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Sarah Richardson · Calm Under Fire

• Col. John Boggs: Welcome to Calm Under Fire. I'm Colonel John Boggs, and I'm the president of Fortitude Consulting. And Fortitude Consulting is an executive leadership development firm and coaching firm. And today we have with us Sarah Richardson. And Sarah is a health care and technology executive who spent her career leading large, complex organizations through transformation. Her work focuses on aligning strategy, people, and systems to improve performance in environments where the stakes are really high and the margin for error is really small. So today we're talking about leadership under pressure, especially when change is constant and the outcomes matter beyond the organization. Sarah, welcome. Thank you for being here. Sarah Richardson: John, it's an honor to join you. And first, thank you for your service and for Col. John Boggs: Thank you, Sarah Richardson: reaching out. And in researching you, I love the line that you share in that leadership is too important to get wrong. And that aligns with what we see every day in healthcare. Col. John Boggs: Wow, well thank you very much. Serving was an honor and thank you. That was very nice, thank you. Well Sarah, do mind if we jump right in it? Sarah Richardson: Let's do it. Col. John Boggs: Okay, well you know, healthcare environments carry a unique kind of pressure. When did you first feel the weight of that responsibility as a leader? Sarah Richardson: Early in my career, and I'll be honest, it's some 32 years in at this point, I still remember the meetings, and this one very specifically, where we were making what felt like standard operational decisions, the timelines, the budget, the system impact, the clinical impact, patient outcomes, et cetera. And... In that meeting, our chief operating officer paused and said, if you guys get this wrong, it's not just a delay. It's going to affect how we deliver care in this organization. And there were two things, John, that stuck with me at that Col. John Boggs: Mm-hmm. Sarah Richardson: time. A, that it clicked for me, especially at that age, I was in my early 20s, that the decisions we make in health care don't stay on a spreadsheet. They show up in patient experiences and. clinician experiences and the outcomes, our reputation as a healthcare organization. It also made me realize what a huge bridge there was to cross to create a partnership with our teams, that IT wasn't an isolated box in the basement, that there really was room for us to grow these expectations together. And once you feel that, once you experience that, you don't lead the same way again. And I had... come from hospitality, from the casino industry, prior to healthcare. And so very different weight on the shoulders of what we were delivering every day. And I have to believe this is probably something that translates well from your military experience, the idea that pressure does reveal how you lead. Col. John Boggs: Yes, it does. Yes, it absolutely does. So how does pressure shape the way leaders think and act in your industry? Sarah Richardson: As you mentioned in the introduction, the margin for error is small, the impact is massive, and it forces you to think. just beyond efficiency or growth. mean, the bottom line is always important, but you're constantly balancing operational decisions with human outcomes. That literally is a conversation of do we fix a leaky ceiling? Do we buy new beds for patients? Do we invest in new infrastructure? Often it can be a trade-off based on timing. That sharpens your judgment because you can't get stuck waiting for the ideal information, but you also can't move fast without thinking through the consequences and the trade-offs you're willing to make at any given time. So you learn to lead with both urgency and responsibility at the same time. That saying of walk a mile in somebody's shoes to truly understand. Col. John Boggs: Yeah. Sarah Richardson: I spent such an inordinate amount of time rounding with or being in the trenches with our clinicians. If you want to understand what a ED physician cares about, go to a trauma ED on a Friday night in a big metropolitan city. Col. John Boggs: There's the pit that's out there now. You just made me think of that television show. my gosh. Sarah Richardson: Yes, that's what my first hospital was actually very much like in terms of just the amount of activity and the pressure and the things that happened. I love that show because it's literally a flashback to where I started my healthcare career. Col. John Boggs: Wow, you've led large scale transformation efforts. So what changes about leadership when everything is moving at once? mean, technology, people, expectations. I mean, it's just, it's a mile a minute. Sarah Richardson: It is, and there's an adage, whether it's you're changing the tires on a race car while it's in the race, or you're fixing the engine on a plane that's flying. You hear both of those pretty often, at least in my industry. But what changes is that transformation isn't about being one thing. It's not an initiative. It's part of the environment you're