“Systems In Place”

I had never heard that phrase until I got to long-term care.  Gotta get your systems in place.  Do you have systems in place?  Huh?

Our admissions process is broken.
Collections are killing us.
Our falls have increased every month for the past 4 months.
Patient satisfaction for food is low.
Our census is struggling.  We’re not really marketing.

I’m not a naturally organized person.  In Myers Briggs terms, I’m an ENTP.  Much more of a dreamer/spontaneous preference than a structured/organized type.  So, when constantly pressed with the notion of having systems in place, I struggled to really get into it.  That difficulty caused me problems.

AND, when you combine a natural disinclination for structure with the ignorance of a rookie, my first facility was a disaster.

Or more accurately put, I was a disaster.

It wasn’t until my third facility when a certain light turned on.  Turns out to be one of the most important lights to turn on in my career.  How to get “systems in place.”

Of course, as you read on you’ll be tempted to think, “Really?  You didn’t know this?  This can’t be that big of a deal.”  Nevertheless, it has been a career changer for me.

Here’s how I can help get systems in place regardless of my experience or knowledge with the “system” or problem or poor outcome we’re trying to solve.

The system tool

With this framework, I now have a way to solve problems in a systematic way – in a way that will stay solved long-term – regardless of my lack of experience or knowledge.

This isn’t the be-all, end-all.  You have to dig deep to the core problem you’re trying to solve.  But, once it’s time to set the system in place, you have to have answers for each of the boxes above in order to do it.

In other words, the more answers you have for the boxes in the system framework above, the stronger in place your system becomes.

I don’t need to be an expert in every department in the facility to effectively run the facility.  I just need to think critically & satisfy the framework above by asking the experts in the facility questions until I’ve filled in the system framework.

I usually start from the bottom up, with the scoreboard.  Stephen Covey famously taught to “begin with the end in mind” and that’s spirit of this.  I begin with the outcome we need and who, how, and when we’ll measure and “scoreboard” it.  Then, we work our way up to fill it in together with your staff.

That’s it.  Hope it helps.

The Biggest Bonus I Ever PAID

In a cluster of Colorado facilities I’ve been a part of these last couple months, we’ve been talking about how to create a culture — within our cluster/company and within our facilities.  It’s a topic I feel passionately about and one that I’ve personally participated in at a couple facilities and at a ‘corporate support office’ setting.  I’ve personally seen MASSIVE strides forward as teams dedicate themselves to a deliberate defining, planting, growing, and nurturing of a unique culture.  The process of creating that will be covered in another post.

Part of growing and nurturing a culture relates to where the rubber hits the road or when staff can see you put your carrot or stick where your mouth is.  The most powerful example of that is a story I’ve shared a lot in training settings about establishing a culture — a story of the biggest bonus I ever gave.

