Resources can flow into the system, but are those resources flowing through the system?
Where permeable boundaries exist, the most healthy, well-resourced systems are the ones with the most connections to themselves.

Triple Loop Leadership is on a mission to improve healthcare for equity, sustainability, and human flourishing by amplifying the power of healthcare professionals to live implementation-ready.
Resources can flow into the system, but are those resources flowing through the system?
Where permeable boundaries exist, the most healthy, well-resourced systems are the ones with the most connections to themselves.
Every scholar-practitioner is an artist. It takes creativity and empathy to assemble a customized solution for the person standing right in front of you. Every time this clinician engages with a patient, their evidence-based decision-making algorithms become infused with skin and bone and immersed in the transforming beauty of human connection.
Be you a nurse, doctor, therapist. Learn the science. Be the art.
The beauty of the Yes/No binary is that it’s a bidirectional relationship. Saying “Yes” to something is an implicit “No” to hundreds of other things, and saying “No” functions as an implicit “Yes.”
Yes to the most meaningful choice, the most impactful project, and the more values-aligned relationship.
Process is power. Results never stand alone⏤They rise and fall with the validity of our analysis.
The detailed description of our rationale for every minuscule choice around a study design makes our work reproducible, and the reproducibility makes it substantive.
If we can’t debate the validity of a study design, then we can’t learn from each other. If there’s no collective conversation, then there’s no refinement of our metrics, no shared mental model, and no advancement of the science.
New knowledge is great, but the true power of scientific inquiry lies in our ability to clearly identify our process.
An answer is like a CD player. It’s a resource that outlives its usefulness. We learn to see past it., move beyond it. To live without it.
Our environment is a byproduct of complexity. Even our best intentions and most thoughtfully crafted interventions produce unintended consequences. But decision paralysis isn’t an option. The worst thing we can do is stand idly by and decline to make a choice.
Choose and move.
Reciprocity is empowering because it’s proof of my influence. Proof of my power. Self-leadership is accepting this, learning to master my internal environment, and choosing the direction of my influence.
I am the culture. Influenced and influencer. Never passive.
The more odd a comment seems. The more heightened the emotional energy. The greater the number of moving parts. The more deeply engrained the problem. The more essential curiosity becomes.
It doesn’t take much curiosity to open up a world of new possibilities or bridge the gap in a collaboration. It doesn’t take much to be part of the solution.
Unless exercising curiosity takes more effort than you’re willing to give. In this case, please don’t point the finger at others the next time you feel like complaining about the status quo.
Co-creating is an empowering prospect until I experience the pressure of it. The weight of reciprocal forces nudging me and simultaneously being shaped by me. It’s a challenge to know where the external ends and the internal begins. I am influenced and shaped, and I influence and shape.
Never mind the rollercoaster. Either the locus of control for my contribution lies within me, or it doesn’t. I can be tossed around on the endless back and forth of complexity, or I can center on the values that move me.
The fact that reciprocity exists is proof of my own substance.
We have no control over external outcomes. Only the internal ones. The first step of successful implementation is creating conditions for change within ourselves.
To lead change we must master the internal, infinite game of change.
Values are direction. Like a mountain in the distance. The forest right in front of you may or may not offer a pathway.
Choose a direction based on available pathways and you will eventually find yourself on a path to someone else’s mountain.
An established path is no guarantee of success, but a life spent climbing your mountain is a guarantee of significance.
It is less about “What do I need,” or “What am I lacking,” and more about how can I use what I have to expand my capacity for good.
Life is moments. If we have some sense of an ideal future, a noble intention, a pure desire, then all we must do is be faithful to that future in this moment.
Experiment, integrate, implement. Repeat.
“All models are wrong. but some are useful.” (George Box, British Statistician)
Whether I’m pulling out a pencil and notebook in preparation for a lecture. putting my feet on a trail, taking a deep breath to gather my thoughts before I begin documenting a procedure, or taking a deep breath before walking into a conference room. Knowledge only transfers into real life when I lean into the embodied practice of it. And it’s only in the application that I truly learn how to be useful.
Even knowledge acquisition isn’t effective unless I can find it in myself to sit still and focus.
Physiology first.
The only thing wrong with being a rescuer is that it needs someone else to play the victim. It’s a zero-sum game. It’s what happens when we buy into the venerated hero narrative.
