High Titles. Low Accountability. Why Leadership Optics Are Costing Us Outcomes.

I have a longer article coming out in a few days—but I couldn’t hold this one back.

This week, I took a call from a major healthcare organization looking for an interim executive to support patient safety, regulatory readiness, and lead quality through a Joint Commission cycle.

It’s the kind of work I know inside and out.

A role I don’t pursue, but have always enjoyed—because helping teams sharpen under pressure is something I do well. Not because it’s easy, but because I’ve lived it—turned systems around, stabilized cultures, and gotten teams inspection-ready with calm, grounded leadership.

But within 10 minutes, it became clear:
They weren’t evaluating readiness. They were checking boxes.

“Have you ever been a Director of Quality?”
“What has your actual role in patient safety been?”
“We don’t really know how the hospital is doing. That’s why we’re looking.”

That last line came from a regional safety officer. Someone who likely rounds on this hospital. Who holds responsibility for outcomes across a multi-site system.

And yet—she didn’t know if her own site was ready for inspection.

This isn’t an isolated moment.
This is a systemic pattern.
And we see it everywhere: In healthcare. In government. In enterprise.

Systems where we reward familiarity over results.
Where leadership is mistaken for tenure.
And where those best equipped to lead are often overlooked for not fitting a conventional template.

The role I was interviewing for?
I’ve functionally exceeded it dozens of times. But because my title didn’t match the mold, the system didn’t compute.

This is the consequence of optics over substance.
Of metrics over traction.
Of titles over trust.

Real leadership isn’t defined by what’s printed on an org chart.

It’s defined by clarity under pressure, by earned trust, and by outcomes that hold—even when no one’s watching.

If you're navigating a system that looks polished on paper but is quietly unraveling beneath the surface, this piece is for you.

🖤 The next article is coming soon. But sometimes, the signal is too loud to wait.