Ep. 040 - Build a Championship Team on a Salary Cap: Healthcare Lessons from Sports

Bridge Builders, we made it to episode 40. In this episode, we're definitely going to be talking about some things that are definitely important, especially when it comes to how to build a team with a limited salary cap. Your resources are low and the importance of mastering the skill set of training. I think it's very important. Those two things run them all over a little bit, but I'm excited to come back in front of you. I think this is three episodes in the same week. I remember the last time that we actually did that. So I'm I'm inspired to share and to teach. So welcome back to bread to lead and we will see you after the intro. I don't take the lead I don't take the lead Since the age of 12 I've been about my father's business At the age of 30 He sent me to his venue As you all know This podcast is an amazing podcast We stay in the top 20, top 15 Top 10 rankings in business category All the time on Apple Podcasts And in all categories, we're always top 50, top 70 between that range that I'm excited and grateful for. And we have an amazing team. But to be honest with you, if you were to look inside my office right now, I don't have a big production team. It's just a camera, a switchboard, my laptop, I mean, my keyboard and my mouse notes in the book. And the biggest concept is because I truly treat each podcast like a pie class. And for those of you that are newer to the to the podcast, I just want to say welcome. I am an operations engineer by trade. I turn around underperforming organizations. I mean, my team are what you will call tornado chasers. We love to go and solve the most difficult problems, especially when it means bringing people closer. Being a bridge builder, the reason why I call you a bridge builder, because building a bridge is someone who's intentionally connecting two sides that cannot naturally be connected. Connecting generations, connecting ideologies, connecting philosophies, connecting spiritual beliefs, connecting generation. Again, generation, if I said that before, connecting beliefs. A bridge builder is definitely a new type of way that I want to identify true leaders that actually care about the developing of people while embracing the beauty and the nuance of technology, innovation and growth. I think that all kind of matter. And I'm excited about doing this podcast simply because, one, I haven't had this much time in a while to just think we've been on the go. We operate our organization in seasons, and this just happens to be the season of system implementation or installation. Hospital systems actually getting our technology in our systems and seeing the importance of having a true standard in their process and departments. And for those of you that are not from the health care space, Norma, I come from private sector. So you'll hear a lot of isms and and things that you can pull away for your own personal businesses or your own categories that you are in. But the concept of bread to lead is specifically focused on building a new type of leader, transformational leader that actually sees the playing field of organizational growth for what it is. It's a developing map of all these different spaces that never have an end. and getting to that is very important to me. And I'm very excited that we all are a part of this journey and that you all have decided to be on this journey with us. So for that, I want to say welcome. If you're new, this is season three, episode 40. And we've been doing this season somewhat a bit different. Of every episode is built around my newest book, Operational Blindness. And we believe that this is the hidden force that's destroying health care. This operational blind is here. And what health care leaders can't see and what's costing them. This is actually available now. You can get a copy at where to lead dot com. Fill out a comment and you'll get a link to get access to the book. So today's episode is going to hit different for some of you because we're talking about something. Every health care leader thinks they understand, but almost none of them actually do. We're talking about how to build a team that wins, not with unlimited resources, not with more FTEs, not with budget increases that never come. We're talking about building a championship team with constrained resources, much like a sports franchise trying to win a title under a salary cap. And I really want to get into it because I want you to think about something with me. Every professional sports league that dominates American culture operates under some form of a salary cap, the NFL, the NBA, the NHL. And these leagues force teams to build winners within financial constraints. You can't just outspend everyone. You can't just buy a championship. And yet some teams figure it out year after year. Certain franchises compete for championships while others with similar payrolls wallow in mediocrity. And there's a reason why. And it's not because the winning teams have better luck. It's because they understand something that losing teams just don't. Building a championship roster isn't about having the most talent. It's about having the right talent in the right positions deployed with a system that maximizes what you have. Now, here's where this connects with health care. And the reason why I bring up health care, for those of you that don't know, we're in the business of health care. And the beauty of it is that the nuances of the lessons can transfer to any industry. Every hospital, every health system, every department you lead operates under a salary cap. And it's called your budget, your FTE allocation, your labor cost targets. And just like any professional team, you can't just buy your way to success. You have to be intentional. You have to build it. But most health care leaders don't think this way. They've never been taught roster construction. They've never been taught talent mix optimization. They've never been taught how to win with constraints. So what they do instead, they do what every losing franchise does respectfully. They complain about the cap. They blame resources. They keep asking for more. But if I had just two more techs, if I could just hire one more coordinator, if leadership would approve one more position, this is the staffing request as a strategy. And it doesn't work. And the truth is, if you look up statistically, it actually never has. And yet it's the default play playbook for many operationally blind leaders everywhere. And I want to read to you from the book this section that's called the under supported leader. You'll find this on page 54. So I'm going to go to page 54 in the book operational blindness. If you do not have a copy, you can go to bread to lead dot com and fill out comment. Fill out a comment and you'll get a link and there's some free goodies. I think that the