1. Section Editor(s): Raso, Rosanne MS, RN, NEA-BC

Article Content

Our to-do lists grow daily, and most of us truly enjoy dropping tasks off the list. That's true in management, as well as with our frontline staff, educators, colleagues, bosses, and even our families. Unfortunately, the phrase "check the box" isn't a positive one. Despite the joy of completing a task, it means to do so at the barest minimal standard. Did you check a box today?

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We want to keep our heads above water, deliver on expectations, be the best we can be, and help our teams succeed. Can we accomplish this by only doing the minimum? Or, even worse, by crossing off a task mindlessly and without attention to what it actually means? A colleague of mine uses a frequently seen example: During quiet times, the lights may be dimmed ("check") but the decibel level hasn't decreased at all (minimal standard at best).


I bet you can think of many other examples. All boxes on the electronic medical record flow sheet completed? Check. Quality assurance audit tool done? Check. Chemotherapy administration double verification finished? Check. Procedural checklist fulfilled? Check. Rounds accomplished? Check. Controlled substance waste witnessed and verified? Check. Performance evaluation submitted? Check. They may be "checked," but there's more than a remote chance that these tasks aren't reflective of intent and haven't been achieved thoughtfully. The result? Outcomes suffer and patient care may be compromised.


Some of the problem stems from natural human behavior, systems, and organizational culture. We're overwhelmed. Our priorities are elsewhere or maybe even conflicting. We don't believe in the importance of the task. We're constantly distracted and interrupted. We forget it isn't about the what; it's often about the how. We're congratulated for box-checking. Do we show our own approval of box-checking or do we emphasize behavior, thought process, and attention to actual intent?


Of course, there are tasks along the way that do get done. But the bigger picture is that our leadership responsibilities can't be simply checked off as completed. Ensuring patient safety, healthy work environments, competencies, positive patient experiences, and much more is a job never done. There's no endpoint in the journey to patient care excellence. If that were the case, we could tear up our to-do lists and declare victory. The actuality is that leadership is forever. Don't despair! This is the joy of our roles.


So how do we ensure that we're paying attention to the right things in the right way? Maybe when faced with failure or not achieving outcomes, whether clinical or not, it will force us to dig deeper into the truth. Demonstrating inquisitiveness and caring with a focus on why and how can change everything. It can open minds to intent or open actions to new behaviors, including our own. Use your huddles and conversations to challenge the status quo, explore the whys, and make improvements to the how.


Next time you check a box, think about avoiding mindlessness and the minimum. Dare I say, think out of the box? Change your approach to full engagement and attentiveness, and, undoubtedly, you'll see the positive outcomes.



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