The person in charge isn't always the person in charge
Dr. Reese spent three weeks winning the chair. The raised eyebrow that stalled the rollout belonged to someone else in the room.
The 60-second version
Your org chart tells you who reports to whom. It doesn't tell you how change moves. Dr. Reese spent three weeks winning the chair; the raised eyebrow that stalled the rollout belonged to Maria, the coordinator the chair checks with before deciding what's real. See six roles instead of titles: sponsor, formal leaders, informal influencers, early adopters, blockers, and the quiet majority. Draw the map this week, names and roles, expect it to be wrong, and ask one question before you go back to the chair: who do I need to win first?
6:18 · Published October 13, 2026 · With Poppy & Dave
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In this episode
Dr. Reese just spent three weeks selling the chair on Medtrics: coffee meetings, a demo, a second demo. Dr. Green says, “This is exactly what we need. Yes.” Then she turns to Maria, the program coordinator, who is also in the room: “What do you think?” Maria raises an eyebrow. Six weeks later, faculty still aren't logging in, evaluations aren't getting completed, and some attendings have gone right back to the old way. Dr. Green never said a word against Medtrics. She didn't have to. Dr. Reese had been working from the wrong org chart.
The org chart tells you who reports to whom. That matters, but it isn't the chart that tells you how change moves through your institution. For that you need to know who listens to whom: who the chair talks to before making a decision, who faculty text during the meeting, who new hires watch to figure out how things really work, and whose raised eyebrow can kill an initiative before lunch. So stop seeing job titles and start seeing six roles people actually play when change happens.
Dr. Reese has three weeks and a chair to convince. Where does she spend them?
“I'll get Dr. Green on board first. Coffee this week, a demo next week, and once she signs off the department will follow.”
Three weeks on the person with authority on paper. The eyebrow that decided it belonged to someone she never pitched.
“Before I go back to the chair: who does she check with before deciding what's real? Maria. I'll start there.”
Twenty minutes with the informal influencer. As Maria put it: next time, just ask me.
The sponsor: the dean or DIO whose authority backs you, the one who said your name in the original meeting with the Medtrics team. Know exactly who this is, because there will be a Tuesday in month four when you need to use that name in a sentence, and the sentence has to be true. The formal leaders: chairs, program directors, coordinators with “director” in the title. Authority on paper; they sign things. Then the informal influencers, which is where champions get blindsided: the faculty member everyone texts before a meeting, the coordinator who has been there since the building was new and has watched four EHRs come and go. Everyone likes Maria. That's why she's dangerous to overlook.
The early adopters: find them fast, because their first successes become the stories you tell everyone else. The blockers: not skeptics, skeptics are healthy, but someone whose no causes other people to delay their yes. A blocker can be technically junior, and a chair can privately be the biggest blocker in the department. And the quiet majority: most of your department, not for it, not against it, watching. They move the way the wind blows, and the wind is set by the roles above them. Dr. Reese didn't lose because Dr. Green disagreed. She lost because she never asked the only question that mattered: who does Dr. Green check with before deciding what's real?
“Dr. Reese didn't lose because Dr. Green disagreed. Dr. Green never disagreed. Dr. Reese lost because she never asked the only question that mattered.”
Dave
What the work is for
The sponsor
A name you can use in a sentence on the Tuesday in month four when you need it, and the sentence is true.
Maria
Asked before the second demo, not discovered after the sixth week.
The quiet majority
Still moving with the wind, except now the wind is set by people you've actually talked to.
Say this
You sit down with the informal influencer you've been walking past
“Before I take this back to Dr. Green, I want your read. You've watched four systems come and go here. What would make this one different, and what would make you raise an eyebrow?”
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