Welcome back Bridge Builders to Bread to Lead, the podcast transforming leadership across industries.

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Jake Taylor-Jacobs, and I'm thrilled that you're here.

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Today's episode awaits Bridge Builders.

Bridge Builders, Bridge Builders.

Welcome back to the show.

bread to lead.

If you're new to the show, first and foremost, I want to say thank you for taking the time to listen to our podcast in an effort to make leaders better.

We want to make leaders great again.

I want to make leaders great again to where we're focusing on what matters most.

And it's not based on positional titles.

It's not based on, you know, people trying to get promotions, but people who truly are inundated with the focus on becoming the best version of themselves is important, especially in healthcare.

You know, whether you listen to this podcast, whether you're in healthcare or not, I think a lot of the lessons that we share in Bread to Lead are absolutely transformational.

And the reason why is because I'm hearing from you.

You're telling me that it's impacting your life and your organization and hearing, how leadership decisions that are made specifically in health care can cause life or death situations.

Now, you're looking at leadership and different dynamics within whatever organization or industry that you're inundated in or a part of.

Now, this is going to force you to actually have to think about leadership.

Our decisions.

And how our decisions can truly impact people's lives every day.

And if you're new to the show, I like to consider this more of a pod class, not just a podcast.

I want you to actually learn information, take notes and actually go apply it into your life moving forward.

And as the show continues to progress and we continue to get better, you all are giving us ideas on how to truly make our show better.

Better with things that you want to learn about.

And we're in a phase right now where you all are inundated in case studies of hospitals that didn't get it right.

And the purpose of us going in this series, I don't know how long it's going to last, breaking down hospitals that didn't get it right.

And I'm sure in the future we'll break down hospitals that had got it right.

But we really want to focus on even the greatest of brands in the hospital sector that didn't get it right, not to expose the leaders that were making these decisions or leading these ships, because we all know the nuances and the complexities of leading an organization.

There are so many things you may or may not know that ultimately you're going to get blamed for.

But to look at some of the fail shoots, the bottlenecks that cause for decisions to not be made the right way.

So buckle up tight, because this one is definitely going to be something that we want to make sure that we're paying attention into and learning from.

So today, bridge builders, we're diving into something that should frighten every leader.

What happens when smart, capable leaders fail to make critical decisions?

What happens when one of the most respected names in health care ignores the warning signs of his own failure?

And let me share a story.

And it's a story that will change how you think about leadership decision making forever, which is my prayer.

In 2018, Johns Hopkins All Children's Hospital, one of the most prestigious names in medicine, faced a crisis that will reveal something chilling about leadership failure.

Their Florida-based children's heart surgery program was seeing mortality rates three times the national average Children were dying from preventable complications The warning signs were clear The data was there The frontline staff were in fact raising alums But the leadership, very smart, very experienced, very prestigious, failed to act.

They hesitated.

They deflected.

They delayed.

And children died because of it.

I think about this, bridge builders.

These weren't incompetent leaders.

They weren't uninformed.

They had the data.

They had the warnings.

They had everything they needed to make the right decisions.

But they didn't.

And understanding why is crucial for every leader.

And 2015.

The mortality rates in heart surgeries at all children's begin rising.

Surgeons and staff repeatedly warned leadership that surgeries were going wrong.

But instead of acting, leadership protected the hospital's reputation.

They chose preservation over protection.

Image over impact.

Nurses and doctors were seeing the problems firsthand.

They were they were watching children suffer catastrophic complications.

One doctor even left the hospital because he couldn't bear watching more children die unnecessarily.

But leadership remained paralyzed.

Caught in what I call the prestige trap.

Where protecting reputation becomes more important than solving problems.

I want you to consider the case of Mia.

A baby born with a heart defect.

Her parents trusted Johns Hopkins, believing that they were putting their child in the best possible hands.

During her surgery, mistakes were made that should have never happened.

The medical team immediately saw things were wrong.

But leadership still didn't shut the program down.

Too much money has been committed to this program.

More children continued to suffer for months before anyone was held accountable.

Here's what makes this story so important for every leader.

The failure wasn't from lack of information.

It was from lack of expertise.

It was from what I call the prestigious paralysis.

When leaders become so invested in their reputation, their status, their image, that they become paralyzed in the face of difficult decisions.

And let me break down why smart leaders fall into this trap.

All the time.

And there are four key factors that create decision paralysis.

It's four.

The first factor.

Is the reputation shield.

When you've built a strong reputation like Johns Hopkins had, it becomes something that you protect at all costs.

