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Beyond the Streetlight
Finding What Really Needs “Fixing” in Medical Groups
In healthcare, especially within complex medical groups, improvement efforts often focus on what’s easily seen—metrics that are already being tracked, processes that are already formalized, or departments that already have structure and visibility. But what if the most meaningful change lives outside those well-lit areas?
This is where the streetlight effect comes in:
“We tend to search where it’s easiest to look—not where the real answers are.”
It’s a cognitive bias that nudges us toward the familiar and the measurable—toward the things that feel safe to fix. But in doing so, we often overlook deeper root causes: lack of trust between physicians and leadership, outdated compensation models, or misaligned incentives that no dashboard currently captures.
Dr. Josh Honaker, Ancore’s Chief Medical Officer, suggests starting with those on the front line: “The clinicians often have the answers regarding increasing productivity, efficiency, patient experience, staff burnout, and such; we just have to create a space, trust, then ask and listen.”
When organizations have the courage to step outside the spotlight and explore those harder-to-reach areas, they often uncover the most powerful levers for change.
What Really Matters
It’s natural for organizations to focus on what’s easy to quantify—wRVUs, no-show rates, or EHR logins. These metrics are important, but they’re often lagging indicators: the end result of a long chain of upstream dynamics. By the time something shows up here, it’s often a symptom—not the root cause.
In contrast, the areas that truly drive transformation—things like trust between physicians and administration, clearly defined roles across teams, or accountability for financial performance—operate further upstream. They’re harder to measure, less likely to live in a dashboard, and even harder to face. They may live in hallway conversations, buried frustrations, or outdated norms that persist because “that’s how we’ve always done it.”
But that’s exactly why they matter.
Real Change Starts in the Shadows
In our work, we’re often brought in to help fix physician compensation models or analyze performance. But time and again, we find the real issues lie elsewhere—hidden in unclear expectations, cultural misalignment, or communication gaps between teams.
Dr. Honaker puts it simply: “Healthcare organizations have to bring healthcare providers to the table to learn and partner if they truly want to improve the delivery and business of healthcare.”
That kind of partnership doesn’t show up in metrics, but it’s the foundation of sustainable performance.
“Once we learn what needs to be done then we have to act, or we will lose trust, support, and the needed momentum to move the needed change.”
The most powerful insights don’t always live in the most visible places. But when medical groups are willing to look beyond the obvious—beyond the metrics everyone’s comfortable with—they unlock real potential for transformation.
Progress isn’t about staying where it’s comfortable. It’s about asking, “What aren’t we seeing?” and having the courage to go there.
So Where Do You Start?
- Ask frontline teams what’s getting in their way—and listen.
- Look beyond the numbers to understand the why. A high no-show rate might point to operational friction, misaligned expectations, or even physician disengagement. The visible metric is just the surface—what lies beneath often holds the solution.
- Create space for honest feedback, especially from physicians.
- Revisit assumptions about roles, accountability, and decision-making.
Even small steps beyond the streetlight can reveal what really drives performance.
