How You Can Apply These Business Principles to Chronic Health Recovery

The principles from business books can work for chronic health conditions, too. Today, I’m taking a look at “The 4 Disciplines of Execution” by Chris McChesney, and applying it to your health.

Here’s a quick summary before diving into the details:

• Focus on one or two goals at most (in addition to maintaining where the rest of your life is at). Pick the ones you think will have the biggest impact. Trying to do too many things means you are less likely to do any of them well.
• Choose actions you will take that are likely to lead you to that goal and are at least 80 percent within your control.
• Once you have a good list of those actions, make visual scoreboard so you can easily see the progress you are making. A good scoreboard helps the game feel winnable.
• Commit to ongoing accountability on the actions you take each week to lead you towards the goal, and update the scoreboard accordingly.

The Whirlwind

The book notes that in the workplace, the majority of big strategic initiatives fail, and a major reason for it is the leaders who propose the initiatives forget that employees don’t have all that much time. They still have the rest of their job to do, stuff that actually needs to get done otherwise they will get fired. 4DX (as it’s commonly known) calls this “the whirlwind,” and it’s such an apt description of work life (and life generally).

For health conditions, your whirlwind is the stuff you need to do to function, like cooking or chores. Some days, you might have to choose between cooking or dishes or laundry but you’re not able to do all three that day. On those days, your whirlwind is big.

Depending on how severe your symptoms are, what kind of help you get from other people, and many other factors, your whirlwind might be bigger or smaller than others, and that’s totally OK. The size of your whirlwind determines how much time and effort you can put into health recovery and management.

In the workplace, employees have at best 10 percent of their time they can devote to some new strategic initiative, around four hours per week. For your health, that number could vary wildly. Regardless, know that you do have a whirlwind (and yours is likely much bigger than other people, even for basic functioning) and that means you can’t possibly pursue everything at once.

This brings us to our first discipline.

Discipline 1: focus on the wildly important

The more goals you set, the fewer you are likely to achieve. The book shares research about this:

• if you set one goal, it’s likely you’ll achieve it
• if you set two goals, you’ll likely achieve one and you might achieve both
• if you set 10 goals, you likely won’t achieve any of them

If you can’t pursue everything at once, it means you should focus on not just important things, but wildly important things. If you have a health condition that impacts multiple body systems, you probably have a lot of goals. Some of them might have to wait for now, and you can put them on a Later List. By narrowing your focus, you can make progress on one thing, which is very motivating.

Once you achieve one of your health goals, you might move to some sort of maintenance mode on it (which means it is now part of your whirlwind) and you can move on to looking at the next goal. For example, perhaps you progress through PT exercises first with a yellow resistance band, then green, and all the way up until your PT thinks you’ve graduated from those exercises. Then you drop down to doing them twice per week to maintain your strength. At that point, you might move on to something else.

How can you tell if something is a wildly important goal? If you write down all of your possible goals, think about which one would have the biggest overall impact for you. Is there one that would “unlock” others or make them easier? Is there one that you know won’t get done unless you put concentrated effort towards it?

At most, you are allowed two wildly important goals, and maybe only one is a good idea, depending on the size of your whirlwind.

For this year, mine is swimming: it’s the only cardio I can do, it builds strength (and I need to build strength) and I feel awesome when the endorphins kick in. My goal was to be at 10 minutes of swimming daily, however long it took.

I also set a second goal but haven’t done a good job of it: I noticed I have a tendency to push myself too hard with exercises, and the amount of time it set me back was bigger than any time I might gain with the faster pace. My goal was that anytime I have some sort of acute injury, to very intentionally rest until I’m back to normal. For example, if I overuse my forearms and they hurt, I need to be extra disciplined with resting until they are back to normal. I’m not very good at that generally and also didn’t have a clear way to measure it. If I don’t have a way to measure it, I can’t tell if I’m winning or losing, so that’s probably why it didn’t work.

This brings us to discipline two.

Discipline 2: act on the lead measures

When we set goals, we usually look at the outcome: but guess what? The outcome isn’t directly in our control. That makes it really hard to make progress. Outcomes are what is called a “lag measure” because by the time you measure it, there’s nothing you can do about it. It lags behind.

In contrast, a “lead measure” is directly in your control. It leads to the result you want. You might set a goal of saving $1,000 (lag measure) but your lead measure could be to figure out what your impulse purchases are (in my case, books) and then focus on cutting back on the impulse purchases and instead direct the money towards your savings.

