Lead Well MD: Transforming Healthcare Through Effective Clinician Leadership
Welcome to Lead Well MD where we dive into the art and science of effective clinician leadership. Through compelling stories and insightful conversations with guests from across healthcare, we explore the intersection between the foundational skills of emotional intelligence and effective clinician leadership. We examine how leaders can drive meaningful change and transform how they care for their teams, their organizations, and their patients.
Join Ashley Wendel, MA—physician leadership consultant, 1:1 advisor, and trusted guide—as she shares practical leadership tips and strategies honed over 17 years of partnering with clinician leaders like you. Each episode is designed to empower you with tools to lead more effectively and inspire change within your teams and organizations.
Our mission is to help you understand yourself and others more deeply while building the critical leadership skills needed to make a lasting impact. Together, let’s equip you to be the most effective leader possible, driving meaningful and transformative change in healthcare.
Tune in and lead well—because your leadership matters more than ever.
Lead Well MD: Transforming Healthcare Through Effective Clinician Leadership
"Building High-Trust Teams in High-Stakes Environments: Lessons From The Battlefield" with Randall Wickman, Col. (Ret.) US Army
In this powerful episode of Lead Well MD, we step outside of medicine and into the world of military leadership — but stay firmly rooted in what matters most: building trust in high-stakes, high-pressure environments.
Ashley is joined by Colonel Randall Wickman, a retired U.S. Army Infantry Officer, combat-wounded veteran, and former Pentagon leader who now works in healthcare leadership development. With nearly 30 years of active duty, Colonel Wickman has led soldiers in some of the most intense environments on earth - and he brings battle-tested wisdom directly to clinician leaders navigating the chaos and responsibility of modern healthcare.
Together, they explore:
- Why trust is everything when the stakes are high
- A three-part framework for trust: competence, character, and reciprocity
- How quiet teams - not loud ones - are often the ones in crisis
- How structured reflection builds accountability and prevents blame
- What it means to truly earn the title of "leader" - in the OR, on the floor, or in combat
If you’re a physician leader navigating burnout, team dysfunction, or the isolation of responsibility, this conversation will change how you think about trust - and how you build it.
Hi everyone, I'm Ashley Wendell and this is Lead Well MD, a podcast that explores how leaders can transform healthcare through emotionally intelligent, effective clinician leadership. So today we're stepping slightly outside of clinician leadership, but staying right in the heart of what matters most. Leading people in high stakes, high pressure environments where trust is not optional, it's everything. I'm joined by Colonel Randall Wickman, a retired U.S. Army infantry officer, combat wounded veteran, and former Pentagon leader, now working in healthcare. With nearly 30 years of active duty, Colonel Wickman led soldiers in some of the most intense environments on earth, and now brings those lessons to healthcare where leadership under pressure is a daily reality. In this conversation, we dig into the parallels between military and clinical leadership and what it really means to build high trust teams when the stakes are sky high, whether you're on the battlefield or in the OR. You'll hear powerful stories, clear frameworks, and lessons that translate directly into how we show up as leaders in healthcare. So let's get started. So today we're going to deviate a little bit from my usual conversations with physician leaders, but we're going to stay in very relevant territory. And I am thrilled to have Randall Whitman with me. Randall is a highly decorated U.S. Army infantry colonel, a former Pentagon leader, and a combat wounded veteran with nearly 30 years of active duty service. He led soldiers from platoon through brigade levels, commanding units at the company, battalion, and brigade echelon. And since 2022, Randall's been acting as the chief operating officer of J3P Health, which is a premier human and organizational development firm in healthcare. So Randall, I'm so, so happy to have you here with me. Thank you for being here.
SPEAKER_01:Thank you, Ashley. I'm glad to be here today and working with you.
SPEAKER_00:Your military background is extensive, and I really just want to pause for a moment and share a little bit about that, if that's okay. You commanded the Khyber Joint Border Coordination Center in Torkham, Afghanistan.
SPEAKER_01:Correct.
SPEAKER_00:You served as a military diplomat between the International Coalition Pakistan and Afghanistan. Correct. You led soldiers during combat tours in Iraq and Afghanistan and peacekeeping missions in Bosnia and Herzegovina. Yes. Which is impressive. Yeah. Your awards... include medals for combat tours, the Purple Heart, and medals for exemplary performance and service. And I just want to pause for a moment and acknowledge that. It's really impressive. It's something.
SPEAKER_01:Thank you. The professions of medicine and military officership, leadership in particular, is closer in parallel than most people think. And since I've been able to walk in both worlds now, I believe that to be true. So hopefully what I know And what I've learned along the journeys that you've just kind of outlined there is helpful to your listeners today.
SPEAKER_00:Oh, absolutely. A couple more things I want to share about some of the leadership positions that you've had in the past. So you have been a commander and professor of military science at Marquette University and the military science department chair for the U.S. Army, Navy and Air Force programs. You served as commander of a basic combat training battalion, raising new soldiers over two years. You know, big job. Yes. You're also a graduate of the Army's premier small unit leadership course known as Ranger School.
SPEAKER_01:That is a test, indeed.
