Healthcare Executives and the Mistakes They Make Regarding Decision-Making and Leadership

In April, Linda Henman and Deborah Perkins published a book entitled Healthy Decisions: Critical Thinking Skills for Healthcare Executives, which challenges the status quo, arguing that the success of healthcare organizations hinges not on abstract concepts like "culture" but on the concrete decisions executives make. Drawing from real-world experience with large systems like Mercy and Banner Health, specialty hospitals like Ranken Jordan Pediatric Bridge Hospital, insurance companies like Blue Cross Blue Shield, and nonprofit elder care systems, the authors provide a practical guide to help healthcare executives make the tough decisions they can’t afford to get wrong.

When I spoke with Linda this month, I asked her: "What are the biggest mistakes healthcare executives make regarding decision-making and leadership?" Here is her complete answer:

The single most catastrophic—and astonishingly common—mistake healthcare executives make is undervaluing their workforce. Not on paper, of course. On paper, they wax poetic about people being their greatest asset. In practice, they slash staffing, ignore burnout, and treat frontline engagement as optional.

Let’s look at the wreckage.

Hahnemann University Hospital collapsed under its own weight in 2019. Leaders gutted staffing and fiddled with spreadsheets while credibility—and then patients—walked out the door. This resulted in a full shutdown in a city that needed that hospital.

Ascension Health, one of the largest systems in the country, thought it could cut its way to profitability. That meant layoffs and razor-thin staffing, even in clinical settings. They didn’t get the results they intended. Instead, the decision caused lawsuits, strikes, and a shattered reputation.

Providence faced strikes and the massive exit of nurses because executives didn’t listen. Executives suspected burnout, but they ignored the warnings for too long. Travel nurse overreliance, plummeting morale, and public embarrassment resulted.

Even public systems like NYC Health + Hospitals remain hamstrung by hiring delays and morale freefall. If you can’t staff behavioral health in New York City, you don’t have a workforce problem; you have a leadership problem.

And then there’s MetroHealth, where the headlines address lawsuits, not life-saving care. When the executive team implodes, culture does too.

Some of these organizations have changed leadership and slowly started the recovery process, but others never will. In turbulent times, no one will recover from hiring mistakes, inaccurate strategic focus, or underdeveloped succession planning.

Executives don’t create culture at a board retreat. Culture forms when executives use advanced critical thinking skills to solve problems they’ve never faced before. They must first start by seeing their workforce not as overhead but as a leverage point. Underinvest there, and you’re not saving money—you’re setting a match to your margins.

Start with the best people delivering the best care. Ignore that, and you’ll join the list above—not as a cautionary tale, but as a case study in how to lose an empire by winning a spreadsheet.

What do you think of Linda's perspective? Do you agree with her regarding the mistakes made by these health providers? Have you worked in organizations that have made these mistakes?

Can Business Leaders Learn to See the "Invisible"?

In October, Michael Bremer published a new book entitled Learn to See the Invisible: How to Unlock Your Potential as a Leader, which describes four key foundations and 25 different actions leaders can practice to become more effective in training their eyes to see things tomorrow that are currently invisible. It helps leaders and managers to become better observers of their current reality by practicing getting better at getting better. 

When I spoke with Michael this month, I asked him directly: “What does ‘learning to see the invisible’ mean regarding leadership, and how does it actually benefit leaders and their abilities?” Here is his complete answer:

Let me begin answering your question with a short story.  

You and your spouse go to a big box shopping center with a large parking lot.  Right after you exit your car, you trip over one of those concrete blocks intended to block car tires. Your spouse looks at you and asks, “Are you OK?”

What is your response?  If you are like me and the 1000s of other people with whom I’ve asked this question, you respond, “I’m OK!”  Even though your toe is killing you.  Why?  You feel like an idiot, and you are embarrassed.  Plus, a host of other emotions.

It’s a very similar challenge inside an organization when a leader asks, “How are things going?”  Even when our intentions are good, there are a variety of reasons that people do not openly share their thoughts.  If a leader truly wishes to better understand the actual reality of what is happening, it requires some effort.

"Learning to see the invisible" in leadership means developing the awareness and skills to recognize factors, patterns, and dynamics that are not immediately obvious but that profoundly influence team performance, organizational culture, and decision-making. These "invisible" aspects lay hidden due to assumptions, biases, unspoken issues, underlying motivations, and systemic inefficiencies that might be overlooked in the daily flow of work. Leaders can make more informed, empathetic, and effective choices by learning to see these hidden elements.

How Does "Seeing the Invisible" Benefit Leaders and Enhance Their Abilities?

