The next several years in healthcare may pose an existential threat. Medicaid reductions and other external pressures will have a significant impact on many hospitals. Some will successfully fight through this very difficult external environment and others may not.
The difference in outcomes is likely to depend on leadership—not leadership in general, but specific, even unusual qualities of leadership. It is essential, therefore, that leaders in senior positions begin to think about how they can be the best leaders possible for their organizations under these very unexpected and difficult conditions.
As part of that examination, I propose consulting an unlikely source: a journeyman quarterback who has been a member of more teams than any other NFL player and has spent far more time on the bench than on the field.
An unglamorous career
Currently, Josh Johnson is the 39-year-old backup quarterback for the Washington Commanders. Between 2008 and 2024, Johnson changed teams 18 times—24 times if you count appearances on practice squads and offseason rosters. During his career, he appeared in only 45 games and started only nine times. In six of Johnson’s 18 seasons, he did not play at all. He has thrown 13 touchdowns compared with 16 interceptions.
Johnson—who grew up in Oakland, California—played for a small-college team, the University of San Diego Toreros of the Pioneer Football League (now the West Coast Conference). The Tampa Bay Buccaneers drafted Johnson in the fifth round, the 160th pick overall.
Johnson’s first victory as a starting professional quarterback came in 2018—10 years into his career—when Washington called on him after three other quarterbacks suffered injuries or played poorly. Before getting the call to join Washington, Johnson was, he said, “at home in the ’hood chilling with the kids, chilling with my family and thinking on the couch that I might never play in the NFL again.”
The unglamorous story of Josh Johnson raises an obvious question: If he has not proven his effectiveness as a quarterback, and at an age when most NFL players are long since retired, why on earth do teams continue to include Johnson on their rosters? Surely there are younger, more promising quarterbacks from which to choose.
The short answer is that Johnson’s ability to find a way to contribute in any situation is the quality that earns him a roster spot year-in and year-out. Captured in an excellent interview in the New York Times, Johnson’s remarkable and in many ways nontraditional observations have as much relevance for CEOs as they have for someone trying to establish their place on a team.
Assets and liabilities
Applied to leaders and players alike, Johnson’s umbrella concept for personal organizational success is to focus on being “an asset more than a liability.”
As Johnson breaks it down, this seemingly straightforward concept is actually prismatic, changing based on role, situation and perspective. According to Johnson, the attitudes, strategies and actions that make a person an asset depend on our ability to “understand the dynamics and structure” of any situation. In the absence of that understanding, even well-intended, or previously effective actions can make us liabilities within our current organizational situation.
This was a hard-earned lesson for Johnson. In March of 2012, Johnson was delighted to be invited to join the San Francisco 49ers, where he would reunite with head coach Jim Harbaugh, who had coached Johnson during his heydays at the University of San Diego. Five months later, Harbaugh cut Johnson.
“It was a very humbling experience,” Johnson recalls. “It was like a gut punch…. In college, it was catering to my view a lot more. And in the NFL, I wasn’t the starter. I was a guy trying to make the team….”
For Johnson, this new situation brought him to a crossroad. Should he stick with the attitudes and behaviors that had made him an asset in the past? Or was there another path?
“My early struggles were teaching me the nature of the business, and I focused on learning that…. I had to check myself. Spiritually, emotionally, mentally, I went down the list of what I could do differently and better instead of making excuses and pointing fingers. It led me to empathy and maturity.”
Adaptability
Critical to Johnson’s new approach was adaptability. It is a quality he has observed in the best coaches. “The best leaders I’ve been around,” Johnson says, “can adapt to anything to become effective. And the ones that aren’t as effective, it’s more situationally based. They need the situation to be perfect, the way they’d prefer.”
Whether you’re a quarterback or coach, or whether you’re a line-worker or CEO, being an asset in a seemingly perfect situation isn’t all that difficult. If your team or a business is outperforming the competition, if the people above, alongside and below you are aligned, if resources are available, then you double down on what you’re doing. Leadership decisions are clear, and implementation proceeds as planned.
Unfortunately, most situations are less than perfect and oftentimes downright harrowing. If we cannot study, understand and adapt to these situations, then even the qualities that made us an asset in many situations will not prevent our being a liability in this more challenging organizational environment.
Diverse perspectives
Closely related to adaptability is another quality Johnson highlights: being able to relate to diverse perspectives.
“One thing sports have shown me,” Johnson says, “especially as a quarterback, is that you’ve got to be able to relate to everybody. Everybody comes from different paths, different walks of life, which leads to different perspectives. The goal is to try to get everybody aligned.”
Johnson continues, “Some people struggle with that because they don’t have the ability to adapt to every perspective, because they might not understand it. So they fight for what they believe in, and that’s what I’ve seen as ineffective over the years. But the best ones understand what they want to get done with their group of people, and they can make it relatable to anybody.”
In hospitals, football teams and, I suspect, every other workplace, culture, lifestyles, attitudes, beliefs and behaviors have diversified exponentially over the past 10 or 15 years. What can make us a liability is trying to relate to people today in the same way we may have in the past. What can make us an asset is trying to understand these diverse perspectives, and to do something different with that understanding—as a leader trying to align a team and as a team member trying to contribute effectively.
“When I was younger,” Johnson says, “I was just like any other young adult, thinking we know everything, but we don’t know nothing…. But now, I take a more critical view: Do I agree? No. But why is it that way? You ask those questions to gain people’s perspective. And then, for me, once I gain their perspective, how can I correlate that to what I believe in so I can understand what’s expected of me?”
CEO leadership
Because of Johnson’s role as a perpetual back-up, his concepts may seem less applicable to CEOs than to middle managers and others who need to work hard every day to prove their worth and make themselves valuable in their roles and to their organizations. However, I would argue that these concepts are equally if not more important for CEOs.
Having a responsible position, extensive experience and laudable qualifications does not mean that a CEO cannot be a real liability in a particular organization or business situation. And by the very nature of leadership, a CEO’s liability is most likely to show up when an organization is under the most pressure—that is, when it most needs the CEO to be an asset. This is likely to be especially true right now as both federal and state budgets challenge hospital reimbursement and force many patients off of critical healthcare insurance.
In this environment, every day CEOs will need to make essential decisions, and those decisions will be more complicated because such decisions will turn out to be integrated and interconnected with other decisions and circumstances. Every CEO will need to do whatever he or she can to serve their organization by staying on the asset side of the managerial ledger. The fewer financial and market strengths a hospital organization has, the more important this will be.
Humility
What I find most striking about Johnson’s approach to leadership and success is his humility. Given his experience, perhaps that should not be surprising. Johnson did not grow up in affluence. He went to a small college. Although he was one of the best players at his college, he has never been a success, in traditional terms, as a professional. Yet year after year, teams bring him back.
“You’ve got to be humble enough to know when it’s not about you,” Johnson says, “but you’ve still got to maintain the confidence that got you there. You’ve got to know when it’s time to apply that and when it’s time to step back. That’s what I’ve been constantly growing at.”
In a healthcare environment as adverse as any we have ever experienced, none of us could be blamed for a certain amount of grumbling and resistance. But leaders would do well, especially in a time of existential threat, to consider the questions that Johnson poses to himself:
“What are the ways I can get better, even with the opportunity I’m given? And how can I make myself better for that opportunity?”