operating in. It becomes part of the culture. Culture takes a long time to establish. You'll hear that, I think it was... I have to refer back to who it was, but culture will eat strategy every single day. And it's an old adage, except for the fact, I think it was Drucker, Peter Drucker that said that. But what's so key about it is that as that leader, and this is in any part of the evolution of your career, your role shifts from managing projects to creating clarity around the outcomes, around the intent. It's not just about tooling, it's about how does this workflow impact our organization? Because everything's happening at the same time, people don't actually want more information. They don't want another dashboard to look at all the metrics. Those are important. There's a place for each of those, but they're looking for direction from you. You have to help them understand what matters most, how their work connects to it and making it meaningful, which is why I'm such a huge fan of organizational change management. I've had previous teams get completely trained on pro-sci, deep understanding of Cotter's model of change and really appreciating where the human element comes in because people process and technology, technology is the smallest piece of that. overall equation. People are most important and then the process all being inside of that. So I always say that technology is actually the easiest part of the job. Col. John Boggs: OK, well the technology, the easiest part of the job, that's really interesting. So you've got the technology, you've got the people, you've got systems. So where does a leader lose clarity? mean, if you're going to lose the bubble, where do they tend to lose that bubble? Sarah Richardson: I'm only laughing, Jong, because when everything is number one, nothing is a priority. And you lose clarity when everything is a fire drill or everything is absolutely the first thing. So you go into governance conversations. And what's fascinating to me is 32 years later, governance is still this like first conversation we're always having. And there's a tendency to focus heavily on the technology or on the work and not enough on how the people are adopting it, absorbing it, adapting to change and for it creating meaningful new outcomes. When that does happen, communication turns into an activity versus clarity on direction, clarity on alignment to the system strategy. And I say like the health system strategy, but that's where alignment breaks down. When everything is looked at as an individual project, every project has the same level of importance and every stakeholder has like claimed their piece of turf, then all you're doing is deploying a bunch of projects, but nothing that's really bringing them collectively together for improved outcomes at an exponential or aggregate level. So one project going well, if it goes well in isolation, then it doesn't really matter if the impact to the rest of organization isn't even realized or made part of how you are defining success for your company. Col. John Boggs: So you just described the wonderful, you know, what is it, the stovepipes. I'm working in my little stovepipe and I don't care what you're doing over there. So how do you work to keep that from happening? Sarah Richardson: So I think of it like when pressure increases, when the stakes are even higher, then Col. John Boggs: Mm-hmm. Mm-hmm. Sarah Richardson: centering on humans or that human centered design piece matters even more because there's always going to be a pull towards speed. Just get it done. Better, faster, cheaper has been an IT thing where people in IT have heard forever and you lose people in the process and you lose Valcom anyway. because it just happens slower and more friction in the process. So when you can stay focused on people, that means that it's being visible. listening actively, really being curious and understanding and making sure that your teams understand not just what's happening, but why it matters. I remember when I would bring people into the org, there was a book years ago called, you How Hospitals Run. And I would say whatever domain you are assigned to, this is even to the service desk agent or the desktop technician who's going out to fix a problem. What are they fixing and what is that person's role in the organization? Because if you keep getting deployed to the business office, as an example, and it's just not their printer breaking or something else, it's really about their workflow or design or different aspects of the application. What is their day to day like? How does it mean for them to do a great job? How do they leave at the end of the day feeling like the fact that they were the ones who were there made a difference in how patient care got delivered? So when you can literally bring everything back to a human level, then other pieces do start to organize around it. Col. John Boggs: Okay, okay. So that's a high performing culture is what sounds like what you're trying to build there. So what happens to accountability? Sarah Richardson: You Col. John Boggs: Where does that come in? Sarah Richardson: Accountability is super interesting to me