Leading, working within, and receiving care within contemporary healthcare is often an overwhelmingly complex and exhausting challenge for even the most skilled and adaptable leaders, healthcare workers and people. Physicians have generally shifted from being small, independent contractors vital to the provision of care to becoming massive medical groups who wrestle with enormous health systems and health plans to get their piece of the massive healthcare spending pie.

Health systems and health plans spend billions every year to try to influence the behavior of physicians, yet most of that investment is to create more and more complex billing and coding practices that tie the physicians up in knots and take them away from essential patient care activities. A few physicians pursue medical group, health system and health plan leadership roles—yet face being ejected from the physician culture as having “gone over to the dark side.”

In the midst of these complex challenges to improving healthcare delivery to every American, COVID-19 continues to surge through our health systems nearly 3 years into the Pandemic. It is creating an unrelenting urgency to adapt and innovate. Telehealth capabilities were available over a decade ago—-yet healthcare inertia left it < 1 % of care provision until COVID-19 struck and opened the floodgates of Telehealth—with CMS demonstrating rare agility to allow for billing for this new activity within weeks. It seems that COVID-19 is quite effective as a disruptor and is emulating the observation offered by Aurelius. COVID is profoundly disruptive precisely because it is interwoven with all other aspects of health care—and even the fundamental values of human society.

One of us [JF] notes that his own healthcare system had a Telehealth capability in place prior to COVID-19—yet when we road-tested it in real-time with COVID we found it wanting and quickly shifted to an EPIC-integrated Zoom interface that has served us very well. That transformation from all-in-person to all-virtual happened in a matter of weeks—something that may have taken a decade or more in pre-COVID times. Yet, we generally have the same leaders in place now as we had prior to COVID.

How can our healthcare leaders build the right new skills to lead healthcare in the post-COVID era? How is complexity confronted in the world of mid-21st Century health care? What puzzles, problems, dilemmas, polarities and mysteries has COVID-19 revealed to contemporary healthcare and how can we harness these opportunities to continue to inertia-busting impacts of COVID-19 on the pace of innovation and transformation in healthcare? How has COVID-19 amplified the pace of Volatility, Uncertainty, Complexity, and Ambiguity in healthcare settings. Which skill sets will both current and emerging healthcare leaders need to seize the opportunity for comprehensive innovation in healthcare in the era of COVID-19? What type of leader will emerge to effectively navigate Aurelius’ interwoven world?