SPEAKER_00:That was a test. And you're a senior parachutist and jump master, so I'm impressed by that, of course, something I would never, never do. And on top of all that, you hold an executive master's degree in organizational psychology from Columbia and a master's degree in diplomacy from Norwich University. So I just have to say I'm incredibly impressed by your background.
SPEAKER_02:Thank you.
SPEAKER_00:So you're working in health care now. Correct. Which is an interesting shift. So why did you decide to move into health care?
SPEAKER_01:Sure. When I came out of the military, I worked in defense for a while as a private citizen. And it became apparent to me that when I was no longer working with the soldiers, that it didn't bring me the same kind of fulfillment and joy that it did. So just being associated with the military, but from the outside, it was no longer holding that spark or that vocational call that I'd had while being in the military. So I said, well, where else can I help? Where else can I lead, albeit indirectly? How can I help? And it occurred to me, people started asking, well, what makes you happy? And I found the parallels, as I said, in health care. Those who are clinical leaders or nursing leaders or administrative leaders in health care, they are to a following a vocation or a calling. And it's not so dissimilar from military leadership. And I found a home in there. And then I found that what I learned knowledge-wise is applicable to the leaders in healthcare. And I said, this is a home I was meant to find. This is where I'm supposed to be taking what I know, replace military terminology and reference points with clinical or healthcare reference points and And it translates. And that kind of became a second vocation in life. It started out as a crazy idea and became a vocation.
SPEAKER_00:And a calling, it sounds like. And a calling, correct. I never knew that. It is important. I think people do feel called to health care. They do feel called to being in that environment and patient care and optimizing that and helping people be better in that. I mean, I feel very similar in that way. So I love that. So today, the topic I really want to dive into deeply is this idea of building high trust teams and high trust cultures in very high stakes environments. And that's where, in my mind, I see a lot of the overlap between military and clinical. And so you've led teams in some of the most high pressure, intense environments imaginable, you know, as I can imagine it. How do you define trust in that context in your
SPEAKER_01:past? Great question. So far, my experience is that trust comes in three parts. But the first one is, do I trust the team members' competence? Are they... Are they educated and able to use the skills that we need them to have for that aspect of a team? It's not much different than a high-performing sports team where every member of the team has to know their individual capacity and be good at it, but then also be good as part of a team, complementary being inclusive or inclusive with the other teammates. Because if you're just a rock star by yourself, then you are not a team and that's a big organization. So the trust aspect comes the first part in being capable to do what is expected of you consistently and reliably over time, both in a training or a relaxed setting, but also under extreme pressure of, say, a surgery or an emergency room or the back of an ambulance bumping around or, in my case previously, was in combat or in high-intensity training. The second aspect of that thing is the type of trust that comes from the human aspect. Do I know you well enough so that i know under regular circumstances or in stress circumstances that i can generally predict your behavior and how it relates to your capacity and competence to do what is necessary from your skill set
SPEAKER_00:right right
SPEAKER_01:and that how is your response going to be predictable so i have to trust the competence i have to trust you as a human
SPEAKER_02:yep
SPEAKER_01:And know you well enough that you will perform the following way so that it's predictable. And then when I integrate the individuals as part of a team, how will the team respond in the following circumstance, both competence-wise and capabilities? And then assurance, when you break it down into their DNA, how will they do it? The third aspect of that is the reciprocal one. And this is what I frequently see a lot of leaders miss. They somehow feel anointed, if you will, to sit at the top of the pinnacle. Well, I think the third aspect of trust is, are you the leader reciprocal in nature that you also have leadership competence and you have technical competence and then you are also trustworthy and It's human because I don't know that enough leaders understand they have to earn their followers respect and have earned trust. And I think that's where a lot of them are blind. But there's three aspects. I have to trust your competence. Right. Trust you as a human. And then I have to, as your leader, there has to be a rest of process. You have to trust me. Right. Right. To be a cohesive team, the leader and the lead, the leader and the followers that are symbiotic. Right.
SPEAKER_00:A couple of things you just remind me of too, when you talk about the competence and the character, that reminds me a lot of Covey's work around the four cores of credibility, because it is, you can't have trust without either competence or character. And then the second piece about reciprocity, I think is so, so critical. You're absolutely right. Leaders who are walking their talk, they're demonstrating, they're modeling what they're asking of other people, right?
SPEAKER_01:Correct. Yes. And the leader... Who says, do as I say, but not as I do. Right. I, the leader, am unpredictable or I, the leader, would be untrustworthy or I have not earned the trust by some virtue that the followers would say I can get behind that. That is a weak leader. Doesn't mean a bad human, but it means that their ability to lead is incapacitated.
SPEAKER_00:Right.
SPEAKER_01:And you have to know your capacity as a leader. You have to know the humans you're working with. You have to know their skill set and vice versa for it to be a truly high functioning team.
SPEAKER_00:In your experience, are there signs when trust is starting to erode or break down on a team, especially in a high intensive environment? How do you see that when that starts to happen and how do you respond?
