The hard case isn't the person who tells you no
Sometimes it's the department where everyone says yes and nothing moves. Pediatrics has flatlined, Dr. Green is warm and supportive, and Dr. Reese has eight weeks.
The 60-second version
Internal medicine is moving, surgery is moving, pediatrics has flatlined, and its chair has never said a negative word. Dr. Reese's brain wants to write a story about Dr. Green. Instead she asks, over coffee with no accusation, gets a warm non-answer, and goes back to the data: no activity, milestones not moving, eight weeks until residents arrive. That's an operational risk, not a feeling. She brings her sponsor a date, a consequence, and a gap, and no theory about Dr. Green. Underneath the silence turns out to be a capacity problem. Don't confuse silence with agreement, or with resistance. Find out.
8:44 · Published November 3, 2026 · With Poppy & Dave
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In this episode
Sometimes resistance is easy to spot. Someone tells you they don't like the new workflow and would rather keep doing things the old way. Not ideal, but refreshingly clear. The harder case is when everyone seems supportive and nothing happens. A few weeks in, Dr. Reese is looking at the adoption report. Internal medicine, moving. Surgery, moving. Pediatrics: flatlined. Dr. Green chairs pediatrics. She was at the kickoff, she told leadership the rollout was overdue, and she has never said a negative word about Medtrics. And pediatrics hasn't started.
So Dr. Reese's brain does what brains do when they're missing information: it makes the information up. Maybe Dr. Green isn't actually supportive. Maybe she's quietly blocking. Or Dr. Reese could just ask her. No accusation, no adoption report attached, just coffee Thursday. Dr. Green is warm, friendly, perfectly reasonable: we're getting there, my coordinator's been buried in ACGME site visit prep. Which makes this harder, because Dr. Reese can walk away and write either of two stories. Dr. Green is quietly undermining the rollout. Or she's busy and everything's fine. Conveniently, both stories let Dr. Reese stop investigating, and she doesn't know that either one is true.
Dr. Reese takes pediatrics to her sponsor. Two ways to frame it.
“Dr. Green isn't engaged with Medtrics, and pediatrics isn't doing what they're supposed to be doing.”
A complaint about a person. And Dr. Reese doesn't actually know that it's true.
“I want to flag something before it becomes a problem. Pediatrics hasn't started its implementation work. We're eight weeks from the July schedule going live. If the department isn't built by week ten, those residents could start their first rotations without schedules in the system. I've talked with Dr. Green; she says they're working on it, but it hasn't moved, and I don't know what's underneath it. I wanted you to see the timeline before we run out of room.”
A date, a consequence, and a gap. No theory about Dr. Green. Her sponsor can act on that.
Diagnose before you respond. She doesn't accuse Dr. Green and she doesn't disappear for three months. She goes back to the data: pediatrics hasn't begun its work in Medtrics, faculty activity is essentially nonexistent, the implementation milestones aren't moving. Now she has something more useful than a weird feeling after coffee. She has a pattern. “I don't think Dr. Green is engaged” is an interpretation. “Pediatrics has eight weeks before residents arrive and the work hasn't started” is an operational risk. One starts gossip. The other starts a useful conversation.
That's what the sponsor on your stakeholder map is for: not someone you summon every time an email takes four hours to answer, but exactly this. Dr. Reese doesn't tell him what to think about Dr. Green. She gives him three things: a date, a consequence, and a gap between where pediatrics is and where it needs to be. Now he can decide what to do, and sometimes, when the silence finally becomes visible, you find something completely different underneath it. “We lost a key faculty member two weeks ago, and I've been trying to cover the schedule while we hire.” That isn't quiet resistance. That's a capacity problem, and it needs a very different response. Don't confuse silence with agreement. Don't confuse it with resistance either. Find out.
“One starts gossip. The other starts a useful conversation.”
Dave
What the work is for
Dr. Reese
Sees the flatline at week four instead of panicking about it at week ten. A date, a consequence, and a gap, not a conspiracy board.
Her sponsor
Gets a risk he can act on: a call to Dr. Green, a steering-committee agenda item, or context Dr. Reese doesn't have.
Pediatrics
Gets the real problem solved, a missing faculty member or an unvoiced doubt about the timeline, before July residents start on email and paper.
Say this
You bring a flatlined department to your sponsor
“I want to flag something before it becomes a problem. Pediatrics hasn't started its implementation work in Medtrics. We're eight weeks from the July schedule going live for the new residents. If the department isn't built by week ten, those residents could start their first rotations without their schedules in the system. I've talked with Dr. Green. She says they're working on it, but the work hasn't moved yet, and I don't know what's underneath it. I wanted you to see the timeline before we run out of room.”
11. Running the Meetings
Premieres November 10, 2026