Transcript of Ep. 038 -The 10,000-Pound Elephant: Why Old Beliefs Keep Hospitals Chained

In the 1950s, researchers conducted an experiment with elephants. They took a baby elephant and chained its leg to a small wooden steak in the ground. The baby elephant pulled, it tugged, it tried everything to break free, but it was too small, too weak. The steak held. Eventually, the baby elephant stopped trying. Years later, the same elephant, now fully grown, weighing 10,000 pounds, strong enough to uproot trees, stood calm only next to that same small wooden steak. It could have broken free with a single tuck, but it didn't even try. Why? Because the elephant believed it couldn't. The belief formed when the elephant was small. And even though the elephant grew, the belief never changed. The chain wasn't holding the elephant anymore. The belief was. Last episode, I introduced you to the invisible belief Beliefs, assumptions that feel like facts that shape your decisions without your permission, that create the outcomes they predict. Today, we're getting specific. I'm going to show you the four beliefs that are training every healthcare organization to dysfunction. Beliefs that formed years ago, beliefs that may have once been true or at least understandable, but beliefs that are now holding back organizations strong enough to break free if they only knew to try.

This is Bread to Lead. Welcome back. Bridgebuilders, welcome back to Bread to Lead. I am your host, Dr. Jake Taylor-Jacobs. In episode 38, 8, Season 3. This is the season of Read and Teach series from my newest book, Operational Blindness. It's talking about the hidden force destroying healthcare operations and why healthcare leaders can't see what's costing them millions and how to finally fix it. If you're just now joining us, go back and start at episode 35. We've been building something here. Episode 35 was the IBM lesson, Why Changing People Doesn't Work When the System is broken. Episode 36 was the healthcare parallel, Why SPD is the upstream constraint everyone ignores. Episode 37 is the dangerous comfort of invisible beliefs. Why the beliefs you don't know have the ones that are controlling you? Why the beliefs you don't know you have are the ones that are controlling you? Today, we're naming them, the specific beliefs, the chains, holding your organization in place because you can't break chain you don't know it exists. If you're newer to this podcast, I just want to tell you, listen, this is more of a podcast, the purpose of every single episode.

We put so much time and attention into it. We build PowerPoints and trainings for my eyes so that I can see on the board so I don't miss the points that you need to make. We really take every single pie class like it's a master class, that 35 to 40, sometimes even an hour of your time in your ears where you can actually get better and have applicable things that you can apply to your life. We're talking about the series of Operational Blindness, and we'll continue to build in this series really showing you how operational blindness in your organization is actually costing you personally and at home. We're going to get into it and why this topic actually matters with the belief. But before I get into the four beliefs, I do want to set some context. Some of you listening aren't in sterile processing. You're executives, you're operators, you're on service lines or entire health systems. You might be thinking, why are we spending so much time on SPD? Here's why. Spd is a proxy, if you will. It's a case study. It's a lens through which we see patterns that exist throughout healthcare and throughout every industry that you may participate in.

Every organization has functions they've written off, departments they've labeled cost centers, and stop thinking about strategically. Upstream operations that constrain downstream performance but never get the attention of or the investment they need. Spd is one of the clearest examples, but the principles apply everywhere. The beliefs I'm about to share, they don't just bind SPD. They bind supply chain teams, they bind IT departments, they bind facilities and environmental services, they bind any function that leadership that's decided is just overhead. So as I walk through these beliefs, I want you to think beyond SPD. Where else in your organization have you accepted dysfunction as inevitable? Where else have you stopped questioning? Where else is a belief masquerading as a fact? Now, let me say this. These beliefs didn't come from nowhere. They have origins. They made sense at some point, or at least they were understandable given the circumstances. The baby elephant wasn't irrational for stopping its attempts to escape. Given its size and strength at the time, stopping made sense. The problem is the circumstances changed, but the belief didn't. And that's the same thing that we're seeing in health care. Some of these beliefs formed in an error when surgical volumes were lower, when instrumentation was simpler, when the financial stakes were different?

They may have been reasonable then, but health care has changed. Surgical complexities has exploded, margins have tightened, competition has intensified, and the tolerance for inefficiency has evaporated. The beliefs haven't kept up. You're a 10,000-pound elephant still chained to a stake. You could break with one tug if you knew to try. Let me read a section out of the book, and then we'll break down each belief one by one. If you're listening right now, I'm currently reading from our newest book, Operational Blindness. If you're still listening, as we are actively posting these episodes, the book will be available, the first bats, only to executives of hospital systems. Executive of hospital systems will be gifting this book to you pro bono to really, truly help out. This is our complementary way to say, Hey, we want to provide as much support and insight as we can. If you are an executive, please stay tuned to how you get access to this the book here. I'll have information on it in further episodes. If you're listening to this in hindsight, I'm sure in the next several episodes, we will definitely have the information. It may actually be live if you are listening back to these episodes as you're reading from this book, because what we're pulling, we're doing an exergesis, if you will, or we're expounding an exposé of every single subtopic within the book.

