"The tools and ideas in this book are so vital for all in health care now. From the wonderful description of Dr. van Pelt’s professional journey to his role as an incredible innovator and improver to the tools and methods all can use to make care better, there is learning for all. I’d recommend that all students―whether medical, nursing, or therapists―and leaders can learn and employ the wonderful learnings for improving care."

– Maureen Bisognano

President Emerita and Senior Fellow, Institute for Healthcare Improvement (IHI)

"There's no social goal more important than rooting out the systemic errors that are killing 250,000 patients a year in America. And there's no better guide than the eloquent Dr. Rick van Pelt, who experienced up-close a near-catastrophic mishap and has devoted his career to the life-saving transformation of the health-care system."

― Larry Tye

Director, Blue Cross of MA (BCBSMA) Foundation’s Health Coverage Fellowship; New York Times Bestselling Author

"Deeply driven by purpose, values, and the power of reflection on life, the medical profession, and the delivery of healthcare, Dr. Rick van Pelt turned a most confronting experience in the clinical practice of anesthesia into a life’s work to find pathways and solutions that would help healthcare and thereby help humankind. Spanning recall on the most personal interactions that happen in the crucible of the doctor-patient relationship to the need for profound systemic change in how health systems and practitioners conduct their work, this volume connects it all and helps us make sense of the need for change. Moreover, he describes an innovative approach to implementing durable and impactful change in a large, complex healthcare setting. His work matters."

― S. Bruce Dowton MD

Vice Chancellor, MacQuarie University, Sydney, Australia

"In this courageous account, Dr. Rick van Pelt candidly explores the profound professional and personal challenges that follow a serious adverse event in the medical field. He reveals the often-hidden emotional toll of such experiences, while underscoring the critical value of compassionate peer support. His journey demonstrates how an empathetic network and the incorporation of peer support principles are essential for creating a safe, collaborative learning environment for problem solving and growth. Helen Keller wisely said, 'Alone we can do so little; together we can do so much.' This book beautifully illustrates that sentiment, showing how connection and understanding turn shared challenges into collective solutions. It is a powerful testament to the enduring impact of empathy and collaboration in the medical profession, offering hope and inspiration for practitioners at every level."

― Susan D. Scott, PhD, RN, CPPS, FAAN

Nurse Scientist/Adjunct Associate Professor, University of Missouri Health Care

"Rick van Pelt, M.D. is a healthcare hero, but more importantly, he is an instrument of healthcare change. Dr. van Pelt has earned his stripes in healthcare and has the scars to prove it. In his book, Rick outlines the steps for improvements. It won’t be obvious. It won’t be easy. But it needs to get done.

The delivery of healthcare in the United States continues to flounder despite incredible advances in diagnostics, medical treatments, and surgical interventions. This has become magnified with the introduction of universal healthcare, urgent care centers, emergency departments, clinics and hospitals are routinely overwhelmed with patients with the bedside providers bearing the burden and the blame of disjointed and fragmented care.

I have worked along-side Rick, delivering patient care. I have worked with Rick fixing problems with 'quality improvement' steps. Just as easily as Rick can diagnosis disease, he easily identifies inefficiencies in care delivery. Rick recognizes that the solution is almost always 'not what you think.' He is able to see the long-term repairs required rather than adding a bandage. His successful methods are based on mitigating conflict and functional change. I advise those in healthcare delivery systems to read his book and implement his methods. You will be delivering better care."

― John Fanikos, BS, MBA

Director, Strategic Initiatives, North American Thrombosis Forum, Brookline, MA

"Dr. van Pelt offers a refreshingly honest look at healthcare's challenges and presents an innovative approach to problem-solving. By integrating personal experiences with systemic analysis, he provides valuable insights for transforming healthcare from the inside out."

― Anthony Patterson

Associate Dean, Clinical Affairs and Strategy, CEO Emeritus, UAB Hospital

"It’s Not What You’re Thinking is the right book at the right time as all leaders work to transform their organizations for current and future success. There’s no way around conflict and differences, finding a way through it is what is essential. This book provides ways of thinking and ways of doing to achieve true collaboration."

― Christy H. Lemak, PhD

Professor and Chair Emerita, Dept. Health Services Administration, UAB School of Health Professions

"Working alongside Dr. van Pelt and the clinical transformation office at UAB has been an inspiring journey of collaborative problem solving. Their innovative approach using the 3D prioritization and precision problem solving framework has led to meaningful, sustained change across departments. By fostering a culture of open communication and minimizing conflict, we’ve been able to improve patient care and operational efficiency in profound ways. It’s been a privilege to be part of this transformative work."

― Kimberly Payne

Vice President, Clinical Operations, UAB Medicine/UAB Hospital

"It's Not What You're Thinking is a must-read for anyone seeking to create lasting, high-impact change in their organization or personal endeavors. The book provides a powerful framework for understanding how to drive meaningful transformation while managing the inevitable challenges that come with it. I have personally worked closely with Dr. van Pelt to solve some long-standing inefficiencies that were driven by both culture and tradition. In utilizing strategies found in this book, we have been able to resolve disputes, turn conflict into a catalyst for innovation, and navigate complex situations resulting in change that has endured."