Several years ago, my new team and I had just defined our new culture.  Our mission, promise, motto, standards, etc.  It was time to show that it was real.
The culture was starting to do what it’s supposed to do — produce results (clinical and financial and resident/patient satisfaction).  After a solid month, I asked my department heads who “lived the culture in your departments the best.”  I received a handful of names and emailed my payroll manager the following:
On payday, please bring me the paychecks of Maria, Cathy, Jennie, Don, and Debbie. (names have been changed).  I’d like them to pick them up from me directly.  In addition, please create separate bonus checks in the following amounts:
     – Maria: $200
     – Cathy: $500
     – Jennie: $300
     – Don: $1,000
     – Debbie: $150
When payday came, Maria went to the payroll manager to pick up her check.  Here’s what went down …
Maria: Hi, can I have my check?
Payroll: Oh, no.  Sorry.  Dave has your check.
Maria: [struck with concern] But, why?
Payroll: You know … he didn’t say.  But, he wants to give it to you himself.
Maria: No.  Really.  Why?  What did I do?
Payroll: No idea, Maria.
     – Maria did not come to my office.  She spoke with the other housekeepers.  She confirmed her fear … they had all received their checks.  She was worried.  Was she going to lose her job?
     – Finally, after her shift was over, she came to my office.
Maria: Hello, Dave.
Me: Maria, come on in.  Have a seat.
Maria: Ok. Payroll tells me you have my check.
Me: Oh, right.  Yeah, have a seat.  [we sit down and I reach into my desk for her check(s)]
Me: Do you know why I have your check, Maria?
Maria: [Visibly worried] No.  Did I do something?
Me: [Smiling] … Sort of.  But, it’s not what you think.  See, last month was a very busy month here.
Maria: Yes.  Lots of room changes!
Me: That’s right.  You guys were very busy making room for the growing census.  Well, when we get very busy like that, we do better financially.  And when we do, we like to share it with those who were so important to making it happen.  So, last week I asked your supervisor, “who lived our culture [me pointing to the newly defined culture poster on my wall] this last month the best?”  Do you know who he said?
Maria: [Recognition coming to her of pending good news] Maybe me?
Me: Yes!  He said you.  In fact, here’s what he told me about you (related the specifics to the newly defined culture on the wall).
Maria is becoming visibly happy.
Me: So, yes … here’s your paycheck. And, here’s another check. It’s a small token of appreciation for being a great example of what we’re trying to become.
Maria: [she opens the bonus and immediately weeps.  As a housekeeper, she had never received a bonus before.]
We talked about what she’ll do with the money.  She’s SO grateful.  I tell her that compensation and bonuses are confidential so please don’t share this news with anyone.

This happens to be the best way to get the word out 🙂  Why?

= Her colleagues already know she didn’t get her paycheck and they’ll be anxious to hear why she had to get it from me directly.  She’ll tell them.  And, that’s exactly what I hope happens.
I hope that the message spreads fast that you can get a bonus when 1) we do well as a facility and 2) are modeling the behavior/culture we are striving to establish.
It’s the biggest bonus I ever paid as measured by its impact on our facility culture.  Here’s why:
  • Everybody was stoked for Maria
  • Communicating to Maria that she got it because of her supervisor built loyalty between her and her supervisor instead of between her and me.
  • Her supervisor, my direct report, was grateful that I made him look like a thoughtful, generous boss.
  • The staff began to believe that we really were committed to the mission we had collectively defined.

Now … multiply that by the other people who received bonuses that month and the subsequent 6 months and you can see how putting your money where your mouth is will ACCELERATE the momentum we need to as we’re looking to transform or strengthen the facility cultures we’re responsible for.

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.

Leadership & Self-Deception

I cannot recommend a book more than this one.

leadership and self deception


I was introduced to it at work as a book that would help me be a better leader/manager.  I’ve got a long way to go, but it has had a huge impact on my approach to people at work.  In addition, there have been several times where my wife and I have relied on its concepts in how we see, relate to, discipline, and love our 5 children.  But that’s for another entry 🙂

80:20 Rule


The Pareto principle (also known as the 80–20 rule, the law of the vital few, and the principle of factor sparsity) states that, for many events, roughly 80% of the effects come from 20% of the causes.[1][2]

Business-management consultant Joseph M. Juran suggested the principle and named it after Italian economist Vilfredo Pareto, who observed in 1906 that 80% of the land in Italy was owned by 20% of the population; he developed the principle by observing that 20% of the pea pods in his garden contained 80% of the peas.[2]

So, what does this have to do with the book?

I don’t know if the ratio is really 80:20, but I’ve observed in my career and in dozens of others that how we see and treat others has more to do with our personal success than the oft-lauded ‘harder’ skill sets that are taught in MBA programs.  You look at the typical coursework of an MBA and north of 80% of it focuses on business knowledge (finance, accounting, strategy, operations, statistics, etc.)  Let’s put the 20% in the PEOPLE MANAGING, SELF-MANAGEMENT, LEADERSHIP DEVELOPMENT, HR categories.  Based on my experience (in healthcare management) for general managers, healthcare administrators, you spend your time and your success is determined by those weakly taught soft/people skills.

leadership and self deception

L&SD teaches, powerfully, why and how we so easily ruin important relationships.  Buy it.  Read it.  Then, like me, read it again.  Every time I do I see my warts, imperfections, and I can better repair damaged relationships that not only allow me to be more effective but also allows the other person to advance.

