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The Leader’s Library: Radical Candor | Curated Summary of the Discussion

By Dina Wallin, MD November 18, 2019 0 comments

radical candor

Welcome back to The Leader’s Library! In our second installment, throughout the week of October 14, 2019, a group of selected learners across the globe tackled Radical Candor by Kim Scott [ALiEM book summary], and generated another fascinating asynchronous dialogue on Slack. This go-round, we had 3 days of discussion with days for reflection in between. Below are the main points that emerged from our robust conversation.

Day 1: Importance of radical candor in effective leadership

We started by discussing why we’d all joined The Leader’s Library in the first place. While participants were, of course, seeking to strengthen “leadership skills,” a common specific focus was improving feedback– making expectations clear and holding the person accountable, while simultaneously supporting them and, hopefully, strengthening our relationships.

I find that my natural instinct is so paternalistic that I don’t want to hurt feelings. I try to inspire them with my actions rather than my words. This book, along with hard experience, has pushed me to really be forthright and candid about performance.  Perhaps the negative feedback is really going to strengthen the relationship (because it shows I really care enough to give it), rather than make them feel belittled.

We dissected Scott’s mantra that a boss’s job is to “guide a team to achieve results” down into core components:

  • Guidance = feedback
  • Team building = putting the right people in the right jobs
  • Results = chase results collaboratively

One participant pushed this further, though, adding in qualifiers:

…guidance = feedback + leading by example, team building = putting the right people in the right jobs + developing your direct reports. In The Five Dysfunctions of a Team by Patrick Lencioni, the pinnacle of the pyramid is “inattention to results,” usually caused by people’s egos and attention to individual outcomes. Our role is then to redirect our team to focus on the team’s goals, which will benefit every team member individually.

5 dysfunctions team Radical Candor
5 Dysfunctions of a Team

Once the effective boss is able to focus team members on the team’s goal, rather than that of the individual, then they can work on building a culture of collaboration and resilience:

[A great boss provides] intentional provision of incremental skills building and strategies that make getting to success easier to achieve rather than simply expecting having an eye on results… I think the challenge for leaders is to align vision with finding simple, achievable steps to reach said goal. That’s cultural empathy. Finding simple, achievable steps that promotes better habit is even better. That drives cultural resilience.

The group felt that any team member (boss or employee) could employ radical candor in their interactions, whether granularly in their own interactions, or more broadly to better understand their superiors and potentially advocate for better leadership; however, radical candor works better if the whole organization understands and “buys in.”  

I think the book helped give perspective to give more grace/understanding to our bosses, but also to see how they possibly need to be pushed to be a better leader. Obviously this is easier said than done and can cause a lot of anxiety, but I can think of previous employment situations where I wish I had been more honest and candid with my bosses about not understanding their expectations because they were being quiet listeners or were exhibiting ruinous empathy.

Radical Candor can be awesome, but if you’re doing it in a department or in a group, the entire group has to (1) know that is what you’re doing and (2) buy in to the idea. I think it is easier to establish in one-on-one relationships (like between me and a medical student/resident/nurse/etc), but in larger groups, it can go very, very wrong.

Participants shared their strategies for establishing trust in their teams, and, although we used different words, most people build the foundation of trust via consistent behavior, integrity, and exposed vulnerability (“going first,” in Scott’s words). We also shared our self-care routines, to better preserve our own strength and lead by example; sleep, meditation, exercise, mindfulness, and journaling were all common behaviors, as was the concept of “radical prioritization” of new opportunities:

I wait 24-48 hours before saying yes to anything. I try to accept work that is collaborative with people I enjoy working with… the delay helps mitigate my initial rush of excitement about a project with a healthier context of would I be a good partner.

Drawing connections about “radical prioritization” to other books, this idea seems very similar to one put forth in the book Peak Performance by Brad Stulberg and Steve Magness — “In order to be a maximalist, you have to be a minimalist.” Basically, in order to achieve “peak performance”, you should identify and strive to cut out all the superficial things in your life. You should be fully intentional with how you spend your most precious resource of all, time.

