Skip to main content

Seven Paradoxes for Effective Leadership

Analysis  |  By Tina Freese Decker  
   May 27, 2021

It became essential, as a healthcare leader, to embrace the paradoxes of effective leadership, balancing the yin and yang of many skill sets in navigating the many unknowns.

Leaders typically rely on tried-and-true skills. Afterall, they've worked. But inevitably, events force us outside of our comfort zones. For many this past year, the COVID-19 pandemic provided such a moment.

Suddenly, the old normal was gone—and we didn't yet know what we were facing. How could we be successful in this uncertain and rapidly evolving environment? What new skills or strategies did we need for a better normal?

Perhaps no industry was in the eye of the storm more than healthcare. The stakes were perilously high as our consumers—the world, really—counted on us to heal the sick, slow the spread of this devastating disease, and help get life back on an even keel.

You might say we were facing crisis management on steroids.

It became essential, as a healthcare leader, to embrace the paradoxes of effective leadership, balancing the yin and yang of many skill sets in navigating the many unknowns. Seven leadership paradoxes rise to the top of the list.

Tina Freese Decker, CEO, Spectrum Health System. Photo courtesy of Spectrum Health System.

1. Think big and small

Leaders have to view everything with one eye through a telescope and the other eye through a microscope.

Ever since the first case of COVID-19 was reported in Michigan, we focused on all the details: how every one of our team members can be protected; how to clear out beds for the surges and then how to ramp back up; how to maintain services during a budget shortfall; how to respond to the concerns and anxieties of staff, patients, and donors; and on and on.

At the same time, we had to look ahead to 2021 and beyond. None of us knew COVID-19 would be one of the defining events of the coming year. Yet we continuously looked forward, monitoring the latest models, vaccine development, economic trendlines, and healthcare initiatives so that we could arm our consumers and our communities with the best information to keep them safe and healthy.

2. Craft a plan, but prepare to pivot

Effective leaders need strategic, operational, and financial plans—a clear road map—to achieve their vision. But in crisis situations, the map can't be static. It's more like a GPS navigation app, modifying, readjusting, and recalculating as conditions change.

Before the COVID-19 pandemic hit, Spectrum Health had a three-year strategic plan to achieve our vision to serve our communities in Michigan—personalized health made simple, affordable, and exceptional. We were well on our way, with goals, metrics, and capital commitments.

The destination is still correct. But we had to take some detours. We recast our short-term plans to address the pandemic, financial distress, social unrest, and great uncertainty. In some areas, we invested more than planned, in others, we delayed or eliminated. And the silver lining: our agility accelerated our strategies by two to three years.

Effective leaders must always be prepared, always plan, and commit to a direction. But they must adapt when conditions change. As Amazon's Jeff Bezos has said, "We are stubborn on vision. We are flexible on details."

3. Overcommunicate and over-listen

Leaders must overcommunicate, with calm and confidence, to build trust and support; some say seven times, in seven ways. That means considering the needs and interests of different audiences and using a variety of media platforms—with just the right energy, tone, and non-verbal cues. Throughout the pandemic, overcommunicating has been essential.

Yet leaders must also listen, intently and actively. One of the greatest desires of all people—especially in a time of crisis—is simply to be heard. In creating our strategic plan, we continuously sought perspectives from team members, patients, health plan members, and the community, leading to a better plan that received widespread support. Likewise, listening and transparency allowed us to build significant trust and support in battling COVID-19.

4. Be decisive yet collaborative

There are times when a leader needs to be the clear decider. But like a conductor leading a symphony, there are other times when a leader should be a participant and allow others to step up, like the soloist who takes center stage. Effective leaders know which chair to occupy in each situation.

A strong, vibrant organizational culture requires effective leadership; however, leadership doesn't come merely from those in traditional leadership positions. Leaders do need to be decisive, but it isn't about being all-knowing. They must also collaborate and benefit from the expertise of others.

In responding to the rapidly evolving health demands of our communities, we streamlined our decision-making processes and empowered others to innovate. When it comes to culture, we all are leaders. In this way, while a decision may ultimately be the leader's, the solutions and innovations come from everyone.

