Improvement (IHI) has outlined the “Triple Aim” (now expanded to the “Quintuple Aim”) of enhancing patient experience, improving population health, reducing costs, supporting care team well-being, and promoting equity. None of these goals can be achieved at scale without leaders who are trained to lead complex system transformation, the building blocks of which are the tools, techniques and methodologies of quality improvement.
Patients, families, and communities have a right to expect safe, timely, effective, and equitable care. But those expectations will continue to be unmet as long as those leading our hospitals and health systems lack the knowledge and capacity to create those outcomes.
What Needs to Happen Now
We must treat the lack of CQI knowledge among healthcare executives not as a minor leadership gap, but as a patient safety and healthcare quality crisis. Here’s what needs to change:
Mandate CQI training for all healthcare executives
This should include certification in one or more improvement models and ongoing professional development in systems leadership.
Evaluate leaders on CQI competencies
Performance reviews, hiring decisions, and promotions should be based in part on a leader’s ability to drive and sustain improvement.
Create shared methodology across organizations
Whether it’s Lean, Six Sigma, or another model, organizations must adopt and institutionalize a consistent approach to improvement.
Include CQI experts on boards and committees
Decision-making bodies must include members with expertise in operations and quality to properly guide and evaluate leadership decisions.
Elevate the importance of operational literacy
Just as we expect doctors to be clinically competent, we should expect executives to be operationally and administratively competent.
Mandating CQI performance expectations into job descriptions
Improving our healthcare system isn’t an optional accountability, it should be a requirement.
Conclusion: A Call for Competence in Healthcare Leadership
The U.S. healthcare system is among the most advanced in the world in terms of clinical innovation, yet its delivery systems are frequently dysfunctional and unsafe. The root of much of this dysfunction lies not in a lack of resources, but in a lack of capable leadership trained in continuous quality improvement.
If we are serious about delivering on the promises of better health, lower costs, and a more humane healthcare experience, we must rethink who we allow to lead, and how we prepare them to do so.
Until healthcare executives are selected, trained, and evaluated based on their ability to lead improvement, we will remain trapped in a model that treats illness rather than promotes health, that prizes buzzwords over betterment, and that endangers the very people it claims to serve.
The time for change is not someday. The time for change is now.
EvaluCare provides medical care review services for patients, families and attorneys. If you have concerns about the care you, a loved one or a client received, EvaluCare can arm victims with the knowledge they need to get the settlements they deserve. If you or a loved one needs medical care reviewed, email info@EvaluCare.net or visit EvaluCare.net
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