Last week I wrote about a doctor named Dr. Shah, a clinical skill called motivational interviewing, and a framework called the Golden Circle: Why in the center, How around it, What on the outside. If your why is clear, Simon Sinek argues, everything else organizes itself around it. If it’s fuzzy, you’re just another person doing tasks.
That’s true for a doctor talking to a single patient. It’s also true for a hospital, a department, or a committee. That’s where things sometimes fall apart.
The Mission Statement in the Lobby
Every hospital I’ve ever walked into has a mission statement somewhere near the front doors. Something like “Patients First” or “Excellence in Compassionate Care,” in a nice serif font.
Now walk past that wall into a leadership meeting, and watch what they actually discuss. In my experience, it’s rarely the Why. It’s the What — productivity, patient satisfaction scores — or the How — the new protocol, the new software rollout. The why stays on the wall by the door, doing decorative work, while the meeting runs on numbers.
This usually isn’t because anyone stopped believing in the mission. It’s because nobody built a habit of saying it out loud before getting to business. A why that only lives on a wall isn’t organizing anyone’s behavior. It’s decoration.
An organization’s real why isn’t what’s painted on the lobby wall. It’s whatever gets said first in the room where decisions actually happen.
The Why That Burns People Out
The harder part of this problem belongs to leadership, not the individual physician.
Jennifer Moss wrote a piece for Harvard Business Review called When Passion Leads to Burnout. She argues that the people most at risk of burnout aren’t the ones without purpose. They’re the ones with it — mission-driven people who never learn to set a boundary, because the mission always feels too important to pause for. She names physicians specifically.
Dr. Edward Ellison, a physician executive quoted in the piece, says that leaders need to actively teach their people that setting limits isn’t a betrayal of the mission. It’s what makes staying in the mission possible.
That’s a leadership job, but it’s often framed as an individual willpower problem. If your organization gives its physicians an inspirational why and then measures them only on productivity and patient satisfaction, it burns out its most purpose-driven people.
A why that inspires people without protecting them isn’t leadership. It’s passing the cost of the mission on to the people who believe in it most.
One Organization That Tried to Say It Out Loud
In 2013, Dr. Toby Cosgrove, then CEO of Cleveland Clinic, shared an internal video with staff called Empathy: The Human Connection to Patient Care. Instead of dialogue, it had footage of patients and staff moving through the hospital, with on-screen text revealing what each person might be carrying that day: grief, fear, fatigue, and hope. The video later went public and is now widely used as a teaching tool, for exactly the reason you’d guess: an organization trying to make its why visible to the people working inside it, not just to the patients walking through the door.
That’s rarer than it should be. Most healthcare organizations are better at printing their why on a wall than practicing it in a meeting.
A Why Without Autonomy or Mastery Isn’t Enough
Remember Daniel Pink’s three drivers of motivation from Part 1: autonomy, mastery, and purpose. A stated why only covers one of the three.
An organization can have a wonderful purpose and still fail its physicians completely if it gives them no say over how they practice and no room to get better at the parts of the job they actually care about. In other words, no autonomy and no mastery. Purpose without the other two isn’t a culture. It’s a slogan asking people to run on empty. If leadership wants its stated why to mean something, the mission statement is the easy third of the job. The other two are harder, and most organizations quietly stop trying there.
Why This Gets Harder, Not Easier, Over Time
There’s a longer conversation waiting here too, about what it takes to stay committed to a Why when there’s no finish line, no quarter where you finally “win” and get to stop. Sinek has another framework for that. It deserves its own post, not a rushed paragraph at the end of this one.
For now, the point is simple: if an organization’s Why doesn’t get said before the numbers, it isn’t actually driving the numbers. It’s just watching them from the wall.
The One Practice
Before your next team meeting, committee session, or new initiative launch, say the Why out loud first. Not the mission statement — your own plain-language version of it. One sentence, before anyone opens a spreadsheet: “We’re doing this because ___.” Then let the how and the what follow.
It will feel unnecessary the first few times. Do it anyway. The room that hears its why before its numbers behaves differently than the room that never hears it at all, and eventually…so does the doctor running it.
This is Part 2 of a two-part series on Simon Sinek’s “Start With Why” framework, applied to physician leadership. Read Part 1, on Dr. Shah and the bedside version of the same question, [here].