5. Balance opposing forces

Leaders need to balance patience with impatience, moving fast with taking time. The key is knowing when to hit the accelerator and when to hit the brake. This past year, there were times we iterated quickly, like ramping up telemedicine to treat patients remotely during the pandemic. At other times, we slowed down.

Our teams felt a deep hurt following the death of George Floyd. I received numerous messages from team members—including physicians—who experienced his death as a traumatic "last straw." On Juneteenth, we made a conscious effort as an organization to carve out time during the workday to slow down and listen to our peers, so that we could better understand the history and pain of systemic racism. We facilitated difficult conversations and let people share their stories.

6. Build the team for today and for tomorrow

Our focus is always on people. Healthcare is a team sport, and a strong culture and sense of connection among team members and with consumers is at the heart of all effective organizations. Building and developing teams and recognizing people's ability to flex is one of the most critical jobs of a leader. Leaders need to focus at least one third of their time on talent recruitment and putting people in the positions where they can thrive.

But the right team for today may not be the right team for tomorrow. Even the best people need new challenges. It's essential to recognize the strengths, interests, and skills of team members, and provide growth opportunities so the organization can benefit from fresh perspectives, fill emerging needs, and prepare seasoned and new leaders. Some people welcome a shift in duties, while others are uncomfortable. The leader needs to help them see the bigger picture.

This leads to another paradox: leaders need to establish strong connections and relationships with their team members to foster engagement and belonging. Yet at the same time, they must give them the space to take risks, sometimes fail, and to learn—to encourage continuous growth, innovation and improvement.

7. Be strongly authentic, but openly vulnerable

Leaders often feel they must project strength, and this is true. But rather than a take-charge tone, true strength in leadership comes from authenticity and a willingness to reveal vulnerability. The best leaders know themselves well and are comfortable enough in their own skins to be authentic and genuine. This includes being able to share doubts and concerns.

Our organization navigated many unknowns, particularly at the beginning of the pandemic. Leaders based decisions on the best science and facts in the moment, but we were transparent and honest to acknowledge that our plans would continue to evolve—and this built trust. We also acknowledged that we couldn't do it alone. We needed the support and help of many, both inside and outside the organization. I often quote the African proverb, "To go fast, go alone. To go far, go together." Being authentic with your teams builds greater human connection and engagement.

Still, it isn't enough to be authentic with others. The best leaders are authentic with themselves. Effective leaders know that leadership is a journey in which we continuously learn and improve as we navigate life's opportunities. Embracing humility to learn, improve, and share one's successes and failures is what makes leaders people worth following.

Growth through adversity

Growth as a leader comes not when the path is easy but when tested, when there are no easy answers. It might be nice to think about the safety of the status quo—and relying on those "auto-pilot" skills that worked well in the past. But when the pressure is great, we must embrace adversity and the many paradoxes of leadership. Our organization achieved so much during the pandemic—gaining confidence, strength, and wisdom for the future—by taking on the unimaginable. This is growth through adversity.

Moving forward, success will be found, not by the leader who tries to manage toward a calm that never comes, but by the leader who embraces the conflicting forces of the storm.


Tina Freese Decker, MHA, MSIE, FACHE, is the president and CEO of Spectrum Health System, an $8 billion integrated health system with a medical group, health plan, and 14 hospitals employing 31,000 individuals in Michigan.

Over her 18 years serving Spectrum Health in various strategic and operational roles, Tina has developed a track record for cultivating culture and driving strategy. She is committed to building a health system that celebrates and reinforces diversity, equity, and inclusion for team members, patients, families, and members.

As President & CEO, she has successfully implemented a new mission, vision, and values. This foundational strategic work has been instrumental to improving health and access, lowering costs, and reducing health inequities.

Care to share your view? HealthLeaders accepts original thought leadership articles from healthcare industry leaders in active executive roles at payer and provider organizations. These may include case studies, research, and guest editorials. We neither accept payment nor offer compensation for contributed content. Send questions and submissions to Erika Randall, content manager,

Tina Freese Decker is president and CEO of Spectrum Health System.

Photo credit: Grand Rapids, Michigan, December 28, 2019: The Medical Mile in Grand Rapids is home to several medical facilities and academic institutions. / Editorial credit: M A Haykal /

Get the latest on healthcare leadership in your inbox.