If you see something, say something….. PLEASE!


As I have traveled by rail and air this summer I have noticed more signs, reminding me “If you see something, say something”.   What would I do if I saw an unattended package?  Who do I report my concern to?   How much time will it take?  What if I speak up and the package is nothing?   Will I be made to feel like a fool for speaking up?

There are so many barriers to speaking up when you suspect something may not be right, so maybe you just don’t bother. Is that our problem in Healthcare?

Creating a culture in which individuals are free to report concerns before they turn into big problems is an integral component of a “Culture of Safety”.  Finding the recipe for the secret “culture of safety” sauce is the goal of transformational leaders because they know “culture eats strategy for breakfast” (Peter Drucker).  If you get the culture right, the rest falls into place.  Performance improves as individuals feel secure enough to put their neck on the line to contribute more than the status quo.

But, the status quo can be scary and hard to change.  The status quo may keep a nurse silent instead of questioning an unclear patient care order! It may stop a co-worker from calling out a break in sterile technique that could lead to a surgical infection!   The status quo may keep a technician from reporting an equipment malfunction that could lead to patient harm if it occurs again.

In healthcare, we are 30 years behind the aviation industry in creating a culture of safety that encourages all levels of employees to speak up about a concern  then accepts the concern and proactively responds to the concern.  By focusing on healthy team communication for the past 30 years, aviation has produced an extraordinary safety records.

In healthcare, our multi-disciplinary, hierarchical teams make establishing a culture of speaking up a challenge.  But, we know creating an environment of Psychological Safety where people can speak the truth without fear of retribution is what we want.

Are you ready to take your organization, department or team to the next level of safety culture and team communication to accelerate your safety performance?  Here are a few questions to get you started in identifying your gaps in order to create your high performing safety culture:

  • Does your staff speak up honestly about vulnerabilities, stress and obstacles or are you blindsided with the information when it is too late to make course corrections?
  • Do you have structured communication processes for staff to utilize to voice concerns and escalate it if needed?
  • Do you have a process to proactively gather concerns from staff?

Do you see an opportunity to promote a culture that embraces speaking up? Now is the time to take advantage of all the tools and resources available to get your team or your organization moving in the right direction.

If we all work together, we can make healthcare better.

Thanks for reading!

Best Thinking: Uncovering the Invisible

When trying to solve a problem or make an important decision, how do you approach thinking about the solution?  Do you go with your first thought and go deeper with your focus on a solution?  Or, do you think wider, considering all the possibilities before you focus?

As an Intrinsic Coach, I have learned the value to the later.  When I am coaching front line hospital leaders who are facing problems, or difficult decisions, their first reaction to a problem is to start talking about strategies to solve the problem.  That seems like the obvious first step, right?  We only have so much time in the day, and we need a solution, now.  Our systemic thinking takes over.

Systemic thinking serves us well and tends to dominate our thinking.  Systemic thinking allows us to react quickly to a situation based upon our experience and knowledge.  This is perfect for solving a problem in an urgent, crisis situation like an internal disaster, or managing an unstable patient.  The solution is black and white and the variables around the situation are visible for all to see.  We base our decision on experience which is based upon old thinking and old knowledge.  Using old information can block our ability to see new information that may not be readily apparent.  That is the flaw in starting with systemic thinking when making decisions about non urgent situations.

In thinking about non-urgent situations, taking an intrinsic approach will serve you better.  When thinking about an important decision or solving a problem, disable the dominance of systemic thinking and consider the intrinsic.   The intrinsic means focusing on the goal and what is most important to you before you start to lay out the strategies to solve the problem.

The intrinsic leans on widening our thinking about the goal before we focus on a solution.  Intrinsic thinking means spending the most amount of time thinking to determine what is most important for this unique person or team, in this unique situation, in this moment in time.  It is based upon new thinking and searching for what is most important by uncovering thoughts that are initially invisible.


