Ep. 030- From Dependency to Design: Hospitals Shouldn't Have to Rent Stability

0:00We're dealing with one of the greatest leadership gaps ever in American history, where education no longer meets experience and experience isn't as in depth as a learning capabilities. needed to run certain organizations and people are running organizations to the ground, specifically in healthcare. I know I haven't posted since February. Thank you for making us top 10 business in a business category. All I have to say is Bridge Builders, I'm back.

0:40As a song says, welcome back, welcome back, welcome back. What is going on, Bridge Builders? Where have you been? No, the question should be, where have you been, Dr. Jake? And I'm going to tell you something. I've been doing what everyone should be doing, getting better and pushing for a much better world to live in collectively together. Bridge Builders, if you are new to this podcast, I want to tell you right now, go ahead and stop and subscribe currently right now. And I may I just may, depending on how many people subscribe, I just may post the full video on YouTube. Other than that, this podcast can be listened to exclusively on Apple podcast and several other podcast platforms that the system that we use distributes it to.

1:26But most importantly, I just want to say again, like I said in the intro, thank you so much for making us the top 10 business podcast in the country in the top 30 all categories podcast in the country. This means that you are open and wanting real information, no fluff, no extra stuff. But I do have some things I do want to address before we get into the podcast. This season is going to be a season of all. We're not just going to have people come on to the podcast. We're going to have master classes on this podcast from the doers and the shakers that are in the health care space, from entrepreneurs to executives to professionals to clinicians to physicians to surgeons.

2:06We're bringing the entire gamut because our goal is to push the thought of innovation into health care in the space that's healthy, but also so that we can be able to adjust and be ready for change to happen. Listen, Bridge Builders, this is the season of change and including this podcast. We're going to see a lot of changes. However, it's going to just continue to get better. So I'm your host. I'm Dr. Jake Taylor Jacobs. And over the next 12 weeks, we're not just going to talk about health care leadership crisis. We're going to talk about how we can redesign it together, because here's the truth.

2:39Nobody wants to say it out loud. Leadership is the software. Systems are the hardware. If we don't upgrade both hospitals, we'll continue to keep crashing. So let's talk about what I call renting stability. For the past 20 years, our company has been in the staffing and consulting space. And I've watched this pattern repeat itself in hospital after hospital. Hospitals across America have become addicted to temporary staffing, travel nurses, local physicians, contract administrators, temp ally support support. We've normalized paying premium rates for short term solutions while our permanent workforce erodes beneath our feet.

3:27And here's what two decades in this industry has taught me. And here's what two decades in this industry has taught us. The hospital that thrives focus on building internal infrastructure. The hospitals that struggle keep reaching for temporary fixes that end up costing exponentially more. The numbers are staggering. A staff nurse might cost a hospital$80 ,000 annually. That same position filled by a traveler. Try one hundred fifty thousand to two hundred thousand dollars, sometimes more. Multiply that across hundreds of positions and you're looking at a budget hemorrhaging millions. But here's what doesn't show up in the budget reports.

4:14It's the hidden costs. The knowledge drain. Travelers rotate every 13 weeks. They take whatever institutional knowledge they gained with them through you and leave. Your hospital never builds memory. Culture erosion. Permanent staff watch travelers make double their salary for the same work. And resentment builds. Engagement plummets. And your best people start updating their resumes, secretly quitting and leaving. Patient continuity, how do you build trust and consistency in care when your team changes every quarter? Now, I'm not demonizing anyone in travel as the large majority of our support has been in travel for the last 20 years.

4:58But many are exceptional clinicians or tacticians who fill critical gaps. But when the gap becomes the strategy, when temporary becomes permanent, you don't have a staffing plan. you have a dependency cycle. And like any dependency, it gets harder to quit the longer that you're hooked. Listen, I know I'm talking to somebody that's listening and I hope that you're taking it. We're not bashing any of what our system has been. And I sure wouldn't be coming to you and telling you this if I didn't feel like there needs to be a better way, even if it means that us as a company, we're evolving to support you differently.

