Rebuilding the Rails

You have assembled brilliant people. You have articulated the right goals. Yet the system continues to do something you did not intend and cannot seem to stop. This is not a failure of leadership. It is a structural signal.

Portia Nelson wrote a poem about a person who walks down a street with a deep hole. They fall in. They pretend not to see it. They eventually walk around it. Finally, they walk down another street. In healthcare leadership, the problem is rarely the hole. It is the street itself.

We are navigating a complex, remote terrain using a map drawn by someone who never walked it. Our persistent challenges such as ED congestion, ALC bed pressure, workforce exhaustion, are not isolated problems waiting to be solved. They are Attractors: stable regimes the system returns to regardless of effort, because the terrain itself pulls everything back.