Looking forward to 2026

We've made it to the final day of the year 2025!  It doesn't seem like it's been 12 months, but time does seem to go faster the older you get!  I want to wish all of you a Happy 2026!

Ringing in the New Year is a time for reflection on the past year, as well as a time for setting new goals for the coming one.  As I look back on the personal and professional goals that I set for myself, there were certainly some that I achieved and others where I came up short.  That’s okay!  I will assess my own performance and use that information as I look to 2026.

Similar to last year, I will be setting goals that will make a better me!  I want to focus again on improving my physical, mental, spiritual, and emotional health.  I feel pretty good about where I ended up this year, and I hope to build on that momentum during the coming year.

One of my goals was to blog more in 2025 than I did the previous year.  With this final post of the year, that goal was achieved!  As I look to the coming year, I will try to emphasize quality over quantity.  In other words, I will be writing fewer posts, but hopefully better ones.

I am proud of what I've accomplished with this blog.  For me, it has more than served the dual purpose of allowing me to write and helping me to remember what I've learned and read over the years.  I've always enjoyed writing, and I've always been able to better commit things to memory when I've written them down in my own words.  The fact that I have an audience beyond the members of my own family is the icing on the cake with a cherry on top!

I look forward to learning and growing my leadership more in the new year!  Happy New Year to all of you, and as always - thank you for reading!

"I heard the bells..."

Merry Christmas to all who celebrate!  This is absolutely one of my favorite times of the year.  Christmas has always been my favorite holiday.  I recently posted about a poem by Henry Wadsworth Longfellow called The Building of the Ship (see my post, "Sail On, O Ship of State").  While researching that particular poem, I came across an article by Joshua Whitfield published on December 21, 2020 that caught my attention ("Longfellow's Christmas Bells and a Better America").  

First of all, I didn't know that Longfellow wrote a poem about Christmas, but I've heard it perhaps a million times in the past.  The Christmas carol, "I Heard the Bells on Christmas Day" was actually based on Longfellow's 1863 poem, Christmas Bells.  The poem was set to music in 1872, but it really became famous when Bing Crosby recorded the song on October 3, 1956.  It's since been recorded by Harry Belafonte, Johnny Cash, Andy Williams, the Mormon Tabernacle Choir, and Elvis, among others!  I personally like the Mormon Tabernacle Choir version the best. 

Longfellow wrote the poem on Christmas Day in 1863 at a particularly bleak time in his life and in our nation's history.  His oldest son, Charles Appleton Longfellow, had just joined the Union Army and was severely wounded in the Battle of Mine Run in November, 1863.  His second wife had tragically died in a fire just two years before he wrote the poem.  The opening stanza of the poem begins as a prayer for peace:

I heard the bells on Christmas Day

Their old, familiar carols play,

And wild and sweet

The words repeat

Of peace on earth, good-will to men!

The next several stanzas, however, tell the real story.  The church bells are ringing, but because of the American Civil War, the prayer of hope becomes a mockery of despair.  As Whitfield wrote in his article, "The bells marked an absence: the memory of peace, the longing for goodwill.  The loss of his wife, his son's injury, slavery, injustice, war, and America torn, it is a Christmas hymn of sadness, a poem written by a man at a loss for America."

And in despair I bowed my head;

"There is no peace on earth," I said;

"For hate is strong,

And mocks the song

Of peace on earth, good-will to men!"

But fear not, faithful reader!  I would not leave you with sadness and despair on Christmas Day of all days!  The last stanza is the key.  Whitfield explained, "This is the poetry of a sad man, but still who did not lose hope, who could not believe in the finality of despair...the poet's despair is not the end of the poem.  And this is the point, the lesson I am unsure we are mature enough to learn.  Because it would mean hearing bells again, hearing in them the hope they speak.  As Longfellow believed, as he wrote at the end of his poem..."

Then pealed the bells more loud and deep;

"God is not dead; nor doth he sleep!

The Wrong shall fail,

The Right prevail,

With peace on earth, good-will to men!"

I hope that you too hear the bells on Christmas Day.  Merry Christmas.  Peace on earth, good-will to all...