SPEAKER_01:Great question. So there's a saying in the army or maybe in the military, and it might even be multinational, but you're okay as a leader if the soldiers are complaining. Because it's in their nature. Nobody willfully takes this on. The pay isn't good enough to make you follow this vocation. Very similar to health care. Ask any nursing leader at midnight. Yeah, how's it going? They're doing it because they love it and they love the reason to do it. As there might be complaining. The time the leader should worry is when there is no more complaining and nobody's talking. That's how you know it's starting to break down. That's a very visible thing. Because when people are complaining or when they're talking with you about how much something is difficult or how hard something is, then you can be reasonably sure that passion, investment, and intent to do well is still there. When things go quiet...
SPEAKER_02:You
SPEAKER_01:should be very worried because that means the intent, the passion has started to fade and the trust is headed out the door. Why say anything? It's not going to matter. I'm just going to sit here until something happens that's really bad. Or I won't do anything because nothing will make a difference. I'm just resigned myself to be in this miserable place. Yeah. So I would say if people are talking with you, they're engaged and they're even complaining or grousing, that's okay. You can work with that as a leader. When all goes quiet, that's close to apathy. The leader needs to be very, very nervous because you're down to one or two things left in your kit bag of tricks to get people motivated again. And the history repeats that. When people finally say, you know what, I can't follow this leader anymore. Yeah. Then you're in trouble. And it's backed up by the simple moniker out there right now, which is people don't quit jobs, they quit their boss.
SPEAKER_00:That's right. And
SPEAKER_01:so when it goes quiet, the leader should be concerned because the leader has just lost followership.
SPEAKER_00:And it's funny because a lot of people mistake silence for agreement, right?
SPEAKER_01:It's worse. It's quite frankly worse. It can be silence is consent. But I would be worried that you know the difference between consent and silence is apathy.
SPEAKER_00:Right. Right. So how did you deal with that if you did see that happening? What was your take?
SPEAKER_01:Yeah, great. So I've been in the circumstances in three aspects of this. I have led soldiers in this context. I have been led in this context. And I have been the leader of other leaders who have been in this context. And I'll walk you through a little bit with each one. As part of the team, you want to demonstrate servant leadership, where you're supporting your higher leader's intent by your own actions. You're conveying the their instructions and their intent from that higher leader down to your folks and you're owning it. You're not... complaining, you do the best you can. And when things start to go sideways, you as the servant leader or a mid-leader somewhat way down and something's coming down from above or outside that's making you do something, this is when your character gets tested. Do you just roll over and say, well, the people above us are all screwed up or they're confused or they don't understand? Or do you do your best to make something of it and lead and influence what you can influence and lead those who can be led, depending on your span of control with that point, do you continue to lead in difficult circumstances that are not necessarily yours to fix? That's the first set of circumstance. And you may also, as an aspect of this, have to reflect back up. You may have to manage up and you may have to carry the water, so to speak, where you're picking up what people are saying in the rank and file, and you have to report that back up and have some moral courage to report back up to the leader who's causing the effects that you're feeling as a good teammate and say, boss, you can do what you want. You're in charge, however, comma. Things you need to be aware of are, and I'm duty bound to present that to you so that you have all the facts at your disposal. That's the first kind of trust aspect in being a subordinate servant leader. Right. The next one is one who's led teams in high circumstances where I've been a member of that team. And in both training or peacetime environments and in wartime or extreme circumstances, I can emphasize a couple earlier points. When trust starts to break down, the very first action I recommend and what I always do is have Have I been clearer? Have I explained our mission, my intent, and my instructions in a clear and concise manner, along with accounting for bottom-up or supportive feedback and input that I could get from a variety of different locations, including your junior leaders? You want to get them to subscribe to be good followers, so you want their input to contribute to the plan.
SPEAKER_02:So
SPEAKER_01:I've also led teams where I have been part of the apparatus that has controlled the outcome. And you want the soldiers to be talking with you. But then when the decision's made, go ahead and do that. The third case I've found myself in is when I have been a leader in both peacetime and in crisis, where I am now responsible for the outcome of leaders who are junior to me.
SPEAKER_02:A
SPEAKER_01:couple axioms I always use, which is a leader teaches the team and a leader builds the team. If I have done all I can to teach my junior leaders, then I can have a reasonable expectation of their performance. I trust them. I would be able to trust or understand their competence. And I would do them as a human and I would be able to understand how they will perform in stressful situations. I've had to. In some cases where the junior leader, I have been clear, the expectations were clear. Yeah. Junior leader has been, I've pulled them aside once for a verbal discussion and compare, contrast their actions against a known pre-established standard.
SPEAKER_00:Right.
SPEAKER_01:The second time I have a problem with them, we're going to put it in writing. The established standard is... And I'm now checking your competence because I've seen a repeat of the behaviors. Now it's going in writing. And so we're at your second warning. And then the third one is, okay, your behavior has remained unchanged or unabated and you are, um, You're performing in a manner that's inconsistent with the expected standards. So that's the, you've hit three strikes. I talked to you once, I put in running twice, writing a third time. Now we have a problem. And so back to trust, I can no longer trust either the human factor that is causing you to have actions that are questionable in character or competence
SPEAKER_02:or
SPEAKER_01:Or I can no longer trust your character and competence in performing what is required to you against the known published instruction standards. So where the trust factor comes in this third case is the people that are working for that junior leader that I'm responsible to guide and direct.
UNKNOWN:Right.