team has for you on the site there. And it's just so that we can, you know, keep information with you and keep up on, you know, who you are and let you know the kind of stuff that we have going. because we do have some phenomenal things going. And maybe in a newer episode, I'll talk to you all about the 44 Fellowship and how we're giving back to leaders specifically in serial processing that want to be developed but doesn't have access to specific resources to get developed. We're going to be supporting that, and I'll talk about that in later episodes. So on page 44, we talk about the under-supported leader. And how it reads is before we go further, I want to be clear about something. SPD directors are often the most under supported leaders in the hospital. And think about what we hand them expectations set by our schedules that don't they don't control. The surgical schedule is built around surgeons preferences, room availability and patient needs. Nobody asks SPD whether the schedule is feasible, giving their capacity. Nobody factors instrument processing time into case sequencing. And SPD is expected to support whatever schedule appears, regardless of the complexity or timing. Budgets based on volume projections that are almost always wrong. Health care volume is unpredictable. Caseload fluctuate. Procedure mixes change. But SPD budgets are set annually based on projections. And when reality diverges from projections, as it always does, SPD is expected to absorb the variance, do more with the same or do the same with less. Staffing models designed for predictable work in an unpredictable environment. SPD staffing assumes a steady flow of instruments moving through a linear process. But the actual work is anything but linear. Stat requests, priority changes, emergency add-ons, equipment failures, staff call-outs, every shift is an exercise in managing chaos with resources planned for order. Technology that often dates from previous era dressed up with modern interfaces. Many SPD tracking systems are decades old in their core architecture. They were designed for a simpler time with simpler instrumentation and simpler expectations. The interfaces have been updated, but the fundamental capabilities haven't kept pace with the demands of modern surgical services. And metrics that measure activity but ignore outcomes. We've covered this extensively. The measurement system is designed to track what SPD does, not whether what SPD does actually serves the organization needs. And through all of this, zero visibility into downstream impact, no systematic feedback loop connecting SPD operations to OR outcomes, no way to know whether the decisions made today are helping or hurting surgical services, no basis for learning, improving or optimizing what matters. Then we put this leader in a room with the CFO, the COO and the CNO and ask them to explain why things aren't working. What exactly did we expect to happen? The SPD director who gives defensive answers in that meeting isn't being obstinate. They're being rational. They're doing exactly what everyone would do when asked to account for outcomes. They can't see using tools they were never given to serve expectations. They weren't consulted on with within a budget that doesn't reflect reality. The problem isn't the director. The problem is the system that sets them up to fail and then holds them accountable for the inevitable failure. I want to I want to I want to again, that's page 54 to 55, the under supported leader and our newest book, operational blindness. I want to I want to teach on this. Because what I read was just a setup. The context. The context. To what I just read needs to be explained, because before we can talk about building a championship team, we have to understand why most leaders are set up to fail before they even get started in the first place. The knee jerk response to operational struggle is always the same. We need more people. But look at what I just read. The problem isn't the head count. The problem is that we're asking leaders to hit targets that they can't see with tools they weren't given against timelines they don't control. Adding staff to that situation doesn't fix anything. It just gives you more people operating blind. In professional sports, teams don't just add players. They build systems first. They create a style of play, a culture, a set of expectations. Then they find players who fit that system. And health care does it backwards. We throw bodies at problems without ever fixing the system those bodies operate in. Then we're shocked when more bodies don't produce better outcomes. And here's the truth. You can't hire a broken system. You can't outstaff dysfunction. You can only mask it temporarily while the costs keep compounding. And I think it's very important for us to actually understand this, especially when it comes to system building. because when we talk about system building, we have to understand that usually when an organization comes or a leader comes or a coach comes to a team, the owner of the team knows that that head coach is probably going to want their own team that understands their system or members on their team this time that they couldn't get last time because that time that person was with another team. But now they have the right people that can think creatively. But usually there's a game plan. There's a natural system. There's a natural flow. There's a natural ebb that each coach brings to the table. And from there, that coach or that system, that structure knows what type of players they want to actually fit and what players that are really, really, really good and really talented actually don't fit that mode or that space. And that's what we bring when we talk about, we install SturlBuy Design. SturlBuy Design is a playbook. It is a system. It is a way that your organization can operate you know regardless of who the players are And most organizations they miss that You don have a system that your entire organization operates on and is held accountable to regardless It's kind of like everyone, it's just kind of plug and play. And in sports, we had, when we go play with our buddies at the park, you have what we call 21, which is organized chaos. It's every man for their self for the for finding one victor um or you have open gym where people just kind of come and they do their thing and they float and they feel each other and you may hope that you have team members that know how to play the ball the game of basketball but if you're on the team with people that just kind of running around it looks extremely chaotic and a lot of organizations are actually built that way um and if we and we take up take a page out of page 81 of our operational blindness book, The Premium Labor Trap. And in a book in page 81, it actually reads in this book that every hospital CFO knows the premier labor over time in agency