Monkeys: LIBERATING Time Management Concept [Video]

Monkeys are the “leading cause of death” of new leaders.

Recent conversations with a few new(er) leaders about this common pitfall, prompted me to post this here. If you don’t have time (28 min) to watch this, then you probably really need to watch this. ūüėČ

This time management concept saved my professional life.

After about 7 years in operations of skilled nursing facilities at The Ensign Group, a skilled nursing, seniors housing, home health & hospice, and radiology company, I spent 5 years there as the Chief Human Capital Officer. What an exciting time. Ensign’s “First Who, Then What” approach to growth meant we had to attract and train a lot of AITs into facility-level CEOs fast. ¬†Over those 5 years, I personally participated in the training of about 100 new leaders. Week long boot camps, case studies, online tests, conference calls, assignments, analysis, etc. ¬†I saw, up close and personal, what helped new leaders succeed … and fail. ¬†

Monkeys has a lot to do with both.

I’ve trained the topic to groups in the hundreds at association conferences to 1:1. And, I wrote about monkeys years ago here:

But, this is the video that gives a thorough explanation of Monkeys and that my colleagues and friends have found most useful to understand the time management concept from theory to practical application.  While there are several healthcare operations and Ensign references, the principles are universal.

I hope it helps you or someone you know:


Jim Rome, John Wooden, Skilled Nursing “Success”

When I was in High School, my buddies and I listened to a new, up-and-coming, cocky¬†sports talk radio guy, Jim Rome. ¬†He¬†constantly played his verbal trump card against people critiquing successful players/teams. ¬†He would simply respond by saying, “Scoreboard!

Does anyone have a better scoreboard than John Wooden? ¬†The best¬†coach in sport. ¬†Scoreboard? 10 national championships at UCLA. ¬†But, why do I love and respect and listen to the man? ¬†Because of how he won. ¬†Coach Wooden came to mind today because of a conversation with another guy who’s the “best” at his sport, my friend David Howell, a facility CEO for The Ensign Group in southern California. In my opinion, Howell’s¬†one of the best SNF EDs in the country. ¬† It’s almost unbelievable to see what he’s built out of his small SNF in a very blue-collar neighborhood. ¬†His facility won Ensign’s highest total quality award today and he shared with me what he was planning on saying at the ceremony … Wooden, “C.S. Wooden” ūüėČ


I want to share these two thoughts from a talk Coach Wooden gave and that Howell shared today as well.  But, you really ought to watch the whole talk below.

  1. Winning is not in the definition of success. ¬†Here’s what C.S. Wooden said success is: Peace of mind attained only through self-satisfaction in knowing you made the effort to do the best of which you’re capable. I believe that’s true. If you make the effort to do the best of which you’re capable, trying to improve the situation that exists for you, I think that’s success, and I don’t think others can judge that; it’s like character and reputation — your reputation is what you’re perceived to be; your character is what you really are. And I think that character is much more important than what you are perceived to be. You’d hope they’d both be good, but they won’t necessarily be the same. Well, that was my idea that I was going to try to get across to the youngsters.”

  2. This. ¬†Poem by George Moriarty, called The Road Ahead, Or The Road Behind.”
    “Sometimes I think the Fates must grin as we denounce them and insist the only reason we can’t win, is the Fates themselves have missed.

    Yet there lives on the ancient claim: we win or lose within ourselves. The shining trophies on our shelves can never win tomorrow’s game.

    You and I know deeper down, there’s always a chance to win the crown. But when we fail to give our best, we simply haven’t met the test, of giving all and saving none until the game is really won;

    of showing what is meant by grit; of playing through when others quit; of playing through, not letting up. It’s bearing down that wins the cup.

    Of dreaming there’s a goal ahead; of hoping when our dreams are dead; of praying when our hopes have fled; yet losing, not afraid to fall, if, bravely, we have given all.

    For who can ask more of a man than giving all within his span. Giving all, it seems to me, is not so far from victory. And so the Fates are seldom wrong, no matter how they twist and wind.