While having a conversation with a colleague who is in job transition, her first thought about her goal is “to find a job”.  “Find a job” is actually a strategy, and if we went forward from there we would have skipped the intrinsic.  As we talked about  what was really important to her about this decision, and about all the opportunities and thoughts about what she is looking for,  new thoughts began to emerge about what is important.  She began to uncover information and new thoughts that were previously not apparent to her.  Her intrinsic formulated a goal:  “To find a job in which I can truly be myself.”  What she is wanting is a job in which she can let her guard down and use her creative skills that she loves.  This opened up a new ideas and more options and possibilities.   Suddenly, there wasn’t panic about how I will find a job.  There was hope and energy about the array possibilities that can unfold in the future.  Her options quadrupled.

The goal in leaning on the intrinsic to promote best thinking is to uncover new learning, new information about what is important.  If we allow our minds the time to think about what is truly important, our strategies and actions will snap into place and we will know what to do, and it will be the right thing for us.

So the next time you are faced with an important decision or problem to solve, don’t go with the first thought that your systemic thinking offers as a solution.  Spend some time thinking broadly about what is truly most important to you as a unique person, in a unique situation in this moment in time.  If you use your intrinsic wanting to decide what to do, you will make better decisions about your future.

Tapping into the intrinsic takes discipline and self management.   Here are a few tips.

1.  Ask the “What” – “What do I want?”  “What is important to me in this situation?  Listen to your internal dialog for clues about what is most important.

2.  Don’t focus on the “How” till you determine the “What”.

3.  Don’t ask “Why?”.  Why takes us into the past and won’t be productive, unless you ask why to create new learnings.

4.  Don’t rehash information you already know.  And, If you are in a conversation with someone trying to make a decision, don’t ask questions about information they already know, for your own curiosity.  That is letting your systemic thinking dominate and it will interfere with their fragile, intrinsic thoughts.

5.  Start with broad thinking before you go narrow.  The broad thinking will make your practical thinking smarter and uncover more options.

Give this some thought.  Best thinking starts with clarity around goals which leads to best planning to achieve the outcomes that matter most.

Thanks for reading my blog!

Happy thinking, creating and being!


Doing More with Less or More with Many?

How many times have your heard “we need to do more with less”? This language of scarcity is coming from a leader’s surrender to the changes that are unfolding in healthcare.  Doing more with less is a recipe for disaster.   To me, doing more with less when it comes quality and safety in healthcare means doing more harm with less thought.

As leaders, we owe those we lead an inspiring, optimistic approach to doing things a new way when we are asked to do more.  Can we, for a moment, shift our thinking from scarcity to abundance?  Instead of fretting over another problem  that needs to be fixed by Monday, take on the “more with many” approach and engage your staff in solving the problem.

Abundant mindset

The people closest to the work need to be the ones to fix the problems.

So why don’t you let them fix it?  Feeling guilty to ask a front line clinician or leader to take on an improvement project?  Think back to how you felt when a supervisor asked you to take on additional responsibilities.  What did that mean to you?  Did you feel awesome and honored?

What’s holding you back from engaging your front lines in quality improvement? Too busy?  Afraid to give up control?  Unable to trust others to step up and meet your expectations?  Clueless on how to start unloading these rocks from your back pack?

Your staff want to be pushed to pursue excellence.  Start small.  Turn to your key, positive influencers to be your foot soldiers in solving problems and improving quality.  Your font line staff want to be part of something bigger.  They want to make a difference. You can give them this opportunity as a gift.

The next time you have a quality improvement project or problem to solve consider these tips to engage your staff and lighten your load.

1.  Ask staff for their opinions on the problem being solved.  Use email, posters in break rooms, huddles to gather ideas.  Round on key stakeholders and physicians to gather information.  Share what ideas are being carried forward.  By gaining input front line staff, you will prevent rework from poorly conceived solutions.

2.  Involve staff in small tests of change.  Ask highly engaged staff and physicians to pilot-test work flow processes.  Start small – one nurse or one doctor or one patient at a time to experiment with new process.  Gather feedback, revise and retest on a small scale.  Staff involved in small tests of change will gain so much insight into quality improvement and you will benefit from this in the future.