because pressure or high stakes doesn't break it. It just reveals where it is or isn't doing what it's supposed to be doing or where it isn't being handled well. When you have a strong culture, and I'll be very specific, that culture starts at the top. And you'll see leaders today, John, get burned out because their leadership changes every two to three years. It depends on the organization, but when your teams are constantly changing leadership, It's really hard to build a culture that has the continuity because accountability will tighten because expectations are clear and people step up into the ownership roles. If the culture is weak or constantly changing, especially with the people, it honestly gets shifted into like blame and confusion. I would say guns pointed inward or doing the corporate coat of arms where you point in the other direction. It's usually a sign that there wasn't the right clarity to begin with. And when there's not the right clarity, people will go and figure out how to fill that time. People, this is one of my best coworkers ever, David Jim Bruno said, people are meaning making machines. So they will go find structure and purpose if it's not provided to them. That's not always a win for an organization. It can be if they are innovative and creative and creating new opportunities, but typically it just leads to more disruption in the organization. And one of the most significant changes I ever made on a team, I got to an organization and everybody had their individual goals and their team goals to a degree, but they were all incentivized with their bonus on did they meet their goals. So the first year I'm there, I'm like, all right, let's go all in. 100 % of our bonus is tied to collective goals. And they all like freaked out. I said, okay. And I did that on purpose because I said, if 100 is too much, what number makes sense? And they just stared at me for a little bit. And this was also because there was a lot of dysfunction on the team. They actually didn't like each other very much or trust each other. And Col. John Boggs: Mm-hmm. Sarah Richardson: they said, well, 10%. And I was like, how about 25? Well, we got to 20 the first year. After four years, 100 % of everybody's goals were collectively the responsibility of did we succeed or fail as a team, not just each individual team's domain. Col. John Boggs: Wow. Wow. I mean, that's a sincere wow. To get people to buy into the collective goal, that had to be... I mean, did you lose people in the process? Sarah Richardson: Yeah, I mean sometimes you'll have people they'll tell you I'm either their favorite or least favorite leader that they ever had for those exact reasons. I replaced about 60 % of that team. A lot of it was self-identified and those conversations are real. I mean those conversations are let's just pretend it's you and me and I'd be like, well, hey, know what, John? This is where we're headed. Is this where you want to go? And if the answer was no, then we could have that thoughtful conversation about what is the next best thing for you. Others just kind of got stuck in the mud. I'm like, you know, this isn't working. And they would say, yeah, I get it. And you can't make those types of big changes overnight. What's really Col. John Boggs: Mm-hmm. Sarah Richardson: key though is having a space where people realize that they are better together and we're going to succeed quickly together. We might fail in some aspects of it, but I always have loved Jim Collins, the good to great author originally when he said, This is level five leadership. When things are going well, you give all the credit away. When things are going poorly, it's your responsibility. So when you take the accountability, and this is something I have always, the hill I have always died on is, if it's not working, it is my fault. And how do we get ourselves out of it? I have left organizations because at some point that weight needed to land somewhere. And so I self-selected out of an org, versus even sacrificing some of my team because... whether it was 100 % me or not, I was still the one at the quote unquote top of that particular pyramid. And so it was potentially time for me to move on so they could get to the next things that made sense. So sometimes things go amazingly well and you're super excited about it. And sometimes things don't go super well in your orgs. It is your responsibility as the leader to own it regardless. Col. John Boggs: How do you? Let me rephrase this. What is the impact of your peers, your leadership peers? They see you, you you've got people to buy into the collective goal. But over here on the right flank, they didn't. So that has to create some friction somewhere along the line. How do you deal with that, with friction from your peers? Sarah Richardson: Peer friction can be fascinating because, and I remember hearing this in a leadership workshop one time, in that if you don't like somebody, they don't like you. And you're like, okay, I get that. However, it's important to find the like in everybody with whom you work because you were all there for a shared or similar reason. You're not making these decisions in isolation. You're