The Best

Five that want it more.

A daily sales & leadership e-serial from Troy Forrest

1. The time budget

For as long as he could remember, David Longines had thought about 'more'. To find something more than existed in the humble insular community of his boyhood. To do better at school and Uni, in the swimming pool, in crafting the right group of friends, in his career trajectory, in his bank account, in the toy collection, and more recently, in raising the perfect family. To build something, imagine something, achieve something more for his life. To make him ever happier. And try as he might, though admired by onlookers for seemingly having and eating his cake, the hole could never be filled. Always came the nagging inner voice droning 'more'. Bang on year ago, sitting in yet another a pin striped suits lounge in LA International Airport, gulping down a forgettable Napa Valley Merlot, his colleague started talking about the idea of 'time budgets'. He'd read somewhere that their ilk - multi-million dollar P&L sheet managers; the smartest dudes in the room - were skilled in strategically apportioning and monitoring their dollar signs in line with the goals. But if they were honest with themselves - which was hard - were they so good at doing it with the more precious and finite commodity of their time? How diligent were they at crafting and sticking to a budget of 24 hours a day, using it like an investor to achieve the goals most important to them? It was a rare philosophical moment in the cash chase. It became an ear worm that got David thinking. And with a year of that thinking white-anting his perfect worldview, it got him acting. Taking 3 weeks leave from his global marketing kahuna role at the mid-size comm tech firm he represented in London, David brought his family to Adelaide, Australia. Partly to see their extended family, part to talk to an inventor who'd come up with something David thought he wanted to be a part of, and in no small part, as a test-drive of a different life. One that might support a more intelligent apportioning of his 24 hour daily time budget. Now, under a general anaesthetic while a team performed emergency surgery on his machinereliant body, David dreamed about enjoying the things he already had. More.

2. Right versus recognised

In the operating theatre next to where David Longines lay, his chest cracked open receiving cardiac massage, Mr Lang Ironfly was performing a comparatively routine surgical procedure. A laparoscopic cholecystectomy. Mr Ironfly was slowly removing the marble-filled gall-bladder of a 33year old post-partum woman through a hole in her abdomen that was no wider than a 20 cent piece. "Babcocks" said the surgeon, referring to the graspers he was diving into the hole, trying to grab the gallstones to pull them out. Aside from the anaesthetic monitors and the occasional scout nurse moving around, the room was silent. "Damn things are too big. Going to have to crush them first. Slippery too. Let's try the Alligators instead", switching to a more aggressively toothed forcep while holding the endoscopic camera in his other hand. Mr Ironfly - Lang as he insisted on - was a remarkable surgeon. Pushing 60 years and possessed with a gentle, kind demeanour, Lang had spent his entire surgical career trying to be the best doctor he could. Like the majority of his peers, Lang had chosen the profession less for what he could get from it, more for what he could give. Medicine's a life, not a career, he'd tell students. Unlike a good number of his peers though, Lang had no burning desire to be recognised for inventing a new piece of surgical equipment or pioneering a procedure or publishing award winning studies or hospital wing naming rights. He just worked to do what he did, really, really well. Perform ever-better to heal the individual. Registrars, nurses, anaesthetists and even experienced sales representatives who'd had the privilege of watching Mr Ironfly perform a laparoscopic cholecystectomy knew it was something special. An almost bloodless procedure, technically brilliant. And while occasionally teased by peers for being a late adopter and frustrating his nursing team for being olympically pedantic in his surgical set-ups, there was one surgeon everyone in the know wanted operating on them. "Ahh, there we go" said Lang, turning momentarily to the attentive student in the corner. "Better to try crushing the stones and keeping the incision small - we reduce a number of potential complications... suction, please." Like all great surgeons, a passionate teacher. The student - a surgical sales representative - stayed quiet and unobtrusive, nodding politely, hyperalert to her surrounds, waiting until the surgeon had completed suctioning out the disgusting gallstone slurry before asking an insightful follow-up question.

3. Eternal compromise
Two stories above the operating rooms where David Longines was having his life saved and Mr Lang Ironfly was perfecting his bread and butter, CEO Karen Millstone was thumbing through a report on her hospital's infection rate data for the past 5 years. The document highlighted surgical specialties, particular procedures and even surgeons whose rates exceeded the mean "clinically acceptable" levels for a hospital their size and case mix. There was a knock on her door. Karen's PA, Renee. "Mr Bull is on his way up." Karen sighed. Another grumbling clinician wanting better conditions, special treatment. "Thanks Renee. Would you mind making him a coffee please?" Renee didn't need to wait to ask Mr Bull, a young but blue riband Orthopaedic Surgeon, how he took his coffee. Karen had taught her very early on to create a chart of who takes their coffee which way. Renee would time the pouring for the VIP's arrival. Karen opened her top drawer, placed the infection rate data inside and took in the impressive city views out her north-facing window. At no step on the ladder that was her stellar career had Karen imagined she'd spend most of her days trying to solve an unsolvable equation. How to please all the important people with one hand tied behind her back and the other driving a vehicle that was only just breaking even. As a junior nurse, Karen had watched the power dressers on the carpeted corridors and thought it all looked so effortless, so glamorous. She liked nursing without loving it. Ambitious, hardworking, bright without being exceptional, Karen was blessed with wonderful interpersonal skills and the ability to give her complete attention to the individual before her. It won her supporters that championed her rise to the point where she now ran one of the busiest private hospitals in the country. Now, sitting in the chair she'd long wished for, Karen racked her brain trying to figure out how she could keep a cash cow happy without blowing the budget and disjointing the noses of the rest of the herd. She clicked the button on her computer mouse and opened up the file that said "Surgeons.Orth.Bull.M" and began once more to read the notes she kept on her talented, profitgenerating internal client with a fiery temperament who was always asking for more toys. What compromise would appease him? The phone buzzed. "Mr Bull is here." "Thanks Renee. Please send him in." Karen closed the computer folder, stood up and walked towards the opening door, running through her pre-meeting checklist in her head. Smile, Karen told herself. He's important.

4. Broad vs diffuse focus

Brett Sleep wasn't getting much. Sleep. "Happy-tired", as he described it to his wife. Having fun, but running on fumes. It was now 11pm, and Brett was working up a proposal to put to a prospective new supplier whose products he'd love to distribute. "Brett, it can wait until morning" called his wife from the bedroom, knowing her protestations were in vain. "Ahh, I just need to get this knocked over - won't take long, it'll be worth it." Brett had been saying that for years. An entrepreneurial soul that first manifested when Brett started renting his matchbox cars out at recess in primary school (5 cents for 20 minutes), the youngest son of a farmer had pursued his version of 'best life' with gusto for all of his 42 years. Straight out of high school, Brett jumped boots'n'all into an eclectic array of commission-based sales roles. The perfect outlet for his natural enthusiasm, entrepreneurial flair and work ethic, Brett won over enough clients to keep bumping his investable income up and up. At 28, Brett met the owner of a stagnant medical supplies business that didn't understand it's own potential. Negotiating his way into the organisation by taking equity in place of commission, Brett turned a sloth into a dynamo. When the owner passed away 8 years ago, Brett negotiated to buy the remainder of the business from his partner's family. The result was Brett building a distribution business that competed far above its weight class, even giving the multinational manufacturing & sales combo deals a run for their money in the South Pacific marketplace. "Brett, you're no good to us if you keel over. Hon, it can wait." Brett sighed. His wife, of course, was right. But he was almost there. Another new opportunity to grab market share from lazy laurel-resters, Brett's proposal to take on the distributorship for a highquality line of surgical instruments was a lay down misere to make cash in his hands. He worried it was stepping away from other core business lines though. Broadening our options to grow? Or getting too diffuse in where I ask my sales team to spend their time and invest energy? No mind. Win the bid first, worry about the management second. Nice problem to have. "Yep. Coming. Won't be 2 sec's." 25 minutes later, his wife sound asleep, Brett turned the laptop off, walked to the bathroom to brush his teeth, remembered something that 'just couldn't wait', and turned his laptop back on. Just for 5 minutes, he told himself. It'll be worth it.

5. Bet on me
Caitlin Williams was the best. And she'd prove it this year with growth numbers and client relationships and strategically important door-openings that no-one else thought possible. Caitlin watched Mr Ironfly closing his patient at the completion of yet another near-perfect laparoscopic abdominal procedure. It was safe and savvy to speak now. "Mr Ironfly, what level of improvement have you found humidified insufflation has on post-op shoulder tip pain in your patients after a procedure like this?" Caitlin asked in part to confirm what she'd heard from Mr Ironfly's nurses; in part because she wanted his positive feedback as testimonial to use with other surgeons; and in no small part to showcase that she was a patientfocused, on-the-ball, genuinely interested supplier - and willing student - that was worth having in the room. "Please, call me Lang. Well, you know, it's interesting. Our early experience with dry heated insufflation was .....". And off went the teacher doing what he loved - sharing his experience with a willing learner. Caitlin knew his hot button. A California native, Caitlin moved to Australia 2 years ago to dominate. Only 26, a cross country runner and economics graduate, Caitlin walked out of Uni into a junior marketing role in a global surgical devices company in Silicon Valley. While impressing most, Caitlin realised the path to promotion in the US was crowded by a gaggle of alpha-overperformers. So when the opportunity arose, Caitlin took an internal transfer Down Under to become a 'big fish in a small pond'. Within a year of starting her sales role in bustling Adelaide (a means to a bigger end, she told herself), Caitlin met Brett Sleep at a trade display. Wooed by his energy, vision and b*lls-on-the-line approach to winning, Caitlin negotiated the work visa hurdles and left the big boys to join Brett's small-but-rising distribution business as the star international recruit. Caitlin saw the business as fertile soil to grow her experience, lay a foundation and earn big coin quickly. The scrub nurse assisting Mr Ironfly began furrowing her brow behind her surgical mask. Caitlin made it her business to watch for the subtle mood shifts that occur in a theatre. She's got power here, Caitlin thought. Shifting closer to the nurse - Kerry - Caitlin made eye contact with her, nodded, and postured herself like she was ready to help. Truthfully, there was little she could, or was allowed to do, but she wanted Kerry to know she respected and deferred to her authority. Without so much as glancing up, Mr Ironfly picked up on it too, and stopped his teaching. "Well, that went very well. Catilin, I like the product - Kerry, what do you think - is it easy for the nursing staff to use?" When the surgeon liked it, he asked the nurse if she liked it. Kerry, who couldn't say yes but had a fair say in a potential "no" to new product purchases, spoke plainly. "It's fine, easy to put together, pull-apart. Caitlin, you're running another inservice this afternoon?" The mood in the theatre brightened again. Caitlin smiled behind her mask. Bet on me, was her inner monologue mantra. I'm going to dominate.

6. The accountability : reliance mix

David Longines lay with his eyes closed, completely still in his bed in the cardiac ward. Humming machines and soft bipping noises were punctuated only by the occasional nurses voice in the corridor. It was David alone with his inner voice, ensconced in a spiders web of tubes and wires. Nothing like open heart surgery as thought fodder. Heart attack? Re-arresting on the table? A sternum wired up like a chicken coop? How did it come to this, wondered the corporate globetrotter. A young nurse walked into David's room. "Good morning, Mr Longines. How are you feeling?" she said, opening the blinds to let some sun in. David opened his eyes a sliver. The light stung. His vision swirled. "Mmmmm. OK, I think. How should I be feeling about now?" He thought he sounded weak, robotic. Talking was tiring. The nurse paused at the end of his bed. "Well, you've been through a pretty big ordeal! Having open heart surgery is like running a marathon with no training, and you had a couple of extra complications too. You'll be quite weak for a while, and we'll help you manage any pain, but it'll take you some time. We'll be getting you out of bed today though - the physiotherapist will be around in about an hour. Before we do that though, I'm going to need you to cough for me." Get out of bed? Cough? Didn't she know he'd nearly died less than 48 hours ago? David weakly and tentatively tried to cough. It sounded like a sigh - a lame attempt to clear his throat. "Sorry, I need better than that. Really try and force a cough - deep and hard as you can. We need to know you can clear your airway, get rid of any mucus that could harbour infections." 3 tries later, David managed something like a cough. The pain through his wired thorax was remarkable. It exhausted him. "Well done. I know that's hard, but it's essential. You can rest a moment now. We're going to help you get well as quickly as possible. But as the doctor would have told you, it is going to take time you're going to have to be patient. Your healing also depends a lot on you. I know it hurts, but practice little coughs whenever you can. The physio will give you exercises too. Don't try anything too heroic, but little frequent efforts punctuated by rest is critical to speed the healing. You've got a great medical team who are here to help you, and you're going to have to rely on us and take our guidance. We'll help you get there. The key thing is, you're going to be well." David closed his eyes and nodded, not yet grasping the magnitude of what lay ahead. He was quite unused to relying on anyone for help. He'd always driven his own success. Now he was forced to rely on the kindness of strangers. And this kind one, in the midst of his pain, was effectively telling him to suck it up and persist. What a strange dynamic. "There's 3 t's we talk about here in unit. It takes Time. Use your Team. And keep Trying. Smiling helps too! Now, let me fix those pillows for you."