We discussed examples we’ve seen of ruinous empathy, manipulative insincerity, obnoxious aggression, and radical candor, and ruinous empathy seems to be ubiquitous in medical education, especially when relating to struggling learners! We then shared ideas on how to shift to radical candor when working with underperforming team members, and landed on 3 main concepts: 

  1. Truly care personally and demonstrate it overtly to the individual
  2. Remember that a bad fit of an employee in a role doesn’t mean the employee themself is bad. 
  3. Approach struggling team members with a growth mindset.

Stop trying to mold person to the work and mold the work to the person!

I think the book helps me think a little bit less about any one person as a “grade” and more about where they fit on the growth trajectory (neither end being “bad”… gradual or steep, all good) and then thinking about performance, as there could be a mismatch between the job/culture’s needed trajectory and the person’s desired/ability trajectory… therefore you get into the “mismatch” construct rather than “you’re not good” type of conclusion.

Along these lines, we had a robust discussion of “rockstars” vs “superstars.” While in all fields we tend to focus on our “superstars,” who shine brilliantly as they traverse their steep growth trajectory, our “rockstars” also need attention and support. “Rockstars” provide consistent stability and are the foundation of our organizations. These labels are dynamic, and participants discussed how they themselves have journeyed from one to the other and back again as their personal lives and careers shifted.

rockstars are now my very favorite employees, especially when they have mini cycles of superstar every now and again… They are dependable, they keep the machine humming along, and I spend time actively and publicly valuing them. I’d love to brag about a team of superstars, but that risks instability and would be energy draining.

… many of us will rotate through times where we are the “boss” and times where we are the employee. To the extent we are aware of the differential value of varied contributors, rockstars vs. superstars vs. others, I think it helps us be more appreciative, collaborative, and productive.

Day 2: Getting Stuff Done and Listening Skills

Get Stuff Done Wheel

The day kicked off with a discussion of the Get Stuff Done (GSD) wheel. Where does each of us feel more comfortable on the wheel? While we all default to different areas of the wheel, “decide” and “execute” were common landing areas for many participants, consistent with our clinical practice. We agreed that our GSD strengths vary throughout our careers, and are also extremely context-dependent. What’s the project? Who’s on the team?


…this is a nice reminder to pause and reflect – almost like a debriefing following a simulation, to explore individuals’ frames and schemas.

I love the learn, listen, and clarify section and then once all is decided love getting it done. At times, the decision fatigue of work makes “Decide” a tough thing for me. It’s part of the reason I’ve been cutting down on projects in general recently so I can get that back.


I think I excel in the clarify part, and although I really value the listen stage, I have to be more present and intentional to listen without jumping ahead. Maybe my focus on clarifying is a coping mechanism I’ve developed to compensate for my “growth opportunities” in listening!

My natural affinity is on the clarify, debate, and decide part. I lose steam on the execute part… because a new compelling project comes by.


I love to problem solve so often jump too quickly to the decide/persuade/execute part of this loop before I’ve spent enough time in the learn/listen/clarify/debate portion. As I mature in my leadership I’ve had to remind myself often to spend more time talking to stakeholders and getting information before I jump right to making a decision.

The one I am working on the most is PERSUADE… The more you move up the leadership org chart, the more you answer to many people above and below you. Managing up and down — and inspiring up and down as a leader — requires the persuade skill set… it requires patience to get the message to be fully heard and processed.

I often feel successful in the persuade step in that I often get immediate buy in from my team when I pitch an idea… but then my victory seems short lived when I realize that I fail at persuading people to execute with me.  This often gets me stuck taking on large endeavors solo which I feel takes away from the quality of the project because I ultimately move on to the execute step on my own.  


I’m a great executor– because I don’t see myself as boss yet. Give me something to do, and I do it.

