Ep. 033 Built to Survive, Not Scale — Rebuild Healthcare While Running

Your emergency department is at 80% capacity and already falling apart. Staff are burning out, wait times are climbing, and errors are increasing.

And leadership solution is typically to work harder, move faster, maybe, just maybe we'll hire more people. But here's what nobody wants to admit.

Your hospital isn't failing because you're understaffed. It's failing because you built it to survive, not scale.

And today we're exposing why healthcare infrastructure shakes at the seams and how to rebuild while running because leadership is the software systems are the hardware and if your foundation cracks at 80

you'll never be able to handle what's coming this is bread to lead the business of healthcare and i'm your host dr jake taylor jacobs let's get into it

since the age of 12, I've been about my father's business. At the age of 30, he sent me to his vineyard.
Welcome back to Bread to Lead Bridge Builders. This is your host, Dr.
Jake Taylor Jacobs.

And

this segment is a very important segment to me because it addresses a lot of the,

I don't want to say issues, but inefficiencies within the hospital system that I believe that can be fixed over time.

And coming from being a corporate fixer and turning around underperforming companies and seeing the commonalities in that, in this healthcare space and us as healthcare being here 20 years, dealing with operations within the hospital system, the commonalities are not only the same,

there's a call for a huge change. And in this podcast, if you don't know Bread to Lead, it is about the business of healthcare.

But if you're listening from anything else, anywhere else, you'll be able to get these isms and apply it to wherever your business is.

But most importantly, to healthcare, to start thinking more operationally sound.

And as we make decisions, as we're increasing things, but also thinking about anything that we add to the department or anything we add to the organization, we are truly focusing on

looking at all things that could be affected when we're implementing certain things within this space, specifically within healthcare.

So, all right, if you are new to Bread to Lead, please stop right now and go ahead and click.

that follow button and share this episode out to someone that's in leadership that may want to hear this information. But most importantly, please rate us as we are in the top 15.

We battle between top 10 and top 15 business podcasts in the country, and we're working on 2026, going for the number one spot. But we cannot do it without your listening ears.

This podcast is meant to be a pod class. We're educating you on how to become a better leader.

Think of every other week or every week, whenever we post, this is a seminar for you to get better as a leader. You can apply it until the next episode.

So, all right, we're just going to get right into the uncomfortable truth. Every hospital has a shaking point,

and it's that capacity level where things start to fall apart. And for some, it's around at 70%.

Others may make it to 85% capacity. But here's what's frustrating.
And what most leaders miss, it's rarely about volume. Indeed, most cases is about infrastructure.

And let me paint you a picture with two hospitals that we worked with recently.

Real hospitals, real problems, very different outcomes. Hospital A, they start shaking at around 75% capacity.
The minute they hit that number, overtime skyrockets. They're calling in agencies.

Managers are in crisis mode. The CNO is living in our office.
Everyone's a hero and everyone's exhausted. Option Hospital B,

in the same city, actually, similar demographics, similar patient acuity. They're smooth at 95% capacity, 95%.

Same patient complexity, same regulatory environment, same everything, except their foundations are different.

And the difference is Hospital B understood something critical that I want you to write down if you're taking notes. You can't optimize what's already broken.

And let me say that again for the people in the back. You cannot optimize what is already broken.
Hospital B took six months, yes, six months to slow down and rebuild their core processes.

They redesigned workflows. They standardized operations.
They built redundancy into their systems. They created infrastructure that could breathe under pressure.

While hospital A, they're still patching cracks three years later, still calling agencies, still bleeding money on band-aids, still having pizza parties to boost morale while their foundation is crumbling.

And here's the truth, Bomb, that's going to make some of you uncomfortable. And sometimes we have to slow down to get faster.
And I know, I know that sounds like corporate consultant speaking,

but just stick with me because I'm about to show you why this isn't just philosophy. It's actually physics.

So before we move forward, if you have not had a chance to read our white paper, operational blindness, you can go to our

company site, sipshealthcare.com, and look at the white paper that I wrote on operational blindness and talking about the inefficiencies of hospital systems because of this operational blindness.

But if you're in any other industry, I think that you'll be able to read this white paper and see areas where you can actually implement them into your business model within the healthcare space or outside the healthcare space.

But I think it's very important for us to understand and diagnose what these things are so that you're able to know like what this,

I call it almost like a disease, this operational blindness. It's like a cancer that begins to expand over time.

I think you should take your time and go to our Simpshealthcare.com site, click articles. You'll be able to see our white paper.
There, I think it's something for you to dive into.

Or if you're on my LinkedIn, go to Jake Taylor Jacobs, Dr. Jake Taylor Jacobs with an ER.
And it is my post, I believe, that's appended there. So you can go check it out there.

So we talk about like getting back into the concept of what we're talking about today and dealing with this.

The first thing that, you know, when it comes to a turnaround in an organization, or if you're a leader at a hospital system and you truly want to be the go-to person for turning around underperforming departments within your system, you have to diagnose the infrastructure.

And a lot of times we bring assessors in or we assess the things such as, you know, bio-burden burden on sets or you know did someone skip a step but that's not truly all of what's inclined in the infrastructure so we're going to talk a little bit about that and and and how to actually diagnose if your infrastructure is truly built to survive or is it built to scale and how do you diagnose whether you're hospital a or hospital b i'm going to give you a diagnostic tool right now So get ready to get uncomfortable because this is going to hit close to home for a lot of you.

But the best thing that we can do is take these tools and actually apply it to our organizations.

A survival infrastructure is actually what most hospitals have. The first sign is heroes are needed daily.

