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Field Notes Newsletter #3 - July 2026

Updated: Jul 13


You Can't Automate a Broken Workflow

 

Healthcare leaders spend a lot of time talking about broken technology.

 

Clinicians complain about documentation burden. Executives worry about interoperability. IT teams struggle to integrate new applications into increasingly complex environments. Every year, organizations invest billions in new platforms, analytics tools, and AI capabilities intended to solve these problems.

 

Yet many of the same frustrations persist.

 

In a recent MedCity News article, Beyond the Blueprint co-host Keith Washington challenged a common assumption: healthcare IT itself isn't broken. The real issue is that many healthcare organizations continue to deploy technology into systems that were never designed for today's care environment.

 

It's a theme that has surfaced repeatedly on Beyond the Blueprint.

 

Whether the conversation is about workforce shortages, data governance, AI adoption, clinical education, or care coordination, the discussion often comes back to a similar conclusion: healthcare tends to treat symptoms while leaving underlying design problems untouched.

 

For years, the industry has responded to operational challenges by adding more tools, workflows, alerts, dashboards, and layers of oversight. Each addition may solve an immediate problem, but it often creates new complexity somewhere else.

 

The result is an environment where clinicians spend significant time navigating systems rather than caring for patients, and where leaders struggle to scale innovation because the underlying architecture wasn't designed to support it.

 

This perspective is particularly relevant as organizations accelerate investments in artificial intelligence.

 

Across healthcare, AI is being positioned as a solution for documentation, staffing shortages, care coordination, and operational efficiency. But many Beyond the Blueprint guests have raised an important question: what happens when advanced technology is layered onto poorly designed workflows?

 

The answer is often disappointing.

 

Organizations may automate inefficiencies rather than eliminate them. They may accelerate processes that were already flawed. They may create new dependencies without addressing the root causes of friction.

 

Technology can enhance a system, but it rarely fixes a system that was poorly designed from the beginning.

 

The challenge facing healthcare is not simply choosing better technology. It is designing environments where technology, workflows, governance structures, and human decision-making work together toward a common goal.

 

Some of the most successful organizations featured on Beyond the Blueprint have embraced this mindset. Rather than asking, "What technology should we buy?" they begin with a different question: "What outcome are we trying to create?"

 

That shift changes everything.

 

Instead of designing around products, they design around people. Instead of optimizing individual departments, they optimize across the care continuum. Instead of measuring technology adoption, they measure operational and clinical impact.

Healthcare's future will not be determined solely by the next generation of AI, analytics, or digital tools.

 

It will be determined by whether leaders are willing to rethink the systems that those technologies are entering.

 

The organizations that create the greatest value over the next decade may not be the ones with the most advanced technology. They may be the ones who are most intentional about how care, workflows, data, and technology are designed to work together.

 

Because the problem was never just the technology. The problem and the opportunity have always been the design.

 



What To Do When You Have A Toxic Leader


 

A Guide for the C-Suite and Staff

 

We all know who they are. Toxic leaders. Leaders who drain the life, and engagement, out of their teams and poison the entire organization. Yet, for some organizations tolerate them. Maybe they are likeable. Maybe they are BFFs with the CEO or other influential leaders. Maybe they’re high performers. Maybe they always meet budget and don’t make waves.

 

Whatever the reasons, and however relevant those reasons may be, toxic leaders are poison and they must be addressed.

 

So what should you do when you have a toxic leader? Whether you're an executive who needs to act or a staff member who's stuck in the situation, there are some steps you can take.

 

A Mandate for Executives: You Must Act

 

1. Stop waiting for formal processes

If you're waiting for the next engagement survey or performance review cycle, you're waiting too long.

 

The worst time to hear about a toxic leader is during an exit interview. There should have been signs and symptoms long before that.

 

Look at the turnover data now. Talk to people now. Act now.

 

2. Have the direct conversation

You can't fix what you don't address. You must talk to the toxic leader directly about specific behaviors and their impact.

