The Staffing Model Disappeared From the Conversation
How fast does your leadership team move from a performance metric to an action plan?
I've been thinking about that question ever since sitting through a leadership meeting where staffing performance across several hospital units was being reviewed. Some units were meeting the budgetary standard. Others were not. As happens in most performance reviews, the conversation naturally settled on the units that had missed it.
At first, nothing about the meeting struck me as unusual. If you had walked into the room, you probably would have thought it was a good performance discussion. People were asking thoughtful questions. They were trying to understand what they were seeing before deciding what to do next.
The conversation worked through the explanations you would expect. Vacancies. Call-offs. Patient volumes. Leaders added context from their own areas, asked follow-up questions, and gradually they became more comfortable with what they believed the metric was saying.
I didn’t notice it while I was sitting there.
We talked about staffing performance, FTE’s and call pay. We talked about efficiency and the quality of the data.
We never talked about the staffing model.
Looking back, that's the part that has stayed with me. The assumptions underneath those numbers never surfaced.
By then the conversation had shifted toward action. Managers were asked what their plans were. Follow-up dates were discussed. Accountability was assigned.
At the time, it all felt normal. Looking back, there was one question we never asked.
Were the units being compared actually doing the same work?
The staffing model assumed they were. The emergency department, the medical floor, and every other unit in the hospital were measured against the same calculation and the same budgetary standard. Patient acuity never entered the model.
The number was accurate. It just wasn’t measuring what everyone thought it was.
When someone mentioned acuity, I remember looking around the room. The managers whose units hadn't been questioned stayed quiet. Nobody challenged the comparison. Nobody added another perspective.
If the staffing model became part of the conversation for one unit, it could just as easily become part of the conversation for every unit.
The discussion moved on to the next agenda item, and before long the meeting was over.
A few months later, the same metric came back. The same units were back. The staffing model hadn't changed, and neither had the conversation.
I've thought about that ever since. Leadership decisions eventually become so familiar that they stop feeling like decisions. They become part of how an organization sees its work. Performance conversations begin there. Action plans are built there. Accountability gets assigned there.
Eventually, nobody thinks to question them.
The next time a performance metric becomes the center of a leadership meeting, stay with the conversation a little longer before the first action item is assigned.
Ask one question.
What leadership decisions created the conditions this data is now reporting?
What has disappeared from your performance conversation?
When the same performance problem keeps returning, the answer may not be another action plan. The leadership team may need to examine the decisions and assumptions that became part of how the organization operates long before the number appeared.
The Organizational Performance Diagnostic helps healthcare leadership teams work backward from the performance they can see to identify the leadership decisions, organizational conditions, and adaptations that may still be producing it.
If your team keeps discussing the same performance problem and arriving at another version of the same action plan, that's a useful place for us to start.
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