The 4 Disciplines of Execution


When considering a new innovation to implement in the respiratory care program there were many. E-portfolios stood out mostly to me, when I created my innovation plan I provided a plan to implement e-portfolios into respiratory care education. Students are constantly on the internet. They choose to use google over books for research, they have their phones constantly in their hands, apps are just a click a way, and they have ease of access to the world wide web. That is why I believe e-portfolios could be a great reflection piece for the students to document day to day assignments and competencies. I want to pilot e-portfolios with a focus group in my clinical III course Summer I 2019 with a full roll out to the new incoming students Fall 2019.

The problem we lack with implementing change is getting others on board, keeping ourselves accountable, and not getting stuck in the whirlwind. With this change comes accountability and with accountability is making sure we implement in a timely manner, set certain goals, and produce an effective product. If we look at the five stages of McChesney, Covey, and Huling’s The 4 Disciplines of Execution it will help us implement our plan of change effectively.

The 5 Stages of Δ

Stage1: Getting Clear                                

This is the stage where we set the foundation. We organize our team come up with our Wig, lead, and lag measures. Also, we would develop a way to score our plan and set up a time for weekly meetings as a group to attend!

My team will either get together via phone, email, or via clinical site for a short meeting and develop a plan to set the foundation on how we will get this done.

Stage 2: Launch

This is the kick-off meeting! Recognize your resistors, models, and potentials in this stage. This stage requires more focus from the leader to gather the group and organize the required meeting times.

This meeting will be held on campus for an organizational meeting to see where we go from here. This will be the following week and we will then see who is willing to put in the time and effort to push this forward.

Stage 3: Adoption

In this stage we can see resisters tend to adopt the change and be more enthusiastic about the plan.  They will become accountable for the new level performance despite the demands of the whirlwind.

By this stage I will have started weekly meeting either on site or via video meetings to see who is willing or are we stuck and not pushing forward.

Stage 4: Optimization

At this stage we will see how we are winning and if we aren’t what we need to do to make a change. We will use a scoreboard to make sure we are reaching our goals effectively.

I will have posted the scoreboard via a network drive such as google that we could share since none of my instructors are in the same place at the same time or on campus by my office. We will know who is pushing the idea forward or is staying behind.

Stage 5: Habits

When your ideas get implemented successfully they should be rewarded consistently. We should help individuals become high performers and celebrate their accomplishments. Once, one wig has been completed the leader needs to move on to the next wig and repeat the stages.

I should reward the high performers consistently. Therefore once one goal has been accomplished successfully come up with a plan for a reward and push them on to the next goal. That way we can be successful as a team.

4 Disciplines of Execution

Discipline One: Focus on the Wildly Important

The 4 DX model pushes us to focus and stick to one to two WIGS (Wild Important Goals) at a time to prevent getting lost in the whirlwind.  We sometimes have many goals, but we need to focus on one to two goals that need to be done now and can be successfully implemented. Brainstorming with your team, peers, and alone to see which goal is important could give you great perspective. I tend to want to get everything done at one time. Therefore this statement is very helpful to me. I think focusing on the important goal is the best thing to do. That way you get the most important thing done first and then move on to the next and you do not get as overwhelmed.

MY WIG: To fully integrate E-Portfolios in Fall of 2019 Respiratory Care Program students  that will enable students to document and reflect on their learning experiences.

In the beginning I will be the only one involved in the implementation. The students will be posting one lesson or clinical blog a week for reflection. After, the 2019-2020 implementation I will work with my clinical instructors as well as my program director to achieve similar goals and actions. This brings us to the lag measure that tells us if we have achieved our goal, they mark  a precise finish line for the team (McChesney, Covey, & Huling, 2012). For E-Portfolios the lag measure is developing a plan to give effective feedback by the end of each week. I will have to put lead measures in place to hold myself accountable.


To fully integrate E-Portfolios to the incoming Fall of 2019 Respiratory Care Program students to help students document and reflect on their learning experiences.

Lag Measure

Lead Measure

For E-Portfolios the lag measure is developing a plan to give effective feedback by the end of each week.

 Is for clinical instructors to pair up at clinical sites for weekly WIG meetings 90% of the time.