7. Task gluttony
General surgeon Mr Lang Ironfly sat in the operating theatre tea room sipping an Earl Grey (just a dash of milk, half a sugar), speaking with his surgical assistant about house renovations. His younger colleague was trying to select a builder to complete his eastern suburbs home. He'd narrowed it to two potentials. "Both do fantastic work, their portfolios speak for themselves. One is about 10 - 15% dearer, but he's ready to go now and I know he only ever has a small number of jobs on the go at any time. The other, who I think does just as good a job, is quite full with a lot of work on the go... I think that it'll be a good 9 months before they're ready to start. We're not in a mad rush - well, I'm not, Mary's quite keen - so for the sake of the extra cash, I'm leaning towards waiting." Mr Ironfly - Lang, as he preferred - nodded and slowly sipped his tea. "It sounds like the less expensive outfit are making up for their lower rates by jamming more clients into their day? Hmmm, sounds like some surgeons I know...", smiling wryly but not unkindly. "Ahh, you sound cynical, Lang! Come on, don't tell me that when you were a younger man, you didn't fill your surgical dance card until it spewed over?! Making hay while the sun shines and you've got the energy?!". The assistant, Dr Robinson GP, teased his 20-year senior colleague. The experienced surgeon kept smiling, nodded, and took another sip. "It's true. When we're younger, we have what I think of as 'task gluttony'. We're so worried about starving that when someone fills our plate with work, we don't know when to say when. We keep consuming, thinking we'll store it up for the winter, that someday we'll know when to ration once more. Seems to be ever-more prevalent in our modern world. And the longer I do this, the more I see it often takes a life-changing moment - usually not a nice one - for people to address their work consumption habits. Hopefully not before it's too late." Lang paused and looked out the operating theatre tearoom window. "Days are gone where I try to fill a list to bursting. 10, 11pm finishes who can perform well like that? I've come to appreciate I won't starve. That being gluttonous in my surgical lists only means I pay a price elsewhere. A more sound approach, a wiser man than I once counselled me, might be to ration, savour and excel at a smaller number of things you love doing." Kerry, Mr Ironfly's scrub nurse, walked into the tearoom. "Your last patient is ready, Mr Ironfly." "Thank you Kerry." Lang put down his teacup and stood in unison with his assistant. "If the economics are more important, and you can bear the wait, then wait. But consider who'll be better geared to the unexpected - the rationer, or the glutton? And be honest - did a renovation ever go as expected?" The surgeon headed down the corridor, ready for the unexpected.

8. Gratitude
Hospital CEO Karen Millstone had any number of first world worries on her mind. People, projections, towing party lines, profit, process improvement, percentage-better patient outcomes. What today gave her was perspective. Standing quietly with her kids who were wrapped in warm woollen duffle coats and blowing condensation smoke rings, Karen listened to the words of the uniformed man while waiting for the sun to crack its daily yolk on the horizon. Her Grandfathers both served. So had her Grandmothers, though not in an official capacity. We've got no idea, she thought. Hardship? How lucky are we? What've we ever been asked to give in comparison? Our best efforts? A little respect? How about to use the luxury of choice their efforts gifted us - maybe the ask is to choose to learn? The Last Post cut through the frigid dawn air. Heads bowed. Eyes glazed. People remembered. Those that couldn't were inspired to imagine. Lest we forget.

9. Ante up
"So what slowed us down? I mean, this shouldn't be hard? They've told us what they want, and we've designed our service to give it to them. So where's it fallen away?" Brett Sleep, entrepreneur, growing business owner, boss of a team of 14, was this morning a frustrated hare. At the weekly team bench briefing, he was releasing the pressure valve. "Ahh, I don't think we're doing that badly Brett" said Roy, Brett's warehouse & kit room manager. "Their order came in very late, the case mix is unusual for this time of year, and there's no history to tell us we might've needed more stock than we were carrying. I think it's all sorted now they got what they needed in time, and I'd be reluctant to carry more shelf stock for what I think was an aberration." "I appreciate that Roy, and well done to you and the guys for getting the last minute booking out. But we're growing, and this expanded caseload should only continue to grow, and we've designed this process to cover contingencies while keeping stock at reasonable levels. So let's look at why this happened, and what we can do to improve it." 2 days earlier, a hospital had called asking where there stock for a busy last-minute surgical list was. The system Brett's business had been refining - a 'best-in-field, guaranteed' ordering and restocking process - was supposed to have prevented last-minute phone calls like this, even for late orders. Apparently, it wasn't foolproof yet. To the team's credit, human responsiveness had patched the system failure and got the products to the hospital before any operations began. But Brett wasn't convinced it was a system error. Rather a 'failure to implement the system' error. But he didn't want to slam the team too much. His were great folk that, for the most part, busted their backsides. "Brett, I've diarised time to work with Roy and Carl for an hour today to reassess the case load for this hospital. I've got updated surgical lists for Mr Bull and Mr Cabot, and we should be able to increase forecast accuracy. We need to make sure the system has the most current data in it." It was Caitlin, Brett's star international sales recruit, taking a measure of ownership. Brett knew it wasn't was her mistake - and Caitlin knew Brett knew - but he appreciated the personally accountable sacrificial lamb because it sucked the anger away via a clear next step. "Good, thanks Caitlin. All - we're only as good as our most recent service performances, and you know the type of systems we're up against", referring to their multi-national competitors. "If the system's not right, we've got to evolve it. If the system is right, and it's simply a case of using it as it's been designed, with discipline? To beat sophisticated cash machines, we have to continue to be a tack-sharp, all-hands-on-deck team. We - you - do an amazing job. To keep growing? Every day, we've got to ante up again. I'll leave that with you and Caitlin, Roy - thank you for owning the fix. OK, to the brightest spot... we got it!" Brett's eyes lit up as he explained the new supplier that had this morning selected their business as their distributor. We're going wider, thought Brett. Now got to make sure the system and the people can deal with it.

10. Part of the solution

"One nearly-late delivery in 3 months - not even late - and he's talking like it's a major systems failure!" Roy, Brett Sleep's warehouse and kit room manager, was annoyed that his boss had intimated his team dropped the ball. The crew held themselves to a high standard and took great pride in the results they consistently achieved. Caitlin, Brett's sales superstar, walked towards the back of the warehouse beside him. "Don't worry about it. He's just nervous about the big boys getting peeved we're taking their market share. I agree with you - this is an uncommon one. And also, you've been operating with older information. Here - I've got the new theatre schedules for Bull and Cabot, plus their updated preference cards." Caitlin handed Roy information that, once in the system, should improve their forecasting system another percent. "Thanks. I'll have Sal put this in now. He's got to learn to praise first, then ask the hard questions. Hell, I know where he's coming from. But the message my team hear? They're not doing well enough. They work damn hard, this crew." "I know, your guys continually help me out, going above and beyond. It's what I love about working here. We've got great people. And the system is good, but it's only going to work as well as we keep it continually updated. What can I do to help your guys with this?" Caitlin exercised the rarest of sales disciplines - the practice of treating her colleagues as VIP clients. Showing accountability. Seeking to understand them. Asking to help. Offering support. It was a practice that buffered her natural 'must win' affect (which would otherwise overwhelm and ostracise some of her more laconic just-get-along peers). And it defused internal tension fast. "Nah, there's nothing you can do. I mean, we'll keep an eye out for these situations - if you ever get early wind that something's going to change, then tell me ASAP and we can manually over-ride the system." "What if we went one better? What if you and I had a very quick daily checkup call - just a minute or 2, and we'll confirm what's happening each day, and I can give you any early warning signals. I know the system is designed to do this, but in my experience, nothing beats a quick daily chat? Would that be OK?" Caitlin knew it was in her best interest to stick like glue to the warehouse crew. She knew they'd dropped the ball here, and it wouldn't be the last time. So she did what she did best. Got on the front foot. "Yeah, not a bad idea. Don't call before 8 - make it after 8:15 if you can." A daily date with the leader of the team that has the biggest potential to make me look bad, thought Caitlin. That's how you do it.

11. Mini goals

Small wins. Mini goals. David Longines spent the week focused on outcomes the able-bodied do on autopilot. Coughing without feeling like his thorax would explode. Sitting up straight. Getting to the bathroom. Walking further and further through the ward. The road to regained health looked incomprehensibly long. Borrowing from his swimming training, David focused on the black line, striving for the next marker. Recovering from open heart surgery is wonderful for keeping your mind in the moment, he thought. A soft knock at the door. David's wife and two children, wearing the trepidatious smiles of hospital visitors. "Hiya! How are you feeling?" asked his wife before she kissed him. His children, 6 and 9, now used to their Dad's strange setting, jumped straight for the TV remote control and the draw full of lollies that David couldn't eat. "Yeah Dad, how's your cabbage?" asked the youngest, making fun of the name of David's surgical procedure, a Coronary Artery Bypass Graft, or CABG. "Better thanks guys. Pain's decreasing. Best of all, I get to come home today!" The kids eyes lit up and they whooped. David's wife smiled, but her eyes showed worry. "Your Mum's got the spare room ready - you're going to have to take it really easy, you know that, right?", knowing full well David was hard-wired to go flat stick. "I do. How are you feeling? This isn't quite what we had in mind, was it?" They'd had this conversation many times over the past 10 days. David's guilt bottomed out his mood a few days ago, but he was now moving into the acceptance and planning stages of the grief curve. "It's been interesting! But you're here, alive, on the road to recovery, and it's certainly put things in perspective." David's wife, pragmatist to his entrepreneur, had also needed to set mini goals of late, to get through the bracken after life threw them this bean ball. David looked at his wife with an admiration he'd let dust settle on for too long. "Let's blow this popsicle stand - I'm ready! Sausages, do you want to push that call button one last time? I think they have to wheel me out of here. Next goal - get to the car!" For the first time in a remarkable fortnight, David felt excited. Everything passes. Eyes on the goals, no matter how small they are, he thought.

12. Never too old

Mr Lang Ironfly, MBBS FRACS, much loved General Surgeon and passionate teacher of his craft, sat quietly in his bottom-softened Chesterfield Wingback, a cup of Orange Pekoe on the side table, perusing an abstract from The Lancet journal. While a pile of more specialist surgical reading awaited his skilled opposable thumbs and hawk-sharp eyes, Lang invested a little time each week keeping abreast of a range of general medical literature. It was, after all, what his referring General Practitioner customers read. "Lang, would you like some pikelets with your tea?" asked his partner of 39 years. "No thank you dear." Finding nothing eye-catching, Lang put down The Lancet and picked up the American Journal of Surgery, heading straight to an article that one of his registrars had earmarked for him. "Systematic review & meta-analysis of electrocautery versus scalpel for surgical skin incisions". It was a subject his own public hospital team were investigating. Despite holding strong personal views on the relative merits of each approach, Lang had learnt long ago that if he was going to be of maximum value to his patients and profession, he had to retain an open mind. Be willing to keep doing the homework and perpetually acid test his own thinking, experience and prejudices. "Are you sure? They're fresh out of the oven - I've made them for the grandchildren tomorrow. Bab's brought over some lovely mulberry jam that goes perfectly with them?" "Oh, just one then. Thank you." A man's not made of stone, thought Mr Ironfly. Decades before, conducting ward rounds as a junior doctor, Lang had been on the receiving end of a life-shaping lesson by a giant of his profession. The senior consultant, a fearsome man whose prodigious skill with a blade was matched only by the sharpness of his tongue when faced with a slack-minded student, had tossed a curly question to his young shadow. Lang, confident in his book learning, tossed up an answer with confidence, only to have it tasered by his mentor. The consultant said (and Lang would never forget the words), "That's out-of-date thinking - haven't you read last month's Langenbeck's Archives? We used to believe that, and now we know better, boy. If you're going to go anywhere in this calling, you better keep up-to-date with what we know. Before you kill someone." "Cream, dear?" "No thank you." It was an epiphany moment, when Lang realised that rather than ever mastering knowledge of his profession, he was just on a continuum. Experience counted for much, but if he didn't keep actively learning, he'd become redundant. Or kill someone. The life-long active learner took in the abstract of the paper while his wife furnished the antiquefilled room with comforting bakehouse smells.