    It’s you and I who make our fates — we open up or close the gates on the road ahead or the road behind.”

Congratulations to David, Lito, and the entire Brookfield team. ¬†You’ve been a stunning SUCCESS for many years before winning the Flag today.

“Bring your heart to work”

I shared this with an operator the other day and thought it would be a good topic to bring me back to after so long …

Like most people I know, I‚Äôm inundated with data/articles/stories/information every day. So much so that I tend to skim the surface of a lot of stuff but I rarely take the time to actually pause and read/watch and think. This article and video caught my eye today and it reinforced for me that the most important thing in skilled nursing is ‚Äúbringing your heart to work.‚ÄĚ I can‚Äôt think of anything more important than deliberately, systematically, structurally driving this in the culture at every level of the organization at every location.

This is a great reminder and a powerful example of another healthcare provider. I hope it inspires you in some way too.

Screen Shot 2015-08-06 at 6.49.20 PM

I just want to be … feared?

This video is a¬†worthy 12 minutes to make us pause and reflect. ¬†The danger I see in talking about leadership is that the “lessons learned” or the lesson “meant to be taught” usually overemphasizes that one aspect of leadership. ¬†The responsibility of leadership REQUIRES several traits/skills/habits, not just one. ¬†Even though this focuses on one, as long as we see it as a string in the tapestry of what leaders need, I find the concept here to ring true.

Making people who “work for us” feel safe seems to require taking the LONG VIEW toward your business and the co-people around us. ¬†Ofttimes, a company’s culture will trump our better-inner-leader. ¬†We perform according to how we’re measured and so its critical that we find a culture that allows for that. ¬†Even better … its critical that we shape our company’s culture into one that fosters that long view as well.

Love, Part 1: “Have I told you lately that I love you?”



Who knew that Rod Stewart was such a management guru? ¬†He doesn’t look like one. ¬†But let’s judge the man by his words not his appearance, huh?



“Have I told you lately that I love you?”

And with that simple question, Rod does more good in the world of “performance management”¬†consulting than most consultants ever could.

Have you ever wondered what you’re boss was thinking about you and/or your performance? ¬†I have. ¬†I’ll get to that in a second. ¬†I was speaking with a colleague the other day whose performance over the course of the last 24 months has been staggering. ¬†As a new leader in the industry he has assembled a team, collaboratively¬†defined its¬†vision, elevated care and customer service, and has achieved fantastic financial, clinical, compliance, and regulatory results. ¬†Can I paint a more successful picture?

And yet, after another record breaking month of results were posted, he was concerned that his boss wasn’t happy with him. ¬†Why? ¬†Because he hadn’t emailed him or called him to comment on his performance. ¬†It had been a few months now. ¬†No thank you. ¬†No Attaboy. ¬†Silence. ¬†So, instead of appropriately celebrating or feeling satisfaction, this top performer’s strongest emotions were¬†concern and doubt.

I experienced something similar several years ago. ¬†My boss was on the road almost all the time. ¬†Not only that but he had the weight of the organization on his shoulders and hundreds of people wanting a piece of his time. ¬†As the weeks, then months went by I tried to just give him (AND MYSELF) the benefit of the doubt …

I’m sure he would call or email me about my performance if he had any concerns.

I know he’s just really busy.

He hired me because I don’t need the supervision or direction.

But, given enough time, its natural to FILL THE VOID with the worst case scenario.

I began to do what my colleague was doing. ¬†I began to not only doubt my boss’ appreciation of my work but I began to doubt if he thought my role was even important to the organization. ¬†After all, if nobody’s talking to you about your work (good or bad), your work must not be that important to people.

The benefit of the doubt turns into the TYRANNY OF THE DOUBT.

Maybe its just me and my colleague, but I don’t think so. ¬†I’ve had people I’ve managed express similar feelings during overdue conversations with me as well.

