Bred To Lead

CERTIFIED DOES NOT MEAN VERIFIED TO DO THE JOB

Recorded live in front of a room of perioperative leaders, Dr. Jake Tayler Jacobs and Dr. Edna Gilliam make the case that the next professional revolution in surgery is happening outside the OR, in sterile processing. Dr. Edna, a periop leader who learned SPD for herself, explains why she took the assessment before asking her own leaders to.

IN THIS EPISODE
• How surgery came into the hospital, and why OR nurses organized in 1949 while sterile processing went 45 years without a career path
• What surfaced when 125 SPD leaders across 189 facilities were assessed: certifications alone were not enough
• Operational blindness: why so many periop leaders see SPD as a black box, and why temporary fixes don't change permanent damage
• Process, people, performance: a development track that turns technicians into verified operators

KEY TAKEAWAY
"If you don't give people something to progress to, they begin to cannibalize where they are."

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YOU ARE A 10,000 POUND ELEPHANT CHAINED TO A SMALL STAKE

A baby elephant tied to a wooden stake stops pulling. Years later, fully grown, it still doesn't try. Dr. Jake Tayler Jacobs names the four beliefs keeping healthcare organizations chained the same way, where they came from, and how to break each one.

IN THIS EPISODE
• Why "SPD will always be reactive" confuses responding to demand with always being behind it
• The math on "cost center": a $50 million OR losing 3% to SPD drag leaks $1.5 million
• Why the OR's dissatisfaction is a signal, not a character flaw
• How "we're doing the best we can" sets a false ceiling, and why you propose a business case instead of a budget ask

YOUR CHALLENGE
Ask your OR: what would excellent SPD support look like to you, and what would have to be true for you to trust us completely? Then really listen.

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THE BELIEFS YOU DON'T KNOW YOU HAVE ARE CONTROLLING YOU

How do you know the sky is blue? You just know. Dr. Jake Tayler Jacobs argues that some of what leaders "just know" about their organizations isn't fact at all. It's assumption, and it feels just as certain.

IN THIS EPISODE
• Why activity metrics like turnaround time and volume can look fine while the OR goes without what it needs
• Five belief markers to listen for, including "that's just how it is" and "it's always been this way"
• How an invisible belief becomes a self-fulfilling prophecy, and why lean can make a workaround more efficient instead of removing it
• Four techniques to surface hidden beliefs, from outside perspective to looking at what you're not measuring

KEY TAKEAWAY
The discomfort of questioning is nothing compared to the cost of not questioning. Courage to question is the price of transformation.

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YOU CAN'T OPTIMIZE DOWNSTREAM WHILE THE CONSTRAINT SITS UPSTREAM

Every week the same meeting happens: the CFO sees rising costs, the COO hears surgeon complaints, the CNO watches quality metrics stall, and SPD says the numbers look fine. Dr. Jake Tayler Jacobs explains why everyone is right, and gives the condition a name.

IN THIS EPISODE
• Why OR improvement efforts stall at a ceiling when SPD, the upstream constraint, goes unaddressed
• The definition of operational blindness: leaders can't see dysfunction because measurement and feedback systems don't surface it
• The NASCAR picture: the surgeon is the driver, the OR is the pit crew, SPD is the garage
• What operational blindness looks like from the CFO, COO, CNO, SPD director and C suite seats

KEY TAKEAWAY
Fix the people and send them back to the same system, you get the same problem. Fix the system, you fix the problem.

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THE SAME PEOPLE LOOKED EXCELLENT ONCE THE SYSTEM CHANGED

In 1993 IBM posted an $8 billion loss and analysts said to break it up. Lou Gerstner kept most of the same managers and changed the beliefs and systems around them instead. Dr. Jake Tayler Jacobs opens the Operational Blindness read and teach series with that story and what it means for healthcare.

IN THIS EPISODE
• Dr. Jake reads "The Elephant Everyone Forgot" from Operational Blindness, word for word, then breaks it down
• The three invisible beliefs that nearly killed IBM, including "the culture can't change"
• Healthcare's own invisible beliefs: SPD will always be reactive, it's just a cost center, the OR will never be satisfied
• What executives, SPD leaders and surgical services should each take from Gerstner's turnaround

YOUR CHALLENGE
Before you replace another director, ask: do they have visibility into their real impact, the resources to succeed, and a measurement system that shows what matters?

