Healthcare organizations are constantly pulled toward whatever feels most urgent.
But when everything demands attention, the work that matters most can easily get crowded out.
The problem is not simply that healthcare has too much to do. It is that many organizations have not made their priorities clear enough to help people distinguish signal from noise.
In this piece, I’ll explore how leaders can make strategy useful in the decisions that shape everyday work:
Define a small number of priorities clearly enough to guide choices.
Use those priorities to decide what deserves attention.
Distinguish strategic work from necessary but lower-value work.
Make it acceptable to leave some problems alone.
Use impact and effort as a second filter for deciding how much to invest.
More than a decade into my medical career, I keep coming back to one painful observation:
In healthcare, we are constantly mistaking the urgent for the important.
There is always another fire.
An accreditation deadline. A complaint. A policy that needs updating. A case review. A new reporting requirement. A meeting someone thinks we absolutely need. An email with URGENT in the subject line.
And we respond.
Lights flashing. Sirens blaring. Everyone mobilizes.
Eventually, the sirens become so loud that they are almost the only thing we can hear.
The problem is not that none of these things matter. Many do. Some really are urgent.
The problem is that urgency has become one of healthcare’s main mechanisms for allocating attention.
And urgency is a terrible strategy.
We have too much work, but that’s only part of the problem
There is an obvious explanation for why this happens: healthcare organizations are overloaded.
There really is more work than there is capacity to do it.
Clinicians are stretched. Managers are stretched. Quality teams are stretched. Leaders are stretched. Basic daily operations consume an enormous amount of organizational energy before anyone gets around to improving anything.
But I think there is a deeper problem.
We often haven’t defined what is important clearly enough to distinguish it from what is merely demanding our attention.
If everything matters, then the loudest thing wins.
That means the remedy has to start before the next fire appears.
It starts with a conversation about what actually matters.
Strategy should tell us what not to do
Most healthcare organizations have a strategic plan. They have mission statements, values, annual priorities and glossy diagrams showing where they want to go.
But here is a harder test:
Could someone use your strategy to decide what they should stop doing tomorrow?
That is where strategy becomes real.
Imagine an organization had only three major priorities:
Make preventable harm exceptionally rare.
Ensure patients move through care without unnecessary waiting or friction.
Build clinical systems that make the right thing easier to do, every time.
The precise wording doesn’t matter. What matters is that there are only a few priorities, that people genuinely believe in them, and that they are specific enough to guide choices.
Now take the next supposedly urgent task and put it through that filter.
Does this move us meaningfully toward one of those priorities?
If it does, how much? If it doesn’t, is this something we truly need to do, and if so, what is the minimum responsible response?
Consider accreditation.
Healthcare organizations can spend hundreds or thousands of hours preparing for an accreditation visit. Some of that work is unquestionably useful. Accreditation can identify important gaps and create leverage for improvement.
But some of the preparation can also become theater: polishing documents, rehearsing answers, chasing signatures and making sure the organization looks right for the visit.
If our priorities are to make preventable harm exceptionally rare, eliminate unnecessary waiting and friction, and build systems that make reliable care easier to deliver, then the relevant question isn’t simply:
Are we ready for accreditation?
It is:
How much will the next hundred hours of accreditation preparation actually advance those priorities?
Those are very different questions.
Some accreditation work may have enormous value. Other tasks may be necessary but deserve only the minimum effort required. And some may contribute almost nothing at all.
A strategy should help us tell the difference.
Priorities have to live somewhere other than PowerPoint
Of course, defining priorities isn’t enough. You have to use them. Every single day.
If an organization says these are its most important priorities, they should become part of its operating system.
Start major staff meetings with them. Put them into committee terms of reference.
Use them during leadership rounds.
Build them into quality and safety discussions.
Ask improvement teams how their work connects to them.
Teach them during recruitment and onboarding.
Use them when evaluating leaders.
Use them when deciding who gets promoted.
Use them when deciding which projects receive staff, money and executive attention.
If a value disappears the moment an inconvenient decision arrives, it isn’t really a value.
And if a strategic priority has no effect on where an organization spends its time, it isn’t really a priority.
The priorities shouldn’t be invented in a boardroom
There is another trap here.