If someone is staying late every day to make things work, if you're constantly celebrating people who go above and beyond, if your operations depend on a superhuman effort, you have a survival infrastructure.

And it's very key for us to actually get keen on observing our organization's structure and seeing if we actually are living on this hero syndrome where one person has to come in and save the day every single day or, you know, pandemonia, pandemonium hits the city like a plague like we're in Gotham City every day.

The second sign of a survival infrastructure is processes depend on specific people. Oh, we can't run Tuesday's OR schedule without Sarah.
Only Tom knows how to fix the sterilizer.

If Maria calls in sick, the whole unit falls apart. That's not a strong team.
That's a house of cards.

So that's the second sign that you're built on a survival infrastructure that's still solely based on having a hero. Again, with the first sign.

The third sign of survival infrastructure is knowledge lives in heads of people, not systems and processes. Your policies are outdated.
Your procedures are suggestions.

And the real knowledge of how things work live inside of people's heads. And it walks out the door every single night.

And so every time that that legacy person or that knowledgeable person or that subject matter expert within your department leaves the hospital, what this is insinuating is that when they leave, your hospital is at risk.

When they are in the hospital or in the department, then everything is fine and well.

But if they get sick or if they're threatened to go to another facility or if they're asked for a raise that you just can't give, now your hospital is in this position

of being

leveraged in a way to where it's only benefiting the person who brings the most benefit, which is the person who has the most information in their head.

That's typically the person that ends up getting overworked and overrun quite naturally because they're the person that has that legacy knowledge inside.

So the goal is for you to pull that knowledge out of people and build it in systems so that the system can operate.

I want you to imagine before there was a such thing as today's technology, people used to use their brains.

As a matter of fact, some great mathematicians were called human calculators where they can calculate the hardest

numbers possible on earth. The arithmetic was absolutely out of this world crazy.
And the complexities of them being able to take take formulas and dilute them into the simplest form or result

was a notion. It's almost like an awe to even think about.

And infrastructure were built on brains of people.

And then when you look at technology today, there's a motherboard just like your brain, and there's wires that go to it, just like your brain.

There's processes and what to do and what not to do, just like your brain.

Inside your organization, the goal is to take the subject matter expert and take it out, the information out of their brain and to actually make it a system. John D.

Rockefeller wrote his son a letter. And in the letter, he said that the greatest leaders of all make the hardest things to do simple for the average ordinary person.

And the worst leaders are the ones that only want to be known as the only person that knows the information.

And you can see that in the Rockefeller system and their structure in comparison to the Vanderbilt's family structure, where everything was built on these knowledge heads within the family.

But once that's gone, it kind of leaves. So those are some of the things I want you to think about.
The fourth sign that you're in this survival infrastructure is that every surge of

new cases feels like a crisis. A 10% increase in volume shouldn't feel like an apocalypse.
But in survival infrastructure, it does.

It just seems like everything is everywhere because in those down times, you're not preparing for a surge time. It's almost like

give and take type of relationship. If there are lulls within case load, we shouldn't be downsizing our staff.
We should actually be building capacity.

So when the increase happens, we can actually deal with that throughput and increase volume in perpetuity, which just means continue time.

So we can continue to build the value of the hospital system of the organization that we're in.

But if on the downtime, we're resting, we're taking a break, we're not getting better, or we're downsizing literally staff during downtime because we have a lull period.

It doesn't prepare us when we have a spike. So it always feels like apocalypse a thousand.
The fifth sign that you're in an infrastructure built for survival is growth means chaos.

The bigger you get, the more problems that you have, the more volume you handle, the more heroes that you need. And it's multiplication of chaos, not leverage of systems.

And so one of the biggest things that we focused on when I came on board with the SIPS and our newest CEO, Donnie, was downsizing bulkiness, our service lines that looked good on paper, but weren't really good on the profit margins.

And it seemed like

our highest level profit margins were actually paying for the larger line items that didn't make as much money. It didn't necessarily make sense for us to keep those service items open.

as it looked great as far as bulkiness in our top line, but it was terrible at the bottom line. And it didn't really help a lot.
So we had to kind of scale a lot of those service lines off.

And then, when it came to the bulkiness of our administrative staff, the bulkiness of our field staff,

you know, as they, as they say, consultants on the beach, people getting paid salaries just to sit and wait, those things had to be shrunk down.

So, we spent about a year, year and a half, really, really fine-tuning and getting

our infrastructure in place and systems and policies and procedures and

proprietary

methodologies written out so that we can then be able to expose those things to the market. But it took a little bit of downsizing.
It took a little bit of saying no to certain opportunities.

It took a little bit of saying no to different service lines that, you know, in theory sounds good to explore, but it doesn't sound good in perpetuity.

For an example, if you're building out another OR wing that's specific to a specific type of service and that rare disease or that rare medical situation, it takes a lot to build out a wing to support that.

But if you don't think about what type of effect that puts on the hospital and what will be the real throughput of that type of service line coming in, you may be able to charge a lot more, but guess what?

Everybody else costs a lot more too, because of the specialty of dealing with that specific type of case.

These are things that you really have to think about because it really sets your organization back.

So us as a company, we have to say, hey, for 20 years, we've been known to do this thing, but this thing that we've been doing, although, yes, we're one of the market leaders in it, but it doesn't truly help the organization.

It just sounds good to stay in that space.

So we have to find a way to kind of maneuver our way from being around that and focus on the things that are the most profitable, but the areas and service lines we make the most impact.

And I think that it's it's very important when you're looking at your department or your organizations, figure out where is all the busy work coming from and what systems can we put in place to either X those things out or spend less time on it so that we can fix that thing.