We tell ourselves stories about the other person’s deficiencies and dysfunction and forget that strength is a much more engaging narrative.
But strong doesn’t need an “intervention.” Strong doesn’t need someone to step in and tell, or do, or fix. So what are we offering society if our patients and coworkers already have what it takes to create the lives they want?
Who am I if I’m not rescuing?
Good god, I hate being wrong! And one of these days my competing commitment to be useful and connected will overcome my fabricated fear of failure and turn me into a transformational leader.
Change and learning always involve tension. It’s a turbulent space between choices. Converging currents tugging us in different directions simultaneously. We can either be right about what we think we know, or we can admit to our previous blind spots and step into something newly expanded.
We are the only ones who can move through the tension for us. Or we can acquiese to our knee-jerk reactions and hold onto our blind spots. I’ll be the first to admit it, sometimes I really like the benefits of avoiding tension.
Fear is a thin veil. It looks opaque from this side, but it’s easily penetrated. On the other side is room to breathe, room to spread wings. Freedom to dance.
Approach change as a byproduct instead of an outcome. Sustainable change emerges from cultural conditions like a tree emerges from the soil.
I can’t control the growth of a tree. All I can do is create the conditions that give it everything it needs to be strong and healthy. I choose which type of tree I plant, and I can guide it’s growth. That’s it.
People create and sustain change, and people are not a KPI to be controlled or a widget to be manufactured.
Humans live within meaning-making the way seeds live in soil. We are drenched in our assessments, interpretations, and stories.
The next time I find myself spinning and fixating on my story, I will stop and consider how that story is either supporting or preventing new choices. I will consider what I want instead, then choose a story that creates freedom for new action.
New action leads to new impact, to new learning, to adaptation. Now I’m dancing.
Listening doesn’t produce healing. It’s a necessary condition for healing, but it’s not an end in itself. Listening is a tool, a means. It’s a context for exchange. The magic is in the connection that listening makes possible.
Listen to learn. Listen to gain a comprehensive understanding. Listen to honor the story. Listen to create safety, and then offer your best self. Invite the other into a thought partnership. Allow yourself to be part of the equation. Participate in co-creation.
Numbers are just a proxy for the things that really matter. They’re meaningless apart from their potential to help us understand the human condition. Numbers without skin are worthless.
How do we put skin on numbers? How do we make the data look and feel like the human experiences they represent?
Try this. Set a timer for seven minutes and push yourself away from your desk. Zoom your thinking way out. Spend a little time looking across the ecosystem that your data set is connected to. Get abstract. Do some concept synthesis. Explore the edges of what you think is most relevant.
Then zoom back in and bring the connections you saw with you. I’ll bet money you generate new insights.
If you don’t generate new insights, write to me, I owe you a drink. If you try this and it works, write to me; I’d like to interview you. Over drinks, of course.
Healthcare will be a commodity when human health becomes standardized.
Care delivery will be a plug-and-play solution when caring no longer depends on human connection.
Health isn’t a discreet product, and healthcare professionals are not cogs.
We are efficient and predictable, like a surfer.
Don’t make following policy a matter of morality. Leadership is human, and human capacity will always have limitations. Growing, evolving, and limited.
The systems we work in are a symptom of the culture we’ve created. All of us: leader and follower.
When a health system c-suite demonstrates moral purity. When we can look at every decision they make, trace their rationale through the net of complexity, and consider them above reproach. When our own commitment to safety opens our eyes to the constraints the “rules” generate. When I get honest about the complicit role I sometimes play. Then, we can talk about venerating company policy to moral law.
Until then, stand your sacred ground and dance with the system.
Mark 8. It was a spontaneous spiritual retreat that drew thousands of people. They’d been together for three days and no grocery stores in sight. They were starving.
The intervention was a massive, divinely supplied soup kitchen. The inspiration for it came from intimate relationship.
How did Jesus know that many of them had come from great distances? How did he know they had run out of food? He wouldn’t know unless he was engaging with them in the mess of their real life. It would’ve been so easy for him to stay at a comfortable distance. To remain merely “the teacher.”
Jesus didn’t just serve through teaching. He served through relationship. His academic training shaped his mind, but it was love that shaped his actions.
Answers are not the goal—-They’re overrated.
