What two healthcare executive search leaders are discovering about earned authority, cultural intelligence, and sustainable leadership.
Finding the right healthcare executive is one thing. Helping that leader succeed once they arrive is another. That’s where healthcare leadership and organizational culture become inseparable.
Neill Marshall and Kurt Mosley of HealthSearch Partners have spent decades helping healthcare organizations find their leaders. What captured my attention was their curiosity about what happens after a leader accepts the position.
Their Earned Authority: First 90 Days initiative began with a surprising conversation. Richard Parks, an experienced healthcare CEO, told them that when he accepted a new position, he moved into the hospital for his first 90 days, sleeping in the accommodations used by medical residents.
Neill, who has interviewed thousands of healthcare executives, had never heard anything quite like it. What other unexpected practices might help new leaders earn trust? That question launched dozens of conversations and a remarkable collection of leadership stories.
I love that their work began with curiosity rather than certainty. And, as it turns out, that’s how our paths crossed.
One conversation leads to another
Earlier this year, I presented a national webinar for the American College of Healthcare Executives (ACHE) about cultural intelligence and the everyday behaviors that shape organizational culture.
Joy Mason, an ACHE colleague of Neill and Kurt’s, heard a story I shared about a hospital CEO whose small behavioral change had an unexpectedly wide impact. Later, when Neill and Kurt were discussing their research with Joy, she recognized a connection and suggested they get to know me.
After reading their work, I understood why. They weren’t simply interested in placing talented leaders. They were exploring what helps those leaders and their organizations thrive together.
We scheduled 30 minutes to talk. An hour later, we were still exploring questions together. Their stories sparked questions, my experiences offered another perspective, and together we began seeing possibilities none of us had brought into the conversation alone.
What does a leader communicate without saying a word?
Neill and Kurt shared the story of a newly appointed CEO at Children’s Mercy in Kansas City who began riding the employee shuttle. It wasn’t originally his idea. Someone mentioned they’d heard he planned to do it. He hadn’t, but recognized the opportunity and decided to try.
Riding alongside employees, he heard experiences that might never reach the executive suite. His colleagues even teased him about information coming from his “shuttle buddies.”
Neill explained that such everyday actions reveal a leader’s values more powerfully than announcements. That reminded me of Sue, a hospital CEO I once coached.
Sue was exhausted and convinced that the answer to her organization’s difficulties was to work harder. When I asked what she needed, she acknowledged that she desperately needed a break. A vacation wasn’t possible, but she could take a real lunch break.
She began bringing her brown bag to the cafeteria each day. Gradually, colleagues joined her, conversations emerged, and more employees began taking breaks. Sue later reported improvements in morale and patient outcomes.
Neill recognized the connection immediately. He called these symbolic acts, behaviors that quietly communicate what matters.
His observation helped me see Sue’s experience differently. By honoring a need she’d been minimizing in herself, she’d given others permission to do the same.
One CEO moved closer to employees by riding a shuttle. Another moved closer to her own humanity by taking a lunch break. Both created opportunities for connection.
How do you learn rules nobody has written down?
Neill raised a question I particularly appreciated. A new CEO needs to learn an organization’s culture before changing it. But how does that leader discover cultural rules nobody has written down?
I suggested that a listening tour also needs to be a watching tour. Notice who speaks in meetings, whose ideas receive attention, and what happens when someone disagrees. These interactions reveal what people have learned is valued, acceptable, or risky.
But another consideration emerged: The new CEO isn’t simply observing employees. Employees are also observing the CEO, learning what their new leader values, welcomes, and expects.
Authority changes what people feel comfortable saying. Someone previously punished for speaking honestly may need repeated evidence that openness is now safe.
Riding the shuttle once might make an impression. Riding it consistently allows relationships and trust to develop.
We were discovering that learning a culture and influencing it happen simultaneously.
Be quick, but don’t hurry
As we explored how leaders might understand unfamiliar circumstances, Kurt offered a phrase from basketball coach John Wooden: “Be quick, but don’t hurry.”
I loved that. Be quick to listen, but don’t hurry to draw conclusions.
Neill had asked about my article, What if the Person Isn’t the Problem? How might a CEO recognize when an apparent people-problem is actually being shaped by the organizational system?
I recalled coaching a financial institution CEO whose employees had stopped collaborating. His angry reactions had taught them to keep their heads down. Everyone was frustrated, and their responses reinforced the behaviors they wanted to change.
Rather than assigning blame, we explored what the CEO could change in his own behavior. As he learned to recognize his reactions, establish clearer expectations, and take an interest in employees, relationships softened.
What interested Neill was whether a new CEO could recognize such patterns before they became entrenched.
Kurt’s reminder brought our thinking into focus. What appears to be resistance may reflect legitimate concerns, previous experiences, or a system that makes change difficult. Understanding those circumstances doesn’t diminish accountability. It makes accountability more informed and compassionate.
When listening becomes something people can trust
Neill kept pressing. Why might a quiet leadership action carry more influence than a strategic announcement? What happens when employees have learned that speaking honestly carries consequences?
His questions brought us to the difference between inviting honesty and making honesty safe.
Employees notice what happens after they speak. Are concerns acknowledged? Can people disagree without punishment? Does the leader explain decisions, even when everyone doesn’t get what they hoped for?
Over time, those responses teach people whether they can trust their leader’s invitation to speak openly.
The leaders Neill and Kurt were studying demonstrated their intentions through repeated actions. Cultural intelligence helps explain why those practices matter. People experience the same workplace differently, and leaders can learn from those differences and adapt their behavior.
Perhaps they change how meetings are conducted, reconsider an inefficient process, or hold a difficult conversation with compassion and clear expectations. What matters is that people experience their perspectives being genuinely considered.
Beyond the first 90 days
By the end of our conversation, I appreciated Neill and Kurt’s work even more. Their curiosity about helping newly placed executives succeed had opened a door to something larger.
Their questions helped me see new dimensions of my own work, just as our conversation revealed connections between theirs and mine.
Neill and Kurt are exploring how executives earn authority through everyday behavior, relationships, and trust. My work in cultural intelligence explores how leaders can become more aware of the cultural systems they’re helping create—and how they can intentionally shape conditions in which people feel valued, communicate openly, and contribute their best.
Together, our perspectives invite two questions:
- How am I earning the trust of the people I’ve been entrusted to lead?
- And how am I using my authority to help those people feel valued, heard, and able to contribute their best?
What touches me about Neill and Kurt’s work is that their concern doesn’t end with a successful placement. They want the relationship between leader and organization to take root and flourish. In healthcare, those relationships matter not only to employees, but ultimately to the patients they serve.
Our conversation began with the first 90 days and led us toward sustainable leadership.
The authority that comes with a position may be granted on the first day. The trust that makes leadership sustainable is cultivated through the days that follow.
And every conversation, decision, and interaction offers another opportunity to cultivate it.
This article grew from a conversation with Neill Marshall and Kurt Mosley of HealthSearch Partners about their Earned Authority: First 90 Days initiative. Dr. Amy Narishkin is a cultural intelligence strategist, executive coach, and author of the book, The Communication Connection: Confidently Create a Cohesive Culture One Conversation at a Time.