So growth doesn't mean chaos for us. Growth means efficiency and growth means productivity still is staying on par as if it was still slower.

The sixth sign that you're in an infrastructure of survival. And the last sign that I have is success depends on individual success.

You're only as good as your weakest link and you pray that that link doesn't call in sick during joint commission. And we see it all, you know, we see it all the time.

And I think it's very important, again, to understand that just all of the ecosystem of an infrastructure that is not built to scale, in most cases, is solely dependent on one person or whether what we say in turnaround terminology, every department only has one star or every organization only has three stars and everyone else is just like the supporting cast.

No, in every department, you need two or three stars in every department.

You need great bench players. You need people that can truly add value that are buying into the system.
And I like to attribute things like this.

In sports, they have what they call 10-day contracts. And 10-day contracts are much like staffing is in healthcare.

You're looking for a good enough, talented person that can come in, not mess anything up, and come back out while your leader is gone.

Or you may have sometimes you have sports teams where the superstar got hurt for the rest of the year, and then they go into the free agency and they pick up a decent caliber person that can kind of fill in that gap.

But that person knows that they're not going to be there forever. They're just kind of there to fill in that gap until the leader comes back or they can find another superstar.

I say that to say, but that new person coming in is still subjugated to the system already in place.

Now, the organization may change a few things just to make that player coming in that's filling in the gaps a little bit easier for them to kind of catch up to the plays.

But overall, that person will eventually have to run the system. And I say that to say this.

A lot of times, even we have a leader that leaves without letting us know or things happen to where that person that was high performing isn't performing anymore. Maybe they have family issues.

Maybe they have external hobbies that are picking up in a way that they never thought before. So it's taking their eyes off kind of the healthcare space of their job.
So they're not performing bad.

They're just not overly performing. And you need them to overperform.

Now, what happens, you call in temp staffing to come in to fill these holes or fill these gaps. And

we're allowing the temp staffing agencies to be able to determine what the cadence is for your department. And how can I say this?

We've been doing it 20 years as a staff, as a company that had a staffing arm and staffing component, when we staffed many times, the hospital system outside of orientation didn't have a true structure.

So our staff is in there kind of having their way and doing what they're responsible for doing, but everyone does it a little bit differently.

So now you have an organization that has two or three different agencies staffing the department, let alone everyone running on their own history of how they run things in the past.

Therefore, there is no one directional system or structure that everyone can be held accountable to.

So this is what we're talking about, truly building a department that can be built on scale, but most of us can't grow within our organizations, within our departments, because it's built on survival.

No one takes the time to say, hey, let's slow this down a little bit so that we can be able to build something. And when it grows, we can grow with efficiency in the best way possible.

So I'm going to go over with you six ways for for you to observe your department and determine if you're, if you're built for scaling.

And the first way to know if you're built for scale is if system runs without a hero. People can take vacations.
They can have lives.

The operation continues because it's built into the system, not dependent on sacrifice. I think it's very important that we understand that.
Okay.

If you want the best people to stay within your organization, you have to make it easier for them to win.

If they feel like they're always having to climb climb a mountain just to see a win, yes, it feels good in the in the newness of the position.

But five, six, seven, eight, nine, 10 years in, and they feel like their body is plummeting, their stress levels are high. What they loved about the job is no longer what they love about the job.

And they're even looking at different careers because this is burning them out so much. You have to really ask yourself, is this just the industry that we're in?

Or is it because we're poorly run and we need to address that system in itself? These are the things that when SIPS healthcare, when we come into hospital systems, we're addressing those factors.

Not this is how we've always done it. You know, we can't get talent.
No, there's a reason why talent doesn't stay and there's a reason why talent never comes

because of the headache of knowing I'm going to have to give 60, 70 hours a week of my life. And yes, they may pay me time and a half on vacations.
I may get another premium.

But outside of that, at some point, your top leaders start asking, is this money worth this in my life?

So what we kind of got to understand so that we can understand that it can't be built on sacrifice. It has to be built on forward thinking and optimizing those areas.
And it takes time, but you can't.

The second way to know if you're scaling infrastructure is processes work regardless of who's there. A new grad or a 20-year veteran.
The process guides them to the right outcome.

That's not dumbing things down. That's smart design.
And again, it goes back to John D. Rockefeller.
He said, man, the smartest people build systems that ordinary people can run on.

They may say, man, that takes away from the value of my leaders. They really do truly feel that,

you know,

what they know people have to put their time and experience in. You can't just give it out.
Yes. And that's going to make your organization stay in a weak position.

You want your organization, your system to run so well that a new person really feels like they're at

another hospital's 20-year vet inability because of the system.

And it actually allows for them to learn a lot faster when you have systems and processes for everything and you have people that are bought into the systems and processes, not calling things dumb.

Third, the way to know that you have a scaling infrastructure is knowledge is documented inaccessible to anyone.

Not in some binder that nobody reads, but in living, breathing, visual systems that guide work, that guide the work in real time.

And that's why I love our sterile by design operational intelligence system.

It's truly built for really running the entire sterile processing department, including materials management and soft goods management, instrument management, but also managing the workflow, but using operational intelligence to stop mistakes before they happen.

We spend a lot of time fixing mistakes and mitigating errors and finding supplies and trying to find all the recall. We spend a lot of time on

monotonous work when we really should be spending time on truly creating an organization that can continue to thrive long term.

So we have to really understand that, listen, you can have all the processes and procedures and you say, man, we have every document that there is, but if it's not living and breathing, yes, it's there, but it's not there.

