Elevate Your Leadership
Dr. Stuart Ablon’s philosophy—"People do well if they can"—challenges a deeply ingrained leadership mindset. It shifts the focus from motivation to obstacles. Instead of assuming performance issues stem from a lack of effort, this approach asks:
- What’s preventing this person from
succeeding?
- What obstacles in our systems, processes, or leadership make success difficult or impossible?
This question is critical in skilled nursing and senior living. Your frontline staff—CNAs, nurses, dietary staff, and housekeeping—are often overwhelmed, burned out, and working within broken systems. Yet, when performance dips, leaders tend to react by pushing harder instead of removing barriers.
The result? Frustration, turnover, and disengagement.
The good news? You have the power to change this today.
The Science of Removing Barriers to Success
Research in organizational psychology and workplace motivation supports this approach. Studies by Edward Deci and Richard Ryan (Self-Determination Theory) show that employees thrive when three psychological
needs are met:
- Autonomy – They feel control over how they do their work.
- Competence – They believe they have the skills and tools to be successful.
- Relatedness – They feel supported and valued by leadership and colleagues.
When these
needs are blocked, performance suffers—not because employees do not care, but because they are stuck.
Harvard Business School professor Amy Edmondson, who coined the term psychological safety, emphasizes that high-performing teams exist in environments where staff feel safe to voice concerns, seek help, and admit mistakes without fear of punishment.
For skilled nursing leaders, if you want better performance, do not demand it—enable it.
What’s Getting in the Way? The 5 Critical Leadership Questions
Before assuming an employee chooses to underperform, ask yourself:
1. Are our systems and workflows setting them up for success?
- Are outdated processes slowing them
down?
- Are we leveraging technology effectively, or is it creating more headaches?
2. Do they have the skills and confidence they need?
- Have we provided real training or just a rushed orientation?
- Are we fostering a culture where they feel safe to ask for help?
3. Are we unintentionally creating burnout?
- Are we asking them to do too much with too little support?
- Are they working excessive overtime just to keep things running?
4. Do they have genuine autonomy, or are we micromanaging?
- Do they feel trusted to make decisions?
- Are they constantly second-guessed or over-scrutinized?
5. Are we listening—or just assuming?
- When was the last time I asked frontline staff what is frustrating them?
- Have we created an environment where they feel safe to answer honestly?
If you cannot confidently answer “yes” to all of these, your team is not failing—you are failing them.
How to Lead by Removing Barriers (Starting Today)
Fix Problems Upstream, Not Downstream
Instead of reacting to performance issues with discipline, ask:
"What process, policy, or system is making this harder than it should be?"
Example:
If med passes are consistently delayed, do not just blame the nurse. Examine:
- Is staffing sufficient?
- Are the EMR systems user-friendly?
- Are there too many distractions pulling them away from their task?
Stop Rewarding “Workarounds” and Start Fixing Systems
In healthcare, we often praise staff for overcoming rather than eliminating those obstacles.
Example:
If nurses stay late to finish documentation, do not just thank them—ask why documentation is not manageable during the shift. Then, fix it.
Create a “Barrier Removal” Feedback Loop
- Weekly Huddles – Ask, “What’s making your job harder than it needs to be?”
- Quarterly Audits – Examine workflows with frontline staff to identify
inefficiencies.
- Reverse Rounding – Instead of just rounding on patients, round on staff. Ask, “What’s one thing I could change to make your job easier?”
The people closest to the problem always know the solution. Most of the time, leadership simply does not listen.
Lead with “How Can I Help?” Instead of “Why Didn’t You…?”
When
something goes wrong, replace blame with curiosity.
- Bad: "Why didn’t you finish that report on time?"
- Better: "What got in the way of getting that report done? How can I help?"
This shift changes everything. It signals to employees that you are there to support, not punish.
Measure Success by “Barrier Removal”
Instead of just tracking output metrics (productivity, census, turnover), track leadership effectiveness:
- How many workflow barriers were identified and resolved this quarter?
- How often are frontline staff giving input on operational decisions?
- How many “workarounds” were eliminated through system improvements?
When leaders focus on removing friction, performance improves without burnout.
The Takeaway: Your Team Wants to Succeed—Help Them Do It
If someone is not
performing well, the real question is, "Why won’t they do it?” but “What’s stopping them from doing it?”
Today’s Leadership Challenge:
Before the day ends, ask one staff member:
"What’s something that makes your job harder than it needs to be?"
Then, commit to fixing it.
That is leadership. It is how you transform teams and create a culture where people actually want to stay.