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TRADITION WITHOUT EVOLUTION IS SLOW DEATH WITH BETTER BRANDING

When Dr. Jake Tayler Jacobs walked into a 30 year old organization and suggested change, leadership told him "that's not how we do things here." His answer: then how is that working for you, and why am I here? The room went silent.

IN THIS EPISODE
• The four stages of a slowly eroding industry, starting with losing young talent and ending in irrelevance
• Why stagnant and stable look alike but are not, and why stagnant things rot
• Five principles of innovative leadership, including building a coalition of the willing before you ask for the yes
• Why gumption without systems is chaos, and why you lead with evidence, not just vision

YOUR CHALLENGE
Identify one tradition in your organization that everyone accepts but nobody questions, and ask why. If you can't get a good answer, start redesigning it.

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ONLY BROKEN SYSTEMS SHAKE AT 80 PERCENT CAPACITY

Two hospitals in the same city, same patient acuity. One falls apart at 75% capacity, the other runs smooth at 95%. Dr. Jake Tayler Jacobs explains the difference: one was built to survive, the other was built to scale.

IN THIS EPISODE
• Six signs of survival infrastructure, including daily heroes and knowledge that walks out the door every night
• Why "slow is smooth, smooth is fast" and the five step playbook for rebuilding while you keep running
• Piloting in parallel: running a new SPD workflow on first shift until second shift begged to switch
• A case study: 47 unnecessary steps removed, 20% more volume with fewer staff, SPD turnover from 67% to 8%

YOUR CHALLENGE
Start this week. Pull six weeks of data and find the capacity where overtime, errors and complaints spike. That is your shaking point.

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WE HIRE FOR CREDENTIALS AND HOPE FOR CAPABILITY

The best nurse becomes charge nurse, the best tech becomes director, and nobody asks if they can actually lead. Dr. Jake Tayler Jacobs calls it the clinical excellence trap and explains why healthcare's leadership famine is a design problem, not a talent problem.

IN THIS EPISODE
• Why the skills that get you promoted (reliable, liked, busy) are not the skills that make you effective
• The five capabilities leaders need: systems thinking, emotional intelligence, change management, development mindset, strategic foresight
• His "three layers down" model for building bench strength, and Xerox's measure of what top people did after leaving
• Five fixes, from parallel clinical and leadership tracks to making succession planning a performance metric

YOUR CHALLENGE
Look at your last five promotions. Did you assess for leadership capacity, or just reward past performance?

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WE FUND CHAOS, STARVE PREVENTION, AND CALL IT DISCIPLINE

A periop director brought her executive team a $300,000 two year plan to fix workflows, training, and staffing. They said no budget. Six months later, eight people quit in three weeks and the hospital spent over a million dollars on agency staff, overtime, and recruiting. Dr. Jake Tayler Jacobs calls it the trauma budget, and the prevention tax every organization pays for it.

IN THIS EPISODE
• Why budgets that were too tight for raises suddenly open up when things are on fire
• The hardware and software check: financial systems built for widgets, leaders trained in crisis mode
• Everything has an ROI: retention, efficiency, innovation, reputation, and outcomes
• Five ways to build a prevention focused budget, starting with "can we afford not to?"

YOUR CHALLENGE
Pull your last three years of financials, total your crisis spending, and ask what 10% of it could have prevented.

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YOU CAN'T BUILD PERMANENT CHANGE ON TEMPORARY HELP

Season three opens with a hard look at the traveler dependency crisis. Dr. Jake Tayler Jacobs shares the story of Sarah, an eight year critical care nurse who quit after watching her hospital pay travelers $100 an hour while she made $38: "They can find money for strangers, but not for people who stayed."

IN THIS EPISODE
• Leadership is the software, systems are the hardware, and hospitals keep crashing when neither gets upgraded
• The hidden costs of renting stability: knowledge drain, culture erosion, and broken patient continuity
• Four design principles: build your own pipeline, compensation transparency, scheduling as strategy, and leadership that listens
• Why leaders who only plan for one term rarely leave lasting change, and why SIPS built Sterile By Design

YOUR CHALLENGE
Ask yourself: am I managing crises or preventing them? Am I renting stability or building it?