making them based on what's ideally a collective agreement on what's best for the organization. There is a ripple effect that goes into that. So I think about things in order of impact, of what happens next, who else is affected. You are in those instances balancing speed and consequences Col. John Boggs: Mm-hmm. Sarah Richardson: and data with your experiences. So you don't have to have perfect answers or ideas, but when you are curious about the environment and you're making thoughtful decisions of the overall awareness and broader impact, what I say to people is, I'm here to make you successful too. This is not about a glory grab for IT. This is about how are we making this health system a place where patients and clinicians are choosing to be. And taking the time to get to know people one-on-one. will never be a waste of your time. Col. John Boggs: How do you keep? I loved it. In my experience, IT can become the root of all evil, or so everyone will say. The businesses will all point to IT. Well, IT didn't do this. IT didn't do that. It's almost like the easy scapegoat is IT. Have you had to deal with that? Sarah Richardson: Always. mean, Col. John Boggs: always. Sarah Richardson: and here's why it's such an interesting space that we're in today. And I always joke about like, when I started back in the day, know, IT Col. John Boggs: you Sarah Richardson: was where you had a problem, you went to fix it, you found the tool set or you built it and you deployed it problem done. And it was a one and done. I mean, so often that was the case. everything now is connected, like literally everything. And more often than not, when you're seeing breaches or security issues or other lacks, maybe some of the system capabilities, it's coming from third party connections. It's coming from your partners. It's coming from the malicious hackers, the people who want to do harm versus the exact opposite of what we're here to do, which is do no harm. And you start to realize that it's... there's not an isolation in some of these decision-making capabilities. And IT is an easy place to dump on, except that when you start to build organizations where IT isn't just... procuring technology, deploying technology, managing technology, et cetera, when they're a strategic partner at the table with the C-suite, with the Col. John Boggs: Mm-hmm. Sarah Richardson: board, making informed discussions, then you're realizing it's a different type of leadership that also is required. So I've gone into organizations and managed to change how IT is looked at. We're not ticket takers, we're actually partners. I've also been in places where the culture was very top-down and IT shall go do what others tell them. Those are organizations Col. John Boggs: Mm-hmm. Sarah Richardson: I left sooner than I maybe would have wanted to, but Col. John Boggs: Mm-hmm. Sarah Richardson: one person cannot change culture unless it's macro inside of an environment. But overall, it's aligning the type of technology that you want with the type of leader who's capable of delivering it. Col. John Boggs: In a large healthcare system, decisions can ripple across an organization. How do you think about? judgment when when the impact is broad when the impact is broad and immediately broad and immediate What's what's the impact? Sarah Richardson: Yes, it's important not to be worried about having a perfect answer. And I did a presentation a couple of weeks ago and also a follow-up to that different industry events over the last couple of weeks, specific to what you don't know and why is it okay to not know something. And as you move up the ladder of responsibility and organization, you may actually know less about the... topics and domains that got you there in the first place. In Marshall Goldsmith has that great book about what got you here won't get you there. You Col. John Boggs: Mm-hmm. Sarah Richardson: get to a high enough level in organization. This is one of my favorite Colin Powell books too, is he said, you know, when you get to the top of the pyramid, it's really pointy and sharp. So Col. John Boggs: Ha! Sarah Richardson: you better be looking down to appreciate what that foundation is built upon. Because if you don't, it's a pretty lonely space and it's pretty dangerous place to be. So when it really does come to the judgment that's required, it's having the informed conversations, it's such a level of trust and transparency that they know you're not hiding anything. And this goes back to my last organization, probably I've been there four or five months and there was a pretty big delay in the deployment of some new software capabilities. And I hadn't been there long enough to really know all of the pieces, pretty darn close, it takes about six months. And the COO said to me, well, who's responsible for this? And I said, I am. And she said, well, if it doesn't go well, then you hold me accountable. And she said, you haven't even been here for six months. I said, you hired me. This is my team. It's my responsibility. Even if it was day two, I would say it's my responsibility to work through and figure these pieces out. At that moment, she and I always have