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Dr. Jake Taylor Jacobs
Bridge builders. Before we get started today, I have an announcement. Operational Blindness. The book is officially out. I'm super excited about it. This book right here is our best work here at Sims Healthcare. We talk about why healthcare leaders can't see what's costing millions of dollars now to fix it, and how the industry currently, right now is not dealing with a people issue, we're dealing with a system issue. If we're having a hard time keeping our best people, if our most 10 year talent are aging out and we continuously deal with shortages, there has to be a systemic root problem and not just what we're visibly seeing. We're not just seeing a shortage, we're seeing something else that we believe that in Operational blindness we begin to talk about just with a subsector of the healthcare space. And we hope that it can be a value add to anyone that is watching or listening. So you can go to breadtolead.com blind breadtolee.com blind so you can get a copy of this book. And if you find us live, we're speaking on stage somewhere, you invite us to your chapter or, or we're talking to you one on one. Some of you also are awarded a free copy of Operational Blindness. If you out and about, if you cannot afford the actual book right now. Things are just tight right now. What I would encourage you to do, I would encourage you to just listen to this free podcast. There's so many value valuable points that we pull out and I use the podcast as a microphone to the book that was actually written. And if you're newer to leadership, Bread to Lead is a great book to start with. If you're newer to SPD management leadership, Built to Bleed is the next great book. This is actually my, I believe, like 11th or 12th book that I've written. If you go to Amazon, you all will see it. And so I know some of you that are listening, you're not in healthcare. So this book, Operational Blindness is great for healthcare. However, there are nuggets that you can pull from it that doesn't necessarily cater to your industry because there are some things that are healthcare specific, but there are lots of things that you can pull from. And I know that there are tons of listeners that are listening that are not in healthcare, but you engage with the bridge builders every single week. And some of you are in manufacturing, you're in tech, you're, you're on a logistics company or professional services firm. You found this podcast because you care about leadership and operational excellence. You might be wondering, is this book for you. And what I will tell you is this book does use healthcare specific studies as a case study because that's my current world that I'm in. That's where we're spending a lot of our time. However, I need you to know those that are listening that don't know me, I'm a, I'm an operational turnaround specialist and re engineering inefficient systems and operational structures. Some of the things that bring me the most joy and, and operational blindness, the condition that we, we, we, we tailored and that we named is in every organization all over the country. So those are things that you know, you can, you can purchase to be able to support. And I'm excited about that. And, and today we're going into, you know, pretty much two things. The last couple of episodes we talked about all types of stuff as, as far as the diagnosis and the first thing of today, I'm going to be painting you a picture of what transformation looks like and, and what becomes possible when you can dream outside of the condition that you're in. And then the second point, I'm going to give you a formal definition, the precise clinical diagnosis of exactly what operational blindness is going to be vis the vision. Then it's going to be precision. Then next. Until then, I will see you all because I'm happy to be back on bread to leave. Let's get it.
Guest Speaker
Since the age of 12 I've been about my father's business. At the age of 30 he sent me to his vineyard.
Dr. Jake Taylor Jacobs
Welcome back bridge builders. I AM your host, Dr. Jake Taylor Jacobs. And yes, I am excited that you are around and you're back again. In case you don't know, this is episode 39, season three. This is the read and teach series from my newest book Operational Blindness which which just launched. It's available on breadtolead.com blind this is what I'm reading as we're going through this series. So let me catch you up. Episode 35 we were talking about the IBM lesson of Luke Gser and how he proved that elephants can dance, that stuck organizations can, can transform and that if you change the system and not just the people, you can see transformation in organization that most people dream of. And then, then we went on to episode 36 where we talked about the healthcare parallel. We showed how SPD is the upstream constraint everyone ignores and named the conditions operational blindness. Episode 37 we talked about the dangerous comfort of invisible beliefs and why the beliefs you don't know are the ones that are actually controlling you. And we Talked about episode 38, the beliefs that bind for specific beliefs that are chaining health organizations and leaders in every organization to dysfunction. And today, we're just bringing it all together. What does the future look like when we break free? And what exactly is the condition you're breaking free from? So let's get into it. I want to start off by addressing something directly.
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Some of you are.
