This week, I’m reflecting on the value of communication, unsolvable problems, and what to do when progress stalls.

A theme in all of these is that as leaders, we need to cultivate an internal locus of control. We cannot always control the environment around us, other people’s behavior, organizational direction or priorities, and the allocation of resources, but we can control our own behavior, communication, and expectations.

As usual, three lessons from my world this week. I hope they get you thinking, and deliver some value for you as you grow as a leader.

Everything Boils down to Communication

We’ve been dealing with some staffing difficulties, and as a result we’re relying more on per-diem staff than usual. One per diem employee picking up extra shifts appeared to be coming in late on a day-to-day basis. This was frustrating.

In the messiness of staffing shortages, there are naturally multiple hands in the pot trying to plug holes in the schedule and backfill vacancies. Inevitably, this creates confusion and opportunities for miscommunication, and that is exactly what was happening. After some frank conversations, it became clear that multiple misunderstandings and incomplete disclosures of information were at the root of the problem, rather than intent, irresponsibility, or unprofessionalism.

In another situation, we had a meeting to discuss a number of issues. Like many meetings, it unraveled into tangential discussions about adjacent topics and lacked actionable direction or resolution. Simply writing and sharing a summary of the points discussed and actionable takeaways, as well as including follow-up clarifications, brought concreteness to an otherwise very abstract discussion.

Both of these situations reminded me that nearly everything in leadership boils down to communication. As leaders, at the heart of what we do we are communicators: translating organizational goals and objectives into actionable plans, ensuring care is coordinated, and keeping operations flowing smoothly. That often comes down to the exchange of information and the flow of communication within and between teams. Everything we do in leadership boils down to communication: written, verbal, and all other forms.

The next time you face what seems to be an intractable problem, ask yourself if you have investigated the quality of the communication around it. Is it really what it appears to be, or could communication be at the heart of it?

When You Can’t Fix the Problem, Acknowledge and Treat the Symptoms

In clinical practice, we recognize that some diseases are not curable. In those cases, treatment is directed at managing symptoms, improving quality of life, and preventing disability over the longest term possible.

As leaders, we often face similar situations in care delivery. Healthcare is fraught with complex, intractable problems that are not solvable by one person, team, or even organization alone. We can often feel pitted against impossible odds, facing circumstances that have no easy or effective solution.

An example that is a thorn in the side of many leaders is staffing. Despite the best efforts in hiring, retention, and employee engagement, people have lives outside the four walls of their employment. Even your best employees will eventually face personal circumstances that disrupt their ability to be reliable. As a result, most frontline leaders find themselves managing a never-ending stream of staffing shortages and complications that never seem to be fully resolved. This can start to feel hopeless at times, leaving many leaders wondering when they will ever be “fully staffed”.

It might be better to simply embrace the reality of staffing as a permanent problem: an incurable disease of healthcare delivery. The problem may never be fixed, but we can acknowledge and treat the symptoms. There are many problems like this, but staffing is a concrete example that most of us can relate to.

Frontline staff often approach us with concerns about how things are going to work on a specific day or time when shortages occur and it is unclear how the work will get done. Naturally, they feel anxious about how they will get through that shift or handle their responsibilities. As leaders, our instinct is to try to fix and solve the problem, but we need to remember that our role may not be curing the disease, but treating the symptoms.

When staff come to me with these concerns, I have to remind myself that they are simply communicating their anxiety and feelings of overwhelm. My objective needs to shift from fixing the problem to treating those feelings. That means asking:
• What can I take off their plate?
• What can I pick up to alleviate some of the stress?
• Where can I establish a more realistic expectation of what should be done, and what can be left undone?

All of these are ways to treat the symptoms of the anxiety that comes from not knowing how to get everything done with fewer people.

The alternative is exasperation: feeling like there are no resources or solutions available. If we allow that frustration to make us throw up our hands and say, “Well, there’s nothing I can do about it,” we miss the point. While that may be practically true, staff are rarely looking for an immediate structural fix; they are looking to alleviate their stress.

If a problem seems unsolvable, consider what symptoms you can treat when you cannot cure the disease.

Not Making Progress? Try Lowering Your Expectations

Sometimes as leaders, we take on improvement efforts that seem to go nowhere, and we can get frustrated thinking that we are not making any progress. I have found repeatedly that my ability to see progress happening is often clouded by the height of my expectations.

Many of us get into leadership because we have high standards. We want to push the limits of what is possible, improve the care delivered to our patients, and improve the work environment for our colleagues. The reality of healthcare, however, involves tremendous complexity: bureaucratic structures that are slow and inefficient, and broad economic forces well outside the circle of control of most leaders.

This week, I asked for feedback on an improvement initiative we had started a few weeks ago, and what I heard was rather disappointing. I was hoping the change we made would have had a better impact and been more consistent across the team than the impression I was getting from our conversations. In investigating further to see what was actually happening, I learned that really only one aspect of the workflow had not been adopted, while the vast majority of what we had introduced had indeed been changed. I still have more work to do to investigate the details of why that one step didn’t stick and whether it is necessary at all, but it shed a light on the fact that perhaps my expectations were simply too high.

Change is messy. Improvement happens in fits and starts, and sometimes we need to settle for a baby step instead of the leap forward we might be hoping for. I am not talking about lowering standards of care, but simply tempering our expectations for the speed of adoption, comprehension, and enthusiasm of staff adopting new workflows. Often, what we think is a clear vision communicated well is not seen that way from the staff perspective. They may struggle to fully understand what they have been asked to do, why they are being asked to do it, and how it will improve patient care or their own workflow.

Incremental changes are often all we get. As leaders, we can save ourselves a lot of frustration by simply lowering our expectations and being happy with slow and steady progress. The old adage, “inch by inch is a cinch,” comes to mind here.

Some of this is personality-driven, and I am sure not all of you reading this will relate to the need to dial back expectations for quick results. However, leadership roles often seem to have a selection bias for this type of personality, so recognize that your staff may not share that same mindset.

The next time you feel like you are not making progress, try asking yourself: am I expecting too much too quickly? Try adjusting your perspective and see if the view changes.