“Getting something done is an accomplishment; getting something done right is an achievement.”
— Booker T. Washington

Most people have good intentions, especially in the healthcare environment. Caregivers want to do what is best for their patients and so do their leaders. However, in high-intensity settings such as health care, leaders often don’t stop first to think about the impact of the actions and interactions that they use to achieve their good intentions.

I’ll use the emergency department as an example, because this is arguably the most intense environment in health care. The situation in the emergency department can go from calm to chaotic in a matter of seconds. Emergency department physicians and nurses who are trying to give timely, efficient service to patients are often at the mercy of other departments with differing policies and procedures, such as the laboratory and radiology.

For example, if you are the medical director of the emergency department, you must be able to work effectively with the head of radiology. During the day, when radiology is staffed, you may not be allowed to read your own X-rays. Then voila, when radiology signs out at 5:00 p.m., you magically become qualified to read your own images. So even though the people in radiology and the emergency department all have good intentions of providing quality health care for patients, all have their own agendas—certain issues that they are looking out for. Often, unfortunately, it comes back to money and pressure to perform financially. The question, “Who is getting paid for this piece of the work?” is often the driver of these wedges.

The interaction between radiology and the ED is an example of a source of frustration that can create a huge gulf between the intentions and the impact of leaders. Blowups can happen between leaders or staff of departments at these flashpoints, and the impact can be detrimental to the smooth functioning of the organization toward everyone’s goal serving the patient with quality health care.

After such a blowup, a leader needs to sit down and have a reflective internal conversation over four points—the issue from the leader’s own perspective, the issue from the other side’s perspective, the leader’s own intentions, and the impact of the actions that were taken to achieve those intentions.

Leaders need to look at what happened in these situations first from their own perspectives. They first should ask themselves, “What really happened here?” The answer might be that, “We were busy, we were inundated with patients, and we had X-rays in radiology that were taking more than an hour to be read, and we couldn’t move the patients or get anything done.”

The next portion of this conversation is, “What is their story?” What does the other side say happened? The other side might say, “We want to do a good job and be thorough because we know how mistakes happen.”

Then the conversation goes to, “What were my intentions?” The leader might say, “My intention in contacting this person and saying ‘Get your butt down here right now and help me out’ was to improve the level of patient care we were giving at the time.” However, regardless of the intentions, the impact of that action was to anger the other individual, which is often detrimental in the long run to those good intentions.

Then, the next time the same issues again are coming to a head, that emergency department leader needs to have that conversation, but in the present and future tense. “What are my intentions, and what will be the impact of my actions.”

Taking a “Time Out”

The Joint Commission on Accreditation of Healthcare Organizations, in its new guidelines for wrong-site, wrong-person surgery, urges the surgical team to take a “time out” before the surgery to discuss what it is they are trying to accomplish and how they intend to accomplish it—intentions and impact. Leaders also need to take that “time out,” but internally. They have to slow down and take advantage of that moment of thought and reason in order to get things moving faster later.

Coaching Can Bring Balance

It is easy to see why coaching can help bring a balance between intentions and impact. Executive coaching involves working intensely with the leader involved, in part through gathering honest feedback from the people around them—something that is difficult for leaders to acquire themselves. The 360-degree survey assesses the client’s behavior on the job against a set of competencies required for success. The surveys are distributed and completed by people from all around the client—supervisors, peers, and direct reports. The resulting multiple responses, including the self-assessment, provides valuable insight and feedback on how others view the client’s actual performance on the job.

There can be a clash of perceptions that causes concerns. This is often the result of various personal styles and how those styles are communicated. In one case, the perception of the people around one of the executive clients I worked with was that he was far too demanding. His self-perception, however, was that he was decisive. The client, after taking the widely-used Myers-Briggs Type Indicator (MBTI) assessment turns out to be an ENTJ—a common type among organizational leaders.

Through my coaching I informed the client that an ENTJ personality style can often be perceived as demanding, and yet these people are very logical, intuitive and decisive, and most of the time they do have the right answers. However, it’s the way they communicate that totally shuts down everything. Their intention is to get things moving, make a decision and get on with it. The impact is often that he’s arrogant and demanding.

We can’t read minds or tell the future, so we can’t always know what impact our actions will have, no matter how good our intentions. However, a little “time out” taken to reflect on our intentions and how we plan to bring them about, preferably before a one-on-one interaction, can have a positive impact on our workplaces and on our effectiveness as leaders.