In this episode, I sit down again with Dr. Jason Kuhl, Chief Medical Officer at Providence Medford Medical Center. Every time we talk, we get into what leadership really looks like when things are hard.

We begin with a reflection Dr. Kuhl shared with his team, drawn from Forged in Crisis. The stories of Abraham Lincoln, Ernest Shackleton, Frederick Douglass, Dietrich Bonhoeffer, and Rachel Carson all point to the same idea: leadership is formed in difficulty, not comfort. Dr. Kuhl highlights Lincoln’s ability to turn opponents into allies and Shackleton’s commitment to his people.

From there, we move into a challenge many leaders face—feeling like they have no control. Dr. Kuhl reframes this through the idea of agency. Even in a broken system, you can improve what is directly in front of you. Small, consistent improvements—what he calls aggregation of marginal gains—add up over time.

We also talk about balancing realism with hope. Healthcare is under real pressure, but leaders still choose how they show up. You may not control the system, but you control your response.

Finally, we discuss emotional discipline, staying present in difficult conversations, and managing your reactions so you can lead well.

The takeaway is simple: you may not control the system, but you always have a choice in how you lead within it. Small actions, done consistently, still matter.

👉  Download The Leader’s Ultimate Guide to Difficult Conversations, a practical framework for entering difficult conversations with clarity, discipline, and influence.

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