Leaders start making decisions based on protecting the reputation rather than addressing the reality.

They filter every decision through lens of how would this affect our image instead of what's the right thing to do.

So when we talk about the reputation shield, many of us.

We do this.

Whether for the company we work for or that we've built.

Or we do it for our own namesake.

For promotions, for raises, for notoriety, for write ups, for publications.

Where we rather protect the reputation of our brand than doing what's right in the moment.

And this is.

The paradox.

Because when you're running an organization, you want to protect the name of the organization.

That's how people have the trust in you.

But not so much that you're destroying all of the good faith and the good work that you're actually, doing and I think this is where it begins to be a hard juggle when pressures from the board pressures for delivering pressures for namesake.

Comes into a play now what the easiest thing to do would be, fixing it and meeting your failure and meeting your shortcoming and then running with it versus, pushing on hoping that it'll turn around and what happens when it doesn't because in most cases it doesn't turn around, So the first factor is the reputation shield.

The second factor is the data paradox.

And this is fascinating, bridge builders.

The more data that leaders actually have.

The more paralyzed they often become.

At Johns Hopkins, they had a mortality rates.

Complication statistics patient outcomes but instead of this data driving action it became something to analyze debate and rationalize more information often leads to less action, it's actually the thing that i'm seeing inside of our field of health care you're all these tech companies and these data brokers and all these subject matter experts talking about data, data, data, make decisions on data, which in fact could be true.

But that goes back to our original episode just before this one.

In episode 28, when I talked about the different realities.

Data is only paper reality.

It's not perceived reality.

It's not ground reality.

And it's not culture reality.

It's just paper reality.

And many times paper reality can tell us a truth.

Lacking context.

Yes, the data says that only these amount of children are losing their lives.

And then you're taking that count into all of the surgeries that are happening inside your system.

And it looks small in number.

But the perceived reality from your your staff, your team, the frontline workers, the ground reality from the community, from the clients, from the patients and the cultural reality of the lack of trust that they're feeling, those things are just as real.

And without those three other realities, the context of the paper reality doesn't really add up.

So the data paradox is where people typically get inundated when i'm running an organization and and and i'm saying this also as a way to talk about what happens when you talk to c-suite c-suite most cases you're in meeting meeting meeting meeting meeting meeting meeting and someone's coming up to you asking you to sign something so you're giving them a synopsis hey give me a synopsis what am i signing why am i signing what's going on okay cool OK, let me see this data.

OK, data.

What's the data saying?

Data says that we're 98 percent successful.

So if I'm looking at data alone, I'm saying, oh, 98 percent successful, then we're good.

Then the field workers say, yeah, you're saying 98 percent, but this 2 percent is real bad.

If I'm only stuck on data now, I'm not going to make a decision.

Because I'm just stuck in a data paradox.

The third factor is the expertise trap.

When you're considered an expert.

And again, this is the third key factor that create decision paralysis amongst leaders.

When you're considered an expert.

Like Johns Hopkins in health care.

You develop what we call.

Everybody knows them.

Blind spots.

You start believing your expertise makes you infallible.

This creates the expertise arrogance that many subject matter experts have.

Where leaders dismiss warnings because they can't imagine being wrong.

And a lot of people are following leaders and following managers that are in leadership positions that are in this expertise trap.

because God forbid you're wrong on something.

God forbid that your data isn't accurate.

God forbid that the decision that you're saying to make, because it worked 10 other times.

That it no longer needs data to prove it right in this situation.

So that expertise arrogance acts like a callous on your eyes and it stops you from being able to see things as you used to prior to be considered the best at what you do that the best the expert those terminologies makes you start to believe your own press and there's nothing worse than believing your own press when you know your press isn't entirely accurate.

And then the last key factor that create decision paralysis amongst leaders is the hierarchical filter.

That hierarchy filter, man.

Information gets filtered as it moves up the organization hierarchy.

At Johns Hopkins, front lines saw the problems clearly.

But by the time the information actually reached the top leadership, it had been sanitized, rationalized and minimized to protect people's position in my eyes.

See, when people care about their position more than they care about their duty and the responsibility of that position.

They will protect their own position at all costs, even at the demise, in this case, of children's lives.

But here's what's crucial to understand.

These factors don't just apply to health care.

I see them playing out in organizations across every industry.

Where leaders become paralyzed by similar forces, whether they're running a hospital, a tech company or manufacturing plants.

And let me share something powerful.

About breaking through decision paralysis.

It's not about having more information.

It's about having the right decision making framework.

And here's what I teach leaders.

The clear decision framework.

Thank you.

