Bred To Lead | With Dr. Jake Tayler Jacobs
Ep. 029: Decision Paralysis: Why Smart Leaders Make Bad Calls
Mon, 17 Feb 2025
Decision Paralysis: Why Smart Leaders Make Bad Calls Through the shocking case of Johns Hopkins All Children's Hospital, where leadership inaction led to preventable deaths, Dr. Jake Tayler Jacobs reveals why even the smartest leaders become paralyzed when facing crucial decisions. You'll discover: ✓ Why prestigious organizations fail to act on clear warnings ✓ How expertise becomes a barrier to decisive action ✓ The hidden cost of delayed decisions ✓ Systems for breaking through decision paralysis Perfect for: Leaders facing critical decisions Organizations struggling with decisive action Executives managing change Teams dealing with analysis paralysis Learn how one of healthcare's most respected names allowed children to die because leaders couldn't make crucial decisions - and ensure your organization never falls into the same trap. 🎯 Ready to break through decision paralysis? Get the blueprint: Grab 'Bred to Lead' on Amazon Join the community: Visit bredtolead.com Connect: Follow Dr. Jake Tayler Jacobs on LinkedIn Share your journey: Rate us on Apple Podcasts When smart leaders make bad calls, everyone pays the price. Learn how to make decisions that matter. #LeadershipDecisions #OrganizationalChange #DecisionMaking #BredToLead
Chapter 1: What is the focus of 'Decision Paralysis: Why Smart Leaders Make Bad Calls'?
Welcome back Bridge Builders to Bread to Lead, the podcast transforming leadership across industries. I'm your host, Dr. Jake Taylor Jacobs, and I'm thrilled that you're here. We're currently ranked as the 30th top business and leadership podcast nationwide. And it's all thanks to listeners like you.
Bridge Builders, if you haven't already grabbed a copy of my book, Bread to Lead on Amazon, it's packed with strategies to elevate your leadership game. Got questions or ideas for the show? Visit us at breadtolead.com. And if you're finding value here, please take a moment to rate and review us on Apple Podcasts. Your support helps us reach more leaders.
Now let's dive in and continue breeding excellence and leadership. Today's episode awaits. Bridgefielders. Bridge builders, bridge builders. Welcome back to the show. Bread to lead. If you're new to the show, first and foremost, I want to say thank you for taking the time to listen to our podcast in an effort to make leaders better. We want to make leaders great again.
I want to make leaders great again to where we're focusing on what matters most. And it's not based on positional titles. It's not based on, you know, people trying to get promotions. But people who truly are inundated with the focus on becoming the best version of themselves is important, especially in health care.
You know, whether you listen to this podcast, whether you're in health care or not, I think a lot of the lessons learned. that we share in Bread to Lead are absolutely transformational. And the reason why is because I'm hearing from you. You're telling me that it's impacting your life and your organization and hearing how leadership changes
decisions that are made specifically in healthcare can cause life or death situations. Now, when you're looking at leadership and different dynamics within whatever organization or industry that you're inundated in or a part of, now this is going to force you to actually have to think about our decisions. and how our decisions can truly impact people's lives every day.
And if you're new to the show, I like to consider this more of a pod class, not just a podcast. I want you to actually learn information, take notes and actually go apply it into your life moving forward. And as the show continues to progress and we continue to get better, you all are giving us ideas on how to truly make our show better. with things that you want to learn about.
And we're in a phase right now where you all are inundated in case studies of hospitals that didn't get it right. And the purpose of us going in this series, I don't know how long it's going to last, breaking down hospitals that didn't get it right. And I'm sure in the future we'll break down hospitals that had got it right.
But we really want to focus on even the greatest of brands in the hospital sector that didn't get it right. Not to expose the leaders that were making these decisions or leading these ships, because we all know the nuances and the complexities of leading an organization. There are so many things you may or may not know. that ultimately you're going to get blamed for.
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Chapter 2: Why did Johns Hopkins All Children's Hospital face a crisis?
What happens when smart, capable leaders fail to make critical decisions? What happens when one of the most respected names in health care ignores the warning signs of his own failure? And let me share a story. And it's a story that will change how you think about leadership decision making forever, which is my prayer.