EnsignPrize! – judging behind the scenes

This has been one of my favorite weeks in YEARS in skilled nursing.  I’ve had the privilege to judge, in person, some of the finalists of the eprize in California and Colorado.  Below are a few photos from my time behind the scenes.  Unfortunate realization … I didn’t have many regrets about my time as an administrator until this week.  Seeing the great work that these leaders have inspired in their staff has been humbling.

Serious Tilapia. Administrator say, “Dave you don’t have to eat it all.” I say, “I wouldn’t if I didn’t want to. This is great.”
“Cheesecake Factory” quality cream of broccoli soup.
Wouldn’t believe it if I didn’t see it. Alzheimer’s facility in Colorado that I was afraid of years ago when we acquired it. Now, didn’t want to leave. What a great feeling. These people have become legit experts in meeting the needs of the cognitively impaired. There, “behaviors” is a bad word. Quote: Behaviors are simply unmet needs.  To have 8 residents with extreme dementia peacefully sitting together engaged in meaningful activities compared to how it was years ago was jaw-dropping.
Organic garden w/ help from local organic gardeners. Chef uses the produce in soups, dishes all the time. Residents help cultivate/grow.

The EnsignPrize! home stretch

At Ensign’s 2011 annual meeting I spoke about some personal feelings re: hitting 10 years with the organization and in skilled nursing. It was a time of deep reflection. It was then that I developed some of the thoughts I’ve shared here about burn out, empathy, and a hunger to do more after surviving industry-common career crushing experiences. Some of those thoughts are found here.

As “luck” would have it, while I was in that very reflective mood, I was hit by some new, related ideas during a couple early morning rides. I love to listen to NPR podcasts during those runs/rides and back then I listened to a Freakonomics podcast that was like lighting a fuse in my mind. When I got to the office that morning, ideas started to crystalize, as seen on my whiteboard:

I don’t expect you can follow the train of thought there. But, with the help and input of my colleagues at Ensign, what started as some 10-year angst turned into the eprize! … our organization’s $150,000 competition to transform the industry by transforming the day-in-the-life of our residents. At that 2011 annual meeting, I shared with my friends and colleagues the story of how the idea of the eprize! was born and then challenged them to run with it. And … they did.

The executive directors and directors of nursing upped the ante to $150k and all agreed to put money into the ‘pot’ from their own facilities to fund the award. For more details about the competition and why we did it the way we did it, see this “halftime talk” I gave to the organization about it:

Well … the applications are finally in and uploaded onto the EnsignEprize.com website and the contestant facilities are lobbying their communities hard to have them ‘vote’ for their application. The eprize! award winner will be announced in early April. As I’ve read through and watch the videos of some of the applications I’ve gotten emotional to see the small and big improvements in the systems we use to care for our residents and patients with more dignity, humanity, and choice. I hope you take a minute to go to the website and see what we’ve been up to for the last year as a group. And, please, by all means … share this with your friends. Better yet, challenge your own organization to do something similar!

The Speed of Trust

This is not a book review.

The Speed of Trust is a superbly TITLED book.

The writing itself was a bit too predictable, formulaic, and fluffy for my personal tastes.  I understand FranklinCovey is having success teaching its principles and I don’t mean to disparage the concepts or ideas expressed at all.  Just the opposite.  I believe deeply in what the title of the book, Speed of Trust, means to relationships and organizations.

Think about it in your own life.  I recently did.  Check out the quick back and forth between me and my wife about choosing a family photo to purchase from a recent family photo shoot.  Start from the bottom.


