December 25, 2025 • 40 mins
This Christmas Day episode is a quieter, more reflective conversation about leadership that actually works — especially in high-pressure environments like healthcare.
Dex is joined by Dr Joshua Hartzell, retired US Army Colonel, physician, and author of A Prescription for Caring in Healthcare Leadership.
Josh has spent 25 years in military medicine and leadership training. His message is simple and deeply relevant at this time of year:
Take care of your people. They will take care of the mission.
In this episode, we talk about:
- Why caring leadership is not “soft” — it’s effective
- What military leadership gets right about standards and support
- Burnout as a leadership systems issue, not a personal failure
- Why psychological safety improves outcomes
- How small human interactions create powerful ripple effects
If you’re a leader who genuinely cares — but feels stretched thin — this conversation will meet you where you are.
Resources:
A Prescription for Caring in Healthcare Leadership https://www.amazon.com/dp/B0DSQ4276K
Dr Joshua Hartzell https://joshuahartzellmd.com/
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dex (00:09):
Hi everyone.
My name's Dex Randall, and thisis the Burnout Recovery Podcast
where I teach professionals torecover from burnout and get
back to passion and reward atwork.
Hello my friends.
This is Dex, and today I'mdelighted to welcome our special
guest Josh Hartzell MD, aretired army colonel who spent
(00:30):
25 years in military medicine.
He's just written a book:"APrescription for Caring in
Healthcare Leadership, Buildinga Culture of Compassion and
Excellence".
And if you've ever listened tome before, you'll know how I
love to support doctors who aredoing it tough at work.
So it should be an interestingsession.
Dr.
Hartzell works now as a speaker,coach, and teacher on leadership
(00:52):
development and an internalmedicine physician.
I discovered him on LinkedIn,because he writes a really
standout post and I do tend togravitate towards anybody who's
promoting caring leadership.
So I've been looking forward tothis topic very much myself
today.
Hi Josh.
How are you today?
Dr Josh Hartzell (01:13):
Great, Dex, thanks for having me.
I'm definitely looking forwardto this discussion and really
appreciate the work and yourjust man positive energy, which
I feel like I get from yourposts and I can already get from
our little discussion before webecame live.
So looking forward to this.
Dex (01:30):
I like to put a bit of warmth on the internet time to
time because not everybody does.
Dr Josh Hartzell (01:35):
We could use a lot more of it.
Dex (01:36):
Especially in healthcare.
We'll come to that in a minute.
We're recording on the 22nd ofDecember here in Australia, and
the show's gonna go out onChristmas day as it happens.
So thank you Josh, for showingup a couple of days before
Christmas.
Dr Josh Hartzell (01:51):
Ah thanks.
Yeah, I'm looking forward to,this is actually the start of my
Christmas vacation.
Today was my last day of workfor the next couple weeks.
So I'm excited to, have some offtime and spend some time with
family.
Dex (02:04):
Is wonderful to hear.
You are the third American I'vespoken to today, and the other
two are working straightthrough, because Americans are
legendary for not taking enoughtime off!
Dr Josh Hartzell (02:18):
Yes.
Dex (02:20):
Oh, you've gotta spend time with your family this time of
year, for sure.
So anyway, this is the specialfestive edition.
I think we're gonna kick itoutta the park.
But I do promise not to sing.
I'm not gonna sing any carols, Idunno about you.
Dr Josh Hartzell (02:33):
I was gonna say, a good Christmas Carol
might not be, might not be bad.
Dex (02:38):
You haven't heard my singing voice! If that's coming
on, you are very welcome to doit.
Alright, so I'd like to ask you,I'm sure it's a boring question
for you, but it looks likeyou've had a really interesting
career journey.
(02:58):
So can you just tell us a littlebit how you got into the whole
military medicine thing in thefirst place?
Dr Josh Hartzell (03:06):
Sure.
Yeah for me, it really startedat, I actually, when I was a kid
I didn't have a lot of familywho was in the military.
My dad had served like a coupleyears in the Air Force and I had
a couple uncles who were in themilitary.
But when I was growing up, Ireally loved history and spent a
lot of time reading historybooks and then also just other
(03:28):
military autobiographies orbiographies and just was drawn
to the topic.
I grew up in a really small townin the state of Pennsylvania
here in the United States.
I graduated with 63 people in myclass.
Part of joining the military wasto, I don't wanna say
necessarily get out, I love myhometown, but to go and see more
(03:50):
of the world.
And, I had the opportunity for,in the United States they were
gonna pay for my college'cause Ihad gotten a scholarship.
And from there I did my fouryears in college and, during
college, decided that I wantedto be a physician.
And was able to fortunatelyapply to the Uniform Services
(04:11):
University, which is the UnitedStates' Military Medical School.
And so I was able to take thatmilitary and combine two things
that I really loved, which wasserving in the military and all
the sort of interesting thingsthat was going to bring but also
being a physician where.
I loved science and my mom hadbreast cancer when I was in high
(04:33):
school and then again in medschool.
So I definitely was drawn to themedical field from personal
reasons.
But yeah, I was fortunate to beable to combine both of them
into to a career.
Dex (04:48):
Sorry to hear about your mom.
Dr Josh Hartzell (04:51):
I appreciate it.
Thank you.
Yeah, that was definitely aimpactful part of my life.
Dex (04:59):
Yeah, an interesting journey has unfolded from there,
though?
Dr Josh Hartzell (05:06):
Yeah, definitely.
And as I look back at a lot ofthings that shaped me, certainly
my parents, both my mom.
It was interesting I just postedtoday about Walmart because my
mom had worked at Walmart when Iwas growing up.
She was a stay at home mom untilI think probably when I was
maybe late middle school, earlyhigh school, and then went to
(05:28):
work at Walmart.
I would talk to her about allthese experiences.
Looking back a lot of thelessons she was telling me were
leadership lessons about howthey were dealing with conflict
at work or how they were takingcare of a associate who maybe
had an illness or somebody had afamily problem, and what were
they doing to jump in andsupport that person.
(05:50):
And, the older I got, I wouldfind myself leading in a
particular way.
And I would draw back and belike, oh, those were lessons my
mom taught me from Walmart.
And then similarly, my dad whohad a variety of jobs when I was
growing up also was the guy inthe neighborhood who was always
helping people.
I think that part of our rolesin life, society, as humans is
(06:14):
to help people who need it.
Anytime somebody neededsomething at their house or
fixed or whatever, he would begoing to do it.
And that was just the norm.
And we did other service as afamily.
I remember we used to have thislike roadside pickup day.
It was like once, maybe once ayear, and you would just go pick
up trash along the highway and.
That was the thing.
(06:35):
And I think it was that constantidea of service, which was also
probably part of what led me tothe military.
That idea of, look, you can goand serve others.
And then obviously as aphysician, it's a very service
oriented career as well.
Dex (06:50):
Wow, that's a great way to grow up.
Dr Josh Hartzell (06:54):
I feel very blessed.
And now with two, two kids of myown who are, 15 and 13, how do
you instill those values andgive them those experiences that
help ground them and help themsee that life is about service
and helping others.
Hopefully we all make an impactand make it a little bit better
for each other and also for thenext generation.
Dex (07:16):
Yeah, old-fashioned values that it's hard for many
youngsters to even connect withthese days because of the
internet and so on.
Dr Josh Hartzell (07:26):
Yeah.
And I think that's partlythough, it's, it is true, but
that's probably why, you justmentioned spending time with
family over the holidays andstuff.
That's why these interactionsare so critical.
Both my kids play sports, so wespend a lot of time with the
teams and for me, some of thatis just...
how do you treat your teammates?
How do you show up for practice?
(07:46):
All those lessons that then theycan hopefully knock on wood will
carry into their professionallives as well.
Dex (07:53):
That's almost the dead opposite of the way that I grew
up unfortunately.
I grew up in England and myfamily, for reasons best known
to themselves, were not veryoutgoing or supportive or
connected.
I'm slightly envious, when I'mlistening to you having that
kind of training ground andgiving that training ground to
(08:16):
your kids is so wonderful tohear.
Dr Josh Hartzell (08:17):
Thanks.
That's interesting though thatyou say they weren't outgoing or
connected because now you'rehosting a podcast and you're
connecting to people all aroundthe world through LinkedIn and
other venues.
It's like, where did that comefrom?
Dex (08:30):
Hard to say really.
But I do love people and I findpeople endlessly fascinating.
Lte me just come back to yourjob.
I've got a burning questionabout the jobs that you've had
during your career, the rolesthat you've had.
