Early in my first year as a program director, I made some changes on clinic scheduling logistics. I announced, on one occasion, and walked away. I was right about the decision but I was wrong about the communication strategy. What people remembered wasn’t the idea — it was that I had walked in, said something forcefully, and left. It took years before anyone celebrated the change instead of resenting the way it was announced.

That is the mistake new leaders in health professions education make most frequently – it isn’t a communication problem in the usual sense. As clinician educators, we graduate from residencies and doctoral programs having been trained to prove that we’re right — sound documentation, the defensible p-value, the airtight argument. Leadership asks something different: not proving you’re right, but making sure people understand why a decision matters enough to live with it, especially when they will have to do a lot of work to accomplish the change.

I learned this the hard way a second time, with a curriculum overhaul that changed how residents presented their cases weekly. I brought it to a faculty meeting and it was shot down within minutes. When I returned several months later, the content of my proposal hadn’t shifted, but my process had. I had done a lot of work behind the scenes to meet with key stakeholders and every senior faculty. I asked for feedback and their suggestions became part of the proposal. When it returned to the full faculty, people said, “Sukirth already talked to me about this — it’s a great idea.” Nothing in my proposal was different. What was different was that it no longer arrived as a surprise and without context. Additionally, everyone felt like they were part of the proposal and it was no longer just my idea.

Communicating the Change

Research on organizational change supports this. John Kotter’s classic study of failed transformation efforts found that leaders routinely under-communicate the vision behind a change by a factor of ten.¹ The solution isn’t a bigger announcement — it’s turning communication into an ongoing conversation, not a one-time broadcast. Leadership musings from researchers at Harvard Business School suggest that avoiding difficult conversations and trying to do everything without delegating are two of the most common mistakes new managers make.² That matches what I’ve seen from the podium and the program director’s seat: a decision announced once, however correct, rarely survives a community of people who weren’t a part of forming it.

None of this means chasing consensus. Some decisions won’t get majority approval, and that’s okay — even the most popular presidents rarely clear fifty percent. It means doing the quieter work first: individual conversations, be open to feedback and modifying your vision, leave room for people to shape what they’ll be asked to implement.

The wrong communication can kill even the best idea. The reverse is also true — an ordinary idea, communicated with patience and respect for the people who have to live with it, can become theirs long before it becomes policy.

Reflective Practice

As leaders who have to make impactful decisions, there’s a companion habit that matters just as much, and it happens after the decision. It is the learning that comes from reflection.³ We teach our students about reflective practice and self-assessment; however, we are often too busy to practice the same. Early in my directorship, I learned how challenging it is to accept feedback gracefully. My first 360-degree review told me that watching me move through the department — running between clinic, surgery, and meetings — was making observers anxious. Some of my colleagues started calling me Dr. Flash.

My natural reaction was defensiveness. My first reaction was defensive: I’m busy, I’m productive, but I know what I’m doing – why should that make anyone else anxious? But that defensiveness was an important problem that hinders improvement. Your impact on others is always important, but, especially when you have a leadership role. A good leader seeks feedback before making a decision. A wise leader also reflects after the decision, when the consequences are visible and the feedback starts coming back. Reflection before change helps shape the decision. Reflection afterward is what shapes the leader.

Reference

1. Kotter JP. Leading change: why transformation efforts fail. Harv Bus Rev. 1995;73(2):59-67.
2. Landry L. Nine mistakes to avoid as a first-time manager. Harvard Business School Online. Published November 29, 2018. Updated August 7, 2019. Accessed August 28, 2026. https://online.hbs.edu/blog/post/first-time-manager-tips
3. Wilson RC, Crenshaw JT, Yoder-Wise PS. Call to action: prioritizing reflective practices for leadership success. Nurse Leader. 2022;20(3):258-264. doi:10.1016/j.mnl.2022.01.008

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Author:

Sukirth Ganesan, DDS, PhD, MPH

Dr. Ganesan is a member of AAL’s Institute for Teaching and Learning Advisory Council. Dr. Ganesan is the Centennial Associate Professor, Director of Clinical Research, and Director, Advanced Education Program in Periodontology, University of Iowa College of Dentistry.