Nancy is a senior administrator at a highly rated regional medical center. She started her career as a receptionist with only two years of community college. No one in her family had gone beyond high school, and she had never envisioned herself in management. But she’s smart, efficient, very hardworking, and remarkably warm and cheerful. Soon after she started, medical teams began relying on her to coordinate with patients.

Patients loved her, and the center soon began receiving notes about how much Nancy had helped them. Community ratings for the center began to rise. Then a local philanthropist made a stunningly large donation because his mother had been so well treated by Nancy. After two years, senior staff decided she was wasting her time with reception duties. They created a patient advocate position for her, and pointed her to a free tuition program where she earned a four-year degree in hospital administration.

Nancy rose steadily through the ranks. She was asked to start an outreach initiative for families of patients with serious chronic disease to involve them in proactively managing care. She created a highly visible community engagement program that raised the center’s regional profile. She helped develop patient-service training for medical professionals that received national recognition. When the medical center was acquired by a larger system, many of its programs were consolidated, but Nancy’s innovations were adapted by the larger system, which viewed them as a fund-raising advantage.

For twenty years, Nancy flourished. Said a colleague, “Anything we did that was outward-facing, it was always ‘let’s bring in Nancy.’ She was our go-to for getting outside people involved.” By her late thirties, Nancy was head of external affairs for the entire system, with patient services given a high priority and folded into her brief.

But upon reaching this pinnacle, Nancy began to hit some bumps.

Put simply, she was spread too thin, in part because her new portfolio was so broad, but also because she was still enmeshed in previous responsibilities. Patients and families she had worked with in the past continued to call on her for help. Nurses and doctors sometimes asked her to run interference when they encountered roadblocks.

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