It's like having a Bible in your home and saying, man, I, yeah, I have a Bible, but do you read the Bible? Is the Bible in your heart? Is God in your spirit?

Do you really truly resonate with the Holy Spirit? Or are you just saying, hey, man, I'm familiar with the terminology. I'm familiar with what's going on.
And that is that.

So those are things we've got to look at. The fourth way to know if you have a scaling infrastructure is your surges that you have are expected and planned for.
You built a flex into your system.

You've got triggers and responses. Yeah,

a 20% surge is uncomfortable, but it's manageable. Not catastrophic.
It's manageable. I'm expecting the worst.

I tell organizations all the time, build your department and your organization on the worst things of life happening and pray and hope for the best.

Because if I build it on the worst happening, worst case scenario, when you hit worst case scenario, because you always will, you prepare for it. You prepare for it.

And I think it's important. The fifth way of knowing if your organization or infrastructure is built on scale is growing.
Growth means leveraging what exists. More volume doesn't mean more complexity.

It means better utilization of the systems that you build. I think that's just key.

And the last way of knowing if your organization is built on infrastructure, if your infrastructure is built on scale, is success is built into the design. You don't need superstars to make it work.

The system makes ordinary people capable of extraordinary outcomes. Simple.

Our system is so good, the average ordinary person looks amazing. You know, my favorite basketball player of all time is Draymond Green.
Everyone talks so much crap.

If Draymond Green was not a part of the San Francisco Warriors, I said San Francisco Warriors.

If Draymond Green was not a part of the Warriors that were in Oakland, the Warriors with Steph Curry,

he would not be. a Hall of Famer in the future.

And my answer is, good for him and good for that organization that they can build such a system that an above average talent can make it into the Hall of Fame as if he were extraordinary because he was able to master the system.

You don't want teams like

OKC in the past, OKC now, Oklahoma City Thunder now to have a system and great talent with a system.

Imagine having a system with great talent,

let alone a system with average or above average talent or average talent, and you're still competing. Now, let's take LeBron James and the Cleveland Cavaliers before he went to Miami Heat.

What happened? He got to the finals every single year,

nearly, and never could win. Why? Because an organization built on one or two talents can never win a championship.

He needed to go to an organization that had a system and top talent to win a championship. What is that parallel? What is that parallel here?

The parallel to this space of healthcare and building organizations is that it's not enough just to have high caliber talented people because they will always leave you and there will always be a numbers game.

You got to pay me more to stay.

Versus having a very well-run system that attracts highly talented people to want to come be a part of the system because their workload is less and the numbers make sense when it comes to the amount of money they ask for.

Now, you have more money in your budget to build your department.

The better run your system, the less that you will have to pay people in premium dollar because they will value the system that they're in more than the personal dollar that they can make being stressed out somewhere else.

Very important that you understand that.

So, when you're And

here's a best diagnostic test.

When your best charged nurse calls in sick, does the unit run smoothly or do they scramble? When your lead tech quits, do you panic or do you promote?

When volume surge, do you strategize or do you just survive? Most hospitals are running on what I call heroic infrastructure. It only works when everyone gives 110%.

But let me ask you this question, something very simple. What happens? when you need 150%?

What happens when 110% isn't enough?

Let's go ahead and get to our commercial, our commercial breaks right now so that we can continue to go.

If you have not received our Bread to Lead book, Bread to Lead or Built to Bleed, please go to SipsHealthcare.com and go and get a copy of our Bread to Lead book or Built to Bleed, or you can get them on Amazon.

These are great reads on how to truly build out your steel process department and healthcare organizations to determine the areas that you are not operating well on.

Bread to lead is definitely something there.

And if you're looking for a technology that truly can stop and mitigate mistakes before they happen, SIPS Healthcare actually is the first company to own a software and a technology that can track your entire store processes department and everything from instruments to soft goods.

But not only that, it can mitigate errors before the errors even happen because humans make the same mistake over and over again, specifically in this space.

And our job is to be able to stop those mistakes before they cause harm to someone else.

You can go to sipshealthcare.com and fill out a questionnaire for us to reach back out to you so they can get a free demo on what it looks like for there.

Another thing to announce is coming up in February. If you are in Dallas, we host

our

Scrub Ball Valentine,

Scrubby Time event every year for your loved ones. So you can get your loved one together, come find a boot thing, ooh thing.

It's a way for us to be able to build camaraderie within the community in Dallas. So if you're out of the state of Texas or you're in the city of DFW, please come on by for that.

In June 25th, we're having our very first annual golf tournament. We're looking for teams.
We're looking for sponsors. If you want to participate in that, you will not only be able to

join and be able to have your sponsorship, company sponsorship things up, you will also be able to be shouted, get a shout out on our platform, which is the top 15 business podcast in the country, and as space for that.

So if you're looking into that, please reach out to us

there.

All right, we are done with commercial time.

So we're in a segment now where we're talking about the scaling paradox. We just talked about how to observe and how to look at different infrastructure.

And I think it's very important for us to be able to do that.

But also with that, I think it's also important for us to talk about the paradox of scaling and the paradox that keeps healthcare leaders up at night.

And if you're in leadership, this is going to sound extremely familiar. The busier you are, the less time you have to build infrastructure.
But the less infrastructure you have, the busier you'll be.

It's a death spiral. I know it.
And most hospitals are trapped in it. You're too busy fighting today's fires to prevent tomorrow's.

You're too overwhelmed managing crisis to build systems that prevent crisis. I get it.

You're too short staffed to create processes that would actually solve your staffing issues. And there's only one way out.