staff. They know the cost. They know what's going on. I'm going to bring it here and read it. Every hospital CFO knows that premium labor, overtime, and agency staff, temporary workers cost significantly more than regular labor. Everyone knows that. The fully loaded cost of an overtime hour can be 1.5 to 2 times the regular weight. Agency staff often cost even more, sometimes 2 to 3 times what a permanent employee will cost for the same hours. The standard assumption is that premium labor is a temporary measure to handle temporary situations. Volume spikes, staff illness, vacancy gaps during recruiting. You pay the premium to get through the crunch, then return to normal operations at normal cost. In departments with operational blindness, premium labor isn't temporary, it's structural. And here's how it works. SPD budgets are set based on projected volumes and standard productivity assumptions. These projections typically assume efficient operations, work flowing smoothly through the department, resources allocated optimally, minimal disruption and rework. But reactive operations aren't efficient. When when you're constantly firefighting, you lose efficiency to context switching to prioritization changes to rework when rush jobs don't meet quality standards. The same volume requires more labor hours to to process than the budget it assumed. And then the SPD director operating with a budget built on efficiency assumptions that don't match the reality. They face structural gap. They can either fail to meet service demands or fill the gap with premium labor. They choose premium labor because failing to support the OR is just not an option. So this is the premium labor trap where the department is structurally understaffed for the inefficiency its reactive mode model is creating. And premium labor fills that gap and is becoming permanent rather than temporary. So what does this cost? Consider an SPD that runs 15 percent over budget on labor due to structural premium spending for a department with the two million annual labor budget. That's three hundred thousand dollars per year in excess cost. In over five years, one point five million. And that's a conservative estimate. And I've seen departments running 25 to 30 percent over budget on labor year after year with no end in sight. And the trap is self-reinforcing. The premium spending consumes budget that could have gone to permanent staffing without adequate permanent staff. The department remains inefficient. The inefficiency perpetuates the need for premium labor. The cycle continues. The trap goes on and on. I want to I want to teach on this. This is from page 81, 82 in the book. And then sports teams. This is like a team that keeps signing expensive free agents to pass the holes instead of building through the draft. They're paying top dollar for short term solutions while the development of pipeline stays empty. Every dollar you spend on premium labor to fill gaps created by system dysfunction is a dollar you can't spend on building real capability. And championship teams understand positional value hierarchy. Not every position is created equal. Not every roster spot creates elite talent or requires it. And trying to fill every position with expensive players is actually a losing strategy. In the NFL, you need an elite talent at quarterback, left tackle, an edge rusher and a quarterback. cornerback you can win with replacement level players at fullback punter right guard that's no disrespect to those positions it's recognition that some positions have more impact on winning than others and healthcare operations honestly works the same exact way you don't need 10 elite techs you need two or three anchors in a system in a system that elevates everyone else but because most departments are blind to actual performance they treat all positions the same same pace structures same expectations same rotations and this is like paying your punter the same as your quarterback because everyone on the team matters equally true in a philosophical sense it's terrible when you talk about roster management and the premium labor trap happens because leaders don't understand that their real roster, what their real roster needs. They keep paying premium prices to fill every gap instead of strategically investing in the positions that actually drive outcomes. And I think it's very important because when you think about it, you have to think about it in terms of what I call the five position framework. And every championship team needs five types of contributors. One position one and the five types of contributors every championship team needs. Every team needs one or two anchors. These are your elite performers. The tech who can handle any trade, any surge in any crisis, they set the standard. They train every they train others by example. They can disproportionately load a carry any load when things get hard. This person right here is very key. And here's why it's key. You probably already have them, but you might not be deploying them correctly. Most departments treat all techs the same, same assignments, same rotations, same expectations. And this is like putting your franchise quarterback in at running back because everyone should be able to do everything. And your anchors should be anchoring. That means putting them on the most critical work during the most critical shifts. That means protecting their time and attention. That means compensating them appropriately so they don't leave. When you talk about an anchor, many organizations actually only have room for maybe one to two anchors. You have your manager and then you have the sidekick. It's either the assistant manager, the supervisor, the team lead or that one tech that is just that good. You can put them anywhere. You can do great. In those type of scenarios, you have to make sure that you are going to one compensate them correctly. You want that person only focusing on your hospital. So you have to pay them accordingly. But you have to do that from being able to have a development process or development or development program so that you know how long you typically will have with an anchor. So usually a championship team, you build around one or two people. You build around that one core person. If you think about a CEO of a company, the team is built around that CEO's capability. um if i if i if i am building a nfl team and my quarterback is very good at running and throwing the ball equally i probably don't have to spend a lot of money on a top tier running back because my quarterback can actually get 60 70 yards themselves a game i just need a running back that can get me 60 70 on their own i don't need a running back that needs a bunch of touches because that creates some type of push and pull i need a running back that can do their job and stays out the way but these are this is kind of how you build your organization you