January 26, 2022

When Things Are Brutal: Three Essential Elements of Leadership

Clinician Leadership | Leadership Development

Reading Time: 2 minutes

For many healthcare leaders, things have been nothing short of brutal. How does a leader stay in a good place and help others do the same when things are so difficult? At MEDI we have noticed three essential elements.

Abide by the Stockdale Paradox

Confront the brutal facts of your present reality while never losing faith in the end of the story.

“You must never confuse faith that you will prevail in the end — which you can never afford to lose — with the discipline to confront the most brutal facts of your current reality, whatever they might be.” ~Admiral James Stockdale

If you are unable to do so, those around you will experience you as blind, deaf, and uncaring. You also set yourself up to miss the opportunity for growth that you’re in.

Read more about it here: The Stockdale Paradox in Good to Great by Jim Collins.


There are choices to made about how you and others make sense of what is being experienced. In brutal times, the best leaders can hold multiple sense-making frames at once. Importantly, they can help others do the same.

“A leader’s ability to reframe sets them free and helps them to avoid getting trapped in cognitive ruts.”

When things are hard, it’s easy to lock into one way of thinking. If you’re unable to hold multiple frames, you may unwittingly take yourself, others, and your organization over a cliff.

Read more about reframing here: Why Reframing is Important to Great Leadership in How Great Leaders Think by Lee Bolman and Terrence Deal.

The First Work of Leadership

Leaders who have prepared for brutal do better. They have done the First Work of Leadership. Difficult times demand from leaders a high level of mental, emotional, spiritual, relational, and physical stamina. You do not walk from the couch to the starting line of a 10k race and expect to win (let alone finish). Doing that would be foolish.

The First Work of Leadership is your mental, spiritual, physical and relationship wellbeing. Every leader is different, but the pattern that we see is a regular cadence of exercise, meditative practice, and time with relationships that matter. These are not niceties; it’s essential leadership (training) work. When things are difficult, do not succumb to the temptation of setting aside your First Work. That is precisely when you need it the most. Rather, double down on it! Think about how you can create the expectation and opportunity for others do the same.

You can lead well in routine times without the First Work. You may even be able to do so (for a while) in brutal times. However, there is a price to pay. To quote a client:

“You can do that [ignore the First Work] for a time, but then the Universe comes knocking at your door.”

For the unprepared leader, the cost can be high. My client’s point was that the “Universe” doesn’t care what it asks for. It may demand payment in health, relationships, or your professional life.

Read more about the First Work of Leadership here. The Making of a Corporate Athlete in The Power of Full Engagement by Jim Loehr and Tony Schwartz.

It is hard to describe how difficult it has been for most healthcare leaders. Brutal seems most suitable to me. Yet, it is in these moments that the greatness of humanity is alive. Removed from the mundane, now leaders lead.

Do well. Be well. Lead well.

Begin the conversation

Share this!

About the author

Michael S. Hein, MD, MHCM, ACC

Michael S. Hein, MD, MHCM, ACC has over 20 years of healthcare leadership experience in multi-specialty practice, large integrated health systems, academic medicine, and start-up companies. He has extensive clinical leadership experience and deep knowledge in transformational change.

Related content