High Stakes

Thoughts for Health System Leaders on Immigration Policy

Dear Health System Leaders,

It’s not normal for health systems to need a carefully considered and deliberately articulated position on U.S. foreign-policy.

Welcome to not normal.

Last night’s firing of acting Attorney General Sally Yates for telling government lawyers to not defend an executive order suspending immigration from seven “terrorist-producing” countries will only intensify an already vociferous public response to this policy and the media’s non-stop coverage of it.

This matters to you. How President Trump’s executive order impacts America’s hospitals and health systems has been a focus of intense media scrutiny in the last 48 hours.

Regardless of where you stand on the policy, this order presents a challenge to the nation’s healthcare delivery system.

According to the AMA, roughly 27 percent of U.S. physicians are foreign born. These foreign doctors play an integral role in staffing a health system that has faced physician shortages in recent years.  Many nurses fall into the same boat, along with international patients seeking treatment from American hospitals. With Friday’s order, there are fears that many of these will face difficulty entering or re-entering the country from trips abroad.

How does this policy affect your hospital’s ability to deliver care? How many of your doctors and nurses are potentially affected? Do you have a position on the policy? These are natural questions for the public and media, especially those scrambling to localize a hot national story.

It would be unwise to ignore this issue. And some prominent CEOs are already voicing opinions. While you might prefer to keep your focus on non-political topics, a fumbled deflection on such a sensitive matter could easily alienate any number of people who are important to you and who are passionate about this debate.

With that said, we offer three communications thoughts to consider as you navigate these uncertain waters.

Be prepared: Develop your response with a “triple threat” mentality.

Consider whether you want to have a position on this issue. Maybe it’s a clearly defined stance that either agrees or disagrees with the policy based on your mission or business strategy. Or, maybe it’s determinedly non-political – “Our focus is to deliver great care with the resources we have” – and refuses to enter the political fray, focusing, instead, on patient care, quality and safety.

No matter what, be clear, authentic and transparent about it.

As you interact with your community’s stakeholders – staff, patients, media, etc. – be ready. Your organization plays a vital role in your community as an employer, provider of care and economic contributor. People expect you to be aware of this issue.

Also, prepare for the unexpected:

  • If your community were to have a rally outside your building tonight, would you be ready?
  • If your mayor announces she wants your city to become a “sanctuary city,” will you support her?
  • If you get a call from your foreign-born physicians wanting to know about your support for them, what will you say? And will your leadership team say it consistently?

Finally, think long term. Unprecedented change could be just around the corner.

Listen intently: Know where your constituents stand on this issue.

One of the clearest lessons from the election is the importance of listening to and being in touch with what your constituents are really thinking. There are different echo chambers within your constituent base. Know who they are, both internally and externally. Consider how to engage them about this issue and make sure they have an outlet for their voices to be heard.

A lesson from Uber: Avoid unforced errors.

On Saturday night, as protestors were massing at New York’s JFK Airport and the New York Taxi union declared a work stoppage in solidarity with the protesters and affected international travelers, Uber announced a suspension in surge pricing in New York to take advantage of the situation.

This move was seen by many as an attempt to undercut the taxi strike and capitalize on an emotionally charged situation. Uber’s action was noticed:  The resulting pile-on was immediate, with #deleteUber trending on social media for days. Meanwhile, Uber’s primary competitor, Lyft, reacted to the controversy by announcing a $1 million donation to the American Civil Liberties Union.  Had Uber done nothing but simply conducted business as usual, it’s difficult to imagine it becoming the target of such vitriol.

Moral of the story: Don’t enter into an emotional arena unless you’re sure about your steps. A feel-good decision in the moment could have unintended and long-term consequences for you and the reputation of your system.


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