have someone what we call on the offense someone that can handle that and you got someone on the defense someone that can deal with customer support customer service they may be the ones going back and forth talking with the surgeons talking with the or they can go in they can scrub in they can do whatever they need to do they're just that good but in most organizations you don't have the budget to have more than one maybe two the organizations that have unlimited budget probably got a solid three to five of those but their organization staff is larger okay position two the reliable core below your anchors like who you're building your organization around You need three to five solid, dependable performers. These aren't superstars. They're professionals. They show up. They execute. They don't cause problems. They won't dazzle you. They won't disappoint you either. This is where most departments actually need to invest, not in adding more bodies, but in developing the bodies they have into reliable core players. This is a training problem, not a hiring problem. And most organizations don't have a development process. Remember, I talked about this. Now, on the top note, let's go back to position one when we're talking about our anchors, our core team, our core people. Now, when it comes to a core person or a core team or your core position players in your organization, any organization, you don't want them to have thinking overload or thinking fatigue. And this simply means you have that's why you have to have a system that can run and operate with or without them so they can use more of their energy on actually making your organization look great. If they always feel like they have to use their energy for heroism or hero ball, it's going to be hard for you all to win a championship. Why? Because they're always operating from a deficit. Think of for think for an example. If you have a star player that always have to operate the organization from a deficit, the team is always losing. You never get to actually experience them actually thriving when ahead. So when they get in the game where they're actually ahead, you see them blow a team out the water. So you just have to make sure that you have a system, Stirl by Design. If you're interested in your health care and you want to know more about our system, please go to SipsHealthCare.com and find out more about our Stirl by Design system. but in this process we have to understand that when we talk about a system now your team your people that are your top performers they're not going to be processing uh having to come back from and having anxiety from coming back from behind many great players yes they like the they like to climb mount everest right but they don't want to call climb um they don't want small mole hills to take the representation of mountains. If you look at a molehill right down on the ground, real small, and you pretend that you're an ant, a molehill looks like a mountain. However, as a human being, I look at the mountain as a mountain and a molehill as a molehill. But if I'm a small critter or I'm a small animal, I may make that happen. And your anchors see those small issues every day as small molehills. But if they feel like they have to climb Mount Everest for something so simple and so small because you don't have a system that can actually correct the reliable core and the people under that support them you're missing it you're missing it and i understand in an organization everybody wants to be treated the same everybody wants the same pay everyone wants the same thing but if you have anchors that are true outperformers they overdo everything you don't want them to feel like they're a part of everyone else because now them them overperforming means nothing And when they realize that, that's when you'll start losing them. Then under your anchors, again, you had your reliable core. We talked about them. Now, position three. Remember, we're filling five positions. Position three is a developmental slot. Every roster needs space for people who aren't ready yet but are worth developing. These are your newer hires. This is your less experienced technician. This is people with potential but without polish. The mistake that most leaders make is expecting developmental players to perform like core players or like your stars. Then you get frustrated when they don't. That's a leadership failure, not a not a staffing problem. And again, again, it goes back to the same thing. If I have too many development players, I look like the Hornets or the Browns. where we're going to have to spend a lot of years taking losses but getting our guys good but if i have the right mix i can develop my players alongside of my core team and alongside of my anchors and then from that development i'm able to see who can be a new core or who will be a new anchor at some point and also understanding that guess what just like in sports everyone has where you want that star player to finish with your team your hospital but the truth is depending on what happens when they're in free agency and everybody ends up naturally kind of looking into the market every two to four years just quite natural every two to four years if you think about a contract and and and uh most sports unless you are a legacy player and they're they're they're banking their bottom dollar on you most people are in a hospital for about two to four years before they're looking for hey i need a raise i need a promotion i need something two to four two to four two to four so when i know that and i know where my people are i have my anchors and i have my core team then i have my development slots i know who's going to be what and i'm sorry everyone in your organization doesn't have the capability of being a star but everyone has the capability of being a leader in their own right okay position four the specialist some roles Require specific expertise That your general staff Shouldn't be expected to have Maybe it's your OR liaison Maybe it's your instrumentation expert Maybe it's someone who handles A particular service line That requires specialized knowledge And specialists aren interchangeable With your general staff So stop treating them like they are So if you have a specialist an endo specialist and they really good at what they do and they really specialize in their thing and all the scopes that needed in their own point stop trying to mix them in with the other people. Some of them, I'm sorry, y'all, your special teams are special teams. You don't mix a kicker and a punter in with a quarterback. You don't do it unless everybody's gone. your specialists are not interchangeable you have to treat them that way but when you have a developmental pipeline that allows for your your developmental team to actually pick what route they want to go your core team those are going to be your captains they're probably going