SPEAKER_01:now should have reasonable expectation that I will do the right thing and intervene on their behalf for the greater organization. And I've had to remove leaders because the stakes are too high. Time is too short. I've tried to teach our way out of this. Apparently that has been ineffective. And now the people below them have the right to expect that I will do the right thing and they have the right to expect competent leadership. So if I make that happen, I owe it to them and I owe it to the mission to remove that leader and put somebody else in.
SPEAKER_00:Yeah. Yeah. And establish and maintain trust with the people around that. Because unfortunately, and I hate to say it, but how many organizations have we been inside where poor leadership continues over and over and is just not dealt with? You know, I've seen it many times myself, you know, incompetent leaders, unfortunately, and they're just allowed to kind of stay and do the same thing over and over again.
SPEAKER_01:Right. We'll give them a new title. And we'll just move them to the side versus corrective to modify behavior. Now, of course, tenure, seniority, background, educational redirection or education all bears on that. So this is not a haphazard thing. I'm removing you because I don't like you. No, I can't change the circumstance. And the people that follow you have a right to deserve better. Right, right, right,
SPEAKER_00:right. Right. Which is important. And then secondly, the vulnerability based trust is another level where we say I am safe to be myself. I am safe to bring things up. I am safe to share mistakes or worries or concerns or whatever and know that that's going to be held. Right. So there are two very different kinds of trust. But how in your experience and your background did you see this manifest in teams and did you see that difference?
UNKNOWN:Right.
SPEAKER_01:Absolutely. So when you refer to military officership, it is described most frequently as part art and part science. The competency-based part or the predictive behavior is the science. I will give you the standard. I will teach you. I will let you do it. And then I'm going to further let you teach it and lead others doing it. So that becomes the predictive behavior. There's a competence that goes with that first thing. You have the competence to do what you've technically been trained to do. The second aspect of that, I think, goes to the vulnerability-based. That's the art part of it. And what I would prescribe, I guess, to other leaders is the more you know the human's At the human level that work with you, and the more they know you, that helps you. First, you have to kind of let them see a little bit of who you are, because then they'll show you a little bit of who they are. That helps to that second type of character-based trust that I talked about earlier, where it's the human level. I know that Randall, under the following circumstances, is most likely to do the following.
SPEAKER_02:Right.
SPEAKER_01:So can I... be trusted and be trustworthy on my competence. And then at the human and vulnerability-based level, do people know that I will do the following things generally, normally, or am I on my game or off my game? Am I distracted? Am I struggling? Am I confident? Am I concerned? And people pick up on that, especially in crisis, especially in the ER environment. or the operating room, people know that the leader is handling it or they're not handling it. And part of that is the competency, but then part of it, what's happening to the human. And you know your people, they know you, they can consistently rely on your behavior. And that's because they know Randall. And I know them, not necessarily by name, hopefully I do, but I know the human that I am talking to to give you that insight because that will be a variable that plays on and either amplifies or mutes the competency aspect of trust. And a leader that doesn't understand this, you can meet with disastrous results because certain behaviors present themselves that no competence can pull them out of. On the other hand, if the person is both competent and you know them as a human, you can expect great, great, great things from them.
SPEAKER_00:Well, let me ask you, do you have any... examples or stories where this kind of trust, this level of trust really made a difference in an experience that you had? I think I've
SPEAKER_01:got one example without going into too much detail. This is a longer story, but I'm going to give you a snippet that I think talks about both character and competence and the predictive and vulnerability based type behavior. So this was my most recent deployment to Afghanistan. And there was a few dozen of us up on a kind of on a mountainside. And it was I'm going to describe a little bit about it so you can get the context. The physical location where we were was surrounded on high ground by mountains and all this kind of news. So, you know, if you put enough bad guys up there, we're in trouble because we're down below. So they immediately have the high ground, so to speak. And literally, they have the high ground. And that makes it really hard for people who are down below. There's really nowhere to go. We're also positioned along a road where you can drive vehicles and pedestrians are going back and forth. So we are in a very undesirable location. We just had to be there because that's where we needed to be. And we knew that. And that kind of comes into play later. It was... night. It was dark out and it was the night after Thanksgiving. I remember very, very clearly because there were leftovers from what we had assembled as a Thanksgiving meal in the far reaches of Afghanistan in the middle of the night. And I said, I'm going to sit down and I'm just going to sit here quietly by myself, kind of collect my thoughts, and I'm going to have what leftovers from the Thanksgiving dinner they helicoptered into us. And I hadn't taken more than two or three bites, but there's a huge Huge explosion. And the ceiling kind of did a concussed reverberation. So it drops all kinds of stuff down on. I'm just sitting there by myself with all this stuff falls from the ceiling right out of my Thanksgiving dinner leftovers. I thought to myself, well... That can't be good. And that wasn't because my dinner had been ruined, but because things don't just naturally explode in a good way. So like, OK, it's obviously going on. What I did next is I just left everything or is that got up and I went right to the command post. And as soon as I got in the command post, I was met by my senior chief, which is a senior enlisted officer. And I met my executive officer and we met right where we were supposed to be. And it's chaos. There's people are all running around and there's a lot of activity. And in that moment, I'm putting my gear on so we can go figure out what's going on outside the command post. I looked over at the young officer who is trying to run the command post for us, the young battle captain. I paused and I looked him right in the eye. And he looked back at me and the radios are going and people are running around. There's yelling. And I looked him in the eye and he nodded. And I nodded. In the next moment, I looked at my executive officer and my senior master chief and we looked at each other and we each kind of put our helmet on tight, grabbed our rifles and both of us, we didn't say anything, we just nodded. But it was eye contact. It was very powerful in that moment. And in that moment, what that look is doing is reestablishing trust. This isn't good.