then had an amazing relationship because she knew I would figure it out and we would figure it out together. So it's really, really key that you're making people aware of what's happening organizationally. but that you're also bringing them into the decision making so that people don't feel like IT's over here making these decisions without really appreciating how it's going to impact the organization. I got to believe John, mean, both military and healthcare environments, these decisions, they can ripple quickly and pretty widely if they're not managed properly. Col. John Boggs: Yes, they can. Yes, they can. Now, Sarah, you have you've you've commented on a number of authors and a couple Sarah Richardson: Yeah. Col. John Boggs: that I know fairly well and and one that I know personally. and that's to your credit, by the way, because to be a good leader, you should you should read. Leaders are always reading, always studying. So that's to your credit. I appreciate that. and I hope everybody's listening to that. What's helped you stay grounded as a leader in IT, in an area that's constantly moving? I mean, probably since we've been here, something has changed that's been magnificent. I don't know, things can move that fast. But how do you stay grounded? How is a leader, let me phrase it that way, how does a leader stay grounded in a fast-paced environment? Sarah Richardson: Especially now, and I like to think I'm super adaptable. I I study change management, I study people, I'm always reading, I'm always writing, I'm always asking people like really in-depth, open-ended questions from my coaching background. And it's harder now to stay in front of everything that's happening, truly. mean, AI has released, depending on how you look at industrial revolutions, you could say it's the fourth or fifth, I'm going with fifth. And experience helps, so does perspective. So I have amazing trusted individuals in my universe who will challenge my thinking. And I make a point to ask them questions like, what am I not thinking about? Who is impacted that's not in this room? Who else should we be seeking perspective from? That question, if you literally say, what are we missing? Or who is gonna be impacted by this? Those questions. Change how you approach a decision. It also keeps you grounded in the reality of the organization, not just the conversation you are having, because so many people lead with a sense of fear, fear of making the wrong choice, the fear of losing their jobs, the fear of having bad outcomes. And when you make that somewhat safe, and there's still accountability there, when you make it safe to be thoughtful about how decisions are being made, then... Col. John Boggs: Mm-hmm. Sarah Richardson: people feel better about it because they know that they were heard and they were seen. And those get overlooked a lot because they're considered soft or squishy skills. I will tell you a thousand times over, people being heard and seen and valued in an organization, that is your intellectual property. Col. John Boggs: wow. Okay. What kind of pressure? Where do leaders, let me ask it this way, where do leaders underestimate? They underestimate the pressure or they underestimate the capability of what their organization can do. So I guess maybe that's overestimate the pressure, underestimate your people. Have you ever seen that? Sarah Richardson: Yes, because I've been really fortunate to work in some of the largest healthcare organizations in this country. I've worked at HCA, I've worked at Optum, and also worked in Trauma One academic medical centers and physician practices and non-for-profit environments. Purposefully, I love being able to try your wares in different types of environments. The emotional weight of leadership, and this was exacerbated during COVID. that the decisions you make affect people in very real ways. And that carries forward over time. Because the cumulative effect of constant decision making and The impact of misalignment across large teams can just, you can just carry it with you like this invisible rock. I tell people that, you know, the Sisyphus example of you're going to roll that rock up and ideally doesn't roll back on me at the end of the day. And sometimes you actually get to push it over the hill only to find that there's another hill right there in front of you. But managing that well requires self-awareness and the ability to stay grounded. even when the environment is really demanding. So Col. John Boggs: Mm-hmm. Sarah Richardson: never underestimate the emotional weight of leadership, especially when you care. And I don't know that everybody's wired to want to be that type of leader. And you can be kind and you can be firm and they are not mutually exclusive. Col. John Boggs: Okay. For leaders, no, not that one. Let me think. What separates You've been at this a long time now. So, and you've seen a lot of things. So what separates leaders who navigate well, they transform, they're moving well from those who seem to just struggle. They just never get out of the struggle. What separates that? What's the difference? Sarah Richardson: For me, I love to share with people I take my