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When I graduated from high school, I thought I had a plan. I started college as a business major and was fascinated by economics. I loved the way it explained behavior, incentives, the relationship between supply and demand, and the decisions people make. At the time, it felt like a clear direction. Then life interrupted the plan. A serious car accident changed the trajectory I thought I was on. Suddenly, the future felt much less certain. I wasn't just deciding what I wanted

From the bedside, compliance can feel like one more thing. One more policy to follow. One more process to complete. One more requirement standing between the caregiver and the work they came to do. Viewed from that perspective, it's easy to look at a regulation, a reporting requirement, or a compliance process and wonder whether it really makes a difference. Take the CMS Minimum Staffing Standards for Long-Term Care Facilities. For many nursing home leaders, the conversation

It happens every year around the holidays. Family visits Grandpa or Grandma for the first time in several months, observes the situation for a short while, then decides their elderly loved one is no longer safe living alone. Several years ago, I was involved in one of those situations. The concern was real. The family's anxiety was understandable. And everyone involved wanted to help. The challenge was that there was no obvious medical reason for an inpatient admission. The i

It happens every year. We start the New Year with resolutions: lose 20 pounds, be more present with our families, exercise daily. By February 1st, though, those good intentions have often been forgotten or quietly reprioritized. We've lost sight of the goal because our focus has shifted. But the shift isn't intentional. It happens when we don't have systems in place to make the right choice the easy choice. Organizations face a similar challenge. When cultural problems show u

Several years ago, someone in a therapy department approached me with concerns about a therapist's billing practices. I reviewed the documentation, billing records, and appointment information. The concern was valid, so I brought the concern to hospital leadership. The information was acknowledged, but no action was taken. Over the next several years, other members of the department became aware of the issue. Eventually, concerns were raised that the matter would be reported

Every healthcare organization is required to have a compliance program. For many, that's the easy part. Some organizations put a few policies together to cover the requirements, have staff complete annual training, and call it done. Other organizations take a compliance program beyond the checklist-style approach to ask the harder question of where compliance exists beyond the program itself. There's a difference between having a compliance program and building a culture of c

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