During my early years as a Certified Nursing Assistant (CNA) in a long-term care facility, I was introduced to a simple yet transformative concept by the director of nursing. It wasn’t formally known as CICARE at the time, but its principles stayed with me throughout my entire career in healthcare. The director of nursing emphasized the importance of how we engage with patients and their families, stressing that a compassionate introduction sets the tone for the entire interaction. Reflecting on this experience, I realize how foundational this lesson was and how it resonates with the CICARE protocol used in many healthcare organizations today.

Healthcare organizations have an unprecedented opportunity to uncover market potential and strategically allocate resources. By combining traditional patient origin and destination data with web analytics, organizations can gain a comprehensive view of where opportunities lie and how to grow their services effectively.

People choose healthcare as a career because it fulfills their individual sense of purpose. It is passion driven.  Consumers select their healthcare provider because they feel a real sense of concern and dedication from those professional providing the care. It is the combination of these feelings and desires that creates the basis of a great culture within an organization. In a practical sense, it is the coming together of two major strategic approaches into organizational goals: one great experience - one great team. 

Differentiation is often confused with simply adding new services or expanding facilities. However, true differentiation goes beyond operational tactics—it lies in creating unique value propositions that resonate with patients, physicians, and communities. To achieve this, we must define what differentiation truly means and challenge our assumptions by asking, "What must be true?" This question sharpens our strategic focus and ensures that our initiatives are grounded in reality.

Physician recruiting in the healthcare environment remains more competitive than ever. While compensation and benefits remain important, culture is emerging as a key differentiator for organizations seeking to attract and retain top physician talent. The physicians I’ve spoken with describe a common theme: beyond pay and career growth, they want to feel valued and have a voice in shaping their practice. Many have experienced what they describe as a “treadmill” environment, where they were seen merely as "producers," leading to burnout and disengagement.

Rural hospitals are more than healthcare providers—they are pillars of their communities. They serve as key employers (generally one of the top three employers within the community), lifelines during emergencies, and providers of essential medical care. However, the ongoing wave of rural hospital closures threatens to dismantle these lifelines, leaving vulnerable populations without access to critical health services. From January 2005 to May 2024, a staggering 219 rural hospitals in the United States closed or converted to facilities without inpatient services. Understanding and addressing the causes of these closures is a matter of urgent concern.

Rural hospitals across the nation are facing mounting challenges—rising costs, limited resources, and increasing demands for quality care. In response, organizations like Rough Rider and Headwaters have come together to form clinically integrated networks (CIN) designed to strengthen rural healthcare systems through collaboration and shared resources. This model, which aligns with national trends, leverages collective expertise to expand care access, reduce administrative burdens, and align with evolving payer models.

As Medicare Advantage (MA) continues to grow in popularity, hospitals, particularly Critical Access Hospitals (CAHs), are finding themselves grappling with new challenges. While MA plans offer expanded benefits to beneficiaries, they present significant financial and operational obstacles to healthcare providers. From delayed and denied payments to increased administrative burdens, these challenges are threatening the financial stability of hospitals, especially those that serve rural communities.

In many healthcare organizations, the key to achieving success lies in effectively managing People, Process, and Plan. To truly harness this triad, it requires a disciplined, structured approach that keeps the entire team aligned with the organization’s mission, strategic goals, and improvement initiatives. One highly effective method for maintaining this alignment and keeping progress on track is what I call the "Around-the-Room Review."

This blog will explore how to set up a structured review process by utilizing the physical layout of a room to track progress and address key strategic priorities in a systematic way.

Emergency departments (EDs) are a pivotal point of entry for patients requiring urgent medical attention, making ED efficiency a critical metric for hospitals. The Centers for Medicare & Medicaid Services (CMS) developed several performance measures to track how well hospitals manage patient flow, including the measure OP-18b: the median time from emergency department arrival to emergency department departure for discharged patients. This measure, while commonly used as a benchmark for time-based performance, is more than just a number. It reveals opportunities for improving patient flow, reducing bottlenecks, and enhancing overall patient experience through effective teamwork and process optimization.

By leveraging Lean Process Improvement principles, hospitals can reduce inefficiencies and enhance coordination between departments, allowing patients to move more seamlessly through the emergency department. But achieving these results requires more than just good processes—it requires a synergy between the people working at the front lines of patient care and the processes designed to streamline their work. This article explores how a thoughtful combination of “People” and “Process” can help hospitals not only meet the CMS OP-18b standard but also significantly improve the quality of care and the patient experience.

Delivering sustainable results requires more than just setting broad organizational targets. It’s about creating a system where every aspect of the organization, from leadership to individual departments, aligns its efforts with a unified purpose. To accomplish this, I propose using a “Pillar” framework by which we measure the success of our efforts across the critical areas of People, Process, and Plan (Employee Engagement/Culture, Lean Process Improvement, and Strategy).

