Tell, Check, Disappointment
The leadership mistake that keeps healthcare founders carrying the cognitive load
Hiring for the first time is a big step. It usually comes after months of frustration and a building task list that the owner can no longer do (or tolerate). When that first hire happens, founders have a pent-up list of tasks they can’t wait to delegate and an idea of how they want them done. They may even have created SOPs to handle the tasks by the time their new hire steps behind the front desk.
Except you don’t need tasks done.
You need outcomes.
“Tell and check” style leadership isn’t really a leadership strategy at all. It describes telling your employees what to do and then checking whether they did it. The employee owns the task. The owner still owns the thinking.
Examples of tell and check include
Asking staff to call all new patient inquiries within 2 days.
Giving staff a list of vendors to pay.
Asking staff to empty the garbage in each treatment room at the end of the day.
All reasonable health care business activities on the surface. The problem with tell-and-check relationships with staff is that nobody knows why the tasks exist, and nobody owns the outcome. Except for the owner.
When staff are told what to do, and tasks are checked, it creates the following results
Owners ask staff whether they have called all the leads because they notice the calendar isn’t as full as they want it to be.
Owners become frustrated when two months of vendor bills end up on the same credit card statement, and you owe double what you normally do in a month.
Owners change the garbage mid-day in the massage room because it overflowed after a busy morning of shorter appointments.
Owners need help sharing the cognitive load of the business, but it doesn’t stop at task delegation. The cognitive load of a task isn't usually in doing the task. It's in remembering that it needs to happen, noticing when it hasn't happened, understanding why it matters, recognizing when the usual process isn't working, and deciding what to do next.
If the owner delegates the action but retains all of those responsibilities, very little has actually been delegated.
Every delegated task has an outcome attached to it, and someone needs to own that outcome. Without clear outcome delegation, owners are stuck in a cycle of task-checking and problem-solving, and staff are never empowered to solve the business’s problems because they don’t even know what the problems are.
When owners can successfully shift to delegating outcomes, they not only free themselves from the “checking” but also harness another person's creativity and ideas. Frontline staff often know the solutions to the business’s problems but are hardly ever asked for their ideas.
Examples of delegating outcomes instead of tasks look like:
Letting the staff know that you need 40 new clients booked per month, and that they have permission to continue contacting people as often as needed to get a clear yes or no. Ask them to note down the reasons people don’t engage after a discussion and ask them to notice any other barriers to client engagement that could be overcome with new ideas or solutions.
Explain each vendor's billing cycle and agree on a mutually agreed-upon calendar day by which bills can be paid to avoid double payments. Ask the staff to create a system to keep the billing clear, regardless of who completes the task.
Let the staff know that you want the garbage to be clear and never overflowing. Explain what you notice about patient volume and flow, and let them decide how to manage the task to keep the outcome (clear garbage bins) in view.
When the outcome and its guardrails are clear, owners can become much less prescriptive about exactly how staff achieve it. Staff can create systems and processes that work for them, add in their own ideas based on what they know about your business, and create a clear KPI (the outcome) to focus on rather than a task to check off a list. Empowered employees will look for ideas on how to help you achieve your goals. They might buy new garbage bins with lids that don’t have to be changed as often. They might realize that emailing and texting clients is a better strategy than calling. They might realize you’ve been missing out on a net-90 with a particular vendor and improve the cash flow of your dispensary.
None of these ideas make it to the surface if we focus on tasks. None of the cognitive load is moved off the owner if we only tell and check. Staff never grow into roles they aren’t offered an opportunity to try.
Delegating outcomes doesn't mean owners stop paying attention. It changes what they're paying attention to.
Instead of checking whether someone completed every step, leaders look at the agreed-upon outcome and ask what happened. If the target was 40 new patients and the clinic booked 31, the conversation isn't "Did you call everyone?" It's "Why did we book 31, and what do you think we should change next month?"
The goal is for the person closest to the work to understand the result, identify the problem and bring ideas for what happens next.
That's when you've actually transferred cognitive load.
Stop delegating what to do. Start delegating what needs to be true.