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

Bridgebuilders, 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 skillset 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 don't remember the last time that we actually did that. I'm inspired to share and to teach. Welcome back to Bread to Lead, and we will see you after the intro. Since the age of 12, I've been buying my father's business at the age of 30. He sent me to his vineyard. 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 podcast. And in all categories, we're always top 50, top 70, between that range that I'm excited and grateful for. 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. The biggest concept The concept is because I truly treat each podcast like a pie class. For those of you that are newer to the podcast, I just want to say welcome. I am an operations engineer by trade. I turn around on the performing organizations. Me and my team are what you will call Ternado 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 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, again, generations, 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 matter. 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 of hospital systems actually getting our technology and our systems and seeing the importance of having a true standard in this process and departments. For those of you that are not from the healthcare space, nor am I. I come from private sector. You'll hear a lot ofisms 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. 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. For that, I want to say welcome. If you knew, this is Season 3, episode 40. We've been doing this season somewhat a bit different. Every episode is built around my newest book, Operational Blindness.

We believe that this is the hidden force that's destroying health care, this operational blindness 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 where2lead. 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 the healthcare 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 Now, let me tell you 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. These You can't 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 while others, with similar payrolls, wallow in mediocrity. There's a reason why. 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. The reason why I bring up health care, for those of you that don't know, we're in the business of health care. 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. It's 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 healthcare 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 playbook for I have many operationally blind leaders everywhere. 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. I'm going to go to page 54 in the book, Operational Blindness. If you do not have a copy, you can go to bred2lead. Com and fill out a comment. Fill out a comment and you'll get a link and then some free goodies, I think, that the team has for you on the site there. It's just so that we can keep information with you and keep up on who you are and let you know the stuff that we have going because we do have some phenomenal things going. 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 sterile 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 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 OR schedules that they don't control. The surgical schedule is built around surgeon's preferences, room availability, inpatient needs. Nobody asks SPD whether the schedule It's feasible, given 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. Budget It's 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. When reality diverges from projections, as it always does, SPD is expected to absorb the variants, do more with the same or do the same with less. Staffing models designed for a 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 fail employers, staff callouts. Every shift is an exercise in managing chaos with resources planned for order. A 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 ORR outcomes, no way to know whether the decision 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 every 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 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. Again, that's page 54 to 55, The Undersupported Leader, in our newest book, Operational Blindness. I want to teach on this because what I read was just a setup. 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 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 headcount. 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 Sture by Design. Sture by Design It is a playbook. It is a system. It is a way that your organization can operate regardless of who the players are. In most organizations, they miss that. You don't have a system that your entire organization operates on and is held accountable to regardless. It's like everyone just plug and play. In sports, when we go play with our buddies at the park, You have what we call 21, which is organized chaos as every man for their self for finding one victor. Or you have open gym where people just come and they do their thing and they float and they feel each other. You may hope that you have team members that know how to play the ball, the game of basketball. But if you're on a team with people that just running around, it looks extremely chaotic. And a lot of organizations are actually built that way.

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 When you're in 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. Here's how it works. Spd budgets are set based on projected volumes. And standard productivity assumptions. These projections typically assume efficient operations, workflowing smoothly through the department, resources allocated, ultimately, minimal disruption and rework.

But The active operations aren't efficient. 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 team requires more labor hours to process than the budget it assumed. 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 model is creating. And premium labor fills that gap, and it's becoming permanent rather than temporary. So what does this cost? Considering an SPD that runs 15% over budget on labor due to structural premium spending. For a Department with a 2 million annual labor budget, that's $300,000 per year in excess cost. In over five years, 1. 5 Five million, and that's a conservative estimate. I've seen departments running 25 to 30% over budget on labor, year after year, with no end in sight. 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 I want to teach on this. This is from page 81, 82 in a 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 their 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. In 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. 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 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. 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. 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. Every Championship team needs five types of contributors. 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, any crisis, they set the standard. They train others by example. They can disproportionately 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 assignment, same rotation, same expectations. And this is like putting your franchise quarterback in at running back because everyone should be able to do everything. And your anchor 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 program so that you know how long you typically will have with an anchor.

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. If I am building an 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 of the But this is 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 Probably got a solid three to five of those, but their organization staff is larger. 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 They 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, in any organization, You don't want them to have thinking overload or thinking fatigue. And this simply means 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 for an example. If you have a star player that always have to operate organization from a deficit, the team is always losing. You never get to actually experience them actually thriving when they're 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, Sterile by Design. If you're interested in your health care, you want to know more about our system, please go to cibsehealthcare. Com and find out more about our Sterile 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 having to come back from and having anxiety from coming back from behind. Many great players, yes, they like to climb Mount Everest, but they don't want to climb. They don't want small mole hills to take the representation of mountains.

If you look at a mole hill right down on the ground, real small, and you pretend that you're an aunt, a mole hill looks like a mountain. However, as a human being, I look at the mountain as a mountain and a mole hill as a mole hill. But if I'm a small critter, I'm a small animal, I may make that happen. And your anchors see those small issues every day as small mole hills. 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 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 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. 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 looking into the market every two to four years.