"Sail On, O Ship of State"

I want to touch on two poems by the American poet Henry Wadsworth Longfellow.  The first poem is the subject of today's post, while the second one will be the subject of my next post.  And, if you are familiar with Longfellow, they are not the two poems that you are probably thinking of.  For those of you who aren't familiar with Longfellow, he was one of the most popular and well-known poets of his day.  One of his friends once said that "no other poet was so fully recognized in his lifetime."  Longfellow is actually one of the few American writers to be honored with a place in Poet's Corner of Westminster Abbey in London (the others are T.S. Eliot, Walt Whitman, Emily Dickinson, Henry James, and Washington Irving.  Importantly, most of the commemorations in Poet's Corner are memorial tablets, busts, or stones placed long after the individual's death and not actual burials.  Longfellow is actually buried in Cambridge, Massachusetts.

Longfellow's poems helped shape the American identity and character, perhaps best illustrated by his poem, Paul Revere's Ride.  Who can forget the iconic first line of that poem, "Listen, my children, and you shall hear of the midnight ride of Paul Revere"?  His other famous poem is The Song of Hiawatha, which tells the story of a fictional Ojibwe warrior named Hiawatha (my first introduction to this poem was via Bugs Bunny in the Looney Tunes episode, "Hiawatha's Rabbit Hunt" which first appeared in 1941 and has since been criticized for its derogatory depiction of Native Americans).  

Today, I want to talk a little about Longfellow's poem, The Building of the Ship.  Longfellow wrote this masterpiece in 1849.  The poem can be taken literally as the description of the ship-building process that Longfellow observed in the shipyards of his native Portland, Maine.  But that would only be of interest to those of us interested in the wooden ships from the Age of Sail.  The poem is better understood as metaphor - it is an allegory of the growth of the United States!  The ship in the poem is named, appropriately enough, Union.  Let's remember what was going on in our nation's history during 1849.  The Union continued to be threatened with secession of the southern slave-holding states, and the discovery of gold in California prompted the famous "Gold Rush".  Longfellow was a staunch abolitionist and was good friends with fellow abolitionist and U.S. Senator, Charles Sumner (Sumner was famously and viciously beaten with a cane by South Carolina Representative Preston Brooks on the Senate floor).  Longfellow had dinner with Sumner on November 11, 1849, who had just delivered a speech at the Free Soil Meeting at Tremont Temple in Boston.  Longfellow was inspired to write a poem, which became The Building of the Ship.

On the eve of the American Civil War, President Abraham Lincoln quoted a passage from Longfellow's poem, "Sail On, O Ship of State!"  According to Lincoln's secretary, John Nicolay, Lincoln was moved to tears upon reading the poem.  Nicolay said, "These lines seemed to stir something deep in Lincoln.  His eyes filled with tears and his cheeks were wet.  He did not speak for some minutes, but finally said with simplicity, 'It is a wonderful gift to be able to stir men like that!'"

On the eve of another national crisis, President Franklin D. Roosevelt sent a handwritten message (ironically delivered by Wendell Wilkie, who Roosevelt had just defeated in the 1940 Presidential Election) to British Prime Minister Winston Churchill with a passage from Longfellow's poem:

...Sail on, O Ship of State!

Sail on, O UNION, strong and great!

Humanity with all its fears,

With all the hopes of future years,

Is hanging breathless on thy fate!

Roosevelt added his own note, writing "applies to you people as it does to us."  Churchill quickly understood, as Roosevelt knew that he would, the meaning and importance of the passage.  He relayed the same message in a radio broadcast to the British public, and the five lines about "the Ship of State" were printed in newspapers, cards, pictures, and calendars throughout both America and England.

From the opening stanza:

Build me straight, O worthy Master!

Stanch and strong, a goodly vessel,

That shall laugh at all disaster,

And with wave and whirlwind wrestle!

to the last one:

Sail on, nor fear to breast the sea!

Our hearts, our hopes, are all with thee,

Our hearts, our hopes, our prayers, our tears,

Our faith triumphant o'er our fears,

Are all with thee, are all with thee!

Longfellow's poem is a prayer for our country.  It is a prayer for all of us.  And in today's holiday season, it is a prayer for peace and goodwill.  It's a long poem, but it's well worth a read.