What was your favorite?
Dr Josh Hartzell (08:45):
So hands down, my favorite position was when I
was the program director for theInternal Medicine Residency
Program at Walter Reed NationalMilitary Medical Center.
Residency training orpostgraduate training, which I
think they call it, in otherplaces outside the United
States, you know that thoseyears out of medical school.
So these are very young,impressionable physicians who
(09:09):
are really learning their craft.
Medical school, you have generaltraining, but when you get to
residency, it's the mostimpactful part of your career.
And it was the job I alwayswanted.
Early in my career, I just Ifelt how much my program
director had meant to me and mypeers and others, and, how we
all really wanted to, emulatehim and be able to have that
(09:34):
impact on others.
Yeah it was a real honor andprivilege to serve in that
position for almost five years.
Being able to guide not onlyeducational development and
professional development as aphysician, but also just the
broader context of, taking careof a team of people who were
(09:54):
there not only to get theirtraining, which obviously was
one of their primary roles, butalso to take care of patients
and to do that, all at the sametime.
It's a phenomenal role and it'sone of those roles I feel like
as a leader still, you have alot of freedom.
There's obviously requirementsand things you have to do, but
there's a lot of ability tobuild and shape the culture the
(10:17):
way that you want.
We spent a lot of time focusedon creating that environment
where people could really learnand feel safe and, also feel
challenged so that when theyleft they felt wow, I got so
much out of this residency, or Ifeel so prepared for the next
stage of my career.
When I look at what really givesme energy, it's investing in
(10:41):
people and helping them develop.
When I'm teaching, that's what Iget the most joy from.
And that role is centered aroundteaching and leading and helping
people develop.
So yeah, it was far and away thebest job I had.
Dex (10:58):
That's interesting.
'cause my favorite job was theone where I had the best leader
that I've ever had too.
It's huge.
The impact's incalculably large.
I would agree with you.
Dr Josh Hartzell (11:10):
Yeah.
And it's also one of the things,I've been thinking about
recently, and you may have someinsights on this.
Sometimes I'll talk to peopleabout some of the leaders I've
worked with, and they'll belike, wow, those were like
really meaningful.
I wish I had that.
Sometimes I almost feel like Iwas blessed with all these great
(11:31):
leaders, that showed me whateffective leadership could look
like.
And I don't know that everyonehas that and which I think why,
like your work and the book,like others who are trying to
help people figure out how tolead more effectively, but also
lead in a humane way wherepeople aren't driven into the
ground and they're not burnedout.
I think having those types ofleaders we're really lucky when
(11:54):
we experience them and hopefullymore people will have that
ability to experience them overtime.
Dex (12:02):
Yeah, I think a lot of people ascend into leadership
without being taught how tolead.
That's one of the core problems.
They're very competent in atechnical capacity, a solo
capacity.
I've got a team and they allshuffle around under me and do
stuff, but you thrust somebodywho's been a solo player into
leadership and you don't teachthem how to do it, it's a
(12:23):
disaster.
Dr Josh Hartzell (12:26):
Yeah, and it's just different skills, right?
I think your point about we'renot trained and, I think in
medicine we're getting better atthis.
We're recognizing that we needto train leaders., Just because
you're the best researcher, orbest physician, or even best
clinician, doesn't mean thatyou're gonna be the most
effective leader when you get inthat position.
(12:47):
And part of that is just, it'snot that people don't have good
intentions and want to leadeffectively.
They just, as you said, theyhaven't been trained.
So really thinking holisticallyabout how do we develop leaders
from medical school forward,particularly in our field, is
important.
And, just as important if you'rein other fields, there's really
(13:08):
no profession or job whereleadership doesn't matter,
right?
Go back to my mom, right?
She worked at Walmart.
My dad built railroad cars andall of those places need
effective leaders.
Dex (13:22):
Yeah, and I've met a lot of leaders in healthcare who've
been doing it for 20 or 30years, and still nobody's taught
'em how to do it, and they'rehalfway drowning, still.
And dying do better as well.
Really highly motivated to dobetter, but it's like how?
How do I do this?
Dr Josh Hartzell (13:41):
Yeah, it's always striking to me.
'Cause I do a fair amount ofcoaching or leadership
development with, differentorganizations and yeah, we have
people who are in pretty,mid-level or senior level
positions who have had maybesome training, maybe not, maybe
none.
Certainly eager to learn.
But yeah we definitely need tothink about how do we make this
(14:03):
routine?
So that, 10 years from now, 15years from now, by the time this
generation of leaders becomes atthat position.
They've had leadershipdevelopment, their whole
careers.
We need to make it alongitudinal training approach
so that folks are betterprepared.
And then recognize that nomatter where you get on the
leadership spectrum, you'realways gonna need more.
(14:26):
'cause you have new challenges,new context.
We're gonna acquire differentskills.
Dex (14:33):
Yes, it really hurts to go from being at the pinnacle of
your technical profession to bedumped into a leadership where
you're floundering.
Very painful!
Dr Josh Hartzell (14:43):
In some ways, and you probably see this with
people you coach too, it'salmost like we push people into
leadership
Dex (14:50):
Yeah.
Dr Josh Hartzell (14:51):
And some people maybe don't even want to
be there, which is okay.
You have to decide, I'm a reallygood surgeon or I'm a really
good researcher.
I don't really want to have todeal with all these other
things.
I just wanna be in the O.R.
I just want to do my research.
And then you have other peoplewho really want to do those
roles.
We need more people to embracethat and be effective leaders.
(15:13):
And even if you're not gonna be,a quote unquote titled leader,
somebody who has a formalposition, everybody in
healthcare leads.
We lead patients at the bareminimum, right?
How do we lead patients andtheir families?
For the most part, you'repracticing in teams and how do
you work with your nurse, yourtechs, your front desk?
(15:33):
All of that requires leadershipskills.
Dex (15:36):
Yeah.
What do you think are thedifferences,'cause you've been
immersed in both worlds, betweenthe military leadership style,
which is very particular, andthe healthcare leadership?
Dr Josh Hartzell (15:49):
To me it's actually interesting.
I did a fair amount of Army.
The US Army has leadershiptraining and then there's
healthcare training.
I will say it's actually similarthan I think a lot of times
people think and I guess I'lljust give you a couple examples.
So when I was doing reserveOfficer Training Corps, which is
(16:10):
the training I got when I was incollege and I had classes on
leadership and we did fieldexercises and other things.
The whole point was to teach youleadership.
Some of those lessons that arenot really different are: you
need to have high standards.
In the military, if you don'thave high standards, like people
(16:30):
get hurt, right?
In healthcare, if you don't havehigh standards, there are
patients we're taking care of.
So I think, it started there.
Like the ability to give peoplefeedback and do that
effectively.
We need it in both places.
I will definitely say some of mymilitary feedback is probably
less kind delivery than maybewhat would be acceptable in a
(16:52):
hospital setting.
But there's certainly the needfor feedback.
The primary thing that I tookfrom the military training is
that our job as leaders, or inmy case an officer in the
military, was to take care of mysoldiers.
And when I was working in ajoint environment, take care of
my soldiers, sailors and airmen.
(17:13):
And it was really that emphasisthat, look, you can't accomplish
the mission if you're not takingcare of your people.
At the end of the day, generals,admirals don't win wars.
They create great strategy andgreat plans, but if there aren't
soldier, sailors, airmen andmarines to carry out those
(17:33):
missions, it's not gonna beeffective.
The same for healthcare.
You really need to have leaderswho understand that if we don't
take care of the healthcare teamand the healthcare team is
large, right?
Physicians, nurses, physicaltherapists, pharmacists, front
desk, techs, the people whosterilize our equipment.
All of these folks are part ofour healthcare team that if we
(17:56):
don't do a good job taking careof all of them, then we're
potentially jeopardizing theability to provide the best
patient care that we possiblycan.
And that lesson was a directcarryover from many of the
things I learned in themilitary.
One thing that really stood outto me was when we were doing our
training exercises, they wouldalways say at the end of a road
(18:18):
march or during a road march,Hey, check your people's feet.
Make sure they don't haveblisters.
If they have blisters, take careof their blisters so that they
can finish the road march.
The other lesson that was prettyconstant in the Army, was, look
you don't eat until all yourpeople have eaten.
Make sure that, your soldiershave been fed, they've gotten
food, and then you can eat.
(18:40):
But to me, those lessons reallystuck in that, hey, my job is to
take care of them so that theycan do what they need to do to
take care of the mission.