Dr. Jake Taylor Jacobs
Johnny, Right now you're listening to this podcast because you're looking for a lifeline. You're exhausted. You're frustrated. You're wondering if anything will ever change. Maybe you're an SPD director. You can't understand why your hard work never seems to be enough. Maybe you're an OR director tired of managing workarounds for problems you didn't create. Maybe your COO who's invested in efficiency initiatives that keep hitting the same ceiling. And maybe, you know, you're. You're a plant manager, maybe a cto. Whatever your role, whatever your industry, if you're stuck, if you keep hitting that same wall, I want you to know something. It's not your fault. You've been operating inside of a system that makes success impossible. You've been measured on things that don't reflect your real impact. You've been held accountable for outcomes that you couldn't see or control. And that's not a personal failing. That's a system failing. But here's the other side of the coin. Now that you know it's a system problem, you have a responsibility.
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You can't just throw up your hands
Dr. Jake Taylor Jacobs
and say, it's the system while continuing to operate the same way.
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Once you see the cage, you have
Dr. Jake Taylor Jacobs
to work to escape it. And today's episode is about what escape looks like and what exactly you're escaping from. And I'm gonna read to you a section in the book that's called the Dance Begins. It starts on page 30. I'm gonna read from page 30 to page 32. And the dance Begins. It says, let me return to that hospital conference room where we started. Picture the CFO with unexplained cost overruns. The COO fielding complaints from surgical services. The CNO worried about quality metrics. The SPD director offering explanations that explain nothing. Now picture something different. Picture an SPD leader who can see downstream impact, who knows exactly how the department's operations affect or efficiency, surgical outcomes and organizational costs. Picture a team that operates proactively rather than reactively, anticipating needs instead of responding to crisis. Picture a department that speaks the language of outcomes, not activities that can translate what they do in terms the C suite understands and values. Picture the surgeon who stops hoarding instruments because they trust the system to deliver. Picture the CFO who can finally trace costs to root causes. Picture the CNO who sees quality risk declining instead of accumulating. This isn't a fantasy. It's what's possible when operational blindness is cured. And everyone told Gerstner that IBM was too far gone to save. Everyone told him the culture was too entrenched, the bureaucracy too thick and the problems too deep. Everyone said elephants can't dance. Well, Luke Gerstner proved them wrong. And your hospital can prove them wrong too. Let's begin. What is operational blindness? I want to tell you about two SPD directors I've worked with. I'll call them Maria and David. The stories illustrate something important about the problem we're trying to solve. Maria ran the sterile processing Department of 400 Bed Regional Medical Center. She had been in a role for eight years. Her team respected her, her metrics were solid. And when I first met her, she walked me through her operation with obvious pride. The turnaround times, the productivity numbers, the process improvements she had implemented over the years. By any conventional measure, she was doing her job well. Then I spent a day in the or. What I what I saw didn't match what Maria had shown me. Cases were delayed waiting for instruments. Surgeons and had personal stashes of equipment they've accumulated because they didn't trust the system circulating. Nurses spent significant amount of time hunting down missing items and the OR director was frustrated. And when I asked about the relationship with spd, she just shook her head. They tell us everything is fine, she said. The numbers look good, but we're struggling every day. When I shared these observations with Maria, she was genuinely surprised. Not defensive, surprised. She had no idea. The dysfunction I witnessed in the OR simply didn't appear on any report she received or any dashboard she monitored. From where she sat, the operations was working. David's situation was a bit different and the details but identical in the pattern. He directed SPD at a large academic medical center. A complex operation with high volume and demanding surgeons. David was sharp experience and genuinely committed to excellence. His department had invested in new technology, implemented lean processes and tracked dozen metrics. And yet the CFO kept asking why Instruments cost were climbing. The quality team kept flagging near miss events. The surgical services leadership kept complaining about reliability. David had all the answers for it. Staffing challenges, physician behavior, supply chain issues, volume growth. But the answer never seemed to resolve the problem. When I analyzed this operation, I found the same Thing I found with Maria, a profound disconnect between what the department could see and what the organization was experiencing. David's metrics measured activity. The organization's pain came from the outcome. And there was no bridge between them. Maria and David weren't bad leaders. They. They weren't lazy or incompetent or dishonest. They were experienced professionals doing their best. Insider system that kept them blind to their own impact. They couldn't fix what they couldn't see. And they couldn't see what this system didn't show. This is operational blindness. And once you understand it, you will see it everywhere. I want to expand on what you just heard. What transformation actually looks like. I painted a picture in that section, But I want to be more vivid. I want you to imagine an SPD leader who can answer with data whether the OR got what it needed yesterday. Not we process 400 trays, but we
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achieved 97 first case readiness, contributed to
Dr. Jake Taylor Jacobs
zero instrument related delays, and supported 52 surgical cases with 99.8% tray accuracy. That's a different conversation. That's outcome language. That's visibility. Imagine a surgical services team that actually trusts the spd.
