This newsletter exists because I believe healthcare is worth fighting for — and because I believe the people inside it deserve better than what the current culture is offering them.
As I’m building my business and speaking with healthcare leaders about my coaching programs, I get a lot of requests for return on investment data — ROI they can take back to their organizations to get coaching reimbursed. I give them data. I give them testimonials. I speak to the unmeasurable benefits.
Guess which ones they want to talk about most?
Not the unmeasurables.
That is the headspace of healthcare. And it’s exactly what this article is about.
I spent 15 years as a healthcare leader. I managed individuals and small/medium/large teams. I sat in boardrooms and budget meetings and strategy sessions, and I can tell you with confidence: we have become excellent at measuring the wrong things.
We measure patient satisfaction scores. We measure throughput. We measure overtime hours and incident reports and compliance rates. We build dashboards and run reports and hold leaders accountable to numbers that, on paper, look like health. We would then erase what we had built, it was never sustainable and then we would build new dashboards and spreadsheets to track it in a new way.
But here’s what the dashboard doesn’t show you: the charge nurse who cried in the supply room before her shift because she doesn’t feel seen. The manager who stopped advocating for her team because every time she did, she was told to “stay in her lane”, “You have a lot to learn about building relationships”, “You’re not focusing on the right thing”. The physician who left a 20-year career because she couldn’t reconcile who she became at work with who she was at home.
The metric that’s bankrupting healthcare culture isn’t on any report I’ve ever seen. It’s the slow erosion of purpose.
When compliance becomes the culture, care becomes a performance.
We Have a Name for This Problem — and It’s Older Than Healthcare
In the 1960s, U.S. Secretary of Defense Robert McNamara became convinced that the Vietnam War could be won through data. His team tracked one metric above all others: body count. If enemy casualties were high enough, the numbers said, the war was being won.
The problem was that the numbers were lying.
Body count was measurable. Morale was not. Strategic momentum was not. The will of a people fighting for their homeland was not. So those things got ignored — not because they didn’t matter, but because they didn’t fit on a spreadsheet.
The result was one of the most catastrophic strategic failures in modern military history. Thousands of lives lost in pursuit of a metric that captured almost nothing about the actual reality on the ground.
Philosopher Daniel Yankelovich later named this pattern the McNamara Fallacy: the tendency to make decisions based solely on what can be quantified, while dismissing everything that can’t — not because it’s unimportant, but because it’s inconvenient to measure.
Here is the uncomfortable truth: healthcare organizations are committing the McNamara Fallacy every single day.
We have become so fluent in the language of metrics that we’ve forgotten the language of meaning. We track everything we can count and quietly stop accounting for everything we can’t. And just like in Vietnam, the numbers look fine while something essential is collapsing beneath the surface.
I’m Not Anti-Accountability. But the Fallacy Is Costing Us Everything.
I want to be clear — metrics matter. Outcomes matter. Patient safety absolutely matters. But when leaders are only evaluated on what gets done and never on how it gets done, something insidious happens.
They stop leading and start managing compliance.
They stop asking “how is my team doing?” and start asking “how do my numbers look?”
They stop building trust and start building armor.
And the people under them feel it. Maybe they can’t name it, but they feel it — the difference between a leader who sees them and a leader who needs something from them.
There’s a phrase I’ve heard in healthcare settings that I want to name directly, because I believe it does more damage than most leaders realize: “Everyone is replaceable.”
It’s a corporate mindset. A numbers mindset. The belief that people are interchangeable units in a workforce equation — that no one is special enough to warrant real investment, real listening, or real care.
In most industries, that mindset is corrosive. In healthcare, it is something worse.
Because here is what I have watched happen: when leaders carry the belief that their staff are replaceable, their staff begin to feel like they don’t matter. And when staff feel like they don’t matter — when they feel unseen, unvalued, and expendable — they cannot show up fully for the people in their care. The mindset flows downstream. Leaders who treat nurses as replaceable create nurses who feel replaceable. And somewhere at the end of that chain is a patient, who deserves to be treated as irreplaceable, being cared for by someone whose own humanity has been quietly dismissed.