Dex (18:48):
Well, it's a pretty high stakes game.
Every time I think aboutmilitary leadership, I haven't
read up very much on it, butJocko Willink springs to mind
and he talks so much about thepsychology and science of how
they operate (19:03):
how they think, how they plan and execute.
And the whole setup seems to mefrom the outside to look like a
cut above what other peoplethink of as leadership because
there's such high stakes.
Dr Josh Hartzell (19:19):
It's definitely high stakes.
And I think the other thingthat's maybe somewhat unique
about, it's just how muchemphasis we put on leadership
development in the military andit's not just the courses and
the different trainings that wehave, but it's the mentoring and
the micro interactions.
We're actually working on astudy now looking at some
different leadership stuff.
And one of the things we've seenis just how much the individual
(19:44):
leaders benefit from theinformal mentoring and coaching
above of people above them andhow that's just been passed down
from generation to generation.
Within the military, your job isto help that next level below
you be prepared to take yourjob.
Because you're always cycling,right?
Our careers are infinite.
(20:04):
I want to go back to the pointyou made about Jocko Willink,
who he is written several goodbooks.
He's a great speaker.
One of the things I love aboutJocko is if you look at Jocko
like he's a pretty tough lookingguy.
He does mixed martial arts.
But he talks a lot about caringand how you have to care for
people as a leader.
(20:25):
It's not what you would expectwhen you see him, right?
You like this guy would beespousing caring.
But he has one quote in hisbook, and I think it's the book
Dichotomy of Leadership, wherehe talks about: If you really
care about your people, then youhave to train them hard and
prepare them because your realgoal is that they can come home
(20:46):
from war, come home fromconflict alive.
And that really resonated withme.
One for my army role but alsofor the healthcare role because
if we really care about ourpatients.
Which, I've really never met aphysician or someone who doesn't
deeply care about theirpatients.
Then we need those highstandards and we need to help
(21:06):
people be able to achieve them.
But we need to do that in acaring way.
In a way that allows them to dothat.
Because what we know is that ifpeople don't have psychological
safety.
If we, work people crazy shifts,it creates environments where
they really can't thrive.
(21:26):
So we have to be able to createthese cultures where people, are
challenged.
Absolutely.
But the level of support equalsthe level of challenge.
Ultimately that leads to betterpatient care, but also hopefully
leads to the healthcare team notbeing as burned out as we really
have been probably for the last,I don't know, several decades
(21:49):
when you look at the data onburnout in healthcare.
Dex (21:51):
Oh yeah, it's horrible.
I work with a lot of physicians,but I'm glad you said what you
just said.
'cause there's the first part ofthe book where it talks about
how do we inspire caring.
Why would you care?
How can you care?
Why don't you care?
What do you care about?
And I've never met a physicianwho didn't care, or a nurse or
anyone else who worked in thehealthcare industry.
By and large, a lot of them arein it because they care.
Dr Josh Hartzell (22:16):
Yeah.
And so 100% agree, and to me,part of the impetus for the book
is if we care this much.
Which is core, it's foundationalto who we are.
Then what are the intentionalactions that demonstrate that
caring?
You go back to the leadership Iwant to care as a leader, but
(22:37):
maybe I've never seen it.
Maybe I've just never had thatexperience of what it looks like
or feels like.
Here are the tangible behaviorsthat you can do if you wanna be
a leader who leads with caring,somebody who places an emphasis
on caring and taking care ofyour people.
Dex (22:55):
Yeah.
I think a lot of people in thosepositions have not had great
leadership modeled to thembecause the people in the next
layers up haven't been taughteither.
In your book there's a lot ofinformation.
It takes a lot of digesting, butI like the chapters set up and I
like the prescription for caringleadership in each of the
chapters with theself-reflective questions.
Dr Josh Hartzell (23:18):
The book it's long.
I will say it's funny when Iturned it in my editor, she was
like, is this a textbook?
I'm like no, it's not.
But I think what I have foundvaluable and what people have
told me that have been readingit is certainly you can read it
straight through, right?
But really to the point you justmade, which is, you know what,
maybe I'm struggling at workwith a particular area.
(23:39):
Delegation.
I feel like I'm just not beingas effective as delegating as I
would like to be.
Let me read that chapter andthen, okay, here's this
prescription at the end of it,let me take one or two of these
ideas and implement them.
Or, Hey, you know what?
I'm actually struggling with myown time management and my own
(24:01):
self-care.
What are some strategies so youcan go to that chapter.
Part of this for me too ishaving been in medical education
for most of my career.
Is that I really wanted there tobe tangible action steps that
people could take.
While I hope the book isinspiring and gets people to
(24:21):
think about it, I wanted someonewho reads it to walk away and be
like, oh, I can do that.
That's a behavior I can startdoing today.
There's, 20 some chapters.
Whatever area you feel like youneed work on, or read that
chapter and then dive in withsome of the action steps.
Dex (24:40):
And when you're talking about this, so I know you do a
lot of speaking and training andall of that, but do you ever
come into contact with HR, withyour ideas and if you do, how
does that go for you?
Dr Josh Hartzell (24:52):
What do you mean by come in contact with HR?
Dex (24:54):
I have worked with a lot of physicians who are on
performance plans, for exampleand sometimes get ejected after
a whole career and things likethat.
My perception from the outsideis there's a lot of HR
involvement in that process andI wonder if there might be some
contentious content stuck inbetween you and them?
Dr Josh Hartzell (25:18):
That's interesting.
I mean it definitely comes upJust recently was talking to a
group, and we were talking abouta couple different groups and
couple issues, both of which hadHR involved.
I think to me it can actually becomplementary.
In an ideal world, right?
We and HR want the same thing.
We want people to be highperforming, to execute well, and
(25:42):
to show up and not createproblems with others at work.
Be good team players.
So we actually want the samethings.
To answer your question, how cansome of the ideas in the book be
partnered with HR?
And sometimes they're part of aprocess.
If we need to have maybe alittle heavier hand in terms of
(26:03):
getting someone to buy into aprocess.
Or if you're having trouble withan employee and you just like,
okay, what are we gonna do withthis person?
I often wonder though that ifthere's not an intermediary
step, which is if we couldimplement some of these
processes in a more caring way.
If we wouldn't get more buy-in.
(26:23):
One of my favorite things isthis idea of compliance versus
commitment.
You probably have way moreexperience with HR than I do,
but generally when we get to HR,I feel like we're getting to the
compliance.
Do this or else and we're reallymissing the,"What would it take
to make this person feel morecommitted to this?"
Dex (26:43):
If HR were motivated on reducing turnover, you would
think they'd want to support thepeople that were there, rather
than just waiting until they hitthe wall and then just going,
no, you're out.
Oh, hang on.
I haven't got enough staff.
I've just fired two.
Dr Josh Hartzell (27:00):
I think from a healthcare perspective, we're
looking at this in terms ofturnover, as you mentioned, it's
expensive.
Dex (27:06):
Super expensive.
Oh my word.
Expensive.
Up to a million bucks peroperative.
Dr Josh Hartzell (27:13):
One of the other things that I've been
thinking about, partly becauseI'm a physician, is this idea of
primary prevention.
So instead of, having to dealwith troubled employees or
people who are leaving becausethey're burned out or whatever,
how do we prevent that fromhappening?
How do we help people thrive sothat they never get to HR, they
(27:34):
never get burned out like weneed to do that primary
prevention.
Dex (27:37):
Yeah, but even the costing of it or the profitability of
it, if you do that is, is a hugereturn.
Dr Josh Hartzell (27:46):
You mentioned the numbers, right?
So the estimated cost is 500,000to a million dollars to replace
a physician.
And there's a variety of thingsthat go into that.
Why not take part of that moneyand invested in more support
staff for your physicians sothat they don't have to write
their notes at night, withpajama time.
(28:07):
Or how about just hire anotherphysician.
Here's an idea for nurses,right?
Nurse turnover is not quite asexpensive, but there's many more
nurses, so cumulatively it stillcosts a lot of money.
Why not hire a couple extranurses to decrease the nurse to
patient ratio so that our nursesone, provide more, safer care,
(28:30):
but also so that they want tostay in your organization so
that you don't have to hiretraveling nurses who cost three
times as much.
Dex (28:40):
Well also you don't have to keep breaking teams that are
working.
I can never quite get my headround why the system persists as
it does, considering that theeconomics are against, nevermind
all the other reasons.
Dr Josh Hartzell (28:59):
It is the right thing to do no matter
what, but if you're notconvinced by just the right
thing, it's the financially bestmove as well.