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The surgeon who used to hoard and
Dr. Jake Taylor Jacobs
instruments in their office. They stopped because they don't need to. The system delivers what they need when they need it. The OR director who used to spend half their day managing workarounds. They're focused on strategic initiatives now because the upstream constraint has been relieved.
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I want you to imagine a CFO
Dr. Jake Taylor Jacobs
who can trace costs to their root causes. The instrument replacement budget. That used to be a mystery. That now there's data showing exactly why those costs are climbing and what operational changes would reduce them. The premium labor that used to be just how things are. Now there's visibility into what's structural and and what's needed to be addressed immediately. Imagine a CNO who sleeps better. The quality risk that used to accumulate invisib invisibly. Now they're surfaced early, addressed systematically and prevented rather than caught the near misses that used to go unreported. Now there's a culture where reporting drives improvement. This isn't fantasy and I want to be clear about it. What I just described isn't fantasy. It's not motivational vision designed to make you feel good. It's real and it's happening in healthcare organizations right now. I built these organ operations. We've seen these transformations. The same people were struggling become successful. The same departments that were failing become reliable. The same relationships that were adversarial become collaborative. Nothing magical. Happened, the system changed. And and I want to pull you back to the universal principle here because
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this applies far beyond healthcare.
Dr. Jake Taylor Jacobs
Every organization has some version of this story. Manufacturing Imagine a plant manager who can finally see how upstream production decisions affect downstream quality metrics. Who stops getting blamed for defects that originated three steps early in the process. And technology. Imagine the infrastructure team that can demonstrate with data how reliability investments prevented outages that would have cost the company millions. Who moves from cost center to strategic enabler in the leadership boss and professional services. Imagine back office operations team that can show exactly how their processes accelerate or constrain client delivery. Who gets investment instead of cuts because their value is finally visible in retail. Imagine the supply chain team that can connect their inventory decisions to same store sales performance. Who stops being squeezed for efficiency and starts being optimized for revenue impact.
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The specifics vary.
Dr. Jake Taylor Jacobs
The principle is constant.
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When you make the invisible visible, everything changes.
Dr. Jake Taylor Jacobs
When upstream functions can see their downstream impact and communicate the impact in terms leadership understands, they stop being overhead and they become strategic. When leadership can see the true cost of underinvestment, not just the line item savings, but the downstream consequences, they make different decisions. We the system enables success instead of guaranteeing failure. The same people produce different outcomes. That's the dance.
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That's what becomes possible.
Dr. Jake Taylor Jacobs
Now. What I just described was destination, but you need the map to get there. And that's what the book provides. It's not just a diagnosis, it's the complete framework. The cost, the cost quantification, the transformation methodology, the road specific playbook. That's what this book does. Go to breadtolead.com forward/blind. The second portion that I want to read of the book is pages 33, 35. And then 33, 35. It's the formal definition. It says Let me be precise about what I mean by operational blindness, because precision matters. We you're naming a problem that most people don't know exist. Operational blindness is a systemic condition in which leaders cannot see the dysfunction in their own operations because the measurement systems, reporting structures and feedback mechanisms they rely on do not surface them. Several elements of this definition are important. First is systemic operational blindness isn't a personal fa, a person failing or personal failing. It's not about individual incompetence or lack of effort. It emerges from the structure of the operation itself, from how information flows, what gets measured and what gets reported. You can replace every person in the department and still have operational blindness if the system remains unchanged. The leaders affected by operational blindness. This is the second definition, especially with visibility and capability is that the leaders affected by operational blinders often have the skills, experience, and motivation to fix problems if only they could see them. The limitation isn't their ability to act, it's their ability to perceive. They're making decisions in the dark. They don't even know that the lights are off. Third, it operates through measurement systems. What you measure shapes what you see. What you see shapes what you manage. And if your measurements are disconnected from outcomes that matter, you optimize for things that don't matter. While critical problems go unaddressed, the metrics become a kind of camouflage, making dysfunction invisible by directing attention elsewhere. Fourth is self portrait perpetuating. Because leaders can't see the dysfunction, they don't know what to fix and how to fix it. Because they don't fix it, it persists. And because it persists, it becomes normal. Because it becomes normal, it stops registering as a problem. Even when its effects are felt through the organization, the blindness sustains itself. It's almost like you're having a headache, but you've been having the same headache for a decade. At first it was an issue you wanted to fix. When you didn't fix it the right way or using the remedy that you thought will work, you just figured that you'll just live with a headache for the rest of your life versus going to get an expert and figuring out what's going on and fixing that problem. You live with a headache for the remainder of your life without even knowing what triggers it. It's exactly what this is. This is why operational blindness is so dangerous. It's so difficult to address. It's not a crisis that announces itself and a slow leak that everyone gets used to. The organization adapts to the dysfunction rather than fixing it. And the adaption itself makes the dysfunction harder to see.