5:38The hard work, slash software check. Every episode, we're going to diagnose a health care leadership problem. The way an IT specialist diagnoses a computer crash. Because hospitals aren't just businesses, they're complex operating systems. And right now we're running outdated code on broken machinery. Let's audit the traveler dependency crisis, the hardware problem, staffing ratios based on outdated models, scheduling systems that can't flex with real demand, compensation structures that haven't evolved in decades, physical environments that burn people out. The software problems are leaderships who manage crisis instead of preventing them.

6:22No systematic retention strategy, culture that doesn't recognize warning signs until people quit and zero investment in building internal pipeline programs. Do you see the issue? We keep installing patches, bring in more travelers, offer small bonuses, pizza parties in the break room when what we need is a complete system rewrite. The hard work. The harder question is, do we have the infrastructure to support sustainable staffing? The softer question is, do we have leaderships, leaders equipped to design and execute that infrastructure? Most hospitals fail both checks. And let me share a conversation I had last month with a critical care nurse.

7:02We'll call her Sarah. Sarah had worked at the same level one trauma center for eight years. Excellent reviews, preceptor for new hires, the kind of nurse you build a unit around. She quit not because of the work, not because of the patients, because every week she watched her hospital pay travelers one hundred dollars an hour while she made 38. She watched administrators tell her that there is no budget for raises, then turn around and sign another contract with the staffing agency. Here's what Sarah said that stuck with me. They can find money for strangers, but not for people who stayed. That's not a compensation issue.

7:42That's a values crisis. When your financial decisions tell your loyal staff they're worth less than outsiders, you're not managing a budget. You're destroying a culture. And culture isn't soft. Earthculture is the operating system that determines whether your people show up engaged or just going through the motions, whether they solve problems or wait for someone else to solve them, whether they stay or they walk. Traveler dependency doesn't just drain budget. It flatlines innovation because innovation requires trust, continuity and people who care about tomorrow, not just today's shift. And what I began to identify and realize is that there's a lot of hospital systems and even executive leaders who underestimate how long it takes to fix a hole.

8:27So so what I've seen is executive will say, oh, we only need 13 weeks. We have 26 weeks. We got a new leader coming in. And they don't take into account how long it takes for even people to adapt to each other. So the very thing that you thought will be a 13, 26 week fix as a whole is something that's becoming a part of your everyday recruiting or development system. And you're showing newer leaders or people that have been there in shorter terms that you're willing to pay without question. People who are coming outside of your system more than people that are coming inside of your system and developing inside.

9:04And matter of fact, I've seen certain professionals leave a hospital system, get with a staffing company just to come back into the hospital system at the price point that they would prefer. So when we talk about the diagnosis, we're talking about true issues that have been historically broken for a very long time, but it takes too much energy to restructure it. So we keep doing the same thing over and over again. I know we're like, Dr. J, you came back a little strong. Now you were supposed to come back into segment 30, into section three, a little softer, not as aggressive. But it's the same, Dr.

9:43J, and the purpose of this podcast is to push you to think bigger, larger, faster and be bold with the decisions that you're making. Even if you have in your mind, you're only going to be at that hospital system for three years. You know, it's going to take you a year and a half just to get the ability to get the confidence of everyone around you to give you signing a power or the ability to influence change. So if you know in your mind, you're only going to be there three to four years, halfway into your bid at that hospital system. You need to be focused on making lasting change. And what I'm beginning to realize is that most leaders in hospital systems never make it to their second term.

10:24And when I'm talking about that, I'm talking about it in more of a presidential type of approach. Presidents have two terms, eight years. Some serve as vice president and all these other things. So they've been around the office for some time, but they only have two terms. And what is what I'm starting to realize is that there are a lot of leaders who who who go to certain hospital systems only for a one term focus. One term focus. I'm here for four years, three to four years and I'm out. It doesn't matter. I'm gone. I just want the title and to say I have the experience. But how can you say that you've gained the experience if you don't have proof of concept of actually winning, creating such change that is still last and they're still using what you developed years later?