It would be easy for a small group of leaders to disappear into a room, emerge with five beautifully worded priorities, print them on banners and announce that these are now everyone’s values.
That is not the same thing as alignment.
One of the most powerful questions in healthcare is also one of the simplest:
What matters to you?
Ask patients. Ask families. Ask nurses, physicians, therapists, housekeepers, clerks and porters. Ask the people working nights. Ask the people who have been there for twenty years.
Ask the people who arrived three months ago and can still see things everyone else has stopped noticing.
People are usually very willing to tell you what matters to them.
And if the same ideas keep appearing across hundreds of conversations, that is far more meaningful than anything a leadership team could manufacture on a retreat.
The job of leadership is not simply to announce values.
It is to discover what people care about, translate that into a coherent direction and then keep showing, through decisions, that those things really matter.
Then comes the hard part: letting some fires burn
Even with clear priorities, the urgent will keep arriving. That part doesn’t stop.
The challenge is developing the organizational courage not to respond to all of it.
There is something psychologically uncomfortable about deliberately not fixing a problem.
An issue lands in your inbox. Somebody is unhappy. A metric turned red. A case review found a weakness. A committee has made a recommendation.
The instinct is to act. Doing something feels responsible and doing nothing can feel deeply uncomfortable.
But in a system with finite capacity, saying yes to one problem is always an implicit decision to say no to something else. The cost is simply harder to see.
Maybe organizations should keep track not only of the problems they solved, but also of the work they deliberately chose not to do.
Call it a stop-doing list.
Or a list of fires we chose not to fight.
Whatever the name, there is something powerful about making those decisions visible.
Imagine a leadership meeting where someone said:
We identified seven issues this month that could have generated new projects. We deliberately declined five because they were not connected closely enough to our priorities.
That should not be embarrassing. It should be evidence of discipline.
We are very good at celebrating people who take on more work.
Perhaps we should get better at celebrating people who protect the organization from low-value work.
Some important problems still won’t fit the strategy
There is a complication.
Sometimes we discover a legitimate problem that does not align neatly with our strategic priorities.
A reported event reveals a process weakness. A chart review identifies an inconsistency. A patient complaint exposes something that should be fixed.
The problem is real. But it may not justify turning the organization toward it.
This is where improvement systems can accidentally undermine strategy.
If our rule is that every identified problem deserves a project, then the portfolio of improvement work will simply reflect whichever problems happened to surface.
Over time, the organization accumulates hundreds of initiatives scattered across countless topics.
Everything is being improved. Nothing is being transformed.
The answer cannot be to ignore every problem outside the strategic plan. But neither can the answer be to treat every problem as equally deserving of resources.
We need different levels of response. Some problems deserve major improvement programs. Some deserve a small local intervention. Some need a reminder, a checklist change or a simple process fix. Some should be monitored.
And some should simply be acknowledged without launching anything at all.
This is where a second filter becomes useful.
Once we have decided that something deserves attention, ask:
How much impact might this have, and how much effort will it require?
A simple effort-impact matrix can prevent a two-hour problem from turning into a six-month project.
Strategy should determine where we are trying to go.
Impact and effort should help determine how aggressively we pursue each opportunity along the way.
Attention may be healthcare’s scarcest resource
Money is scarce. Staff are scarce. Time is scarce.
But underneath all three is another resource that may be even more constrained:
organizational attention.
There are only so many problems an organization can think deeply about at once.
Only so many improvement projects leaders can meaningfully support.
Only so many changes frontline teams can absorb.
Every additional priority dilutes the others.
That means one of the most important jobs of leadership is not generating more activity.
It is protecting attention.
Clearly define what matters.
Repeat it until everyone knows it.
Use it to decide where to put people, money and time.
Create permission to leave some problems alone.
And reward people who are disciplined enough to distinguish a true priority from the latest thing screaming for attention.
Healthcare will never run out of fires.
The goal isn’t to extinguish all of them.
It is to make sure we still have enough water left for the things that matter most.
Continue the conversation
What is one thing your organization spends too much time on because it feels urgent, even though it is not especially important?
I’d especially like to hear from people who have found good ways to protect attention, say no to low-value work, or keep strategic priorities from getting buried under day-to-day demands.
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