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What We Can Learn From The ER!

by David Brock on August 27th, 2014

If you’ve ever had the misfortune to be taken to an Emergency Room, you know the concept of Triage.  In triage, they aren’t trying to determine what caused your heart to stop, why you may have stopped breathing, what’s causing profuse amounts of blood to pour from your body.  All they are trying to do is keep you alive long enough to determine the underlying problem.

They do what they must to get your heart beating–then send you into cardiology, or get you breathing, or stop the bleeding.  It’s never pretty.  It’s seldom the “solution,” it just allows you to get to have the opportunity to get beyond treating the symptoms, to diagnosing and addressing the real problems.  Smart trauma doctors and nurses  always triage with an eye to the future.  If possible, they avoid solutions that preclude the ability for others to address the root problems impacting a person’s health.

While not as dramatic, and seldom a case of “business life or death,” as leaders and executives, we have to know when we have to triage a problem, and when we have to look at and fix the root causes.  In my experience, you seldom do both simultaneously.

Sometimes, as managers, we see things that are just wrong–terrible performance, things that distract sales, possibly the rest of the organization, from producing results.  We have to get some sort of “turnaround” and positive progress quickly–even the early indicators of progress.  We have to look for some quick, albeit temporary fixes.  We have to get some quick victories–if only it provides some breathing room to address and determine the real problems.  If we’re smart, we triage it with an eye to the future–not precluding opportunities for more systemic fixes of the real problems.

Sometimes our triaging efforts are more symbolic.  Recently I sat with an executive reviewing substantial performance issues with his senior management team.  There were some big challenges and deep rooted issues impacting the organization’s ability to grow.  One of the managers casually mentioned hassles with reporting, the time he and his people spent preparing reports he was convinced nobody looked at.  Without skipping a beat, the executive said, “Then we will stop doing that.”

It was a pretty simple move, but it changed the tone of the meeting.  The senior managers in that simple step saw the executive was committed to solving their problems–all their problems–and helping them re-establish growth.  Did it immediately put us on a recovery path?  Absolutely not, but in eliminating this annoyance, the sales managers and people started seeing a path to success.  The managers felt they had permission to tackle the tough, deep rooted challenges they had been facing.

Triage is a necessary step in any organization that has serious performance issues and needs to make large and rapid changes to improve performance.  It may not be solving the root problems, but it starts minimizing or eliminating the things that distract the team from being able to address them.  If customers are unhappy, if management is beating you up about performance, if people are unhappy and leaving, you have to take some quick steps to reduce these distractions.

We won’t fix serious customer experience problems overnight, but we can talk to customers, listen to them, do some quick fixes, then continue to communicate what we are trying to achieve–we might even engage them in designing the experience.

We won’t fix months of bad sales performance, catching up to our Year To Date goals in the next 30 days–but we can make our number for that month by focusing on “must wins,” and working with our people to help them close enough deals to get through the month.  We can start can focus on a few areas–perhaps certain solutions, certain customers, certain opportunities where we can reverse the course of losing and begin to win.  We can show them it is possible to win and achieve.

As I mentioned, much of triage is about eliminating just enough of the distractions (the proverbial alligators that keep us from draining the swamp) that prevent you from addressing the systemic problems.  The simplest method of sales and business triage is simply, “What do we stop doing?”  I’m constantly amazed, the most troubled organizations are usually distracted by a lot of meaningless crap.  It may have been useful in the past, it may be the way they have always done things, but so much is no longer relevant or necessary.  Stopping everything that doesn’t contribute to our attainment of our goals eliminates a huge amount of distraction and frees up time to be focusing on the right things (and doing them right).

We seldom stop too many things.  We seldom stop the wrong things.  But if we do, we can just restart them.

So triage is a critical first step in fixing chronic, systemic performance problems in organizations that have huge performance problems.

But, too often, the mistake managers make is they stop at triage.

It’s like the patient who has had a heart attack and has had their heart jump started walking out of the ER and going home.  The underlying problems are still there!

As managers and leaders, we get distracted by the immediate.  Many of us have become outstanding “ER doctors or nurses.”  We know how to fix the immediate problem, then we move on to the next, then the next, putting Band-Aids over problems.  Very much like the ER doctor moving from patient to patient.

If we are going to sustain performance improvement, we have to address the root issues.  We have to understand the bigger issues at play, the interrelationships between them and the changes we must make to sustain high performance over time.

Perhaps taking the heart attack patient example to an extreme–if the patient doesn’t go see the cardiologist to address the root problems, the patient will keep having heart attacks until he dies!  Our triaging of our organizations is very much the same.  We can’t just rely on band-aids and quick fixes, they buy us time and attention.  But we have to identify and fix the underlying problems if we are going to create a healthy, high performance organizations.

In hospitals, there are Trauma Doctors and Nurses, focusing on Triage.  Then there are the specialists, the cardiologists, neurologists, internists, and so forth who focus on the systemic problems.

In the sales and business world we have to be a little different.  Great business leaders have to be great at both triage and identifying/fixing long term — systemic problems.  We have to leverage both, appropriately, if we are going to maximize performance over the long term.

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2 Comments
  1. “We seldom stop too many things. We seldom stop the wrong things. But if we do, we can just restart them.”

    Great summary! Mind if I use that quote and attribute it to you sometime?

    The Pareto Principle is alive and well. Focusing on the crucial 20% of our activity yields 80%+ of our results…

    • My pleasure, quote away. Loved your blog post on what your mother taught you about forecasting.

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