And you have to be willing to slow down strategically. And I can already hear the objections.
I hear them all the time. Dr.
Jake, we can't slow down. Patients need us.
The board's watching.

Metrics matter. The budget's tight.
And I get it. I've been there.
I've sat in those meetings. I've heard those arguments.
Hell, I've even made those arguments myself.

But let me ask you this, and I want you to truly, truly think about it. What's more dangerous? Taking three months to rebuild your still processing workflow?

Or having instruments unavailable during surgery because your system breaks that capacity? What costs more?

Six months of strategic restructuring or three years of agency staffing, overtime, and turnover. What's riskier? Slowing down right now to build it right or pushing forward until it falls apart.

The military has a saying that I love,

and it says, slow is smooth, but smooth is fast. When I was doing corporate turnarounds, before I focused entirely on healthcare, I learned this lesson the hard way.

Companies will hire me when they were in a crisis, everything was on fire, everything was in panic mode, and their instincts were always the same. We need to move faster, we need to work harder.

And my answer simply is no, you need to work smarter.

You need to build systems that create speed, not demand it.

And healthcare needs to learn this lesson before we shake apart completely. Because here's what's coming.
And if you're not ready for this, you better get ready. Patient volumes are going to go up.

Complexity is going to increase. Reimbursements are decreasing.
Workforce shortages are anticipated. And if you're shaking on 80%

now, what happens when the wave hits? That's the question I want you to ask yourself. Because trouble is coming.
The question is, how prepared are you for that trouble? How prepared? And

I get it. There's a lot of hospital systems saying, man, we're sending our team to go get their lean Sigma 6 belts and blacks and blues.

But then when you put them into the field, they can't fix anything.

Can't fix it anyway. Can't fix anything because rebuilding an organization isn't always based on analytics either.
There's a human component that is built into there.

There's There's a safety component, a psychological safety component. It's a workforce safety component.

It's an operational safety component that has to be put into place or put there so that you can be able to know where your organization truly stands.

Because if you are the top man on the totem pole as a leader, you're probably only going to get about five to 10 people in your hospital system or in your department.

depending on how large it is, that's going to tell you the truth about where things really are.

Everybody else is going to kiss your butt, going to tell you what you want to to hear, and you're going to post on LinkedIn how amazing everything is running when deep down inside, you know, it's not.

And the only way that you beat those odds when you're going to go talk to your board is if you skew the P ⁇ L sheets. By saying, hey, let's say no to that right now.

Let's put this up to the next budget. Let's approve it, but let's not get it.
Let's recapitalize this here.

Let's approve this budget so that we can get approved for it and then use this money over here to help this stopgap that we had over here.

We're running the hospital departments like we run our own personal finances. It is in a mess.
It is ensembles, but yet we drive nice cars.

We look good on the outside, but our financial balance sheet at home is terrible and it's looking the same way at the hospitals that we're running. That's the truth.
We got to fix it.

And the truth is, I'm going to be honest,

some people should never be running hospitals or organizations in the first place.

If you can't balance your own home books to make the right decision at home, you shouldn't be allowed to run a hospital where other people have to depend on you. I got it.
I got it.

You're tired of me fussing at you this podcast. I told you it's a podcast.
It's like coming to class every single year. You know, every single week, you know, your professor is going to be passionate.

I'm just passionate. That's it.
I'm just passionate.

You know, I thought about ways to dial it down to, you know, sound a little bit more astute, like earning a doctorate isn't enough.

I actually heard someone say that there's no way that I could be a doctor, earn my doctorate, because I don't give doctor.

I guess I'm just boisterous or I'm loud or I'm ambitious or I'm excited.

Or what about I'm passionate about what I do? That I'm seeing the same common mistakes happen over and over, time and time again.

And the scariest thing is that those same common mistakes, it's different when I'm turning around a

company who sells toilet tissue.

It's another thing when I'm seeing the same mistakes happen in a hospital that's supposed to be saving lives.

That's where the passion is. But okay.
All right. Enough with the diagnosis.
Let's talk about the treatment.

In this phase of the podcast, I always start with the problem at hand and I finish with the solution.

I always want you to leave with something that's applicable and you can apply it to your life or in your department.

The question is, how do you actually rebuild while running? Because I know you can't shut down the hospital. I don't want you to.
I know patients will keep coming and I know the work doesn't stop.

I'm going to give you the exact playbook that we've used with dozens of hospitals through SIPS Healthcare. This is the sterile by design methodology applied to infrastructure scaling.

So get your pens out because it is actionable. Step one, you have to identify your shaking point.
Okay.

Step one of the rebuild, how to rebuild your organization. Step one, you have to identify your shaking point.
You need data, not feelings. Map out exactly when and where your system starts to fail.

Is it 70% capacity or 80%?

Which departments crack first? Is it sterile processing that becomes the bottleneck or is it the OR? Is it environmental services? You want to document everything. You want to create time studies.

You want to know the error rates, overtime hours, agency usage, patient complaints, staff turnover. and find a correlation between capacity and chaos.

Most leaders think they need to know their shaking point

and you don't.

You know when people start complaining. That's different from when the system actually starts failing.
The system usually starts failing way before people speak up.

So again, what I was saying before, most leaders think that they know their shaking point and they don't.

They don't know it.

So you're waiting on people to come tell you something. You're like, oh my God, something's happening.

No, I want you to think of people telling you something like your body finally aching or reaching out.

If you all of a sudden started to, you know, urinate blood,

you're like, oh, my body's talking to me. No, your body was talking to you when your kidneys were hurting or you stayed up late at night for three months straight because your back was getting tight.

You didn't know what it was.

