Parable of the Non-Visionary Leader

Many years ago, in the early 21st-century, were two people who ran medium-sized companies that competed against each other.

It was a day of simpler times—when PowerPoint was the de facto corporate communication tool and LinkedIn managed your professional network.

This was in the age before artificial intelligence created all revenue projections. It was long before corneal projection technology. The ubiquitous smartphone owned the most timeshare of anything a professional owned.

The first executive was setting his strategic priorities to achieve blowout performance by the year 2020. Income projections looked exactly like what his board expected, a fast rising slope that easily outpaced GDP. They should expect triple their current revenue over the next several years.

The second executive was also setting her goals, and while they weren’t as aggressive as the first’s, they had an impressive trajectory. It was an excellent growth rate for a business of their size and was ahead of what the industry growth rate was.

Revenue projections are usually based on what executives want to achieve, what they think is expected of them, and what their bonus structure enables. Unfortunately, the disconnect usually begins there. They fail to have strategy trickle down to tactics that achievef financial goals.

Executive one had climbed the ranks through sheer force. He knew the company’s service well but wasn’t the strongest leader. The exec struggled to succinctly develop and convey a game plan to achieve growth. He was an operational specialist, and this always seemed easy before he was in the top position. The words to describe his growth plan were plenty and his explanation plausible but his associates were skeptical. After a couple years of rocky performance, he was returning to the strategy and tactics of the glory years, a time of unprecedented growth for his company. It was based on what his predecessor had done many moons ago.

Executive two had a difficult climb to her position. This was years before gender equality had been achieved but still she had made it. Her number one trait was that she was visionary. She knew the world was changing fast and her company had to adapt. She made bold moves, quickly changing the strategy to align with the reality of the market. It was a gamble but one she knew she had to take.

2020 arrived. Executive one came nowhere near his projections. In fact, his company was slowly whittled down to a fraction of what they had been and was bought for pennies on the dollar.

Executive two beat her projections. Her gamble paid off. Her choice to restructure and refocus had impeccable timing. Their stock value had skyrocketed.

Stuck in the past or a visionary? The early 21st century taught us one thing. That successful CEOs were always the latter. Anything else and you’re company descended along the glide path to obsolescence.

Mandatory Steps for Basic Healthcare Reform

W After ten years of driving healthcare reform with healthcare systems, medical device OEMs, and thought leaders, I have an opinion on how we can get it done. I posted this on social media recently:  “There are 2 parts to driving #healthcarereform of reducing cost and improving outcomes: 1) Who gets care and 2) How care is delivered. Both need a radical overhaul.”

Someone replied, “Can you provide more detail around those points? How do you envision rationing who gets care? How would you go about innovating the delivery [for] that care?”

This article is meant to hit the highlights for each of those three questions. To keep it short, I’m not going to include all of the statistics so you will have to research them yourselves.

Who Gets Care

With the discussion of Obamacare and its repeal, the topic of “medically uninsured” is top of mind for many people. Some argue that healthcare is a right and that inequality and disparity of outcomes is unacceptable. Maybe it is, maybe it isn’t. I will leave that to the politicians and social reform.

There is much we can do regardless of where we stand on that topic. There’s a significant amount of healthcare spend and poor outcomes with births, untreated chronic diseases, and end of life.

Babies and their moms

Our babies need to come healthy into the world. Costs can be driven up for their entire life if someone has a poor start in life. Many infant mortalities and complications can be avoided with simple, prenatal care that is unavailable or unused for or by too many people.

The Chronic Diseased

With 45% of Americans having at least one chronic disease, healthcare reform must address this. We have to care for people with chronic diseases before exacerbations. Ultimately, we would like to drive down the rates of diabetes, hypertension, asthma, and others, but we can make a significant improvement in healthcare by offering easier treatment and education plans that are non-hospital, non-clinic based with minimal physician involvement.