To allow students thirty to forty-five minutes during a clinical day to work on the e-portfolio to blog or reflect on their clinical experience that day 90% of the time.

Discipline 2: Act on Lead Measures

Lead measures must be both predictive of achieving the WIG and influenced by the team. They must be counterintuitive, they are hard to keep track of, and often look too simple (McChesney, Covey, & Huling, 2012). Lead measures are harder to measure than the lag measures. They are the behind the scenes. If you think of the analogy in the book about dieting  in a whole most people are focused in on the weight in pounds lost. Actually that is you lag measure and technically you should be more focused in on the calories and inches, right? These are your lead measure. We need to be focused on the mustard the details to get the result.

To ensure we have a smooth roll out in the Fall of 2019 we will need to ensure that my team of clinical instructors are meeting in pairs once a week. They usually our on location at clinical sites at least once a week. Therefore, lead measure one is for clinical instructors to pair up at clinical sites for weekly WIG meetings 90% of the time.  This cannot be 100% due to the fact they are not all on the same schedule and they all work at different locations and I am not at the same place at the same time. I also, plan to pair up instructors to get the resistor with an instructor who is more of a influencer on the WIG.

My next lead measure is to allow students thirty to forty-five minutes during a clinical day to work on the e-portfolio to blog or reflect on their clinical experience that day 90% of the time. This cannot be 100% of the time due to unpredictable conditions in the hospital setting. Their day to day plans in the hospital setting is unplanned and unpredictable.  I am hoping these lead measure will ensure 100% on my implementation rollout for 2019 and the future of clinical instructors implementation e-portfolios.


Discipline 3: Keep a Compelling Scoreboard

People play differently when they are keeping score. There’s a remarkable difference between a game where the leader scores the team and a game where the players score each other. It means the team takes ownership of the results. It’s their game to play (McCHesney, Covey, & Huling, 2012). This rings so true, people are competitive in nature. Most of my students are always trying to out due the next. Therefore, if you keep score they are willing to work harder for it.

I will keep score by posting charts on the bulletin board in the hallway by my office and also on google documents for ease of access. Below, shows my lead measure where the student is receive access at the clinical site and the minutes they are receiving each week to work on their e-portfolios:

Next, I could measure my clinical instructor meetings with a chart that shows zero or 100% compliance. I could post it as well on google sheets or docs and along side my office.

Last we could look at the lag measure overall and how could we measure it as a score overall. Below you will find a chart showing the performance overall.

Discipline 4: Create a Cadence of Accountability

I already plan on sending the weekly spreadsheet and updates to the clinical instructors to keep them updated where we are at on our goals. When the weekly WIG meetings are held I hope that I will be apart of them. Due to the way our system works it is sometimes hard for me to be at every hospital and lecture on campus at the same time. Therefore, I am hoping maybe I can phone in or be there via through an email update. I want to get as much feedback, and information from the clinical instructors as they will see with my lead measure how the students are doing while they have 35 to 40 minutes posting on their eportfolios what their challenges are. They will be able to bring any information from that to our WIG sections.

I will have to send out a weekly agenda to keep us to date:

    1. How much time did the student’s get to spend on their portfolios?
    2. What were your struggles with giving feedback via the e-portfolio?
    3. What is our plan of action this week?

4DX vs. Influencer Strategy

I believe that the influencer strategy and the 4dx have the same idea but different concepts. The influencer strategy focuses more on social and emotional behaviors. How can you make a change by demonstrating and imitating others who have already done it correctly. While 4 Disciplines of Execution is stating accountability and focusing on the mustard. When I mean the mustard the grit the detail. Not the big picture. What is it that we need to do to really get down and dirty and make that change to get what we need done to make it work. They are saying if you follow these steps your big picture will come and you will be able to master that one goal.


Grenny, J., Patterson, K., Maxfield, D., McMillan, R., & Switzler, A. (2013).

             Influencer: The new science of leading change: 2nd ed.

             New York: McGraw-Hill Education

McChesney, C., Covey, S., & Huling, J. (2012). The 4 disciplines of execution:

           Achieving your wildly important goals. New York, NY: Free Press. 

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