 

Vague feedback like, "People find you challenging,” is useless. Be specific with your feedback:

 

"Your turnover rate is X% while the organizational average is Y%. That tells me something is wrong. Let's talk about what's happening in your department."

"I've heard from multiple people that they have been publicly humiliated in team meetings. That has to stop."

 

"I'm seeing a pattern where your team members are afraid to speak up. That's not the culture we're building."

 

Be direct. Be specific. Be clear about expectations.

 

3. Provide support—but with accountability

Some toxic leaders don't realize the impact they're having especially if that is the modeling they received. I was working with an organization where the CEO was toxic and constantly micromanaged others with an extremely negative attitude.

 

These behaviors had been modeled as she “grew up” in the organization so they were the norm. In this case, the CEO benefitted from coaching and feedback, but only because she was willing to change in order to make the culture better.

Regardless of the position that the toxic leader holds, coaching can be a vital resource. But also make it clear: The problematic behavior has to change. And there's a timeline.

 

4. Be willing to make the hard call

Sometimes people can't or won't change.

 

And if that's the case, you must be willing to make the hard call: This person can't continue in this role.

 

It’s difficult. Especially if they're delivering results. Especially if you're worried about who will replace them.

 

But the cost of keeping them is higher than the cost of losing them.

When you tolerate toxic leadership, especially when you say the culture and values are important, you send a message to the entire organization: We value results over people. That destroys culture faster than anything else.

 

5. Don't make excuses

"They're just tough."

 

"They have high standards."

 

"People are too sensitive these days."

 

"But they're so productive." You’re supporting toxic superstars.

 

These are excuses. And everyone sees through them.

 

Call toxic behavior what it is. And address it.

 

6. Create safe channels for feedback

How are you finding out about toxic leadership? Are people afraid to speak up? Do they think nothing will change?

 

Create multiple channels: Anonymous surveys. Skip-level one-on-ones. Exit interviews that actually get reviewed. HR processes that people trust.

And then act on what you hear. Because if people give you feedback and nothing changes, they stop giving feedback.

 

Guidance for Staff: Yes, There Are Things You Can Do

If you're working under a toxic leader and the organization isn’t taking action, or won't act, you have limited options. But you do have options.

 

1. Document everything

Keep a record of toxic behaviors. Specific incidents with dates, times, what was said or done, who witnessed it.

 

Not because you're trying to "get" the leader. But because if you do decide to report it or if you eventually leave and give an exit interview, you'll have specifics instead of general complaints.

 

2. Set boundaries where you can

You can't control your leader's behavior. But you can control some things:

 

Don't take work home if you don't have to. Don't respond to messages during off hours unless it's truly urgent. Protect your mental health by creating separation when possible.

 

3. Decide if you can speak up

In very few cultures is there an environment safe enough to give feedback about toxic leadership.

 

You have to assess: Is there any possibility that speaking up will lead to change? Or will it just make you a target?

 

If you decide to speak up, do it strategically:

  • Document specific behaviors, not general complaints

  • Go to HR or skip-level leadership, not just the toxic leader

  • Be prepared for the possibility that nothing will change or you'll face retaliation


4. Know when it's time to leave

Sometimes the healthiest thing you can do is leave.

 

If the organization won't act, if you're being harmed, if your mental health is suffering—it's okay to prioritize yourself.

 

You don't owe your health to any organization. And staying in a toxic environment isn't noble. It's damaging.

 

5. Use your exit interview

If you do leave, use your exit interview to be specific about why.

 

Not "it just wasn't a good fit." But "I'm leaving because of X, Y, Z specific behaviors from my leader that created an environment where I could not stay."

 

Give them the information they need to see the pattern. Even if they don't act on it for you, maybe they'll act on it for the next person.

