Core IM | Internal Medicine Podcast #198 Microskills for Change That are Big Enough to Matter, Small Enough to Win
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Jan 21, 2026 Dr. Eileen Barrett, an internist and healthcare leader, shares her innovative approach to improving clinician workflows. She introduces the concept of 'baby alligators,' the small frustrations that hinder productivity. Eileen suggests using regulated curiosity and strategic empathy to tackle these issues effectively. She recounts her successful efforts in changing the rifaximin ordering process, emphasizing the power of small, well-chosen actions that can lead to substantial change. Her tips on navigating collaboration and advocating for improvements are both practical and inspiring.
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Baby Alligators Steal Time And Purpose
- Small, frequent workflow frictions are "baby alligators" that betray purpose and drain clinicians daily.
- Removing one small friction often teaches how to remove others and builds momentum for more change.
Rifaximin Workflow Flip Saved 500 Calls
- Eileen Barrett flipped the rifaximin workflow so clinicians order first and pharmacy verifies affordability afterward.
- That single change saved over 500 phone calls in under a year and reduced delays and frustration.
Lead With Appreciation And A Question
- Start problem-solving conversations by acknowledging intentions and asking who to talk to about process changes.
- Offer concrete, low-effort proposals and invite the other team to respond rather than accusing them.
- those betrayals of purpose 
, or, death by a thousand paper cuts 
!