I do think there's growingrecognition of this because of
the financial implications.
I think as people are reallylooking at the data and
realizing, wow, this is reallyexpensive, that's starting to
(29:22):
motivate people to think about,okay, how can we do this more
effectively save money?
The other thing we know from,again, the burnout literature is
that when you have burned outhealthcare providers, they
provide less safe care, theyhave less patient satisfaction.
There's all these otherindicators that if we do a
(29:45):
better job of taking care of theteam, they would just naturally
get better and it would lead tobetter financial outcomes,
patient outcomes, and healthcareteam outcomes.
In terms of wellbeing,
Dex (29:59):
Yes.
In my mind that's the definitionof a no brainer.
But anyhow, let me ask you fromthis direction then, what are
you most worried about inhealthcare right now?
Dr Josh Hartzell (30:10):
Most worried?
That's a really good question.
I think what I'm most worriedabout is that if we don't do
something to fix some of theissues that we were just talking
about that a lot of people whoare mid to late career, so the
(30:32):
core who I would consider thecore body right now.
You have like junior trainees,physicians who are coming up.
Incredibly important, right?
But they're just out of theirtraining.
And then you have this middlegroup, this is the group I'm
talking about, and then you havethe more senior people.
What I'm worried is that if wedon't fix some of these issues,
they're just gonna keep leavinghealthcare or they're not gonna
(30:55):
leave healthcare completely, butthey're gonna look for jobs that
are gonna give them the workenvironment they want.
And we already see this in somerespects.
We have, physicians who leavecertain practices to go to
environments that are better fora variety of reasons, or they
work part-time for a variety ofreasons.
(31:16):
I think if we don't createbetter work conditions and
change some of the culture ofmedicine, we're gonna have even
more of a physician shortagethan we already do.
And I think you could say thesame for nursing.
I know nurses who are just like,I'm not gonna do this anymore.
I can go get another job.
I can make as much money and nothave to deal with this.
(31:38):
So my biggest fear or concern isthat if we don't really embrace
culture change, we're gonnahave, significant shortages of
healthcare providers as we havea, increasingly aging
population, which is really arecipe for disaster.
With those two things happeningat the same time.
Dex (31:58):
And you train a lot of physician leaders, don't you?
When they come to you, what dothey ask you for the most?
Dr Josh Hartzell (32:06):
I think it's a variety of things.
It depends on their roles.
A lot of the topics we covermost are how to deal with
conflict.
Feedback is always a topic.
I think people are reallyuncomfortable giving feedback.
I think those are theinterpersonal ones that we see
the most of.
And then the other thing, a lotof it is time management and how
(32:30):
do you prevent burnout?
And for me, part of that is afew things.
One is reminding people, and Idon't know if you've read the
book, essentialism by GregMcKeown?
Yeah.
Like life changing book for me,but like this idea that we have
choices.
And really coaching people tounderstand that there's choices.
Dex (32:52):
That must be a hard sell telling a physician they've got
choices'cause that's not theirsensation of life.
Usually, when I meet them.
Dr Josh Hartzell (33:00):
Yeah.
I think that's part of it,right?
We're almost enculturated intothis is what you do as a
physician, or this is what youdo as a nurse to step back and
say no, these are choices.
And there's everyday choices wemake, but there's also career
choices.
So a lot of it is about thatagency around making choices and
also being okay with certainthings.
(33:21):
One of the things that I think Isee a lot of is we do a lot of
things in medicine because wethink other people expect it of
us.
And that might be doing researchor working crazy hours, all
these things that we just do.
And then part of that is justbecause we've agreed to do it
and we don't choose or push backagainst the system that we're
(33:44):
not gonna do it.
Or you could just say for meit's not important.
I don't need to do this to befulfilled.
What I really want to do in mycareer is this.
So focusing on the fact that wehave agency in choices, and then
the other big one, on anindividual level is that, that
same idea, but giving people thepermission to say no.
(34:05):
People ask you to do certainthings, that you can literally
just say, no, I don't want to dothat, or I'm not particularly
interested.
Dex (34:14):
Because that was the other thing I wondered how you teach
them all of the self carepersonal health prioritization
rules you put in the book.
That'd be a tough sell to aphysician in a hospital, for
example.
Dr Josh Hartzell (34:29):
You do a lot of coaching, right?
For me that's when I startchallenging assumptions and I
say Why would that happen?
What would it look like if youtried this?
Really getting them to, eitherchallenge that assumption or I'm
a big fan of piloting things.
Why don't we just try it once?
See what happens, right?
Did the world end?
(34:49):
Did your, clinic collapse?
But just getting them to, givingthem that permission,
challenging assumptions and thenjust try it once and see what
happens.
But I agree it's not easybecause the other thing I think
for physicians, we carry a lotof guilt.
That if we don't do something,something bad is gonna happen to
(35:10):
the patient, or I don't wannalet my coworkers down.
Fully get it.
And trust me, I should also saythat I speak confidently about
these things and I struggle withthem all the time.
So it's not like I have allthese things figured out, but
we're, we are all works inprogress.
But helping people understandthat yes, you feel guilty but if
(35:31):
we don't change some of thesethings, we're gonna continue to
live in this world of burnoutand not having the cultures that
we want.
We have to be able to push backagainst the system, for system
and process changes, while atthe same time ensuring that, no
patient or family suffers fromthat.
(35:52):
There, there has to be abalance.
My concern is that for too long,some healthcare systems,
organizations, departments,different levels have used
physician altruism and nursealtruism to not fix the problems
that need fixed.
Dex (36:11):
I'm gonna say anything about them.
in any case we didn't get timeto sing any carols or anything,
but we're pretty much out oftime.
Was there anything else youwanted to talk about today?
Dr Josh Hartzell (36:21):
The only thing I would say Dex, I think just,
this is gonna air on Christmas,which is awesome.
That's exciting for me.
The thing I've really beenthinking about is twofold.
One is, on a daily basis weinteract with a certain number
of people, and that may be a fewpeople, it may be a lot of
people.
But every one of thoseinteractions is really an
(36:43):
opportunity for us to thinkabout how can I positively
impact this person's life?
And, it could be as simple as asmile.
It could be as simple as holdingthe door for somebody who's
walking out of the grocerystore, carrying their groceries
and looks like they, are gonnastruggle.
It could be having a mentoringconversation with somebody.
(37:05):
But this idea that all of theseinteractions are opportunities
for us to positively impact thatperson's life, which in and of
itself is worthwhile andimportant and we should feel
good.
I feel good about theseinteractions, but then
recognizing that each one ofthose interactions, that person
(37:25):
then goes and interacts withsomebody else.
So these positive interactionscan have this ripple effect
throughout your team, yourorganization, your family, your
community.
So really as we think about,going into 2026, like, why don't
we try to make this the yearwhere all of us with what we can
(37:46):
control, or trying to positivelyimpact the lives of those
closest to us that would make2026 a banner year in my mind.
Dex (37:54):
Yeah, I would agree.
And that comes right back to thetopic we started with in the
beginning.
How can we support our fellows?
Dr Josh Hartzell (38:03):
Yep same thing.
Dex (38:07):
Marvelous.
Alright.
If listeners were gonna rememberonly one thing from today, what
do you wish that one thing wouldbe?
Dr Josh Hartzell (38:16):
To me, it's simple.
It's take care of your people.
They will take care of themission.
This idea that as leaders it'spart of our job to help take
care of others.
And I think as humans, it's partof our job or should be part of
our job to, to take care ofothers.
So just that idea that if youtake care of others, it's gonna
lead to good things in yourorganization.
Dex (38:38):
I love that you're out there making a big noise and
supporting so many people to bethat kind of person and be that
kind of leader out in a toughworkplace, really.
I think you're doing a marvelousjob, and I love your book.
Dr Josh Hartzell (38:51):
Thank you and thanks for for having me on.
I really appreciate it andhaving the opportunity to spread
this message, which we, I thinkboth agree is important.
Dex (39:00):
Very important! And thank you so much for being here
today, Dr.
Josh Hartzell.
It has been such a pleasure.
Dr Josh Hartzell (39:08):
Thanks Dex.
Dex (39:11):
Listeners, please don't forget to pick up a copy of
Josh's excellent book, APrescription for Caring in
Healthcare Leadership, becauseit's packed with practical
leadership advice andsuggestions that everybody can
use.
The link will be in the shownotes.