Those Dying

We need to start talking about end-of-life sooner. When a loved one is in the hospital, it’s too late. I have seen far too many instances of family members trying to extend the life of their loved one for weeks days or even hours however possible. Not only is it uncomfortable for the person dying, it’s outrageously expensive and ultimately ends in death anyway. We should move to having 100% of advance directives in place prior to hospitalization. We should also talk about death with dignity in a non-hospital environment.

How Care is Delivered

Any industry is going to protect the status quo and tradition. It’s easier because it doesn’t require the players to change. Healthcare is no exception. Its employees are the most educated in the world. They have significant incomes and tremendous power. They accept change when legally mandated or when it could negatively impact revenue or personal income. Healthcare reform demands a change in how care is delivered.


Last week, two major academic institutions announced hospital projects. Total spend for two facilities is expected to be $8 billion! Both were claiming to advance medicine and offer the absolute highest level of care for patients. They used fancy words like artificial intelligence and precision medicine. With healthcare spend in the U.S. at nearly 20% of GDP, projects like this are fiscally irresponsible.

Hospitals should only be used for the highest acuity issues, academia should conduct research but everything else should be treated somewhere else. The smaller and more distributed treatment places are, the better. The centralized hospital model continues to drive unprecedented levels of inconvenience, cost, and societal impact. They increase traffic, have poor or expensive parking, require long patient commutes, have acquired infections and more. It also puts people in the worst healing environment: a hospital room.


We have overqualified medical professionals treating patients with simple issues. For many health issues, we don’t need to see an actual doctor. A nurse, nurse practitioner or physician’s assistant is more than sufficient. For other issues, our primary care physician isn’t the best and we should talk to a specialist. We can’t overutilize the high-priced experts, though.

We must use specialists, subspecialists, and super subspecialists only when necessary to return a patient’s health to “normal.”


We can’t continue to require a patient to schedule an appointment at a doctor’s office. It’s overkill. A significant number of appointments don’t require “hands-on” presence of a physician and they can be done via phone call, video conference, email or text. We must kill the office visit unless absolutely necessary.


Having open hours when the majority of dual-income families are working is ridiculous. Opening at 9 AM and closing at 4 PM doesn’t work. Non-acute healthcare, especially primary care, needs to be available before normal working hours and after normal working hours. Finally, we can no longer have providers that reject evidence-based medicine and instead rely solely on their own experience. Too many physicians and offices are clogging their schedules with appointments that are medically unnecessary. This includes everything from annual physicals to how often and how early a woman should get a mammogram.

Innovating Care Delivery

We have to innovate our patient care model to achieve healthcare reform. As much as I would like to think that an existing healthcare system can do this, there is little evidence that they can. There are very few systems that even have an innovation center in place and even fewer that focus on the patient care model. Most want to be a tech incubator for new ideas from the surgeons or physicians. While I applaud those efforts, we can have a significantly higher impact by investing equivalent time and resources into care model changes.

This requires a systematic approach with a dedicated team. A hospital or healthcare system must invest in the minimal number of resources required to develop new care models. It is a skill set not possessed, taught or practiced in any healthcare environment yet we must establish and expand this skill set, everywhere.

We can’t expect corporate mega-conglomerates to come up with the best way to care for patients. They are focused on selling technology and solutions at a high-profit margin. They rarely understand the customer, the entire healthcare process or the people delivering it. You must have an immersive, ethnographic process, such as design thinking, coupled with technology development and change management. It must be internal- healthcare systems know their patients and market best.

Create Healthcare Reform

Now, when I say it only takes two things to impact healthcare reform, they are big things. However, I have personally led and experienced organizations that are taking the right steps. There are companies like CVS which are redefining care delivery.

Reform will happen. Time will determine the winners and the losers. It can’t be the patients. Check out my article on Population Health for a deeper dive.

Work – Balance Your Week For a More Meaningful Life

Dear Work Professional

How many hours a week are you willing to work to seem valued by your employer: 60…80…100+?