1. Improved Decision-Making: Leaders who can see beyond the surface make more informed and nuanced decisions. They understand the broader context and implications of their choices, which leads to better outcomes for the organization and their team.

2. Greater Empathy and Connection: Leaders build stronger relationships by recognizing their team's true needs and motivations. Empathy fosters trust, increases engagement, and enhances collaboration, as team members feel understood and valued.

3. Increased Agility and Adaptability: Leaders who are aware of invisible factors are better prepared to adapt to change. They are attuned to internal and external shifting dynamics and can pivot strategies or approaches in response to new information or challenges.

4. Empowering and Developing Others: Leaders who understand the hidden potential in their team members can provide targeted support, coaching, and growth opportunities. This empowerment leads to a more capable, engaged workforce, with team members who are better equipped to take the initiative and contribute in a more meaningful way.

How Do You Unlock this Potential to Become a Better Leader?

When you look at professional athletes who become champions in their sport, how do they get there?  They get there through hours of practice and constantly strive to improve the way they play their sport.  If your profession is leadership, shouldn’t you also consciously practice getting better at what you do?  

Learning to See the Invisible lays out four foundational elements for leaders to practice:

Step 1: Reflection – Understand how you currently lead and identify your starting point. 

Step 2: Unifying Purpose – Create a meaningful purpose that motivates and guides change. 

Step 3: Build Relationships – Foster trust and open communication while empowering your team. 

Step 4: Visual Leadership – Implement visuals that inspire improvement and facilitate discussions about progress against the purpose you seek to accomplish.

The book lays out 28 different actions leaders can practice to get better at doing the above. 

Leaders who adopt this transformative mindset can improve their relationships and take decisive steps toward becoming a champions. They exhibit a vulnerability through their curiosity and willingness to learn.  That vulnerability creates space inside an organization where other people can feel more secure in responding to the questions they are asked. 

The world needs better leaders, and I genuinely hope readers embark on this journey.

What do you think of Michael's perspective on leadership awareness and its effect on decision-making and workplace culture? What is the state of leadership in your organization? Are they making choices based on assumption or "confirmation bias"? Or are they truly understanding some of the hidden aspects that might be driving the true workplace culture of their organization?  

Does the Decalogue Methodology Improve Management Effectiveness?

Back in September, Angela Montgomery published a book entitled The Human Constraint: How Business Leaders Can Embed Continuous Innovation, Conflict Resolution, and Problem Solving Into Daily Practice, which explores an increasingly complex, interdependent, and fast-changing world where companies must have a way to overcome obsolete mental models and embed continuous innovation in their operations with a coherent organizational model.

When I spoke with Angela recently, I asked her: “How does the Decalogue methodology improve management effectiveness?” Here is her complete response: 

Whether it’s a startup, a scaleup, SME or multinational, smoke stack or hi-tech, leaders, founders, managers, and investors face challenges today unlike before. Applying linear thinking and conventional management tools is no longer adequate or effective. Our new reality is a complex, highly nonlinear network of cause-effect relationships. Moreover, the digital age requires better decision-making, faster innovation, and flawless delivery of products and services. What’s needed is a new way of thinking and operating. 

The Decalogue method introduces leaders to a systemic approach to managing operations. It helps them connect dots they would not otherwise see and strategize, plan, and execute at a whole new level. Learning to behave as one cohesive system involves identifying a unique leverage point (constraint) to propel performance and achieve significant and sustainable growth. The method enables a company to develop a systemic value proposition for the market that competitors cannot imitate while improving performance company-wide to deliver their offer reliably. 

The Ten Steps of the Decalogue enhance all aspects of business, from production to marketing and sales, project management, new product development, supply chain, finance, and M&A. The steps give business owners and leaders a clear and focussed path to achieving maximum value with the resources available. A leap in overall performance is achieved by defining a clear goal and measurements, understanding variation to map effective processes and interdependencies, and identifying the one factor that determines the pace of throughput. 

A key part of the journey is embracing and implementing necessary change. Our human ambitions and emotions all have a role to play, and this is what I hope to emphasize in the book. The Decalogue introduces a set of systemic Thinking Processes that enable companies to overcome cognitive barriers to change and channel their energies in a positive direction towards a common goal. These processes embed into daily practice the ability to solve problems, resolve conflicts, and continuously develop breakthrough solutions that add high value. 

What do you think of Angela Montgomery's perspective? Do you have experience with the Decalogue method? Do you think it would be effective in your organization? 

Humility -- Does It Affect Leadership Effectiveness?