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INDECISION IS A DECISION, USUALLY THE WORST ONE

At Johns Hopkins All Children's Hospital, the pediatric heart surgery program saw mortality rates three times the national average while frontline staff raised alarms and leadership delayed. Dr. Jake Tayler Jacobs unpacks what he calls prestige paralysis, the trap where protecting a reputation matters more than solving the problem, and the nearly $43 million in settlements that followed.

IN THIS EPISODE
• The four causes of decision paralysis: the reputation shield, the data paradox, the expertise trap, and the hierarchical filter
• The Love Tour at SIPS and what frontline workers said that administration never reported
• The 70% rule, the reversibility test, and setting decision triggers before a crisis
• Four kinds of decision debt: operational, cultural, strategic, and trust

KEY TAKEAWAY
Stop asking whether you should act. Ask what it will cost you not to act, because problems do not age well.

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YOUR FIRST 90 DAYS DECIDE YOUR WHOLE TENURE

In March 2014, North Adams Regional Hospital in Massachusetts closed with three days' notice, leaving 37,000 residents without their local hospital. Dr. Jake Tayler Jacobs walks through how new leadership misjudged its reality, cut costs before diagnosing the problem, and lost the trust of staff and community in the critical first 90 days.

IN THIS EPISODE
• Three levels of reality assessment: paper reality, perceived reality, and ground reality
• The trust triangle: transparency, engagement with team, peers and upline, and early wins that matter to them
• The impact matrix and balanced urgency: fast enough for momentum, slow enough to bring people with you
• Why cutting costs does not always mean cutting people, and how to find the real power centers

YOUR CHALLENGE
Make five commitments for any season of change: truth, people, future, learning, and legacy.

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STEWARD HAD PLENTY OF PLANS. WHAT IT LACKED WAS FUTURE FOCUS

In May 2024, Steward Health Care, one of the largest private hospital systems in the country, filed for bankruptcy. Dr. Jake Tayler Jacobs breaks down how a model built on turning around struggling hospitals failed at the very operational excellence it promised, and what every leader can learn from the difference between planning for the future and leading from it.

IN THIS EPISODE
• Three failures: confusing expansion with evolution, financial engineering over operations, and no sustainable organization
• The now game, the next game, and the after next game, and why you must play them together
• Four pillars of future focused leadership and a five point future ready assessment
• The phantom tax: why leaders you develop stay loyal and leaders you buy keep moving

KEY TAKEAWAY
Culture eats strategy, and leadership is about legacy, not a paycheck. Ask what condition your organization will be in when you leave it.

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YOU CAN ONLY HAVE WHAT YOU ARE

Dr. Jake Tayler Jacobs comes back from his first real vacation in eight years with a lesson from his mentor: you cannot become a millionaire until you are worth a million. Success happens before the moment of opportunity arrives, and life gives you what you have prepared and trained for, not what you wish for.

IN THIS EPISODE
• A leader who rehearsed crisis scenarios for years and found the real crisis easier than the ones she imagined
• His three part framework: mental simulation, physical practice, and integration
• Why generic affirmations fail and visualization has to be specific enough to feel real
• Leadership labs and readiness rhythms: recorded practice, real pressure, and specific feedback built into the week

KEY TAKEAWAY
Hope is not a strategy. Build your career and your company on the worst happening, and practice for it, so the best is icing on the cake.

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POSITIONAL POWER GETS COMPLIANCE. INFLUENCE GETS COMMITMENT.

A senior executive with every title and all the formal authority couldn't get his initiatives off the ground. A mid-level manager with no authority over most of the people she worked with kept getting things done across departments. Dr. Jake Tayler Jacobs explains the difference, and why the bigger your scope, the more you need influence instead of your title.

IN THIS EPISODE
• The four elements of real influence: credibility, connection, contribution, and consistency
• Why "I do my job" is not contributing to your organization
• Value-first leadership: the leader who spent her first weeks learning what each department head needed
• The three C's of scaled influence, and why he hands his own ideas to others so they get the credit

KEY TAKEAWAY
Your title might give you authority, but your impact comes from influence. Start building it now, whatever level you are at.