This is a patient safety problem. A “everyone is replaceable” culture is a hostile work environment by another name. It is the antithesis of psychological safety. And it has no place in healthcare.
Frankly, I find it disgusting — and I think anyone who has spent real time at a bedside would agree.
The things that don’t show up on the dashboard — psychological safety, trust, a sense of purpose, the feeling that your work matters — are not soft extras. They are the load-bearing walls of a functioning healthcare culture. When we strip them out in pursuit of cleaner metrics, the building doesn’t fall immediately. It just quietly becomes unsafe.
The Research Is Not Subtle on This Point
Psychological safety — the belief that you can speak up, make mistakes, and be your full self without fear of punishment — is one of the strongest predictors of team performance we have. Google’s Project Aristotle found it to be the single most important factor in high-performing teams. Studies across healthcare organizations consistently link it to reduced errors, lower turnover, and better patient outcomes.
And yet, most leadership development in healthcare doesn’t teach it. Most performance reviews don’t measure it. Most organizations don’t even have a shared language for it.
We’re leaving one of our most powerful tools on the table because it doesn’t fit neatly into a spreadsheet. The McNamara Fallacy, playing out in real time, in hospitals and health systems and outpatient clinics across the country.
So, What Does It Look Like to Lead Differently?
I’ve spent years working with healthcare leaders who are tired of leading from fear — fear of the next survey, fear of their own leaders, fear of saying the wrong thing or losing the wrong person or missing a number that was always just out of reach anyway.
What I’ve watched them discover — and what I believe in my bones after 15 years in this work — is that the shift from compliance-driven to purpose-driven leadership isn’t a personality overhaul. It’s not about becoming someone you’re not.
It’s about three things. I call them Cost, Clarity, and Choice.
Cost is about telling the truth about what the current culture is actually costing you — in turnover, in engagement, in your own energy, in the kind of leader you want to be. Most leaders are absorbing enormous costs without ever naming them. The McNamara Fallacy has trained us to discount these costs because they’re hard to quantify. But they are real and naming them is the beginning of change.
Clarity is about getting honest about the kind of leader you actually want to be and the kind of environment you want to build. Not the buzzword version. The real, specific, lived version — what does psychological safety look like on your unit, with your team, given your constraints?
Choice is where agency comes back. Because once you see the cost clearly and you have a picture of what you’re building toward, every day becomes a series of small brave choices. Not a dramatic transformation. Incremental, intentional, sustainable change.
That’s where the work actually happens. And that’s where culture actually shifts.
This Is Not a Soft Skills Problem
I want to name something directly because I’ve heard it too many times: purpose-driven leadership is not a soft skills problem. It’s not about being nicer or more emotionally available or holding more feel-good team meetings. It’s about building teams that are safer, more effective, and more resilient — which ultimately shows up in exactly the kind of metrics your organization cares about.
Brave leadership is good business. The data supports it. The human experience confirms it.
Healthcare is in crisis. Burnout is at historic levels. Turnover is devastating units. Leaders are leaving the profession they trained a decade to enter because the culture is unsustainable. We are not going to solve this with another compliance training or a revised policy.
We’re going to solve it by investing in leaders who are willing to do something genuinely difficult: lead with intention, build trust on purpose, and create the conditions where their people can do the best work of their careers.
We’re going to solve it by refusing to let the McNamara Fallacy have the last word.
That’s the Work I’m Committed To
If you’re a healthcare leader who has been doing this job long enough to feel the gap between who you were when you started and who the system is shaping you to be — I want you to know that gap is real, it’s not your fault, and it’s not permanent.
The culture can shift. It shifts when leaders decide that what can’t be measured still matters. It shifts one brave leader at a time.
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I’m currently enrolling a small cohort for the Brave Culture Shift Lab — a 90-day group coaching program for healthcare leaders who are ready to move from compliance-driven to purpose-driven leadership. We start March 5th. Enrollment closes soon.
If this resonated, I’d love to have you in the room. Learn more and enroll here: Brave Culture Shift Lab.
Or drop a comment or send me a message — I’m happy to answer any questions directly.