Jim Decker’s 25/50/25 Rule For The First 90 Days
James L. Decker, LFACHE, (pictured above) is a veteran healthcare executive serving in CEO roles for MEDIC Regional Blood Center in Knoxville TN, Gateway Health System in Clarksville, TN, Sumner Regional Medical Center in Gallatin, TN, and as Senior Vice President of the Baptist Health System of East Tennessee and Vice President of Fort Sanders Regional Medical Center. A native of Louisiana, he holds Bachelor of Science and Master of Science degrees in Microbiology from Louisiana State University, a Master of Science in Hospital and Health Administration degree from the University of Alabama at Birmingham, a Master of Business Administration degree from gthe University of Tennessee, and a Doctor of Health Administration degree from the Medical University of South Carolina. Dr. Decker is a Life Fellow in the American College of Healthcare Executives. He is current serving and has served in volunteer roles on boards of directors for several healthcare and community organizations.
In our ongoing series exploring what successful healthcare leaders do in their first 90 days in a new job, we’ve heard about a lot of innovative tactics—CEOs sleeping in resident lounges, replacing every mattress on the floor, or walking parking lots to pick up trash before sunrise. These stories are often surprising, but the real takeaway is the strategic intent behind them. Great leaders don’t wait for approval—they create momentum.
Jim Decker, a retired healthcare CEO turned author and leadership coach, offers a different kind of wisdom—less flashy, more foundational. Over his 47-year career, including CEO roles at Gateway Health System, Sumner Regional Medical Center, and MEDIC Regional Blood Center, Decker refined a deceptively simple framework to guide leaders through turbulent transitions: the 25/50/25 Rule.
The 25/50/25 Rule: Know Your Audience, Focus Your Energy
“There’s nothing scientific about it,” Decker admits, “but in every organization I’ve led, it’s held.”
- 25% of the staff will welcome you from the very first day. These are early adopters—hopeful, hungry for change, and ready to help.
- 50% of the staff are on the fence. They’re skeptical but curious, cautious but not closed.
- 25% of the staff are resistors. They’re loyal to your predecessor, invested in the status quo, or just plain suspicious of outsiders.
Based on this formula, Decker’s advice to new leaders—don’t try to win everyone over at once.
“You’ll waste time and energy chasing the bottom 25%,” Decker says. “Instead, empower your top 25%, and win over the 50% who are watching. That’s where transformation begins.”
This is more than just a management hack. It’s a mindset that enables leaders to remain grounded, avoid unnecessary conflicts, and establish credibility through consistent, visible actions.
First 90 Days: Listening, Learning, Leading
When Decker joined Sumner Regional, he followed a beloved CEO who had led for 25 years. At Gateway, he replaced another 28-year veteran. In both cases, he knew that “coming in hot” would only alienate those still grieving the change. Instead, he listened.
“You’ve got to understand the loyalties and emotions that come with long-tenured leadership,” Decker said. “Spend your early days understanding the terrain before you start making big moves.”
But he didn’t just sit back. He walked the halls. Sat in the doctors’ lounge. Ate in the cafeteria—without a name tag or title. “I wanted to feel and understand the organization the way patients and employees experience it,” he said. That intelligence guided both his strategy and his tone.
Leadership In The Lounge And The Bakery
Not all moves landed smoothly. When Decker swapped out the beloved local doughnuts in the physicians’ lounge for a nationalbrand. It backfired.
“They actually made a motion at the general staff meeting to bring back the old donuts—and it passed,” Decker laughed.
The lesson? Culture lives in the details. A donut isn’t just a pastry, it’s a symbol of familiarity, loyalty, and respect for traditions. New leaders must tread carefully when tinkering with what staff hold sacred.
Creating A New Day, Symbolically And Strategically
In another first-90-days move, Decker led a complete makeover of a tired hospital lobby. “The place looked 30 years older than the new wing we just built,” he said. “We upgraded lighting, furniture, layout—everything. That made a statement.”
It’s one of the recurring themes in our 90-Day Series: a symbolic act that communicates new leadership without needing a speech. Whether it’s cleaning a parking lot, removing a wall, or hanging new art, these acts say, “Something different is happening here.”
Crucibles And Compassion
Decker’s recent book, Reviving the Heart of Leadership, reflects on the personal and professional crucibles that shaped his style. One came early—within weeks of starting as CEO at Gallatin, he had to lay off staff and close a nursing unit. “It was devastating,” he said. “But the mission doesn’t survive without margin.”
Decker believes leadership must be both financially responsible and emotionally present. That’s why the 25/50/25 Rule works: it’s not about placating everyone—it’s about moving the middle with authenticity and action.
Final Takeaway
The First 90 Days aren’t about perfection. They’re about momentum—earned, not demanded. Jim Decker’s 25/50/25 Rule reminds us that you don’t need 100% consensus to be a leader. You need strategic clarity, servant-minded engagement, and just the right amount of support to turn the corner.
As part of our 90-Day Series, we’ll continue exploring these kinds of stories—real, raw, and replicable—offering leaders tools they can use on day one. Because in the end, leadership isn’t a title, it’s a thousand small decisions that add up to trust.
Stay tuned for more insights as we continue exploring the innovative tactics used by healthcare leaders to make their first 90 days count. If you have adopted this tactic, or any others featured in this series, we’d love to hear from you. Please contact us to share your story.