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AN OPEN DOOR NOBODY WALKS THROUGH IS NOT AN OPEN DOOR

One leadership team prided itself on its open door policy, yet almost no one walked through it, because frontline ideas kept getting dismissed. Another had every report and metric and was still blindsided by problems any employee could have named. Dr. Jake Tayler Jacobs breaks down how leaders drift away from the front line one logical decision at a time, and what it costs.

IN THIS EPISODE
• The elevation effect and the filter effect, and how bad news gets sanitized on the way up
• His four-part framework for staying connected: presence, process, people, and proof
• The leader who blocked two hours a week to work, not observe, alongside frontline teams
• Why good habits have to be modeled, not told, and what teaching his kids taught him about it

YOUR CHALLENGE
Will you be a bridge builder who stays connected, or a manager who drifts away? Put frontline time on your calendar as a meeting you cannot miss.

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IF YOUR PEOPLE DON'T BELIEVE IN CHANGE, NO PROCESS WILL STICK

Watching Coach Prime rebuild Colorado football, Dr. Jake Tayler Jacobs saw what he has taught leaders for years: real transformation starts with belief and culture, not metrics and process maps. He walks through why "we've tried that before" is a symptom, not an excuse, and why new systems fail when the culture underneath them never changed.

IN THIS EPISODE
• The three phases of transformation: cultural reset, technical evolution, and sustainable excellence
• Why resistance during technical change usually means your cultural reset isn't finished
• How one organization that had failed three system rollouts rebuilt belief through small, visible wins
• Why your company should run like an internal university where learning never ends

YOUR CHALLENGE
Before you touch a process or a metric, find out what your people truly believe is possible or impossible in your organization.

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MANAGERS PUT OUT FIRES. EXECUTIVES MAKE SURE THEY STAY OUT.

Three months after a promotion to executive, Sarah was working longer hours than ever and things were still slipping. In the first live episode of Bred To Lead, Dr. Jake Tayler Jacobs explains why: she was still managing what she should have been overseeing. Managers own the how and the what. Executives own the why, the when, and the where.

IN THIS EPISODE
• Why "I can do their job" is how managers burn the bridge to their executives
• The operations leader whose firefighting strength became his weakness, and the questions that fixed it
• What King David learned as a shepherd, a harp player, and a warrior before he ever became king
• "We make 10 million a year, why can't I get $1,000?" and the business fundamentals behind the answer

YOUR CHALLENGE
Name one shift you can make this week to start thinking like an executive: stop solving the fire and ask what system would prevent it.

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THE HIGHEST PAID POSITION IN THE WORLD IS NOT A TITLE

Closing a conference in Delaware, Dr. Jake Tayler Jacobs told the room that too many people want leadership roles before they have mastered where they are. Using the story of King David, who was the best at every role he held long before he became king, he lays out why playing the promotion game instead of the mastery game gets leaders exposed.

IN THIS EPISODE
• The four phases to master in order: skills, people, the business, then scale
• Why he would have a new director of periop spend three months in SPD before taking the role
• How one department head got full funding once he stopped pitching passion and started speaking ROI
• Self-check questions to tell which phase you are actually in

YOUR CHALLENGE
Be honest about which phase you are in right now, then pick one area to strengthen this week before you ask for the next promotion.

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YOUR BEST EXPERT MAY BE YOUR WORST CHOICE TO LEAD

Picture a hospital that promotes its top surgeon to run perioperative services and its most experienced technician to run sterile processing. Six months later, OR efficiency is down, costs are up, and both new leaders are drowning. Dr. Jake Tayler Jacobs calls this the leadership paradox, and explains why deep expertise and transformational leadership are rarely found in the same person.

IN THIS EPISODE
• Subject matter thought leaders own the what and how. Transformational leaders own the why and who
• Why he estimates only about 1 in 10 professionals truly have both skill sets
• A case study where pairing experts with operational leaders cut OR turnover 20% and instrument delays 50%
• His answers to "we can't afford it" and "outsiders won't understand our challenges"

YOUR CHALLENGE
Take a hard look at your leadership team. Are you building both technical expertise and transformational leadership, and giving them room to work together?

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TEMP STAFFING SHOULD BE A TOOL, NOT YOUR WHOLE STRATEGY

Picture flu season: the ER is overflowing, periop is surging, and two of your most experienced sterile processing techs just retired. Dr. Jake Tayler Jacobs explains why calling in temps feels like a lifesaver in that moment, and why a pressure bandage left on without real treatment never fixes the wound.