That's quite natural. Every two to four years. If you think about a contract in most sports, unless you are a legacy player and 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. When I know that and I know where my people are, I have my anchors, then 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. Position four, the specialist. Some roles require specific expertise that your general staff shouldn't be expected to have. Maybe it's your OAR liaison, maybe it's your instrumentation expert, maybe it's someone who handles a particular service line that requires specialized knowledge. And specialists They aren't interchangeable with your general staff. So stop treating them like they are. So if you have a specialist, the endo-specialist, and they're really good at what they do, and they really specialize in their thing and all the scopes that's needed in their own point, stop trying to mix them in with the other people.

Some of them, so I'm sorry, you all. Your special teams are special teams. You don't mix a kicker in a punter in with a quarterback. You don't do it unless everybody's gone. Your specialists They're not interchangeable. You have to treat them that way. But when you have a developmental pipeline that allows for 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 supervisors, your 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 those anchors. Then you have that core. Those are going to be like some good star, the starters. They support, they're pretty good at their job. They can do their thing, but they're not the stars, but they can handle their weight. Then you have your development team. Those are your newbies coming in that are new 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 Robin 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. Number 5, position 5 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, 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 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. That is something that is extremely key. I cannot skip that. I can't allow for you to skip that.

You have to start really assessing where your team is. 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 like on the sports team. They know who is capable of being a star and who's not. You know who has natural talent, but they don't have the Are they a 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? When you start looking at your organization, much like people look at their team, it'll be easier for you

Knowing the fold them, knowing the rock away, knowing the run. You got to know who can you keep building what that actually looks like in perpetuity. Which takes me to knowing when I'm building a team, When People are Actually the Problem on page 143. If you're reading the book, go to 143. We're slinging through this thing. 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 It's not 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 where the 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 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 mattered. But 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. 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. 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 standardize 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 healthcare leadership We call it roster hoarding. Losing teams hoard players. 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 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 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 interacting 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.

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, 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. 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 point for whatever What we want to do.

So the capability engine is layer four of an architecture that we create. And in the architecture, our sterbi-design architecture, there are by design architecture. There are four layers. You have the foundation of visibility operations rhythm in the capability engine. We're going to focus on layer four, capability engine. It's on page 178 in the book. 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 solving. 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 to 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 That solves a problem, that solution becomes organizational knowledge rather than individual expertise that walks out the door when they leave. 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, and I want to teach on this, and this was on page 178-179 in the Operational Blindness Book. I want to teach on this because this is what we call the multiplier effect. I referenced this a bit earlier.

Some positions compound their impact across the entire team. You're a preceptor, you're a supervisor, you're a 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 actively dragged 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 techs. Bad preceptors create bad techs over and over and over again for forever. So stop. If you're a manager, you're a preceptor, you're a trainer, whoever is licensed or given the access or approval to train and develop people in the organization, their DNA, their temperament, their jokes, their Their snootiness, 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. I went to go teach. As a new teacher, I couldn't I had to build my own lesson plan.

I had to build from the lesson plan of the curriculum for the curriculum instructor. 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 It didn't give us the freedom in a way to teach it, but the structure 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. As a teacher, you learn people that have cognitive dissonance, people that are cognitively gifted, people that are delayed. You learn how to read in the eyes if 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 teacher to child. Pedagogy, this is what this is called, pedagogy. But many adults need angiography and pedagogy. 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 I write there. That's exactly why we have the 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 a room, but nobody actually knows how to train and develop. I don'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. The book, it says, Write it down and make it plain so that those who see it can run with it. He's talking about structure and order. He's talking about that. When you 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, or 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 It's 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 or 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 the 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 created the 44. We're training leaders on how to train. For sure, we're doing that. When we work inside the 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 Five player development coaches.

Their job is to develop that player's 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. 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. 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. 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 to 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 wanted 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, I'm assuming that you have a great system, and I'm assuming that you have sterile by design and your sterile processing department as a system. Those are the 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 manager, 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. 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 Corps? Are they developmental? Are they Specialist? Are they restless? Are they flexibly slightly? If you can't 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 staff a training program, not a functional department. Here's the deal. When you're looking at this challenge, and I know some of you are like, Hey, we don't need Cips Health care. We don't need your educators, and we 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.

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 crazy because that same certifying board has managers and other certification processes that have the same exact certification approach. If you're telling me that when it comes to teaching in 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 organizations. You have to know how to build people. You have to truly be a bridge builder to be a true impact person that understands that. Challenge number 2, 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 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. That never normalizes. It might be how you're using travel or labor. It might be a position that's overcompensated for the actual impact it actually has. Find one trapped and ask yourself, what systemic change That 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 take them on. Excuse me. Lastly, challenge number 4, 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 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?

I We're like, policies, processes? Then we have to explain what the 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. I want to close the episode by saying this, Bridgebuilders, 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 to 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.

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 organizations have a development problem. They have no programmatic way on 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 field swoop. That's the biggest thing that we have to make sure that we're operating on. Go and get our newest book at bred2lead.

Com. You can go and take our assessment at cipshealthcare. Com. You can download the white paper at cipshealthcare. Com/white paper. 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. Jake, 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. Since the age of 12, I've been bound my father's business ever. Age of 30, he sent me to his vineyard.