13. Mounting the inspiration pony

I'm sick of settling, thought Karen. Sick of the creaking of process wheels that everyone can see are becoming redundant. It's dumb. We can be better - we have the talent. Standing at the service counter of her hospital's coffee shop waiting for a take-away latte, CEO Karen Millstone had one foot in the stirrup of the inspiration pony and was getting frighteningly close to swinging the opposite leg over. The previous day, Karen had attended a multi-industry CEO seminar delivered by a highly paid change leadership speaker. The thought-provoker's message, delivered with repetition and emotion-panging anecdotes, had grabbed her. It wasn't that Karen hadn't heard variations of it 47 times before. Simply a case of a lesson resonating when the student was ready. The message - if you as a leader don't prioritise building a continually evolving organisational process framework that lets your ship's sails swivel more freely to catch the constantly moving market desire winds (so that you might reach lands you can't even imagine yet), then your future is as certain as getting through the Bermuda Triangle in a storm. Or as Karen wrote - "Get busy engineering for change now." As she waited for her coffee, Karen took in the standard layout of their hospital. A standard emergency department down the corridor. The standard lift bank up to the standard operating theatres and surgical wards. Standard signs pointing to Radiology, specialty rooms, medical wards, the catering department, the bathrooms. Last night in bed looking at the ceiling, she'd let the standard problems a hospital administrator like her faced interrupt her sleep, and then played around with some obvious action steps that were, well, standard. The Robusta Grande coffee machine hissed and pulled Karen's ruminations from problems back to the pony. I've got to get on the front foot here, she thought. I've got to stop being peppered by reactive forces and stick my head into a place that's scary. Taking her mobile out of her handbag, she dialled her PA Renee, who diligently and politely answered on the second ring. "Renee, I have to cancel my 10am. I've just had a really important meeting come up - would you apologise to the rep? Thanks - I'll be in at 1." Hanging up, Karen felt the surge of adrenaline that comes with pre-committing to something she had a sneaking suspicion could be life changing. An appointment with herself. A half-day to mudmap road-blocks into ideas into principles into actions. While she knew she couldn't and shouldn't tackle this beast all on her own, she'd come to appreciate that before pulling a team together, it needs one and only one person leading from the front to get motion. Karen, hot latte in hand, mounted the pony and stepped outside the hospital.

14. Carrot sticks

Brett Sleep watched his team going about their daily business. Accounts staff, warehouse workers, customer service and a few sales team members ferreting around looking busy (why were they in the office?). Impatience banged his frontal lobe. How can I motivate them? One night when Brett was 6, finishing dinner at the table alongside his parents and 6 siblings, Brett's Dad wiped his mouth with a serviette, stood up and told the family he was going back to work. It was harvest. Brett, who like any six year old thought his Dad was better than Superman, groaned. "Why do you have to go back to work, Dad? You've been at work all day! Come play with me!" Brett's father looked at him and smiled. "Mate, you have to work hard in life. If you want nice things and good food and a good life, you have to work hard." Brett continued his protest - "But you did work hard today, didn't you? Can't you have the night off?". His Dad ruffled his hair and said "Yes I did, but if we're going to get ahead and stay ahead, I have to keep working just a little bit harder." Brett watched his Dad push through the creaky screen door and disappear into the cool dark of the farm night. Sitting in his office chair watching the gentle activity pattern of his team, Brett didn't think his team really understood what his Dad had shown him. Maybe their Dads didn't know? It never occurred to Brett that his expectations might be too high. It's simply a case of finding the right motivator to get them moving quicker and doing more. He needed them to want to grab hold of the opportunity that Brett's reputation, products and footholds was gifting them. He needed a carrot stick - a motivator with a powerful fear-of-failure factor. Brett's internal line rang. His warehouse and kitroom manager Roy. "Brett, I've got Harry from Central Supply on the phone for you. And a heads up - Jerome is feeling crook, he's heading home. We'll be fine to cover him." "Thanks Roy" said the business owner, struggling to hide his sigh. Work ethic. Jerome, 22, big as a house, soft as a pansy, resilient as wet grass. I've got to get to their hearts, Brett thought. Hearts first, heads follow. They've got to want to sweat for this. "Hi Harry. Did you get my note?"

15. Training that sells

"So how do you clean it?" asked the scrunchy-faced theatre nurse, one of 6 gathered around the table in the spare operating theatre where Caitlin Williams was running a training in-service on a new laparoscopic instrument. "Sure - I'll show you. Here - would you like to hold it? Great. OK, so all you do is take your left hand and grab the tip... yes, that's it. Then with your right hand on the handle, just press gently down and twist anti-clockwise... perfect! That simple! The insert just pulls out, and it's fully reusable. The lumen is designed in accordance with the Australian Sterilising Standards - bottle washers, tunnel washers, autoclave, Steris and Sterrad are all fine. What do you think - pretty easy?" The nurse passed the demonstration instrument to her colleague and adjusted her facial scrunch to a reserved but affirmative look. "So why is it better than the old one?" asked her colleague. "Well, the old ones are great for procedures that don't have complications. What this instrument does, with its altered tip angle and rotating barrel, is it lets you easily mobilise the organs to get better visibility of the cutting plane whenever there's a bleed or your patient has multiple adhesions... which of course can be anyone." Cailtin was very careful to use the word "you" and "yours" rather than "the surgeon's". If I remind the nursing team that they have real ownership of clinical outcomes, it doubles their reasons to support the product - clinical and practical. "Mmm - so who's going to be using it?" asked a third nurse. "Well, Mr Ironfly has asked for it to be included on his preference chart, which Kerry has done, and we're going to provide shelf-stock of 6 to begin with. I've been asked to speak with a number of the surgeons over the next few weeks to see if they'd like to use it as well. I've got lists booked with Mr Onno and Dr Kalidis, and we're speaking to Mr Marsh and Mr James... can I ask you, do you think there's anyone in particular I should speak with?", the question directed in general to the group. Get 'em involved, thought Catilin. A dominant personality spoke up. "No way you'll change Mr Onno - he's set in his ways. But I can see this being something Dr Kent would like - have you met her? She's new. Seems to like new technology, and doing a lot of lap chole's." Everyone likes having their opinions asked, thought Caitlin. "Oh, OK, I've met Dr Kent at another hospital, I didn't know she'd moved here just yet. Thank you I'll let her know it's here if you like. The aim of putting this instrument on the shelf is to give you something really easy to use, that helps all abdominal laparoscopic cases go faster and more smoothly, and that helps prevent you having to open the trickiest ones up. It's designed to help patients get better faster. They've called it the Lap Lamp - it "lifts to lets more light in."" Caitlin thought back to the remarkable ear worm that OJ Simpson's lawyer had planted with the jury - "If the glove doesn't fit, you must acquit!" If they remember it, they might just sell it for me. Caitlin let the remaining nurses have a play while she got some hand-made laminated cleaning cheat-sheets out of her compendium.

16. Muscle hypertrophy stimuli

David Longines was convinced that if he watched Ellen Degeneres dance one more ridiculous step, his mending heart may just give up the ghost, such would be its lack of will to go on. I've got to get back to work, he thought, turning off the TV. Reclining in the easy chair in his parent's lounge, pressure stockings itchy on his deconditioned legs, David grabbed his laptop and started surfing. A 3-week leave pass from his marketing hotshot role in London to visit folks in Adelaide (and quietly scout out an alternative family life) had taken one heck of a turn. 2 days into the visit, David scored himself a heart attack and had to have an emergency bypass graft. Nearly four weeks on, David was mending. His wife and young children, having navigated the sheer terror phase that came with nearly losing their otherwise fit big cog, were now starting to enjoy the extended holiday forced on them. They'd bundled out of the house an hour ago to spend the day with David's mother at the Zoo. David's father volunteered to stay home and play nurse (although David insisted he now felt well enough to look after himself). His father walked into the rose-scented room in stockinged feed, leaving his muddy gardening shoes at the back door. "What's this then? I thought they said rest? Doesn't look like rest to me?" David's father was a kind but practical man brought up in an era of knowing your place and not questioning the doctor. "Oh, it's nothing. I'm fine, just surfing. The guy I told you about the first day I got here - the mad inventor? I just want to do a bit more market research before meeting him." David's father stood looking down at his son, remembering the sort of teenager he'd been. Little really changes in 20 years, he reflected. "Well, it's a few weeks before you'd be ready for a meeting like that, I'd have thought." A concerned but clear message in his tone. David stopped tapping and smiled up at his father. "I get it. I'm resting. I've become pretty good at listening to my body these past weeks. I know I've got a way to go. But I've got start to re-engage my brain and rebuild some muscle. Little bit at a time, bit more each time. Anyway, I'm not quite onto the work stuff yet. Though judging by the drop-off in emails this past week, it doesn't seem I'm as indispensable as I thought I was." The world moves on. The business world, fast. "Well, just take it easy, or both our wives will have my guts for garters!" David chuckled then winced as the bifold door that was once his solid sternum reminded him of the palaver David's heart had put it through. His father saw it and frowned. David reassured him. "It's fine. One set of muscles is healing slowly with TLC. Nothing wrong with me exercising the big goopy grey one though. Tough as this time's been Dad, it's a pretty sharp reminder that you're a long time dead. And I tell you, rather than waste my limited number of breaths watching that woman dance around like a goose, I'm damn well going to use what I've got left to do something more with my life... for our family. It's exciting, this 'second chance'. I'm lucky. Now come have a look at what this bloke is making - it's remarkable." David's father, knowing continued protestations would be in vain, moved behind the easy chair and looked at the thing on the computer screen that was stimulating hypertrophic growth in David's mojo muscle.

17. Habit vs Discipline

"Good morning Marjory. How was your night?" asked the tall smile-lined surgeon. The ward nurse smiled back at one of her favourite doctors. "Not too bad thank you, Mr Ironfly. Shall we start?" "Please." Marjory went to the computer and pulled up the records of the three patients Mr Ironfly had recuperating in this wing of the hospital. With each patient, Marjory read out the patients name, particulars, procedure they'd had, then detailed precisely their care and activity during the night, noting anything the patient had mentioned or asked for. Lang, as he tried unsuccessfully to have nursing staff call him, replied with a few questions he'd considered during the drive to the hospital, and the pre-ward round briefing was completed in a few short minutes. "Thank you Marjory. Once more, it sounds like you've provided exceptional care to these people." A simple and sincere compliment separated this one from the pack, thought the nurses. When agency nursing staff were exposed to this simple daily ritual of the good doctor's, many commented on the nitpickyness of it. I mean, the patient notes are at the end of their bed for him to read, they'd say. And while it's not uncommon for doctors to ask questions of a nurses before seeing patients on morning rounds, none had ever seen a surgeon interview a nurse about every single patient every single day to the level this one did. One morning, an agency nurse plucked up the courage to ask Mr Ironfly why he went through this routine. "This pre-round briefing habit of yours, Mr Ironfly, it's.... uncommon. How long have you been doing it?" The kind clinician looked her in the eye and said "Well, it's not a habit, Carol" (for he always took the time to remember the names of anyone who shared responsibility for caring for his patients). "Habits are routines you do on autopilot. The problem with habits, as I see it, is they can sometimes go bad - you can get lazy with them, cut corners, do them without thinking about why. And in this case, the 'why' is particularly important." The nurse, trying to process this perspective, just stared at him. Lang continued. "This, Carol, is a discipline. A conscious choice I make every day, to make sure we're fully ready to speak with and assess the patient who's entrusted their health to us. I could, of course, just read the charts or ask for an 'exceptions report' on any extraordinary happenings during the night. But I believe in - and I was taught - the importance of this thoroughness. I must admit, it's tempting to skip it for the routine procedures on busy mornings. But if 35 years of operating has taught me anything, it's that the routine, benign, 'unexceptional' ones are quite often the ones that can bite you on the nose. That's why I do it. Now, let's talk about Mrs Janssen..." Marjory closed the 3 patient files on her desktop and stood. "I'm off now Mr Ironfly. Please say good morning to the patients for me, and have a lovely day!" A kindred patient-focused spirit. "Thank you Marjory, you have a lovely day too. Right, let's go see my friend Mr Bayer..."

