I help organizations get unstuck so they can move forward. Typically, they want to move quickly to creating goals, which is often everyone’s “wish list” of things they want to see done or accomplished. The goal setting is frequently unfocused and there are too many. What about in your organization, when the goals have been achieved, is the organization really any different? I expect the answer is “no”, which makes everyone resist another goal setting exercise.

It doesn’t mean setting goals is wrong, we need them. The missing piece is identifying the most critical problem or issue facing your organization that must be solved. Your focus must be on dealing with it, you can’t avoid it. How do we do that?

Your leadership team should begin by creating a list of problems or issues facing the organization today, which is easy. Then look at the list and put a mark by any problem you believe is holding back the organization from its long-term vision? Resist making finances your answer. Why? Because finances are a lagging indicator of organizational performance. To fix finances you must solve something else first.

From your list of problems or issues holding back the organization, you need to find the one which is the most critical. Let’s assume your list is 10. Discuss each one of them, then vote on which 5 to eliminate. Discuss those 5 more in depth then vote on 2 to eliminate. Discuss the final 3 in greater depth and then vote on 2 to eliminate, leaving your most critical problem.

In your discussions about each problem, make certain it can be solved by your organization. As an example, if you need a legislative change to solve the problem then you can’t do it on your own, so discard it. Make certain you talk about what else gets easier once you fix the problem. The most critical problem, if solved, makes many things easier.

Let me give you an example to clarify this concept.

Nursing School Capacity

I once worked on a project with area nursing schools and hospitals, the success of which was later chronicled in the Journal of Nursing Education.

The area hospitals needed more nurses to fill vacancies of nurses leaving hospital nursing to other healthcare settings or leaving healthcare. The nursing schools did not graduate enough students to meet the area hospitals needs, so the hospitals asked the nursing schools to increase their enrollments. The nursing schools understood the problem but they were at their maximum capacity and couldn’t do more.

We needed to determine what was the critical problem holding back hospitals and schools. The critical problem we identified was there were not enough clinical instructors. In nursing school, the students spend time practicing their skills, primarily in a hospital setting, under the guidance of a clinical instructor. If we couldn’t solve this problem of getting more instructors, a secondary problem of not enough hospital units to train wasn’t worth spending time on.

We determined a source of part time clinical instructors was currently working at the hospitals. Hospitals had experienced nurses who often trained and mentored newer nurses. To use them, a hospital would need to release these experienced nurses from their duties on a part time basis to become a clinical instructor. This meant in the short run, they would have less staff available to work. Because most of the potential instructors wanted to work at their hospital on their unit, the hospitals agreed to also make more training space available on their units.

The nursing schools were appreciative of getting more instructors, but wary of having experienced clinicians with no teaching background teach their students. The solution was the creation of a Clinical Faculty Academy, providing them with the basics for teaching clinical students. The Academy instructors were professors from the various schools of nursing, experts in education. We made attending the Academy a requirement for all new clinical instructors,

With the Academy in place, hospitals released instructors and the area nursing schools were able to increase their enrollments. In the first three academic years over 1,000 new nursing students were enrolled in area schools. Our community benefits today from more nurses graduating each year.

Notice that once the critical problem was identified, solving helped solve other related problems.

I was very much afraid, but I said to the king, “May the king live forever! Why should my face not look sad when the city where my ancestors are buried lies in ruins, and its gates have been destroyed by fire?”  The king said to me, “What is it you want?” Then I prayed to the God of heaven, and I answered the king, “If it pleases the king and if your servant has found favor in his sight, let him send me to the city in Judah where my ancestors are buried so that I can rebuild it.” Nehemiah 2:3-5

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