Answers are fantastic if the environment is stable; if the playing field is unchanging. But in an environment of frequent disruption, forget it. The answers are only as meaningful as they are durable.
And it goes deeper than that. When I go after answers, I tense up, I get really concerned about being right. My decision-making gets skewed by my desire for respect and status. In the setting of those constraints I’ll never lean into the process of learning.
The most effective answers are a byproduct of learning. Learning happens through questions.
The goal is to ask phenomenal questions.
I recently heard a member of the old guard complain about how “soft” all these new nurses are.
In fact, this is the first time in history, we have a generation of nurses entering the profession who refuse to acquiesce to bully culture.
Last time I checked, saying “No” to injustice was an act of grit and principled leadership.
These new nurses just might be some of the toughest we’ve had yet.
Being spread too thin. Compelled to do it all. No focus. No clarity of purpose. I tell myself a story that I’m creating value, but it’s a delusion. My impact dissipates and is quickly forgotten. Thsi. isa dilution of energy, focus, and resources.
The Colorado River flows through the Grand Canyon. Surrounded by walls of rock, we could say the river is boxed in and limited, but show me any other place on the planet where the water feels more alive and free. The Colorado River moves with a sense of purpose that a swamp will never experience.
A life of purpose is a life of focus. Focus is saying “no” far more often than we say “yes.”
The next time you feel boxed in, ask, “Is this the limitation of oppression, the limitation of guidance, or both?”
Living on the edge is easy and effortless: I bump into my edge all the time!
I know I’m bumping into it because I can hear second-guessing voices in my head whenever I feel myself being drawn toward something that aligns with my highest, most noble intentions and my deepest, most pure desires.
Damn the story that tells me values-based decision-making is only for special people.
Show me a group of leaders who are living from their most noble intentions and purest desires, and I’ll show you a culture that’s being remade from the inside out.
I can count the number of the things that are truly and universally wrong in this world using about 10 fingers. Everything else is contextual.
Which is why going after being right rarely moves the needle in a meaningful way. Instead, chase effective.
The need to be right keeps us stuck in what we already know. The desire to be effective keeps us curious, humble, and agile.
And that means that I can be wrong and still be very effective (If you work in the healthcare industry, be careful who you say this around).
The patient and his wife held hands, locked in intimate conversation. Through the small window into the hospital room, the couple looked like a tragic scene from a silent 1920s film. His eyes traced the lines of her face. Her brow held a tension that belied the tears she was holding back.
But a team of nurses walked in without so much as a knock. No permission seeking. Not even an acknowledgment of the sacred ground they were stepping onto. It was shift change, and there were tasks to be completed. Never mind the struggle for life and death playing out right in front of them.
The difference between a professional and a technician is the nuanced contentiousness a professional weaves into their service delivery. Professionalism is a human skills competency. There’s no amount of pathophysiology, IV skills, or memorized assessment tools that can make you a professional.
Nursing is a profession, but some nurses insist on behaving like technicians.
She couldn’t take her eyes off the trainwreck and then wondered why her life became a trainwreck.
Job performance and workplace engagement are not an indicators of wellbeing.
You can be damn good at your job and wake up with a sense of dread about going to work every morning.
You can go the extra mile, contribute, be great to work with, and be completely dead inside.
You can hustle and close and get promotion after promotion and lose it all to a stroke at 50 years old.
When did we give Milton Friedman the last word on what value creation looks like?
When stakes are high, holding space for everyone is a waste of precious time and energy.
The people that are capable of offering meaningful support will declare themselves by the way show up.
The people that are going to distract and prevent and drain and demand will also declare themselves by the way they show up.
We get to choose who we journey with.
And it begs a question, “If I don’t want to journey with an energy-draining distraction when the stakes are high, then why am I tolerating it at all?”
When I say to myself, “WTF am I supposed to do here?” or when I shut down and knee-jerk into a coping mechanism. That moment, when I notice myself feeling overwhelmed is both a realization and an invitation.
The realization pinches a little because the feeling of overwhelm usually comes packaged with a handful of unhelpful decisions that I just made. I get to see how I’ve been wrong, and that’s something I work hard to avoid because I like being right. Seeing how I just contributed to the problem is phenomenally uncomfortable.
But the invitation is a do-over. It’s an open-door opportunity to try something new and to keep trying until the new feels natural. The invitation is so liberating and fun that the pain of realizing becomes a distant memory.
