The Work Before the Work
I walk my dog Rapha three miles every morning. Same route, most days. It is not exercise, exactly, though my body appreciates it. It is the thing I do before I do anything else, because I have learned, slowly, and at cost, that I cannot lead a room I have not first met myself in.
This is not a wellness post. I am suspicious of wellness posts written by executives. They tend to be performances of balance offered by people whose calendars suggest otherwise, and I am not interested in adding to that pile.
I am writing this because I want to say something about how change actually works inside institutions, and I cannot say it honestly without starting where the work actually starts. Which, for me, is a sidewalk at 6:15 a.m. with a dog who does not care what my title is.
I spent a long time believing that the work of leadership was external. You assess the situation, you build the plan, you assemble the team, you execute. By the time I was sitting in the President and COO seat of an academic health system, I had a decade of evidence that the external work was the work.
And then I watched, over and over, strategies I believed in fail to land in organizations that had every reason to want them to succeed.
Not small strategies. Big ones. Consolidations. New service lines. Cultural interventions the board had unanimously endorsed. I would sit in the debrief six or nine or eighteen months later and listen to smart people explain why the thing had not worked, and I would notice, because I am trained to notice, that the explanations were always about the plan, or the market, or the people who had left, or the people who had stayed and resisted.
The explanations were rarely about the room where the decision had been made. And they were never about the leaders who had made it.
Here is what I know now that I did not know then:
The organization does not receive the strategy. It receives the leader.
If the leader has not done the internal work, if the leader is walking into the room carrying unexamined fear, or unprocessed grief, or the specific brittleness that comes from having built one's identity around competence, the organization will feel that. It will not name it. It will not put it in the engagement survey. But it will act on it. It will move around the leader instead of with the leader, and the strategy will drift, and everyone will wonder why.
I know this because I was that leader for longer than I want to admit. I was a woman who had learned to be excellent as a form of self-protection. I was a leader running an operational tempo that did not require me to sit with what that meant. Have you ever poured the intensity of unspoken hurt into your work, and called it drive?
The work looked good. It won awards. It moved metrics. And it was, in ways I could not yet see, being distorted by everything I was not willing to feel.
I have made my peace with that season. It is a diagnostic offering, because I meet executives constantly who are running the exact same play.
The Shift Method™ came out of this reckoning. I built it because I needed a way to describe, operationally, what I had learned experientially: that culture moves before strategy lands, and that the leader is part of the culture. You cannot move a culture from a stance you have not moved from yourself.
In practice, this means the readiness work does not start in the town hall. It does not start with the change-management deck. It starts with the executive team, in a room with far fewer chairs than they are used to, doing the honest work of naming what they are actually carrying into the decision. Not their opinions about the strategy, those are cheap and always available.
What they are carrying.
What they are afraid of.
What they have not said.
What they are protecting.
This is Gestalt work, and it is uncomfortable. Most executives have spent their careers being rewarded for not doing it. But I have watched, repeatedly, what happens when a leadership team does this work before a major decision, versus what happens when they skip it and hope the plan will carry them.
The teams that do the work do not always agree at the end of it. Sometimes they change the strategy. Sometimes they change the sequencing. Sometimes they realize the decision they thought they were making is not actually the decision in front of them.
I am both fragile and hard-core. I have said this out loud in more executive settings than I ever expected to, and every time I say it, someone in the room exhales. Because most senior leaders are also both, and most of us have been trained to show only the second one, and the cost of that training, to us, to our teams, to our organizations, to the patients and communities we serve, is enormous and largely invisible.
The invitation I want to offer, to the executives and board members reading this, is not to become soft. I am not soft, and neither is the work.
The invitation is to notice that the plan you are trying to execute is being received by an organization that is reading you more carefully than you are reading yourself. And to consider that the highest-leverage thing you could do this quarter is not another off-site, or another dashboard, or another restructure.
It might be a walk. It might be a conversation you have been avoiding. It might be the work before the work.
So my question, for the leaders in this network: what is the piece of internal work you know you have been putting off, the one you suspect your team is already paying for? You do not have to answer me publicly. But I would ask you to answer yourself honestly, sometime before your next project launch.
I will be here chilling with Rapha.
#HealthcareLeadership #TheShiftMethod #GestaltLeadership