In 2018, Johns Hopkins All Children's Hospital, one of the most prestigious names in medicine, faced a crisis that will reveal something chilling about leadership failure. Their Florida-based children's heart surgery program was seeing mortality rates three times the national average. Children were dying from preventable complications. The warning signs were clear. The data was there.
The frontline staff were in fact raising alums, but the leadership, very smart, very experienced, very prestigious, failed to act. They hesitated. They deflected. They delayed. And children died because of it. I think about these bridge builders. These weren't incompetent leaders. They weren't uninformed. They had the data. They had the warnings.
They had everything they needed to make the right decision. But they didn't. And understanding why is crucial for every leader. In 2015, the mortality rates in heart surgeries at all children's began rising. Surgeons and staff repeatedly warned leadership that surgeries were going wrong. But instead of acting, leadership protected the hospital's reputation.
They chose preservation over protection, image over impact. Nurses and doctors were seeing the problems firsthand. They were watching children suffer catastrophic complications. One doctor even left the hospital because he couldn't bear watching more children die unnecessarily.
But leadership remained paralyzed, caught in what I call the prestige trap, where protecting reputation becomes more important than solving problems. I want you to consider the case of Mia. A baby born with a heart defect. Her parents trusted Johns Hopkins, believing that they were putting their child in the best possible hands.
During her surgery, mistakes were made that should have never happened. The medical team immediately saw things were wrong. But leadership still didn't shut the program down. Too much money has been committed to this program. More children continued to suffer for months before anyone was held accountable. Here's what makes this story so important for every leader.
The failure wasn't from lack of information. It was from lack of expertise. It was from what I call the prestigious paralysis. When leaders become so invested in their reputation, their status, their image, that they become paralyzed in the face of difficult decisions. And let me break down why smart leaders fall into this trap. All the time.
And there are four key factors that create decision paralysis. Four. The first factor. is the reputation shield. When you've built a strong reputation like Johns Hopkins had, it becomes something that you protect at all costs. Leaders start making decisions based on protecting that reputation rather than addressing the reality.
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Chapter 3: How does decision paralysis affect leader actions?
So when we talk about the reputation shield, many of us, we do this, whether for the company we work for or that we've built, or we do it for our own namesake, for promotions, for raises, for notoriety, for write-ups, for publications, where we rather protect the reputation of our brand than doing what's right in the moment. And this is the paradox.
Because when you're running an organization, you want to protect the name of the organization. That's how people have the trust in you. But not so much that you're destroying all of the good faith and the good work that you're actually doing. And I think this is where It begins to be a hard juggle when pressures from the board, pressures for delivering, pressures for namesake comes into a play.
Now what the easiest thing to do would be fixing it, admitting your failure, admitting your shortcoming, and then running with it versus pushing on, hoping that it'll turn around. And what happens when it doesn't? Because in most cases, it doesn't turn around. So the first factor is the reputation shield. The second factor is the data paradox. And this is fascinating, Bridge Builders.
The more data that leaders actually have, the more paralyzed they often become. At Johns Hopkins, they had a mortality rates, complication statistics, patient outcomes. But instead of this data driving action, it became something to analyze, debate and rationalize. More information often leads to less action. It's actually the thing that I'm seeing inside of our field of health care.
You're all these tech companies and these data brokers and all these subject matter experts talking about data, data, data, make decisions on data. Which, in fact, could be true. But that goes back to our original. Episode just before this one in episode 28, when I talked about the different realities. Data is only paper reality. It's not perceived reality.
It's not ground reality and it's not culture reality. It's just paper reality. And many times paper reality can tell us a truth. Lacking context. Yes, the data says that only these amount of children are losing their lives. And then you're taking that count into all of the surgeries that are happening. Inside your system. And it looks small in number.
But the perceived reality from your your staff, your team, the frontline workers, the ground reality from the community, from the clients, from the patients and the cultural reality of the lack of trust that they're feeling, those things are just as real. And without those three other realities, the context of the paper reality doesn't really add up.