SPEAKER_00:Right.
SPEAKER_01:We're in this together. Right. I've got you. You've got me. We've got each other. I did it with the battle captain without saying a word. I just looked at him and he knew I trusted him to make decisions he needed to do. He knew he had my authority to do so. Same with my XO and my senior master chief. And we then the three of us, my senior noncommissioned officer, my executive officer, we headed out in the dark.
SPEAKER_00:Based
SPEAKER_01:on a drill that we knew to do. And myself and the senior noncommissioned officer, we went clockwise around the perimeter, stopping at every single fighting position where the soldiers, sailors, and airmen had all gone to the defensive positions in all their full gear. And the executive officer with his radium and went the other way. They went, I guess that would be counterclockwise around the perimeter. And at each and every single position I stopped at, I stopped and I pulled the junior leader in and I got within inches of their face. And it's night, so you can't really see much. And there's all kinds of yelling and hollering. So you have to be pretty close. But in each moment, I looked them in the eye and they looked me in the eye. And then before I left, I either put my hand on their helmet or on their shoulder.
UNKNOWN:Mm-hmm.
SPEAKER_01:And you pause for just a second. And I moved on to the next. And I went all the way around. And eventually, we all met at the other side. And this went on for the better part of the night. Remember, I said we were in a very untenable position. First, what will happen? How will our adversaries come after us? I said, well, they're going to blow up something, put a hole in our defensive perimeter. And they're going to come down from those hills. Or they're going to come up from the road. And so we... And now experiencing what we had thought this would be our worst case scenario. So we stayed ready all night expecting to, you know, face some pretty grim circumstances. But I say this because I want to take you back to have I been predictive in my trust and have I been vulnerability based? I'm going to show you all played out in this story. We had drilled this. I had all the confidence in the world in that young battle captain.
SPEAKER_02:Right.
SPEAKER_01:You know, to be able to do what he needed to do and handle the situation, to send the reports, to gather the information, to do what he needed to do. I had the trust of my senior non-commissioned officer and my executive officer. They all knew what they needed to do because they had trained this. I stopped with every junior leader and looked them in the eye to make sure that they were maybe not calm because it was a very tense situation, but they were in control of themselves. Right. control of their soldiers, sailors, and airmen. So that's that competency trust. Do I trust your competence? And do they trust me? Here's the colonel. We've drilled this a hundred times. The colonel's here. This is exactly like the drill. It's okay. This is just like the drills. They trusted me. I trusted them on the competence side part. Why I look each one of the other humans dead in the eye and held their gaze is And why I put my hand on their helmet or their shoulder. That's the human aspect of it. That's that vulnerability trust. I know you, Sergeant, Lieutenant, Captain, so-and-so, and you know me. We are going to take care of each other and we are going to cover each other's back. We are going to be okay. Or if something happens, we're all going to be in it together. So that was both the vulnerability aspect of it. That was the predictable. competence aspect of it. And then the third part that I like to remind leaders of, where were you at as a leader? Did you set the example? Did your actions match your words? Did you put yourself in the exact same circumstances? And they knew you were in with both hands, both feet, and you were all in just like them and that you were trustworthy, worthy of having earned their trust. So in this brief, and this goes on for the whole night, but For a while. But in the brief onset, within the first hour, this is the example where trust, I thought, and look back on it and say, that is probably one of the moments where all the elements of trust came out in dire circumstances in very short order. Wow.
SPEAKER_00:Yeah, Randall, it's a very powerful, powerful example of everything that we're talking about. What struck me the most is that human contact, the hand on the shoulder. I mean, the eye, but that physical touch too, I think is really interesting. It grounds you. It really hits home that I am, we are here, we're here together, right? That is a very human moment. So that's just an incredible example. So let me pivot for a second. I think there's something that I find kind of interesting around creating avenues for structured reflection. And I think the military does this really well. Right. With things like briefings and you look at reviews after. Right. How do you think these these pauses to reflect in a very structured way help teams and help trust and help alignment on on teams like that?