What we've done is actually pretty creative. What we've done inside the book, we actually have each one of the subtopics actually categorized in the page number. Why? Because as an executive, most of us don't have time as a leader. You don't really have time to try to find the chapter in that one point versus looking at the subtopic and then knowing that that point was made in that subtopic. You can just go here to the table of contents and just write some notes here. If you're wanting to know where the video This portion of this podcast is going to be or this podcast, I misspoke and said on YouTube, but my team is going to be gathering the information, the videos, and putting them in our community. So you can go to bred2lead. Com or you can go to spd911. Com, either way, and get access to our leadership community and join. We have master classes, and you'll be able to see these podcasts actually live. Thank you again, you all, for keeping us top 15, top 20 of all business podcasts throughout the country. We'll be reading out of page 27-29, and it is the beliefs that bind.

If you worked in healthcare operations for any length of time, you probably absorbed certain beliefs without ever explaining them or examining them. These beliefs feel like facts. They feel like the future, the nature of reality. But they're not. They're assumptions, and they're keeping your organization trapped in dysfunction. Spd will always be reactive. That's just the nature of the work. This is the foundational belief that makes transformation impossible. If reactive operations are simply inevitable, then there are no point in trying to change them. You just manage the chaos as best you can. But this belief isn't true. Proactive SPD operations are possible. They're just rare because most organizations have never seen them and can't imagine them. Spd is a cost center, not a strategic asset. This belief determines how much attention an investment SPD receives. If it's just a cost to be minimized, then leadership will always look for ways to cut rather than optimize. But the belief ignores a basic reality. Spd directly enables surgical revenue. Every case delay, every frustrated surgeon, every quality issue has a financial impact. The department isn't just a cost. It's a constraint on hospitals those most profitable service line.

The OR would never be satisfied no matter what we do. This belief poisons the relationship between sterile processing and surgical services. It creates an adversarial dynamic where SPD sees the OR as reasonable, and the OR sees SPD as unreliable. Both sides stop trying to solve the underlying problems because they've decided those problems are unsolvable. But the belief is a symptom, not a cause. The OR dissatisfaction is a signal that something is broken. Dismissing that signal as inevitable ensures the break will never be fixed. We're doing the best we can with what we have. This is perhaps the most dangerous belief of all. It sounds humble. It sounds hardworking. But what it actually means is we've accepted dysfunction as normal. We've stopped asking what excellence would look like. We define the ceiling based on our current constraints instead of imagining what might be possible with different constraints. Every one of these beliefs was present at IBM in 1993. The company believed it was a hardware company when the future was services. It believed decentralized was essential when integration was the advantage. It believed the culture couldn't change when the culture was the only thing that needed to change, Gerstner rejected all of those beliefs.

He didn't accept the premises that everyone else accepted. And in doing so, he made transformation possible. Your SPD can do the same, but only if you're willing to question the beliefs that everyone has stopped questioning. And finishing that sub section of the book, pages 27 through 29. I'm going to show you where they come from, these beliefs, how they manifest, and what it takes to actually break free. Belief one: SPD will always be reactive. That's just the nature of the work. This is the foundational belief, the one that makes all the others possible. If you believe reactive is inevitable, you don't pursue proactive. You don't invest in it, you don't measure for it, you don't even imagine it. Where this belief life actually comes from, SPD work is by nature responsive to demand. Instruments come back from the OR. You process them, you send them back. The workflow is triggered by external events. Because the workflow is responsive in nature, people assume the entire operational model must be reactive. They conflate responding to demand with being perpetually behind demand. This belief also gets reinforced by resource constraints. When you're understaffed and overwhelmed, reactive is all you can be.

You're so busy fighting today's fire that you can't prepare for tomorrow's needs. After years of operating this way, reactive starts to feel normal, then inevitable, then just the nature of the work. When leadership believes reactive is inevitable, This is how the belief manifest. They don't fund proactive capabilities. Why invest in something impossible? They staff for crisis response, not prevention. They measure speed, turnaround time instead of readiness. They accept firefighting as a sign of hard work rather than a symptom of dysfunction. They celebrate heroes who save the day instead of questioning why the day needed saving in the first place. The entire operational model gets built around the assumption that you will always be catching up. This belief is wrong because proactive SPD operations are not only possible, they exist. We've built them, we've seen them. They're operating in hospitals right now. In a proactive SPD, tomorrow's schedule is to be reviewed today. Work is prioritized based on surgical needs, not processing order. First-case instruments are stays the night before. Problems are anticipated and prevented and not It's just caught and fixed. Staff go home knowing what's coming instead of wondering what will explode. This isn't fantasy.

