Category Leadership

The Standardization Tax: Not Every Tradeoff Is Worth It

continuity of care is a given in rural medicine

What would a pre-med student think if she heard how many doctors today say that they would steer their own kids away from medicine? They blame increasing corporatization, shrinking autonomy, and burgeoning documentation burden. These stem from increasing standardization in medicine. This post, the first in a series, introduces the idea that while standardization has benefits — catching errors, controlling costs, protecting clinician time — it also has a cost. Not all eliminated variation is waste.

Anecdote, Story and Speech: What Every Leader Should Know

What makes a story a story is transformation

A phone call from a crying teenager, a residency training director who didn't ask a single clarifying question, and six words that changed how one physician has led ever since. This post opens with the story, then takes it apart. Drawing on a distinction learned in a storytelling class — an anecdote is something that happened, a story is something that happened and changed someone, a speech adds a call to action — it argues that physicians aren't bad storytellers. They were trained out of the middle term. The case presentation is built to strip away transformation. Leadership requires putting it back. Includes the line between using a story to illuminate your ask and using it to smuggle one, plus a two-sentence exercise for finding your own.

One Year of Writing and the Question I Keep Coming Back To

write every week

I wrote my first post on Voice That Moves one year ago. Except for a short break this summer, I have published a post every Sunday. This anniversary post highlights eight posts from the past year – on the communication gap between doctors and business executives, the discipline of hope, healthcare's strange economics, the truth about office politics, lessons from a national speaking competition, physician well-being and agency, the evidence behind servant leadership, and leading peers without formal authority. One question underlies my writing: how do you help those trained to heal learn to lead? There’s no tidy answer here…just a year spent working on it one post at a time.

The Most Important, Invisible Thing Regular Meetings Do

The important, invisible thing that regular meetings do

A clinic administrator announced a set of changes in the local newspaper. The staff who would carry out those changes found out the way everyone else in town did — over coffee, from the paper.

For days, people complained in hallways and parking lots. It went nowhere. Then, at the pointless monthly committee meeting, one senior physician said it out loud, in the room, in front of everyone. That naming set events in motion that eventually removed the administrator.

How did that happen? Because of every "pointless" meeting session that came before it. The committee had been building the team's connective tissue the whole time — badly, by accident, and without anyone naming it.

The Meeting That Had No Idea Why It Existed

Meetings without a clear purpose are a waste

Physicians already run superb meetings. A code has a leader, defined roles, one goal, and a decision at the end. So does morning rounds. So does tumor board. Then the same physician walks into a 2 p.m. committee meeting and forgets all of it.

This post tells the story of a clinic executive committee that met for years without anyone asking what it was for. It had no governance structure, no minutes, and made no real decisions — and when it kept running over, the group solved the problem by making the meeting longer.

Meetings earn their place on the calendar only when they do a specific job. Name the purpose before you gather the people.

A Short Note and a Short Break

I’m not going to publish a post this week, and I may not for a couple of weeks after that. My father passed away this week. I’ve built this blog around a belief that leadership and communication mean nothing if…

Leading Peers: How to Influence People Who Don’t Report to You

Leadership is about influence, not about authority

When I became chief resident 25 years ago, the title came with a $1,000 a year increase in stipend and authority over the call schedule — yet I still spent the year asking peers for favors. That paradox opens a hard truth about medicine: authority rarely works, even when you have it. Every physician is independently licensed, and replacing an unhappy one costs a fortune. So leaders at every level run on influence, not authority. Drawing on a spring-break scheduling standoff between two psychiatrists I once supervised, we see how to move people who don't have to move — asking before telling, letting facts speak, reframing the stakes, and let them find their way. And when influence fails? Protect the relationship and try a different key.

Why You Can’t Practice Your Speech Without Saying It Aloud

Someone told me they practiced their speech while walking their dog. "Do you say it out loud?" I asked. "No," they said. That's not practicing — that's thinking. Part 3 of the series about lessons I learned from my Toastmasters contest last year covers two lessons about preparation: practice aloud to find the words make you stumble, and rehearse with real people to find out if your message actually lands.