Student Corner

Gaming the Balance of Priority and Risk in the C-Suite

Exposing a truth that is obvious to you but elusive to the organization with which you are working can be simultaneously simple and monumental. In my healthcare coaching practice, I have the opportunity to work with teams of senior executives that often include the CEO, the CFO, the Chief Nursing Executive, and others in the C-suite of hospital leadership. It is clear that the brief time spent with me may be the only time they have for a collective pause and some unscripted group reflection. I recently worked with a brilliant team that despite having a great dynamic, they could not get on the same page when asked to create a plan for a major transition effort that was only a few months away.

Realizing that there were significant underlying issues of confidence and differences in risk tolerance among the group of four, I had to think quickly about how best to expose these sensitivities in a way that would be fair to everyone and would actually expose the truth versus provide another opportunity for the group to come to consensus on the easy items and further delay any movement on the difficult ones. On the fly, I decided to make a game of it by creating 12 cards (simply marker on post-it notes), each with one word or simple phrase – profitability, patient satisfaction, employee engagement, physician loyalty, operational innovation, technology integration, nursing competence, management skill, clinical excellence, move day, patient safety, and health information/EMR. Working with the team of four leaders, I paired them up and gave each couple a set of cards. I then instructed them to do two things:

  1. Order the cards from most important (1st) to least important (12th) for the success of the new hospital and then record the position of each card in rank 1 through 12
  2. Order the cards from least confident (first) to most confident (12th) in terms of preparedness for the upcoming transition and hospital opening and then record the position of each card in rank 1 through 12.

The benefit of the exercise was two-fold. The discussion and arguments related to the ranking did exactly what I had hoped – it clearly exposed how differently the members of the team saw the challenges and opportunities ahead and did so in a way that was nonthreatening and productive. The other benefit was that the results were eye opening and critically important – there were inconsistencies in the top five priorities and more problematic, many of the top priorities also showed up on the list of those in which there was the least amount of confidence.

As a coach, I focused on my role as a facilitator and used strategic inquiry to frame questions that would provide the mirror that reflected the important “aha moments” back to the group. I asked them to discuss what changes were needed to raise the confidence of the group in certain areas. I asked them to tell one another what it would take for the cards to move from less confidence to more confidence in the key areas over which they had responsibility.

Overall, I think this is a simple tool that any coach could use with a team that seems to be out of balance but unable to articulate the source of the disconnection. For this particular client, we circled back two months later and repeated the exercise, looking specifically for an inverse relationship between the highest priorities and the greatest areas of risk and vulnerability. The cards made the “hard conversation” into a group-oriented game, which for this client, was much more productive than a fact-finding and finger pointing mission to figure out the source of the discontent.


Juliet Rogers, Cohort 8A, currently serves as President and CEO of Blue Cottage Consulting, a full-service healthcare consulting firm dedicated to transforming healthcare one project at a time. She works with hospitals and academic medical centers across North America to strategize, innovate and provide the highest quality patient care possible. A significant part of her job is coaching executives, clinical providers, students and employees.