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:


“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?

McKnight‚Äôs Guest Column & Attack of the Killer Email Monkeys

I recently wrote a guest column for McKnight’s that was apparently really well received according to their editorial staff. ¬†You can read the article here:

McKnight’s Guest Column: The “Leading Cause of Death” of LTC Leaders

There are several really good comments at the bottom. ¬†One comment, along with my reply, I’ll post here below. ¬†I literally had this very same Q&A yesterday with a colleague who is fighting to get a handle on his workload/monkeys and establish a stronger method of follow-through. ¬†Here’s the back and forth for the comment and I’ll include a little more from my email exchange with my colleague …


2 days ago
Dave, nice job. Speaking as a casualty (or fatality) of this very issue, I can attest to the principles here 100%. I’m always curious about what people use to “know” their monkeys, tasks, etc. Given the close relationship between time management & monkey management, have you discovered a great time management tool / system that effectively discharges monkeys?


A colleague of mine shared with me his secret for seeing his EMAIL MONKEYS a few years back. And this usually takes a bigger leap of faith, but it is HUGE for my ability to SEE my monkeys and act quickly on them. “A monkey is whatever the next move is when dialogue between two parties ends,” right? Therefore, emails become a massive collection of monkeys.
So, here’s what I do ‚Ķ I delete EVERYTHING that doesn’t REQUIRE a response. My Trash folder becomes my massive archive if I ever need to review an email from before. I TRY to keep my inbox below 10. I have 8 in there right now (I have 24,985 in my Trash Folder). Again, I delete everything that doesn’t require a response, a next move. So my inbox are only monkeys that need my attention. I’ll sometimes put on my calendar an email/monkey to address if it can’t be done immediately or if I’m in the middle of other more important things. It gives me a tremendous sense of control and organization.
I breathe/sleep easy knowing that I don’t have monkeys hidden in an inbox of 10,000 emails (those hidden/forgotten monkeys are the ones that undermine my credibility with people who are WAITING forever for me to respond). I do not use folders to organize emails from So-And-So or emails on a certain topic. I’ll use Evernote to record emails on a certain topic of a project I’m working on. Folders are just more hiding places for monkeys. It could take a weekend to thin out your inbox depending on the size. So, you may just want to rip off the bandaid and delete everything older than two months and thin from there.
I go into more depth here (caution: don’t click unless you’re really interested in the “nitty gritty” of handling monkeys AND I’m fully aware what works for me won’t necessarily fit you): Monkey Nitty Gritty or “It’s About Time”

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.

“I’m a prisoner here.”

I just heard one of our patients say that.  He had been sitting in a chair outside my office for about an hour.  Quietly fuming inside.

About an hour earlier, he had pushed the elevator button when a therapist intervened. ¬†It went something like this …

Where are you going?


No, you can’t do that.

Why not?

You have to stay on your floor.

Oh, and why’s that?

Well, because we have to know where you are. ¬†We’re responsible for your safety.

Ok. ¬†I’ll tell you where I’m going. ¬†Outside by the entrance. ¬†I want to go outside.

No, you can’t leave this floor. ¬†If something happens to you, we’ll get in a lot of trouble.

An hour later, his nurse and CNA both tried to get him to go to the dining room. ¬†This time he was resolute. ¬†He wouldn’t budge. ¬†He called himself a prisoner b/c the staff wouldn’t let him leave. ¬†I would’ve been the same way. ¬†After a few back-and-forths about whether he would or would not go to dinner or even ever leave that chair, I stepped out of my office and said,

You want to go outside?

They won’t let me.

Who won’t let you?

The people here.

There must be some misunderstanding.  They probably meant that you needed to go with someone.

No. ¬†They said, “You can’t leave this floor.”

Well … let me see what I can do. ¬†[I went to the gym and asked the therapists about him. ¬†They were thrilled with the idea of me escorting him outside. ¬†They just didn’t want him to go alone as he still has a ways to go to get his strength back and is at risk for falling. ¬†I came back with the good news. ¬†He couldn’t believe it.]