And if you are heading into NewYear's, feeling a little bit
(39:31):
fried and strung out yourself, alittle bit buried under this
never ending workload.
And if your leadership issuffering the strain, now would
be a really great time to book aconsult with me because I can
help you make 2026 the year thatyou are proud of.
One way your performance,leadership, and passion revive
in a way you never thought thatthey could.
(39:53):
So if you'd like that, you canbook a time at dexrandall.com.
And let's get 2026 startedright.
Now I just wish you and yours awonderful holiday, whatever you
are doing and all the very bestfor the New Year.
Hi everyone.
My name's Dex Randall, and thisis the Burnout Recovery Podcast
where I teach professionals torecover from burnout and get
back to passion and reward atwork.
Hello my friends.
This is Dex, and today I'mdelighted to welcome our special
guest Josh Hartzell MD, aretired army colonel who spent
(00:30):
25 years in military medicine.
He's just written a book:"APrescription for Caring in
Healthcare Leadership, Buildinga Culture of Compassion and
Excellence".
And if you've ever listened tome before, you'll know how I
love to support doctors who aredoing it tough at work.
So it should be an interestingsession.
Dr.
Hartzell works now as a speaker,coach, and teacher on leadership
(00:52):
development and an internalmedicine physician.
I discovered him on LinkedIn,because he writes a really
standout post and I do tend togravitate towards anybody who's
promoting caring leadership.
So I've been looking forward tothis topic very much myself
today.
Hi Josh.
How are you today?
Dr Josh Hartzell (01:13):
Great, Dex, thanks for having me.
I'm definitely looking forwardto this discussion and really
appreciate the work and yourjust man positive energy, which
I feel like I get from yourposts and I can already get from
our little discussion before webecame live.
So looking forward to this.
Dex (01:30):
I like to put a bit of warmth on the internet time to
time because not everybody does.
Dr Josh Hartzell (01:35):
We could use a lot more of it.
Dex (01:36):
Especially in healthcare.
We'll come to that in a minute.
We're recording on the 22nd ofDecember here in Australia, and
the show's gonna go out onChristmas day as it happens.
So thank you Josh, for showingup a couple of days before
Christmas.
Dr Josh Hartzell (01:51):
Ah thanks.
Yeah, I'm looking forward to,this is actually the start of my
Christmas vacation.
Today was my last day of workfor the next couple weeks.
So I'm excited to, have some offtime and spend some time with
family.
Dex (02:04):
Is wonderful to hear.
You are the third American I'vespoken to today, and the other
two are working straightthrough, because Americans are
legendary for not taking enoughtime off!
Dr Josh Hartzell (02:18):
Yes.
Dex (02:20):
Oh, you've gotta spend time with your family this time of
year, for sure.
So anyway, this is the specialfestive edition.
I think we're gonna kick itoutta the park.
But I do promise not to sing.
I'm not gonna sing any carols, Idunno about you.
Dr Josh Hartzell (02:33):
I was gonna say, a good Christmas Carol
might not be, might not be bad.
Dex (02:38):
You haven't heard my singing voice! If that's coming
on, you are very welcome to doit.
Alright, so I'd like to ask you,I'm sure it's a boring question
for you, but it looks likeyou've had a really interesting
career journey.
(02:58):
So can you just tell us a littlebit how you got into the whole
military medicine thing in thefirst place?
Dr Josh Hartzell (03:06):
Sure.
Yeah for me, it really startedat, I actually, when I was a kid
I didn't have a lot of familywho was in the military.
My dad had served like a coupleyears in the Air Force and I had
a couple uncles who were in themilitary.
But when I was growing up, Ireally loved history and spent a
lot of time reading historybooks and then also just other
(03:28):
military autobiographies orbiographies and just was drawn
to the topic.
I grew up in a really small townin the state of Pennsylvania
here in the United States.
I graduated with 63 people in myclass.
Part of joining the military wasto, I don't wanna say
necessarily get out, I love myhometown, but to go and see more
(03:50):
of the world.
And, I had the opportunity for,in the United States they were
gonna pay for my college'cause Ihad gotten a scholarship.
And from there I did my fouryears in college and, during
college, decided that I wantedto be a physician.
And was able to fortunatelyapply to the Uniform Services
(04:11):
University, which is the UnitedStates' Military Medical School.
And so I was able to take thatmilitary and combine two things
that I really loved, which wasserving in the military and all
the sort of interesting thingsthat was going to bring but also
being a physician where.
I loved science and my mom hadbreast cancer when I was in high
(04:33):
school and then again in medschool.
So I definitely was drawn to themedical field from personal
reasons.
But yeah, I was fortunate to beable to combine both of them
into to a career.
Dex (04:48):
Sorry to hear about your mom.
Dr Josh Hartzell (04:51):
I appreciate it.
Thank you.
Yeah, that was definitely aimpactful part of my life.
Dex (04:59):
Yeah, an interesting journey has unfolded from there,
though?
Dr Josh Hartzell (05:06):
Yeah, definitely.
And as I look back at a lot ofthings that shaped me, certainly
my parents, both my mom.
It was interesting I just postedtoday about Walmart because my
mom had worked at Walmart when Iwas growing up.
She was a stay at home mom untilI think probably when I was
maybe late middle school, earlyhigh school, and then went to
(05:28):
work at Walmart.
I would talk to her about allthese experiences.
Looking back a lot of thelessons she was telling me were
leadership lessons about howthey were dealing with conflict
at work or how they were takingcare of a associate who maybe
had an illness or somebody had afamily problem, and what were
they doing to jump in andsupport that person.
(05:50):
And, the older I got, I wouldfind myself leading in a
particular way.
And I would draw back and belike, oh, those were lessons my
mom taught me from Walmart.
And then similarly, my dad whohad a variety of jobs when I was
growing up also was the guy inthe neighborhood who was always
helping people.
I think that part of our rolesin life, society, as humans is
(06:14):
to help people who need it.
Anytime somebody neededsomething at their house or
fixed or whatever, he would begoing to do it.
And that was just the norm.
And we did other service as afamily.
I remember we used to have thislike roadside pickup day.
It was like once, maybe once ayear, and you would just go pick
up trash along the highway and.
That was the thing.
(06:35):
And I think it was that constantidea of service, which was also
probably part of what led me tothe military.
That idea of, look, you can goand serve others.
And then obviously as aphysician, it's a very service
oriented career as well.
Dex (06:50):
Wow, that's a great way to grow up.
Dr Josh Hartzell (06:54):
I feel very blessed.
And now with two, two kids of myown who are, 15 and 13, how do
you instill those values andgive them those experiences that
help ground them and help themsee that life is about service
and helping others.
Hopefully we all make an impactand make it a little bit better
for each other and also for thenext generation.
Dex (07:16):
Yeah, old-fashioned values that it's hard for many
youngsters to even connect withthese days because of the
internet and so on.
Dr Josh Hartzell (07:26):
Yeah.
And I think that's partlythough, it's, it is true, but
that's probably why, you justmentioned spending time with
family over the holidays andstuff.
That's why these interactionsare so critical.
Both my kids play sports, so wespend a lot of time with the
teams and for me, some of thatis just...
how do you treat your teammates?
How do you show up for practice?
(07:46):
All those lessons that then theycan hopefully knock on wood will
carry into their professionallives as well.
Dex (07:53):
That's almost the dead opposite of the way that I grew
up unfortunately.
I grew up in England and myfamily, for reasons best known
to themselves, were not veryoutgoing or supportive or
connected.
I'm slightly envious, when I'mlistening to you having that
kind of training ground andgiving that training ground to
(08:16):
your kids is so wonderful tohear.
Dr Josh Hartzell (08:17):
Thanks.
That's interesting though thatyou say they weren't outgoing or
connected because now you'rehosting a podcast and you're
connecting to people all aroundthe world through LinkedIn and
other venues.
It's like, where did that comefrom?
Dex (08:30):
Hard to say really.
But I do love people and I findpeople endlessly fascinating.
Lte me just come back to yourjob.
I've got a burning questionabout the jobs that you've had
during your career, the rolesthat you've had.
What was your favorite?
Dr Josh Hartzell (08:45):
So hands down, my favorite position was when I
was the program director for theInternal Medicine Residency
Program at Walter Reed NationalMilitary Medical Center.
Residency training orpostgraduate training, which I
think they call it, in otherplaces outside the United
States, you know that thoseyears out of medical school.
So these are very young,impressionable physicians who
(09:09):
are really learning their craft.
Medical school, you have generaltraining, but when you get to
residency, it's the mostimpactful part of your career.