The system will let you know the error points if you know what you're looking at. So step two.
for being able to rebuild your department.

You got to design your department for the 150%.

And this is where most hospitals get it wrong. They design for today's volume and maybe add about 10% for growth.
That's survival thinking. I want you to design for 150% of your current capacity.

Ask yourself, what would this process look like if we doubled in volume? Because here's the secret. If you design for 150%,

running at 100% feels easy. If you design for 100%,

running at 80% feels hard. This isn't about buying more equipment or hiring more people.
It's about designing processes that scale. It's about rebuilding systems that leverage, not just expand.

Meaning, if I had to bring in a slew of more people,

what would be the quality of those people through our intake? and onboarding process that can ensure I can get people up to speed quick enough for the expansion. That's what that means.

It doesn't mean that you have to hire hire 20 more FTEs to just sit and wait on your books. No, it just means what is my onboarding system?

And most organizations think you have a phenomenal onboarding system until I observe what your turnover rate is and how inefficient people are and how long they're inefficient in your department.

But because you got, you have good PowerPoints and you have a great speaker and someone's charismatic and you think that that is what it takes to have a great onboarding system. And it's not.

It's not the process. Step three and what you need for a rebuild.

Now,

you got to pilot in parallel. You can't shut down a department to rebuild.
So you run a new system alongside the old one. Pick a unit, one department, one process.

Build the new one while maintaining the old. This is where the magic happens.
Your staff will be able to see the difference. They can feel the difference.

They become your evangelists evangelists for change because they're living the improvement.

We did this with a stealth process department in the Midwest, ran the new workflow on first shift while maintaining the old workflow on second shift.

Within two weeks, the second shift was begging to switch to the new system. That's how you create a pull for change, not a push.
Okay. A lot of organizations try to do overhauls in the department.

And a lot of it is because the hospital says, hey, this company is coming in. Y'all have six months to fix this.

When in fact, you really need three to six months to master first shift to get the second and third shift to want what the first shift has. So it's easier for that implementation process.

But trying to overhaul an entire department,

overhaul an entire department for change can move too fast. So this piloting in parallel is important.

I'm going to run my new technology and my new system alongside of my old technology and my old system

until I can make an exchange.

That's how it works. Step four in this rebuilding of your department.
Variation is the enemy of scale. I'm going to say that again.
Variation is the enemy of scale.

The more standardized your core processes are, the more capacity you create for complexity where it matters.

Standardize the routine so you can customize the exception.

When I say customize the exception, what I mean is in your organization, you're going to have an exceptional things that pop up, maybe in personnel, maybe in a case, maybe in a surgeon, maybe in a tech where you create the exception for.

But the exception is not the standard. Everyone operates on the same standard.
This does not mean robotic mindless work.

It means creating frameworks that free people to think about what matters instead of figuring out basic processes every single day. Think about it like this.
At McDonald's, okay,

they've standardized the burger making process so well that they can serve millions consistently.

But at Michelin star restaurants, they've standardized the prep work so the chef can focus on creating art. Healthcare needs both.
Standardize the routine and excel at the exceptional.

The fifth step in rebuilding your department or organization

is to stop celebrating how fast you're moving and start measuring how stable you are at speed. Can you maintain quality at 95% capacity? That's the real metric.

Can you sustain performance without burning out your team? That's what matters. Create what we call stability indicators, metrics that tell you when your system is starting to shake before it breaks.

Maybe it's when overtime hits a certain percentage. Maybe it's when specific errors, error types increase.
Maybe it's when certain staff start calling in sick a little bit more often.

These are your early warning signs that tell you that you need to adjust before you break.

And the thing I love about our our system and our technology, Stir by Design, is that there's bells and there's a different sounding bell for everything, like just like your body, just like your car.

When you get inside your car, you have different bells and different sounds that mean different things that let you know what's going on inside your car that you can't see.

The same thing with your body, which should be the same thing for your organization. It's very important.

Now we're going to get into a

we wanna get into the Valley Regional case study that we have. In order for us to get into there, I definitely want us to take some time to process what we just talked about.

We have performed a regional case study on a system that we're participating with, we're partnering with, to turn them around.

I'm going to tell you, because their story perfectly illustrates everything we're talking about. The hospital system was shaking.

No, they weren't convulsing. at 75% capacity, but they were definitely shaking.

Still processing was indeed the bottleneck and or delays were daily surgeons were furious one surgeon actually threw an instrument tray not at anyone just threw it because he was so frustrated uh with the delays and staff were quitting left and right they gone through three spd managers in 18 months overtime was through the roof they were spending about a hundred thousand dollars a month on agency staff just to maintain basic operations the leadership solution was hire more tech add more shifts, buy more equipment, throw money at the problem until it goes away.

We said no. We said stop actually.
Let us actually solve this. The CEO looked at me like I was insane.

He said, we can't slow down. He said,

we're barely keeping up as it is. And I said, exactly, you're barely keeping up at 75%.

What happens when you hit 100%?

Pause and he didn't have an answer. So here's what we did.
We implement this third by design methodology, methodology, but we started with infrastructure, not training.

First, we mapped out every single instrument flow, and I mean every single one, from the movement it left, the moment it left the OR to the moment it returned. We found 47 unnecessary steps.
47

steps that added no value, just complexity. Second, we redesigned the workflow from scratch, not tweaking what existed, reimagining what could be.

We asked, if we were building this department from scratch, from a hospital twice our size, what would it look like?

Third, we rebuilt redundancies into the system, not redundant people, redundant processes. If one autoclay went down, the workflow automatically adjusted.