Here’s how I see this exchange, through the speed of trust lens:

  • Even in the mundane communication(s), love is expressed, setting a positive, supportive, sincere tone.
  • My reply was honest and I thought it would be fun to have the kids ‘vote.’
  • Her response was SPEEEEEDY.  Cut to the chase.  No fluff.  No framing.  No setting the table.  No positioning statements.  Just her true, actual opinion.
How valuable, how precious to an organization or team or relationship to have true, actual, authentic, unfiltered, un-sugar-coated opinions and dialogue?!
If our relationship lacked trust, her response would’ve been very different.  And it would’ve been longer.  Maybe a little something like this …

You know, I really like the idea of printing them out.  I wish I could figure out how to do that myself.  Would you be able to do that for me this evening?  I wish I was as good with computers as you are [read: flattery leading up to a soft disapproval of your opinion to soften the blow] …. as far as the kids voting goes.  I love the idea.  On the one hand it could be really fun to see the differences in how they see the family.  On the other hand it might not turn out exactly as you/we might think/hope it would.  What do you think?  I could possibly see Caleb choosing the opposite of Madi just to be different.  You know what I mean?  I don’t know.  Maybe we can talk about it more tonight before dinner when you get home.  Maybe we could limit it or make it a blind test somehow so they don’t know which one they’re picking.  I don’t know.  You know?  I’d hate to see something that’s a positive possibly turn into a negative.  But, I love the idea of printing them out.  Can you do that for me from work or do you have to be home for that?  Thanks!


Now multiply the difference in the authenticity and speed of the response by the number of times you communicate as a team in department head meetings, in emails, in 1:1s and you come to realize just how critical it is to MAKE time to develop the trust as individuals and as a team.  A couple of books that I use and highly recommend to others (a lot less textbook feeling than Speed of Trust) are:

Leadership & Self-Deception (best for 1:1 relationship trust repairing/building)

5 Dysfunctions of a Team (best for team trust/dynamics issues)

“It’s About Time”

“I wish I had time for that.”
“I don’t have time.”
“There’s not enough time in the day.”

The issue of time/self management plays a major in new leaders’ ability to succeed. No matter how brilliant your ideas are, if you aren’t managing yourself effectively, your results, your work, your happiness SUFFERS. I’ve written and spoke a lot about the why & how time/self management tends to be the LEADING CAUSE OF DEATH in new leaders.

With his permission, let me share with you a recent email exchange between myself and a relatively new Executive Director (Administrator) to reinforce those principles with this real-life scenario and to take it from the conceptual to the nitty gritty


Email #1:

“Dave, what have you seen successful leaders do to be organized day by day? I feel I need a better skeleton than I’ve had – maybe I need to go to a franklin planner or something… I know everyone functions, remembers, and acts differently but I’m thinking there is a wheel out there rolling somewhere that I can jump on and customize rather than sitting over here designing a new wheel. 

To give you an idea of where I personally fall short (big fat looks in the mirror, and many partners giving feedback – these are some of my areas of necessary improvement).

  1. Giving assignments and forgetting to follow up.
    • For some forsaken reason my mind works really well in the present tense. When we talk about principles/concepts – I totally get it. You want to talk strategy or theory, I’m your guy. Along those same lines, my mind does not spend much time in the past (assignments I’ve given or received, things to follow up on, etc). I need a good system that won’t allow me to forget or hit “snooze.”  And not nearly enough time making specific plans for the future (Maybe I need to get checked for A.D.D.)
  2. Not setting clear expectations/Vision
    • When we talk vision I get excited and I’m able to get others excited about the big picture but when the details come into play there can be a lack of continuity on my part (or as partners may see it, Mark talks a good game but doesn’t  follow through with what he said he’d do, or things never materialize according to plan because everything falls through the cracks)
  3. Justification
    • On occasion I let people off the hook with a great excuse. This goes back a bit to setting clear expectations, but If I don’t do numbers 1 and 2 above I can’t possibly hold people accountable properly.