SPEAKER_01:And I would I would encourage organizations to consider making this part of their culture for the individual before you start any rated period or any endeavor in the military. You sit down with the person who leads you. And you do what we call like a leader or an officer support form. Here's the known standard. I've been handed that by the person who is going to be my boss and said, this is what I expect of you. And I respond with, here's what I think my roles and responsibilities are. And then you meet back together. And so at the individual level, down to the entry level service member, up to the highest leaders, there is an agreement right off the bat when it's calm and quiet and it's peaceful. Here's what we can expect from one another. That's the competence part of it. The second thing that we do as an organization, we are huge advocates for the after action review where it's normed in culture, whether it's a combat operation, a peacetime operation, a training environment, could be academic, could be in the field somewhere, could be at sea. You have an after action review to discuss what was the standard,
SPEAKER_02:What
SPEAKER_01:was our expectations or what were our expectations? What was our plan? Then what actually happened? Because that allows you to norm. We have these conversations normally. It's not personal. It's the competence of the organization. We are trying to find things that did not go well so we can address. Is there a systemic functional challenge that needs to be addressed? Is there a training issue that needs to be addressed with one of the members of the team? Right. And very similar to high-performing sports teams or even like an astronaut crew or what have you, they review. How did we do against the known standard? Does the standard need to be modified? Does our education need to be modified? Does our application of the education to the standard need to be modified? And now you've got a very academic, non-personal conversation that keeps the organization aimed at being highly efficient, highly effective, and high-performing. And Again, you may change the standard to maybe the standard is off. It should continue to evolve, but so do the humans. And so that sets you apart as a highly aware learning organization. If you don't do that kind of thing, you are at risk for not being a learning organization. And it's the, in essence, back to one of the first things I said, you've effectively muted the feedback mechanism inside your organization. Now the soldiers have gone quiet.
SPEAKER_02:It
SPEAKER_01:may not be consent. Right. Might be complacency. And now you might be in trouble as the leader. So I always advocate it is normed to set expectations individually and collect the front and then review periodically.
SPEAKER_00:Well, I love that because another thing that I hear often, and I'm sure you hear this too in healthcare and with physician teams and with clinical teams, is sometimes they can devolve into cultures of blame. So things don't go well. People start pointing fingers at each other. Right. And what it seems to me that this sort of structured reflection time gives you that ability to be hard on the process, not the person. Take it away from from being a personal failing or attack and say what went wrong, but not what did you do? Right. It's a very different conversation, I would imagine.
SPEAKER_01:Right. And so the default setting that I would abdicate for and I personally use is that third aspect of trust, which is I the leader.
UNKNOWN:Yeah.
SPEAKER_01:Where is my role first? Before I wag my finger at anybody else, what was my role in this? Was I clear? Was I competent? Was I trustworthy? Have I earned their respect and trust? And if the answer to all the above is true against the printed standard and at the human vulnerability level, then okay, it probably wasn't me. But as I roll into the situation, I'm looking for the details of what was supposed to happen according to a printed known and established That was standard versus what happened. Okay, now we're having an academic discussion or investigation against what happened compared and contrast to what was supposed to happen. So it's just business and it's a very framed, unemotional conversation or process at that point. And then you can worry about what went down later. A leader who wags their finger and says it was all you and not me, that's dangerous. I was taught a very important lesson even before I became commissioned as an officer. I was taught this as a young cadet. You are responsible for all that you can affect. Right. And you are responsible for everything the organization does or or fails to do, and that includes management up, management adjacent to peers, and management down to subordinates. So if you didn't do something, say something, then you might become part of the problem. Right. You better check yourself before you wag a finger at somebody else because that breaks down your trustworthiness.
SPEAKER_00:Yeah, it does. It does. Wow. They teach you that early, huh, in the military?
SPEAKER_01:I learned this as a cadet, and it's a great story, but I remember... One of my mentors was a senior sergeant major who had been multiple tours in Vietnam because when I came in, the people who were teaching the young cadets then were Vietnam veterans.
SPEAKER_02:Yeah.
SPEAKER_01:And the conversation that day, this is probably one of my most two pivotal lessons in life. And I asked the sergeant major and I said, well, how do you handle it then as a leader when somebody has died in combat? Because that can just be, I mean, it doesn't, He'd had multiple tours, so certainly he had seen a fair share. So how do you handle that as a leader when you've had casualties or fatalities? And he walked up. He's a big barrel-chested man. He got right near my face, and he said, I'm going to tell you something, cadet. Never, ever, ever let a soldier die because you failed to train them properly.
SPEAKER_02:You
SPEAKER_01:will never forgive yourself. Those ghosts will haunt you forever. Sometimes the bad guys or circumstances has a good day or they just get the better of you. But it wasn't because you didn't try.
SPEAKER_00:Don't
SPEAKER_01:try. Those ghosts will be with you forever. And from that, I've just learned along the way that I am accountable for everything the organization does or fails to do. And so even if things are going sideways, if I fail to take opportunity to influence to a more positive result. Right. I was either complacent or complicit in the circumstances we found herself in. And a good leader just won't do that. They will hold themselves first accountable to themselves, then accountable to the standard. And then again, they're going to be judged by their people. So you've been ready for that. Right. Or you even walk out to judge anybody else.
SPEAKER_00:That's right. And, you know, I think that that kind of mindset, it permeates. People see that. They feel it. I think that's part of being a trustworthy leader is that you carry that part of things. And one of the things, I think you and I have talked about this before, but this idea that rank doesn't automatically equal trust. And this, to me, would be an exact example of why that is. Sure. I
SPEAKER_01:used to, I believe in that firmly. I would walk into every new organization and of course they always get them all together because you're the boss, you're walking in, you're meeting for the first time. I always introduced myself as Randall. And that unnerved a lot of people. I said, no, no, that's, I am Randall. That's who I genuinely am. That's the name I was given when I was born. That's the way I have been, whom I always will be. Now, the Army tells you that I'm Colonel Wickman. And so he said, okay, we've recognized the competence, the potential in this individual, and we give them to you on the competency portion of it as Colonel Wickman. And that's what you're probably going to address me because you've been told to. But the real metric here is, do you call me, sir?
