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In this post I recount five stores which illustrate what happens when you let the ball slip through your fingers. The case will be made for the essential strategic role of MBWA and Inspecting What you Expect.

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This post recounts several stories from my life. Three of them relate to hospitals and healthcare. Please read the important disclaimer at the end of the post. The hospital examples I describe are based on experiences in private hospitals in my country – not public ones. This distinction is important as the disclaimer makes it clear.

The baby guard's asleep!

The prime message of this post is that effective leadership/management and strategy implementation – which implementation helps to reduce or mitigate risk - involves a healthy level of MBWA – Management By Walking Around. Linked to this is the need to Inspect what you expect and practice Ken Blanchard's principle of "Catch People Doing Something Right and Reward Them".

Baby looking dubious
Baby looking dubious

I was in hospital following a procedure that often makes one the butt of jokes – pun intended. It was late at night, and I was in a fair amount of discomfort, not pain. Hot showers – as recommended by the duty nurse - were not making any measurable difference. So, I was wandering the deserted corridors of the hospital, unable to sleep.

When I walked past the maternity ward – the only one with a permanent guard outside – the guard was fast asleep. I didn't wake her. Hopefully, there were no baby nappers on the loose that night.

As a matter of interest – there does not seem to be a universal code for when a baby goes missing from a hospital. I have seen it variously described as code Adam, code Amber, or code Pink. For new parents – for whom having their baby stolen is a concern – it's consoling to know that the theft of babies from hospitals is, fortunately, a relatively rare event.

Hospital-acquired infections

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Hospital-acquired infections (HAIs) are a significant problem:

"In American hospitals alone, the Centers for Disease Control (CDC) estimates that HAIs account for an estimated 1.7 million infections and 99,000 associated deaths each year." (

My late father went into hospital to have a pacemaker fitted. When I visited him in the High Care Ward after the procedure, access was barred, and I was made to wash my hands with a handwash and don a mask before being allowed to see him. This same hospital had required me to wash from head to toe with a particularly pungent coal tar soap before being admitted for the procedure described in the first story above).

On my second and subsequent visits, the ward doors were open, no handwash was supplied or required, and no masks were in evidence. My father was discharged and came home.

Shortly after his discharge, he had a toxic shock episode and – after being stabilised at home – was taken to the hospital by ambulance, where the pacemaker was removed. In due time he was discharged. Some months later, the pacemaker was fitted again with no other adverse outcomes.

Observations from the floor of an HCU

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I was dozing on the floor of the High Care Unit on the hospital's night shift. My late life partner had had major surgery during the day involving two surgeons and was reacting badly to morphine. It wasn't keeping her pain-free, and she was hallucinating. In the absence of any doctor – seemingly in the entire hospital – coupled with a determined aversion to calling one out – the nursing staff dialled up the morphine. Eventually, soothed by my presence, she fell into an uneasy sleep.

Late that night, nurses abandoned their workstations all over the hospital. They had a meeting in the staff area adjacent to the HCU. Staff relations were terrible, and the senior ward sister – a 20-year veteran – told me she would leave at the end of the month as she had had enough. The nurses' fear of the doctors and calling one out was palpable. I had several confrontations on this issue during that hospital stay.

Early in the morning, a doctor wafted through, making sundry superficial comments. Hot on his heels came the veteran gynae who had taken part in the operation. When he discovered what had happened, he had a restrained tantrum. He moved her to the maternity ward, which fell under his direct control. A change of pain medication then resolved the immediate challenge.

The night shift always leaves a mess!

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The factory was part of an international group and ran three shifts. Some of my students complained bitterly that the night shift always left a mess for them to clean up on the day shift. I asked them how come? "Management never visits the factory at night," they said.

The case of the high-pressure seal

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I was training supervisors in one of the largest factories of its type in the world. One of the students – who had recently joined the factory from an international group, told me a story.

"I noticed that every Monday, a rep in a smart SUV delivered pump shaft seals to the factory". "I got chatting to him and noted the type of seal he was delivering".

"It turned out that the seal was the wrong type as it could not withstand the temperature/pressure combination it needed to.” "And this incorrect seal supply had been going on for years." "No wonder he could afford the smart SUV."

The message from these five stories?

It seems to me that these five stories reinforce some of the fundamental principles of good management and strategy delivery:

  • Inspect what you expect: In the case of the hospital-acquired infection;
  • Be visible and support your people: In the case of the HCU and the factory night shift; and
  • MBWA (Manage By Walking Around): In the case of the sleeping guard and the story of the wrong seals.

A disclaimer

All the hospital incidents I write about above occurred in private hospitals. In my country, these are those you go to when you are on medical aid or plan.

Over the past decade, I have trained thousands of healthcare professionals at all levels in the public healthcare system. These are hospitals you go to if you are not on medical aid. Trainees have included hospital administrators, doctors, nursing staff, social workers, ambulance teams, and administrative personnel. Not in healthcare but in soft skills like leadership, mentoring, supervision, and office skills.

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