work very seriously. I don't take myself very seriously because if you're not having fun in the work that you're doing or feeling like Col. John Boggs: Hmm? Sarah Richardson: it matters, it's something like a legacy for you and your career. And I say this to often because you wake up and all of sudden you're in your 50s and you're like, wait a minute, what am I leaving behind? I've been at this for 30 plus years. Like what am I literally leaving behind? And so... Col. John Boggs: When did that happen? Yeah. Sarah Richardson: When you navigate it well and you stay anchored while everything else is moving, then Col. John Boggs: Mm-hmm. Sarah Richardson: I have experienced that you can navigate transformation better. Change is going to happen anyway. Most people don't like change. If you are the orchestrator of the change in a way that has communication directed towards outcomes versus noise, you stay connected to your people and you don't lose yourself when things pick up. That consistency is what allows everything else to work. don't remember whoever said it, was champions are made when no one's watching. It's that discipline to be in the gym to stay healthy. It's the discipline to read the book, look at the report, fix the bugs, have the extra conversation, stay after till 8 p.m. because that's when Dr. So-and-so is available to share his grievances or her grievances with you over workflows in the OR. When you take the extra time to care and also give yourself room to breathe, then you're going to be fine. Because it's not always going to be great. In fact, another one of the, you call them geisms from the gentleman I mentioned before, he'd say, any idiot can deliver good news. It's how you're showing up when it's tough that's going to matter. Allow for it to be hard sometimes because then you're going to grow and reflect upon it. That was hard lesson to learn in my 20s is I thought if you did everything right, then you'd always get accolades for it. Well, you can do everything right and still get in trouble kind of a thing. Col. John Boggs: Mm-hmm. Sarah Richardson: How you manage the ups and downs is really key in navigating transformation and what's expected from you both technologically, but also as a human being. Col. John Boggs: Sarah, thank you. Sarah, for leaders who are navigating transformation in complex environments like healthcare, what's the best way for them to connect to you to learn more about you and your work? As a matter of fact, let's stop for a second. And if you can tell us about you, your work, how do people connect with you? Can you give us a little bit on that? Sure. Sarah Richardson: Sure, thank you. I've been, I said, mentioned doing this for 32 plus years. Started in hospitality, I'm in healthcare and I've stayed in healthcare very purposefully. Best place to find me is LinkedIn. Super active on LinkedIn and it is the only social platform that I engage in only because, gosh, you if you're gonna figure out how do you spend your time, that is where my audience is, is what I like to say. So LinkedIn, I do a ton of thought leadership and content both on my... under Sarah Richardson, also under my primary organization, This Week Health. But I also own a coaching organization. And so my personal website is conciergeleadership.com where I do workshops and transformation and executive coaching, all kinds of level setting so that people can show up as the best version of themselves. You could be a new early careerist or you can be the CEO of a major company or a board seat and having those conversations and the ability to navigate that well. I share perspectives on leadership, healthcare, transformation, currently managing AI in a time when humans still need to be big part of that conversation in the loop. So those are the areas that say LinkedIn, concierge leadership, And I do reply and respond. So if you send me a DM in LinkedIn and it's not a sales pitch, then I'm happy to respond immediately. Col. John Boggs: Perfect. Wow. Thank you very much, Sarah. And that's conciergeleadership.com. And folks, if you've been listening like I've been listening, you can learn quite a bit about leadership, about staying calm, about pressure. You can learn a lot from Sarah. So if you're listening and you want to reach out, don't hesitate, reach out. And I think you'll be very glad that you did. Sarah, thank you so much for this. I greatly appreciate it. I don't know how I can thank you enough. Sarah Richardson: Well, John, thank you. Meaningful conversation. I've loved having the opportunity to chat with you and the appreciation for the perspective that you also bring to leadership. Again, it's too important to get wrong and conversations like this are how we keep getting better at it. Col. John Boggs: Yes, yes it is. Sarah, thank you very much. And to everyone out there that's listening, thank you very much. Remember, leadership is too important to get wrong. So do what you need to do. Read, study, listen to podcasts such as this one. I mean, there are many out there and many to talk about leadership. Do yourself a favor and learn something. Hey, that's it on this end. I'll see you next time out here.