Dave Sedgwick

Every year, the Centers for Disease Control and Prevention publishes a list of the leading cause of death in men and women in the United States.  Presumably, one goal in publishing the data is to alert us of the hidden dangers, and ultimate outcome, certain lifestyle choices can have on our life.  After assisting with the recruitment, training, and development of over 100 administrators-in-training in recent years, I’ve had an intimate view into what leads to their successes and also what has led to failures.

The “leading cause of death” of new leaders in long-term care is: monkeys.

In a 1974 Harvard Business Review article, William Oncken Jr. taught about the hidden dangers of monkeys.  The article is one of HBR’s two best-selling reprints ever. In an entertaining and convincing way, Oncken taught about the absolute need a leader has to master the art of delegation and time management. A monkey is, he taught, whatever the next move is after dialogue between two people ends, i.e. after “Hey boss, we’ve got a problem.”  

Who has the monkey?  Whoever took the next move on the problem.  

New leaders are supercharged monkey magnets. They even spend time devising ways to collect and organize their monkeys.  Their monkey cages include 3×5 cards that conveniently fit in pockets, smartphones, laptops, and note pads.

Unaware to the danger of monkeys, leaders become overwhelmed and find themselves on a treadmill — running hard but not moving forward.  Soon, they have so much to do that they take their monkeys home and even spend more time at home at night with them!  

As leaders fall behind at work, the leaders’ subordinates become increasingly frustrated with their leaders’ poor follow through.  Morale drops. Confidence suffers. Results fall. Time is running out.

When diagnosing heart disease (the leading cause of death of adults in the United States), physicians identify the risk factors for the disease itself and prescribe corrective action to reverse the disease.  In like manner, let’s identify the main risk factors for our new leaders who get buried by monkeys:  

  1. The credibility gap: Our new leaders in long-term care are faced with a dilemma. They need to supervise people who know their job way more than the new leaders do.  A natural, hidden insecurity takes hold of the leaders’ decisions and actions. How do they overcome this subconscious credibility gap? By taking every opportunity to show their subordinates just how capable and trustworthy they are. They take on their subordinates’ problems. They want to prove their worth.
  2. Servant leaders: Our industry attracts servant leaders. Many new leaders believe that they must not ask too much of their subordinates; that they shouldn’t ask them to do anything they wouldn’t do themselves. That becomes their guiding principle and so they take on their subordinates’ work and end up working for their subordinates. A key indicator that the roles have been reversed is when the subordinate is the one asking the question, “How’s it coming?”
  3. Incompetent subordinates: What do you do when your subordinates are incompetent? Or, more kindly put, how do you deal with monkeys that you could do a much better job completing than others? The new leaders may convince themselves that it matters that they “can do a better job,” as the monkeys pile up.

When you combine the insecurities of the credibility gap with the approach of a servant leader, you get martyrs-in-the-making — those who worked so hard for their staff (sacrificing what matters most in life like family relationships) only to be dismissed because the overall operation performed poorly.  Now, let’s reverse course before it’s too late:

  • If you don’t complete a task (monkey) you’ve given yourself, it’s called procrastination. If you don’t complete a task your supervisor gave you, it’s called insubordination.
  • An inferior job done by a subordinate is 100% better than a superior job procrastinated and never done by you.
  • So, if there are tasks (monkeys) on your to-do list that have been there for a couple weeks (or months) that you haven’t had time to get done (procrastination), give it to your subordinate so it becomes insubordination if it doesn’t get done.  Guess what.  It will get done.


Remember, monkeys will not rest until they’ve not only ruined your career but also ruined your family life. Nevertheless, this is not a lazy or selfish act. Admittedly, I had an allergic reaction to this seemingly unsympathetic, corporate talk of subordinates and insubordination, and making people do extra work that I used to take off their plates  But then I woke up.  Getting dismissed from your first facility has a way of waking you up! Re-directing monkeys to your subordinates empowers them! It pushes them to grow. It removes you as the bottleneck in your operation.  Progress accelerates.  Change happens as you finally start doing your job, not theirs.

Now, for doctors’ orders:

  • Write down every monkey (anything that you’ve taken from subordinates or given yourself to do, such as emails to reply to, voicemails to return, research to do, things to buy, people to counsel, systems to fix, etc.) on a large piece of paper.
  • Highlight everything that can be done by someone else.
  • Assign those highlighted monkeys to their rightful, and usually, original home with an accompanying date and time for the resolution of the monkey to be reported back to you.
  • Repeat. If you don’t see at least half of your plate of monkeys assigned to others, you’re in trouble. Depending on how severe your case is, you could see two-thirds of your monkeys reallocated.
  • Make time, the same time each week, to repeat this exercise. No matter how good we get at identifying upward leaping monkeys, it takes discipline and effort to reallocate.

What happens next? You step off the treadmill. You begin to move forward and upward as a leader and as a facility. You transition from student to teacher and from player to coach. You occasionally take on some monkeys on purpose, with eyes wide open, in order to serve and relieve times of acute pressure.  

But your primary role is to mentor, teach, and coach your subordinates as they begin to stretch and grow into leaders themselves. You see, these new leaders were hired to influence the facility to greatness.  And, that only happens when they work on the important non-urgent stuff that only the leader can do. Ultimately, you beat the odds and avoid an untimely “death” as a new leader in long-term care.”

Dave Sedgwick has served as executive director, vice president, and chief human capital officer for The Ensign Group since 2001. He’s currently the interim Executive Director at an Ensign Group-affiliated facility in Denver, CO. His healthcare leadership blog can be found at http://worldclasscare.wordpress.com