In the clear decision framework, we confront the reality.

We listen to the ground level.

We evaluate impact.

We act decisively and we review and we adjust.

We confront the reality.

We face the unvarnished truth about our situation.

We listen to ground level.

We pay attention to the frontline insights.

When I joined Sips Healthcare and our CEO became the newly appointed CEO, we made a decision to go on what we call the love tour.

Where we toured every facility that we supported and talked to the ground level frontline workers that were making everything happen within our organization.

And you know what we found out was that the feelings that the front line had versus the feelings that administration reported to us were two total polar opposite feelings.

Which is why there was always this growth and contraction within our organization that we had to beat out.

When we evaluate the impact, we consider the cost of the inaction.

What will it cost us to not act?

Can I tell you something?

Fixing a problem that you know needs to be fixed does cost a lot in the moment.

But do you know what costs more in the moment?

When you lose it all because you didn't make a decision.

Then we when we when we talk about this clear decision making framework then we act decisively we make clear decisions with clear timelines, not hey let's make no we need a clear timeline the last one we review and adjust why because every decision that we make doesn't necessarily mean it's the right exact decision But it's good to move forward in the right direction.

And then we review, we monitor the outcomes and adjust as needed.

And at Johns Hopkins, they failed at each step of this framework.

They didn't confront the reality of their mortality rates.

Someone dying of HIV or dying from, you know, being older, you know, It's different than a baby dying from complications that could have been avoided.

They didn't listen to frontline staff.

They didn't evaluate the true impact of their inaction.

They failed to act decisively and they didn't have effective systems for reviewing and adjusting their approach.

Y'all, can I tell you something?

This is why hiring consulting firms, advisory firms, specialty consulting firms are important.

Why?

Because when you hire a third party to come in and manage, monitor or run.

Or advise specific departments and flows of things that are not inundated in the day to day commitment to the organization.

The reason why those are great options is because there's no bone to pick in the fight from a third party person, from a third party entity.

But if I'm hired at the same facility and I'm required to actually give contrary recommendations that are against the hospital leaders, my uplines.

Motivation or vision, I could lose my job and be silenced.

That's why third parties work great.

This is why hospitals, they need their they need to turn their SPDs from call centers into profit centers.

This is why they call us.

Why?

Because we're not going to sugarcoat it, nor are we trying to keep a position.

We're trying to run our facility, our department, the department.

We're trying to turn it into a profit center.

And we want the best, the brightest and the most willing in those departments to ensure that we support the OR in the best ways possible.

And when all of these things Begin to bubble up Guess what happens The pressure finally becomes too much.

2019, the chief of surgery, the chief, the chief surgeon and other top leaders were forced to resign.

But here's what's tragic.

Bridge builders.

None of this had had to happen.

Every death every complication every failure was preventable if leadership acted sooner, but in healthcare we're always in this reactive state, and the best facilities the best companies no matter the industry would much rather invest into proactive care than reactive any day.

Because it makes you look good when you report to the board that you're cutting costs, you're efficient, you grew a new service line, programs are growing.

But do you know what type of leader you are?

If you can go right to that same board and say, y'all, we got it wrong, children are dying, we need to cut this off now and give every dime that was given to us for this subsidy from the government for this research part, we got to give it back now.

But when the hospital is inundated with bills and operating in the red, not profitable.

Now those decisions now become convoluted.

Because now people got to be fired.

People have to be let go.

But I'd much rather somebody lose a job than a baby to lose their life.

Let me share something crucial about decision making.

that could have changed everything at Jones Hopkins.

I call it the decision velocity framework.

It's built around understanding that the speed of decision making is just as important as the quality.

People believe that just because we're big, a big organization, we have to make decisions slow.

No, we can make decisions fast.

Everyone just has to be on the same page.

Think about this.

every day that Johns Hopkins leadership delayed making a decision, they weren't avoiding risks.

They were actually increasing it.

Every day of inaction, meant another child was at risk.

Another surgery that shouldn't happen.

Another family trusting their reputation instead of the reality.

Because all brands can be rebuilt.

Look at Johns Hopkins now.

years later, rebuilt, all wounds heal.

At some point.

But it didn't have to be as dramatic as it was.

So here's how the decision velocity framework works.

The first is the risk assessment matrix.

What's the risk of the action?

What's the risk of the inaction?

Which risk is growing faster?

The second, time impact analysis.

How does delay affect outcomes?

What opportunities are we losing?

What problems are we allowing to grow?

Just no different than when hospitals are contemplating on using our SPD services.

I don't know if we can afford it.

