Harvest the Signal

Florence Nightingale is remembered as the lady with the lamp.

She should also be remembered for the chart.

The lamp has become the symbol of her compassion. It is the image most of us carry: a woman walking quietly through dark hospital wards, bringing comfort one bedside at a time. The chart changed history.

During the Crimean War, military hospitals were overwhelmed. Soldiers were dying in staggering numbers, and the accepted explanation was simple. War was killing them.

Nightingale wasn't convinced. She began collecting data, not because she loved statistics, but because she suspected something everyone else was missing.

When she plotted the deaths, a startling pattern emerged. Far more soldiers were dying from preventable infectious disease than from battlefield wounds. The problem wasn't only the war. It was the system surrounding the war: poor sanitation, contaminated water, overcrowded wards, broken infrastructure.

Later, when she laid that pattern out on paper, it did more than organize information. It made the deaths impossible to explain away as tragic but inevitable.

I've thought about that chart for years, not because I'm fascinated by Victorian medicine, but because Nightingale demonstrated something I keep rediscovering in modern organizations.

As a midwife, I've always felt a particular affinity for her story. Midwives are often remembered for the same qualities people remember in Nightingale: presence, reassurance, steadiness, compassion. Those things matter deeply, and they always will.

But many midwives are doing something else at the same time. They're noticing patterns. They're asking why the same fears, the same barriers, and the same failures keep repeating, and wondering how care could work differently, not only for the woman in front of them but for every family that comes after.

Part of that is training. Midwives are taught to think longitudinally. They don't just ask, “How do I help this person right now?” They ask:

That's systems thinking embodied. Not because anyone taught “systems engineering,” but because the work itself requires seeing relationships across time.

The best midwives don't simply care for births. They think about the systems surrounding birth.

I suspect that is true of many professions. We tend to celebrate the visible act of care while overlooking the invisible work of redesigning the conditions that make better care possible.

Recurring problems rarely stay hidden because the evidence is missing. They stay hidden because we look at individual events instead of the system producing them.

Every organization has recurring conversations. The same handoff breaks down. The same project slips. The same supply is missing. The same meeting somehow has to happen again.

Eventually someone says, “We need more accountability.”

Maybe.

But I've come to believe there's a better first question. If the same problem keeps returning, what system is producing it?

Not who.

What.

That single shift has changed the way I look at leadership.

For most of my career I worked alongside extraordinary clinicians and administrators. The kind of people who stay late because they can't leave something unfinished. The kind who remember details no checklist captured and quietly hold entire organizations together.

Often I was the lead net myself, on call for patients, juggling operations, chasing compliance, playing whack-a-mole with problems that seemed unrelated until you stepped back far enough to see they weren't. I know how it feels.

Healthcare celebrates those people, and it should. But over time I noticed something uncomfortable. The same people were rescuing the same kinds of failures.

Different day. Different patient. Same rescue.

We called them heroes. I started wondering why the system kept requiring one.

A recurring problem is information. It's made of knowable parts woven together so tightly that we stop seeing them. It isn't automatically a training problem. It isn't proof that someone doesn't care. It isn't evidence that people are failing.

It's a signal, often the clearest signal you'll ever receive about the system underneath the work.

I've started paying attention to one question whenever I talk with an organization. What sentence do people say with a shrug?

“That's just how we do it.”

“It's always been that way.”

“You just have to remember.”

“Mary knows.”

Shrugs fascinate me. They're often where invisible systems are hiding.

Systems rarely arrive fully formed. They accrete. One workaround survives because Tuesday was busy. Someone builds a spreadsheet no one intended to keep. An exception quietly becomes policy. Five years later everyone assumes that's how the organization was designed.

That's why recurring problems are deceptive. We experience them one event at a time. Systems produce them as patterns.

If something happens once, study the event. If it keeps happening, get curious about the system.

When you board an airplane, you don't hope today's crew happens to be extraordinary. You trust thousands of invisible routines, maintenance schedules, checklists, and communication protocols working together so an ordinary flight remains uneventful.

That's what good infrastructure does. It fades into the background, and we usually notice it only after it fails.

Healthcare is no different. Organizations that consistently deliver excellent care rarely depend on extraordinary memory or constant heroics. They make the right action easier than the wrong one. Knowledge survives turnover. Learning survives vacations. Good decisions don't depend on one indispensable person.

The people are still exceptional. They're simply no longer carrying the entire system themselves.

So I've adopted a simple rule. Every recurring problem is a system until proven otherwise.

Notice what that doesn't say. It doesn't say every problem is a system. Sometimes people make mistakes. Sometimes randomness wins. But recurrence changes the burden of proof. When the same issue returns, I stop asking, “Who made the mistake?” I start asking, “What is the system trying to teach us?”

When an organization absorbs one of those problems into its identity, the shrug hardens into a fact. It starts to sound like a description of reality rather than a choice. That's usually the moment learning stops.

Recurring problems aren't accusations. They're invitations.

Nightingale didn't stop at the chart. Seeing the pattern was only the first step. She and the sanitary commission changed the conditions that kept producing the same outcome. They improved sanitation, cleaned the water, and ventilated the wards. The death rate fell dramatically.

That's the part we forget when we picture the lamp. The lamp comforted the person in front of her. The chart revealed the pattern around them. The reforms changed the future for everyone who came after.

Those aren't competing acts of care. They're concentric circles. Compassion at the bedside. Compassion through observation. Compassion expressed by redesigning the system itself.

Thank you for reading our very first-born post! If it resonates with you, please subscribe and share—connect with me on LinkedIn or @HarvestTheSignal on Threads and let’s keep the conversation moving!

What recurring problem have you accepted as inevitable that is actually a system waiting to be redesigned?

Hit reply and tell me. I read every response personally. The next Harvest the Signal may begin with something you've stopped accepting but haven't yet put into words