IN THIS EPISODE
• The pros and cons of temp staffing in the ER, periop and central sterile processing
• Why a new hire needs about three months to get comfortable and 24 months to master a system
• Four scenarios for choosing temp staffing, integrated management, or a hybrid of both
• How a community hospital cut sterile processing errors 40% in six months using just two experienced temp techs

YOUR CHALLENGE
Look hard at your staffing and ask: are we just filling gaps, or are we building for the future?

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BECOME WHO YOU HAVE BEEN PRETENDING TO BE, OR GET EXPOSED

Dr. Jake Tayler Jacobs was called in to turn around a tech startup whose CEO had an Ivy League résumé and glowing references, much of it inflated or made up. With the company months from collapse, a humble mid-level manager took the seat, and two years later the company was thriving.

IN THIS EPISODE
• Five reasons faking it fails, starting with this: leadership is influence, and influence is built on trust
• Seven steps to becoming the real thing, from an honest self-assessment to a focus on value creation
• The $4 million business mistake that taught Dr. Jake failure is not bad when your eyes are open
• His college shooting slump, and why four 5% wins add up to a 20% gain

YOUR CHALLENGE
Take off the mask. Stop running from opportunity to opportunity, face the truth, and do the work.

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EVERYONE CAN NAME THE PROBLEM. FEW FIX IT FOR GOOD.

Dr. Jake Tayler Jacobs pulls back the curtain on life as a corporate fixer, including why SIPS brought in someone from outside healthcare to see things differently. He shares a company that had gone through three CEOs in two years and was six months from bankruptcy, and how a town hall with frontline staff started a comeback that had it profitable 18 months later.

IN THIS EPISODE
• Six signs a turnaround is needed, from falling revenue and lost market share to a strategy that drifts
• His five steps: diagnose, stop the bleeding, build the strategy, implement and monitor, build for the future
• Why huddles are for adjustments, not celebrations, and why accountability only happens through transparency
• Why fixing SPD without fixing the OR is only half a turnaround

KEY TAKEAWAY
Be honest about the reality, make tough decisions quickly but not recklessly, and bring your people into the turnaround.

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YOUR PREPARATION BEFORE THE PROMOTION DECIDES WHETHER YOU SHINE OR BURN

Dr. Jake Tayler Jacobs tells the story of Alex and Jamie, who start in hospital administration together. Alex jumps at every promotion, reaches senior management first, then struggles with imposter syndrome. Jamie spends three to five years mastering each role and walks into the executive seat ready on day one.

IN THIS EPISODE
• The four levels of skill development: confidence, efficiency, proficiency and mastery
• Five reasons patience pays: skills, relationships, organizational understanding, credibility and less burnout
• What King David's road from shepherd to king teaches about being number one at every role
• Why you should already be able to do 70% of the next job before you take it

YOUR CHALLENGE
Before you chase the next title, ask yourself honestly: am I the best at the job I have right now?

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CAPABLE BEATS WILLING WHEN YOU PICK YOUR NEXT LEADER

Dr. Jake Tayler Jacobs introduces Next Up Leadership: building leaders from within before the seat is empty, not after. Drawing on Jethro's advice to Moses, he gives three tests for who deserves your investment: are they capable, are they accountable, and are they in it to be the best or just for the check?

IN THIS EPISODE
• The five principles of Next Up Leadership, from early identification to alignment with organizational goals
• Battlefield promotions versus prepared successors, and the four risks of promoting out of necessity
• Why everyone starts at foundational, then strategic, then executive, no matter how long they have led
• Why accountability means never repeating the same offense to the same person twice

YOUR CHALLENGE
Ask yourself who is next up behind you, and how well you are developing them to succeed you in the seat you hold today.

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TEMP STAFF STOP THE BLEEDING. THEY DO NOT HEAL THE WOUND.

Dr. Jake Tayler Jacobs runs a staffing and workforce company, and he still calls temporary staffing what it is: a band-aid. He compares it to a temporary parent who leaves when the 13, 26 or 52 week contract ends, and lays out the cycle that sends the same hospitals back to agencies every six to eighteen months.

