OKUMU: December: The month that reveals the truth about healthcare businesses

December looks festive from the outside. Inside a healthcare business, it behaves like a pressure test no one scheduled but everyone must survive. It exposes what is resilient and what is fragile. It strips away the assumptions that carry organisations through the rest of the year. It reveals whether a healthcare business is built to last or held together by momentum and hope.

Clinicians have long understood that December disrupts the system. A BMJ study found that patients discharged just before Christmas had poorer outcomes and higher readmission rates. Italian hospitals noted that holiday-week admissions tended to be more complex. Time-series data from Iran showed mortality rising during major holidays. These are clinical findings, but they point to a broader truth: when staffing thins and access narrows, even strong systems strain.

The same strain plays out on the business side, but it is spoken about far less openly. December disturbs the delicate rhythm that healthcare relies on. Elective work slows. Chronic patients postpone reviews. Families travel. Accident patterns change. Insurers stop moving. Corporate HR departments delay decisions until January. Approval officers vanish into leave schedules. Payments that would have landed mid-month slide quietly into the new year.

Revenue softens at the exact moment fixed costs peak. Rent is due. Staff bonuses and year-end allowances must be paid. Supplier accounts require settlement. Licensing renewals fall into the same period. Cash flow tightens not because leadership has failed, but because the entire ecosystem collectively shifts its tempo.

Inside many organisations, a single staff member’s leave exposes a deeper weakness. In one clinic, a radiographer’s December holiday revealed that he was the only person who fully understood the PACS workflow. Productivity slowed, bottlenecks formed, and leadership discovered that the system had been depending on a single point of failure. In a small or medium facility, such gaps are not inconveniences. They are vulnerabilities.

This is why December matters. It is not an unfortunate month. It is a diagnostic tool. It reveals whether an organisation is held together by systems or by individuals. It reveals whether liquidity is built on planning or on optimism. It reveals whether revenue is diversified or dangerously concentrated. It reveals whether leadership has built resilience or assumed stability.

If a healthcare business struggles because patient flow drops for two weeks, the model was already fragile. If three staff members taking leave destabilise operations, the team design was already thin. If delayed insurer payments threaten survival, margins were already too tight to absorb normal fluctuations.

December does not cause these weaknesses. It exposes them.

This is why healthcare leaders should adopt deliberate stress testing long before December arrives. The financial sector does this routinely. Banks simulate shocks to assess whether their structures can withstand pressure. They do not wait for real crises. They engineer the tests early because resilience cannot be improvised.

Healthcare businesses deserve the same discipline. Leaders can simulate a 20 per cent drop in patient volume. They can model a month of delayed payments. They can ask what happens if the lead physiotherapist, ultrasound technologist and claims officer all take leave at the same time. They can test how long the business would last if revenue paused but payroll did not. They can examine what would break if the busiest insurer held back approvals for 10 days.

These exercises do more than expose operational gaps. They expose leadership psychology. They reveal whether decisions were shaped by reality or by hope. They reveal whether systems were designed for resilience or convenience. They reveal whether the organisation was prepared for the cycles of the year or was depending on luck. And they sharpen judgment. They shift leadership from reactive behaviour to intentional design. They move the organisation from being shaped by December to being strengthened by it.

Every great op-ed needs one sentence that holds the thesis in a single breath. Here is the truth for healthcare:

A business that only works in perfect months is not a business. It is an accident waiting for December.

The greatest value of stress testing is not the list of risks it produces. It is the mindset it builds. It teaches leaders to create systems that bend without breaking. It teaches teams to operate with clarity rather than panic. It creates organisations that are prepared for the natural cycles of the healthcare ecosystem instead of being surprised by them year after year.

December will continue to arrive. It will continue to compress pressure into a brief period. It will continue to reveal the systems we have built.

The question for healthcare leaders is simple. Do you wait for December to expose your weaknesses, or do you expose them yourself, early enough to strengthen them?

Healthcare organisations that thrive are not defined by their best months. They are defined by their worst weeks. December will show what your business truly is. Stress testing simply allows you to decide in advance what December will find.

Surgeon, writer and advocate of healthcare reform and leadership in Africa