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All right,
Dr. Jake Taylor Jacobs
let's break this down piece by piece. The formal definition. The formal definition, the operation of blindness is a systemic operation condition in which leaders cannot see the dysfunction in their own operations because the measurement systems, reporting structures, and feedback mechanisms they rely on do not surface it. So we talk about the systemic conditions, which is element one. It's talking about how operational blindness isn't a personal failing. It's not about individual incompetence or lack of effort.
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It emerges from the structure of the operation itself, from how information flows, what gets measured and what gets reported.
Dr. Jake Taylor Jacobs
And this is critical and crucial.
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You can replace every person in the
Dr. Jake Taylor Jacobs
department and still have operational blindness if the system remains unchanged. I've watched the organizations literally cycle through directors Cycle through consultants, cycle through technology implementation, cycle through technicians, cycle through supervisors, cycle through chief executives and into right where they started.
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Because they kept trying to fix people and replace people and remove people. But nobody actually said, wait a minute, our system is still the same. So it's, it's producing brokenness because our system was built in broken parts. And people come and go. But if the system is broken, the outcome remains broken, regardless of who's operating within it. Let me make this universal. In any organization, manufacturing, tech services, retail, healthcare, you'll find functions where leadership has cycled through managers repeatedly and nothing improves. The instinct is to say we keep hiring the wrong people or people aren't the same anymore. The reality is usually we keep putting people in the same broken systemic means. The problem is the architecture, not the individual. And the issue that we're dealing with in health care is that we, we're just throwing people into broken systems and wondering why they're even coming out broken. I want my leader to do more, but I have nothing to actually give them to help them do more. They just need to already have more. From broken system to broken system to broken system, and everyone's just plugging the little spark of little successes you're having. You're taking these little sparks and you just putting it together with missing parts. Imagine putting a car together with all different parts that don't even fit each other. Does the car drive? Yes, it drives. Does it stop? Yes, it stops. But all those parts are built to actually work together. No, but it's okay, because this is something that we've always done. And these are the issues that we deal with in organizations, in every industry where we stop trying to find the truth because we want to stand on our version of the truth that fits our narrative of our story, of our position versus allowing the truth to say, hey, what may have worked in the past doesn't work in today's time, so it's okay to evolve and get better. Yes, your idea was a great idea ten years ago, three years ago, two years ago. But when the idea or the truth changes, the facts change. So do you as a leader. What I believed in a decade ago, after evolution of engineering and process improvement and, and system and system manipulation, you begin to realize with the more data sets you have, the more you can get actual truth. And the more truth you have, the more efficient and productive you can become at the thing that you do. But if I don't have any progression in that stage or in that phase, and I'm staying 20 years ago, today, you're the bottleneck of your organization. You're causing the harm and the concern. And no, I, Yes, I'm saying people first, systems always. I'm saying people first. Yes. I'm not saying that people don't need development. What I am saying is that if your organization has no development structure from beginning to end to actually improve your organizational growth or your actual people in your organization, it's kind of funny. It's funny that it seems as though when you're farming, farmers care more about the well being of their animals than just the output of the work that
Dr. Jake Taylor Jacobs
they can do for them.