I know that there is not a quick fix for these issues, but I would love to be able to develop a strong system that can help offset my weaknesses and give me the structure I need to be an effective transformational leader… Any ideas are welcomed.

Observation: Talk about humility/trust!?  It’s a very rare leader and a very rare organization where being that vulnerable is not just OK, but expected.  Usually our EGO gets way in the way and we can’t show weakness … and therefore we don’t improve.  Impressive.

Email #2:
(My Response)

I feel your pain.  You sound like me at Desert Sky and the start of Victoria.  Almost word for word.

For me it took experimentation.  I gave the franklin planner a good few years.  I went paperless and tried everything Outlook and then the mac had to offer to get organized.  Lots of trial and error.  I’ll tell you where I’m at today because I’ve found a system I love.  No guarantee this will work for you. 

There are 5 important aspects to my work that I consider ‘blocking and tackling.’  These are the organization and follow-up responsibilities that I have historically struggled with that are somewhat related but different enough in how I prefer to experience them that I haven’t found an all-in-one solution.

  1. Calendar/Appointments/Follow-Ups
  2. Ideas/Creative
  3. Journal
  4. Calls to return
  5. Tasks (Long-term & short-term)

 Here’s how I manage each …

 1 – Calendar/Appointments/Follow-Ups

I use iCal on my mac and iphone.  Here’s what I love about this.  My wife’s computer is also a mac.  We have a mobileme account that syncs all of our contacts and calendar items.  I can make different calendars that I can click on/off depending on what I want to see.  The homerun is that Jess can see my work calendar which helps catch things (travel/meetings) that I failed to communicate.  I can also flip on the kids’ calendar for sports, practices, activities, etc. when I make my plans so I can arrange to be there more if possible.  The calendar syncs with Ensign’s Outlook server so I can send/accept meeting invites from it too which is clutch.  Having the reminders/alarms on my computer and phone is necessary for me.  If this were paper based like it has been in the past, I’d miss half my appointments and conference calls.  The image below is of my calendar for this week.  You’ll notice the checked and unchecked calendars on the far left panel.  The blue is family stuff and that is basically Jessica’s calendar.

Regarding the related item of ‘following up’ … I’ve learned to take a page out of the Monkey doctrine for this.  And, it has made a HUGE difference for me.  Anytime I can assign my responsibility of following up to someone else, it gets done.  For example, I asked “Virginia” (name changed for the blog) here at the service center for help in setting up CEO-in-Training (CIT) weekly call guest speakers.  I spent 30 minutes with her mapping out who I wanted to talk on the next dozen weekly calls.  I then gave her the task to contact all those people, send them the calendar invite (and to copy me) and to send us both reminders on the Friday before.  What used to sneak up on me each week has turned into something much more meaningful for the CITs.  No dropped balls. No “dangit, I forgot about the call.”  Just another little example … during yesterday’s CIT call, I decided to have the closest to the pin competition again.  Whoever gets closest to their projected EBT wins a dinner for two.  The old me would have taken the responsibility on myself to take note of everyone’s projections on the 31st (I would have to put a reminder on the calendar to do that) and then check the actual EBT results when financials came out.  But, yesterday I said to Mike in CO, “Mike would you run the competition for us this month?”  He said, “Sure.”  Will it get done?  Yes.  He already sent the email to everyone requesting them to send their projections to him at the end of the month — passing the monkey down the row!!  I love it.  Off my plate.  Assigned to someone else.  Bingo.  

Remember the 2 rules for monkeys: 

1) anything you assign yourself or accept from a subordinate that you don’t do is PROCRASTINATION.  Anything your supervisor (and you could make the argument, your cluster partners) gives you that you don’t do is called INSUBORDINATION.  

2) An inferior job done by a subordinate is infinitely better than a superior job procrastinated and never done by you. 

