The Journal of Continuing Education in Nursing

Leadership and Development 

Health Care Leadership in the New Economy

Michael R. Bleich, PhD, RN, NEA-BC, FNAP, FAAN


Most health care organizations are designed using industrial model performance standards based on conformity and conventionality. In the new economy, marked with exponential change, convergent competition, and empowered consumers, leaders are faced with building a model that can accommodate personalized medicine, managing patient-centered expectations, and value-creating hubs to remain viable. [J Contin Educ Nurs. 2019;50(5):196–198.]


Most health care organizations are designed using industrial model performance standards based on conformity and conventionality. In the new economy, marked with exponential change, convergent competition, and empowered consumers, leaders are faced with building a model that can accommodate personalized medicine, managing patient-centered expectations, and value-creating hubs to remain viable. [J Contin Educ Nurs. 2019;50(5):196–198.]

As a diligent steward and procurer of primary care and medical follow up involving specialists, it was a challenge to contain myself when, during a recent visit, each provider's office required a list of current medications (which was never referenced), paper forms to complete that were duplicative of information already contained in the integrated medical record, and identification and insurance cards for hard-copy printing because the provider lacked access to that which was already situated in the medical record. As a consumer facing time demands, I ensured that radiologic and laboratory tests were completed prior to seeing the physician specialist, lest the provider sees me sans results, orders the tests during the visit, and then communicates the results, which were needed for decision making at the time of care through a post-visit computer portal. In this model, the patient bears the responsibility for their own care coordination. This is the industrial model at work in a sophisticated medical center.

Most people today are new economy consumers. Gone are the days when computers and technology supported old economy industrial designs; computers and technology are now the primary infrastructure in the global economy. Without warning, consumers react and adapt to the influence of computerization, health care agencies converge to create value hubs touting seamless care experiences, and consumers are opting for freedom to interact with providers more directly, rather than through the maze of systems and processes that are disconnected.

Development Issues

Professional development educators with responsibility for leadership development must assess whether leaders reflect old economy, new economy, or blends of both in how they think and perform. This article discusses the repercussions of new economy thinking as proposed by Bishop (2017).

In a multigenerational workforce, it is unsafe to assume that individuals have grown up exclusively in an old economy model. Mental models are shaped consciously and unconsciously by lived experiences, what is seen and heard, and educational preparation, all which predisposes one to a hardwired set of behaviors culled from these collective experiences. In the industrial model era, leaders were groomed with a predilection toward reducing work into parts, showing deference to hierarchical authority, and creating and insisting on performance objectives driven from the top of the organization down. Mental models shaped by new economy thinkers include exposure to cocreated actions marked by flexibility, respecting specialists as lateral collaborators alongside those holding formal leadership positions, and using technology as a foundation for performance, not the adjunct data feedback loop-linked linear structured work processes.

Bishop's Repercussions

In his book, The New Economy Thinker, (2017) author Bill Bishop created a working framework that captures the shifting marketplace paradigm that leaders face, many of which are subtle and may not rise to a level of consciousness. The repercussions of the new economy are universal but seem especially relatable to those seeking care in and leading health care organizations. In designing an educational program for leaders, the following points could be used to name prevailing changes, encourage leaders to lay claim to new changes, and tame the change through improved strategic and operational decision making. Bringing leaders together using the Bishop framework to guide learning activities can increase their agility and intrinsic motivation to creatively lead.