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But if we go into the workforce, we say, hey man, I pay you to do your job. Yes, you're paying them to do the job, but the extra additive is that you as an executive, as a leader, you're also paying extra investing and also the future of that person. You're paying them for the job they're doing now. The investment is in the growth that they'll have in your organization for later. The investment in your people never stop. The problem is, is that there are leaders in every organization I've ever been to, in every industry that I've been that says, hey, I pay you for your job, so do your job. So you want to pay somebody for their job, but they have to invest in their own future. But you want them to take the investment of their own future and put it in your organization when you put nothing into them. That's what a development pathway says. It says, hey, I'm invested in your future. I'm paying you for today, but I'm investing in you staying. So I need to develop you, I need to curate you and I need to show you that with, within our organizational structure, we do have room for you. And even if you don't have a position for them, you can have development for them at least while they're there. Can they get everything that they can get? This is the big piece systemically that we're missing. Because historically healthcare has used the military as, as a big piece of their, their recruitment meal mule. So a lot of people that were in health care came from the military. So they naturally had order, structure and system. But you forget that somebody invested in that development, someone invested in those skill sets, someone invested in those soft development skills that are needed that brought structure to health care. Because historically health care didn't have systemic or systematic structure until the military came back. The, the, the vets came back from the military and nurses and surgeons and a lot of the surgeries we know today actually were founded and created on the battlefield of war. So they brought those mechanisms to the hospital system, thus making the hospital system a revenue driver. I. E. 60 to 70% of revenue of hospitals are made up of surgeries, surgeries that were created and, and things that were built or the industry that was created from being at war. So knowing that history now we can understand, okay, we're outdated. Our system, Our system is outdated. And that is what, that's the solution that we're bringing healthcare. We're saying, hey, we have such great talent here. But has anyone just actually looked at the system? It doesn't matter. The new body set that you put on that car is still a 1920 Camaro. You can put the new kit on a 1920 Camaro, it's still going to drive like a 1920 Camaro. In element 2, the leaders cannot see this function. This is about visibility and capability. The leaders affected by operational blindness often have skills, experience and, and motivation to fix problems if only they could see them. The limitation isn't their ability to act, it's their ability to perceive. Think about it like this. You may have a brilliant SPD director, a or a talented plant manager, a skilled I. T. Leader that knows how to solve the problem. They've done it before. They want to succeed, but they're making decisions in the dark. They don't even know that the lights are off because they've been in the dark their entire life. Like, my brother has been blind since birth.
Dr. Jake Taylor Jacobs
Literally, my little brother has been blind since birth.
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He has never seen a light of day. So he doesn't know how to operate in the night or the day. So when the lights are off and he's making decisions, he doesn't even know that the lights are off because his lights have always been off. Do you all get it? So a lot of leaders are, are being asked to make decisions based on the, the darkness. Already used to. So, so, so, so they see what the measurement system shows them and they manage whatever is seen, whatever's in the darkness that they're used to. You create the metrics around that. And because those metrics are disconnected from outcomes that matter, they optimize for the wrong things while critical problems go unaddressed. And here's what makes this so insidious. The leaders don't know that they can't see. They, they, they think they're seeing clearly. They have dashboards, they have reports, they have data. But what they don't have is the connection between what they are measuring and what the Organization actually is experiencing, they're measuring activity, the organization is experiencing outcomes. The gap between them is blindness. Like for an example, it's kind of like in sports, in the NBA, right? People that have played ball, you know
Dr. Jake Taylor Jacobs
the feel of a game, you know the look of a player, you can
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see it because you, you were, you were, you, you, you played in those shoes. But you have people that are really great at analytics, that have, that brought analytics to the game of basketball. And those analytics, yes, it does work,
Dr. Jake Taylor Jacobs
but it doesn't tell you the full story.
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The analytics, yes, if I'm measuring wingspan and speed gaps and enclosing gaps and where I sh. On what days, yes, that has an element to it. But the data, the true read of that data is what I'm physically seeing. It's kind of like the data can show you you have a star, but only a feeling can let you know if that person can feel stardom. Like I can look at data and say, oh, this guy should be a star.
Dr. Jake Taylor Jacobs
But when I look and I feel
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him, when I, and I think about the magnetic pool, it's not that of a star. It's the exact same thing. Data can only show you data based on the data that you want to see, not on the measurements that, that need to be seen. So it's all subjective. And your data can be subjective based on what you choose to see, but it doesn't mean what you choose to see is the right data that you
Dr. Jake Taylor Jacobs
should be looking at.