And it was the job I alwayswanted.
Early in my career, I just Ifelt how much my program
director had meant to me and mypeers and others, and, how we
all really wanted to, emulatehim and be able to have that
(09:34):
impact on others.
Yeah it was a real honor andprivilege to serve in that
position for almost five years.
Being able to guide not onlyeducational development and
professional development as aphysician, but also just the
broader context of, taking careof a team of people who were
(09:54):
there not only to get theirtraining, which obviously was
one of their primary roles, butalso to take care of patients
and to do that, all at the sametime.
It's a phenomenal role and it'sone of those roles I feel like
as a leader still, you have alot of freedom.
There's obviously requirementsand things you have to do, but
there's a lot of ability tobuild and shape the culture the
(10:17):
way that you want.
We spent a lot of time focusedon creating that environment
where people could really learnand feel safe and, also feel
challenged so that when theyleft they felt wow, I got so
much out of this residency, or Ifeel so prepared for the next
stage of my career.
When I look at what really givesme energy, it's investing in
(10:41):
people and helping them develop.
When I'm teaching, that's what Iget the most joy from.
And that role is centered aroundteaching and leading and helping
people develop.
So yeah, it was far and away thebest job I had.
Dex (10:58):
That's interesting.
'cause my favorite job was theone where I had the best leader
that I've ever had too.
It's huge.
The impact's incalculably large.
I would agree with you.
Dr Josh Hartzell (11:10):
Yeah.
And it's also one of the things,I've been thinking about
recently, and you may have someinsights on this.
Sometimes I'll talk to peopleabout some of the leaders I've
worked with, and they'll belike, wow, those were like
really meaningful.
I wish I had that.
Sometimes I almost feel like Iwas blessed with all these great
(11:31):
leaders, that showed me whateffective leadership could look
like.
And I don't know that everyonehas that and which I think why,
like your work and the book,like others who are trying to
help people figure out how tolead more effectively, but also
lead in a humane way wherepeople aren't driven into the
ground and they're not burnedout.
I think having those types ofleaders we're really lucky when
(11:54):
we experience them and hopefullymore people will have that
ability to experience them overtime.
Dex (12:02):
Yeah, I think a lot of people ascend into leadership
without being taught how tolead.
That's one of the core problems.
They're very competent in atechnical capacity, a solo
capacity.
I've got a team and they allshuffle around under me and do
stuff, but you thrust somebodywho's been a solo player into
leadership and you don't teachthem how to do it, it's a
(12:23):
disaster.
Dr Josh Hartzell (12:26):
Yeah, and it's just different skills, right?
I think your point about we'renot trained and, I think in
medicine we're getting better atthis.
We're recognizing that we needto train leaders., Just because
you're the best researcher, orbest physician, or even best
clinician, doesn't mean thatyou're gonna be the most
effective leader when you get inthat position.
(12:47):
And part of that is just, it'snot that people don't have good
intentions and want to leadeffectively.
They just, as you said, theyhaven't been trained.
So really thinking holisticallyabout how do we develop leaders
from medical school forward,particularly in our field, is
important.
And, just as important if you'rein other fields, there's really
(13:08):
no profession or job whereleadership doesn't matter,
right?
Go back to my mom, right?
She worked at Walmart.
My dad built railroad cars andall of those places need
effective leaders.
Dex (13:22):
Yeah, and I've met a lot of leaders in healthcare who've
been doing it for 20 or 30years, and still nobody's taught
'em how to do it, and they'rehalfway drowning, still.
And dying do better as well.
Really highly motivated to dobetter, but it's like how?
How do I do this?
Dr Josh Hartzell (13:41):
Yeah, it's always striking to me.
'Cause I do a fair amount ofcoaching or leadership
development with, differentorganizations and yeah, we have
people who are in pretty,mid-level or senior level
positions who have had maybesome training, maybe not, maybe
none.
Certainly eager to learn.
But yeah we definitely need tothink about how do we make this
(14:03):
routine?
So that, 10 years from now, 15years from now, by the time this
generation of leaders becomes atthat position.
They've had leadershipdevelopment, their whole
careers.
We need to make it alongitudinal training approach
so that folks are betterprepared.
And then recognize that nomatter where you get on the
leadership spectrum, you'realways gonna need more.
(14:26):
'cause you have new challenges,new context.
We're gonna acquire differentskills.
Dex (14:33):
Yes, it really hurts to go from being at the pinnacle of
your technical profession to bedumped into a leadership where
you're floundering.
Very painful!
Dr Josh Hartzell (14:43):
In some ways, and you probably see this with
people you coach too, it'salmost like we push people into
leadership
Dex (14:50):
Yeah.
Dr Josh Hartzell (14:51):
And some people maybe don't even want to
be there, which is okay.
You have to decide, I'm a reallygood surgeon or I'm a really
good researcher.
I don't really want to have todeal with all these other
things.
I just wanna be in the O.R.
I just want to do my research.
And then you have other peoplewho really want to do those
roles.
We need more people to embracethat and be effective leaders.
(15:13):
And even if you're not gonna be,a quote unquote titled leader,
somebody who has a formalposition, everybody in
healthcare leads.
We lead patients at the bareminimum, right?
How do we lead patients andtheir families?
For the most part, you'repracticing in teams and how do
you work with your nurse, yourtechs, your front desk?
(15:33):
All of that requires leadershipskills.
Dex (15:36):
Yeah.
What do you think are thedifferences,'cause you've been
immersed in both worlds, betweenthe military leadership style,
which is very particular, andthe healthcare leadership?
Dr Josh Hartzell (15:49):
To me it's actually interesting.
I did a fair amount of Army.
The US Army has leadershiptraining and then there's
healthcare training.
I will say it's actually similarthan I think a lot of times
people think and I guess I'lljust give you a couple examples.
So when I was doing reserveOfficer Training Corps, which is
(16:10):
the training I got when I was incollege and I had classes on
leadership and we did fieldexercises and other things.
The whole point was to teach youleadership.
Some of those lessons that arenot really different are: you
need to have high standards.
In the military, if you don'thave high standards, like people
(16:30):
get hurt, right?
In healthcare, if you don't havehigh standards, there are
patients we're taking care of.
So I think, it started there.
Like the ability to give peoplefeedback and do that
effectively.
We need it in both places.
I will definitely say some of mymilitary feedback is probably
less kind delivery than maybewhat would be acceptable in a
(16:52):
hospital setting.
But there's certainly the needfor feedback.
The primary thing that I tookfrom the military training is
that our job as leaders, or inmy case an officer in the
military, was to take care of mysoldiers.
And when I was working in ajoint environment, take care of
my soldiers, sailors and airmen.
(17:13):
And it was really that emphasisthat, look, you can't accomplish
the mission if you're not takingcare of your people.
At the end of the day, generals,admirals don't win wars.
They create great strategy andgreat plans, but if there aren't
soldier, sailors, airmen andmarines to carry out those
(17:33):
missions, it's not gonna beeffective.
The same for healthcare.
You really need to have leaderswho understand that if we don't
take care of the healthcare teamand the healthcare team is
large, right?
Physicians, nurses, physicaltherapists, pharmacists, front
desk, techs, the people whosterilize our equipment.
All of these folks are part ofour healthcare team that if we
(17:56):
don't do a good job taking careof all of them, then we're
potentially jeopardizing theability to provide the best
patient care that we possiblycan.
And that lesson was a directcarryover from many of the
things I learned in themilitary.
One thing that really stood outto me was when we were doing our
training exercises, they wouldalways say at the end of a road
(18:18):
march or during a road march,Hey, check your people's feet.
Make sure they don't haveblisters.
If they have blisters, take careof their blisters so that they
can finish the road march.
The other lesson that was prettyconstant in the Army, was, look
you don't eat until all yourpeople have eaten.
Make sure that, your soldiershave been fed, they've gotten
food, and then you can eat.
(18:40):
But to me, those lessons reallystuck in that, hey, my job is to
take care of them so that theycan do what they need to do to
take care of the mission.
Dex (18:48):
Well, it's a pretty high stakes game.
Every time I think aboutmilitary leadership, I haven't
read up very much on it, butJocko Willink springs to mind
and he talks so much about thepsychology and science of how
they operate (19:03):
how they think, how they plan and execute.
And the whole setup seems to mefrom the outside to look like a
cut above what other peoplethink of as leadership because
there's such high stakes.
Dr Josh Hartzell (19:19):
It's definitely high stakes.