If one tech called in sick, the system compensated. Fourth, we created standard work that anyone could follow, not dumbed down, smartened up.

Visual management, clear indicators, mistake proofing built into the design. Fifth,

this was critical and crucial. We implemented what we call pool systems.
Instruments weren't pushed through the process. They were pooled based on the actual OR demand.

No more processing instruments just in case. No more searching for what you need.
It took four months. The board was nervous.
The OR was skeptical.

Several surgeons told the CEO it was a waste of time and money. Today Today they run smoothly at

95% capacity. Get this, with fewer staff than they had before.
Let that sink in.

They're handing 20% more volume with fewer people. They're handling 20% more volume with fewer people.
Overtime is down 60%,

and they haven't used an agency in 18 months. Our delays related to instruments are down 94%.

But here's my favorite metric: staff turnover in the SPD went from 67% annually to 8%.

8%.

They slowed down to speed up. And now they're fastest, they're the fastest in the region.
And other hospitals are sending teams to study the operations.

The CEO who thought I was insane now opens every board meeting with what he calls their new principle. Invest in infrastructure before crisis, not after.

If you have consulting companies coming in trying to train your staff and get them up to speed, you cannot train staff about a system that they cannot see.

Even Jesus performed miracles before he told people to follow him. You have to build the miracle, let them see the change, and then train them on the new way.

That's how it works.

Most people and organizations are pragmatic. They're not optimistic.
So you have to build around that concept.

The next portion is that cultural component.

But here's what no one talks about. And this is what most infrastructure rebuilds, this is why most infrastructure rebuilds fail.
Rebuilding infrastructure isn't just about processes.

It's about culture. You have to build a culture that values stability over heroics.
Let me repeat that. You have to build a culture that values stability over heroics.

This is hard in healthcare. We're addicted to adrenaline.
We love the hero narrative. We give awards to people who stay until midnight to fix problems.

We promote firefighters, not fire prevention specialists. Think about your last staff meeting.
Who got recognized? Was it the person who prevented the problems or the person who solved them?

Was it the person who built the system that eliminated errors or was it the person who caught the errors before they reached the patient? We celebrate the catch, not the prevention.

We reward the save, not the system. But if you want to scale without shaking, you need leaders who understand the goal isn't to be, to manage crisis better, it's to prevent crisis all together.

This requires a fundamental shift in how we think about excellence. Excellence isn't working harder.
It's working smarter. Excellence isn't individual heroics.
It's system reliability.

Build processes that prevent burnout, not just manage it. Create systems that anticipate surge, not just survive it.
Design infrastructure that thrives under pressure, not just endures it.

I was working with the CNO recently who told me, Dr. Jake, our staff loves being heroes.
They love the adrenaline rush of saving the day. And I said, great.

What happens when they can't be heroes anymore? What happens when they're too burned out to save anyone? She got quiet. Here's the truth.
Your staff don't actually want to be heroes.

They want to be professionals. They want to do excellent work without sacrificing their lives.
They want to go home on time knowing they did their job well, not stay late being a hero.

The hero culture isn't serving anyone, not your staff, not your patients, nor your bottom line. Now, I do want to talk about

the

leadership component in this, because this is honestly where the rubber hits the road.

If you have not had a chance to look at our operational blindness white paper, please go to sipshealthcare.com and and get you a copy of that white paper. It's also on my LinkedIn, Dr.

Jake Taylor Jacobs, E-R-T-O-L-E-R, Dr. Jake Taylor Jacobs on my LinkedIn.
It's posted, it's pinned. You should be able to go in, read that white paper.

It's a very detailed white paper, and I also have an AI audio reader.

In case you go to our site, my Simpson Healthcare, to read that white paper, you will be able to just kick, click, play on a YouTube video. And watch that.

And if you have not gotten our books bred to lead

or built to bleed, you can go to our site and find those books. You can go to Amazon and order you a couple of copies for you and your team to actually diverge, divulge and go through together.

Now, we're in this leadership initiative.

If you're in leadership and you're listening to this thinking, this sounds great, but my executives will never go for it. You're proud of the problem.
I don't say that to be harsh.

I say it because it's true. Change doesn't happen from the bottom up in infrastructure.
It happens from the top down.

And if you're waiting for someone someone else to lead this charge, you're waiting for failure. Here's what leaders need to understand.

Every day you derail or you delay rebuilding your infrastructure, you're choosing crisis, you're choosing burnout, you're choosing turnover, you're choosing to shake at 80% instead of scaling at 150%.

It's not a passive choice. It's active.
Every budget meeting where you don't allocate resources for infrastructure improvement, you're actively choosing chaos.

And infrastructure improvement is not only subjugated to the building itself. Infrastructure improvements also in reference to the workflow, the operations, the processes.

That's the invisible that is causing effects in the physical. It's important.

It's important.

It's very important.

You'll say, Dr. Jake, we don't have the budget.

You don't have the budget not to do this. That's what you don't have.
You can say you don't have the budget at all, but you don't have the budget not to do it either. What's your agency spend?

That's my question. What's your overtime cost is my question.
What's your turnover expense is my question. What's the cost of delayed surgeries, medical errors, patient dissatisfaction?

And add it all up. And I guarantee you, it's more than the cost of rebuilding your infrastructure.
Another excuse, Dr. Jake, we don't have time.

You don't have time because you haven't built systems that create time. You're stuck in the paradox.
The only way out is through. But Dr.
Jake, the board won't understand. Then make them understand.

Show them the numbers. Show them what shaking at 80% is actually costing them.
Show them what scaling to 150% could save. This is your job as a leader, not to manage crisis, but to prevent it.