Therefore, I also give the responsibility to follow up on things my subordinates.  Meaning, if I give an assignment that I need to follow up on I will also assign the subordinate the time and place for them to account for their work.  “Great.  Thank you so much.  Will you let me know on Thursday by the end of the day how it went?”  I then put a reminder on my calendar at 3:00pm to call/email F/U the issue.  I can’t talk about Assigning work/To-do’s (below) without talking about monkeys.  The more you have time to just work on your stuff, the more effective you’ll be.  If you find your subordinates checking on your commitments, you’re working backwards.  Whoever says, “How’s it coming?” is the supervisor! 

I handle the next 4 in a bit of an unconventional way … 

2 – Ideas/Creative

3 – Journal

4 – Calls to return

5 – Tasks (Long-term & short-term)

I love my Moleskine.  Pictured below at Amazon.  I use it for all 4 of these parts of my work.


4th Quarter Projects/To-Dos/Monkeys I’ve accepted, given myself, or been given on the left page.  Calls to return on the right page.  I will recreate this several times per book.


Idea, brainstorming generation … In a previous moleskine I have the notes, drawings, etc. that formed the eprize.  I treasure some of these a-ha moments and I’m stoked I have them all in one place.


My personal life and work life interact all the time.  I use the moleskine for both.  Below is a song I wrote Jess.  Here’s what I love about mixing work, personal, and church note-taking, brainstorming, tasks, etc. all in one.  This is the ultimate journal.  Yes, I write formal journal entries about my life in here too.  But, it will show my kids/grandkids more than just what I wrote about my life.  It will show them what I did.  What I worked on.  Who I supervised and who supervised me.  It will show what I dedicated my time to.  It will show them a creative/professional side to me that they don’t see as just their dad.  And, it is an awesome record for me to keep of my life for all aspects of my life as well.  At the end of the year, I look back page by page and reflect and lift my sights and set goals.  Having one notebook like this also makes it easy to not forget it.  I take it with me everywhere.  And, it’s way skinnier and lighter than a franklin planner.  Also, the free-form vs. day by day approach is better suited to me.  I never liked the day by day franklin format b/c there would always be some days where I would need to take 7 pages of notes and then weeks without needing the notes section at all.


I really hope this helps in some way for numbers 1 and sort of for number 2.  Unfortunately, I’m an expert at #3 as well …

This one is more personal.  It’s less about tools and more about a shifting of mental/emotional/leadership gears that I was forced to learn the hard way.  The reason I let people off the hook was, looking back, more about me than about them or results.  I wanted to be liked.  Very much.  Not wanting to hurt feelings b/c I wanted to be liked.  Not holding people accountable b/c I feared I would lose their admiration or lose them altogether.  Ironically, that philosophy/practice is incredibly undermining and ineffective at getting people to like me.  With each subsequent facility I ran I became more and more rigorous with my standards and expectations and accountability.  And, again ironically, I would venture to say that each subsequent facility ‘liked’ me more than the last.  I stopped worrying about myself and whether or not people liked me and instead focused as much as possible on results.  That creates an environment that people really appreciate and respect.  Letting people off the hook isn’t for them, it’s for me.  I stopped doing that b/c I realized that I was hurting them and myself as a leader.  It’s not easy, but it’s become very natural now for me to be frank, direct (you can still be kind and encouraging), and quick in my feedback and/or correction.  

These aren’t quick fixes like you said.  I’m stoked you’re looking hard in the mirror on these things though because I believe that these make up the ingredients needed to fill the gap between new leader and game changing CEO.  I’ve see it in myself and countless others here at Ensign.  Good luck hermano.  Let me know if I can help with anything.