Winter Solstice

Today, December 21, 2025 is the Winter Solstice.  Well, technically that is only true for those of us in the Northern Hemisphere.  Just as importantly, today is officially the first day of winter.  I have to tell you though, it's felt like winter here in Chicago for at least a month!

From a scientific standpoint, the Winter Solstice marks the exact moment when the Earth's axis tilts the farthest away from the Sun.  Because less sunlight reaches Earth, the winter solstice is also the day of the year with the least amount of daytime, known as the shortest day of the year (see the Figure below).

That exact moment varies from year to year, but the Winter Solstice generally occurs at some point between December 21st to December 23rd.  This year, the Winter Solstice occurred exactly at 9:03 AM Central Time.

Winter Solstice is culturally significant as well.  Throughout history, humans have celebrated Winter Solstice in unique ways.  The day marks the point on the calendar when the days start to become longer again, and so it was celebrated as a spiritual rebirth of the Sun.  Various traditions to celebrate the Winter Solstice that have been passed down from history, include hanging evergreen decorations, lighting candles or burning a Yule log (hence, "Yule-tide carols being sung by a choir"), and feasting.  Notably, in ancient Rome, December 25th was celebrated as the Winter Solstice, or the spiritual rebirth of the Sun.  It is no mere coincidence that early Christians chose December 25th to celebrate the birth of Jesus Christ (hence, Christmas, which literally means "Christ's Mass").

Victor Hugo wrote in his classic Les Miserables, "Even the darkest night will end and the sun will rise."  These words also appear in the musical, during the Finale:

Do you hear the people sing?

Lost in the valley of the night

It is the music of a people who are climbing to the light

For the wretched of the earth

There is a flame that never dies

Even the darkest night will end and the sun will rise.

Hugo's words are a message of hope.  So too, the Winter Solstice.  We've made it through the darkness!  The days are going to start getting longer again, and Spring is just around the corner.  Even though we still have to make it through all of winter (it literally just started today), it's an important time for us all to sit back and reflect on where we have been, and more importantly, where we are going.  And to look at our collective future, with a renewed sense of Hope.

"Put on your own mask first"

I was traveling over the Thanksgiving holidays, and one of the flight attendant's instructions struck me, as it always does: "Put on your own mask before assisting others."  Basically, if there is a sudden cabin depressurization and the oxygen masks drop from the compartment above, passengers should place their own mask before helping others (e.g. a child sitting in the next seat).  It's become a great metaphor for the linkage between patient safety and staff safety.  If the hospital staff feels safe, they will be in a much better position to keep their patients safe.

While it is commonly accepted that the safety of the patient and provider are inextricably linked, there is surprisingly little, if any, data to support this statement.  The research in this area that has been done relies on safety culture data as a proxy measure for employee safety, which may not be valid.  With this in mind, one of my former colleagues at Cincinnati Children's Hospital Medical Center reviewed over 2 years worth of hospital patient and safety data for 25 patient care units (grouped into intensive care units (ICUs), medical/surgical units, and psychiatry units) (see Dr. Nancy Daraiseh's study, "Patient and employee safety events - are they related by common hospital unit factors?").  Dr. Daraiseh's research team also considered the relationship between safety events and five hospital metrics of staffing, occupancy, and patient acuity.

Contrary to expectations, patient and employee safety events showed very little correlation, with inpatient units having higher rates in one category (e.g., patient safety) often showing lower rates in the other (e.g. employee safety).  What was not surprising (at least to me), the highest patient safety event rates were found in the ICU's, psychiatry/medical (an inpatient psychiatry unit for patients with medical co-morbidities), and the complex airway/pulmonary unit.  In other words, patients who were either very complex or critically ill had the highest rate of patient safety events.  Conversely, the highest employee safety event rates were found in the psychiatry units and were most commonly due to patient aggression and/or injury by the patient.  Some of the commonly cited risk factors for safety events (high unit occupancy, low staffing, or high patient acuity) were significantly associated with patient safety events.  However, the relationship between these hospital metrics and employee safety events was weaker and not significant.  

I still believe that there is a connection between patient safety and employee safety.  As Dr. Daraiseh writes, "A safe and healthy worker can provide safe, exemplary patient care."  She goes on to write that "addressing each [patient safety and employee safety] separately can result in duplication of effort and missed opportunities.  By unifying efforts, health care organizations can improve patient outcomes while fostering an environment in which workers are unharmed."  I couldn't have said it better myself...