Not to be the hero, but to build systems that don't need heroes. If you wanted to be a hero, call it being a hero.

Be the hero, the leader that stands up for your department and for your hospital when they can't stand up for themselves.

And here's something that should keep you up at night. If you're in healthcare leadership, your competitors are figuring this out.
Because don't forget, you're still in the competitive business.

While you're shaking at 80%,

there's a hospital across town or right across the street or right next door that's smooth at 95. While you're patching problems, they're preventing them.

While you're calling agencies, they're developing internal talent. This isn't theoretical.
This is happening right now.

The hospitals that invest in infrastructure, real infrastructure, not just equipment, are pulling away from the pack, and it's easy to see. They're becoming destination employers.

They're becoming centers of excellence. They're becoming the places where the best want to work and patients want to be treated.
They're not competing on price. They're competing on reliability.

They're not competing on marketing. They're competing on outcomes.
They're not competing on promises. They're competing on performance.
And here's the kicker.

Once they build this infrastructure advantage, it's almost impossible to catch up. Because while you're trying to build, they're already optimizing.

While you're trying to stabilize, they're already scaling. And it's like trying to fix a plane while flying it, while the other plane is already cruising at altitude.
And

this is why the time to act isn't when you're in a crisis. It's now before the crisis, before the shake, before the break.

So you say, okay, Doc, I see the problem. I understand the solution.

I already know what you're thinking. You're asking, where do I even start?

Start this week. Identify your shaking points.
Look at your data from the last six weeks. In what capacity do overtime hours spike?

At what capacity does it spike?

Where do error rates increase? When do complaints rise? Find your numbers. Then this month, pick one process, just one, that's critical to your operation.
Map it completely.

Every step, every handoff, every decision point. Then ask if we double the volume with this process work.
If the answer is no, you found your starting point. Then this quarter, run a pilot.

Pick one unit, one shift, one team. Rebuild their process from scale for scale.
Run it parallel to your existing process. Measure the difference.
Document the

improvement and use it to build your case for broader change. And then this year, make an infrastructure investment.

Make infrastructure investment a strategic priority, not an operational afterthought. Put in your strategic plan.
Allocate budget to it. Assign leaders to it.
Measure progress on it.

And stop treating infrastructure as something you'll get to when you have time. You'll never have time.
You have to make time.

So here's your choice. And it really is a choice.

You can keep patching cracks and calling agencies and burning out staff and shaking at 80%, or you can slow down strategically, rebuild your foundation and create infrastructure that handles whatever comes next.

Your competitors are making this choice right now. They're choosing to build, not just survive.
They're choosing to scale, not just sustain. They're choosing to lead, not just manage.

The question isn't whether you can afford to slow down and rebuild it. It's whether you can afford not to.
Because here's the truth. And this is what I want you to remember.

Every system has a shaking point. But only broken systems shake at 80%.

If your hospital is shaking, it's not a capacity problem. It's an infrastructure problem.
And infrastructure problems don't get better with time. They actually get worse.
The cracks get wider.

The shaking gets worse. The breaking becomes inevitable.
So you need to stop optimizing chaos and start building for scale and stop celebrating heroes.

Start creating systems that make everyone feel heroic without the pain or the time that heroes have to take away from doing the things they love most or being their family. Stop managing crisis.

Start preventing it. Look, I know this episode went a little bit long and it may have hit hard for some of you.

And I know some of you are sitting in your car or at the desk or on your commute or on the floor thinking, this is exactly what we're going through. And good.
Awareness is the first step.

But awareness without action is just anxiety. You have to do something with this information.
You have to take the next step.

If you're thinking, I'm just a manager, I'm just a director, or I'm just a tech, stop. You're not just anything.
You're a leader regardless of your title.

And leaders don't wait for permission to solve problems. They identify them, they build solutions, and they make the case for change.

Whether you are in the basement or the boardroom, you can be a catalyst for building infrastructures that scale. Now remember, leadership is the software, systems are the hardware.

But if you're shaking at 80%, it's time to rebuild both. And I want to leave you with something.

You judge a leader not by how well the organization operates when they're there.

You judge a leader by how well

our organization operates when the leader leaves. That's when you know if they truly build an organization that can sustain and grow without them.

If they cannot, if every time a leader leaves a hospital, it collapse, that lets you know how weak that leader truly is.

You should see breadcrumbs of amazingness built when the leader leaves, not bricks laid out from disaster when it broke when the leader left. This has been bred to lead.
This is Dr. Jake Taylor Jakes.

I'm reminding you that the distance from the basement to the boardroom isn't measured in floors. It's measured in decisions.

Your decision to build infrastructure that scales instead of systems that shake, that might be the most important decision that you make this year.

So if you found value in this episode, share it with another healthcare leader who needs to hear it. Subscribe wherever you get your podcast.

And remember, if you're ready to stop shaking and start scaling, the resources are in the show notes. Until next time, keep building, keep leading.

And remember, from the basement to the boardroom, it is all possible. And most importantly, be a bridge builder that changes the healthcare industry forever.
I'm going to take the lead.

Next week on Bread to Lead, we're diving into clinical excellence trap. Why promoting your best technician may be the worst leadership decision.

We're exposing how healthcare keeps selecting for the wrong traits and wondering why leadership fails.

Plus, I'll share the five capabilities every leader needs that have nothing to do with technical skills. You won't want to miss it.

And hey, if you want to go deeper on building scalable infrastructure, check out Built to Bleed, my book that exposes why healthcare is designed to fail and how to fix it. Link is in the show notes.

This is Bread to Lead, Keep Building Bridge Builders.