A few months ago, I kept missing a 1:1 with one of my department heads. ¬†Things kept getting in the way. ¬†One postponement after another. ¬†Sure, we’d talk briefly in our daily department head meeting or in the hallway but we missed quality 1:1, focused time to talk about her department (employees, goals, challenges, etc.) ¬†When we finally met, I told her how impressed I had been by her improvements and resident/patient satisfaction I was seeing. ¬†She was stunned. ¬†She fought back the tears. ¬†You see, she thought I was avoiding her because I was unhappy with her. ¬†I had inadvertently created a void and she filled it with the worst case scenario. ¬†Shame on me.

As leaders, we can way too easily fall victim to the illusion that silence creates. ¬†“All is well.” ¬†We can forget that even (especially) our top performers need regular feedback. Ironically, too often we spend an inordinate amount of time with under-performers at the expense of quality time grooming, coaching, rewarding, and recognizing those whose work we rely on so very much.

Let’s make the time.

–> Let’s set reoccurring appointment reminders on our calendars to reach out and fill the void with true conversation that builds loyalty and reaffirms mission.

“I am through waiting”

Kevin Costner Dances with Wolves


It’s a great story. ¬†One of my favorite movies. ¬†Dances With Wolves. ¬†I used to watch it all the time as a kid. ¬†After about 20 years, I watched it again recently. ¬†It’s funny how music, scriptures, books, movies can mean something so different depending on one’s circumstances. ¬†This time, I saw a lesson of management/leadership that didn’t really apply to me at age 12.

Procrastination is a challenge for many of us. ¬†For some (me) more than others. ¬†There are plenty of causes to procrastinate a decision or an action … (insufficient information, analysis paralysis, laziness, passive-aggressive attitudes, misunderstanding, feeling stuck in a rut, etc.) ¬†About 18 months I found myself feeling stuck.

Almost like a victim of circumstance.

That, my friends, is an uncomfortable feeling.  I was trying to navigate personalities, agendas, and business objectives and I felt like I was failing.

Looking back, I was taking a passive approach which is very much not my style.

Luckily for me, I snapped out of it. ¬†Or, I got slapped out of it ūüôā ¬†I doubt I’ll forget that particular meeting wherein the conflicting personalities, agendas, and business objectives blew up. ¬†Toward the end of that meeting, I resolved to “get back in the game.” ¬†Maybe, just maybe, Dances With Wolves came up from my subconscious. ¬†Lieutenant John J. Dunbar had a similar wake up call …

“I realize now that I have been wrong.
All this time I have been waiting.
Waiting for what?
For someone to find me?
For Indians to take my horse?
To see a buffalo?
Since I arrived at this post I have been walking on eggs.
It has become a bad habit and I am sick of it.
Tomorrow morning I will ride out to the Indians.
I do not know the outcome or wisdom of this thinking, but I have become a target and a target makes a poor impression.
I am through waiting.”

It can happen in a moment.  The change of momentum.  In fact, look at the word.  


Momentum. It is the secret to love, health, body, mind, spirit. How do you get it? We all know what it‚Äôs like to have it. Those happy days when we were ‚Äėon the wagon.‚Äô I don‚Äôt care how or why we fall off whatever wagon matters to us. I just care that we get back on. Quickly. But how?

Momentum is made up of one ordinary yet powerful word: MOMENT. We take moment(um) back moment by moment. The moment we turn off the TV and go to bed early. The moment we arise early in the morning and run instead of sleep longer than is needful. The moment we say no to the candy, fast food, junk food, soda, and choose healthy food. Each moment builds upon moment until you feel the momentum lifting you out of bed to exercise, eat right, make time for the most important things and people in your life. If you don’t have the momentum you once did in any aspect of your life, it’s just a moment away. Seize the moment. Regain the moment(um).

Whoa.  Took a little personal life detour there.

What about your facility?  What are you waiting for?

Stooping to Greatness, Part 1

It’s ironic that I spend as much time as I do here and with colleagues on time management. ¬†Ironic because I’m not naturally a very organized person. ¬†The opposite is true.

I’ve learned the hard way (and the incredibly rewarding way) that the only way I can get to the VERY IMPORTANT x NON-URGENT stuff that will either transform a facility or take it to the next level is to become great at time management.