Over half of US healthcare workers plan to switch jobs before next year...

I recently read an article from Reuters by Mrinalika Roy, entitled "Over half of US healthcare workers plan to switch jobs by next year, survey finds".  The survey was conduced by The Harris Poll and surveyed 1,504 frontline healthcare employees and 304 employers between June 26th and July 21st earlier this year.  Not surprisingly, the survey found widespread burnout, dissatisfaction, and a high attrition risk.  I say that is not surprising because many surveys on employee engagement, burnout, and work satisfaction have shown almost identical results.  And those results have been shown in just about every sector outside of the healthcare industry as well.  

The study found that 55% of workers intended to search for, interview for, or switch jobs in 2026.  Only one in five of those surveyed said that they believed that their employer was invested in their long-term career growth, while 84% said that they felt underappreciated by their current employer.  These results are certainly sobering, particularly at a time when experts are predicting a shortage of physicians, nurses, and allied health workers in the near future.

Adele Webb, a registered nurse with over 40 years of experience, reviewed the findings and said, "In my experience, it is worse than it's ever been.  We are losing more staff than we have ever lost.  Jobs are harder, patients are older and more chronically ill.  We do not have enough staff."

Most of these problems are longstanding, and while they became dramatically worse following the COVID-19 pandemic, they were certainly there even before 2019.  What is also not lost, at least on me, is that these problems are not unique to healthcare.  The survey did reveal at least one potential solution - over 60% of the workers surveyed said they would be more likely to stay if tuition assistance or other continuing education and/or professional development opportunities were offered.  Webb commented on this point, "A really surprising finding (was) the role that opportunities for continuing education and career advancement play in keeping our patient-facing healthcare workers at the bedside."

I am reading a book by the author and researcher Zach Mercurio called The Power of Mattering (see also Mercurio's Harvard Business Review article, "The Power of Mattering at Work").  I've mentioned Mercurio's concept of mattering a couple of times in recent posts (see "Mind-set matters" and "To be of importance to others is to be alive...").  Mattering can be defined as feeling valued - it is the feeling that we, as individuals, are seen, valued, and needed by others.  Studies have shown that when people feel valued (i.e. when they feel that they matter), they experience less burnout and more engagement.  So, it seems reasonable to suggest that one of the reasons that so many health care workers are experiencing burnout and are planning to leave their current jobs (or worse, planning to leave health care altogether) is that they do not feel valued - in short, health care workers today do not feel as though they matter.

Martin Stillman and colleagues reported the results of "The Coping with COVID-19" survey, which surveyed over 58,000 health care workers between April 2020 and December 2020 (see "Understanding what leaders can do to facilitate healthcare workers' feeling valued: Improving our knowledge of the strongest burnout mitigator") in the journal, BMJ Leader.  Consistent with previous studies, feeling valued as significantly negatively related to higher burnout and higher likelihood to leave practice.  In other words, health care workers who felt highly valued had 8.3 times lower odds of burnout and 10.2 lower odds of intent to leave compared to their peers.  Through qualitative analyses, Stillman and colleagues identified six major themes associated with feeling valued:

1. Ensuring health care workers are safe from physical harm

2. Adequately supporting health care workers financially when needed and making sure that the organization's financial compass aligns with patient care

3. Demonstrating high-quality communication

4. Supporting high-functioning teams that foster efficiency, camaraderie, and a sense of belonging

5. Having present leaders that are empathetic and welcoming of feedback

6. Providing organization support of health care workers through access to mental healthcare, childcare, flexible work schedules, and assignments that account for health care workers' abilities and preferences

While the survey was conducted during the COVID-19 pandemic (and was directed at the burnout and moral distress that occurred as a result of the pandemic), these six recommendations certainly apply to what health care workers continue to experience today.  What is clear is that healthcare leaders will need to work together to try to address these longstanding issues.  Our teams - and ultimately our patients - are depending on us to find the solution to this "wicked problem".  The future health of our nation is depending on us to figure this out.

