Forcing Mechanisms

Most health systems have decisions that have been "under review" for two years. Everyone on the leadership team knows what the review will conclude. The CFO has run the numbers. The board has seen the trends. The market has been signaling the answer for longer than anyone wants to admit.

And still — the decision waits. This is not a failure of courage.

It is a failure of structure. When no mechanism exists to force a decision to resolution, the path of least resistance is always to extend the review. Commission another analysis. Seek broader consensus. Wait for better data. The language of diligence becomes the architecture of delay. The decision remains open. The capacity it consumes — financial, operational, and managerial — is unavailable for anything else. And the window to act on your own terms quietly narrows.

In owner-governed organizations, this doesn't persist. Capital markets impose a clock. Equity enforces a consequence. The cost of delay becomes visible whether leadership wants to see it or not. In nonprofit health systems, that clock must be designed. And most haven't built it. The result is not a system full of weak leaders. It is a system full of capable leaders operating without a forcing function — and performing below their potential because of it.

What decision has been on your leadership team's agenda the longest?