The only thing I enjoy more than having answers is discovering new questions that get me to better answers.
The IV nurse lifted the patient’s arm like he was assembling an IKEA chair.
The staff nurse responded to her patient’s disclosure of pain as though she were solving a math equation.
The incoming night shift nurse entered the room with drifting eye contact and announced that he already knew the patient’s story.
The coworker listened to his fellow RN describe her shift and cut her off to list why she shouldn’t feel that way.
Somewhere in the middle of all this fixing problems and fixating on problems, the people experiencing the problems are going completely unseen.
Humans don’t draw conclusions from data. We draw conclusions from our interpretation of the data.
The information we gather is only as useful as our ability to take a perspective that makes it useful.
Maybe it is time for a change of scenery. Or maybe it’s time for a new take on an old data set.
Opposites. Disparate elements held harmoniously in the same space at the same time. Learning from each other. Becoming together.
The moment we smash science and art together, we induce transformation.
When we describe nursing as a science and an art, we’re not talking about a profession. We’re talking about a craft.
Profession serves as a decent reference point, but it’s more science than art. Profession is a regimented, pre-defined skill set that instills technical proficiency in yesterday’s technologies and molds us into a socialized way of being. Professionals belong to a tribe. They become experts.
Craft is capacity expansion. It is science contoured; profession nuanced. Craft plays by simple rules, extends itself beyond pre-determined boundaries, and gleans from adjacent communities. Craft is borne of self-leadership, using yesterday’s tech to invent the future. Craftsmen become masters.
Professionals play to win. Craftsman play to learn.
The professional asks, “What is right and necessary? What am I supposed to do?”
The craftsman asks, “What is effective and beneficial? Who am I called to be?”
The English language needs new ways to describe all the different kinds failure.
I want 100 different ways to tell myself the story of my own failures.
There’s a sneaky conversation happening inside us, silently, in the background. It’s the conversation we are having with ourselves about who we are, should be, and could be.
The conversation carries an eerie resemblance to the words and voices of our past, but here it is, in our present, shaping our future.
Then, a breakthrough happens. We discover new information about ourselves, see a new fact, embrace a new possibility, and a whole new future opens up.
It’s moments like this when we are most susceptible to the sneakiness of that background conversation. If we’re not careful, the new discoveries will be overshadowed by old opinions. That precious new fact frequently gets dog-piled with all the old facts, and that beautiful new future suddenly seems less available to us.
It’s also moments like this when we are most creative, resourceful, determined, and focused. How we engage with our background conversation can either pull us back into darkness or it can become the very thing that launches us into the light. We can choose to stay rooted in the voices of the past, or we can choose to become grounded in a new story and begin speaking to ourselves with a new voice.
I see you, Sneaky Conversation. Come over here, into the light with me, and let me tell you who I really am.
Quiet Management. It feels so good! When I’m frazzled by the frenetic pace of the never-ending healthcare to-do list, any opportunity to be quiet feels like a breath of fresh air. But this isn’t a selfish denial of responsibility. Being quiet actually makes me a more effective leader.
Instead of telling myself to stop micromanaging, or saying to myself, “Wow, Rebecca, you should be a better listener.” I simply shift into quiet, into a moment of stillness.
It’s feels a little counter intuitive, doesn’t it? The thing that I need most for myself, that my team needs most from me, is the one thing that, in the heat of the moment, I feel I cannot possibly have. So, my choice to create it feels a little rebellious.
Like a moment of defiance. Resistance through stillness. Culture change through quiet.
I’ll admit it, I spent most of my life prioritizing hard skills over human skills. Then life took me by the collar and showed me that who I am is how I lead. No amount of “technique” will reshape my assumptions, beliefs, and values.
Human skills are crucial but elusive because we can’t learn them by watching a webinar. They are only developed in relationship with other humans⎯This is the power of coaching. Building on a foundation of vertical development within the context of a safe connection, impacts our performance across the board.
If you’ve never experienced the impact an experienced coach can make, or would like to see the difference an ontological-vertical development approach can make, message me. Let’s learn from each other.
Emotional boundaries are a key differentiator between the Rescuer and the Coach, archetypes described in the popular models, “The Drama Triangle” and “The Empowerment Dynamic.”