18. Planting imagination seeds

It started with an automated signature line on her emails to internal staff. "What one thing could we strive to be the very best in the world at?" Hospital CEO Karen Millstone was going to lead change. Not evolutionary change. Not the-way-ourindustry-does-it reactive change. She was going to provoke change that no-one really knew where it would end. Change that had no roadmap, but half a chance of changing the world. To do this, Karen knew she needed all hearts, then minds, then hands and backs on deck. And to start that domino chain of events, Karen knew she had to provoke thought and ownership of the idea of change in every player. Karen's mornings got earlier. Sporadic gym visits became daily treadmilling in the dark to increase her body's Oxygen carrying capacity and bolster stamina to help her think and act with gusto and discipline. Her evenings became more concentrated. An hour of veg-out TV time switched to a structured follow-up note writing hour - important, but something she could do in 3rd gear and, in the process, free up Mayfair-valuable time real estate during business hours. The morning hours, the Cortisol spiking time, she seconded for ideation, plan progression and passion-sharing. So as not to let her enthusiasm for change get away from her, nor overshadow her daily governance responsibilities to ensure the hospital ticked key operational boxes, Karen employed 3 supports. She called them "The stick", "The leash" and "The mirror". The stick was Karen's vision board. A white-board collation of her 'what if' thoughts, own desires for the hospital of the future, examples of what the world's-best are doing and statements of the outcomes that such a facility could achieve (along with imagined stakeholder words). Weaved in with this were words reminding her that if she didn't carry out her obligatory tasks at a sufficiently high level now, then her hospital would have no platform for next steps to be built on. When Karen found herself overbalancing in either proactive or reactive domains, she'd look at her stick and let it give her a corrective poke. The leash was Karen's coach. Someone she engaged and briefed to ask the hard stuff that the stick couldn't. A skilled user of questions and guilt to help her achieve her goals. The mirror was a checklist Karen developed for herself - daily fundamentals she knew she needed to do in order to feed the machine and still stay on track in pursuit of her dream. She programmed a 10-minute daily appointment to review the list and face the reflection. All of these steps, the plan Karen was building, the stakeholder's she'd begun engaging, to build something truly 'world best'.... .... it had to start with planting imagination seeds. What one thing could we strive to be the very best in the world at?

19. Divide, provoke, unify

"Roy, what does a great year look like for you this year?" Brett Sleep, medical supplies business owner, boss of 14 and possessor of a burning desire to light a mojo fire in his crew, had his warehouse & kit room manager out for coffee. Roy, arms folded, raised his eyebrows, pursed his lips and shrugged. "Oh, I just want us to achieve our goals, and have a happy team that's working well together." The type of vague, fob-off answer Brett expected, and was dissatisfied with. "OK. Fair enough. I'm really interested in you Roy, and I want to get specific. Not trying to be all warm'n'fuzzy here. I'm interested in what you want to finish this year having achieved - what'd get you saying "my life is unbelievably good"?" Knowing he'd have to give a little more to get it back, Brett tapped a release valve. "Mate, here's the thing - we've got a great team, and I think we've got a great business that's doing, and can do even more, awesome things. But as the guy running the show, I want to know what everyone in my team wants to achieve... I want to make sure they get it. If we've got happy engaged people kicking the goals they want, then we've got a platform to do even more down the track. So what is it for you Roy - how does the sentence end? "2012 was brilliant for me because ....."". Roy, not one for self-help sermons or fridge door goal posters, sat stum a moment. "Uhhh... do you mean, like, I want a new boat?" "Sure! Great! What else - what'll put a smile on your dial?" "Look, I'll be frank, Brett. If we have a crew that just gets on and does their jobs, and there's no really big stresses, and I'm not bogged down with paperwork and having to replace staff and dealing with irate customers.... and I get a fair day's pay for a fair day's work... then mate, I go home pretty happy. And a boat would be nice." Roy finally uncrossed his arms. Brett smiled and nodded. "Roy, I want you to have all that. Do you think there are some things we as a business need to do better to help you get it? I mean we're pretty good now, but...", and he let the sentence hang. Roy completed it. "Yeah, we are, but we've got to make things easier for people. This new system... now I know it cost a lot of money, but I'll be honest, at the moment it's giving us more headaches than it's fixing. What I think we need is to ...." Brett repeated this dance with each of his 14 staff, getting them to the "what I think we need is to ....". There lay his platform for reunification. For transformation that the team owned. For change that tapped into 14 sets of intrinsic motivators. Time consuming. Necessary.

20. Positive pressure

Caitlin Williams knew that to get her desired outcome in the face of opposing forces, she had to keep applying positive pressure. Like stemming bloodflow by putting a tourniquet on a wound. In this case, Caitlin's desired outcome was laparoscopic instrument sales. She'd built desire in Mr Ironfly, made it easy for him to choose her wares by upskilling his nurses and placing product on the theatre stock shelf. She'd inserted a physical barrier to opposing competitor forces and persistent nurse routines by getting her product listed on Mr Ironfly's surgical preferences sheet (his standing order). The remaining opposing force was the trickiest to resist - a human being's natural enthusiasm wane and the biological safety magnet that pulls them back from the edge of change and into the old comfy chair. She couldn't let that happen. She'd built momentum with her surgeon. Now she had to strap a saddle on it and keep the pressure on. Caitlin stepped into the reception area of Mr Ironfly's rooms and approached his receptionist. "Hi Rose! How are you this morning?" Big warm smile for the VIP. Rose, who Caitlin imagined was someone's favourite Grandma, reciprocated. "Hello dear - Caitlin, isn't it? I'm very well thank you. Isn't it a beautiful day?" Caitlin thought it only made sense for the lovely Mr Ironfly to be represented by this tremendously calming human first impression. "I know - it puts a spring in your step! All the flowers are out this morning, it's gorgeous." "Oh, yes, I've got some beautiful Birds of Paradise poking their heads out at the moment - they're quite stunning! Actually, these are from my garden too", gesturing to a striking vase of lillies. "Wow! You have a green thumb, Rose, they're beautiful", pausing a respectfully long moment to admire that which stirred great pride in her VIP. Rose smiled contentedly and asked what she could do for Caitlin. Caitlin didn't try to ask for a 'drop-in' moment with the surgeon - she knew his roster as well as he did and knew he was in a public clinic this morning. "I just wanted to pop in and let Mr Ironfly know we've finished all the training for his nursing team at the private. They're all set with the new instrument, and I'm booked in with him for the first procedures next week. Knowing he's been thinking about another application for the product, I thought he might like to take a look at this before the case", handing Rose a clinical paper with a hand-written with-comp's slip paper clipped on the front without obscuring the paper title. "Thank you dear, I'll make sure he gets it tonight. He's got quite a few big lists coming up, so I'm sure he'll get lots of opportunities to use your product". Caitlin skilfully and genuinely wrapped up small talk and made her goodbye. When hearts are engaged, stay front of mind. Stay front of mind. Stay front of mind. Caitlin played her intracranial positive pressure mantra all the way to the car.

21. Watching for star alignment

Before his blindsiding heart attack, David Longines was a tentacle projector. Someone who would routinely 'touch base' with a long LinkedIn list, continually scout for folk he could 'do coffee with' and use his marketing & PR prowess to make sure his name and talents stayed inside the attention orbit of diverse networks. It made him valuable to all he touched, and it was this discipline that led him to Leo Campbell. David had been developing a marketing campaign for a new piece of communication technology designed for operating theatre applications. Not specialists in the medical environment, David's company needed to find and partner an experienced distributor in the field. Talented tentacler, David went about nurturing the market by wining and dining a handful of surgical equipment company representatives. One such evening went famously and dinner became 1am scotch and cigars in a funky SoHo bar. Despite imbibing a skinful himself (albeit slyly much less than his prospects), seasoned campaigner David kept his mental stenograph recording while his lubricated and increasingly loose lipped guests opened up about their intentions and excitement about a partnership. One of his prospects, a senior marketing manager with the wobbly boots on, made it known that their company had been tossing up between taking on David's communication technology and going with a smart but raw product that a guy in Australia had been developing. "Ahhh, but'sshh too hard.... only prototype... damn good kit though! Shomeone'll pickidup... shuch a clever idea....don't worry, 'ts all shorted! We'll go wif you...". In the sober light of day (and before his mandatory sub-24-hour follow-ups), David did his due diligence and made some calls to find out more about his most-likely second place competitor. It led him to Leo Campbell in Adelaide. Now, sitting in the passenger seat of his parent's car outside Leo's humble premises in an outersuburbs industrial estate, David thought about star alignment. A drunken tip from those in the know. A hankering for a work & lifestyle realignment. A trip home with the family to suss out whether the sea change was as appealing in the flesh. A grounded-for-8-weeks heart attack forcing deeper introspection and opening up bigger timehomes to explore this guy's idea. An idea that killed a dozen birds with one stone but was being overlooked by the big boys for its rawness. And now, sitting next to his father, who insisted on driving his still-recuperating son to the meeting ("Bl**dy fool doesn't know when to rest"), David felt that gut feeling that so many get but so few listen to. David's ears were now finely attuned to his body's messages. It was telling him to go dig. Explore. There's something amazing here. David carefully got out of the car, let the sun put a smile on his face, and ambled to the building.

22. The value of forums

A small ripple of applause moved from the audience to the presenter, a 3rd year surgical registrar presenting early findings from a study into the applications and impact of robotically assisted laparoscopic surgery. The lecture theatre crowd, spanning the experience spectrum of 4th year medical students to supposedly-retired Professors, murmured as the vacated their seats and adjourned to the morning tea set up in the Department of Surgery conference room next door. "Lang! I see your boy in the Annals this month. He's taking a controversial standpoint. Didn't pick up this maverick thinking under your tutelage, I suspect?!" Mr Lang Ironfly, respected general surgeon and likeable cat, smiled without his eyes and nodded at the ruddy-cheeked colleague invading his personal space. A foot shorter than Lang, twice the girth and who'd perfected the art of sounding friendly & collegiate while sinking the slipper in with each sentence. "Maurice, good to see you. I knew the article was coming, but didn't know it was out yet. I must grab a copy. He's his own man. You mightn't agree with him, but you can't fault his research." Lang and his frenemy Maurice, also a surgeon of some talent, were referring to a protg of Lang's from a decade before who was now operating on the world stage out of Johns Hopkins in the US, and who'd apparently just been published in a major surgical journal. A surgeon whose commitment to pushing the envelope in pioneering techniques was in stark contrast to his mentor's more organic methods. "Ahh, well, plenty are! You and I Lang, we're from a time of 'prove first, perfect second, improve third'. This younger breed, they're driven by the need to show it's different, then that it works. We need to be safeguards Lang, temper this constant need to tinker. I expect you'll have a word - or don't you have his ear anymore?" The man was tiresome. Lang smiled and dunked his English Breakfast teabag five times. "The slower yin to their blazing yang, is that it Maurice? I suspect the voices like yours will prove sufficient acid to balance community judgment of Mark's work. Good to see you - we need to catch up soon about the liver trial." And with that, Mr Ironfly excused himself and made a beeline to congratulate another student - the registrar who'd nervously presented this morning. En route through the crowd, the surgeon considered this forum, a fortnightly gathering of surgeons-to-be, game-atop'ers and once-were's. I don't like them all, but they're my fellows and they provide insights, balancing perspectives and, well, kinship. The value is in the frequency, the diversity, the sharing between old and young... and that keeps me younger. "Michael! Well done, that was a fine presentation. I'm interested to hear ...." With his elder's interest, Lang made the young doctor's day, and for the next 40 years, the younger man would do his best to model his own teaching approach on the kind surgeon he'd had the fortune to work beneath.

