When Leadership, Healthcare, and Technology Collide

Healthcare economist William Kissick first introduced the theory of the “Iron Triangle” in the mid-1990s, describing the three essential aspects of a true healthcare system: access, quality, and cost containment (Beauvais, et al., 2021). Believing these three domains are in a perpetual state of competition with one another, Kissick posited that a healthcare system could never achieve simultaneous success in all three aspects; success in one aspect would inevitably result in compromising success in one or both other aspects. 

As an example, if quality is increased in one area of healthcare, this often comes at the expense of cost, and, in some cases, access. Likewise, reducing costs often results in decreased quality of care and access for certain populations. One needn’t look too far past the World Health Organization Global Health Expenditure Database or the Fraser Institute’s performance comparison of countries with universal healthcare systems to appreciate the merits of Kissick’s theory.  

With the increasing shift towards the adoption of digital technologies in healthcare, it could be argued that governments are indeed already equipped to create greater balance in all three aspects of the healthcare system: access, quality, and cost containment. Viewed in isolation from one another, advances in telemedicine have increased access to certain populations, particularly those living in remote or rural areas (Rural Health Information Hub, 2024). 

Combining artificial intelligence with radiologists for image analysis has led to improvements in breast cancer diagnosis and allowed for personalized treatment regimens, resulting in better outcomes (Seok Ahn, et al., 2023). Moving beyond the clinical uses of technology, supply chain management systems have been optimized using digital technologies, saving healthcare organizations millions of dollars (Kim & Song, 2022). 

These are only a few examples of the many ways digital technologies can enhance the access, quality, and costs of a healthcare system. But how can improvements be achieved simultaneously? 

To do so requires reflexive and adaptable leadership with a particular focus on effective digital transformation skills. Leadership within a contemporary healthcare context requires embracing digital fluency; leaders need to understand the technologies used in their areas of practice and how they can be leveraged to improve health outcomes and reduce costs. This includes leveraging data, fostering innovation, and creating an environment of continuous learning that inspires engagement (Harvard Business Publishing Corporate Learning, 2019). 

Disease patterns change, technology changes, and people change; adaptability and reflexivity are imperative for leaders within healthcare. Learning to lead through complexities is a minimum standard in today’s working world, and this is not unique to healthcare environments. Adopting a leadership for innovation stance using change management principles can promote a more human-centric approach to leadership. 

Ultimately, instead of leaning into Kissick’s Iron Triangle, perhaps the healthcare leaders of today should focus on disproving it.

References:  

Beauvais, B., et al., (2021). Testing Kissick’s Iron Triangle—Structural Equation Modeling Analysis of a Practical Theory - PMC (nih.gov) 

Harvard Business Publishing Corporate Learning. (2019). 21325_CL_LeadershipCapabilities_White_Paper_Digital_Sept2019.pdf (harvardbusiness.org) 

Kim, S., & Song, H. (2022). How Digital Transformation Can Improve Hospitals’ Operational Decisions (hbr.org) 

Rural Health Information Hub. (2024). Telehealth and Health Information Technology in Rural Healthcare Overview - Rural Health Information Hub 

Seok Ahn, J., et al., (2023). Artificial Intelligence in Breast Cancer Diagnosis and Personalized Medicine - PMC (nih.gov)