It's achievable. It requires investment, visibility, and operational discipline, but it is, in fact, achievable. The belief that reactive is inevitable isn't a fact about SPD. It's a fact about SPDs that have never been given the resources and systems to operate differently. And breaking this belief requires evidence. You need to see what proactive looks like. Visit an organization that's done it. Talk to leaders who've made the transition. Read the case studies, watch the videos. And once you see that proactive is possible, the belief loses its power, you no You're no longer a baby elephant. You're a 10,000-pound adult who just realized the stake can be broken. If you're somebody, as a health care executive, if you want to see what that looks like, you can always reach out to us and ask us at By the facility that we outsource, is it possible for you all to come actually just walk and see what proactive actually looks like inside of a hospital system? If you're standing, starting to see how this first belief has shaped your organization's decisions, its investments, its staffing, its metrics, I want to point you to a resource. I've written extensively about these beliefs and how they translate into operational and financial outcomes.

You can find these articles at cipshealthcare. Com/articles, this white paper on articles. And we have a white paper, Case Studies and Breakdowns that go deeper than I can in a podcast episode. Real examples of organizations that broke free from these beliefs and what changed. As a result, you just go to cipshealthcare. Com/articles. It's free access. Start on whichever topic is most relevant to your situation and just keep going from there. Let's go to believe two. Spd is a cost center, not a strategic asset. This belief determines how much attention SPD gets, how much investment, how it's positioned in the org chart, how leadership talks about it in meetings, and it's fundamentally wrong. Where this belief comes from, SPD doesn't generate revenue directly. Everyone knows that. It doesn't build patients. It doesn't have a service line PnL. In traditional accounting terms, it's overhead, a support function, a cost to be managed. This framing made more sense decades ago when surgical volumes were lower and the connection between SPD and surgical outcomes were less critical. Back then, you could tolerate SPD inefficiency because that's where there was slack in the entire system. That slack is gone, but the belief persist.

And when leadership believes SPD is just a cost center. This is exactly how this belief manifestsates. Investment requests get denied or minimized. Why put more money in overhead? Staffing is perpetually lean. Keep costs down. Technology of The grades are deprioritized. The money should go to revenue-generating department. Spd reports several levels below the C-suite. It's not strategic enough for executive attention. When budgets are tightened, SPD gets cut first. Start with the overhead. The entire organizational posture toward SPD becomes about minimization rather than optimization. This is where that belief is wrong. Spd doesn't generate revenue directly, but it directly enables revenue. Think about it. Medical services is your biggest revenue generator. The OR is the engine. Everything else exists to keep the engine running. What happens when SPD fails? Cases start late. Revenue leaks through the lost OR time. Cases get canceled. Revenue disappears entirely. Surgeons get frustrated. They take their cases elsewhere. Revenue walks out the door. Quality event occurs. Revenue gets consumed by complications, liability, reputation, or damage. And SPD is an overhead. Spd is a constraint on your most profitable service line. When SPD operates well, the constraint is relieved. Cases start on time.

Surgeons stay happy. Quality improves. Revenue is protected. When SPD operates poorly, the constraints tighten, and no amount of downstream optimization can actually compensate. Now, I want to put this in financial terms. If your OR generates $50 million annually, and SPD dysfunction is costing about 3% of drag through delays, cancelations, and surge in attrition, That's 1. 5 million in linked value. Your entire SPD budget might be 2. 3 million. This dysfunction is costing you half of what you're spending, and you're calling it a cost center. So breaking Getting free to this belief is not only important, it requires reframing. Stop asking how much does SPD cost? And start asking, what's the ROI on SPD investment? And when you invest in SPD and track downstream outcomes, OR efficiency, surgeon satisfaction, quality metrics, instrument longevity, you will see returns that dwarf that investment. Spd becomes a strategic lever, not a budget line to minimize. Now, Now, I've been making claims about financial impact of these beliefs. You might be thinking, Okay, but is this really a big issue? Is this really a big problem inside of organizations? I will tell you, we conducted an operational blindness index study, a comprehensive research initiative examining how these beliefs and visibility gaps manifest across health care organizations.