In August, Andrew J. DuBrin published a book entitled Leadership Humility: A Characteristic that Enhances Professional Effectiveness, which describes an opinion about the most relevant aspects of humility as it applies to leadership and professional effectiveness, yet the emphasis is on leadership. Humility as it relates to leadership and professional effectiveness is covered from many angles. Among these topics are the many meanings and components of humility and how leadership humility impacts group member performance and behavior.

When I spoke with Andrew this month, I asked him:  “How does humility actually increase leadership effectiveness?” Here is his complete answer:

An appropriate degree of humility is essential for leadership effectiveness because today’s effective leader is expected to demonstrate humility in addition to standard leadership attributes such as self-confidence, high-level cognitive skills, creativity, charisma, and the ability to articulate visions. Leadership effectiveness is enhanced when interspersed with other key leadership attributes including assertiveness, a sense of humor, and strategic thinking ability. Many brash, aggressive, and successful leaders would be even more successful if they sprinkled their leadership approach with humility.  

Another way in which humility increases leadership effectiveness is that being a little humble has an impact on performance. The performance, or results, could be at the individual, group, or organizational level. Leadership humility can improve a leader’s decision-making. Intellectually humble leaders are likely to gather multiple inputs before making a decision because they do not think they have all the answers. Leaders who express humility often enhance the creativity of group members because they set up a climate conducive to imaginative thinking. A humble leader will often create a psychologically safe environment, meaning that staff members feel safe to take the risk of making a mistake. The person who feels psychologically safe believes he or she will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes.

A leader with humility helps establish a group climate in which people can learn and develop. A climate of this nature enables group members to invest more of themselves into their jobs, and therefore be engaged in their work. Leadership humility often has a big impact on team performance. The humble leader seeks the cooperation of all team members, shows openness toward their ideas, and encourages them to become actively involved in solving problems the team is tackling. One of the many ways in which leadership humility improves organizational performance stems from workers observing that their strengths are appreciated.

What do you think of Andrew's perspective on humility and leadership? What role does humility play in your company's leadership and management training?

Bioinspired Strategies -- Do They Help Companies Survive?

During this past July, Daniel J. Finkenstadt and Tojin T. Eapen published a book entitled Bioinspired Strategic Design: Nature-Inspired Principles for Dynamic Business Environments, which shows that the same three capabilities essential for the survival of living organisms in harsh environments – efficiency, resilience, and prominence – are also critical for organizations in their process of navigating through their own hostile environments.

I spoke with both authors shortly after the book's publication, and during our conversation, I asked them: "What are bioinspired strategies and how do they help companies survive?" Here is their complete answer:

The bioinspired strategies described in the book draw inspiration from adaptations and mechanisms found in living organisms to solve complex problems. These strategies can be analogically applied to identify survival strategies applicable to human organizations, including companies.

This approach of analogically associating nature with business problems also encourages viewing business operations and challenges as part of an interconnected system.

Bioinspired strategies help companies survive by improving their efficiency, resilience, and prominence (we call it "ERP" capabilities) in challenging environments.

The key lesson in the book can be described as follows:

"The effect of any action on survivability cannot be understood by merely looking at its impact on one of the three ERP factors, efficiency, resilience or prominence that it seeks to modify, but requires looking at indirect effects mediated by the other two factors."

This means that a company’s actions don't exist in isolation – they can have ripple effects across all three factors, which together determine the company's overall ability to survive and thrive.

Firstly, companies can optimize their efficiency (E) by studying how organisms efficiently manage limited resources through principles such as resting, reduction, and reuse.

For example, consider how certain desert plants, like cacti, have adapted to conserve water in arid environments. They have developed specialized structures to store water and minimize water loss through transpiration. This natural strategy can inspire businesses to find innovative ways to conserve and efficiently use their critical resources, especially in resource-scarce operating environments.

Secondly, nature's lessons in adaptation to external forces guide business on resilience (R). Specific principles found in nature such as replacement, repair, and reinforcement can help businesses become more adaptable to market changes and crises.

For example, consider the well-known case of how camels store fat in their humps for long journeys. The camel's hump illustrates the role of reservoirs and reinforcements in survival when faced with extreme unpredictable forces. This principle is also found in business environments, such as building up buffer stocks or cash reserves to manage uncertainty.

Thirdly, the concept of prominence (P), inspired by how organisms balance their visibility towards predators, prey, and mates, can be applied to managing complex relationships that involve both attracting and avoiding attention from observers.

In nature, prominence capability is apparent in the ability of various cephalopod (squid, cuttlefish, octopi) species to alter their appearance in the presence of different observers (predators, prey, or potential mates).