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So you have the measurements, you have the systems, you have the reporting structure, you have the feedback mechanisms. And these are all the, the machineries of blindness. The measurement system determines what you track. What you measure shapes how, what you see. What you see shapes what you manage. And if you, if you measure turnaround time, but you're, but not readiness. You're optimized for turnaround time, even if faster processing of the wrong things makes readiness worse. If you measure output per labor hour, but not downstream impact, you're optimizing for speed, even if speed creates quality problems that cost more than efficiency gains. If you measure cost per transaction, but not value enabled, you cut costs, you'll cut costs, even if those costs reduce value that exceed the savings. The measurement system creates the frame. Everything outside of the frame now becomes invisible. That's why we have to be careful. Even what we measure. When we talk about reporting structures, the reporting structure determines what information flows, where, who sees what, what gets elevated and what gets buried. And if SPD reports through operations, while Surgical Service reports through clinical, there's no structural connection there. The information doesn't flow between them. The upstream can't even see the downstream and the downstream can't see the upstream. If the IT reports through finance while product reports through the CEO, there's a structural gap. It becomes a cost to be minimized rather than enabler to be optimized. Because the CEO is not seeing both sides. The reporting structure creates information silos. And what happens in one silo, it stays invisible to the other unless the other wants to interpret or want to include. Now if you talk about the feedback mechanisms. Feedback mechanisms determine whether systems learn. Does surgical services have a way to provide systemic feedback to spd about their experience, not complaints when things go wrong. Systematic data about what's working and what isn't. Does the customer facing team have a way to provide systemic feedback to the back office about how their processes affect customer experience? If the feedback loop doesn't exist, the system can't learn, it can't adapt and it can't improve. The absence of feedback mechanisms is itself a form of blindness. You're not just unable to see the problem, you're unable to see whether the solutions are working. So we talk about technology. AI algorithms that read and talk back to each other and get smarter. Well, what does the algorithm of AI mimic? It mimics humans. It mimics biology. It mimics how things can duplicate itself one to another. So our feedback mechanisms doesn't have to start with technology. Our feedback mechanisms can start with process and systems that hold everyone accountable to these feedback mechanisms to get smarter. And the only thing different about technology versus humans is that technology doesn't get frustrated. When technology forces itself to get smarter because it read new data, it fixes the data, it recodes, it retrains itself. Now it operates on new data with the human component. Humans get frustrated when there's a course correction or new data that states that what we've been doing is is no longer the most efficient or the best way. So we need to counsel those things. Humans say, hey, I've been doing it this way. Even with this new data, this way works best for me. So I refuse to get better. And thus the conflict happens there. That's the only difference between technology and humans. But the humans that can actually progress and process like technology, your system becomes technology which without the electronics.
Dr. Jake Taylor Jacobs
That's what I'm trying to tell you.
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Technology doesn't make. Electronics are what make technology. Technology is built through people. That's why we say people first, systems always. So now we have a self perpetuating system that doesn't know how to fix itself. So dysfunction that begets dysfunction that begets dysfunction that happens over and over again. And that's exactly how blindness sustains itself. So if we think about those implications, the organization adapts to the dysfunction rather than fixing it. The workarounds become standard operating procedure and firefighting becomes the job. Complaints becomes the background noise. New employees join and learn how things work here. They absorb the dysfunction as normal. They stop questioning what veterans stopped questioning years ago. And the system perpetuates itself across generations of employees. The beliefs are hardened, the assumptions calcify. The blindness deepens. And this is why operational blindness is so dangerous. It doesn't announce itself. It doesn't create visible crisis. It's slow leaks that every. It's a slow leak that everyone gets used to until the building building floods and there's mold everywhere. And this is the thing that we have to see and have to understand. So if you want to look at some of the reports that we've done, our newest and latest report is our operational blindness index where we a personally 101 a surveyed 189 periopoliters and I
Dr. Jake Taylor Jacobs
think that you will be surprised about
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the report that we received about how
Dr. Jake Taylor Jacobs
many hospitals were actually operating in the blind. Go to sipshealthcare.com forward/obi10s healthcare.com forward/obi10 to get access to that report.
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So
Dr. Jake Taylor Jacobs
here's the teaching part and here's the application across all industries. Once you pull this, I want you to take this, I want you to mull it away and this is how to spot operational blindness in any organization. Before I close, I want to give you something that you can actually use. I got you. I got you. Five questions. Five questions. First question.
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Can your upstream functions tell you with
Dr. Jake Taylor Jacobs
data how their work affects downstream outcomes?
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Can SPD tell you how their operations affects or efficiency? Can manufacturing tell you how production decisions affect quality?
Dr. Jake Taylor Jacobs
Customer quality scores can.
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Can IT infrastructure tell you how their investments affect application performance? If the answer is no, if the upstream can only report on the in
Dr. Jake Taylor Jacobs
on their internal activity, you have a visibility gap.
