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Have you ever noticed that the longer a process exists, the more likely someone is to ask, "Why do we still do this?" While it may sound whiny or irritating, sometimes it is exactly the right question. It may reveal an outdated process, or something else entirely unexpected. Maybe it's a forgotten lesson. The strongest organizations aren't afraid of those questions. Rather, those questions are welcomed and appreciated. Asking why is a sign of engagement. Processes and policie

A few years ago, I worked with a patient recovering from a stroke. He was 75 years old. A widower. The kind of person who had spent most of his life taking care of himself and expected to keep doing so. He lived alone in the same house he had occupied for years. He wasn't particularly active, but he kept busy. He mowed his own lawn. Tinkered with his car when something wasn't running quite right. Ate more like a typical American than his physician probably preferred. The rout

Patient Behind the Policy Few healthcare tasks generate less enthusiasm than documentation. Ask almost any clinician about reporting requirements, checklists, attestations, or reconciliation processes, and you'll hear a familiar question: Why do we have to do all of this? It's a reasonable question. Most requirements arrive without their history. The processes are inherited long after the reasons are forgotten. Medication reconciliation is one of those safeguards. There is no

I grew up around farming, so I realize this analogy may be a little predictable. But sometimes the simplest lessons are the hardest to ignore. No farmer stands in a field demanding that crops grow faster. At least, not successfully. We understand that growth depends on conditions. Moisture matters. Temperature matters. Soil conditions matter. Fertilizer matters. Sunlight matters. When those conditions are present, growth follows. When they aren't, no amount of pressure change

Last week, I wrote about what happens when leaders don't hear what is being said. More accurately, what happens when people stop believing they're being heard. When that happens, we tend to focus on the employees who leave or openly disengage. Those responses are visible. They're easy to recognize. What I've found more interesting are the people who stay. The high performers who have always brought something extra to the organization. The person who notices a process that cou

I remember one situation where concerns about documentation practices were raised repeatedly over an extended period of time. The concerns never seemed to gain traction, and eventually people responded in different ways. Some left. Some kept their heads down and focused on their own responsibilities. A few quietly kept track of what they were seeing. What struck me most wasn't the problem itself. It was how many people already knew about it. The information had been shared. C

I worked with a hospital once where staff routinely raised concerns. Some involved physician behavior. Others involved coding and billing practices. Documentation concerns surfaced regularly. None of these issues were secret, and none were particularly surprising to the people doing the work every day. The concerns made their way through the appropriate channels and onto the right agendas. And then, more often than not, nothing happened. Excuses were made. Issues were minimiz

I was standing outside talking with my husband one afternoon when our son, who was barely two years old at the time, wandered over to the combine parked nearby. Harvest was approaching, and the machine was being serviced before heading to the field. From where I stood, I watched him discover the ladder on the back and begin climbing. As a mother, I had options. I could have stopped him immediately. I could have told him not to climb. I could have created a rule. Instead, I qu

Several years ago, I was involved in a healthcare process improvement initiative. We had assembled a strong team, spent time understanding the problem we were trying to solve, and developed a plan that felt ambitious but achievable. The work was moving forward, not always quickly, but steadily. Then a leadership transition occurred. The project itself didn't change. The objective was the same, the team was the same, and the work still needed to be done. What changed was the e

I've been in meetings where everyone agreed. The deadline was ambitious, but nobody objected. Heads nodded, next steps were assigned, and the conversation moved on. Everything looked fine on the surface. Then the meeting ended. As people filtered into the hallway, the conversation changed. "There's no way we're going to hit that date." "I thought someone was going to say something." "So did I." Nobody had spoken up when it mattered. Not because they didn't see the problem, an

The goal was never to be more disciplined. The goal was to build a life that required less of it. Tomorrow, I'll attend my 30th high school class reunion. Thirty years. Long enough for careers to be built. Families to grow. Plans to change. Long enough for people to become who they are. I've found myself wondering less about what everyone is doing and more about who everyone became. Not because people stay the same. They don't. Life has a way of reshaping us. Success changes

If a system stops working, it doesn’t mean you failed. It usually means you’ve outgrown it. Recently, my son needed a new bike. Not because anything was wrong with the one he had—it fit him really well… for a while. But at some point, it didn’t. Too small to ride comfortably. Not quite ready for an adult-sized replacement. So we had to find something in between. Not perfect forever. Just something that fits now and will carry him forward for a while. It made me think about ho

Stop trying to build the perfect routine. Build a default you can come back to. There’s a difference between having a planand having a consistent way of starting. For a long time, my days were… thoughtful. I knew what needed to get done. I was clear on priorities. Nothing was disorganized. But the way I moved through the day was always a little different. I’d adjust the order.Re-sequence what came first. Reconsider what made the most sense that day. Individually, those were g

If your week always feels reactive, it’s probably because you’re not resetting it. Every Friday afternoon, before I head into the weekend, I sit down and look back at the week. What got done. What didn’t. What showed up that I didn’t plan for. Not everything carries forward. Some things resolve on their own. Some get replaced by something more important. Some were never mine to hold in the first place. So I reprioritize. I remove what no longer matters. I keep what does. And

Consistency doesn’t come from trying harder. It comes from having something to rely on. There’s a certain kind of pressure that comes with needing to communicate clearly in real time. Not just what happened, but what matters. What changed. What someone else needs to know right now to move forward. For a long time, I approached that the way most people do: Pay attention. Remember the details. Organize it in my head. Then translate it into something clear. It worked. But it req

I don’t rely on memory. I rely on structure. There was a point in my work where everything felt like it needed to be held… all at once. Names. Details. Medications. Timing. What mattered right now vs what could wait. Individually, none of it was complicated. But together, it created constant pressure to remember, track, double-check. So I stopped trying to keep it all in my head. I built a simple structure I could return to. Each patient had the same layout: Name in the upper

You don’t need better habits. You need fewer decisions. For a long time, I thought the answer was to be more disciplined. Better routines. More intention. A little more effort in the right places. But then I started noticing how much of my day was just… deciding. What to wear. What to eat. Where to start. What mattered most. None of these were big decisions. Individually, they barely registered. Together, they were exhausting. There’s a reason some people default to the same

Most systems don’t fail because we're inconsistent. They fail because they were never built for a real life. I used to think the problem was me. Every evening around 5:30, the same question would show up:What are we having for dinner? And to be clear—this wasn’t an energy issue. It was a creativity issue. Because I don’t like cooking. So, not only am I responsible for dinner…I’m apparently also responsible for inventing it every single day. Some nights it was fine. Other nigh

Over the past few weeks, I’ve been writing about the myths many of us inherit about compliance. Not as criticism—but as recognition. Because most of these beliefs didn’t come from nowhere. They came from experience. From pressure. From environments where people were doing the best they could with what they had. We learned to believe: That compliance is here to catch us. That if we don’t know, we shouldn’t speak. That good processes are straight lines. That more rules make us

When something isn’t working, the instinct is to move quickly. Fix it. Address it. Make sure it doesn’t happen again. And often, that means training. I saw this play out in a small—but telling—way. A nurse wasn’t consistently updating the care plan before team conferences. It happened more than once. And it mattered—because the conference depended on having accurate, current information. So the response was immediate. Training modules were assigned on creating and upd