23. We can't do that

"We can't do that!" It was a phrase Karen would come to hear a lot. "Why? Granted, it's a change of process, but look at the outcomes and savings we'd make, all without clinical compromise and ultimately for much-improved results. Not only that, with the express support of the clinical teams who've been crying for innovation in this area for years!" Karen Millstone, Hospital CEO gripped by the need to shake it up, sat before her Board explaining her proposal to change the way they served their clients - their patients - their clients. "Well, for a start, it'd be ludicrously expensive" said grey haired shiny pants man in the corner, who'd been on the board for years as a professional Devil's advocate. "All I'm asking for is an endorsement to run a feasibility study. Agreed, there'll no doubt be some big potential investments to be made if we can demonstrate the justification. It's why I want to identify the areas of minimum exposure, financial and risk, and start there to show some positive ROI and improved outcomes to begin." "Not only that, but the stress on the system, on the staff, who you tell us are already overworked and many of whom you say are disengaged... our numbers are somewhat soft now, let alone taking staff eyes off the ball to implement radical changes..." said magenta power-suited hair bun lady, who'd come from nursing but long since forgotten the look in a patient's eyes when you told them it'd be a 3-hour wait for the doctor. "My contention - and early strawpolling will back this - is that even the trialling of some of the initiatives outlined here would be a means of re-engaging and re-invigorating our staff's approach to their work - many of whom long ago accepted that their system was frustrating but unimproveable. I'm looking at this not only as a way of significant future revenue streams and cost savings by process flow improvements, but - and no less importantly - as a way of giving everyone who touches our institution the very best, most rewarding experience possible. Patients, providers and staff. That's not only good for business, it's good for people." The following 10 minutes was all sidebar hubbubing, objection hurtling and defending staid perspectives while Karen logically and passionately tried to put her low-risk test-drive wish forward for endorsement. The compromise, negotiated by the Chair, was a shorter, more constrained pilot process than Karen's worst case scenario. But it was a start. It was a sprout.

24. Arranging the chairs

It was early and cold. The sun was still deep in REM dreams and only delivery drivers and a lone excitable boss were moving. Brett Sleep was in the warehouse of his business, Healthmend Technology, arranging the chairs. This morning he'd have a crack at putting some birdseye chilli heat into his team's engagement and activity levels. From the one-on-one interviews with his staff, Brett had identified 3 key logjams to greater hustle. One - people really not understanding the WIIFM bit. His take was, he had a team who mostly thought "why would I bother to move quicker - really, what's in it for me?" As far as Brett could tell, it wasn't just about offering bigger or clearer performance incentives (though that was part of it), but a quorum of the team were just not getting the concept that they were in charge of their own destiny. That if they bent their knees and put their backs and their smarts into it, they'd be amazed at what they could achieve. They needed to see just how their effort has a positive ripple effect on so many people. Brett planned to address this first up. Two - silos with moats and only a handful of drawbridge operators had been allowed to spawn. This was Brett's fault, and he'd chided himself severely once the penny dropped. In such a small business, in the pursuit of excellence in individual work tasks, a culture of my-job-your-job had emerged. There were exceptions - Brett's sales gun Caitlin was one - but largely people focused on performing their own tasks at the exclusion of learning more about how they could help their peers. A nice problem, Brett first thought. As he looked at it more closely though, he realised his creating a team of high performing specialists wasn't actually helping his customers in the way he'd thought it might. They're going deep in their own domains, but it's coming with blinkers, and that blindness has consequences. A balancing act, Brett thought, and we've leant too far to one side. Weight redistribution today. Thirdly, and perhaps the biggest of all, Brett's business had developed processes that were ironically disincentivising personal accountability, due diligence and smart decision making. A system that had been built to make sure customers got their orders on time was in fact giving most staff grief, causing a lot of "it's the system's fault" shoulder-shrugging excuse-making. By pouring too much focus on making the system better, they'd forgotten that the best system of all is to have a pride of invested, accountable people who make and own their well-considered decisions each day. So today, the system was being put back in its place, and the role of the individual as considered choice-maker was being re-elevated to its rightful position on the customer service totem pole. Brett finished arranging the office chairs in a 3/4 circle and dragged the butchers paper flipchart next to his chair. The caterers would arrive with the bain marie shortly - the most lavish working breakfast his team will have ever seen. Brett grabbed the vouchers he'd ordered and taped them under each chair. Then, on the nearby whiteboard, in the biggest, neatest writing he could, Brett wrote the only three rules he wanted each team member to follow from this day forth whenever they needed to make a business decision.

25. Just faster than you

"Oh, I'm sure Caitlin has some fancy product for that, don't you Caitlin?" W*nker, thought Caitlin. An Aussie term she'd come to appreciate the meaning of. "It's not our specialty area Stuart, but", turning her attention from the self-important sales rep to the quiet surgeon, "if it's something you're looking for, Mr Trolley, I can put you in touch with those who are specialists in solving that problem." Caitlin Williams, the top shelf US import sales rep for Healthmend Technology, was sitting in the operating theatre tea room at a table with an anaesthetist, a surgeon and a competitor company sales rep named Wayne. None of whom she was here to see (her guy was still in theatre closing a patient), but prospective customers all the same (at least the medico's were). The rep, he was just a pain in her.... "Haven't you guys just been made distributors for Kablation? I thought they'd had some issues around a product recall?" Ar#ehole. Just setting out to make a competitor look bad in a hamfisted attempt to elevate his own status in the client's mind. Surely he understood how customers noticed his barely veiled nastiness? Mind, he's got his finger on the pulse - that was only made public a couple of days ago. "You're right, we are distributing their instruments, it's a separate company from the one you're referring to." Back to the prospects. "The reason we took on the instrument line was Brett'd had a lot of feedback about a lack of good instrumentation for certain hep bil procedures. I'd be interested in your opinion Mr Trolley, how do you find .....", and Catilin took the prospect down the conversation path of her choosing. Wayne sat opposite, now barely smiling through thin lips, venom in his eyes. Caitlin knew he was p*ssed that he'd just lost control of the conversation - his sales call with his prospective client. That'll teach you to be a smug gossip monger. Caitlin reflected on the joke about two friends in the ocean when a shark came along. One friend turned to the other and said "we have to outswim this shark!", and the other said "I don't have to outswim the shark - I just have to be faster than you." Caitlin knew she was faster than this dolt. No need to stoop to the barb-swapping level. Eyes on the customer, Caitlin - what's going to pique their interest? Leave the competitors to think about competing - you worry about winning.

26. Lots of birds with one trolley

"Leo! Good to meet you!" David Longines stuck out his hand and grasped the working man's, the calluses he felt a contrast to his own dishpan softness. "Good to meet you man!" came the still-thick South African accent. "Wow, a hell of a way to extend your holiday, huh! You had to go and have a heart attack! You could've just asked for a bit more leave, hey?!" The salt'n'pepper-bearded engineer chuckled at his own humour. David rolled his eyes in self mocking and nodded. "My heart was too anxious to see what you've built, it was bursting with excitement!" After being alerted to Leo's existence and the prototype he'd built that the big boys were showing interest in (but likely to look over, or just copy and make themselves), David had done some more homework and booked a meeting with the inventor. Here he stood eye to eye with a visionary in his workshop. The host was no-nonsense. "Well, you probably want to come and have a look, hey? Over here - mind your step. Got a few other things I'm working on, but let me show you the Rolls Royce..." Leo led his still-weak-but-game-faced guest through a large garage sized workshop that was, David guessed, organised chaos. Electronic testing machinery competed for floorspace with mechanical parts, toolboxes and electric motors. Circuit boards, cable offcuts, soldering irons and precision tools littered workbenches. It felt like a cross between the auto-mechanics, a junkyard for computer nerds and your grandfather's shed. Beyond the piles at the back of the workshop was a white door which Leo promptly opened. Inside was a contrast as stark as the skin on the two mens' palms. Talk about not judging books, thought David. A small sterile white room, brightly lit, with uncluttered benches around three walls and 4 massive white computer screens and touch pad controllers that David could imagine being at home in the Googleplex. In the centre of the room, like a new Lamborghini on stage at the Detroit Auto Show, was the bit of kit he'd come to see. "Here it is. The A-Trolley. I wanted i-trolley, but you know those guys at Apple, they've branded everything that's not nailed down! So I went with A, for Adelaide, you know? It's my new home, it's been good to me, so... and I like that it comes first in the catalogues..." What had piqued David's interest when he first heard about Leo's product was that it seemed to kill multiple birds with one stone... or trolley. A device that met the unique but continually-evolving product transport & storage needs of surgical equipment suppliers and end users; that harnessed technology in a flexible, evolvable way to manage inventory and facilitate information sharing; that could meet the rigorous standards required in operating theatres and be robustly functional when being wheeled around a busy supplier warehouse. And that would save all who touched it time, money and deliver peace-of-mind. It was, on paper at least, genius. In the flesh, it looked like a souped-up white airline food trolley. "Come on, let me show you how it works. Say "A-Trolley" in a nice clear voice..."

27. Hippocrates
"I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone." Mr Lang Ironfly stood still a moment as his conscious processed this original crux of Hippocrates' Oath. How does it apply here? "What's your approach, Lang?" asked his surgical assistant, a GP of similar vintage who scrubbed in with his friend once a fortnight. "Mmmmm...." They'd encountered something Lang hadn't anticipated. A diagnostic laparoscopy which should have unveiled a common, relatively benign cause of the patient's pain had presented them with something altogether different. The surgeon had seen variations of it before, but this was uniquely challenging. Multiple tumours inside a patient without the risk factors or the symptoms usually associated with cancer this advanced. Clear tumour identification, but their ugly placement on vascular structures made them very tough to remove. If taken cleanly, a near 70% chance of survival, perhaps more given this patient's otherwise fine health. But if it was the type of tumour Lang suspected it was, then failure to achieve clear margins around the growths would almost certainly result in their proliferation, perhaps even shortening the patients life. Mr Lang Ironfly, a surgeon of renown, not a trailblazer, but esteemed for his precision and competence in his bread-and-butter work, looked up at his colleague. "The right thing to do here is bring in Charles", referring to an oncologically-skilled colleague. "Getting these out cleanly, if it can be done, is paramount, and we can't do it here. Let's get some pictures and video footage - is the camera on? Good. We can give them a good look at what they're dealing with. Needle biopsy too. Helen, have you got the biopsy tray?" In an efficient exchange, the surgical scrub nurse relayed instructions to the scout, who started towards the door in search of the tools Mr Ironfly would need to help them diagnose the tumour. As he stood thinking, the surgeon changed his mind. "Before we do that though, hold a moment. Let's get Charles on the phone - I want to make sure he's happy with the biopsy approach. Kerry," referring to the now-paused scout, "would you mind grabbing my phone on the bench there, and looking up Dr Marx's number... thank you". Know your limit of maps. Have the courage to call it. Implement Plan B without fuss. Bring in the right people for the job. And try wherever you possibly can to do no harm. Why, limited as his skills were, Mr Ironfly was the first choice of most in need.

28. Curling the initiative

Tsss Tsss Tsss Tsss Tsss Tsss. Karen Millstone's $280 Asics touched the rubber of the treadmill in a gentle hissing cadence. It was 5:45am and she was doing 11kph. Karen loved the way the repetitive rhythm helped her keep her thoughts focused. Tsss Tsss Tsss. I've set the Curling Stone in motion now. The idea, it's now a plan. It's on the ice, I've let it go and it's moving forward. Tsss Tsss Tsss. My job now is to sweep in front of it. Help it to the 'house'. Get a testimonial-inspiring result. Tsss Tsss Tsss. The friction sources abound. The will of a good many will be to create comfort deviations that pull the stone off course. They'll want to touch it, alter it, vanilla-ise it. Tsss Tsss Tsss. Got to direct it. Carve the path as we go. Smooth the way, keep it clear to let the initiative, and its implementers, do what I know it can. Do what it was planned to do. Tsss Tsss Tsss. Got to stay ahead of the initiative. Anticipate. Be ready for redirections. Tsss Tsss Tsss. I can't touch it now - everyone's watching, and they need to see that the momentum will sustain it. But I can use the broom. Move fast. Sweep Tsss Tsss Tsss. While the rest of the crowd slept, Karen thought of sweeping strategies to help the initiative keep going without touching it. Tsss. Tsss. Tsss. Tsss. Tsss.