― Alison R. Garretson

Interim Vice President, Care Continuum and Care Transitions, UAB Medicine/UAB Hospital

"Dr. Van Pelt has been key in transforming practice culture at UAB. His understanding of the integral role of systems, high performing collaborative teams, professionalism with associated peer support, and the implementation of principles of change management, has been the source of his success. His approach of sustained learning: to understand with humility and curiosity and to rethink and pivot with the powerful lessons articulated by Adam Grant. In the complex and ever-changing environment of health care, incentives and motivators are too often misaligned, leading to disenfranchisement of physicians and staff and ultimately burnout. Dr. Van Pelt’s approach works to align the key psychological needs of self-determination and intrinsic motivation including competence, autonomy, and purpose as part of the transformative change within teams. The success of his work is important not only to the wellbeing of the providers but it’s absolutely critical to the safety of the patients we take care of."

― Dan E. Berkowitz, MD

Professor and Chair, Department of Anesthesiology and Perioperative Medicine, UAB Medicine/UAB Hospital

"Transformational change is difficult to achieve in a complex high volume, high acuity medical environment that involves multiple, intertwined patient care platforms. This became blatantly clear to me as a leader who had tried unsuccessfully to bring about effective, sustainable change to our practice in an effort to improve efficiency and quality outcomes measures for our trauma service. Dr. Van Pelt’s process of maximal engagement of key stakeholders in an iterative and thoughtful approach deconstructed pressure points of conflict and created a practice redesign that resulted in remarkable improvements in key metrics that exceeded our expectations. Improved efficiencies in the care process have increased patient care capacity and eliminated diversion issues, allowing us to remain continuously available for our community in their time of need. It has also resulted in the best quality outcomes measures in the history of our trauma program. Building on this initial success, we have engaged Dr. Van Pelt in other patient care related restructuring processes with similar results. I am glad that Rick has decided to share his process so that others can likewise realize its benefits."

― Jeffrey D. Kerby, MD

Professor and Division Director, Trauma and Acute Care Surgery, UAB Medicine/UAB Hospital

"Health care workers will recognize my experience as a physician: despite the dedication and skill of the staff, care delivery often remains fragmented, contentious, and overly complex. This environment can breed frustration and cynicism. However, I have transformed my perspective by learning from Dr. Van Pelt and embracing precision problem solving. This approach fosters an understanding of diverse viewpoints, clarifies core issues, and enables the development of impactful, sustainable solutions. As a result, teams emerge revitalized and motivated. Having successfully applied precision problem solving with numerous teams across various contexts, I wholeheartedly endorse its transformative potential!"

― David McCollum, MD

Hospitalist UAB Hospital Medicine, Associate Principal, Clinical Transformation Office (CTO), UAB Medicine/UAB Hospital

"Dr. van Pelt details his journey in healthcare from surgical internship to transformational problem solving in a way that challenges your assumptions about why we continue to face deficits in healthcare quality, safety, and efficiency. This book offers a unique paradigm for problem solving, based on systems principles and human nature, which can elevate our existing quality tools and forge a path for transformative changes in healthcare."

― Carlie Dobbins, MHA

Director of Operations, Clinical Transformation Office (CTO), UAB Medicine/ UAB Hospital

"As a healthcare leader who has spent years at the frontlines of patient care and organizational transformation, I can confidently say that the methodologies outlined in this book―3D prioritization and precision problem solving―aren’t just theoretical frameworks, but practical tools that can drive real change in clinical environments. Rick’s candid reflections in the chapter 'Another Day of Surgery: From Catastrophe to Catalyst,' are incredibly inspiring. His openness not only humanizes the challenges we face as healthcare professionals but also shows how even the worst moments can spark innovation (and, let’s be honest, a few sleepless nights).

I was a new nurse manager on a very busy medical-surgical unit when I first met Rick. My first thought? 'Oh, great. Another project to manage.' But that feeling faded fast as he demonstrated real support in developing a new process on our unit. Before I knew it, we had built an incredibly strong, cohesive leadership team across disciplines. Honestly, I’d never experienced that level of teamwork outside of direct patient care.

Now, let me tell you about the coffee. His team made having the best coffee on the unit a thing. Seriously? Coffee? We’re talking about hospital coffee―how good could it possibly be? But somehow, it became a rallying point and my first experience with 3D thinking. And let me tell you, I’ve been using that approach ever since, across roles and teams. The methodology may start with something as small as coffee, but it turns into transformative leadership strategies that have long-lasting impact on patient care. This book is a must-read for any leader looking to inspire real, sustainable change (and maybe upgrade their caffeine game in the process)."

― Toni Beam, MSN, RN, NE-BC

Nurse Wellness Manager, WE CARE Program, UAB Medicine/UAB Hospital