And I think the other thingthat's maybe somewhat unique
about, it's just how muchemphasis we put on leadership
development in the military andit's not just the courses and
the different trainings that wehave, but it's the mentoring and
the micro interactions.
We're actually working on astudy now looking at some
different leadership stuff.
And one of the things we've seenis just how much the individual
(19:44):
leaders benefit from theinformal mentoring and coaching
above of people above them andhow that's just been passed down
from generation to generation.
Within the military, your job isto help that next level below
you be prepared to take yourjob.
Because you're always cycling,right?
Our careers are infinite.
(20:04):
I want to go back to the pointyou made about Jocko Willink,
who he is written several goodbooks.
He's a great speaker.
One of the things I love aboutJocko is if you look at Jocko
like he's a pretty tough lookingguy.
He does mixed martial arts.
But he talks a lot about caringand how you have to care for
people as a leader.
(20:25):
It's not what you would expectwhen you see him, right?
You like this guy would beespousing caring.
But he has one quote in hisbook, and I think it's the book
Dichotomy of Leadership, wherehe talks about: If you really
care about your people, then youhave to train them hard and
prepare them because your realgoal is that they can come home
(20:46):
from war, come home fromconflict alive.
And that really resonated withme.
One for my army role but alsofor the healthcare role because
if we really care about ourpatients.
Which, I've really never met aphysician or someone who doesn't
deeply care about theirpatients.
Then we need those highstandards and we need to help
(21:06):
people be able to achieve them.
But we need to do that in acaring way.
In a way that allows them to dothat.
Because what we know is that ifpeople don't have psychological
safety.
If we, work people crazy shifts,it creates environments where
they really can't thrive.
(21:26):
So we have to be able to createthese cultures where people, are
challenged.
Absolutely.
But the level of support equalsthe level of challenge.
Ultimately that leads to betterpatient care, but also hopefully
leads to the healthcare team notbeing as burned out as we really
have been probably for the last,I don't know, several decades
(21:49):
when you look at the data onburnout in healthcare.
Dex (21:51):
Oh yeah, it's horrible.
I work with a lot of physicians,but I'm glad you said what you
just said.
'cause there's the first part ofthe book where it talks about
how do we inspire caring.
Why would you care?
How can you care?
Why don't you care?
What do you care about?
And I've never met a physicianwho didn't care, or a nurse or
anyone else who worked in thehealthcare industry.
By and large, a lot of them arein it because they care.
Dr Josh Hartzell (22:16):
Yeah.
And so 100% agree, and to me,part of the impetus for the book
is if we care this much.
Which is core, it's foundationalto who we are.
Then what are the intentionalactions that demonstrate that
caring?
You go back to the leadership Iwant to care as a leader, but
(22:37):
maybe I've never seen it.
Maybe I've just never had thatexperience of what it looks like
or feels like.
Here are the tangible behaviorsthat you can do if you wanna be
a leader who leads with caring,somebody who places an emphasis
on caring and taking care ofyour people.
Dex (22:55):
Yeah.
I think a lot of people in thosepositions have not had great
leadership modeled to thembecause the people in the next
layers up haven't been taughteither.
In your book there's a lot ofinformation.
It takes a lot of digesting, butI like the chapters set up and I
like the prescription for caringleadership in each of the
chapters with theself-reflective questions.
Dr Josh Hartzell (23:18):
The book it's long.
I will say it's funny when Iturned it in my editor, she was
like, is this a textbook?
I'm like no, it's not.
But I think what I have foundvaluable and what people have
told me that have been readingit is certainly you can read it
straight through, right?
But really to the point you justmade, which is, you know what,
maybe I'm struggling at workwith a particular area.
(23:39):
Delegation.
I feel like I'm just not beingas effective as delegating as I
would like to be.
Let me read that chapter andthen, okay, here's this
prescription at the end of it,let me take one or two of these
ideas and implement them.
Or, Hey, you know what?
I'm actually struggling with myown time management and my own
(24:01):
self-care.
What are some strategies so youcan go to that chapter.
Part of this for me too ishaving been in medical education
for most of my career.
Is that I really wanted there tobe tangible action steps that
people could take.
While I hope the book isinspiring and gets people to
(24:21):
think about it, I wanted someonewho reads it to walk away and be
like, oh, I can do that.
That's a behavior I can startdoing today.
There's, 20 some chapters.
Whatever area you feel like youneed work on, or read that
chapter and then dive in withsome of the action steps.
Dex (24:40):
And when you're talking about this, so I know you do a
lot of speaking and training andall of that, but do you ever
come into contact with HR, withyour ideas and if you do, how
does that go for you?
Dr Josh Hartzell (24:52):
What do you mean by come in contact with HR?
Dex (24:54):
I have worked with a lot of physicians who are on
performance plans, for exampleand sometimes get ejected after
a whole career and things likethat.
My perception from the outsideis there's a lot of HR
involvement in that process andI wonder if there might be some
contentious content stuck inbetween you and them?
Dr Josh Hartzell (25:18):
That's interesting.
I mean it definitely comes upJust recently was talking to a
group, and we were talking abouta couple different groups and
couple issues, both of which hadHR involved.
I think to me it can actually becomplementary.
In an ideal world, right?
We and HR want the same thing.
We want people to be highperforming, to execute well, and
(25:42):
to show up and not createproblems with others at work.
Be good team players.
So we actually want the samethings.
To answer your question, how cansome of the ideas in the book be
partnered with HR?
And sometimes they're part of aprocess.
If we need to have maybe alittle heavier hand in terms of
(26:03):
getting someone to buy into aprocess.
Or if you're having trouble withan employee and you just like,
okay, what are we gonna do withthis person?
I often wonder though that ifthere's not an intermediary
step, which is if we couldimplement some of these
processes in a more caring way.
If we wouldn't get more buy-in.
(26:23):
One of my favorite things isthis idea of compliance versus
commitment.
You probably have way moreexperience with HR than I do,
but generally when we get to HR,I feel like we're getting to the
compliance.
Do this or else and we're reallymissing the,"What would it take
to make this person feel morecommitted to this?"
Dex (26:43):
If HR were motivated on reducing turnover, you would
think they'd want to support thepeople that were there, rather
than just waiting until they hitthe wall and then just going,
no, you're out.
Oh, hang on.
I haven't got enough staff.
I've just fired two.
Dr Josh Hartzell (27:00):
I think from a healthcare perspective, we're
looking at this in terms ofturnover, as you mentioned, it's
expensive.
Dex (27:06):
Super expensive.
Oh my word.
Expensive.
Up to a million bucks peroperative.
Dr Josh Hartzell (27:13):
One of the other things that I've been
thinking about, partly becauseI'm a physician, is this idea of
primary prevention.
So instead of, having to dealwith troubled employees or
people who are leaving becausethey're burned out or whatever,
how do we prevent that fromhappening?
How do we help people thrive sothat they never get to HR, they
(27:34):
never get burned out like weneed to do that primary
prevention.
Dex (27:37):
Yeah, but even the costing of it or the profitability of
it, if you do that is, is a hugereturn.
Dr Josh Hartzell (27:46):
You mentioned the numbers, right?
So the estimated cost is 500,000to a million dollars to replace
a physician.
And there's a variety of thingsthat go into that.
Why not take part of that moneyand invested in more support
staff for your physicians sothat they don't have to write
their notes at night, withpajama time.
(28:07):
Or how about just hire anotherphysician.
Here's an idea for nurses,right?
Nurse turnover is not quite asexpensive, but there's many more
nurses, so cumulatively it stillcosts a lot of money.
Why not hire a couple extranurses to decrease the nurse to
patient ratio so that our nursesone, provide more, safer care,
(28:30):
but also so that they want tostay in your organization so
that you don't have to hiretraveling nurses who cost three
times as much.
Dex (28:40):
Well also you don't have to keep breaking teams that are
working.
I can never quite get my headround why the system persists as
it does, considering that theeconomics are against, nevermind
all the other reasons.
Dr Josh Hartzell (28:59):
It is the right thing to do no matter
what, but if you're notconvinced by just the right
thing, it's the financially bestmove as well.
I do think there's growingrecognition of this because of
the financial implications.
I think as people are reallylooking at the data and
realizing, wow, this is reallyexpensive, that's starting to
(29:22):
motivate people to think about,okay, how can we do this more
effectively save money?
The other thing we know from,again, the burnout literature is
that when you have burned outhealthcare providers, they
provide less safe care, theyhave less patient satisfaction.