There’s a great thought in scripture that goes like this: Where your treasure is, there will your heart be also (Matthew 6:21). ¬†Adapted to the nursing home administrator, we can say …

What you spend your time on, that’s what matters most to you.

You may protest. ¬†You may say, “No, Dave. ¬†The reality is I can’t get to what matters most to me because I have to spend so much time on this other stuff that keeps coming at me.” ¬†As we climb up to the balcony and look down at our operations and at ourselves, we’ll probably see way too much work that is reactive vs. proactive. ¬†Reversing that pattern is what separates the great leaders/facilities from the pack. ¬†So …

  • First things first = First who, then what. ¬†Let’s first surround ourselves with people more talented and driven than ourselves. ¬†They’re there. ¬†In every position. ¬†If we settle for less than “A” talent, we will be settling for mediocrity and burnout.
  • Second (simultaneously), get the fundamentals in place. ¬†Apply our Daily, Weekly, Monthly system approach to marketing, expense management, labor, clinical metrics/outcomes.
  • Third, control the monkeys before they lead to your downfall.
  • Fourth (and finally!), you now have time to dedicate to the fine-tuning, pro-active, culture building work that ONLY YOU can lead.

This post is the first of a series that I’ll dedicate to what I believe is the most important work of a healthcare leader: to create a powerful, unique culture.

Culture Model
My step-by-step, “how-to” reinvent the wheel. If you take your parent organization’s mission statement or use some other company’s culture stuff, you are missing the chance of a leader’s lifetime. There is a POWER that comes from the creative process. Or, the birthing process. What you collectively give birth to becomes your baby. You want to protect it. Nurture it. It becomes your competitive advantage that your competitors cannot replicate.

DOWNLOAD PDF Version Here: Culture Model

The title for this post, Stooping To Greatness, is stolen from a similarly themed article by Patrick Lencioni. ¬†I’m a big fan of his books that illustrate simply and powerfully that what matters most to create lasting, quality success is the SOFT stuff. ¬†The attention to people and culture.

Ready, Fire, AIM

ready fire aim

One of the most important lessons of the last 12 months for me has been the perils of firing before sufficiently aiming.  With the Myers Briggs personality preferences as context, its easy to understand why this can be a huge stumbling block for some (like me) while a no-brainer for others.

By aiming, here’s what I mean …

  • Taking the time to engage those who will be affected by the ‘fire’ in discussion, debate, persuasion, listening, reconsidering.
  • Creating a plan and …
  • Creating it WITH the people who have to implement the ‘fire.’
  • Taking the time to test, reconfigure, test some more, get a scoreboard of results to show the org. BEFORE flipping the switch to require the change.¬† This is particularly necessary when there are mixed reviews with the current state.

There’s a balancing act here.¬† On the one hand you can aim too long (analysis paralysis) and results may suffer from that inaction.¬† On the other hand (the one that I dealt with most during the last 12 months) to pull the trigger too quickly (even if the decision is logical and the right one) can lead to a botched implementation that prevents the ‘right decision’ from taking root.

Though somewhat against my nature, I’m working at ‘taking the time’ to talk with most involved parties.¬† I’m convinced this doesn’t have to be a slow process.¬† It just has to happen.¬† I’m reminded of what the book 5 Dysfunctions of a Team teaches on this topic … that without conflict/debate/dissent/discussion, real buy-in or commitment cannot take place.¬† But, with that pre-decision conflict, even those who disagree can come around and commit — knowing that their voices were heard AND having had a chance to better understand the rationale/intent of the other side.

Do you share financials w/ staff?

3 legged stool


I am all about analogies. ¬†It’s a curse. ¬†It’s my go-to. ¬†I have a problem. ¬†But, sometimes it really just works. ¬†(I’ll get to it … hang with me).

Nursing Home Administrators are easily seen by their care-giver/clinician staff as only caring about the financial aspects of the facility. ¬†Years ago I became very reluctant to share financial information with my staff out of fear that they would think that’s all I cared about. ¬†I also feared they would mishandle the information.