29. The 3 rules

Brett Sleep, tiptoeing the tightrope between deluded idealist and magnetic trailblazer, stood between his team and his "Commander's Intent" inked on the butchers paper that plastered the whiteboard. Our job - To help the client and Healthmend Technology in equal measure. Why we do it - To fix what's broken. To nurture the healthy. To innovate & prosper. Because we can and we should. Who are our clients - Healers and their crew. Healthmend and its crew. The 3 rules every Healthmend Technology representative agrees to remember; 1. If you see it needs doing and you know it's important to ensure we do 'our job', then do it or make sure the right person does something about it today. 2. If you can see a way we can do our job better, faster, more, then speak up immediately and prepare to drive the change that must follow. 3. When faced with a hard choice, take 10 seconds to imagine you owned the business, and imagine it was your child on the table, and then make your choice, and then move. Brett's crew stared at him. "If you - we - follow these rules, I will make you 3 guarantees. One, we'll start to make some decisions that will bring us all a fair whack of short-term discomfort, but that will make us a better business, a more profitable business, and let us help more people in more ways. Including you. Two, you'll never get fired for applying these rules. Three, you will love what you do more, you will earn more - not just money, but satisfaction and respect and gratitude and loyalty - and you will be an essential contributor to something much bigger than yourself. Something that will change the world for a great many." Brett let his stump speech sink in a moment before asking for the business. "This is not warm and fuzzy. This is hard. It's essential. And it starts right now. I hope you're up for it. I know we've got the team to nail it. Now for my Jerry McGuire moment... ... who's coming with me?"

30. Bags not it

Caitlin got this. She thought in slightly different words to Brett, and the ra-ra stuff? She knew Brett was trying to get the team salivating like the Looney Tunes Weasel, but it certainly wasn't needed to pump her tyres up. Living on the front line of their business, Caitlin made her choices this way anyway. It was the only way people became successful. The only way. Over an early-morning working breakfast, the Healthmend Technology team had heard their boss roll out a clear business mandate. 3 simple but scarily empowering rules for all to follow. Now he was asking for everyone's buy-in. From her seat at the edge of the semicircle, sales gun Caitlin could see the lizard brain applying its must-resist-change pressure in every team members head. The team weren't making the mental connection as quickly as Brett would have hoped. Some of the facial expressions were almost indicating physical pain. Caitlin knew that if she waited another second, the objections would start cascading. She doubted anyone else would volunteer to be Brett's 'Dorothy Boyd' - the lone sole that risked it all to follow her maybe-unhinged boss in pursuit of something remarkable. The culture of 'bags not going first' in supporting initiatives, as in most businesses, was strong here. She knew the value of first followers supporting the lone shirtless dancing guy. "Well, you're not as good looking as Jerry McGuire, but I'm with you Brett! I think it makes complete sense to create a business structure that frees people up to make better decisions for our business and our customers. And I think that, given we've got a team of clever, experienced and mature people, a 'freedom framework' like this can and will improve what we do and what we achieve, quite quickly. No doubt it'll present challenges - I can see there'll be times when our traditional roles and duties butt heads with this more free range approach - and self-interest things like how we get looked after are pretty important to us - I'm sure you're going to talk more to that Brett. We all pride ourselves on doing our unique jobs really well, so we'll each no-doubt resist some of the changes I can forsee coming...." Caitlin paused a moment to let her colleagues spend a little mental reassurance time with their old friend 'comfort zone' before continuing. "But I think that, as you said, if we remember that we are our business... that we get to benefit from it doing better, and, as you said Brett, if it's our kids on the table, wouldn't we want to know a supplier is making choices with that in mind? Wouldn't we want to be a part of that? I think if we keep remembering that, this will be amazing. I'm excited! Roy, how about you?", handing the talking stick to the blank-faced warehouse & kitroom manager. Caitlin was a natural user of the sandwich technique for gaining engagement - talk about upside, then be frank about the downside, then finish strong with upside. Support the boss, paraphrase him. The look on Brett's face, while Caitlin knew he would have expected this from her, was one of restrained delight. Now the pressure was on Roy to follow Caitlin's first-follower lead. Caitlin knew there was a clear choice to be made in life. Be enthusiastic in embracing change and energy. Or be tumbled along in the whitewash as it moves forward regardless.

31. Can I sell it?

On David's voice command, the trolley beeped and its iPad screen came to life. Leo walked him through it. "I came up with the idea after a conversation with a friend who runs some operating rooms back in South Africa. He said they have so many different products coming in and out each day, equipment from different companies, you know? For when they replace your hip and when they do big heart operations, yes?" Sandpaper-edged Engineer Leo was explaining the origins of his new A-trolley to David Longines, who see-sawed his gaze between Leo and the souped-up white airline food trolley. "Well, my friend said it was hard to move all the stock, hard to keep tabs on stock locations and what they had. I talked to some companies in the equipment industry, and it's a real pain in the ars@ for them too, hey? 'Cause the equipment's too expensive for a hospital to buy, so they just rent it out, and the kit changes so much, and they never know precisely what they'll need for any operation, so they have to keep packing and shipping a whole load of stuff, sending it to all these different hospitals every day. And just using some parcel courier company too! Big crates too, carrying thousands of dollars of stuff, made no sense." The engineer described issues David could imagine weren't just confined to the hospital environment. "So I took the airline trolley concept - simple, modular, you know? And I created a flexible 'concertina' skeleton with flex mesh sides, so the trolley can actually change sizes depending on the size of your trays. Then I put a bit of sexy in it, so it's got its own inventory management & communication system built in - RFID & bar code scanners, but you can change these easy enough. A small server, feeds into a cloud, this little touch screen system that runs on a simple bit of software you configure as a conduit between the hospital and the supplier's systems. And some voiceactivation technology so you can ask questions without touching the unit, good for sterile environments. Really simple - hey, I'm a simple guy, right?" It didn't sound so simple to David. "Anyway, so I wanted to deal with a few problems - transport, modularity, flexible sizing, combining an inventory tracking system, and it had to be light and easy to use and meet the sterilising standards too. I'm working up the next issue - sterilising it without putting it in a steriliser... got a great idea for this! So many applications, I think! Something that suits both suppliers and clients alike. I have to say, I've had some interest from the big boys." This David knew. He also knew what Leo didn't, or might've been deluding himself about. They were going to bypass his idea. Or copy it and make their own. "It's very clever Leo. I've got some questions..." The biggest one, and the one he kept to himself, over-rode all others. If David got on board, if he cue-jumped the big boys and found a way to partner Leo.... could he sell it?

32. Sometimes it goes wrong

Despite trying, sometimes you can't fix them. Sometimes there are hiccups. Sometimes it goes pearshaped and you make it worse. And sometimes they die. Mr Lang Ironfly knew he couldn't prevent the law of averages exerting its will and making bad things happen. Having circled the block a few times though, he knew the best antidotes and poultices. One - know what you're dealing with as fully and early as you can. Dig deep. Ask rigourously. Do the screens and tests and get confirmations before diagnosing the ill and building the plan. Two - manage expectations at the front end. Warn completely of the risks. Paint worst case scenarios while describing how you'll work to negotiate to avoid them. Be confident but transparent. Ensure your guidance isn't bullying - that decision owners know they're owners. Three - mitigate mitigatable risks. If it's likely to go wrong and you can plan to prevent it, do so. Have Plan B ready. Be conservatively bullish and invest in whatever insurance you can. Four - use the plan while keeping your eyes open. In the heat of battle, do your best to stick to the sober thinking and logic that developed the plan... until the early warning signs flash brightly enough that you flex and accommodate. Be scientific first, artistic second. Five - when you find yourself in the hole, stop digging immediately. Think. Think. Safety before cure. There might be another way. And, when despite best intent and efforts, antidotes and poultices, it still goes bad and there's no more to be done to turn it around... ... look them in the eye, explain precisely what's happened, what you'd recommend to do now to make it better, and apologise on behalf of the Universe that this has happened. Owning it - the responsibility - is success Cod Liver Oil.

33. Pit crews versus grain silos

The guts of what Hospital CEO Karen Millstone was trying to do was simple. Make it easier for every patient her hospital touched to get diagnosed, get treated and get well, faster and with less anxiety. Anyone who's been through a serious illness requiring hospitalisation or surgery knows the palaver involved with the grain silo model. Ill and worried people pin-balled between departments and buildings, appointments on different days that just don't synch, waiting by the phone for a clear next step to wellness (only to find out more information or tests are required). Protraction leading to frustration and stress exacerbation. Karen's goal was to try and take every opportunity to re-engineer how the hospital delivered its services with the patient in mind. Elevating their needs above historic or logistical conveniences for the institution. Her starting point, the test drive, was a small and seemingly simple one. Rather than bounce them between silos, create a 'pit crew' for the most anxious clients - new visitors to the Emergency Department. The first step she chose was to relocate a single radiologist into the ED. The feedback she'd had was that the delay between an initial triage examination of an emergency patient and them being scanned by radiology to confirm breaks, bleeds or blockages was delay opportunity for the patient's anxiety to worsen. By having a member of the second diagnostic level standing next to the primary assessor & care giver, not only would information flow be expedited and the right scans confirmed immediately, but the potential for miscommunication significantly decreased and, from a PR perspective, the patient and their family sees a connected crew all pitching in together to help them. Anxiety decrease, stressor removal, expedited processes, potential for accurate diagnosis, treatment and healing bolstered. Bob's your uncle. At least that was the hypothesis. Karen had had this feedback from all and sundry in the hospital for a long time. The concept of better, faster information flow, of teaming for the patient, made sense to all. But as Karen found, it's one thing to complain, and it's another to accept the changes that would stymie the complaints. The resistance logjams and die-hardiness still took Karen by surprise.

34. Writing the Matrix code

"I'm trying to free your mind, Neo. But I can only show you the door. You're the one that has to walk through it."
Morpheus, The Matrix.

In spite of his stirring '3 rules' unveiling and the clear support of his #1 sales gun, Brett Sleep's team weren't able to fully give themselves over to the moment. The Lizard Brain over-rode the excitement that revolutionary change stirs in even the most jaded. And while they tried to hide the body-language cues that come from such mental discomfort, and they did their best to say the right things ("yeah, sounds good...."), the "but's" were poking through the surface like soursops after spring rain. "What if this happens?" "How will we deal with that?" "This won't allow us to do the other!" Brett listened. He nodded and jotted notes on the butchers paper. He let people unpack their feelings. He used the power of facial expressions to direct their conversations back to facts rather than fear alone. And then he waited for silence. And he sat at a chair in the semicircle, and he let a little more silence hang. "Thank you all. I don't say this enough. I know that I'm a very lucky bloke. I've got a business that excites me and gives me purpose and hopefully pays a few bills along the way. It's something that helps a lot of people. I know that my business is nothing without a sh*t-hot team to run it. You guys make it hum. I know, and don't say enough, how lucky I am that you choose to work with me to do something cool and helpful every day. And I know I'm a pain, because I push, because I ask for a lot. And because I'm constantly tweaking." Brett stopped for 5 seconds, looked at the floor and formulated trial close #2. "All of the things that can slow our adopting this more customer-centric approach, the things you've put up here? They are real. They will get in the way. They will need negotiating over or around. That won't be easy. Here's the thing though - and I've learnt this and seen it and am amazed by individuals who apply the thinking every day..... we get to decide what type of business we'll be. If we shut the doors tomorrow and paid out some cash, the world wouldn't end. And if we said we were going to start selling party hats and deck chairs, well, pretty quickly people would accept that. And if we say we're going to be the best at something, and that we use 3 rules to determine every single minor decision that we make? Pretty quickly, it can happen." "Remember that movie "The Matrix"? The world was whatever they programmed it to look like. Well, I reckon we get to write the code here. Here's our chance. Here's the shot we have to rewrite how we operate, what we do, what we achieve. My question is then - and it's a big one ... are you willing to work with me to find the ways to iron out these 'code bugs' so we can start doing something more amazing?" His second attempt at getting buy-in was more successful.

35. The front door trigger

When she saw the magic sign on the front door of the hospital, the private rooms or the clinic, Caitlin Williams had trained her mind to auto-cascade. The word "Open" had been synaptically joined to the word "Sesame", something her Dad used to say to her when they approached automatic doors in shopping centres. Daggy but memorable. "Sesame" got connected to "Street" and the ear-worm theme song Caitlin remembered more than 20 years after she regularly watched it ("Come and play... everything's A-OK...."). "Street" was linked to "Car", and the image of Ned Flanders on The Simpsons parodying the famous Tennessee Williams play ("StelllllAAAAAA!") "Car" hooked up with "toon", and the image of Porky Pig in the Loony Toons closing sequence ("Abedeh, abe-deh, abe....that's all, folks!") "Toon" took her mind to "itune". "itune" honed her in on the word "listen", on shuffle, repeated. Listen. Listen. Listen. So when Caitlin Williams, pre-call plan in compendium under armpit, walked to the front door of any client business with an "Open" sign on the front door, here's the mnemonic she'd ingrained. Open. Sesame. Street. Car. Toon. i-tune. Listen. Listen. Listen. And with that, she remembered that her job here, before all else, was to focus on the listening. Caitlin found listening got her remembered, because most don't remember to do it. And it had only taken her 10 minutes to develop the cascade and a week of conscious practice to ingrain it. Open sesame.