UNKNOWN:Mm-hmm.
SPEAKER_01:Because not only are you required to, that's one aspect, but really you call me sir because you want to. That's that vulnerable human accountability portion of where I have earned your trust, where it's just natural for you to say sir as a term of deference and respect. I have earned your trust. I've earned your respect. And when things go sideways, I will be there with you in the dark, under a helmet, all our gear, rifle in hand. I'm going to put my hand in your helmet, on your shoulder. I'm going to look you in the eye. And I will be vulnerable with you. And you will willfully call me, sir, because you know I'm in it with you. And thrive or fail together. So I think it comes down to that as a leader. Have you earned that trust? And have you been both competent and human with them?
SPEAKER_00:Yeah. Do you show that? Yep. Yep. So what do you think if you were a fairly new, say, clinician leader that might be listening to this? What advice would you give them in terms of trying to start small, maybe? It might be a mindset shift. It might be an action that they can take to doing this better. What would you say to them?
SPEAKER_01:Yep. I think, and what we would, when I used to teach young cadets, I said that it was going to come in these two aspects. One is your confidence, know your job, do it really well, do it to the best of your physical and emotional and mental capacity. So be competent at your job. So nobody questions it. They look at you and just at face value, you are exceptionally competent against the known standard for that role. That is the first thing. And it's the easiest thing for you to address. And so we tell our young cadets or lieutenants, be competent. The second part of that is a little more difficult, but it's character. Do you resemble somebody who can be trusted and you are trustworthy of their followership or not? If you're for your senior people who are seniors, are you worthy of being delegated authority to do what it is you need to do? So how do you achieve that? I would say that your actions match words.
SPEAKER_00:Yes.
SPEAKER_01:Are as close as you can be to above reproach. And you when you expect things from the people you are leading or demonstrating the desired behavior first. So people would look at you and say, you know what? That leader will never ask me to do something that they are not willing to do themselves. That is one of the simplest things you can do as you start out. Be competent, but then walk the walk that you talk and be the first one to show that this is what right looks like. And people will start to get behind that because that's easy things. We teach it to our young 22, 23 year old leaders. And that's the first thing they start with.
SPEAKER_00:Let me ask you something. This idea of trustworthiness is so, so important. And they say that one of the best ways to start building that is to extend trust out. And that's really hard for people sometimes. And certainly it's hard for people who are in the position where the weight of responsibility falls on them for whatever the outcome is, right? If you're in the OR, at the end of the day, and I hear this from many, many physicians, it's on me, right? Correct. These are situations where, of course, it's harder to trust. So how do people who struggle with that begin to start extending trust out, do you think? A
SPEAKER_01:couple of ways I think you can go about it, because I am aware of the surgical teams a lot of times are experienced. not consistent in being together formed at the point of you do the operation. Ideally, you would know each other beforehand. You've established that human to human, you know, trust type where you've established that human factor. You are finding yourself in a rapidly evolving situation where the surgical team is assembling and you've got your anesthetist, you've got your surgical house staff, you've got your nursing staff is in there and so you're having to build it. Taking a moment's pause a lot of times is The surgical teams will do a check-in, but that's where I would say that's where you're looking for that human aspect. You may have to start with human first, which you might want to try competence first. I'm going to come back to that. So I'm looking around the room. Do I trust your character? And I'm looking you in the eye to see if I get a weird vibe or if we're okay. And they're probably doing the same to you because you're the one that's leading them through the procedure. But then how do you trust but verify? That's the second part where now is I'd be looking for the competence. Am I seeing the behaviors based on what I think your competence and your role and responsibilities is supposed to be? So if I expect something out of you and your role in that surgical team or in that OR emergency room or in clinic or what have you, I'm looking to see, do you demonstrate what I would expect the norm to be of a somebody who's clinically and competent in the similar circumstances? And so that's how I can come at it from the outside, coming in on a pickup team, if you will. I'm going to do a little bit to establish the human contact first. I'm going to watch, I'm going to trust, but verify doing competence being demonstrated. And if I had a weird vibe from the person, When an eye contact thing or in that first moment of bonding, and then I see a couple of things about, you know, a couple of indicators in the competence side, that would hit the brakes.
SPEAKER_00:Trust but verify. Tell me more about that.
SPEAKER_01:You're looking inquisitively because, again, on a trained team that has been together, they've practiced together, that you get a lot out of the training environment. You put yourself out there to see, can we be trusted? Can we be trustworthy? And vice versa. And you do that under the duress and pressure, this crucible, if you will, of training where you have to assume a bit of risk is when you're on a pickup team. You don't know everybody on the team. And so competence might be in question.