We looked at the correlation between how organizations view SPD and how they invest in it. The findings are clear. There's a lot of organizations that are struggling from operational blindness. You can go to cipshealthcare. Com/obiitn. Cipshealthcare. Com/obiitn. You can request a free copy of our study so that you can see exactly what's going on with over 189 facility leaders that we've gotten to voluntarily take our intake study. I think it's very important for you to look at some of those insights so that you can make the best decision for your organization and truly continue to thrive. Stop surviving. Belief three. The OR will never be satisfied no matter what we do. This one is personal. It poisons the relationship between SPD and Surgical Service services, and it guarantees the very outcome it predicts. Where this belief comes from is OR teams are demanding. Surgeons have high expectations. They want what they want when they want it exactly how they want it. And they complain a lot. That's just the truth. And SPD leadership gets beaten up day after day, complain after complain. No matter what they do, someone's unhappy about something. After years Because of this, a protective belief forms.

They'll never be satisfied. So why kill ourselves trying? It's a defense mechanism. It protects the SPD staff from the emotional weight of constant criticism. But it's also a trap. And how this belief manifestsends. When SPD believes the OR will never be satisfied, they stop seeking feedback. It'll just be more complaints. They get defensive instead of curious. When problems arise, they dismiss surgeons' concerns as unrealistic. They don't understand our constraints. They stop trying to exceed expectations. Why bother? And they frame the OR as an adversary rather than a customer. They just always want more. The relationship becomes adversarial. Both sides stop trying. Both sides blame the other. The chastism widens. And this is why the belief is wrong. The OR's dissatisfaction is not a character for long. It's a signal. It's telling you something is broken. When you dismiss the signal as inevitable, when you decide the OR is just unreasonable, you cut off the feedback loop that could drive improvement. And here's the truth. The OR can be satisfied. I've seen it happen. When SPD operates reliably, when instruments are ready, when quality is consistent, when communications is proactive, the complaints actually drop. The relationship transforms.

Partnership replaces adversarial dynamics. The OR doesn't want to complain. They want their instruments. Give them reliability. You'll get respect. Breaking free from this belief requires a lot of courage. Instead of defending, get curious. Instead of explaining, ask questions. Instead of avoiding feedback, seek it out. And ask the OR, what would excellent SPD support look like to you? What would have to be true for you to trust us completely? Then listen. Really listen. You'll probably hear things that are achievable, things you could actually do. Things you haven't done because you assumed it wouldn't matter anyway. Test the belief. Try satisfying the OR, and you might be surprised. And then the last belief, belief four. We're doing the best we can with what we have. This belief sounds humble, hardworking, realistic, It's actually a trap that guarantees stagnation. Where this belief comes from is SPD team works hard, often harder than anyone else in the hospital. They come in early, they stay late, they put out fires, they manage chaos, and they do it with inadequate staffing, outdated technology, and minimal organizational support down in a basement. And given those constraints, they are They're doing the best they can.

The belief isn't technically wrong about the effort, it's wrong about the ceiling. The best we can with what we have assumes what we have is fixed. It accepts the constraints as permanent. It stops asking what might be possible with the different resources, different systems, different approaches, and how this belief manifestsends when leadership believes they're doing the best they can. They stop advocating for more resources. There's no point in asking. They stop imagining excellence. This is the ceiling. They defend current performance instead of questioning it. We're maxed out. They normalized dysfunction. This is just how it is here. And they burn out because They're working at 110% inside of a system that can only produce 60% of its results. The belief protects people from the discomfort of asking for more, but it traps them in a permanent state of inadequacy. This is why this belief is so wrong. What we have, it's not fixed. Resources can be relocated. Technology can be upgraded. Systems can be redesigned. Leadership attention can be redirected. But none of that happens if you've already decided you're at the ceiling. The belief that you're doing the best you can is often an excuse to stop demanding better.

It protects you from the uncomfortable work of making the case for change, from having the hard conversations, from risking rejection. But that discomfort is the price of transformation. So breaking free from this belief requires advocacy. To stop accepting constraints as permanent, to start making the business case for different constraints, to document the cost of current operations, to quantify the impact of dysfunction, to show leadership what they're losing by underinvesting. Then propose, don't request. Here's a $300,000 investment that will produce $900,000 in recovered revenue. That's not a budget ask, that's a business case. You might get rejected, but you might not. And if you do get rejected, you planted a seed, you've challenged the assumption that what we have is all we'll ever have, and that's how belief starts to change. You keep just chiseling away of So you know the beliefs. Reactive is inevitable. Spd is a call center. The OR will never be satisfied. We're doing the best that we can. Four chains, four stakes on the ground, four beliefs holding organizations in place. And the question is, how do you break free? Not just intellectually, operationally. How do you build systems that aren't based on these beliefs?