When I'm looking at the delays, I'm like, how could you not afford it?

Y'all are costing the hospital $22,000 a month, a day, excuse me, from delays.

When you look at the numbers, how could you not afford to move forward?

What opportunities are we losing for this time impact or delay?

And what problems are we allowing to grow?

And then the decision triggers.

Clear points, the demand action, predetermined response plans, automatic escalation protocols.

So many organizations run their organization without anyone in their organization knowing exactly where to go and what to do when things are hitting the fan.

Before you take off on a plane every single time no matter how many times you fly they go through all of the protocol for if things hit the fan, let me show you how this could have changed things at Johns Hopkins if they just use this framework they would have seen that the risk of inaction more children dying was far greater than a risk of action or reputational damage.

The people would have much rather said, we dismantled this program because it hurt children than to keep it up.

Because at least the people would know that when it comes to doing the right thing, this hospital will always do it.

Time was making their problems worse, not better.

And they pass multiple decision triggers that should have forced action.

But here's what's powerful about this framework.

It's not just for life or death situations in healthcare.

I've seen organizations across industries fail because leaders couldn't make timely decisions, whether it's market changes that they ignore, employee concerns that they dismiss, problems that they hope will solve themselves, or people that need to leave your organization now.

The pattern is always the same.

Smart leaders become paralyzed by the weight of their decision, not realizing that indecision in itself is a decision, usually the worst one.

So let me share three critical strategies for breaking through decision paralysis after this commercial.

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That's right.

So we're going to talk about the three pre-commitments, the three pre-commitments.

Okay.

The critical strategies for breaking through decision paralysis, excuse me.

The pre-commitment strategy make key decisions about what would trigger action before you're in the crisis.

At Johns Hopkins, they should have had a clear predetermined point at which they would stop surgeries based on mortality rates.

The outside view actively seek perspectives from outside your normal circus circle.

Johns Hopkins leaders were trapped in their own echo chamber.

They needed external voices to break through their paralysis.

And then lastly, the reality check protocol.

Regularly pressure test your assumptions and beliefs.

The leaders at Johns Hopkins believe their reputation meant they couldn't fail.

They needed systemic ways to challenge their belief.

Let me tell you something.

I don't care how great your leadership team is.

If they believe that their job will be on the line if they talk against or.

Or not in favor of up upline leadership or senior leadership, most people will never tell you the truth have you noticed that when you're in meetings when the senior leadership says says does anyone have any questions any problems any concerns No one says anything.

And then the moment that senior leadership leaves, everyone has the complaints.

Talking mess, crap, upset.

Why?

Because to say something to somebody about something that is wrong.

It takes guts.

Think about this, Bridge Builders.

when the Tampa Bay Times finally exposed exposed what was happening at Johns Hopkins the public was shocked but the real shock wasn't that things had gone wrong it was that leaders had known all of the facts already and failed to act, which brings me to something crucial about decision making that every leader needs to understand your reputation isn't built on the decisions you make Your reputation is built on the decisions you fail to make when it matters most.

And in order to prevent decision paralysis, and if you're new to my podcast, you know, I operate in frameworks.

I come from sports.

Everything had a play.

Sideline play, under the basket play, right at a halftime play, start the game play, depending on if we're down 20 or if we're up 20 play.

There's plays, a huge playbook.

And I operate within these frameworks that help us get out of situations.

And we work on these frameworks so that everyone is good and ready.

And I call it the decision debt framework.

Just like financial debt from the financial industry I come from.

Decision debt compounds over time.

Every decision you delay, every problem you ignore, every action you postpone, it all adds up with interest.

And at Johns Hopkins, they accumulated massive decision debt.

Each delayed decision about the surgery program didn't just maintain the status quo.

It made the inevitable reckoning worse.

This is true in every organization or every organization.

Problems don't age well.

Delays compound challenges.

And inaction has a cost.

Inaction may not cost you anything today.

But I promise you, inaction costs millions of dollars later.

And what.

Johns Hopkins.

Came to find.

Was that their inaction.

Cost the hospital to pay a near a near 43 million dollars.

To families of children who died or were hurt in that heart unit.

And two families received eight-figure settlements because they're caring for children who are permanently disabled.

This is what's important to understand.

Inaction comes at a major cost.

But true leadership is to make decisions when your back is against the wall and you're making it for the betterment of everybody else.

But here's what's most powerful about understanding decision debt.

It changes how you view decision making.

Instead of asking, should we act?

You start asking, what's the cost of not acting?

Here's the four types of decision debt I see organizations accumulate.