So the data paradox is where people typically get inundated when I'm running an organization. And I'm saying this also as a way to talk about what happens when you talk to C-suite. C-suite, most cases you're in meeting, meeting, meeting, meeting, meeting, meeting, meeting, meeting. And someone's coming up to you asking you to sign something. So you're giving them a synopsis.
Hey, give me a synopsis. What am I signing? Why am I signing? What's going on? OK, cool. OK, let me see this data. OK, data. What's the data saying? Data says that we're 98 percent successful. So if I'm looking at data alone, I'm saying, oh, 98% successful, then we're good. Then the field workers say, yeah, you're saying 98%, but this 2% is real bad.
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Chapter 4: What are the four key factors causing decision paralysis?
You start believing your expertise makes you infallible. This creates the expertise arrogance that many subject matter experts have. Where leaders dismiss warnings because they can't imagine being wrong. And a lot of people are following leaders and following managers that are in leadership positions that are in this expertise trap because God forbid you're wrong on something.
God forbid that your data is inaccurate. God forbid. That the decision that you're saying to make because it worked 10 other times. That it no longer needs data to prove it right in this situation. So that expertise, arrogance acts like a callous on your eyes and it stops you from being able to see things as you used to prior to be considered the best at what you do.
That the best, the expert, those terminologies makes you start to believe your own press. And there's nothing worse than believing your own press when you know your press isn't entirely accurate. And then the last key factor that create decision paralysis amongst leaders. It's the hierarchical filter. That hierarchy filter, man. Information gets filtered as it moves up the organization hierarchy.
At Johns Hopkins, front lines saw the problems clearly. But by the time the information actually reached the top leadership, it had been sanitized, rationalized, and minimized to protect people's positions. In my eyes. See, when people care about their position more than they care about their duty and the responsibility of that position.
They will protect their own position at all costs, even at the demise, in this case, of children's lives. But here's what's crucial to understand. These factors don't just apply to health care. I see them playing out in organizations across every industry where leaders become paralyzed by similar forces, whether they're running a hospital, a tech company, or manufacturing plants.
And let me share something powerful about breaking through decision paralysis. It's not about having more information. It's about having the right decision-making framework. And here's what I teach leaders. The clear decision framework. In the clear decision framework, we confront the reality. We listen to the ground level. We evaluate impact. We act decisively and we review and we adjust.
We confront the reality. We face the unvarnished truth about our situation. We listen to ground level. We pay attention to the frontline insights. When I joined Sips Healthcare and our CEO became the newly appointed CEO, we made a decision to go on what we call the love tour.
where we toured every facility that we supported and talked to the ground level front line workers that were making everything happen within our organization. And you know what we found out was that the feelings that the front line had versus the feelings that administration reported to us were two total polar opposite feelings.
Which is why there was always this growth and contraction within our organization that we had to beat out. When we evaluate the impact, we consider the cost of the inaction. What will it cost us to not act? Can I tell you something? Fixing a problem that you know needs to be fixed does cost a lot in the moment. But do you know what costs more in the moment?
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Chapter 5: How can leaders break through decision paralysis?
And the best facilities, the best companies, no matter the industry, would much rather invest into proactive care than reactive any day. Because it makes it makes you look good when you report to the board that you're cutting costs. You're efficient. You grew a new service line. Programs are growing. But do you know what type of leader you are?
If you can go right to that same board and say, y'all, we got it wrong. Children are dying. We need to cut this off now and give every dime that was given to us for this subsidy from the government for this research. We got to give it back now. But when the hospital is inundated with bills and operating in the red. Not profitable. Now those decisions now become convoluted.
Because now people got to be fired. People have to be let go. But I'd much rather somebody lose a job than a baby to lose their life. Let me share something crucial about decision making. That could have changed everything at Johns Hopkins. I call it the decision velocity framework. It's built around understanding that the speed of decision making is just as important as the quality.
People believe that just because we're big, a big organization, we have to make decisions slow. No, we can make decisions fast. Everyone just has to be on the same page. Think about this. Every day that Johns Hopkins leadership delayed making a decision, they weren't avoiding risks. They were actually increasing it. Every day of inaction meant another child was at risk.