As though they weren’t sophisticated enough to appreciate the need for the facility to ‘make money.’

So, instead of educating staff on the financial fundamentals and enlisting their help to eliminate waste and be efficient as co-owners of the facility and their departments, we ration out just enough information to get them to do what we want. ¬†We give them a budget for hours or expenses for the month based on our projected census. ¬†They toil away under your close management, trying to hit that budget WITHOUT understanding the larger picture. ¬†I’m not saying that doesn’t ‘get the job done’ b/c in many cases it does. ¬†But, they deserve more. ¬†And with the trust you give them (along with the education), something powerful happens … they come alive and take MORE ownership of their responsibilities. ¬†They take pride in their new understanding and they become more creative problem solvers, now that they see the whole problem to solve and not just their little piece.

Here’s what I’ve concluded …

… if presented properly, sharing the financial realities (challenges and successes) are an empowering, trust-building lever administrators should pull in their management of the facility.

The key phrase, of course, is ‘if presented properly.’ ¬†I’ve been burned by sharing facility financial information. ¬†So … the best way I’ve found to empower my staff with this lever is to use the analogy of the 3 Legged Stool. ¬†Here’s how the conversation went at a recent all-staff meeting at a facility that has been losing money ….

Me: What do you think I care most about?

Them: [Thinking: I’m not stupid enough to answer that question … Suspicious smile … long pause]

Me: Really. ¬†It’s ok. ¬†What do you think I care most about in running this facility?

Them: [Still Thinking: I don’t know him well enough to be honest. ¬†He’s just like all the rest, probably. ¬†Money. ¬†The answer is money]. ¬†“Patient Care.”

Me: Yes.  What else?

Them: [Oh, there’s more than one answer. ¬†I’ll say it …] ¬†Profits.

Me: Yes.  What else?

Them: [What a dork. ¬†He can’t care MOST about more than one thing!] Ummm … Customer Satisfaction?

Me: Yes.  But, how can I care MOST about more than one thing?  Have any of you ever seen a 3 legged stool?

Them: Yes, of course.

Me: Which leg is most important?  Which leg do you care most about when you sit on it?

Them: The one that’s going to break.

Me: Put yourself in my shoes.  If you were me, what would you say make up the 3 legs holding up our facility?

Them: Money, Patient Care … and … ?

Me: And … customer & employee satisfaction. ¬†Which one do you think I think is most important?

Them: Whichever is weakest?

Me: That’s right. ¬†That’s exactly right. ¬†You’ve heard me talk a lot lately about some our financial challenges. ¬†You’ve seen me tighten up our processes around approving overtime and tightening our belt in other ways too. ¬†We’ve had to flex staffing to appropriate levels that match our lower census. ¬†Our patient care is great. ¬†Our customer satisfaction is high. ¬†Our turnover is low. ¬†But, financially, the facility has been losing money for a few months in a row because we haven’t adjusted our spending appropriately to our low census. ¬†Right now, the leg that’s weakest … the leg’s that’s breaking is the financial one and we have to strengthen it. ¬†Here’s what we’re doing (overview of efficiencies we’re trying to regain). ¬†What else do you suggest we try? ¬†What can you do to help?

(I then asked if any of them had ever been ‘cancelled’ or sent home early from a shift. ¬†100% of their hands shot up. ¬†I asked if they understood the rationale for flexing hours. ¬†If they understood nursing hours PPD and the state minimum requirements. ¬†They did not. ¬†I explained how the hours PPD number is calculated and we calculated it for our facility). ¬†They saw – and understood – how high we were staffed. ¬†They began to ask insightful questions about staffing for acuity and skilled mix and how we derive our goals/staffing targets (which the director of nursing determines based on acuity, by the way).

The feedback from the meeting was very positive. ¬†They went to work the next day with a sounder understanding of what makes me/us tick and WHY we’re managing the financial side of things so tightly right now. ¬†I finished the meeting focusing on the other two legs. ¬†I reaffirmed to them where my heart/passion lie … in creating an environment where they are free to thrive as caregivers. ¬†An environment that creates a surprising experience for our patients and their families. ¬†I concluded with the Cab Driver story. ¬†That’s at an all staff meeting.