36. Heart first, head follows

"So here's this "mad engineer" South African, right, and he's gone and invented a medical equipment trolley, it looks like something that belongs on a plane, and he's souped it up, made it out of this really clever concertina aluminium mesh that lets you make it bigger or smaller, with these railing inserts you slide equipment trays into, and it's got all this stock logistics tracking ICT on board, bar code scanner, the works. Voice activated, ipad, I mean, it's schmick but simple. And as best I can tell, no-ones done anything like it before! Why? I'm still not sure? Insufficient profit potential? Mmm, but this game is used to paying. The product kills lots of birds with one stone, and ...." David Longines sat in the passenger seat as his father drove him home from a first meeting with the entrepreneurial engineer Leo. With every recollection, David moved a little further towards the 'yes' end of the decision-making see-saw. "So are you quitting the UK and coming here to sell this guy's product?" His father was a straight-tothe-point kind of guy. David stopped his blurting and looked out the side window at the passing streetscape. "It's a risk. The fact that the big boys haven't already done this is concerning. I mean, I know they're interested. That they can very easily copy it and put a marketing machine behind it is perhaps more worrisome. I can see applications for it outside of hospitals, but for now, it's pretty niche. Is Leo a guy I can partner - I think so, but.... we've got some great security at home", referring to his on-hold high-level corporate gig in London. "So what are you going to do?" An impatient man too. "I've got to talk to the team about it", referring to his wife and kids, "and we've got to look at finances - there's a lot more due diligence I'll have to do on Leo and the market, and the business plan... well, a bit to do..." David's father, straight-to-the-point, impatient... and perceptive... "Sounds like you're going to do it." David looked at his Dad and thought a moment before speaking. "The signs are there. It feels right. I.... I just feel like... I've always trusted my gut, and I've got to complete the homework and check and double-check my plan... but it feels right." David's next challenge - use his head to vindicate his mending heart's choice.

The Best
Five that want it more.

37. Working your way around the hedge maze

"Cut from where you know to where you don't." It was the first dissection rule Mr Ironfly had been taught as a young medical student. Start your surgery from a place you're familiar with, and work your way outwards into lesser known planes. Trailblaze from a trail base. Build on a foundation, not castles in the air. And in the absence of breadcrumbs, keep one hand on the wall of the hedge maze as you follow it around. When a new product entered his operating theatre, Mr Ironfly looked first for the points of familiarity. What did he recognise? What was he comfortable with? What do I know works? While the sales rep tried to spruik all the revolutionary problem-solving aspects of the slick bit of kit they were trying to make money from, Mr Ironfly sought first to recognise a proven and trusted old friend feature. It was, after all, the logic he applied when explaining a diagnosis or procedure rationale to patients - mental acceptance and stretching can only happen when the fear of the unknown is first tempered by a knowledge affirmation. Maslow's hierarchy of needs puts 'safety' three rungs lower than 'self actualisation' for a reason.

38. Remember the spur

"Dr Allen. He wants to speak with you. I told him you're just about to enter a meeting. He's demanding you call him when you're done." Karen Millstone's PA Renee relayed the message to her boss, who knew it would be yet another grizzle about the simple but apparently unsettling initiative she was trialling. As part of her larger vision of a hospital 're-engineered for maximum patient wellness', Karen had been given approval by the Board to test the idea softly-softly and relocate a Radiologist (who normally lived in the Radiology Department) into the Emergency Department. The theory - improve the quality of diagnosis through greater cross-functional collaboration, expedite the wellness pathway by removing communication delays and reduce patient stress through presenting a 'tight pit crew' front. Apparent were becoming the hurdles. Dr Allen, a senior Emergency Department staffer, had called Karen 3 times this week to complain about the encroaching of 'non-emergency-trained staff' into what he thought of as his little fiefdom, and overestimating his authority, once called her about the opposite - "where's that damn Radiologist who's supposed to be working for me?" The Radiology team, who largely supported the concept and created a roster for who'd be in the ED on any given day, were showing that old habits die hard and finding reasons to pull their colleague back into their department for protracted periods. Dr Allen of course didn't want a "rotating procession of people with a superficial understanding of how his department functions", but a single dedicated bod he could shape and mould and control. This led to some robust discussion with the head of Radiology, who dug her heels in and gave whichever staff member was in the ED explicit reminders that they worked for her, not him, and that they shouldn't bow to unreasonable requests. Karen watched this political dynamic unfold, frustrated that the one thing - the one reason - they'd set this initiative up for was being completely forgotten. "Thanks Renee. I'll call him after the meeting - can you plug that call into my diary please?" I've got to find a way to get the rationale, the goal of this trial, elevated in the minds of these stakeholders, get them looking above the political inconveniences they're muddling through. I've got to give them a purpose mirror - something to remember the spur that started this. Karen left for her 11am.

39. Morpheus, meaning & manifestations

Brett Sleep (or "Morpheus" as he was now being affectionately called after his stirring team speech referencing "The Matrix") saw some positive early signs. The first was that the words were being woven into the lingo, even if in the first instance they were tinged with sarcasm. "Well Jerome, as it says, "It's our job to help the client and Healthmend in equal measure!"" "Thanks Evelyn, as it says up there, we're here to "fix what's broken'!" Brett knew there was a fair degree of p*ss-taking going on, but the first step to meaning was remembering. The team had taken Brett's new rules (wordy as they were) and, on the butcher's paper plastering their walls, used fat black texta to change them to points that had meaning to them. Rule 1 became Do it! Rule 2 became Improve it! Rule 3 - Own it! Maybe the most heartening manifestation of all came from Brett's Operations & Kitroom Manager Roy (who, it was fair to say, was one of the most cynical of all about this cultural shift). It happened the day after the team breakfast meeting, where Roy knocked on the door of Brett's office. "Brett, I went home last night and thought about what you said, about our crew being 'clients' as well. It think I get that. I think I'm an alright boss, but I've never really thought of my guys as 'clients', and I'm not really sure how to adjust my approach to do that. I thought maybe I'd get some advice from Caitlin on that - you know, she's a sales gun, on how to talk to clients, what they want... what do you reckon?" Morpheus did a little internal jig.

40. Pushing back

Scoreboard-bothering sales star Caitlin Williams (with a C) held the nurse unit manager's gaze. "Mary, I'm confused. If I understood correctly, you said you're looking for a more cost-effective way to manage your scope fleet?", referring to the vast array of surgical telescopes Mary's unit owned. "Yes, and the other ones are $200 per scope cheaper." "Yes, the ticket price per scope is that bit lower. I understand that what you and the hospital want is a hassle-free program to make sure you've got the right amount of high quality, functional scopes in your theatres for the next 3 years at least... and that you need it for the most economical price you can get?" "Well, yes, we're unlikely to get funding for more scopes for a number of years after this, given the other priorities we'll have to fund. If I can save $200 per scope, I can use the cost savings towards some other equipment we need." Caitlin looked at Mary intently but warmly; focused but contemplative; she wanted Mary to see that she was working to fully see things from Mary's side of the fence, but also to portray someone who believed - no, knew - they could help her better than the next guys. She momentarily contemplated taking the question path into what Mary's 'other needed equipment' was, but knowing that answer already from an earlier discussion, and knowing it would distract from what needed to happen now, Caitlin kept it straight. "I understand Mary. I know every dollar is tight, and the demands on your budget keep rising. My goal here is to give you exactly what you've asked for - the best value for money and the most costeffective way to give your surgical teams the tools they need to do their job at the highest level.... and in doing so, growing the reputation and future revenue streams and profitability for your hospital." Maybe over-stretching, but Caitlin thought she may as well test the edges. She kept going. "What I can do to help you here Mary is give you a scope fleet upgrade that, while the ticket price per scope is $200 more, the savings in fewer repairs and replacements, based on the numbers you gave me, we've calculated will equate to approximately $430 per scope. So take up my offer, and you get better scopes, happier surgeons, better visualisation - leading to better surgery and better patient outcomes - and also a more harmonious work environment because you're seeing fewer breakdowns. And you get it for $230 less per scope than the lower-quality scopes. $230 more you can use towards the other equipment you need. So - cheaper, better and more reliable....is that what you're after?" Wait for it, wait for it.... "And Mary," big smiles, "you get me... for free! Is there anything we've missed?"

41. Do the best rest?

On the Queen's Birthday public holiday, David Longines - heart-attack survivor, once-was-corporatewarrior, contemplator of a new business partnership and family man deciding on the right future was 'a little bit on the job'. Walking Semaphore beach with his kids and better half, he carried on a conversation about ships they could make out on the Gulf horizon while mentally tumbling over how he'd approach his next conversation with Leo, medical trolley designer and probable business partner. His wife knew the glazed look meant he wasn't fully with them, but she was grateful he was with them at all. In his backyard workshop, Mr Lang Ironfly, non-trailblazing surgeon of hard-earned skill and respect, applied bees wax to the sideboard he'd almost finished restoring. He immersed himself fully in a hobby he'd pursued with the same attention to detail that his patients enjoyed. He didn't think about the theatre list he had tomorrow. Tomorrow was tomorrow. Now it was about the wood. At an extended family gathering in her brother's backyard, Hospital CEO Karen Millstone piled coleslaw on her plate to go with the lamb and sage sausages her sister-in-law insisted were "to die for". English pork were just fine as far as Karen was concerned, but she knew the showing off was important to her insecure in-law, so she smiled and embraced. She tried her best to be fully present, but the restlessness gnawed at her and her subconscious kept her neck muscles stiff, not letting her get away from the fact tomorrow would present more struggle. She made small talk with her nephew over wood-oven-toasty bread and carried out her duty as a family member. Business owner Brett Sleep was at work. Public holiday or not, the work needed doing. The auditors were in tomorrow and a representative from a potential new supplier was coming in to tour the branch and look at the potential. Brett had done the family roast last night. Now was the opportunity to get ahead of the resters. Caitlin Williams, a sales rep with fire in the belly, was at her study desk finishing off her planning for the following day. She'd given herself until 2pm to take care of the work before heading out for a bike ride then drinks with some friends. Just one or two though - an early start the next day to make up for the shorter week. 4 days to make a 5 day sales week number - it needed extra focus and concentration. Rest to refresh? Or grab the opportunity while others relax?

42. The five minute discipline

Mr Ironfly turned on the scrub sink tap with a wave. He lathered his hands and arms with antimicrobial soap, then opened a surgical scrubbing brush and cleaned under his fingernails with its nailfile. Next, he took to his fingers with the brush, scrubbing their sides and between his fingers and the front and back of his hands for a full two minutes. He knew this because he watched the clock on the wall the way a professional swimmer times their laps. Then, keeping his hands higher than his elbows to prevent dirty soap backflow, Mr Ironfly scrubbed his left arm to within 3 inches of his elbow for a further one minute before repeating the procedure for his right arm. If for any reason he touched anything during the scrub - which he didn't - he added a further 1 minute to the scrubbing time. Finally, Mr Ironfly rinsed his hands in the warm running water, moving in one direction only, starting at fingertips and letting the water work its way down the arm to his elbow. Holding hands above elbows, Mr Ironfly then proceeded to back his way into the operating theatre through the swingdoor to where his sterile glove pack lay open waiting for him. Mr Ironfly calculated he had performed this discipline in excess of 20,000 times throughout his surgical career. The discipline wasn't one that could be ignored, corner-cut or expedited. It was protocol for a reason. The data showed it stopped infections. History showed it worked. And on the busiest of surgical list days, when the hour grew long and the desire to hurry up was overwhelming, Mr Ironfly scrubbed for the full five minutes for every procedure, every patient, every life.