4DX says a good lead measure must be:

• predictive – will doing this action lead to the results I want? If I’m not sure if it will, is there a good chance that it will?
• influenceable – do I have direct influence (at least 80 percent) of taking this action? In the workplace, it’s common to set goals that other people have to do, but that isn’t a good lead measure because you don’t have 80 percent of control over it. For your health, there are parts of it outside of your control and so would be better to focus on things you can influence.

For my swimming goal, I learned from my PT that 10 minutes daily of cardio was helpful for treating pain (in addition to being helpful for my health overall), so that was my goal, my lag measure. My lead measure was to swim for one minute, three times per week, then slowly increase inasmuch as my body tolerated it.

• It was predictive: slowly increasing my swimming time would lead to my goal of 10 minutes daily.
• It was influenceable: I had direct control over whether I drove to the pool or not.

It passed the test of whether it was a good lead measure.

My other goal, not so much. “Rest whenever there’s a setback” doesn’t paint a clear picture in my mind of what that looks like. It’s influenceable, but only if I know what I should be doing. It can only be predictive if I can see how doing it would lead to an end goal.

So for your wildly important goal, schedule some time to think through what your lead measures could be. You can have a few lead measures for each goal, but you don’t want it to be too many or it’s easy to lose track.

This brings us to the third discipline.

Discipline 3: keep a compelling scoreboard

If you’ve watched a game of pickup basketball before, you know that the game changes as soon as people start keeping score. The scoreboard is an external way to see who is winning.

For your goal, the scoreboard lets you visually see if you are winning and progressing. You wanted to be a winnable game. If it doesn’t feel like it’s a winnable game, you probably won’t do it. But, if it feels like it’s a winnable game, even if the progress is extremely slow, you’re more likely to keep going.

The scoreboard is of whatever your lead measures are. There are lots of ways to visually represent it, maybe a bar graph or a thermometer graph or a red/yellow/green color code. You know you’ve made a good scoreboard if you can understand it within 10 seconds of looking at it.

If not, it might have to many lead measures you’re tracking. Imagine if the scoreboard at a football game showed every single stat that coaches and commentators keep track of. That’s a lot of stats. Viewers and fans would get confused. Instead, the actual scoreboard shows number of points, time left and a couple other things, but the number of points is big and in the center because that’s what you want to look at.

For my swimming, my scoreboard was a piece of paper that had tally marks on it. I kept track of number of days per week and number of minutes I swam each day. Every week, if it seemed like I tolerated the previous level, I would add one minute per day and added a tally mark. It was slow going, but I saw the tally marks grow and grow.

For my other goal, I didn’t have a clear lead measure, and you can’t make a scoreboard for something you can’t measure. Yet another reason why I probably haven’t made good progress on that one.

Discipline 4: create a cadence of accountability

If you’re anything like most people, you can’t accomplish your goals on your own. Having some form of accountability helps, but even better than sporadic accountability is an ongoing, repeating cadence of accountability.

At the workplace, this is fairly easy to build then: you add it to an existing team meeting or make a new meeting for it. Everyone comes together and reports on what actions they took the previous week to help move the lead measure forward, and then you update your scoreboard as a group. Then, you commit to what you will do by this time next week. Fairly straightforward for work.

If you or someone on your team regularly isn’t following through with their actions they said they would, someone can point out patterns or give feedback on why that might be happening. You might have to course correct to get back on track, and that’s part of how life goes.

How can you build a cadence of accountability in health? You might have to get creative. Who in your life could help provide this? How might it look? Would you meet in person, over video call or over text? What would be most helpful for you? What frequency would you do, and then what day of the week and what time?

Once you have answers to these questions, you can begin seeking these people out and see if they’re interested. If they are, great! They are now on your team. If not, or if they’re not able to, that’s not a problem. There are always other people.

For my swimming goal, I didn’t seek anyone out, but my wife would regularly ask me how swimming went today, or how many minutes I was at. Being able to tell her I increased up to six minutes that week felt really exciting.

For my heal-from-setbacks goal, I didn’t seek anyone out and didn’t have anyone in my life asking me this. This goes to show that if you don’t have the cadence of accountability, you’re much less likely to do it.

In summary, the four disciplines of execution can apply to your health, and the four are:

• focus on the wildly important
• act on lead measures
• keep a compelling scoreboard
• create a cadence of accountability

By picking one or two goals to work on, by breaking them down into actions you can take each week, visually tracking those actions and meeting regularly with someone about your progress, you are very likely to keep at it when things get tough and eventually reach the goal that you want.