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Question 2 Do your measurement systems track activity or outcomes? Are you measuring turnaround times or readiness? Are you measuring output volume or customer impact? Are you measuring cost per transaction or value creation? If you primarily measuring activity, you're probably optimizing for the wrong things because if you you can't just look at someone's activity and then decide based on activity that they're a value enabler. When somebody can stay busy 40 hours a week. And that makes you happy because you're looking at productivity. But they created no new value for the company. They just appease your productivity log. This is why it's very important to be careful. What you pay attention to will be what you measure. And what you measure will be what you manage. What you manage will be what you have to grow. Question number three. Do systemic feedback loops exist between interdepartment functions? Interdependent functions? The surgical services provide regular structure feedback to spd. Not just complaints, but data. And how does SPD receive it? Does customer success teams provide regular input to product development?
Dr. Jake Taylor Jacobs
Product development, not just escalation or patterns.
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And how do they receive it? The sales provide systemic feedback to operations about what's affecting those close rates and how is it received. If feedback is ad hoc, as I want to, or complaint driven or absent, the system can't learn itself. You have to build a culture that's okay with short being short sometimes, because that's what makes the system get better. What I always state problems create new policies that we can now govern and regulate. So if a problem is new and we don't have a policy or process for it, I can now put a process together for it in a policy to regulate the process. Therefore, we now have a governing loop. Now we're protected on that end. What was now a lot was. Was once a liability, is now a legal strength. Question 4. When things go wrong, do you look for people to blame or systems to fix? When the OR is pressure with spd, do you fire the director or do you examine the measurement?
Dr. Jake Taylor Jacobs
The measurement systems?
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When production quality drops, do you retain
Dr. Jake Taylor Jacobs
the workers or redesign the process?
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When IT projects fail, do you blame the team or do you investigate the structural constraints? And if your instinct is to blame people, you're probably missing systems.
Dr. Jake Taylor Jacobs
Yeah, you're probably missing system problems.
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And the last question. How many times have you replaced leadership
Dr. Jake Taylor Jacobs
in a function without seeing sustained improvement?
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If you cycle through multiple directors, managers of eps and the outcomes stay the
Dr. Jake Taylor Jacobs
same, you don't have a people problem, you have a system problem. The people keep changing. The system stays the same, you and the results stay the same.
Co-host or Interviewer
That's the clearest diagnosis.
Dr. Jake Taylor Jacobs
Diagnostic indicator of operational blindness right there.
Co-host or Interviewer
People keep changing. The system stays the same, but the
Dr. Jake Taylor Jacobs
result is the same.
Co-host or Interviewer
So if the people change and the system has stayed the same the entire time, and I keep getting the same results, odds are it's not the people, it's the system. Fix the system. New people, same results. So your system is what produces your
Dr. Jake Taylor Jacobs
same Results, not people.
Co-host or Interviewer
But here's the good news.
Dr. Jake Taylor Jacobs
I want you to take this away. Operational blindness is common. It's pervasive. It exists in organizations across every industry. But it's also curable. You can build visibility systems. You can connect upstream activity to downstream outcomes. You can change measurement systems to track what actually matters. You can, you can create feedback loops to enable organizational learning. You can structure reporting relationships to bridge information silos. You can challenge the beliefs that have calcified over years. The elephant can dance bridge builders. But first you have to see the chains. And when you can see the chains that's holding you back and holding your organization back, you going to realize you're tied to a small stake and you can just pull it apart. You can do that. Okay,
Co-host or Interviewer
so now that you have a
Dr. Jake Taylor Jacobs
vision of what transformation looks like, you have the definition of exactly what operational blindness is. The question now becomes how do you actually cure it? And that's what sterile by design is. Sterile by design is our operating system that we built specifically to cure operational blindness. It addresses every element of the definition. It's systemic. It changes the system, not just the people. It creates visibility, connecting upstream operations to downstream outcomes. It builds measurement systems that tracked what matters. It establishes feedback mechanisms that enable learning. It breaks the self perpetuating cycle by surfacing what's been invisible. We've implemented it across healthcare organizations and the principle applies beyond healthcare, but specifically for the OR and sterile processing department. If you want to see a demo what this look like and you're running a hospital that has a surgical department, please go to simshealthcare.com forward/demo. Let's talk about what the operational blindness has cost the organization and what it will look like to cure it. Everyone, this is Dr. Jake of Bread to lead the business of healthcare. And we're talking about operational blindness today. And we pulled a little bit out the book. I hope you took some of these nuggets. This is a pod class, not a podcast. Our whole purpose is to educate and train you, not to just entertain you. Most importantly, I love you. There's absolutely nothing you can do about and I'll see you on the very next show. Peace.
