The Knowns and Unknowns of Health Care Meta-Leadership

Questions in Health Care
The number of unknowns in the health care world are endless, making it crucial for health care leaders to use a wide “meta-“ view of challenges and solutions to ensure success.

The state of health care in this country could best be described as predictably unpredictable. The future of the Affordable Care Act—and the financing that underlies it—is open for question. Evolving technology challenges health care organizations both to keep up and to stay smart in how they adapt to new opportunities and capabilities. And the face of health care organization is changing as systems face mergers, closures, and non-traditional players entering the fray. The competitive landscape is turbulent.

Nevertheless, each day health care leaders make decisions, develop long-range plans, and remain adaptive to the environment that surrounds them. Those decisions are accomplished even when all the facts are not known: Decide before you know? The conundrum is both counter-intuitive and inescapable.

Understanding and Utilizing Data in Health Care

As one of those leaders, you face a combination of knowns and unknowns. Clarity on the knowns is relatively easy. It is the search for and reliance upon data, evidence, and scientific analysis. It is noteworthy that just a few years ago, the notion of “evidence-based medicine” assumed the clarion call of a movement. Going with the gut, relying upon intuition, and building off experience were simply not adequate. These practices created the illusion of knowing when in fact, the facts weren’t there.

Nevertheless, the unknowns persist and they can be dangerous. What if that decision could have been improved by accessible information that you overlooked or simply ignored? What if you make assumptions based on data that was, in reality, guesswork? If others know what you don’t, you are at a competitive disadvantage.

Decoding the Types of Unknowns in Leadership

Making yourself deliberately aware of the unknowns is a critical and complex leadership responsibility. As a health care leader, you face this ambiguity every day. When you make decisions, you acknowledge that you are doing so with limited information. What do you really know and what are the very real unknowns? Making yourself deliberately aware of the unknowns is a critical and complex leadership responsibility. In meta-leadership terms, we call this intentional process, “Driving to the knowns.”

Meta-Leadership: The Road Ahead

Leading in a health system is to continually and deliberately balance and assess these knowns and unknowns. Employing a wide “meta-” view of problems and possible solutions – along with the systematic framework for driving to the knowns – creates clarity of thinking and action. By carefully observing and assessing patterns and trends, and by intentionally making yourself aware of what is known and unknown, you are more likely to reach your best possible decisions and outcomes.

This is Meta-Leadership thinking and practice, designed to systematically reveal and apply the knowns to your health care decision-making and actions.


Harvard T.H. Chan School of Public Health offers Leading in Health Systems: Integrating Effort, Improving Outcomes, a high-impact health care leadership development program, which focuses on meta-leadership.