Early in my career, I sent an email to an entire department that opened with two words: effective immediately. I was a clinician used to leading a team, and I had made a decision about a prep process. We were changing who did one step in it, to prevent defects and misses. I was confident in the change. I am still confident it was a good one.
The response to the email was silence.
The response in person was different. A few members of the department pushed back. A few made mild fun of it. In the end the change took hold, and the group accepted it reasonably well. What stayed behind were occasional comments about my tone, and one or two about my lack of humility.
I had been right about the process and careless about everything around it. It took me longer than I would like to admit to understand that those were two separate accounts.
Leadership is not one dial
We tend to talk about leaders on a single scale, from poor to great, with good somewhere in the middle. James Bailey, who teaches leadership at George Washington University, took that scale apart in a 2016 piece for Harvard Business Review. He disputes “the stubborn resolve that great and good are points along the same stream.” Great, in his telling, “is a force.” It moves people and organizations. Good is about “protecting and advancing widely accepted principles,” the direction that force is pointed. A leader can have either one without the other.
Draw the two as axes and you get four kinds of leader. Bailey calls the leader with both vital. The leader with principles and no force is amiable. The leader with neither is vacant. The leader with force and no principles to steer it is maleficent, “meaning capable of causing harm.”
The labels matter less than the claim underneath them. If force and principle are separate, then more of one does not make up for less of the other. A surplus in one account does not pay down a deficit in the other.
Trusted to deliver, not trusted to lead
One of the clearest examples I have seen was a surgeon who chaired his department. He was very skilled, and everyone trusted his clinical decisions. He was also command-and-control in nearly everything he did, and distant from the members of his department and from other leaders across the organization. For a long time, that was enough.
Then the organization needed significant change across its clinical enterprise, and the department needed someone to carry its voice into that work. It was not going to be him. His colleagues trusted his hands. They did not trust him to represent them, or to bring the change back to them in a way they would follow. Eventually, the chair seat passed to someone else.
Heidi Gardner, who studies collaboration among professionals at Harvard Law School, gives this split a name. She separates competence trust, faith in someone’s “professionalism, skill set, and capabilities,” from interpersonal trust, which turns on “character and intentions.” Her description of having the first without the second is close to what I watched. “Even if you’re the only person who can help me, if I really don’t trust you interpersonally, I’ll basically keep you in a box while we’re solving this problem.”
He had a surplus of the first kind of trust. It did not buy him any of the second.
A behavior, not a person
It would be easy to stop there and file the surgeon and my younger self in the same box. Kim Scott would object, and I think she would be right.
Scott’s Radical Candor grid uses two different axes, caring personally and challenging directly. Challenge without visible care is what she calls obnoxious aggression: “You challenge, but you don’t show you care.” That describes my email well. Her own guidance on the grid is blunt, though. These are “behaviors everyone slips into sometimes, not personality types.” And: “Please don’t write anyone’s name in these boxes.”
I now sit on the other side of that email. Every so often, someone who reports to me sends their own version of effective immediately to their team. I usually agree with the decision. My response is almost always a groan, and a note to coach them on the style rather than the content.
One tenet of coaching I hold onto is that people are creative, resourceful, and whole, and that a good question unlocks what they already know. So the coaching is almost always some version of the same questions. Have you received any feedback or response to your message from the other day? Then, regardless of the answer: have you re-read it since you sent it? If not, take a quick look now. If so, what might you have done differently, in hindsight, to better deliver an important message?
Those questions mark the difference between the two stories. I landed in the wrong box for one email, people told me, and eventually I heard them. The chair stayed in his for years. Whether anyone told him, I do not know. For me the box was a moment. For him it became a description.
Where the maps disagree
These three maps do not line up neatly, and it is worth exploring where they don’t. Bailey’s amiable leader is principled but lacks force, “friendly and pleasant to be sure, but not necessarily animating.” That is a different failure from Scott’s ruinous empathy, which is care that withholds the challenge. And Gardner’s distinction is not about the leader’s behavior at all. It is about what the people around the leader decide.
Bailey’s map also lets my email off the hook. The decision served a sound principle, and the email certainly had force. By his test it was vital. The cost showed up only on the other two maps, in the care Scott asks for and the trust Gardner describes. That is the reason to read all three.
Three maps, drawn for this essay. To see each framework as its author published it: Bailey’s original in Harvard Business Review (HBR limits free articles), Kim Scott’s Radical Candor grid, and Gardner and Matviak on competence and interpersonal trust.
I’d argue the disagreement is useful. Bailey describes what the leader brings. Scott describes how the leader behaves in a single conversation. Gardner describes what the people around the leader conclude after enough of those conversations. They are looking at different sides of the same relationship, and they draw their boxes in different places. The one thing all three agree on is that the axes are separate. None of them lets you trade one for the other.
Why strong clinicians end up there
The strongest objection to all of this comes from the operating room. When a patient is crashing, force without consensus is correct. We train for it. A clear voice saying what happens next, right now, protects the patient, and a leader who stops to build consensus in that moment is doing harm. Effective immediately is sometimes exactly what a clinical decision requires.
I agree with all of that. It is also why so many of us land in the wrong box in other circumstances. The operating room rewards force and competence trust, and so do most of the ways we pick clinical leaders.
Interpersonal trust is clinical work too, and in anesthesia it is the entire challenge of meeting a patient. Patients have consults and pre-op visits to build a trusting relationship with their surgeon, and time to decide whether they trust that relationship before an elective surgery. They usually meet their anesthesia care team on the day of surgery, often for only a few minutes, immediately before heading to the OR. We get minutes to do the same thing, often while the patient is at their most stressed.
We choose the clinician everyone wants on the hard case. Then we ask them to lead a group of peers who do not report to them and do not have to follow them, where the work runs on principle and interpersonal trust, built over months instead of minutes.
Later this week I will spend two days with the clinical council I chair. Most of the people in that room were chosen, at least in part, for how good they are clinically. I was too. That alone will not carry the conversations we need to have. What carries them is whether the people at the table trust each other’s intentions as much as they trust each other’s hands, and whether any of us can say “here is what I think we should do” without saying effective immediately.
Two ledgers
I still believe in the change I made all those years ago. The process was better for it. But the accounts never merged. Being right about the process did not earn me any trust as a person, and the comments about humility were the bill.
If you lead clinicians, or are about to, look at both ledgers. Ask what you are trusted to deliver and what you are trusted to be. Then, before you send the next one, look for the words effective immediately and ask whether the moment requires them.
Sources: James R. Bailey, “The Difference Between Good Leaders and Great Ones,” Harvard Business Review, September 2016; Heidi K. Gardner and Ivan Matviak, “Implementing a Smart Collaboration Strategy, Part 1,” Harvard Law School Center on the Legal Profession, 2020, and interview; Kim Scott, Radical Candor, “Our Approach”.
The minutes-versus-months point hit home, David! Walking someone through what the next ten minutes would look like was usually the whole trust-building window before we rolled back. Thank you for writing this one.