to be your managers your supervisor leaders that's going to be i'm sorry not your core your anchors are going to be your supervisor your manager your leader that's going to be that those anchors then you have that core those are going to be like some good star star the starters they support they're pretty good at their job they can do their thing but they're not the stars right but they can handle their weight then you have your development team those are your newbies coming in that are newer to the industry every organization you have to have new blood coming in or your organization is going to die then you also have to have the specialist the one that can play offense or the one that can only play defense dennis robin was a specialist you did not treat Dennis Rodman the same way you treated everyone else, nor did you treat him like a leader or a captain. He was a defense and rebounding specialist. So you kept them there and you judged them based on that. Okay. And number five, position five is your flexibility slot. This is where smart teams gain an edge. The flexibility slot is someone who can plug into multiple positions at an acceptable level, not elite anywhere, but functional everywhere. In sports, So we call this the six man, the utility player, the Swiss army knife in health care. This is the person who covers gaps without creating new problems. Now, here's the revolution revelation. Most departments don't think about their team this way. They think in terms of FTEs and coverage ratios. They think about bodies per shift. They think about headcount as a number, not as a portfolio. And because they think this way, they keep asking for more staff when what they actually need is better deployment. of the staff that they actually have. And that is something that is extremely key. And I cannot, I cannot, I cannot, I cannot, I cannot skip that. I can't, I can't, I can't allow for you to skip that. You have to start really assessing like where your team is. And this is why we have in our talent development system, we have a special way that we're able to identify who's going to be our stars and who are not. We know. It's kind of like on the sports team. They know who is capable of being a star and who's not. You know. You know who has natural talent, but they don't have the natural talent that can carry a team. Can they score the ball? Sure. Are they extremely athletic? Absolutely. Do they have gifting here? Are they analytical? Oh, my gosh. You name it. Can they memorize anything? Yes. But am I going to build my organization around this person? No. Am I going to give this person my resources, our time, invest in going to conferences? Is this the person for us or is it not? And when you start looking at your organization, much like people look at their team, it'll be easier for you to start kind of building what that actually looks like in perpetuity. OK. And. Which takes me to knowing when I'm building a team, you got to know when to hold them, you got to know when to fold them, you got to know when to walk away, you got to know when to run. Know when to fold them Know when to walk away Know when to run You got to know when to hold them Know when to fold them Know when to rock away Know when to run You got to know Who can you keep building with and who not And on page 143 on the operational blindness book When people are actually the problem On page 143 If you're reading the book, go to 143. We're kind of going, we're slaying through this thing. When it talks about when people are the problem. And in the book I state, I've argued that the system should be the primary target of transformation. But I want to be honest about a more complicated reality. Sometimes after the system is fixed, some people still can't perform. This is different from blaming people from the system's failure. It's recognizing that even in a well-designed system, not everyone has the capability, motivation or fit to succeed. And once you've created the conditions for success, you can fairly evaluate whether individuals are actually meeting them. The key is your sequence. Fix the system first. create visibility true visibility provide resources build infrastructure train people on new processes give them time to adapt and then only then do you evaluate their performance in my experience most uh incumbents rise to the occasion when the system supports them the director who seems to be struggling becomes effective when they can finally see their impact The staff who seems resistant. Become engaged when they understand. Why the changes matter. But not everyone. Not everyone makes the transition. Some people are genuinely mismatched with the requirements of a transformed operation. Some lack skills. That can't be developed quickly enough. Some are so burnt out from years of firefighting that they can't embrace a different way of working. And some simply just don't want to change. And when you encounter these situations, when the system has been fixed and someone still can't perform, you can make personnel changes with confidence. You know, the change is necessary because you've ruled out the system as the cause. You can explain the change fairly because you gave the person every opportunity to succeed. The point isn't the people are never the problem. The point is that you can't know whether people are the problem until you fix the system. Lead with the system change and follow with individual evaluation. Get the sequence right. We say people first, systems always. So we have to, in order to put the people first, you have to ensure that the system is always intact so that you're properly judging the people. If your head coach sucks and their scheme sucks, I can't really blame the players if the head coach keeps calling wrong plays. If the O-line team, if the O-line is not on the same page as the offensive coordinator, O-line coach, all of these things matter. And this is usually when a union is created. A union is usually created when staff feel like they're not being fairly judged or assessed based on their ability because of other factors that have nothing to do with them. So they union up to protect themselves. But the best way to break a union is to provide an environment that is standardized and that is fair for people to grow and rise in. But fair does not mean everyone has the same access. Fair means everyone has the same opportunity. To get themselves to the table to be chosen. I want to teach on this. In sports, we call what most do in health care leadership. We call it. Roster hoarding. Losing teams hoard players. They're afraid. They're afraid to let anyone go because they might need them someday. So they keep mediocre talent around, taking up roster spots and salary that could be used for better fits. Winning teams build rosters. They make hard decisions. They move on from players who don't fit the system, even if those players have