We went down together and I pulled the bench into the sun. ¬†Gorgeous day. ¬†We talked for about 45 minutes. ¬†WWII veteran. ¬†married to a ‘saint’ for 60+ years. ¬†A few kids. ¬†He’s the last surviving child of 8 kids in his family. ¬†He told me about his ‘crooked’ father in law who died with $500,000 in the bank. ¬†We laughed. ¬†I teased him. ¬†He teased me back. ¬†We talked about religion and faith and cashing in his chips after 92 years on the earth. ¬†After a while, he said, “Well, is it time for dinner?”

Yeah, are you ready to go back in?

You bet.

He literally had a large smile on his face when he sat down to eat dinner (after everyone else had already eaten by this time). ¬†It struck me as I sat back down in my office how differently that could’ve gone (and sadly too often does) … the nursing/therapy staff get frustrated by the patient’s “behavior” and start to treat him as an object more than as a person. ¬†He becomes a problem. ¬†Stubborn. ¬†“Non-compliant.” ¬†A pharmaceutical intervention is ordered and the man, the WWII veteran, loses a little bit of his identity and dignity and control.

As a facility leader, it’s my role to establish a culture within the facility where that latter scenario is avoided — when it’s avoidable. ¬†We have to create a mission, a purpose for our staff that is larger than a paycheck or a task to constantly motivate them to SEE their brother, sister, mother, or father in the eyes of the patient sitting in that chair. ¬†I saw the difference tonight in being task-driven/objectifying and human-driven/personalizing.

Our great challenge is to systematically enable our great staff to personalize their residents’ and patients’ experience …

#1 Cause of Death or Monkeys: A How-To

I recently trained many of our leaders on Monkey Management.

I’m convinced that this principle is the #1 cause of death in new leaders.

So … how do you recognize the problem & overcome it?¬† Let’s go through it.¬† Unless, of course, you don’t have the time ūüôā

Take a minute to look at this To-Do List.¬† It’s not uncommon from many leaders’ lists.¬† It contains things that came up today (on the left) and things to do from yesterday and before on the right.¬† Normally, one’s list is spread out on Post-it Notes, 3×5 cards, Notepads, Computer To-Do lists, Calendars, and email In-boxes.

To-Do List

Do you see the MONKEYS?!¬† They’re all over the place!¬† Remember, ‘a monkey is whatever the next move is when 2 parties end a conversation.’¬† Whoever has the next move has the monkey.¬† If you have to respond to an email, memo, or voice mail, you have a monkey.¬† If you’ve agreed to do something for someone else (buy, research, analyze, look into, make, meet with, write, etc.) you have a monkey.¬† Unless you’re paranoid about attracting monkeys, you likely have A LOT of them …


Remember the Monkey Gospel Truths:

Procrastination vs Insubordination
Possible Insubordination = Getting work done

Hopefully the reasons why you must destroy monkeys from your plate before they destroy you are obvious.¬† But, in case you’re skeptical.¬† Let’s reason together …

  • If you are doing work others could/should be doing, then you are, by definition, NOT DOING work that only you can do.
  • Monkeys keep you from working on what Steven Covey illustrates so masterfully in 7 Habits of Highly Effective People as Quadrant III stuff (next slide below).¬† The Non-Urgent/Important quadrant of our to-do list.
  • Regardless of your motive, you are stunting your direct reports’ ability to grow and develop by doing things for them.¬† Stop it!¬† Let’s see if they can sore.¬† If they fail (which is practically guaranteed eventually), teach them and help them grow.
Monkeys laugh when they keep you from Quadrant III

Take your ‘Total Plate’ which, again, includes your to-do lists, post-it notes, voice mails, emails, projects, etc. and strike a line through everything that doesn’t ABSOLUTELY have to be done by only you.¬† Look at my list below and notice in the next 2 slides how I identify other people’s monkeys that landed on my back and how I returned them to their rightful owner.

What can you – AND ONLY YOU – do?
Kill the Monkeys before they kill you

Wow.¬† Compare my list now (below) to my original list.¬† FREEDOM!¬† Freedom to finally lead.¬† Freedom to run my operation instead of being run by it.¬† If you don’t take a stand against monkeys and commit to a discipline of spotting them before they land on your plate and deflecting them, you will NEVER get to quadrant III.¬† If you’re too busy for quadrant III then, SOONER OR LATER, you will fail.¬† You will get burned out.¬† You will be frustrated.¬† You will remain miles away from your potential.