Guest Speaker
Since the age of 12, I've been about my father's business. At the age of 30 he sent me to his vineyard.
In Episode 39, Dr. Jake Tayler Jacobs explores the concept of "operational blindness" in healthcare organizations—an unseen, systemic issue that impacts leadership effectiveness and organizational performance. Drawing from his new book, Operational Blindness, Dr. Jacobs uses vivid storytelling, tangible examples, and a step-by-step teaching method to both diagnose operational blindness and inspire transformation. While rooted in healthcare, the lessons are broadly applicable to leaders across industries.
Dr. Jacobs defines operational blindness as the inability of leaders to see the true dysfunction within their organizations due to flawed measurement systems and siloed feedback mechanisms.
It's not a people problem—it's a systems problem: Replacing people doesn't fix recurring issues when the system itself obscures problems or measures the wrong things.
“Operational blindness is a systemic condition in which leaders cannot see the dysfunction in their own operations because the measurement systems, reporting structures and feedback mechanisms they rely on do not surface them.”
— Dr. Jake Tayler Jacobs ([17:41])
Two SPD (Sterile Processing Department) directors, "Maria" and "David," both considered competent, were unable to solve recurring issues because their reporting structures and metrics didn't reveal the real problems.
Their environments exemplified how activity metrics (like number of trays processed) do not equal meaningful outcomes (like surgical readiness or quality).
“Maria and David weren’t bad leaders... They were experienced professionals doing their best inside a system that kept them blind to their own impact. They couldn’t fix what they couldn’t see. And they couldn’t see what the system didn’t show.”
— Dr. Jake Tayler Jacobs ([12:16])
Organizations often adapt to dysfunction, normalizing workarounds and inefficiencies.
Without accurate visibility, leaders make decisions “in the dark.”
This blindness is self-perpetuating: the longer issues remain hidden, the more “normal” they seem.
"It’s a slow leak that everyone gets used to until the building floods and there’s mold everywhere."
— Dr. Jake Tayler Jacobs ([37:00])
Transformation happens not by swapping out people but by redesigning systems for visibility and alignment with meaningful outcomes.
Examples span healthcare, manufacturing, tech, services, retail—wherever systems bury dysfunction, operational blindness exists.
“When you make the invisible visible, everything changes. When upstream functions can see their downstream impact... they stop being overhead and become strategic.”
— Dr. Jake Tayler Jacobs ([16:49])
Dr. Jacobs provides five diagnostic questions (from [39:18] onward) to uncover operational blindness in any organization:
“If you cycle through multiple directors... and the outcomes stay the same, you don’t have a people problem, you have a system problem. The people keep changing. The system stays the same, and the results stay the same.”
— Dr. Jake Tayler Jacobs ([43:08])
Leaders should shift from reporting just numbers to connecting their work directly to outcomes.
For instance, instead of “400 trays processed,” use “97% first case readiness and 0% instrument-related delays.”
“That’s a different conversation. That’s outcome language. That’s visibility.”
— Dr. Jake Tayler Jacobs ([13:28])
On normalizing dysfunction:
“New employees join and learn how things work here. They absorb the dysfunction as normal. They stop questioning what veterans stopped questioning years ago.” ([37:39])
On the need for systemic change:
“You can replace every person in the department and still have operational blindness if the system remains unchanged.” ([22:15])
On learning from data:
“What you measure shapes what you see. What you see shapes what you manage. And if your measurements are disconnected from outcomes that matter, you optimize for things that don’t matter.” ([17:57])
On hope for transformation:
“Operational blindness is common. It’s pervasive... But it’s also curable. The elephant can dance, bridge builders. But first you have to see the chains.” ([43:55])
Dr. Jacobs speaks directly and with urgency, using vivid analogies (“like a headache you’ve had for a decade”) and memorable stories. The language is both conversational and instructive, aimed at equipping listeners, not just entertaining them.
For more resources:
Memorable Moment:
“The elephant can dance, bridge builders. But first you have to see the chains.”
— Dr. Jake Tayler Jacobs ([43:55])