Unfortunately, for many, long hours at work is worn as a badge of honor. It’s a rite of passage. Long hours demonstrate the highest level of commitment. It is used as a tool to compare employees. It is one of the most treasured of unspoken corporate awards: The Long Hours Award. My career has benefitted from the Long Hours Award and I’ve been a victim of others winning the Long Hours Award. I have had many bosses that mistakenly held “hours work” as the benchmark for performance. I have had many that haven’t.

This is what I have learned.

Long hours equals long hours.

Nothing else. 

Long hours does not mean hard work. Long hours does not mean high value. 

Not Hard Work

There are countless examples from my past about people who were “on the clock” but were effectively useless for many hours of the day. They were there to show they were there; they weren’t working hard; and they took long breaks, long lunches, and long desk chats. They got less done in 60 hours than I did in 40. But when the weekly overtime report came out, they were champions. 

Not High Value Work

Ok, you’re burning the midnight oil. Every night. You’ve built in the expectations to your employer that your job is 1 FTE when it clearly isn’t. You can’t back down now. You agreed to the role. The thing is, when those hours tick by, you become less and less effective at your work. Every hour on the clock become mere minutes of productive effort if any. You aren’t fooling those who work under you, even if your work is still impressing those above you.

Loss of Life Balance

We aren’t built to work the hours we do. Our relationships weren’t either. Unless we’re married to our job and our best friend is someone at the water cooler. Here’s what you lose when you put too many hours in–personal health, family relations, volunteerism and personal breadth.

“But,” you say, “If I stop, I’ll lose.”

Who are you competing against? Where is the finish line?

You’ve already lost. Your company won.

Your Health

Long hours in the office can wreak havoc on your health. The minimal amount of cardio exercise recommended is 2 1/2 hours every week. Include prep and clean up and that number can balloon to double that. And that’s the minimum. Your heart and health can hold for a while. You certainly can pack weight on through your 20s and 30s without really feeling it. At some point, it starts to catch up with you. Your blood pressure is suddenly high. You become diabetic. Your joints are aching all the time. You can’t catch your breath. Maybe it becomes a major medical event. Perhaps your quality of life suffers. 

Maybe you are squeezing in workouts, at the expense of your family.

Work Family or Real Family

Do you think your spouse cares about your career as much as you do? Even if you think they do, how long will they think that before they change their mind? It’ll be sooner than you think. You’ll drift. Unofficially two separate lives until it becomes officially two. Your kids certainly don’t understand it. Eventually, they will become teens, teens you are or aren’t connected with. Those teens will make decisions that impact them as they enter adulthood. But I had to provide for them, for college. Then it’s too late for your to get off of the hamster wheel. You’ll get back what little time you invested.

Volunteer Work

So the school/church/neighborhood needs help. They know they can’t ask you. You’re too busy. Your spouse/child/friend is always embarrassed by the suggestion they ask you to help. You’ve already made your decision. Your career. Your work. You. YOU. All of those teachers, parents, coaches, helpers, and the army of people that helped you grow up, learn and become who you are today…

So you write a check instead. Bravo!

Work Breadth

If narcissism is the trend from long hours, then here is where you lose. You gain tremendous expertise in one, infinitesimally-small slice of the professional world. Your expertise is limited to one industry, one company, one series of roles. If that company folds or downsizes or offshores your role, you may be looking at relocation or unemployment.

You running under the misassumption that all of your time is for your personal consumption.

Choosing to play the game of long hours at work will always catch up to you. Always. You may seem invincible. It may seem like you have everything under control. You may think people don’t know what’s percolating behind the scenes. Spoiler alert: you can’t win. I’m trying to head off your regrets before it’s too late for you.

Win the Award that Matters: Your Legacy

Start with working forty hours, not fifty, not eighty.

  1. Do a great, focused job while you’re working 
  2. Give a little extra time on occasion when needed
  3. Balance the rest of your life and give time for others

It’s worth it.