There's all these otherindicators that if we do a
(29:45):
better job of taking care of theteam, they would just naturally
get better and it would lead tobetter financial outcomes,
patient outcomes, and healthcareteam outcomes.
In terms of wellbeing,
Dex (29:59):
Yes.
In my mind that's the definitionof a no brainer.
But anyhow, let me ask you fromthis direction then, what are
you most worried about inhealthcare right now?
Dr Josh Hartzell (30:10):
Most worried?
That's a really good question.
I think what I'm most worriedabout is that if we don't do
something to fix some of theissues that we were just talking
about that a lot of people whoare mid to late career, so the
(30:32):
core who I would consider thecore body right now.
You have like junior trainees,physicians who are coming up.
Incredibly important, right?
But they're just out of theirtraining.
And then you have this middlegroup, this is the group I'm
talking about, and then you havethe more senior people.
What I'm worried is that if wedon't fix some of these issues,
they're just gonna keep leavinghealthcare or they're not gonna
(30:55):
leave healthcare completely, butthey're gonna look for jobs that
are gonna give them the workenvironment they want.
And we already see this in somerespects.
We have, physicians who leavecertain practices to go to
environments that are better fora variety of reasons, or they
work part-time for a variety ofreasons.
(31:16):
I think if we don't createbetter work conditions and
change some of the culture ofmedicine, we're gonna have even
more of a physician shortagethan we already do.
And I think you could say thesame for nursing.
I know nurses who are just like,I'm not gonna do this anymore.
I can go get another job.
I can make as much money and nothave to deal with this.
(31:38):
So my biggest fear or concern isthat if we don't really embrace
culture change, we're gonnahave, significant shortages of
healthcare providers as we havea, increasingly aging
population, which is really arecipe for disaster.
With those two things happeningat the same time.
Dex (31:58):
And you train a lot of physician leaders, don't you?
When they come to you, what dothey ask you for the most?
Dr Josh Hartzell (32:06):
I think it's a variety of things.
It depends on their roles.
A lot of the topics we covermost are how to deal with
conflict.
Feedback is always a topic.
I think people are reallyuncomfortable giving feedback.
I think those are theinterpersonal ones that we see
the most of.
And then the other thing, a lotof it is time management and how
(32:30):
do you prevent burnout?
And for me, part of that is afew things.
One is reminding people, and Idon't know if you've read the
book, essentialism by GregMcKeown?
Yeah.
Like life changing book for me,but like this idea that we have
choices.
And really coaching people tounderstand that there's choices.
Dex (32:52):
That must be a hard sell telling a physician they've got
choices'cause that's not theirsensation of life.
Usually, when I meet them.
Dr Josh Hartzell (33:00):
Yeah.
I think that's part of it,right?
We're almost enculturated intothis is what you do as a
physician, or this is what youdo as a nurse to step back and
say no, these are choices.
And there's everyday choices wemake, but there's also career
choices.
So a lot of it is about thatagency around making choices and
also being okay with certainthings.
(33:21):
One of the things that I think Isee a lot of is we do a lot of
things in medicine because wethink other people expect it of
us.
And that might be doing researchor working crazy hours, all
these things that we just do.
And then part of that is justbecause we've agreed to do it
and we don't choose or push backagainst the system that we're
(33:44):
not gonna do it.
Or you could just say for meit's not important.
I don't need to do this to befulfilled.
What I really want to do in mycareer is this.
So focusing on the fact that wehave agency in choices, and then
the other big one, on anindividual level is that, that
same idea, but giving people thepermission to say no.
(34:05):
People ask you to do certainthings, that you can literally
just say, no, I don't want to dothat, or I'm not particularly
interested.
Dex (34:14):
Because that was the other thing I wondered how you teach
them all of the self carepersonal health prioritization
rules you put in the book.
That'd be a tough sell to aphysician in a hospital, for
example.
Dr Josh Hartzell (34:29):
You do a lot of coaching, right?
For me that's when I startchallenging assumptions and I
say Why would that happen?
What would it look like if youtried this?
Really getting them to, eitherchallenge that assumption or I'm
a big fan of piloting things.
Why don't we just try it once?
See what happens, right?
Did the world end?
(34:49):
Did your, clinic collapse?
But just getting them to, givingthem that permission,
challenging assumptions and thenjust try it once and see what
happens.
But I agree it's not easybecause the other thing I think
for physicians, we carry a lotof guilt.
That if we don't do something,something bad is gonna happen to
(35:10):
the patient, or I don't wannalet my coworkers down.
Fully get it.
And trust me, I should also saythat I speak confidently about
these things and I struggle withthem all the time.
So it's not like I have allthese things figured out, but
we're, we are all works inprogress.
But helping people understandthat yes, you feel guilty but if
(35:31):
we don't change some of thesethings, we're gonna continue to
live in this world of burnoutand not having the cultures that
we want.
We have to be able to push backagainst the system, for system
and process changes, while atthe same time ensuring that, no
patient or family suffers fromthat.
(35:52):
There, there has to be abalance.
My concern is that for too long,some healthcare systems,
organizations, departments,different levels have used
physician altruism and nursealtruism to not fix the problems
that need fixed.
Dex (36:11):
I'm gonna say anything about them.
in any case we didn't get timeto sing any carols or anything,
but we're pretty much out oftime.
Was there anything else youwanted to talk about today?
Dr Josh Hartzell (36:21):
The only thing I would say Dex, I think just,
this is gonna air on Christmas,which is awesome.
That's exciting for me.
The thing I've really beenthinking about is twofold.
One is, on a daily basis weinteract with a certain number
of people, and that may be a fewpeople, it may be a lot of
people.
But every one of thoseinteractions is really an
(36:43):
opportunity for us to thinkabout how can I positively
impact this person's life?
And, it could be as simple as asmile.
It could be as simple as holdingthe door for somebody who's
walking out of the grocerystore, carrying their groceries
and looks like they, are gonnastruggle.
It could be having a mentoringconversation with somebody.
(37:05):
But this idea that all of theseinteractions are opportunities
for us to positively impact thatperson's life, which in and of
itself is worthwhile andimportant and we should feel
good.
I feel good about theseinteractions, but then
recognizing that each one ofthose interactions, that person
(37:25):
then goes and interacts withsomebody else.
So these positive interactionscan have this ripple effect
throughout your team, yourorganization, your family, your
community.
So really as we think about,going into 2026, like, why don't
we try to make this the yearwhere all of us with what we can
(37:46):
control, or trying to positivelyimpact the lives of those
closest to us that would make2026 a banner year in my mind.
Dex (37:54):
Yeah, I would agree.
And that comes right back to thetopic we started with in the
beginning.
How can we support our fellows?
Dr Josh Hartzell (38:03):
Yep same thing.
Dex (38:07):
Marvelous.
Alright.
If listeners were gonna rememberonly one thing from today, what
do you wish that one thing wouldbe?
Dr Josh Hartzell (38:16):
To me, it's simple.
It's take care of your people.
They will take care of themission.
This idea that as leaders it'spart of our job to help take
care of others.
And I think as humans, it's partof our job or should be part of
our job to, to take care ofothers.
So just that idea that if youtake care of others, it's gonna
lead to good things in yourorganization.
Dex (38:38):
I love that you're out there making a big noise and
supporting so many people to bethat kind of person and be that
kind of leader out in a toughworkplace, really.
I think you're doing a marvelousjob, and I love your book.
Dr Josh Hartzell (38:51):
Thank you and thanks for for having me on.
I really appreciate it andhaving the opportunity to spread
this message, which we, I thinkboth agree is important.
Dex (39:00):
Very important! And thank you so much for being here
today, Dr.
Josh Hartzell.
It has been such a pleasure.
Dr Josh Hartzell (39:08):
Thanks Dex.
Dex (39:11):
Listeners, please don't forget to pick up a copy of
Josh's excellent book, APrescription for Caring in
Healthcare Leadership, becauseit's packed with practical
leadership advice andsuggestions that everybody can
use.
The link will be in the shownotes.
And if you are heading into NewYear's, feeling a little bit
(39:31):
fried and strung out yourself, alittle bit buried under this
never ending workload.
And if your leadership issuffering the strain, now would
be a really great time to book aconsult with me because I can
help you make 2026 the year thatyou are proud of.
One way your performance,leadership, and passion revive
in a way you never thought thatthey could.
(39:53):
So if you'd like that, you canbook a time at dexrandall.com.
And let's get 2026 startedright.
Now I just wish you and yours awonderful holiday, whatever you
are doing and all the very bestfor the New Year.
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