11:06That's positively affecting the hospital system, not negatively drawing it back. We're not talking about making shortcut changes where you're cutting staff or you're cutting people off just to make it look like you made the hospital more profitable for your next transition in the jump. We're seeing these jumps happen over and over again. And yes, you're saying based on experience and environment. Yes, you were around all of these things. But can you say that you've mastered the job responsibilities that you were put in charge of why you were in that system? This is what we have to actually acknowledge and see before we decide to move about.

11:44All right, I got it. That's enough diagnosis. Let's talk about design. What if instead of renting stability, we actually built it? Some hospitals are already doing this. They're not perfect, but they're getting results. I want to go over a couple of design principles so that you can be able to say, you know what? You're right. This is something that does require change and I have to see it in that way. So the first design principle that I want to bring you to and listen closely, this is when I stopped the podcast and say, listen, take notes, bring out your pen and pad. If you're on the floor right now, screenshot me saying this so you know what to come back to.

12:30So you understand the design principle notes. Okay. Design principle. Number one, every great organization invests in their own pipeline. They don't wait for the market to deliver talent. They grow it themselves. Partner with nursing schools, partner with junior colleges, partner with trade schools, partner with alternative schools, partner with gifted programs, partner with residency programs. Create these things inside your department, inside your facility. Just as they have residency programs for surgeons and doctors and physicians, build residency apprenticeship pathways for non-clinical roles.

13:08Truly develop internally so that you can see what true growth looks like. Yes, it costs money up front, but you're already spending it just on travelers instead of your future. This is exactly why we built our still by design operational system. After 20 years of watching perioperative departments cycle through the same temporary staffing crisis over and over, we realized something. The problem wasn't the people. It was the absence of a true infrastructure. Matter of fact, there's a timing thing that we have in this space. It says once a hospital gets everyone out, there's always this wager six months or 12 months before they'll need them back.

13:46Because most people make these changes without considering the consequence. The change seems easy when the consequence isn't considered. So I'm hoping that this podcast or this hits your airways in a way that makes you rethink, wait, We may have a problem here You may say dr. Jake. I don't want to spend time investing in people that will leave Where you're spending time investing in people that are sure to leave they're on a 13-week contract currently right now And after this crisis happened over and over again, we realized something the problem wasn't the people It was the absence of a true infrastructure Stir by design doesn't just help you fill today's gap.

14:26It helps you build permanent solutions for the structural problems most hospitals have been ignoring for decades. We're talking about the operational frameworks that address workflow designs, competency development, quality systems, and leadership pipelines. All the things that get sacrificed when you're in constant crisis mode. Because here's what we've learned. You can't build a world-class peri-op department on the backs of temporary workers. You need real permanent infrastructure that creates stability, that develops talent, that builds institutional knowledge, that compounds over time. Simply, you can't build permanent change on the backs of temporary help.

15:11This is not building a building where you bring in part time contractors. We're talking about ensuring patient safety, but most importantly, ensuring profitability for your hospital system, which means you need people in your hospital system that cares about it being profitable and it being successful. But you can't get that if your team or your staff or your organization doesn't see that you're willing to invest into that to see that change. But it also goes to leadership that are great at being tacticians, but not really great at developing infrastructure and systems The very first thing I look at when rebuilding or restructuring your organization is how can I start to build a talent development system?

15:58I can't change the momentum of bad things happening currently Because if I implement new change with the same people that I have with the same mentality The new technology the new instrumentation the new machines the new processes the new policies don't change the fact that we still have the same people. So inherently to change the very system I'm looking to create that looks positive and healthy and profitable, I must change, develop or curate the type of talent or people within my organization so that they understand and honor the new systems, technology, machinery that we're putting in place.

16:30But to do one without the other, you can't have one without the other. So these are the things that we don't consider when we're implementing something new. I know that technology sounds great, but technology, new technology with the same type minded people are the same as you're going to get the same result. Just faster and more chaotic and less ability to hide it. Now, design principle number two, radical compensation, transparency. If you're paying travelers one hundred dollars an hour, your staff knows. Stop pretending they don't. Instead, create transparent retention incentives, market adjustments, longevity bonuses, make staying worth it financially for them, not just emotionally.

