Reflection is a critical habit that builds our leadership skills, self awareness, and situational judgment.

Today I’m sharing a few things I’m reflecting on this week; lessons I’m either learning or having reinforced by my experiences.

Stop Making a Big Deal out of Everything

Change is the name of the game in healthcare; so as leaders, we have to be good at managing change. A principle I’ve seen repeatedly and come to appreciate recently is the value of simple packaging.

A recent example is a change to our process for routing telephone triage messages between our reception and nursing teams. Myself and our lead receptionist had been tasked with improving our process to reduce missed opportunities when patients return a call.

Going directly to the triage nurses, I simply asked “what if we tried X instead of Y? do you think that would work?” Through a series of short informal conversations, we had productive discussions of practical constraints and rationales, and generated buy-in to try a new approach before the end of the day.

Too often we overhype change. Consider the way many changes are deployed in healthcare organizations:

Leaders in suits come to the unit and hold a “big meeting” with all the staff to discuss the importance of a “strategic initiative”, drop a bunch of buzz words, and grandstand about how they believe in the team and… blah blah blah. That’s probably all the team heard anyway.

At best, this kind of approach elicits confusion from the staff because the lead is buried under corporate buzzwords and grandiose language, and at worst gets eye-rolls because staff can smell the BS a mile away. Having been on both sides of this scene, I feel I can say this frankly: what’s obvious to the front line is often the blind spot of the suits – this meeting does more to serve their egos than it does to serve the frontline team or the objective.

The result is often predictable – little real traction or progress, leading to more “big meetings” to “motivate the staff,” along with meetings between upper and middle managers and the frontline leaders to discuss “why it isn’t working.” Meetings that beget meetings, instead of conversations that produce curiosity, creativity, and experimentation.

Unfortunately, career administrators and clinicians who’ve gotten too comfortable in conference rooms have a strong “meeting reflex.” Every change requires a meeting, and every meeting gets a slide deck, a calendar invite, and a pretty templated agenda. Meetings are familiar, safe, and structured. Real change, however, is uncertain, risky, and messy.

Next time you have a change to implement, try shrinking the packaging, communicating less formally and more directly, and focusing on the practical implementation rather than the abstract rationale.

If you’re in middle or upper management, encourage (or better yet – model) this approach with frontline leaders. Resist the reflex to book a meeting. Go to the gemba, talk to the people, keep it informal, direct, and practical. Then empower your frontline leaders to spearhead the change with small experiments locally (which generally means getting out of the way).

Shorten the Time from Idea to Implementation

A closely related and complementary principle of change is that short lead-times are often more effective than long ones. If an idea is discussed, strike while the iron is hot. Experiment, learn, adjust, repeat.

Too often in large healthcare organizations, positive changes get bogged down in committees and bureaucratic approval processes. This lengthens lead time, and by the time the change gets back to the frontline, everyone has forgotten why it came up in the first place. Or, worse, the real world has moved on and the change is now obsolete or irrelevant to frontline reality.

In contrast, when changes are managed locally and informally, they often move faster and create more realistic solutions through rapid iteration. In the example I shared above, we reached agreement to try the new approach by the end of the day.

No meeting.

No slide deck.

No buzzwords or discussion of the “strategic plan.”

No need to coordinate schedules for a month to find the perfect date or even get the whole team together.

We just went directly to the staff involved in the workflow.

By the end of the week, the team has further refined the change because real experimentation reveals flaws and generates new ideas that, crucially, can be acted on immediately. The feedback loop is short and compounds powerfully.

These first two lessons are, of course, complementary. Its far easier to move quickly when things are kept simple and direct.

Of course, some degree of bureaucracy, structure, and approval are necessary. It works when it’s serving the goal of improving care delivery, not the other way around.

Leadership Leaves a Lasting Impact

My final lesson from this week is on a completely different tack. This one is about people.

I’ve had the privilege of onboarding two excellent nurses to our team in the past few months. But one of them has a problem.

It’s not her performance – she is actually crushing it. It’s her self-perception and mindset.

I approached her the other day to ask about the above change initiative; I opened with “do you mind if I ask you a question?”.

Her response was: “oh no, did I do something wrong?”

Puzzled, I stopped and said “what makes you think you did anything wrong?”

She shrugged and stated “I don’t know it’s just trauma from my last job, every time someone in management approaches me I’m expecting the worst.”

What’s worse is, this isn’t a one-off interaction, it is a genuinely reflexive response. She will frequently approach me or respond to a benign inquiry with:

“Did I do that wrong?”
“Am I in trouble?”
“Was that not ok?”
etc.

How sad.

My experience has been that this woman genuinely wants to do a good job, has a great work ethic, takes initiative, and is eager to learn. Her previous leaders apparently chose to focus on other things.

The sad part is, that’s the piece that stuck with her.

Now I don’t know her previous leadership; they are probably nice people and I’m sure they have their strengths. Whether intentional or not, what she remembers and carries with her is their constant criticism and negativity toward staff. The effect was so powerful it’s now part of her habitual response to leaders; a subconscious element of her work personality.

Its critical to maintain awareness of the disproportionate impact our behavior has on our subordinates. Our habits, communication styles, and criticism hold much more weight, and leave a more lasting mark than others’ because of our authority (real or perceived).

We must remember that these are people with fears, insecurities, performance anxiety, and emotions, not resources to be mined or robots to be reprogrammed.

I observe many managers interact with their staff in an adversarial stance, as if they are on different teams. When something goes wrong their first assumption is “someone screwed up”, or “they’re just lazy and incompetent.” The staff are guilty until proven innocent. This mindset reflects more on the competency of the leader than the staff.

While occasionally you will encounter a genuinely bad apple – unapologetically checked-out, toxic, lazy, or incompetent – in my experience that’s not the majority of people.

Give people the benefit of the doubt.

Be curious rather than critical.

When something goes wrong, look for why and how, not who.

Don’t just shine a spotlight on staff weaknesses and shortcomings – look for ways to encourage them to grow into their strengths.

I am by no means perfect in this regard; no one is, which is why this lesson is so critical to keep top of mind.

Because the real impact of leadership is not on the bottom line or the strategic plan, but on the people.