In the book, we show how cephalopods' strategies for managing visibility can be applied to startups dealing with various stakeholders like investors, competitors, and customers.

Nature-inspired strategies offer design principles such as combination, removal, and segmentation. These serve as practical guidelines for generating ideas and managing trade-offs in strategic decision-making. By looking to nature for inspiration, businesses can discover innovative solutions to complex challenges and enhance their chances of long-term survival and success.

What do you think of Daniel and Tojin's ideas? Has your company implemented any methods that use nature as inspiration to solve problems?

Shop Floor Management -- What Are the Future Trends?

Earlier this year, Philip Gisi published a book entitled Fundamentals of Daily Shop Floor Management: A Guide for Manufacturing Optimization and Excellence, which explores the fundamental elements, management practices, improvement methods, and future direction of shop floor management. 

During a conversation with Philip this past month, I asked him: "What has changed regarding shop floor management? What is the current direction?” Here is his complete response:

The discipline of shop floor management has undergone significant changes in recent years due to advancements in technology and changes in industry practices. With the advent of automation and robotics, the shop floor has become more efficient and productive. Robots can perform repetitive tasks with a high degree of accuracy, speed, and reliability, which can help reduce production costs and improve product quality. Automation has also led to the integration of real-time data collection and analysis, enabling better decision-making. As I stated in my book, companies working toward excellence “can’t lose sight of the fundamental activities necessary to preserve what they have already achieved. This is the role of Daily Shop Floor Management (DSFM); to maintain operational performance while realizing and sustaining productivity improvements on the never-ending journey of operational excellence." 

The current direction of daily shop floor management is towards greater efficiency and productivity through the use of technology and data-driven decision-making. One of the key trends in this area is the use of real-time data analytics to monitor and optimize shop floor performance. By collecting data from various sensors and systems on the shop floor, manufacturers can gain insights into how their processes are performing in real time. This allows them to quickly identify and address any issues that may arise, as well as optimize their processes to improve efficiency and quality.

Another trend in daily shop floor management is the use of mobile devices and cloud-based applications to enable better communication and collaboration between shop floor personnel and management. This allows for more effective and timely decision-making, as well as improved coordination between different departments and teams. In essence, the goal of daily shop floor management is to continuously improve operations and drive greater value for customers, shareholders, and other stakeholders. This requires a commitment to ongoing learning, experimentation, and adaptation, as well as sustaining what has already been achieved while embracing new technologies and approaches.

What do you think of Philip Gisi's perspective on the current state of shop floor management? Does it reflect the changes on the shop floor in your company? What trends in shop floor management have you seen?

There are Problems and There are Paradoxes

Information is at our finger tips. We are able to communicate with anyone around the world instantaneously for free. We have specialists in every field who have spent years learning and mastering technical information. Yet on matters most critical for our success and areas where we know we must change (e.g.,the economy, healthcare, the environment), we often struggle to succeed. The same forces at play within society often exist in organizations, families, and even inside ourselves.

I asked Ralph Jacobson, author of the just published book, Getting Unstuck: Using Leadership Paradox to Execute with Confidence, to explain this widespread phenomenon and his understanding why this occurs and what can be done about it. Here is his complete response:

Problems have answers. Humans and organizations are often effective at solving them. But we face issues that are more complex. Many have no easy to implement solutions. They harder we try to fix some of these, the more futile it feels. In most organizations there are stories of, “We first had this same problem 15 years ago, nothing we have done has worked... guess this is just how it has to be.”

That’s an important clue that we are not dealing with a problem that can be solved. Instead, we have a paradox that has to be balanced. The last time most people encountered that word was in a college philosophy class. That’s unfortunate. The reality is that most of the issues that keep us up at night, keep companies from being successful, and societies from making progress is because they are better perceived and understood from the perspective of paradox. And, there are easy-to-use approaches and ways of seeing paradox that can reduce silos, create new pathways for success, help companies succeed, improve leadership, facilitate the implementation of change, and help people sleep better at night.

It is crucial to make the distinction between problems which can be solved and paradoxes that must be balanced. Once the effective solution has been applied to a problem, it ceases. But paradoxes must be balanced, they exist in perpetuity. Once we understand that paradoxes have two polarities that can be both right and wrong at the same time we have a new lens to view the issues that defied resolution. How do you find the critical paradoxes? Look for the tension -- "the heat." Look for issues that defy resolution. Look for things that have more than one good, usually opposing answer. Rather than running away from them or fix them, see them for what they are -- paradoxes.

What do you think of Ralph's ideas? What are some of the paradoxes that are important for your career and the success of your organization?