17:17It's important. And the very thing that hurts your legacy professionals, your legacy players are when they've been in the industry for 10, 15, 20 years. Yet you want them to act like there's a blind eye, like you're not paying a traveler more. Then the traveler comes in and they give lackluster effort or they're they're a weaker professional or tactician than your current staff. There's the very first way to break any trust with your current organization is to bring somebody in and pay them double or triple times more an hour. And they'd be worse than your current staff that you currently have.

17:57Design principle number three, treat scheduling as a strategy. Most hospitals schedule reactively. Fill the holes, pray nothing breaks. High-performing organizations schedule proactively. They use predictive analytics. They flex based on real-time demand. They give staff control of their schedules. They turn out. Autonomy, what turns out is that autonomy is a powerful retention tool. But if you want your staff to have control of their schedules, you have to create parameters and put provisions in place. Meaning performance matters to full control of schedule. And yet everyone still has to rotate the dead hours that they do not want so that you always have a fill in the gap.

18:40These are the areas that give you true synergy and alignment. Why? Because every single person in your organization is a leader, an adult, a parent, a mom somewhere else. So to come into the organization, giving some form of earned autonomy, I'm telling you, that's one of the greatest retention tools on planet Earth. Design principle number four, leadership that listens. Here's a radical idea. Ask your staff what they need. Not in an annual survey they know is going to get ignored. Real listening, regular leadership rounding, exit interviews. Take them seriously. Hear what people are saying as they're leaving your organization.

19:22Because most people don't quit jobs. They quit leaders who don't see them. And none of this is magic. It's just design thinking. Applied to health care leadership. It's choosing to build systems instead of buying more and more band-aids. And it's what separates the hospital still stuck in dependency cycle from the ones breaking free. in 20 years of staffing and consulting as a company. We've seen both paths. The hospital that commits to building internal infrastructure and the ones that stop treating every problem like an emergency and start designing for long term. Those are the ones that win, not just financially, culturally, clinically.

20:08They become the places people want to work, not the places people escape from. And here's the uncomfortable truth. The traveler crisis is a symptom, not the disease. The disease isn't that we've tolerated leadership by crisis management for so long. We've forgotten what proactive design looks like. We've accepted that hospitals should run on burnout and turnover, that losing your best people is just how it is, that spending billions on temporary fixes is somehow more realistic than building sustainable solutions. But it doesn't have to be this way. Leadership is the software. Systems are the hardware.

20:45And we can upgrade them both. Over the next 11 weeks, we're going to show you how. We're going to talk about workforce planning, financial stewardship, cultural architecture, and yes, the role of faith and the purpose in leading through chaos. Because healthcare leadership isn't just a job, it's a calling. It's time we start treating it like such. So here's your challenge this week. If you are a leader, ask yourself, Am I managing crisis or am I preventing them? Am I renting stability or am I building it? And if you're not in leadership yet, if you're the Sarah of your organization, watching the dysfunction and wondering if anyone's going to fix it, maybe you're the one who needs to step up.

21:30This season is called From Dependency to Design for a reason. We're done being victims of broken systems. It's time to rebuild. I'm your host, Dr. Jake Taylor-Jacobs. This is Bread to Lead. And in this season, we're talking about some really good stuff. So next week, episode 31, we're talking about the trauma budget, why we fund chaos, but star prevention. And remember, this season, we've got an exclusive masterclass content that you will not want to miss. Head to Bread to Lead dot com to join our community and get access. Subscribe, share this with any leader who needs to hear it. And let's start building the health care system that we deserve.

22:12Thank you for tuning in to another episode of Bread to Lead. Don't forget to subscribe to our podcast to ensure you never miss an episode. And for those bridge builders ready to embrace authentic leadership, check out our Next Step Leadership program at Sips Healthcare. It's time to invest in your future and become the genuine leader your organization needs. Wait, before you go, let's shine a spotlight on our partners at a center.