SPEAKER_02:So
SPEAKER_01:where I've had pickup teams on the battlefield where you meet somebody and we're going on a mission together in a matter of hours, I can assume you've been sent to me with a degree of competence. And you can assume that I've been sent to you with a degree of competence, respect to our roles and responsibilities. So we're going to give each other the doubt for an hour. And we're going to spend whatever time we have. You'll see soldiers in service, you know, sailors, airmen, Marines, students, all that. You will shoot the shit with each other. You're having a human moment to bond, to build that second type of trust is, do I know you as a human so that we're vested in our mutual outcomes together? Same thing in the OR, emergency room, in clinic, labs, what have you. But then the trust, but verify. Until we know one another better, I'm going to give you the benefit of doubt. Assume good faith that you sent to me with a degree of competence. But if I haven't picked up anything yet, I'm going to watch for a while. As I know you're watching me, do I have the competence to do what's expected of me in my role? So I'm verifying. I trust you, but I'm going to verify that my trust is warranted.
SPEAKER_00:Right.
SPEAKER_01:And vice versa. The leaders always assume that they might be above the law. But no, no, you're being judged every minute you walk in. Everybody's looking at you and they're waiting for you to fail. Not because they want you to fail, because frankly, that's worse. What they're watching for is, can I trust your competence? Right. Will you lead us well?
SPEAKER_00:Right, right, right.
SPEAKER_01:That's the trust but verify.
SPEAKER_00:Trust but verify. I got you. I think the key that I take about that is that you assume positive intent. That's the starting point, right? Yeah. You have to start at that place. And then you're right. You kind of. Right. Now, that's interesting. I like that. OK, so just to kind of put a put a wrap around this, because we've talked about a lot. It's fascinating to me, Randall, all of this. If you could offer what you think the most important mindset shift would be to leaders in health care in this regard, what do you think? What do you think it is?
SPEAKER_01:Absolutely. The first thing is. This is one of the things I always, I mean, I've made it one of my actions, but be, I'm going to give you two things. Be self-aware. The more self-aware you are of your tendencies and your behavior, this is rule number one, the more self-aware you are, the more helpful you can be to yourself in either getting in front of or picking up the pieces afterwards. If I know that I am this type of behavior or this type of tendency, then in the following circumstances, I can get in front of, I can be aware of where I might be self-defeating or self-inflicting here so that I don't lead people in an errant direction or errant manner. So self-awareness, rule number one. Be humble. Just because the leader is is designated as the leader and just because you've got this education or this acumen or even competence be humble you're not special you may be talented but you are not so unique that you can assume some sort of a higher authority that you're this magnanimous or this this super important being you're just a humble part of that team so leader who's self-aware and is both competent but humble, that's someone that people will naturally follow because you come at it from a position of, like I've said, with humility. Was I clear? Did I explain myself? Did I emphasize the standard? That humble leadership will get people to follow you. It's the derogatory type of leadership and the accusatory type of leadership are, you know what, you did wrong. That humble breaks down trust and then people don't want to be around or with that leader. So be self-aware. Second, be humble, be complimentary to your team, be part of the team and pass on positive atmosphere so that when people work with you, around you or depart from being with you, they feel inspired to be better themselves.
SPEAKER_00:Right. That's right. I mean, it's interesting because that is another area that I see a lot of physician leaders struggle with is moving from feeling the need to be that expert in the room, right? It's a comfort zone for them, obviously, because to be successful clinically, they have to be the smartest person in the room to get the outcomes they need sometimes. But to carry that into leadership is really tough. And so I think allowing themselves to lose that guise of having to be the expert and becoming more curious and and becoming more open to opinions and voices of other people and seeing the value in that, I think all of that drives that humility. I think that's so critical, what you just said.
SPEAKER_01:Being humble. You are complementary as in being a part of that team. So you can individually be the best surgeon, nurse, doctor, If you are not able to integrate that with the other elements of the team are only a resource of one. And that takes me back to you're not special. But to be special, to be the one who harvests the best or harnesses the best of everybody that you've got, everything that you can control or influence, you do that. So if I'm able to bring out the best elements of every person in that team, Now I'm a really good leader. Doesn't matter what kind of clinician I am. You want to be competent. But the ones who really lead well is they get the best out of everybody on that team, whether it's a pickup team or an ad hoc team or one that's been together for a long time. They get the best out of that team and each individual and then collectively.
SPEAKER_00:That's right. That's right. I agree. All right. Well, on that note, on that note, Randall, thank you so, so much for being here with me. I really appreciate your wisdom, your insight, your hard-earned insights. I hope you come back another time.
SPEAKER_01:Okay. Be happy to come back.
SPEAKER_00:All right, Randall. Thanks so much. You very much.
SPEAKER_01:Bye.
SPEAKER_00:Bye-bye. If today's conversation left you thinking differently about trust, leadership, or the weight of responsibility, then it's done its job. What struck me the most about Randall's stories is how trust isn't just a nice-to-have in high-stakes environments. It's the foundation for survival, cohesion, and performance. His three-part definition of trust, competence, character, and reciprocity offers a powerful lens for any clinician leading a team today. As leaders in healthcare, you carry enormous responsibility. But Randall reminded us that trust isn't just built from authority. It's earned moment by moment through humility, consistency, and shared humanity. I'm thankful to Randall for his service and his wisdom and for sharing so generously with us. So for those of you listening, I hope you take something from his lessons and apply them with your own team. Any step you take in the direction of building greater trust will benefit you and everyone around you. So... Take care, be well, and I'll see you next time.