1:1 meetings with department heads allow for deeper education on the financial management of the facility and their departments. ¬†I recommend we stop rationing crumbs to the ‘leaders’ of the facility. ¬†Let’s let them eat at the table. ¬†(See? ¬†I had to throw in another analogy!) ¬†Let’s be more transparent with our P&Ls so they can take ownership, and eventual PRIDE in the successful operation they’re responsible for shaping.

“You Don’t Have Credibility”

Ouch.  No, really.  That hurt.

Can you hear more humbling words as a new leader? ¬†That’s what our CEO told me years ago when I passionately made the case for him to have me train anyone in the organization who would listen about creating a world-class service environment in their facilities.

I had just gotten religion and like any new convert, I was ready to evangelize.

ritz carltonAfter attending a Ritz Carlton day-long training, I was convinced that becoming the ‘Ritz Carlton’ of skilled nursing facilities would be the ultimate lever to pull to transform and turn around a facility that had failed survey 8 years in a row (under prior ownership) and lost us a lot of money out of the gate. ¬†Not only that, but I had found my voice as a young leader in long-term care. ¬†I came back to my facility after that training and, with my team, created our version of a world class service culture.

(Remind me to post on the process later b/c the process is where the magic lies, not the outcome).

After just a couple months of establishing the new culture, I made my pitch to our CEO. ¬†I can get pretty animated when I’m talking/debating/evangelizing something I’m passionate about. ¬†I knew this was the answer for my facility and, therefore, all of our operations.

One thing you got to know about him is that one of his greatest strengths, in my opinion, as a leader, is how he encourages entrepreneurship, innovation, intelligent risks. ¬†He rarely says no to the enthusiasm of his partners. ¬†So … after listening to me go on and on about world class service being the game changer for our group and my desire to hit the road to train all of our facilities in it, he said (to the effect of):

“You don’t have enough credibility — yet.”

[Dramatic Pause]

I was a combination of offended/disappointed/humbled/surprised. ¬†Initially, I thought he was stupid. ¬†I thought to myself (and out-loud to him): “how can you argue against elevating, systematically and massively, the level of customer service in our facilities?! ¬†It’s going to pay off!”

Looking back, I’m EXTREMELY fortunate to have had this lesson taught to me in such a poignant way at an early stage in my career. ¬†He was, in fact, not stupid at all. ¬†He was totally right. ¬†At the time I couldn’t see it. ¬†But, just 18 months later it was crystal clear…

The facility had transformed.  In about 12 months time it went from worst to first in the org. financially and passed survey for the first time in 9 years.  Customer satisfaction was high.  Turnover was low.  We had RESULTS.  Those results are what caused my partners throughout the org. to PULL me to their facilities to share what we had done instead of me trying to PUSH my way on to their radars.

He was right. ¬†Ideas and passion are important when it comes to bringing transformative ideas/culture to a facility or organization. ¬†But, if presented prematurely — before the results or proof to back it up — the idea or idea giver won’t take root and won’t make the difference s/he’s so passionately trying to make.

18 months later, I began each training session on world class service with the results – Before on the left side of the white board and After on the right side. ¬†I then put a big question mark in between. ¬†The stark difference in the before and after is what brings the credibility … and causes the DEMAND for you and your ideas.

The Other Day …

It’s easy now to look back and see the wisdom of my CEO’s candid rebuke. ¬†But, at the time it was devastating ego-bursting stuff. ¬†I recently interviewed someone who wanted to be a regional resource. ¬†He has a magnetic, positive personality and he knows his stuff. ¬†His problem, however, is that his on-paper results are sub-par. ¬†We talked candidly about the huge challenge he would have coaching/teaching others without being able to say, “Do this because I did and look at my superior results.” ¬†For him, like me years ago, the timing isn’t right. ¬†I’m sure he’ll get his shot … when his results match his enthusiasm.