And that's why the Steerle by Design operating system was created. The Steerle by Design is an operating system built on different assumptions. Proactive operations are achievable. Spd is strategic enabler of surgical success. Surgical services can become collaborative partners. Excellence is possible with right systems, visibility and investment. I want you to think about having a technology in a system that's the Tesla of Surgical Support Services technology and operating systems. See, Tesla has created a technology that allows It allows for the driver to even go on autopilot and it's able to adjust the risk based on human behaviors, time, travel, and all these quantum physics that it uses to be able to be proactive and protecting the people in the car. Where we have a new technology, a new system that's built on the same subset of ideas. Human behavior actually can be mitigated because it's been the same problems happening in organizations all over the country for the last 30, 40 years, regardless of the institutional technology that we have. This is not philosophy, it's methodology. Visibility systems that connect SPD to outcomes, operating rhythms that enable proactive work, capability development that builds the skills. And I know that even with Teslas, ever so often it tells you just to put your hands on a wheel so that it knows that you're awake and that you're attentive.

That's exactly how our sterobotors and operating system works. Once you at least keep your hand on the wheel, you can see all the functions happening, but the system does a lot of the monitoring and supporting your department as it can, ensuring compliance, mitigating mistakes, and then letting the supervisor know immediately when things are coming to a head. And unfortunately, that's the end of this session. That's episode 38. That's the beliefs that bind. Let me recap to you what we went over. The elephant doesn't try to escape because it believes it can't, even though the belief is no longer true, and it used to be true. Just because something was true in a moment doesn't mean that there's truth today. My grandfather used to tell me all the time, Son, if you're going to be a successful executive or an executive leader or a successful business owner, you have to understand that when facts change, so do you. He said, So I need you to repeat after me. I said, Yes, He said, When facts change, I said, When facts change, so do I. So do I. When facts change, so do I. And a lot of you are living in an older world when facts have changed to a newer world.

But because this used to be true, then it must be true now. And that's the number one belief destroying all organizations all throughout the country. And it's also destroying relationships and friendships and marriages. Things can evolve, and what was true in moment should not be affecting you today when that moment actually changed. You should not be chained down to the past moment that that circumstance was true in. Next episode, we're looking at what the Book promises. What this Book will show you is a roadmap of everything that comes after the diagnosis, after you see the beliefs are causing you harm. Once you name the condition of the actual problem, once you realize that it's not just the people there, it's the old systems that we're operating on, what do you actually do about it? Here's what I need from you. One, I need you to subscribe, follow new episodes every week. Two, share the episode with someone who stuck. Someone who keeps saying that's just how it is. Someone who's giving up without knowing they've given up. And this might be episodes that wake them up. Read the articles and the white papers at cibsehealthcare.

Com/cibsehealthcare. Com/cibsehealthcare. Com/cibsehealthcare. Com/cibsehealthcare. Com. Go deeper on any of these beliefs. Four, I need you to request an OBI study. Go to cipshealthcare. Com/obii10. See our research, see the data, and what we're talking about. And if you're ready to break these chains, go ahead and schedule a demo in a session with us at cipshealthcare/demo. If that doesn't work, just go to cibshealthcare. Com and schedule some time with us because here is the truth. The truth is, if you could do it alone, you would have already done it. And if the old ways worked that you know about, we wouldn't be talking about those same problems today. So there's a new help. There's a new way. There's a new approach that we can take. And we've been in the game 20 years, and we're introducing this new way to the world. Go ahead and reach out to us. Here's the deal. We do have qualifiers with who we choose to work with and what organization. It doesn't matter how much money you have, it doesn't matter how fast you can get a signature, it doesn't matter how big your facility is. If all the leaders are not lined up and ready to support and going to champion this change, if we can't get a commitment, everyone working together to really help stabilize your facility so that you can have a better quality organization, which means a better quality life, then you wouldn't necessarily be a fit for us.

It's not about the money for us as much as it is about truly helping the healthcare community and these teams that are saving lives every day. Our goal is to help those who are actually doing the work to save their lives. This is the best that we can do. And join the community at bred2lead. Com. Exclusive content, master class videos, all of our podcast videos will be uploaded there at some point, and a network of leaders who refuse to stay chained. Bridge builders, you are not a baby elephant anymore. The state can be broken, but only if you try. I am Dr. Jake Taylor-Jayce. This is Bread to Lead. Go and build your legacy and remember one thing, that greatness starts with you. Since the age of 12, I've been buying my father's business. At the age of 30, he sent me to his.