Rescuing is a dysfunctional form of helping and it’s rampant in the helping professions. As nurses, as leaders and change makers, it’s important that we recognize our own “rescuer” tendencies and seek to flip that script.
Stepping into responsibility doesn’t mean we accept blame for relationship dysfunction. It just means we’re willing to own our contribution and make a move to do something about it.
Changing healthcare culture from the inside out. The more I learn about Claudine Gay and the tragic death of Eddie Bernice Johnson the more compelled I feel to recognize “resilience” as the silver lining to a very ominous cloud.
☣️ The strongest and most accomplished among us are often the most persecuted and exploited.
☢️ The qualities we admire most in another are frequently born from circumstances we try to stay blissfully ignorant of.
In conditions like these resilience is not just a virtue, or a sophisticated form of energy management for change agility, it’s an act of resistance.
But what happens when staying in the game takes a toll that eventually takes your life? We don’t have to look very hard at health disparity stats to see that stresses associated with living a life of active protest is bad for your health, however inspirational it may seem to those looking in from the outside.
Health Equity = What we do + What we refuse to allow.
Inclusivity begins with leaders. “Emotional intelligence and effective communication are not soft skills; they are human skills…Common human skills such as emotional agility, trust, cultural intelligence, allyship, growth mindset, vulnerability and empathy have been proven to be highly correlated with business performance and should be part of an inclusive-leadership development program. “
Employers see a 7:1 ROI for leadership development. The results are not hard to measure. Employers prioritizing leadership development see reduced turnover, increased engagement, and greater team cohesion.
Leading with the heart, head, and hands means starting with the messiness of our humanity and that mess to inform our strategy. Once we do that, then we get radically tactical.
Every single change we want to see in our teams and organizations begins with the leader. We acknowledge that every aspect of our work happens within the context of relationship and that the relational dynamic on our teams will align with the tone we set. We take responsibility and begin with ourselves.
We don’t take the blame. We take the responsibility. That’s radically tactical. My sleeves get rolled up. My hands get dirty. I show my team how it’s done, then I ask them to follow suit.
Don’t go big. Go bold.
Often the smallest adjustment can have the biggest impact. Honest, vulnerable action, even small ones are always experienced as boldness by the people around us.
Never underestimate the power of your own humble honesty.
Who we are on the inside is all that matters, right? My intentions. My values. What about my impact?
“Reputation” is a story others tell about the impact my choices generate. Am I willing to listen to that story? Because, my leadership will only be as effective as my willingness to accept the impact my behavior has on the people around me.
Humans don’t make decisions based on data. We make decisions based on our interpretation of the data. So, whether it’s the story I tell myself about who I am, or the story others tell themselves about how they experience me, that story drives outcomes.
No doubt, reputation is as much a construct as my own sense of self. And here’s the beautiful thing about that: the co-active, integrated, reciprocal nature of identify formation means that any shift I make to my own internal narrative will contribute to shifts in those I influence.
This is the work of leadership: Taking responsibility. For my sense-making system and the “way of being” it creates. For the choices it leads to and the impact those choices generate.
Responsibility begins with awareness.
Developing the technical skills for leadership is the easy part. We forget that it’s the way we do things that creates the culture.
If we survey the work conditions of other public servants that face regular threat of violence as an occupational hazard we see significant structural support, resources, and authority granted to them to mitigate the risks involved.
Fireman do not set foot on a scene if that scene involves threat of physical violence. They wait until the police arrive to remove the threat, then the Fireman move in. Police officers do not arrive on scene alone, and regardless of what you believe about use of force laws, law enforcement officers are given a wide variety of tools, training and authority to maintain safety. A growing number of law enforcement departments are implementing a special mental health unit to support deescalation.
Nurses are given none of these supports, granted none of this authority, offered none of these resources. Yet we are asked to step onto a scene involving threat of violence, with ineffective means to mitigate risk. If this is a known issue, as the statement issued by Legacy suggests, “… this unfortunately is not a new trend…” then its unconscionable that it hasn’t been adequately addressed.
Effective leadership is a skillset and a mindset. An art and science. Cultivated from the inside out and gleaned from the outside in. Both are essential.
Focus on learning. When change happens so quickly that our answers are rendered obsolete before we can implement them into practice, we focus on learning.