Listening Skills

This inevitably led us to a discussion on listening; after taking the Mind Tools Listening quiz, we found that all of us were very average listeners who love to excitedly interrupt. We reflected together on how we could help create a culture of listening. Loud listening is not only common in academic medicine; it’s also inherent in our specific careers as emergency physicians. Some strategies we generated were creating space for “quiet listening” and cultivating empathy (such as via switching spots and arguing another person’s position, or employing a framework like Liberating Structures):

… [there is] lots of loud listening in academic medicine. Sometimes it makes me wonder how or if we actually listen to our patients since we have such trouble listening to our colleagues.

What makes it even harder is that we are not trained to listen professionally.  We are trained to hear what we need to make a diagnosis (or even more important a disposition)… I especially liked the idea of “quiet listening,” as a way to listen with the plan to understand as opposed to listening with the plan to push my own agenda or to get something done.

I… conscientiously make an effort to put someone at ease, knowingly stay completely still so that I don’t distract them, and try to read the other person’s body language as I listen… it comes from a place of feeling like I was not heard in the past or having walked away from a discussion feeling like I was rushed or not understood, so I try to put myself in someone else’s shoes to avoid someone walking away feeling like that.

Day 3: Concept of “Think Time”

The day opened with a discussion of “think time,” during which we have no tasks other than to allow our creativity to flourish and invite big picture ideas. While participants who identified as junior in their career admired the concept, few have been able to practice it in reality; several reported that space for reflection and introspection had only been created through conversations with, and probing questions by, others. Conversely, more senior leaders consistently enforce this time, typically in the early morning, to allow themselves space for growth.

One thing I have started to do is taking walks… to operationalize think time. One hour of this think time investment usually results in at least five hours of return in time saved from radical prioritization or execution.

We are historically good at using our time to produce and we have validation of our past efforts — based on our accomplishments, we were promoted to a leadership role. Then we move up the org chart and are charged with executing strategy and vision. Many of us — me included — are guilty of retreating to what we are good at, being productive. We struggle to learn the art of reserving time to think, reflect, create, innovate, and drive strategy.

We then discussed how we were going to escape the other quadrants and really live in radical candor, whatever that looks like for us:

I think Kim Scott’s paradigm is useful and instructive. I’m not certain it is the ideal paradigm for everyone… I think it is most important that each of us:

1) assimilate the essence of [Scott’s] message,
2) be mindful of our own vocabulary and approach to this, and
3) be methodical in implementing it consistently in our own behaviors.

… I would observe that consistently high-performing and well-regarded leaders are generally thoughtful, methodical, respectful, consistent, courteous, and clear. If each of us creates a few-word mantra to consistently remind ourselves of the behaviors to which we aspire, and we remind ourselves daily of the mantra, I think it will be easier for us to be more self-aware, recognize in real-time when we deviate from our desired behavior, and self-correct in real-time.

We closed with public declarations of concrete behavioral changes we’d be making after our group discussion.  Several people reflected on changes to the feedback they’d be giving learners (more clear, less “nice”), and others described how they’d implement “think time.” Many participants plan on better nurturing their rockstars and providing them with sustenance to continue their steady growth.

All in all, the second installment of The Leader’s Library was a success with participants emerging with specific plans of action to better create and foster an environment of listening, collaboration, and growth in their organizations. We hope you can join us next time. Ta-ta for now!

Thanks to our global facilitators!

  • Sonia Twigg
  • Michael Gisondi
  • Dimitri Papanagnou
  • Felix Ankel
  • Chris Doty
  • Rob Cooney
  • Nikita Joshi

Mentioned and Related Resources




Author information

Dina Wallin, MD

Dina Wallin, MD

ALiEM Series Editor, The Leader's Library
Co-Medical Director of Pediatric Emergency Medicine,
Zuckerberg San Francisco General Hospital;
Director of Didactics, SFGH-UCSF Emergency Medicine Residency;
Assistant Clinical Professor of Emergency Medicine and Pediatrics,
University of California San Francisco

The post The Leader’s Library: Radical Candor | Curated Summary of the Discussion appeared first on ALiEM.

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