IN THIS EPISODE
• Why travel nurses can cost $5,000 to $10,000 a week against $1,500 to $2,000 for a staff nurse
• The real cost of turnover: $40,000 to $64,000 per hospital employee, and over $100,000 for specialty roles
• The Leadership Improvement Plan (LIP) and why every person needs their own development pathway
• The research on soft skill, empathy and leadership training across pharmacy, PT, radiology and nursing

KEY TAKEAWAY
If what worked actually worked, we would still be working it. Invest in the people already inside your walls before you pay a premium for people who will leave.

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CONTENT WITHOUT CONTEXT GIVES PEOPLE NO REASON TO CARE

Dr. Jake Tayler Jacobs learned this from his mentor Tony Stevens Sr., who kept answering his questions with stories. Tell someone to sprint home from the office and they won't. Tell them their house is on fire with their family inside, and they are already running. In part three of the influence series, he shows why leaders who just "get straight to the point" end up with no connection.

IN THIS EPISODE
• Six reasons stories work, from making ideas memorable to building shared meaning across a team
• Reaching a sterile processing tech named John: would you trust this tray with your grandmother's surgery?
• A simple three-act structure: set up the challenge, walk through the struggle, share the resolution
• Why Jesus taught in parables (Matthew 13), and why "just talk to me straight" is the exception, not the rule

KEY TAKEAWAY
Start collecting stories from your own work and your organization. When people finally get it, they remember who gave it to them.

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IF YOU DON'T GRIP YOUR EMOTIONS, THEY WILL GRIP YOUR LIFE

On a new golf course, Dr. Jake Tayler Jacobs sliced a ball into a homeowner's yard, went in to grab it, and had the owner sprinting out of the house cussing him out. Instead of assuming the worst, he centered himself, validated the man's frustration, and they parted with a handshake. Part two of the influence series breaks down emotional intelligence and ten ways to use it ethically.

IN THIS EPISODE
• The five parts of EQ: self-awareness, self-regulation, empathy, social skills, and motivation
• Active listening with all your senses, and what picking up your phone mid-meeting tells your team
• Emotional mirroring at home: popcorn on the floor so his daughter feels seen
• Why "I can't control my face" signals low emotional intelligence, and building a richer emotional vocabulary

KEY TAKEAWAY
You are not striving for perfection. Be proud of how fast you catch yourself and fix it.

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TO CREATE REAL URGENCY, YOU HAVE TO BE WILLING TO WALK AWAY

Season two opens with Bred To Lead reaching number 48 on the US business and leadership charts, and Dr. Jake Tayler Jacobs starting a three-part series on influence and persuasion. His argument: influence is not manipulation when it starts from ethics and mutual benefit, and it is a skill every leader can learn.

IN THIS EPISODE
• Cialdini's seven principles of influence, from reciprocity and social proof to scarcity and unity
• Why he calls himself multilingual: shifting from his Texas twang to boardroom diction to meet people where they are
• Give a taste first: why people lose promotions waiting to get paid before they show their ability
• Handling objections by making people feel heard, felt, understood, and seen

KEY TAKEAWAY
All great things start with small commitments. Break big ideas into bite-size promises you can keep consistently, and people will trust you with the bigger ones.

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THE $4.5 MILLION LOSS THAT TAUGHT HIM FAILURE IS FEEDBACK

Before joining SIPS, Dr. Jake Tayler Jacobs watched the firm he founded lose $4.5 million in 45 days after a bad partnership and red flags he overlooked. He paid $30,000 for one hour with a mentor who runs a half billion dollar hedge fund, and walked away with perspective: try losing 40 million, then complain about your 4.

IN THIS EPISODE
• The five areas of resilient leadership: growth mindset, self-awareness, connection, purpose, and adaptability
• Consider the source: why his father built him on his failures, not his wins
• The root of "emotion" means to stir up, and why the leader who regulates it controls the room
• His rule "When facts change, so do I," and why you build your organization planning for the bad

KEY TAKEAWAY
Resilience is not a trait you either have or lack. It is a practice, and like a muscle, it only grows when you stretch it.

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Bred To Lead is powered by SIPS Healthcare Solutions.
BredToLead.com
SterileByDesign.com
SIPSHealthcare.com