Happy Monday, Healthcare Leaders!
Welcome to this week’s issue of The Healthcare Leader, where we’ll compare thermostat vs thermometer leaders, when you need to encourage your team to target getting Bs instead of As, and one of the most important elements of landing your next role as a healthcare leader.
Let’s dive in.
In Today's Issue
🧠 Leadership: Great Leaders Are Thermostats, Not Thermometers
There’s a classic leadership question:
Are you a thermometer or a thermostat leader?
A thermometer measures the temperature in the room but does nothing to change it.
In leadership, this can feel like advocacy or relationship building — when it may actually be amplifying problems rather than solving them.
A thermostat leader, on the other hand, sets the temperature.
They recognize what can be controlled, influence culture, and provide stability during uncertain or stressful moments.
In Leadership Without Easy Answers, Ronald Heifetz describes a core leadership responsibility as regulating the “distress” within an organization:
“Leadership is the activity of mobilizing people to tackle tough challenges and thrive… Leaders must regulate the heat of the system.”
Thermostat leaders don’t just cool things down. Sometimes they turn up the heat — creating enough urgency and accountability to avoid complacency.
Too little pressure leads to apathy.
Too much pressure leads to panic.
Great leaders maintain urgency while leaving enough slack for people to believe success is achievable.
As Quint Studer wrote in Hardwiring Excellence:
“Organizations move in the direction of the conversations leaders are having.”
The tone leaders set — especially during pressure — shapes the entire system.
Organizations move in the direction of the conversations leaders are having.
Discussion & Reflection
When pressure rises in your department, do you tend to reflect the temperature or set it?
Where might your team benefit from either more urgency or more support right now?
⚙️ Operations: I’d Rather Have 5 B’s Than 1 A and 4 F’s
In my first healthcare leadership role, I supported a team responsible for creating training resources for change management initiatives, software rollouts, and onboarding.
Many of these projects were tied to quarterly launches where the system would go live whether we were ready or not.
We often had multiple initiatives competing for attention – and it quickly became clear that trying to perfect one project meant several others would fall short.
That’s when I first started using a phrase I’ve used many times since:
“I’d rather have 5 B’s than 1 A and 4 F’s.”
Of course, everyone would prefer five A’s. But when time and resources are constrained, it’s often better to get several initiatives to 80% than to perfect one while others fail entirely.
The concept mirrors the Pareto Principle — focusing the first 20% of effort on the highest impact work across multiple priorities.
Healthcare operations research supports this idea as well.
In a well-known Health Affairs study, Litvak and Long (2000) examined hospital flow and concluded:
“Hospitals often attempt to solve flow problems by increasing capacity rather than reducing variability.”
However, they concluded, inefficiency often comes from operational variability, not lack of resources.
When inconsistent results occur across too many processes — registration, discharge order delays, lab bottlenecks, room turnover — the entire system slows.
Today lab is on time, but the physician is late. Yesterday registration was smooth, but EVS was behind on room turnover.
Operational excellence often isn’t about perfecting one area – it’s about creating reliability across the entire workflow. Developing a process that works the same, day after day, to deliver results everyone can rely on.
Discussion & Reflection
Where in your organization might leaders be over-optimizing one initiative while neglecting others?
What would improve if multiple processes were brought to “B-level reliability” rather than waiting for perfection?
🚀 Career: Build Reputation Before You Need It
“Your brand is what people say about you when you're not in the room.”
When a healthcare leadership position opens, the first question executives ask is:
“Who do we know who could step into this role?”
In many cases, leaders already have three to five potential candidates in mind before the job is even posted.
Tony Hsieh, the founder of Zappos, was well known for his ability to build relationships. In his book Delivering Happiness, he encouraged people to focus less on traditional networking and more on building genuine friendships and professional connections.
His reasoning was simple: you rarely know where a relationship will lead – with the personal or professional benefits often emerge two or three years later.
In many cases, your next role is being decided right now.
The bosses you work with, peers you collaborate with, and industry colleagues you engage with are taking note. Is this someone I would choose to work with again? Is this someone I could trust to support my team in the future?
You’re much more likely to step into that next role if the hiring leader already knows you and trusts you to deliver results with integrity.
Start building those relationships today.
Discussion & Reflection
If a promotional opportunity opened tomorrow, what would people say about your readiness when you're not in the room?
What relationships or collaborations could you invest in today that might matter years down the road?
Know someone passionate about becoming the best healthcare leader they can be? Forward them this newsletter – let’s all grow as professionals together.
Until next time, stay inspired!
Rob Erich