A physician executive I coach recently described her days this way: she wakes up wondering if today’s the day someone finally realizes she doesn’t have all the answers. Then she gets through the day and thinks, I made it. Tomorrow, she’ll wonder again.
If that sounds familiar, take some comfort in knowing it’s one of the most common experiences among the leaders I coach. It’s also a sign your leadership perspective might need to shift.
The hero model was built for a different kind of problem
Most of us absorbed the same idea of what a leader looks like: the person who knows the answer, gathers the smartest people in the room, and hands down the blueprint. Everyone else follows. It’s a compelling image, and it works — in the right environment.
There’s a useful way to think about this, borrowed from the Cynefin framework (pronounced ky-nev-in) for decision-making. The framework divides reality into predictable and unpredictable worlds, and is designed to help leaders discern the various contexts they find themselves in. As Michael Hein, a fellow MEDI coach writes, this framework has long been used by governments around the world to formulate policy, by pharma giants to develop new products, and by entrepreneurs looking to innovate and avoid trouble.
Some problems are Simple: the inputs and outputs are clear and predictable, and almost anyone can manage them well. Others are Complicated: there are a lot of moving parts, but with the right expertise, you can predict the outcome with real confidence. That’s where the heroic leader thrives. Gather the experts, build the blueprint, execute.
But a great deal of healthcare leadership happens in a third zone: Complex. There are so many variables interacting that pulling one lever creates consequences somewhere you didn’t expect. Competing priorities that can’t be resolved, only held in tension. And every so often, healthcare tips into a fourth zone entirely: Chaotic, where you’re reacting in real time with no map at all.
Apply the hero model to a Complex environment and it backfires. The leader who insists on having the answer, or assembles a task force to engineer one, ends up generating a wave of unintended consequences. Anyone who’s watched a well-intentioned policy roll out across a health system and land differently in every department has seen this play out.
(If you’d like to deepen your understanding of the Cynefin model, Michael expands on this concept in Shifting Toward Unorthodoxy)
The gardener leads differently
There’s another model, one I first came across in General Stanley McChrystal’s book Team of Teams: the gardener leader.
A gardener doesn’t pretend to control the weather. She can’t force a plant to grow on command. What she can do is cultivate conditions, plant with intention, watch closely, and adjust. Nudge, observe, nudge again. It’s not passive. It’s a different kind of active — one built for an environment where you don’t get to dictate the outcome, only shape the conditions that make a good outcome more likely.
In a Complex environment, that’s the leadership behavior that actually holds up. You don’t have the whole answer walking in. You have a direction, a next step, and a willingness to treat the people around you as co-creators rather than followers of your blueprint. You experiment. You assess what happened. You adjust and move again.
It’s a harder model to sell than the hero, admittedly. Boards and search committees still tend to look for the person who projects certainty. But certainty is exactly what a Complex environment can’t honestly offer, and leaders who fake it usually pay for it later.
Direction isn’t delivery
Here’s where a lot of gardener leadership stalls out, though: the strategy. Leadership teams do the hard work of setting direction, feel good about the plan, and assume the organization will simply absorb it.
I grew up helping my grandfather irrigate his farm in the high desert of Eastern Utah, where water is the difference between a harvest and a lost season. When our turn came at the head gate, it didn’t matter if that turn landed at 2 a.m. or 2 p.m. — we were out there with boots and a shovel, because between waterings, dirt dries and shifts, and a gopher hole or a collapsed bank can block a row without anyone noticing. Opening the gate wasn’t the job. The job was walking every row, clearing every obstruction, making sure the water actually reached the end.
Leadership works the same way. Setting a strong direction at the senior level is the equivalent of opening the head gate. It matters, but it isn’t the work. The real work is what a colleague of mine calls co-creating coordinated movement: walking the organization row by row, clearing what’s blocking people from actually moving with the strategy, long after the announcement meeting has ended.
Healthcare’s leadership turnover makes this even harder. Every transition is another moment where the water can stop reaching the end of the row, another gap between a good strategy on paper and what people actually experience on the ground.
Where to start
You don’t need to abandon expertise or stop setting direction. You need to hold both roles: the gardener who cultivates rather than dictates, and the leader who walks the rows instead of assuming the water gets there on its own.
Start by asking where in your organization the water isn’t reaching the end of the row right now. Where has a strategy landed on paper but not in practice? That’s usually where the next stretch of leadership work is waiting.
Leading well in complexity isn’t something any leader figures out alone. It helps to have a thought partner who can walk alongside you as you cultivate direction, test your next move, and adjust when unintended consequences show up. If that’s a conversation worth having, let’s talk.
