One hallmark of the rapidly changing COVID-19 crisis is that any statement about the situation one day is likely to be incorrect the next day. However, after more than eight months of battling the virus, we have enough data to make several important observations about the state of play that are highly relevant for the strategy—and indeed the very thought processes—of healthcare organizations.

First, the facts.

Nationwide COVID-19 Metrics Since April 1 (7-Day Average)
Nationwide COVID-19 Metrics Since April 1 (7-Day Average)

Source: The COVID Tracking Project


When the pandemic hit in the early spring of 2020, the most hopeful scenario was a steady decline in number of new cases, with the virus at very low levels by late summer or early fall. Less hopeful scenarios suggested a series of subsequent surges of gradually decreasing intensity.

The reality, of course, has been very different. As of early November, almost every day brings a record high in the number of new cases. The graph on the far left above illustrates the story extremely well: New cases are coming in waves, and the waves are getting larger. As of this writing, the number of daily new COVID-19 cases in the U.S. is more than 50% higher than the number of new cases during the previous spike in mid-July, and it is an increase of more than 200% over the number of new cases in the mid-September trough.

As we have learned more about how to treat patients, and as we have identified cases earlier, the number of deaths from COVID has declined since April. However, as shown in the graph at the far right, that number also has been trending higher during October and November.

Very concerning for hospital executives is the center graph, showing the number of people hospitalized for COVID each day over the course of the pandemic. As of early November, the number of hospitalized COVID patients is back to very near the peaks we experienced in April and July. And the number has been rising daily.

Thus, fighting the virus for most of 2020, we are at the greatest level of uncertainty yet. Far from the temporary pandemic many of us expected, the virus is moving from pandemic to endemic and back to pandemic, with the intensity and duration of the crisis impossible to predict. Further, every hospital and health system is experiencing its own version of the pandemic, with its own short-term and long-term consequences.

The ongoing pandemic has challenged our most basic assumptions about organizations and organizational decision making, about organizational strategy, and about the organizational thinking process itself.

Let’s summarize these assumptions through a series of questions.

First, in a pandemic of uncertain intensity and duration, what is now the appropriate direction for a complex healthcare organization?

Second, in such an environment, how is capable leadership defined, and what does competent management look like?

Third, in the fog of one of the worst public health crises in American history, what tasks and strategies must be attended to and which can be left undone?

These questions are in no way theoretical, nor are their answers. Rather, these questions and their answers are as real as it gets.

Given this state of play, it is not possible, nor is it useful, to define a so-called pandemic roadmap at this time. What is more helpful is to call out a series of strategic observations and identify a series of management thought processes that can act as an organizational gyroscope in times of unprecedented macroeconomic turbulence.

The first strategic observation is, as described above, the intensifying waves with which COVID-19 is hitting hospitals and, of course, the associated operating and event risk that comes with the accelerating pandemic. In subsequent blogs, I will lay out further observations that can help describe organizational strategy and the organization thinking process in such perilous and remarkable times.

Meet the Author

Kenneth Kaufman

Managing Director, Chair
Kenneth Kaufman offers deep insights on the economic, technological, and competitive forces undermining healthcare’s traditional business model.
Learn More About Kenneth