talent. They're willing to create short term gaps to build long term strength. Health care leaders are notorious are notorious roster hoarders. We keep underperformers because firing is hard. We retain mediocre managers because we've always had them and we tolerate dysfunction because the devil we know feels safer than the devil that we don't. But here's what the book makes clear. Here's what it makes clear. You all. And I want and I want you to hear this. I want you to hear this loud and clear. Here's what it makes clear. You can't make those personnel decisions with integrity until you fix the system first. and too many leaders blame people for system failures and that's cowardice disguised as accountability real accountability means creating the conditions for success then fairly evaluating who meets them and who doesn't and building a championship team sometimes means subtracting before you add it means creating space for the right people by removing the wrong people but Only after you've given everyone a fair chance to succeed in a system designed for success, do you have the opportunity to actually see the talent that you actually have and to be able to grade that. And so within our organizations that we support with our system, the very first thing that we do, we do a system assessment and a people assessment. We do a competency review and an operation review. Because if you get the system right and you handle that system first, personnel will be great. And we always say people first systems always. Meaning the only way you can put people first is if the system is always on the forefront of your mind. It's very key. And I think it's very important because. it reminds me of in the book um and this is going to be off of the whim so i need to think the capability engine the capability engine i think it's on page 178 it reminds me of this and how i wrote the book i wrote it for you to be able to go look at it um but the table of contents doesn't have chapter one chapter two chapter three the table of contents have frameworks methodologies and concepts literally already pulled out so you're just not getting the chapter you're getting these points so anytime you're trying to make a point or you need to reference something once you learn the book you understand it it'll be easier for you to be able to navigate and use this as a basis points for whatever you want to do so the capability engine is layer four of a of an architecture that we create. And in the and in the architecture, our standby design architecture, there are four layers. You have the foundation of visibility, operations rhythm in the capability engine. So we're going to focus on layer four capability engine is on page 178 in the book. OK, and it reads the capability engine builds and sustains the human capacity for proactive operations. It ensures the organization doesn't just transform once but continues to develop over time. The capability engine has three components. Competency development. A structured program for building the skills proactive operations require. Listen to this. Require. This includes technical competency, proper processing techniques, quality protocol, equipment operations, and operational competencies, prioritization, anticipation, communication, problem solvation. I'm kidding. It's problem solving. And staff progress through defined levels from basic proficiency to advanced capability to mastery with clear expectations and assessments at each stage. It's very important. With our leadership development, proactive operations require proactive leadership. The capability engine includes a specific development pathway for supervisors, managers, and directors. This covers management skills, setting expectations, providing feedback, developing staff and leadership skills, building culture, driving change, navigating organizational dynamics. Leaders at each level understand what's expected of them and have development resources to meet those expectations. The knowledge management is also in this layer. This is the fourth layer inside of layer four the third layer inside of layer four level of layer four which is knowledge management notice what's happening here what the organization learns must be captured and preserved the capability engine includes systems for documenting best practices recording solutions to reoccurring problems and sharing knowledge across shifts and team members when someone solves a problem that solution becomes organizational knowledge rather than individual expertise that walks out the door when they leave and the capability engine addresses a fundamental change transformation is sustained by people and people changing over time do you hear me when i say this the capability engine addresses a fundamental challenge transformation is sustained by people and people change over time staff leave new staff join leadership transitions without a deliberate Capability building transformation erodes as the people who created it move on with the capability engine. Capability is continuously renewed. It's very important. I want to teach on this and this was on page 178 to 179 and the operational blindness book. And I want to teach on this because this is what we call the multiplier effect. And I referenced this a bit earlier. Some positions compound their impact across the entire team. Your preceptor, your supervisor, your charge techs. These are your multiplier positions. If the multipliers are excellent, they elevate everyone around them. If they're mediocre, they cap the performance of the entire shift. If they're poor, they're actively dragged. They actively drag the team down. So I want you to think about it Your preceptor trains every new hire Their dna gets replicated across your entire roster over time good preceptors create good texts bad preceptors create bad texts over and over and over again for forever so stop if you're a manager your preceptor your trainers whoever's in in a licensed or given the access or approval to train and develop people in the organization their dna their temperament their jokes their snootiness their their sidebar remarks become embedded in the dna of the people that they're developing let me pause here and say this as an educator a trained educator i went to school for education four years plus six months of student observations plus three tests that I had to pass to become a licensed teacher in the state of Texas and I went to go teach and as a new teacher I couldn't create my own lesson plan I had to build from the lesson plan of the curriculum for the curriculum the curriculum instructor and the curriculum instructor used a program or a system and then they guided the teachers on what we needed to make sure that we mastered along the way then they gave us the freedom in a way to teach it but the structure of the of the lessons were all the same what is this even as a teacher we had