This brings me back to the basics: Internal Structures ∞ External Structures. I feel compelled to consider how I’m contributing to the creation of my own experience. Because at the end of the day, the only thing I have any power to change is myself.
And that doesn’t dismiss the role external structures play in shaping my experience. In fact, it empowers me to engage with external structures from new perspectives and opens up new possibilities for meaningful impact.
In what ways does my mental complexity lag behind the world’s demands… Where’s my journal!?
Even small action, because effective leadership isn’t about going big—it’s about going bold!
In a world that is constantly changing, in an industry (healthcare) that punishes any hint of “I don’t know,” there is nothing more bold than trying something new.
Bold doesn’t mean cavalier. We’re talking about safe-to-fail experiments—data-informed baby steps.
And let’s be leaders: Safe doesn’t mean fearful. Even if all you have is one meta-analysis or just a couple of longitudinal studies, design a safe-to-fail experiment and take action.
Our future depends on leaders who are willing to learn.
The coaching style of leadership acknowledges that the work of leadership happens through conversation. This perspective empowers the coach-leader to transform every interaction into an opportunity to develop their people.
Every conversation is an opportunity for development; an opportunity for transformation.
No system change without culture change. No culture changes without the growth and development of individuals and teams (… communities).
The bigger and more persistent a problem, the more likely that we’re dealing with a combination of Technical Challenges and Adaptive Challenges.
A technical challenge requires a shift in tactic. Just learn a new skill and carry on as usual.
However, an adaptive challenge requires a shift in the assumptions, beliefs, and values that shape our interpretation of data, and our assessments of a situation.
A technical challenge is a lateral development move. Adaptive challenges are vertical development move. They go deep, right to the perceived core of our identities, and invite us into a kind of change that may cost us something we value, and that makes them harder to tackle.
Adaptive challenges tend to be the ones we work hardest to avoid. They’re also the ones that have the greatest impact on generating lasting change.
For more on adaptive challenges read anything by Ron Heifetz.
Leadership development is a necessity, not a luxury. While we work to change healthcare culture, we are committed to developing ourselves to thrive in the current culture.
The complexities of the healthcare landscape demand leaders who can navigate change with agility and grace. But how do we cultivate such leaders? The answer lies in creating a learning culture that values connection, capacity expansion, and continuous growth.
In my work, I’ve found that the most effective leadership development happens in a nurturing atmosphere, where individuals are free to confide in and draw strength from supportive peers. It’s about linking arms with like-minded leaders and embarking on a journey of personal growth together.
I believe in the power of connection to fuel agility and change culture. By leveraging evidence-based coaching we can equip our healthcare leaders with the tools they need to overcome adaptive challenges and achieve greater fulfillment in their professional and personal lives.
If you’re a healthcare leader or aspiring to be one, I invite you to join the conversation. What does leadership development mean to you? How do you foster a learning culture in your organization? Let’s learn from each other and grow together.
I’m stuck! Heading into 2024, I need to rethink how I approach challenges. I want to truly embrace failure as learning.
But there’s a problem. It’s not enough for me to say, “Failure is learning” because I can sense that I don’t truly buy it.
How do I know? Because when I repeat that phrase to myself, I notice tension in my body. I can feel myself recoiling. It turns out my distaste for failure is stronger than my love of learning. My mind makes a move psychologists call “backward association,” and I associate learning with failure instead of the other way around.
But I crafted a solution. I decided to just take failure out of the picture altogether, and focus on what I want. I want victory and joy, and it just so happens that learning is my favorite ways to get both of these.
Now, I know I sound a little pie in the sky. We don’t always get to control which goals we take on or the resources available to us. But we do control how we go after the goal. So 2024 is my year to go after my goals with curiosity, for two reasons:
⚡️Curiosity isn’t just the best way to learn everything, it promotes creative thinking and a more motivated state of being. Behavioral psychologists at UC Santa Barbara found a correlation between curiosity, creative behaviors, and a feeling of desire.
⚡️Curiosity makes me thoughtful to consider all the moving parts before pulling the trigger on a solution. This safeguards me from failing too big and inadvertently causing harm. The aim is a create safe-to-fail experiments that increase our wisdom for effective solution-crafting. You can learn more about safe-to-fail experiments in the book Immunity to Change by Kegan and Lahey.
2024 is a year of learning! (… failure?)