  • Conceptual Recombination. Bishop speaks to the centrality of computers and smartphones, tablets, and other devices such as sensors, cameras, and appliances, sometimes called the “internet of things.” Voice-activated solutions, such as Alexa, are now in use to decrease social isolation, promote wellness, and cue discharge planning instructions in health care—all extensions of its original purpose. Social media now influences perceptions, beliefs, and preferences, as recently noted through debates surrounding immunizations.
  • The Race to the Bottom. Tradition has it that the classic solutions to industrial model problems are to lower the cost of operations and sales, decrease the percentage of fixed costs and those associated with risk, and increase economies of scale. Although health care organizations market their distinctiveness, the consumer sees very little, if any, of these distinctions, preferring instead to choose low-cost options. As competition for low-cost options mount, there is little choice among providers but to join in lowering costs.
  • The End of the Middle Market. Health care consumers opt for two broadly categorized types of services—basic care, which is lowest cost and is satisfactory to the market, or the concierge model in which they pay more for customized and elite services. As more care-delivery options are available outside of traditional hospitals and clinics, consumers want direct patient-to-provider alternatives. Television advertising promoting drug solutions for clinical problems puts the consumer in the driver's seat to ask the provider directly for the drug.
  • The End of the Salesperson. The previous example provides clarity as to why fewer people in sales are needed or desired. Health care may soon see fewer care coordinators as new care models emerge that are designed for simplicity, access, and direct-provider contact as care coordinators represent old economy disorganization and inefficiencies.
  • The End of the Single Transaction. Hubs where multiple services can be provided are preferred over silos of services. Many pharmacies offer primary care, prescriptions, groceries, and more, for example.
  • The Freebie Factor. There is a cost to everything, but new economy thinking may lure a consumer to get free devices for the benefit of access to their health information that can be used later to offer fee-for-service. The low cost of genetic testing creates large databases with individual and population health information. Most retail stores offer discount coupons based on individual shopping patterns and trends, including those related to health and well-being. Blood glucose monitors are low cost, but the testing strips and lancets are customized to the monitor, where profit is ensured.
  • The Demand for New Kinds of Value. To the new economy consumer, there is less satisfaction in buying a device and more satisfaction in things of emotional value—such as those linked to stress management, peace of mind, empowerment, and connectedness. Health care is generally provided in high stress environments, the antithesis of the well-being that customers prefer and will pay for in spas, for instance.
  • The End of Fixed Overhead. Replacing buildings and technology that is fixed purpose and time limited is the desire for lower cost and convenient locations for health care services. There is less celebration of large construction projects and what they represent to the consumer, linked to their demand for peaceful experiences.
  • No More Jobs. Although this sounds ominous, it represents new ways of working—with the emphasis on the explosion of work. Traditional place-bound jobs will provide a steady core of opportunity while others will seek new forms of employment brought into new organizational partnerships and configurations. Rifkin (1995) provided an astonishingly accurate foreknowledge of the state of the workforce as an additional point of reference.
  • The End of Industries. Early in my career, my parents said, “As a nurse, you'll always have a job.” What was not said is what opportunities lie ahead and what the job entails. Many industries are hard to classify, such as Amazon with its far-reaching services. The traditional drugstore, mentioned above, is hardly where compounding drugs is the only function. Specific industries are waning in our midst.


It should be apparent that many changes are afoot, the marketplace has and is actively shifting, and health care is not immune. Some might conjure that the structural rigidity of many health care organizations makes it ripe for disruptive technologies, as evidenced by new players entering to reinvent the entire health care experience from insurance to provider optimization and strong and detectable experience-changing service for consumers. Professional development educators can use Bishop's model and repercussions to stimulate leadership awareness, ownership, and action.


  • Bishop, B. (2017). The new economy thinker: The complete guide to your success in the new economy. (n.p.): Author
  • Rifkin, J. (1995). The end of work: The decline of the global labor force and the dawn of the post-market era. New York, NY: Putnam.

Dr. Bleich is President and Chief Executive Officer, NursDynamics, Ballwin, Missouri, and Senior Professor and Director, Langston Center for Innovation in Quality and Safety, Virginia Commonwealth University School of Nursing, Richmond, Virginia.

Address correspondence to Michael R. Bleich, PhD, RN, NEA-BC, FNAP, FAAN, President and Chief Executive Officer, NursDynamics, LLC, 221 Jasmin Park Court, Ballwin, MO 63021; e-mail:


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