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“You Need to Fix That!” The Case for Leadership Apologies

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I’m driving to the hospital for my 7 a.m. case. I just finished a workout. I’m on a post-workout high. Ding. The text comes through.

“Good morning, Dr. Patel! We have serious humidity (93%) issues in your OR. The room is unsafe to operate at this moment. The crews have been working since 4 a.m. For now, everything will be delayed until we have an answer.”

The text is from the OR charge nurse. I text back, “No problem”; after all, I’m feeling good after my workout.

About 45 minutes later, I’m now in my OR chatting with the nurse and scrub tech. We just received the green light to open the room.

Thank goodness.

My post-workout high has worn off. I have a busy day of cases and I’m on call. I’m setting up the images for my first case.

7:10 a.m. My phone sends me a text page. It’s the transfer service. The transfer service coordinates the transfer of a patient from an outside hospital to our tertiary care hospital for a higher level of care.

7:20 a.m. Another page. It’s the transfer service again. More details to coordinate the care for transfer. I’m a little irritated because of the second text for the same transfer. I am trying to juggle a delayed full day, and another page for the same transfer instantly adds to my stress. At this time, the irritation in my voice and volume is lancing. While the temperature in the room was going down, the temperature in my body was going up. I verbally dissect the person on the other side of the phone. I feel good in the moment of decompression; however, a small piece of me is a little unsettled. A feeling of: I could have handled that better. I am a physician leader.

They know I’m a surgeon; they’ll get over it, I justify to myself. But my behavior in that scenario nags at me all day.

The next day, I decide to call back the transfer service and speak to that specific nurse. I feel ashamed, and so I own up to my shortcomings. To my surprise, the nurse — in weeping acknowledgement — listens to me and even (unnecessarily) takes part of the blame. I can tell the conversation was needed for both of us.


Physician leadership can be emotionally challenging. As a leader, I pride myself on keeping my emotions under control. My emotionally steady state is key to my competence, and that competence is foundational to ensuring trust and respect. So, too, is apologizing when it’s needed.

On paper, apologizing sounds easy to do — just say, “I’m sorry.” But for someone in my position, it can lead to paralysis — because it means that I’ve made a mistake. And because physician leaders are known to be calm in the middle of a storm, it can feel like we are not allowed to make emotional mistakes — lest they, and our subsequent apologies, throw doubt on our skills.

And yet, not long after the incident with the nurse, something happened that helped me reconsider this mindset: I attended a scheduled leadership meeting with the CEO of our health system. During the meeting, he recounted a time when he had behaved less than professionally to one of his directors. After the offense, his COO followed him back to his office and told him, “You need to fix that.” And so, my CEO marched straight into his director’s office and apologized. Summing up the story, the CEO explained that that event was a turning point in his leadership, where his leadership apology helped him realize that true leadership is about managing relationships. To this day, I am not sure if him telling me the story was coincidental or intentional. Either way, in that moment I came to the realization that owning my mistake and salvaging the relationship was part of the process of being a strong leader.

And yet, resolving to apologize is one thing, but learning how to do so properly and effectively is another. While ruminating on my fear of being seen as imperfect for apologizing, I decided to create an algorithm for leadership apologies based on the conversation I had with the transfer nurse. The next time a scenario comes up, I have a recipe for apologizing that demonstrates remorse but also confidence in recognizing and correcting mistakes. 

Step One: Acknowledge my behavior and my standards.

“Nurse X, when we spoke yesterday, my behavior was demeaning and disrespectful. The truth is that I hold myself to a higher standard and I let us both down.”

Step Two: Apologize for that behavior.

“I’m sorry for speaking to you in that manner.”

Step Three: Appreciate the opportunity and space given.

“I appreciate you giving me the opportunity and space to talk to you.”

Step Four: Promise behavior change.

“I am a work in progress. I promise not to disrespect you again.”

Reflecting on the conversation with the nurse, I believe my apology did affect my trustworthiness as a physician leader, but not in the way I imagined. To my surprise, my apology humanized me to those I lead, and demonstrated humility. The very fact that I was willing to admit I was wrong only added to my skills of being a competent and trusted physician leader. 

I am learning every day that great leadership requires self-awareness. It’s about knowing how I will handle a situation before the situation arises. The leadership apology I gave to the nurse helped me become more self-aware. I hope to impart that same self-awareness and emotional resilience to all those under my wing.

What do you think makes an apology successful? Share your thoughts in the comments below!

Nimesh Patel, MD, MBA is the section chief of neurosurgery and executive medical director for the Methodist Health System in Dallas, Texas. 

Illustration by Diana Connolly

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