43. Going for broke

Hospital CEO Karen Millstone finally decided she was never going to please all of the people, ever. So she went back to the reason she'd started the conversation about re-engineering the hospital's processes. It was to serve their clients - patients - much, much better. Karen didn't want to implement changes that drew polite applause - minor improvements that came out of committee machinations as shadows of their former bold-idea-spark selves. She didn't even want the tougher-to-achieve standing ovation initiatives - ones that screamed 'look at me' and get people excited for a little while (before eventually fading back into the grey). No, what Karen was after were those rarest of changes. The ones that drew gasps of breath and forced quiet self-reflection from all that saw them. That inspired and moved people so deeply that they don't even think to get out of their chair and cheer. That fractured staid thinking and caused irrevocable perspective shifts. That stung people to want to do better for having seen what can happen when someone goes so much further down the line than anyone else dares to. Karen wanted awe-striking supernova changes. On a cold June morning, Karen decided to go for broke, fully aware it might break her career. And she knew she'd need help. Karen picked up the phone to her PA. "Renee, could you get me Mr Ironfly's secretary please?"

44. Public declarations

At the exact moment Hospital CEO Karen Millstone was teeing up a time to recruit the help of one of her most respected surgeons, Healthmend Technology boss Brett Sleep was on the phone to Karen's PA arranging an appointment to let her in on the new Healthmend promises. "She's got a 30 minute vacancy on Thursday at 11am - would that suit?" asked Karen's competent young assistant. "That's great, thanks Renee. Would you let her know I'll have Caitlin Williams, who's our Key Account Manager, with me? Caitlin and Karen have met before." Appointment squared away, Brett sent the follow-up email directly to Karen. "Hi Karen, I hope you're well! A quick note to let you know I've spoken with Renee and booked a short time to see you on Thursday. The attached document gives you a quick overview of what I wanted to speak about. We're re-engineering some of our processes to make sure we're better able to help our clients (and in doing so, better help you help your clients). As one of our most valued partners, I'm keen for us to discuss what this might look like for you and your hospital. Have a think about what you'd like to see us get even better at, and Caitlin Williams and I will catch up with you to discuss further. Thanks Karen, see you Thursday! ...." Brett repeated this exercise with the boss cockies of the 8 biggest hospitals Healthmend dealt with (his Pareto's 20%), and to each email he attached the rules his team agreed they'd let themselves be held accountable for. Brett was determined these wouldn't be symbolic fluff words on a wall or lofty aims that get ignored at the first sign of gunshots. He believed sticking it out there and letting it go public was a powerful way to induce positive guilt that would keep them honest. "If we said we'd do it, and they know we said we'd do it, then guess what?...." Karen Millstone didn't know whether the timing was a divine sign or just dumb luck. Amazing what turns up when you decide you're going to be brave! She started planning for the meeting immediately.

45. The skin stretcher

Caitlin Williams, with big dreams and a Gen Y'ers belief in her skills, understood there was only one way she could achieve her goals. It was, as her father once put it, to stretch people's skin. To make them just a little uncomfortable. In a sales call, she worked to delicately plant provocation seeds in client minds, that their doing nothing would end in longer-term pain, that to go with a competitor might just result in tears, that parting with cash was the lesser of two discomforts. Inside her employers business, her position was to continually try taking their production and supply capabilities to and beyond their limits. To be the customer-representing agitator for change while supporting her colleagues through niggling but necessary process evolution. With her boss, Caitlin's role was to make him aware that their line of offerings was never complete enough, that their margins continually needed tweaking, that their service practices were fast redundant and more needed to happen. With suppliers she dealt with, Caitlin used the carrot stick, simultaneously reminding them that she was their advocate and it was in their best interest to look after her, all the while pushing, pushing, pushing to help them improve and serve her better. In this loveable irritant role, this professional grain of sand needed to make client clams produce sales pearls, Caitlin sat with Mr Ironfly in the tearoom of Karen Millstone's hospital tearooms and asked "For a full list of Lap Chole's, how many sets of disposable instruments would you ideally like on hand to prevent procedure delays?" I want more product on shelf. I want it in his theatres. I need to push Brett to get an in-situ inventory management system of some sort we can sell to these theatres. A trolley of some type. Caitlin agitated and sold.

46. In for a penny

His family team agreed, so David Longines took the leap. England back to Adelaide. Corporate highflying to a 2-man band with no charted course. Risk, family and a scarily exciting future. Sitting in the industrial workshop with his about-to-be business partner Leo, David used his pre-call planning skills to make sure the finer details didn't work against him. "Leo, I know you're confident one of the big guys will buy this out. If that happens, we've got to have a tight agreement to ensure that anyone who's already bought the product & support package to doesn't get tossed out like the bathwater. You need to cover yourself from this risk. What I'd need to do is "go with the product". Here's something I've drafted - have a look and tell me what you think." While Leo wanted a partner to sell his baby, David knew he wouldn't give up equity too early, so he contented himself by proposing a generous commission structure. One that protected him by starting with earnings on revenue rather than profit (who knew how much they'd have to go in at to get a critical mass of early adopters?), but ramped up exponentially when profit started climbing. Leo's coverage was that he only paid David when product moved, and his seller had a strong and tiered incentive to 'shift boxes'. It was also David's idea to not just sell the trolley, but also develop and sell a support package to go with it. He'd done the homework on outsourcing this to suitable 3rd parties, and based on the numbers Leo had shown him for parts and labour, David had drafted up a theoretically profitable service program concept that would tick a client's peace-of-mind box. "Ah, man, I know, you need to protect your backside, hey? That's fine, I'm not one for fancy agreements, but if you think we need it, let me let my lawyer look at it - looks OK though. This service package idea is sensible - how are we going to train someone to do it, hey? I'm going to be flat stick building the trollies - got to train my lackies to get that bit done, hey?" A small production line was being developed in Leo's warehouse with some contract techo's and welders ready to join. David smiled. There was so much they hadn't got in order. So many things that could go wrong. But his gut told him this was worth going in for a penny, in for a pound with. "Leo, this is going to be fun. We've got a lot to do though."

47. Job, Career, Calling, Life

Mr Lang Ironfly's father believed in working hard at school so you could get yourself a good job. Something stable and honourable; pay the bills and keep your family and avoid the hellish fate of the idle-handed. Lang knew a few people that had jobs. Good people working hard to earn a means to ends. A greater number of his contacts were careerists - folk committed to building tenure and experience and titles and results and wealth (in whatever form that took). As a young man, Lang considered that medicine might be a career worthy of pursuit, and so did what it took to become a doctor. What he found was a calling. It didn't come as some blinding-flash epiphany. It grew and evolved in his subconscious while his mind was busy with medical school studies. It became apparent when, under the pressure of examination after examination, Lang was repeatedly forced to confront what might happen should he not pass. The idea grew to be horrifying; that he might not progress down the pathway of helping people with the curative wisdom he'd been frantically borrowing from predecessors. It occurred to him that he was seeing in 2am night after night, burning oil and mental energy to devour the cleverness, and though he registered he was tired, he was also exhilarated. It dawned and dawned that he was being given an opportunity by the universe to contribute in a bigger way than most could. Many moons on, sitting in the corner of the operating theatre once more dictating case notes and following a well-trodden i-dotting procedure that saved more lives than ever fully appreciated, Lang paused a moment to think about what he actually had in the strange vehicle that is medicine. A life. To be satisfied with less than a life doing what lets me make my biggest dent, thought the surgeon. I can't imagine it. I can't imagine why anyone would. For the umpteen hundredth time, Mr Ironfly closed his case notes and went to set someone's worried beloved's mind at ease.

48. Borrowing wise

Karen Millstone loved the experience of checking into the best 5-star hotels. The speed, the attention to detail, the warmth and interest the best concierges and bell captains paid you - a complete stranger - and whose top priority was making you feel special, at home (with room service). A home renovator, she loved the way a great construction supervisor coordinated his tradies with a clear plan and time-homed schedule with inbuilt flexibility. The constant and proactive communication about what's coming next; a leader who could have a carpenter, plumber, brickie, roofer and electrician all climbing over one another in controlled chaos when the rain was coming and the roof just had to go on. The big picture vision with a details checklist. Karen loved the sensation of walking into her local butcher's, a noisy hive where the staff (an extended unrelated family) bantered and barked and chirped, and she always got welcomed by name and everyone knew their fish and recommendations were always preceded by insightful questions about her wants and needs. Karen loved the way her hairdresser focused on the experience of the haircut as much as the end result. The newest magazines, the nice coffee, the TV in the mirror, the listening ear and confidant she, a high powered exec, happily borrowed from someone in charge of her highlights. And Karen loved the absolute feeling of confidence she enjoyed whenever she saw her accountant, whose memory of her financial guidance & support needs was matched by his to-the-minute understanding of relevant traps, tips and tax min strat's. As Karen went about pulling her revolution posse together, she jotted down the feelings, the experiences, the smartness from diverse sources that she wanted to find ways to build into a new way of being for her hospital. Innovation isn't reinventing the wheel, she thought. It's borrowing and translating wise.

49. Hug the trailblazing client

Do it. Improve it. Own it. The three pillar terms that Brett Sleep's team had coined for how they'd all tackle their roles at Healthmend Technology. And now, here, right before his very eyes, was a customer that not only got it, but was trying to take innovative evolution even further inside their own business. In a hospital. Even by Brett's standards, the type of changes Hospital CEO Karen Millstone was imagining were out there. I mean, there were laws, rules, protocol! Proven processes (albeit cumbersome, seemingly inefficient ones) - they existed for a reason! Was this just a rogue CEO throwing it all at the wall before the Board pulled her in and kicked her out? Did she really think she could tear down institutional barriers that thousands, millions before her had built up? Or was this someone who just had an intense genuine desire to improve on a system that had in so many ways grown in on itself, like a mandarin tree left untended. Brett wasn't yet sure. What he did know was that the enthusiasm was infectious. In the face of such rawly described change windows, Brett shamefully realised he'd merely come in to share a little puffery. Self-indulgent "here's how clever we are" news to a client he wanted more business from. What the CEO had done, no holds barred, was trumped him for trailblazing thinking and shown him what change leaders really had to embody. Brett wanted in. He could hear Caitlin's mental cogs whizzing beside him. If a watered-down tenth of what this client is describing is able to be done, it'll be remarkable, he thought. If we're there supporting her and her team, not only are we Johnny-on-the-spot for business... we're also part of something remarkable. That's the bigger one. That's the lasting one. "Karen, I don't know where this will begin, or indeed where it will go, but we want to play a part. I'm in deep admiration of your vision - we want to help you realise it."

50. All sizzle no sausage

Healthmend Technology Power Rep Caitlin left the meeting in Karen's C-suite office. After pausing outside the doorway and booking a debrief conversation with her boss Brett in an hour's time, Caitlin took the elevator down 3 levels to the operating theatre changerooms where she'd swap her Country Road pant suit for blue theatre PJ's. Two other reps were in the changeroom - Caitlin knew one as a complementary non-competitor. "Oh, hi Caitlin!" said Sharon, a 50-something careerist with trolly dolly hair and a popular line of surgical drapes Blind Freddy could have sold. "Caitlin, this is Monica, she's from our marketing team in Sydney. Monica, Caitlin works for Healthmend - they have that line of instruments I was telling you about? Caitlin's great - she and I have swapped numerous leads." Well, no, that's not quite right, thought Caitlin. I've brought you in on numerous sales conversations where I thought you could help my client, but despite eternal promises of returning the opportunity, I've seen bubkis. All sizzle, no sausage. Caitlin smiled and Sharon continued. "So Caitlin, who are you seeing today?" "I'm in with Mr Ironfly's team for an inservice, he's just taken up a new instrument and we're making sure everyone's good with it." Sharon turned to Monica and continued like Caitlin wasn't there. "Oh, Caitlin's great with training and support. She and I have often talked about doing something together, you know, like an expo-style inservice where we'd even bring in other reps from other companies. I mean, it's all in the interest of the hospital." Caitlin had once suggested her idea to Sharon - it was something Caitlin had driven with other reps in other accounts and the clients loved it. But it had gone nowhere at this hospital because Sharon seemed incapable of organising a bonfire in a lumberyard. Sharon was unaware that Caitlin had gone ahead and begun to arrange such an event with other reps who were both interested and capable. "I'm glad I bumped into you Sharon. I was out at Westbridge yesterday and Ken said they're putting an inservice program together especially for their agency staff. He's after reps to lend a hand - if you're keen, you might call him." She might be floaty, but she's part of the supply fabric supporting my clients, thought Caitlin. And besides, as Ikey Solomon said, "always leave a little salt on the bread". Particularly because this one's got no sausage on hers.

To be continued
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