The first type of decision debt that an organization will accumulate is operational debt.

When you delay decisions about operations, processes, or systems, this compounds into inefficiency, waste, and eventual failure.

The second debt I see organizations accumulate, cultural debt.

When you avoid decisions about people, behavior, or standards, this compounds into toxicity, disengagement, and talent loss.

The third type of decision debt I see in organizations that they accumulate, strategic debt.

When you postpone decisions about direction, markets, or competition, this compounds into missed opportunities and strategic vulnerabilities.

And the fourth type of decision debt that I see organizations accumulate is the trust debt.

When you delay decisions that affect stakeholders' trust, this compounds into reputation damage and loss of credibility.

Let me share something powerful about breaking free from decision paralysis.

It's not about making perfect decisions it's about making timely ones the leaders at Johns Hopkins were paralyzed by the pursuit of certainty.

They wanted to be absolutely sure before acting, but in leadership certainty is a luxury you rarely have.

And here's a framework I teach leaders for making decisions under uncertainty.

It's the 70% rule.

If you have 70% of the information you think that you need, you have enough to decide.

Waiting for 100% certainty often means waiting too long.

Two, the reversibility test.

Ask yourself, is this decision reversible?

If yes, you can make it faster with less certainty.

If no, you need more analysis, but not endless analysis.

You just want to get to 70%.

And then we evaluate the impact scale, the impact of action, the impact of inaction, and the impact of delayed action.

And let me start by saying this.

A lot of people's resumes give false indications of someone's leadership ability because of the positions that they were in, not their ability to navigate difficult situations.

I judge leaders based on the height of the largest mountain that you had to climb.

You got a leader that's just been winning all the time never never overcame a big mountain it's not a leader that you want at the ship of of large decisions, because you don't know what their plan is you don't know what is mike tyson used to say everyone has a plan until they get bust in the mouth so i want to know can you take a punch and And if so, what was the biggest punch that you've taken and how did you navigate out of it?

That's how I judge leaders and their ability to lead.

Now, let me show you something.

Share something crucial about breaking through paralysis.

You need to build decision-making systems that work before you need them.

At Johns Hopkins, they had no system for escalating concerns, no clear triggers for action, no predetermined responses for critical issues.

And if they did, it's obvious that everyone wasn't trained on it.

Think about the doctor who left because he just couldn't watch more children die.

That wasn't just a staffing loss.

It was a massive red flag that the system was broken.

In a healthy organization, that kind of departure would trigger immediate action.

But when you're paralyzed by prestige, even the clearest warnings get rationalized away.

So we want to fact check.

F.

Face reality.

A.

Act on triggers.

C.

Create accountability.

Build an external accountability for decision making.

Nobody was holding the leaders in Jones Hopkins accountable, but the leaders that were in Jones Hopkins.

T, test assumptions.

You want to regularly challenge your basic assumptions about your organization.

Johns Hopkins assumed their reputation meant they couldn't fail.

And then S, scale.

Your scale response.

Not every decision needs to be an all or nothing.

You need responses based on different scenarios.

Remember, Bridge Builders, the tragedy at Johns Hopkins wasn't just about the leaders, what the leaders did.

It was about what they failed to do.

It was about the decisions they couldn't make because they were paralyzed by their own success, their own reputation, their own expertise.

And let me leave you with three commitments that every leader should make one the reality commitment always commit to facing reality no matter how uncomfortable build systems that force you to confront the truth about your organization to the action commitment commit to timely action recognize that delay itself is a decision usually the wrong one three the learning commitment.

Commit to learning from every decision, good or bad.

Build feedback loops that help you improve your decision making.

These three commitments will force you to have to be accountable to everything.

My mentor used to tell me, you can't maintain what you can't measure and you can't grow what you can't maintain.

Like Santa Claus.

He's making a list.

He's checking it twice.

He's going to find out if you're naughty and nice.

We know that Santa Claus is a myth, but what is his elf?

What are his elves doing every day, every moment?

Checking.

What's going on?

What's the information?

How does this impact and what good is it to push off something and I want to leave with this I'm so sick and tired of the leaders, that make selfish decisions that help their careers but leave their organizations, that put them in position to help their career in shambles when they leave, when I'm looking at organizations and leaders and I'm judging their capabilities, I'm always asking myself, when they left the organization, what condition did they leave it in?

Because that'll tell me everything I need to know about you as a leader.

This is Dr.

Jake Taylor Jacob signing off.

Thank you for tuning in to another episode of Bread to Lead.

Until next time, keep leading, keep deciding, and keep breeding excellence in everything you do.