"Why clinicians hold the key to fixing health care's complexity problem"

I once wrote a post with the title, "A jumbo jet is complicated, but mayonnaise is complex..." with the point that there is an important difference between complicated and complex.  Mary Uhl-Bien and Michael Arena came up with the concept in one of their articles ("Complexity leadership: Enabling people and organizations for adaptability"), stating, "… a jumbo jet is complicated but mayonnaise is complex. When you add parts to a jumbo jet they make a bigger entity but the original components do not change–a wheel is still a wheel, a window is a window, and steel always remains steel. When you mix the ingredients in mayonnaise (eggs, oil, lemon juice), however, the ingredients are fundamentally changed, and you can never get the original elements back. In complexity terms, the system is not decomposable back to its original parts…"

As Alex Di Miceli explains in a blog post on Medium ("Complex or complicated?"), complex systems are emergent, meaning that the whole is always greater than the sum of its parts.  Like the mayonnaise, you can't break complex systems down into their individual components easily and figure out how they work together.  Complicated systems are not emergent, so you can break these systems down into their individual components rather easily and see how they fit and interact together.  He writes further:

"A car engine is complicated, traffic is complex."

"Building a skyscraper is complicated. The functioning of cities is complex."

"Coding software is complicated. Launching a software startup is complex."

The differences between complex and complicated is similar to the difference between Newtonian physics and quantum physics (see my post, "Like clockwork?" for more on this point).   Classical physics, often called Newtonian physics is based upon Sir Isaac Newton's three universal laws of motion and emphasizes the linear, cause-and-effect nature of the world around us.  To every action there is an equal and opposite counteraction.  Output is proportional to input.  The overall system is a sum of its individual component parts.  Under this paradigm, we should be able to both predict and understand exactly what happens in a system by breaking it down into its individual components.  The laws of the universe should work like clockwork.  Quantum physics, however, is completely different.  Rather than the machine-like, clockwork universe of Newton, we appreciate that the world is quite complex (rather than complicated).  It is non-linear and emergent.  We could never fully understand or appreciate how exactly a system works just by understanding its individual components.

Alejandro Quiroga and Thomas Lee recently wrote an article for NEJM Catalyst, "Why clinicians hold the key to fixing health care's complexity problem".  They suggest (and I tend to agree with them on this point) that clinicians are ideally suited to a world of complexity, because that is exactly what they deal with on a daily basis.  They write, "The decision-making processes honed by clinicians in medical school and residency, which emphasize teamwork, hypothesis-testing, and rapid adaptation, are better suited to complex problems than the processes typically taught in business and health administration programs, and organizations can benefit from harnessing their clinicians' skills to address complex operational problems."

Drs. Quiroga and Lee also suggest that the current state of U.S. health care is a paradox, in that "systems are managed as single, predictable machines, even though they frequently face complex, unpredictable problems."  Hospitals and health systems employ a vast army (their exact word) of physicians and nurses who are used to working in a non-linear quantum universe!  And yet, over the last couple of decades health care organizations have created operating systems based upon the business and/or manufacturing industry, with a focus on Lean/Six Sigma, the Toyota Production System, standardization, dashboards, checklists, huddles, etc.  While these changes have made our operating systems better, they have fallen short of the results observed outside of health care.  A major reason for these lower-than-expected results are that they work well in a complicated world, but they don't work as well in a complex one, like health care.

They suggest that physicians and nurses are trained to lead in the complex world of health care.  They write, "If clinicians want a more agile system, then they have to engage with how it works, not just how it feels.  That means stepping into strategy, governance, and operational design with the same adaptive, emergent mindset they use at the bedside.  Administrators must allow clinicians to step into those realms, and move from controlling to enabling, from predicting to learning, and from perfect plans to rapid, iterative pilots."

It's a great article written by two very well-respected leaders in health care.  Dr. Quiroga is currently the President and CEO of Children's Mercy in Kansas City, while Dr. Lee is the Chief Medical Officer at Press Gainey Associates, Inc.  They end their article by recommending that leaders at every level (even non-clinician leaders) can start by:

1. Creating adaptive space for experimentation, in addition to standard operational systems

2. Learning to pivot and paying attention to emergence

3. Flattening hierarchy to increase information flow, ensuring leaders have access to the information being learned on the front line

4. Nurturing social capital as core infrastructure

5. Leading with curiosity and humility, knowing that without a doubt, we don't know it all.