These strategic pillars - Quality, Workforce, Patient Satisfaction, Finance, and Community - serve as foundational guides that shape our future. Each pillar will have overarching organizational goals that cascade down to specific departmental objectives, creating a cohesive framework where every hospital department plays an active role in achieving the organization’s mission.

Fostering a strong organizational culture is a competitive advantage and a key factor in driving employee engagement, patient satisfaction, and operational success. A thriving culture doesn’t happen by accident; it is cultivated through intentional leadership and active participation from all levels of staff. This blog explores two critical themes: (1) how consistent leadership expectations, guided by evidence-based practices, can create an environment where staff excel, and (2) the importance of gathering input from staff on the organization’s future, fostering a culture of inclusion and ownership.

In any organization, communication is more than just the exchange of information; it is the foundation upon which a strong culture is built. Effective communication fosters transparency, builds trust, and encourages employee engagement. Over the years, I've found that when communication is thoughtful and intentional, it not only strengthens relationships but also aligns the entire organization toward shared goals. 

At the core of strong communication are three critical elements: message, mode, and audience. When these elements are carefully considered, communication becomes an enabler of engagement rather than just a tool for relaying information. Let's break down how these three aspects work together and why they matter.

Evan Williams and I grew up in Clarks, Nebraska, in the late 1980s and early ’90s, in a small, rural community where most families, including ours, were tied to farming and agriculture. Our classes were small—generally 10 to 15 students—and life was grounded in hard work and simple values. Yet from this modest background, Evan went on to co-create platforms that reshaped how the world communicates: Blogger, Twitter, and, most recently, Medium. Today, I find myself writing blog posts in healthcare, an industry in dire need of the same type of forward-thinking innovation that Evan pioneered in technology. There’s a certain irony in that, and it’s this contrast that I want to explore—how Evan’s remarkable ability to create what wasn’t even available can inspire the healthcare sector to reimagine its own possibilities.

"Patient Centered Strategy" by Jeff Hunter provides a comprehensive guide for healthcare leaders looking to transform their organizations by focusing on patient-centered care. The book argues that by putting patients at the center of strategic decision-making, healthcare organizations can achieve better clinical outcomes, higher levels of patient satisfaction, and greater operational efficiency. It’s a strategic approach that balances patient needs with the overarching goals of healthcare providers, aligning the two for mutual benefit.

Hunter offers a roadmap for implementing this strategy, focusing on key areas such as leadership, organizational culture, operational excellence, and the adoption of value-based care models. He emphasizes that the transition to a patient-centered strategy is not just a superficial change in policy but a fundamental shift in how healthcare organizations operate.

Emotional intelligence (EI) has emerged as a vital skill for both personal and professional success. Understanding your own emotions and those of your team members can create a more cohesive, productive, and empathetic workplace. At its core, emotional intelligence is about awareness, control, and expression of emotions and handling interpersonal relationships judiciously and empathetically. But how can you measure and improve your emotional intelligence? Thankfully, there are tools and assessments designed to help you better understand yourself and your team.

In this post, I will discuss some key assessments I have taken, which have provided invaluable insights into my emotional intelligence and the dynamics of team.

Having spent the past 25 years in healthcare administration, I’ve had the privilege of observing the lives of physicians up close. From the outside looking in, the role of a doctor often appears prestigious—one marked by respect, financial security, and a sense of purpose. Yet, the daily life of a physician is one of immense physical, mental, and emotional demands, many of which remain hidden from public view. As healthcare professionals, they carry the weight of responsibility for the well-being of their patients, and the cost of this duty is often felt on a deeply personal level.

In healthcare, we often focus on clinical outcomes, patient satisfaction scores, and operational efficiency. But beneath these metrics lies something fundamental to every hospital’s success: its culture. A strong organizational culture isn’t just a buzzword—it’s the very foundation that supports positive staff relationships and enhances the quality of care patients receive.

When a hospital or healthcare organization fosters a healthy, supportive culture, the effects ripple through every aspect of the organization, from staff morale to patient outcomes. In contrast, when culture is neglected, even the best clinical practices can falter under the weight of disconnection and discontent.

In our previous discussion about managing the "big rocks"—those major, resource-intensive initiatives critical to an organization’s success—we explored the importance of dedicating focus and resources to what truly drives value. However, as any leader knows, while current strategic initiatives are being executed, new ideas, opportunities, and potential projects constantly emerge. How can organizations balance the need to advance these "big rocks" while ensuring that promising new initiatives aren't neglected?

This is where the concept of a "wait/work" board becomes an invaluable tool. By creating a place to "park" future initiatives, organizations can focus on the present without losing sight of what lies ahead.

Hospital leaders face a constant challenge in balancing day-to-day operations with the pursuit of long-term strategic initiatives. This balancing act becomes even more critical as hospitals strive to maintain quality care, adopt new technologies, and respond to evolving patient needs. One of the most effective frameworks for managing time and resources is identifying and budgeting for "big rocks"—those essential but non-differentiating tasks that consume significant organizational bandwidth.