Another surgery that shouldn't happen. Another family trusting their reputation instead of the reality. Because all brands can be rebuilt. Look at Johns Hopkins now. years later, rebuilt, all wounds heal at some point. But it didn't have to be as dramatic as it was. So here's how the decision velocity framework works. The first is the risk assessment matrix. What's the risk of the action?
What's the risk of the inaction? Which risk is growing faster? The second, time impact analysis. How does delay affect outcomes? What opportunities are we losing? What problems are we allowing to grow? Just no different than when hospitals are contemplating on using our SPD services. I don't know if we can afford it. When I'm looking at the delays, I'm like, how could you not afford it?
Y'all are costing the hospital $22,000 a month, a day, excuse me, from delays. When you look at the numbers, how could you not afford to move forward? What opportunities are we losing for this time impact or delay? And what problems are we allowing to grow? And then the decision triggers. Clear points, the demand action, predetermined response plans, automatic escalation protocols.
So many organizations run their organization without anyone in their organization knowing exactly where to go and what to do when things are hitting the fan. Before you take off on a plane every single time, no matter how many times you fly. They go through all of the protocol for if things hit the fan. Let me show you how this could have changed things at Johns Hopkins.
If they just use this framework. They would have seen that the risk of inaction, more children dying was far greater than a risk of action, a reputational damage. The people would have much rather say we dismantled this program because it hurt children. Then to keep it up. Because at least the people would know that when it comes to doing the right thing, this hospital will always do it.
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Chapter 6: What is the 'Clear Decision Framework'?
I've seen organizations across industries fail because leaders couldn't make timely decisions, whether it's market changes that they ignore, employee concerns that they dismiss, problems that they hope will solve themselves or people that need to leave your organization now. The pattern is always the same.
Smart leaders become paralyzed by the weight of their decision, not realizing that indecision in itself is a decision, usually the worst one. So let me share three critical strategies for breaking through decision paralysis after this commercial. Are you ready to transform your leadership journey? Get my book, Bred to Lead, on Amazon now.
In it, you'll discover the proven frameworks and strategies I've used to help leaders across industries master each phase of their leadership development. Don't just lead, be bred to lead. Get your copy today on Amazon. Don't just lead, be bred to lead. That's right. So we're gonna talk about the three pre-commitments. The three pre-commitments.
The critical strategies for breaking through decision paralysis, excuse me. The pre-commitment strategy make key decisions about what would trigger action before you're in the crisis. At Johns Hopkins, they should have had a clear predetermined point at which they would stop surgeries based on mortality rates. The outside view actively seek perspectives from outside your normal circus circle.
Johns Hopkins leaders were trapped in their own echo chamber. They needed external voices to break through their paralysis. And then lastly, the reality check protocol. Regularly pressure test your assumptions and beliefs. The leaders at Johns Hopkins believe their reputation meant they couldn't fail. They needed systemic ways to challenge their belief. Let me tell you something.
I don't care how great your leadership team is. If they believe that their job will be on the line, if they talk against or not in favor of upline leadership or senior leadership, most people will never tell you the truth. Have you noticed that when you're in meetings, when a senior leader says, does anyone have any questions, any problems, any concerns? No one says anything.
And then the moment that senior leadership leaves, everyone has the complaints, talking mess, crap, upset. Why? Because to say something to somebody about something that is wrong, it takes guts. Think about this, Bridge Builders. When the Tampa Bay Times finally exposed what was happening at Johns Hopkins, the public was shocked. But the real shock wasn't that things had gone wrong.
It was that leaders had known all of the facts already and failed to act. Which brings me to something crucial about decision making that every leader needs to understand. Your reputation isn't built on the decisions you make. Your reputation is built on the decisions you fail to make when it matters most.
And in order to prevent decision paralysis, and if you're new to my podcast, you know I operate in frameworks. I come from sports. Everything had a play. Sideline play, under the basket play, right at a halftime play, start the game play, depending on if we're down 20 or if we're up 20 play. There's plays, a huge playbook. And I operate within these frameworks that help us play.
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