3.  Recognize a Champion.  Meet them where they are in terms of what they can or are willing to do.  Start small and let them bloom or give them the project to lead.  If there will be administrative time needed, sit down with the Champion and determine how much time and how they will schedule to get the work done. Depending upon the skill of the Champion, they can take care of steps 1 and 2 for you.  This is a great way to begin grooming your future leaders and create a culture of continuous learning and improvement.

It’s up to you on how many rocks you want to carry in your back pack.  Sharing the load with key front line staff has so many benefits.  You get to give front line staff the gift of being part of something bigger, build the department’s leadership and quality improvement capacity, and create your leadership legacy.

Thanks for reading my blog!

Happy thinking, creating and being!







Biggest Mistakes of the Chronically Overwhelmed

We have all had times in our lives when we have bitten off more than we can chew.  It’s human nature for many of us in the helping field of healthcare.  We are overly optimistic about how much we can accomplish.  It is our optimism and desire to serve others that gets us into trouble.

In coaching front line leaders in health care, I see many making the same mistakes over and over again, and wondering why they can’t achieve their goals.

Is this you?

1.  You are an early adopter.  You love new ideas and want to be the first to pilot, so you volunteer.

2.  You love to help other people.   If a coworker from another department has a crisis, and they need your help, you drop everything on your to do list to help.

3.  You are easily distracted and welcome interruptions. Sitting down and planning for a better future is boring compared to fixing or problem solving an urgent issue.

4.  You like being the “go to” person who helps when others might take a pass.  It’s all about the team, right?

5.  You believe that “one more thing” won’t significantly impact your workload, so you say yes.

The problem lies in your optimism and spirit of teamwork.  It is both a blessing and a curse.  

1.  The “one more thing”  is probably the tenth extra thing you took on.

2.  As the “go to” person, you are so busy helping others that you are not helping your own department, or staff.

3.  The distractions prevent you from spending time doing your best thinking, to build a better future.

4.  The spirit of teamwork may not be reciprocated.  You help others to “pay it forward”.  Do you ask for help in return?  Do you get help or support when you need it?

5.  Always being the early adopter can put a strain on your staff,  and distract you from your core work.  It can also rob other peers of the opportunity to be a pilot site.

angel_marquee-newFor all this teamwork and action packed activity you will be rewarded, right?  People around you will recognize and appreciate all you do, right?  Your staff will see how hard you are working, right??????

Wrong……….. here’s what your peers and staff see:

1.  You are so busy.

2.  You stay late and bring your work home.

3.  You can be counted on to volunteer for extra work.

4.  Your staff are dealing with work processes that are inefficient because you are too busy to attend to your own house.

5.  You fall behind in meeting deadlines because you added one more thing for someone else.

6.  You are becoming increasingly anxious as you become overwhelmed.

Is this what a leader looks like?

Prioritization Matrix 2A leader spends time working in the upper right hand quadrant of the priority matrix.   A leader has focus and spends their time doing the right things at the right time.   If you are overwhelmed, chances are that you are not saving enough time for the sacred work that gets done in the upper 
right, or quadrant II.

Think about the leaders you admire.  Do they have an aura of peacefulness and balance or frenetic activity?

Which leader are you?  Which leader do you want to be?

What can you do?

1.  Analyze your time for one week.  How much of your time at work or play is spent in each quadrant?

2.  Learn to say no.  Explain to a requester what priorities you currently have an why you cannot take on an additional project at this time.

3.  When you must say yes, be realistic.  What priorities do you currently have and when can you fit in a new project or activity?  How long will it take you to complete the work when you fit it around your work?  Is there an opportunity to share the project or activity with a subordinate as a growth opportunity?  Don’t just plop it on top of your important work and hope for the best.

4.  Don’t invite interruptions, especially when you are doing upper right quadrant work.  Shut your door.  Let calls go to voice mail.

5.  Respect your work and your time as much as the work and time of others.

It’s time to reclaim your priorities and focus on what is most important to you and those you lead.

Thanks for reading my blog and engaging in the process of thinking about your leadership potential.