 

Toxic leadership brutalizes organizations. It destroys trust, drives away good people, and erodes culture. But it’s not inevitable. It's a choice. Organizations choose to tolerate it or not. Leaders choose to address it or not. Staff choose to speak up or not. Individuals choose to participate in it or not.

 

What are you choosing?

 

Enjoyed this article?We appreciate Kristin Baird for allowing us to share her work with the Field Notes community. To read more of her writing and subscribe to her newsletter, visit her blog.


From the Field

Notable conversations you need to hear



EP49 - Leadership by Design: Creating Cultures Where Caregivers Thrive


Healthcare organizations spend a lot of time talking about culture, engagement, and retention, but according to workforce strategist and nurse leader Elizabeth Jeanes, culture isn't built through mission statements or values posters. It's built through the daily decisions leaders make, the behaviors they reinforce, and the standards they choose to uphold. In this episode, Elizabeth joins Kristin Baird and Keith Washington for a candid conversation about why leadership development may be one of healthcare's most overlooked workforce strategies. Together, they explore leadership burnout, psychological safety, generational differences in the workforce, and the difficult challenge of managing toxic high performers whose behavior undermines team culture. The discussion also examines how leaders can help caregivers stay connected to purpose, create environments where people feel valued and supported, and build cultures by design rather than by default. For healthcare executives, nurse leaders, and frontline managers navigating retention, engagement, and workforce challenges, this episode offers practical insights into creating workplaces where both caregivers and patients can thrive.

 

 


Sound Bites

The moments that made us hit rewind



EP50 - Treat the Patient, Not the Alert: AI, Alert Fatigue, and Nursing Decision Support


Artificial intelligence can identify patients at risk, but it can't tell whether the nurse receiving the alert is already managing another critical patient. In this thought-provoking episode, Gregg Malkary is joined by nursing and informatics experts Daniel Gracie, Carolyn Harmon, and Troy Seagondollar to explore one of the biggest challenges in healthcare AI: translating intelligent alerts into meaningful clinical action. The conversation examines alert fatigue, cognitive overload, workflow design, accountability, and why even the smartest AI can't compensate for broken processes. Most importantly, the panel reinforces that clinical decision support should enhance, not replace, clinical judgment. Whether you're a nursing leader, informatics professional, healthcare executive, or technology innovator, this episode offers practical insights into designing AI-enabled workflows that support caregivers while keeping the focus where it belongs: on the patient, not the alert.

 

 


Sound Bites

The moments that made us hit rewind


Footnotes

Further reading for curious minds


Every great conversation leaves you with something to explore. Footnotes is where we collect the books, articles, research, podcasts, and other resources mentioned or recommended by our guests, along with a few additional references that add context to the ideas discussed. Think of it as a curated reading list for anyone who wants to dig a little deeper.  You're welcome!

 

Further reading:

  • Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference - Hardwiring Excellence offers a road map and practical how-to guide for creating and sustaining a culture of service and operational excellence.

  • Start with WHY - Start with WHY is Simon’s first and most popular book, having earned a spot on the New York Times and Wall Street Journal bestseller lists. In this book, Simon shows that the leaders who’ve had the greatest influence in the world all think, act, and communicate the same way—and it’s the opposite of what everyone else does.

  • IHI's PDSA Cycle Toolkit - This is IHI's official overview of the Model for Improvement, which includes the PDSA cycle and explains how to use it in quality improvement initiatives.

  • The Checklist Manifesto by Atul Gawande — Argues that tools such as checklists should support clinicians by ensuring critical steps aren't missed while leaving diagnosis and clinical decision-making in the hands of healthcare professionals.

  • TeamSTEPPS - TeamSTEPPS is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare teams, including patients and family caregivers.

  • Root Cause Analysis - Root cause analysis (RCA) is a structured method used to analyze serious adverse events. Initially developed to analyze industrial accidents, RCA is now widely deployed as an error analysis tool in health care.


Upcoming Events


July 20-22, 2026 / Denver, CO

 

August 2–5, 2026 / Minneapolis, MN

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