One last thought about Monkeys.¬† They hate you.¬† They will only be happy when they not only destroy your professional life, but your personal life as well.¬† Talk about Non-Urgent/Important!?: date night with your spouse, being home for dinner with your kids/family, family vacation, personal fitness/health, reunions with friends, community/church service, etc.¬† All these things are, to a degree, sacrificed when we lack the discipline and understanding to treat monkeys as the enemy they are.¬† You could have all the talent, charisma, & smarts in the world.¬† But, none of that matters if you’re spending 75% of your time on monkeys others should be doing.

Remember …
Managers Do Things Right.  Leaders Do The Right Things.

Take Monkeys personally.¬† If they could, they would spit in your mother’s face.

No more monkeys jumping …

As a follow up to A Leader’s Downfall, I want to comment on one of the most common mind sets that new leaders lack – to NOT take on too much themselves.¬† There’s several reasons why we try to tackle too much ourselves.¬† Here’s what we normally tell ourselves:

  • My direct report(s) are incompetent
  • I can do a better job than they can
  • I need some hands on in this department to completely understand our current situation so I can better supervise in the future
  • My direct report(s) are too busy to pile on them more stuff
  • I’m afraid that if I ask them to do this stuff they’ll burn out

So the big question … are those legit?


They may be true.¬† But that’s irrelevant.¬† They are self-deceiving, self-aggrandizing excuses for not doing your job as a leader.¬† Your job is NOT to do everyone else’s work.¬† Your job is to assemble, inspire, measure, coach, and train leaders who can take your shared vision to produce incredible results.

I can hear your protests now …

  • Dave, you don’t get it.¬† I’m a servant leader.¬† I don’t ask them to do anything I wouldn’t do myself.
  • Dave, you don’t understand my team.¬† We have some serious weak links right now and if I didn’t take on this stuff (that they should be doing) it wouldn’t get done.

I do get it.¬† And, I do understand your team.¬† Perfectly.¬† I understand the stress, the frustration, the underachievement, etc.¬† And, I’m telling you, you’ve got to wake up and do your job!¬† One of the reasons this is so tough for newer leaders, in particular, is because we feel so much insecurity during the beginning of our leadership.¬† There’s so much we don’t know.¬† And, everyone knows it.¬† Since we don’t have the instant credibility that years of doing this provides, we try to gain it the only we know how … becoming superman for our staff.

  • Dave, we need a HMO contract with XYZ company.¬† Can you get one for us?¬† Sure!
  • Dave, I’m having problems with 2 of my staff.¬† Can you talk to them for me?¬† You bet!
  • Dave, we need some new landscaping out front.¬† What do you think?¬† I’ll go to Home Depot!
  • Etc …

What’s the problem?¬† Every one of those things (and probably 50% of your to-do list) are things your people should be doing.¬† After a few years of struggling to become superman for my staff to make up for my own incompetence and lack of experience, I finally took the leap of faith to adopt the mind set taught by Bill Oncken, described as Monkeys.¬† I’ve posted here a long excerpt of Oncken teaching it himself.

A couple of the main principles:

  1. An inferior job done by your subordinate is 100% better than a superior job procrastinated by you and never done.
  2. If you don’t complete a task you’ve given yourself (or accepted to do for your subordinate), it’s called … procrastination.¬† If you don’t complete a task your supervisor gave you, it’s called … insubordination.
  3. So, if there are tasks (monkeys) on your to-do list that have been there for a couple weeks that you haven’t had time to get done (procrastination), give it to your subordinate so it becomes insubordination if it doesn’t get done.¬† Guess what.¬† It will get done.
  4. This is not a lazy or selfish act.¬† I had an allergic reaction to this talk of ‘subordinates’ and insubordination, and giving people work that I normally did.¬† But, then I woke up.¬† It empowers them!¬† I pushes them to grow.¬† It removes you as the constraint in your operation!¬† Progress speeds up.¬† Change happens.¬† Because your doing your job … not theirs!

It saved my career.  I hope you can make time to listen to it.