Happy thinking, planning, being!




Rescue a drowning leader

What does it look like when a leader is drowning and needs to be rescued?  Have you ever been overwhelmed and didn’t want to share this fact with your supervisor? Sometimes it’s hard to spot.  If you are the one drowning, you know it.  How can you keep your head above water, or help those you lead stay stay afloat when the tide of work rises?

red_life_buoy_on_wooden_wall_background_padfolioMy favorite tool for leaders who are feeling overwhelmed and paralyzed with the amount of work on their plate is the “Sticky Note” exercise or “Brain Dump”.  This is the best 45-60 minutes you can spend to get a handle on the work and clear your mind of all the worries.

This link to my website coaching page has the instructions for the “sticky note” exercise that will enlighten you and end with a realistic plan to get the most important things done.   I have helped numerous leaders dig out from leadership quicksand in one telephonic coaching call using this tool.   Arm yourself with a pack of good sticky notes to write everything down that you do or need to do and have a large surface to arrange,  categorize, prioritize and schedule what is most important to you and your success.  You can do it on your own or with a trusted coworker or supervisor.  The important thing is to DO IT.  Time spent thinking and planning will put you on the right track in doing the right things at the right time and give you peace of mind that you haven’t forgotten something.

Thanks for reading my blog!  Happy thinking, planning, doing!


Drowning prevention, rescue and treatment: Prevention First

The clinical, front-line managers that I coach often describe their feelings about their workload as “I’m drowning”,  “I feel like my head is spinning”, “I am overwhelmed”.    These leaders are conscientious, go getters who were recognized for their initiative and promoted into leadership positions.  They have a desire to please, and accept an overwhelming workload and mounting assignments in a spirit of teamwork and optimism.  They are hanging by a thread and they are afraid to tell you.

teaching staying afloatIf you are supervising a front line leader, what are you doing?  Are you helping or hurting?  Do you continue to pile on the work because these go getters are willing?  Have you evaluated their workload and supported taking tasks off their plate?  Have you helped them prioritize what is really important, and what can be delegated?  Have you coached these leaders on spending time on non-urgent, important tasks, like relationship building, planning and designing better processes, strategizing to build a better future, to get out of the firefighting mode?

Our front-line leaders in healthcare are drowning and yet we need them to be the captain of the patient safety and patient experience ship.  Here’s what you can do to throw your drowning manager a life raft to improve the longevity of these managers and improve the experience of the patients and staff they serve:

  1. Make time for non urgent, important activities a priority.  Leaders need time to think, plan and strategize as well as build relationships and have fun.  Provide planning time in retreats, encourage planning time on leader’s schedules even if it means time away from the office.  Role model this by scheduling or promoting fun activities that build bonds within your team. Use this helpful prioritization matrix as a tool for yourself and those you lead.
  2. Evaluate their schedules and workload.  Analyze their time.   Be realistic.   How much time is spent on daily and monthly schedules, meetings, patient and employee rounding, patient, physician and employee concerns?   What time is left over for improvement?
  3. Before adding a task or responsibility, determine what can be let go. What activities no longer add value?  What activities can be delegated to subordinates as a growth opportunity?
  4. Reevaluate time spent in meetings. What meetings can be eliminated?  What meetings can be scheduled in 30 minutes instead on an hour?  Can daily leadership huddles provide a valuable communication venue and eliminate other management meetings?
  5. Create clear expectations around teamwork and serving patients. Support departments must support the leaders who support direct caregivers.  If service from a support department is lacking, don’t burden the recipient of the service with fixing the problem.
  6. Provide safe harbor…a mentor, coach trusted peer who can be an objective sounding board and who is willing to ask the tough questions about what is realistic and what demands needs to be triaged away. Make it safe for the manager to speak to you about their concerns about workload.  Build the conversation into your supervision meeting agendas.  “Are there important activities on your plate that you want to spend more time on?”  “Are you finding enough time to think and plan for the future?”

Continue reading Drowning prevention, rescue and treatment: Prevention First