Leadership
I started the VBCA Podcast because I wanted to have conversations I wasn't having anywhere else.
Not panel discussions. Not conference keynotes. Actual conversations — the kind where someone says something that surprises you, and you follow it instead of steering back to the prepared questions.
Fifty episodes in, I've talked to health system executives, payer leaders, founders, clinicians, policy experts, and people who don't fit neatly into any of those categories. I've asked about strategy and gotten answers about grief. I've asked about innovation and gotten answers about failure. I've asked about the future of healthcare and gotten answers about what it felt like to sit with a dying patient.
The podcast changed how I think about strategy. But the more important thing it changed was how I listen.
Before I started hosting, I thought I was a good listener. I had evidence for this belief. I'm good in meetings. I ask follow-up questions. I don't interrupt. I remember what people tell me.
What I didn't understand was that most of what I was doing in conversations wasn't listening. It was processing.
I was taking in what the other person said, running it through my existing frameworks, categorizing it, and formulating a response. That's not listening. That's pattern-matching. It's useful, but it's not the same thing.
The difference became clear to me about fifteen episodes in, when I had a guest who said something that didn't fit any of my frameworks. My instinct was to redirect — to bring the conversation back to territory I understood. Instead, I followed it.
What came next was the most interesting ten minutes of conversation I'd had in years.
After fifty episodes, I've interviewed enough exceptional healthcare leaders to have a reasonably confident answer to the question: what separates the best from the rest?
It's not intelligence. The healthcare industry is full of brilliant people. It's not work ethic. Everyone I've interviewed works hard. It's not even vision — plenty of people have compelling visions for what healthcare could be.
The trait that consistently distinguishes the leaders who are actually moving things is this: they are genuinely curious about being wrong.
Not performatively humble. Not strategically open to feedback. Actually curious — in the way a scientist is curious about a result that contradicts their hypothesis. They want to know where their model of the world is incomplete. They treat disconfirming information as interesting rather than threatening.
This sounds simple. It is extraordinarily rare.
Healthcare leadership selects against it.
To get to a senior leadership position in a health system or a payer organization, you have to be right a lot. You have to project confidence. You have to make decisions under uncertainty and defend them. You have to build a track record that justifies the authority you're given.
All of that creates a powerful incentive to protect your existing model of the world. Being wrong is costly. Being uncertain is read as weakness. The organizational culture rewards conviction and punishes doubt.
And so leaders learn to listen for confirmation rather than contradiction. They surround themselves with people who share their frameworks. They interpret ambiguous information in ways that support their existing conclusions. They become, over time, less curious — not because they're bad people, but because the system rewards it.
The leaders I've interviewed who have broken out of this pattern have almost all had some version of the same experience: a moment when their model of the world failed them badly enough that they couldn't explain it away. A strategy that didn't work. A relationship that collapsed. A bet that lost.
The failure cracked something open. And they chose to be curious about what was inside rather than to patch it over.
I came into the podcast as a strategist. I thought about healthcare in terms of systems, incentives, and structures. I still do. But the conversations have added something to that framework that I didn't have before.
The best healthcare leaders I've talked to don't just understand the system. They understand the people inside it — the clinicians, the patients, the administrators, the payers — as people with their own histories, fears, and motivations that don't always map onto the system's logic.
That sounds obvious. It's not. Most strategy work treats people as rational actors responding to incentives. The podcast has convinced me that this is a useful simplification that becomes dangerous when you mistake it for the whole truth.
The most important thing I've learned from fifty episodes of listening is that the gap between what people say and what they mean is almost always where the interesting work is. Not because people are dishonest — most aren't. But because the most important things are often the hardest to articulate, and the best listeners are the ones who create enough space for those things to surface.
That's the skill I'm still working on. I suspect I will be for a while.
"The most important things are often the hardest to articulate, and the best listeners are the ones who create enough space for those things to surface."
About the author
Alex Yarijanian is a healthcare strategist, founder, and speaker. He writes about leadership, systems, and the gap between how organizations say they work and how they actually do.