Case Study: Leading Under Pressure — Coaching Emerging Physician Leaders in a Crisis
Context
As part of a pilot leadership coaching cohort, I worked with a group of high-potential new doctors at a leading research hospital in Philadelphia. Each physician had recently transitioned from being a resident to leading a clinical team in one of the most demanding environments possible — the emergency department.
The goal of the year-long coaching engagement was to help these emerging physician leaders strengthen their leadership presence, emotional intelligence, and the relational skills vital for leading multidisciplinary teams.
Halfway through the program, the COVID-19 pandemic hit. Suddenly, the environment shifted from high-intensity to nearly chaotic. The doctors faced situations that tested not only their clinical knowledge but also their humanity, composure, and moral courage. They weren’t just caring for critically ill patients; they were also concerned about their own well-being and that of their families.
Approach
The coaching process combined individual coaching sessions, emotional intelligence and personality assessments, and reflective practices. Key tools included:
• Emotional Intelligence (EQ) and Personality Assessments – To assist them in understanding their interpersonal styles, strengths, and blind spots.
• Values clarification exercises—especially important as the pandemic prompted them to reevaluate what truly matters in their lives.
• Mindset and cognitive reframing techniques – To help them shift from reactive to reflective thinking under intense stress.
• Boundary-Setting and Communication Coaching – To help them advocate for themselves, challenge unreasonable expectations, and learn to identify alternative solutions to these expectations.
Early Leadership Challenges
Early in the program, several common themes surfaced among the new physician-leaders. They were all highly intelligent and deeply dedicated, yet many found the shift from individual contributor to leader unexpectedly challenging.
Some of the most common mistakes included:
• Equating authority with control. Many believed leadership meant always having the answers. This often resulted in micromanaging or hesitating to seek input — behaviors that unintentionally hinder collaboration.
• Under-communicating under pressure. In the rush of ER life, they sometimes forgot that clear communication is just as important as clinical precision.
• Overlooking the experience of seasoned staff. The doctors hesitated to rely on veteran nurses or support staff, fearing it would seem like a weakness — when, in fact, it’s a sign of wisdom.
• Avoiding difficult conversations. The doctors found it uncomfortable to address conflict, performance issues, or emotional strain within their team — especially when working with peers they trained alongside.
• Neglecting self-management. The hectic pace, high stakes, and emotional strain led to exhaustion. Few recognized early on how much their tone, energy, and self-control impacted the overall team’s morale.
Learning from the Environment
Hospitals serve as natural testing grounds for leadership development — especially in the emergency department. The environment itself becomes the greatest teacher for those learning there.
Through coaching conversations, reflection exercises, and lived experiences, the physicians started to internalize several key lessons.
• Leadership is about relationships, not titles. They realized that influence doesn’t come from rank — it stems from trust. When they slowed down, asked for input, and truly listened, the team performed better.
• Emotional intelligence is a type of clinical intelligence. They found that composure, empathy, and clear communication are just as important to patient outcomes as clinical decisions.
• Resilience is a collective effort. They discovered that relentless uncertainty depends on connection and mutual support, not stoic self-reliance.
• Humility fosters credibility. Admitting what they didn’t know or seeking help didn’t weaken their authority — it enhanced it.
• Values become evident under stress. As COVID-19 surged, they were compelled to reconnect with their core “why”: compassion, service, and integrity. The crisis clarified their sense of purpose.
Results and Reflections
By the end of the program, many of these young physicians described themselves not just as better leaders but as more grounded human beings. They started modeling calm, compassion, and collaboration — even in the midst of chaos.
As one participant reflected, “The pandemic didn’t just test what kind of doctor I am. It revealed what kind of person I want to be.”
From a coaching perspective, the experience showed that leadership development in medicine is never theoretical — it happens in real time and under real pressure. The hospital, with all its intensity and imperfections, is one of the most powerful leadership classrooms there is.