a system that we had to uphold and we had a curriculum instructor a lead preceptor that their number one job was to make sure that all of the teachers that were training were teaching the same content and their students were receiving the same type of test the same assessments but the teacher had their ability to add their color to it but the context of what you had to teach had to be the same i was trained to be a teacher and as a teacher you learn cognitive uh people that have cognitive dissonance people that are cognitively gifted people that are delayed you learn how to read in the eyes of somebody is receiving it or if they're just saying that they're receiving it because they don't want to tell you again that they don't really understand you understand these things and when you understand adult learning you realize that adult learning is a total different beast than uh than than teacher to child pedagogy this is what this is called pedagogy but many adults need andragogy and hewtagogy but if i don't understand the different levels of even teaching how can i expect my precept to know exactly how to train and develop people and ensure that they have what's going on your preceptors and your trainers have never even been trained classically or institutionally on how to properly train and teach. Obviously, I know I'm passionate about that, obviously. But how can you put somebody, not let alone, not train them at all as a manager, but you don't train them to teach, and that's why we created the 44 Fellowship. That's exactly why right there. That's exactly why we have the 44 Fellowship. We're training leaders on how to train. The number one deficiency I see in many leaders in health care is their inability to train and develop. Everybody wants to be the smartest one in the room, but nobody actually knows how to train and develop. I won't say nobody, but the majority. Many SOPs are not SOPs. There's a favorite scripture that I read and my favorite book is a collection of books they call the Bible. in the book it says write it down and make it plain so that those who see it can run with it it's talking about structure and order it's talking about that we talk about structure and order write it down and make it plain so that those who see it can run with it there needs to be no interpretation issues when they're reading something so it allows for me to train and develop people on structure and order first when i'm teaching a kid on how to walk i'm teaching a kid on how to play sports. I'm teaching my son how to play basketball. I'm not teaching him all the fancy stuff first. I just want to make sure he masters dribbling and loving the game and knowing why it's important. It's the same thing in organizations all over the country. If your preceptors have never been trained on how to precept and train, that's your number one issue. If your trainers are your managers, they've never been taught for one how to manage, let alone how to train. That's the number one issue that you're having. Many organizations struggle because they have a terrible preceptor period and point blank you can be great you can be kind you can be knowledgeable but that does not mean you know how to teach period and point blank and someone who knows and loves how to teach you already know most people who love how to teach will prefer to teach rather than manage that's another conversation for another day so your organization if you lack even having trainers and you're a leader and you're supposed to be running an organization Shame on you. If you didn't know, still shame on whoever trained you. We got to fix that. And that's why we create the 44. We're training leaders on how to train. For sure we're doing that. When we work inside an organization, we implement our system. It's one of the biggest things we focus on. Who's qualified and adept and capable of training, not just because they're knowledgeable, they're capable, they have the patience. They want to see the best out of people because your precept is your trainers. Those are your developers of people in your organization. Just like in sports, say the NBA or the NFL or MLB, they have player development coaches. Their job is to develop that player skill. The head coach is not needing to worry about developing your personal skill. You have to be a great development coach. You have to have one on the team. Period. Period. Your supervisor sets the tone for every shift. They either model proactive operations or they're modeling firefighting. They either develop people or they just manage the coverage. And most departments underpay and underdevelop their multiplier positions. They treat them as administrative overhead instead of strategic leverage. And this is backwards thinking. If you want to improve overall team performance without adding headcount, Invest in your multipliers, train them, pay them, protect them because their improvement compounds across the entire team. Your managers, your supervisors, your preceptors. Those educators. Those are your multipliers. This is your multiplier positions. And this is what the capability engine is about. It's not just training programs. It's a systemic approach to building human capacity that scales and sustains over time. And without it, you're constantly rebuilding capability instead of advancing it. Every turnover sets you back. Every transition erodes what you built. And with it, capability renews itself. People develop knowledge transfers. The system gets stronger even as individuals come and go. And that's how championship organizations operate, not by hoarding talent, but by building systems that continuously develop talent. If I were to tell you something, if I were to give you a tip, there's two people that you need in your organization. If you want to start with two core that you want to focus on, you need a phenomenal manager that knows how to manage people in operation. Phenomenal. And you need a phenomenal trainer. if you have those two with i'm assuming that you have a great system and i'm assuming that you have stir by design and your stir processing department as a system so those are two main things you need those are your two multiplier positions or liaison is too isolated it's just that's customer support that's executive level customer support going to talk to the surgeons talking to or managers You're talking to charge nurses. You're communicating back with the SPD. Yeah. It's not really a multiplier role. It's an important anchor role, but not a multiplier role, a good core role, not an anchor. Your anchor roles are your trainers and your managers. Your leadership and your trainers. Those are your anchor roles. And if they're combined together and that manager hasn't been taught how to manage or train, your department is screwed and that's why you're underperforming. Very simple. So I want to give you something that's practical so we