Email #3


Worth the wait. Thank you. As you can imagine, I didn’t wait in taking action on these issues as I have really felt the pain and want to bring relief asap. I am attaching my first attempt at being able to keep myself more organized and structured on a day to day basis. In reading up on time management techniques recently (including re-listening to Monkeys) I determined that I am only going to focus on quadrant I and III with the things that I even allow to get to my list. So I start each day by bringing forward my quadrant I and III from the previous day and new additions. I type in the new items from yesterday and remove items that I accomplished yesterday. I print this out and put it in a binder that I have labeled with days 1-31 so I can track day by day what I’m accomplishing as well as when something that was supposedly urgent AND important hit my quadrant I and why it is still there. I have a column for assignments/monkeys so I can follow up on assignments I have made as well. I keep this binder open on my desk and hand write in new additions and check off accomplishments. It has been a little slow going since my initial list of Q I and QIII have accumulated for quite some time. I find that I am having much more success making assignments and avoiding “Procrastination” then I have done in the past. This is not a perfect system, but so far it is really helping me know where I am and where I need to be.

I LOVE the idea of integrating the home/work calendar. My wife uses the Mac and this could help me both at work and at home.

Moleskine: I’ve been using disposable notebooks and transferring the info that I accumulate, but I can see real value in preserving and reviewing from all aspects of life. I think I will find myself incorporating that one as well – dig it. 

#3 – Work in progress still. I relate very much to your statement on this one. Not holding my team accountable is a “me thing.”  I’m resolved to change – some of my team have already commented about a few little things with me. Its encouraging. There will be more pain I think, maybe even some rebellion. I’m getting kind of excited and looking forward to it – that might sound kind of sick, but I’m ready to take it on and stop running in circles.

Thanks for this – I’ll be touching base on it. I’d love some follow up – you can put it on your people to email list for a few weeks/months down the road.

Several takeaways for me from this exchange …

  1. Without humility and vulnerability on the leader’s part, his growth is stunted.

  2. Without a culture that makes it safe to be vulnerable and reach out for help, the leader’s and organization’s growth is stunted.

  3. Self awareness & humility is often the differentiator between those who get second and third chances and those who don’t.

  4. Managing time is impossible.  It marches on no matter what you try.  We can only manage ourselves.  We need to take it seriously and experiment until we find what works with our unique personality.

I hope this helps you get a better grip on how you organize and manage yourself.

Which is more complex?

Which is more complex?

One of the most stubborn paradigms we have to shatter as new leaders is illustrated above.  Which is more complex?  I admit it’s a bit of a trick question.  Almost everyone instinctively picks B.  But A is infinitely more complex.

Here’s what I mean …

With B you see relationships.  You could even possibly infer cause and effect depending on how those dots were organized and labeled.  As new leaders we tend to see the problems we deal with in isolation.  That’s how A is portrayed.  The trouble (and complexity) with A is that you don’t know relationships between dots/issues/problems/ideas/etc.  If you don’t know relationships, particularly cause/effect relationships how can you correctly prioritize and assign resources best?


During my Theory of Constraints and 6 sigma training by Dr. Tony LaTurner I learned a powerful way to visualize the problems or challenges an operation is experiencing.  Take ALL (I mean ALL) the things you wish were different about your operation and write them in short phrases onto index cards.  Then tape them up on a wall in the order of cause and effect with the cause being below the effect.  What is produced is the shape of a tree with the core problem or root cause at the bottom.  The research says that if you solve that core problem 70% of the other UDEs (undesirable effects) will be eliminated or reversed.


So, how are you allocating your resources?  That is essentially what you are paid to do as the Executive Director of a facility or like operation.  How much time do we spend on our most important, least urgent issues as opposed to the urgent, less important/strategic issues that fight for our attention?

What is your core problem?  Chances are that you’re not spending nearly enough time fixing it because all of the undesirable effects of it are drowning you.

Washington Healthcare Association

Presentation Summary in Brochure

I had a great time speaking at the Washington Healthcare Association conference last week.  Great vibe.  Great people.  Beautiful place.  It’s a class organization.  Several attendees asked for a copy of my presentation which I’ve posted here as it’s too large to email.

Download Here: Washington_It’sTheCultureStupid