Winning With What You’ve Got: Lessons from the Gridiron for Hospital Leaders
Ray Grady, President and CEO, Franciscan Alliance Lake County, and Senior Advisor, Juniper Advisory, Jordan Shields, Partner, Juniper Advisory
“Success Is What You Do With What You’ve Got”
As a new year begins and football playoff season captures much of the country’s leisure hours, we turn to the great Ohio State football coach Woody Hayes for inspiration as the industry assesses the challenges presented by the One Big Beautiful Bill. Experience helps reveal patterns and the longer you work in hospital administration, the more often you find yourself confronting situations that feel strangely familiar, even when the details have changed.
Coach Hayes was a pragmatist. He believed that hard work and persistence would win the day. As the hospital industry digests a daunting One Big Beautiful Bill, Woody’s wisdom is resonating with us. “Success is what you do with what you’ve got” is a call to action. Just as the game seems impossibly complicated, we look back to what came before and remind ourselves that these are not the first challenges that the industry has faced. The acronyms are new and the stakes feel higher, yet we have a well-tested game plan that can keep us on the field.
“Be a pragmatist. First, find out what works. Then, keep doing it.”
Woody Hayes believed deeply in pragmatism. He was not interested in novelty for its own sake, and he had little patience for strategies that looked good on paper but failed on the field. When things stopped working, his answer was not to complicate the game. It was to strip it down.
Healthcare today feels anything but simple. Payment models erode. Regulations accumulate. Federal reimbursement drops. Technology promises transformation while demanding capital and attention. Coverage rules change faster than operational realities can keep up. For hospital administrators, the environment can feel like a playbook that grows thicker every year while the margin for error shrinks.
In moments like this, pragmatism becomes a survival skill. The question is no longer what is theoretically possible, but what actually works in practice. Leaders who endure are often those willing to focus less on trend chasing and more on execution.
“When the game gets complicated, you go back to blocking and tackling.”
The Balanced Budget Act of 1997 remains a defining example of what happens when policy complexity collides with operational reality. Designed to control federal spending, the BBA placed hospitals under sudden and sustained financial pressure. Reimbursement declined. Graduate medical education funding tightened. Uncompensated care became harder to sustain.
Hospitals that survived did so by returning to fundamentals. Lengths of stay were reduced. Service lines were evaluated with new rigor. Cost control moved from an abstract goal to a daily discipline. Regional and academic-led systems formed to realize scale efficiencies and operationalize best practices. The lesson was clear, even if it was uncomfortable. Fundamentals matter most when conditions are hardest.
That lesson has not expired.
“The will to win is not as important as the will to prepare to win.”
Nearly three decades later, hospital leaders find themselves confronting another environment shaped by uncertainty. The One Big Beautiful Bill has reintroduced questions about coverage, reimbursement, and the role of hospitals as the healthcare system’s safety net. While the structure differs from past reforms, the challenges are familiar.
Hospitals today are not operating from a position of abundance. Margins are thin. Labor remains scarce and expensive. Capital is harder to deploy. Patient acuity continues to rise. Success in this environment is not about ideal conditions. It is about making disciplined decisions with limited resources.
Managing labor, supplies, and length of stay once again sits at the center of the conversation. Quality and safety become even more critical when resources are stretched and tolerance for error disappears. Information technology functions as support rather than salvation. It helps sustain performance, but it does not replace leadership or judgment.
“Paralyze resistance with persistence.”
One constant across every cycle is people. Hospitals rise or fall on the strength of their workforce and their medical staff. Managing physician talent has never been optional, but in times of stress it becomes decisive. Recruitment, retention, alignment, and trust determine whether organizations move forward or stall.
Persistence matters here. Leaders who consistently invest in relationships and culture, even when finances are tight, are better positioned to navigate disruption. Putting the patient first remains one of the few strategies that reliably cuts through noise and complexity. Nine times out of ten, patient-centered decisions lead organizations in the right direction, even when policy signals are mixed.
“Failure is not fatal, but failure to change might be.”
Hospitals will continue to adapt because they must. Leaders will make difficult choices, stretch resources, and reimagine how care is delivered in their communities. But adaptation now carries consequences that are harder to ignore, including reduced access, workforce fatigue, and long-term sustainability concerns.
As we look at the year ahead and the challenges facing the industry, we ask ourselves what guidance Coach Hayes might have offered.
An inability to recognize when fundamentals alone are no longer enough puts hospitals, and community healthcare, at risk. Where organizations most often go wrong is prioritizing the status quo over care for their communities. It is distressingly common to see “independence” and “local control” as objectives or even incorporated into organizations’ missions, instead of asking how to best ensure local, high-quality care. As Woody cautioned on the football field, it is worth reminding ourselves in hospital board rooms that being unwilling to adapt in the face of new evidence is a more daunting opponent than even the most draconian policy shift.