can get about it here so that you can do this week. Challenge number one, I want you to map your roster. Write down every person on your team next to their name. Identify their position. Five position framework. Are they anchor? Are they reliable core? Are they developmental? Are they specialist? Are they flexibility slot? If you can't category or categorize someone, that's a sign you don't understand their role or they don't have a clear role. Both of those are problems. If you have no one in the anchor category, You have a leadership crisis. You need to either develop someone into the role or recruit for it. If everyone is categorized as developmental, you you staff a training program, not a functional department. And here's the deal. When you're looking at this challenge. Right. And I know some of you are like, hey, we don't need some health care. We don't need your educators and we don't show don't need your system. We got this. We can hire our own educator. Good luck. Because you're also assuming that those educators are even trained. It's funny because one of the certifying boards actually had a preceptor or educator certification program, and they tried to create certifications from it. And the reason why they disbanded the certification or preceptor program was because they couldn't promise that everyone that went through the program actually followed all of the principles or all the trainings within the program. Well, that's kind of crazy because that same certifying board has managers and other certification processes that have the same exact certification approach. So if you're telling me that when it comes to teaching and preceptors, that's not vague enough. You have to be specific when you're talking about a preceptor and educator. Those things are very specific. You have to know how to build organization, how to build people. You have to truly be a bridge builder to be a true impact person that understands that. Challenge number two I want you to do, I want you to go to identify your multipliers. Who on your team has the multiplier effect? Whose performance directly affects the performance of others? Write their names down. Now ask yourself, are you investing in these people appropriately? Are they trained? Are they supported? Are they compensated in ways that retain them? If your multipliers are neglected, you're capping your entire team's potential. Stage challenge number three, find one premium labor trap. Where are you paying premiums for and what should be the standard? It may be structural over time. They never normalize us. It might be how you're using travel or labor. It might be a position that's overcompensated for the actual impact that actually has. Find one trap and ask yourself what systemic change would eliminate the need for the premium spend. We actually call it intimately the leadership circle and we have a strategic way of how we actually compensate the leadership circle. So that in that group, once you hit that leadership circle, those are what we call our multiplier positions. they have a total different world that we we take them on excuse me and lastly challenge number four get the sequence right before you make any personal decision ask yourself have i fixed the system do i have a system do we have an os system that we're that we're running on have i given this person the visibility resources and infrastructure that they actually need to succeed if the answer is no fix the system first. Then evaluate fairly. If the answer is yes and they still can't perform, then you have to make the hard decision with confidence. They don't belong in your organization. The number one question we ask organizations after we get out the assessment is what operating system are you running on currently? Meaning I'm like policies, processes. Then we have to explain what an operating system is. What's the playbook? What's the framework? What's the end goal? What's the development strategy. What are these things? That's an operating system. All of these things matter. You can't just plug in programs and have some people come and teach leadership and think that's going to be enough. You have to have a programmatic way in how you do things, and that's why it's important. So I want to close the episode by saying this. Bridge Builders, building a championship team isn't about having the biggest budget. It's about deploying the budget you have with precision. Every winning organization in history has operated under constraints. The one that wins learns how to optimize within those constraints. The ones that lose spend all of their energy complaining about the constraints instead. And that's the biggest irritation. Your salary cap is real. Your FTE limitations are real. Your budget pressure is real. Your market availability to actually recruit people that want to come to your market into your city to support your hospital. Those pressures are real. But so is your ability to build something excellent within those boundaries. And stop asking for more staff until you've maximized the staff you have. Stop treating all positions as equal when they clearly aren't. Stop retaining people who don't fit because letting go just is so hard. Stop blaming people for system failures you haven't fixed. Stop and start building your roster with intention. Start investing in your multipliers. Start creating systems that evaluate everyone's performance and start getting the sequence right. System first, personnel second. And that's how you will with constraints. That's how you will yourself to win with constraints. That's how you build something that lasts. That's how you go from operationally blind to operationally visible. So that's the end of today's episode. I'm inspired right now because team building, process building, macro operations. This is the thing I love the most. And to be honest with you, most people, most organizations have a development problem. They have no programmatic way of how they're running their department. Everything is just ebb and flow and go. There's no operating system. There's no flow. There's no one way that everyone does things in one, you know, one fell swoop. And that's the biggest thing that we have to make sure that we're operating on. So go and get our newest book at bread to lead dot com. You can go and take our assessment at Sips Health Care dot com. You can download the white paper at Sips Health Care dot com forward slash white paper. And here's the other portion I want you to understand. You can do great things, but the first thing you must do is start by making sure that you're the great thing. That's not missed. This is Dr. Jake Taylor Jacobs. I love you. And there's absolutely nothing on Earth that you can do about it. I will talk to you on the next episode. I'm gonna take the lead Since the age of 12, I've been about my father's business At the age of 30, he sent me to his vineyard