Strong leaders do not avoid difficult conversations — they handle them in ways that improve outcomes, according to a March 16 McKinsey article.
How leaders communicate is increasingly tied to organizational performance. Courage, the authors argue, means addressing reality directly, inviting challenge and strengthening trust through everyday interactions.
Hospital and health system CEOs are also placing greater emphasis on workforce engagement, often starting with more intentional communication. Leaders across the country have pointed to strategies such as regular staff huddles and listening sessions — paired with visible follow-through on employee feedback — as key to improving trust and retention.
McKinsey outlined four types of conversations that consistently separate high-performing organizations from the rest:
1. Legitimizing professional dissent. Teams with high psychological safety are more likely to generate breakthrough ideas. However, fewer employees feel safe challenging a superior’s view, McKinsey wrote. The CEO sets the tone for whether those conversations are welcomed or discouraged.
In one example, the CEO of a global manufacturing company starts each executive meeting by asking, “What are we not seeing? What are we not saying?” Leaders can also assign a “chief challenger” to test assumptions or a “learning observer” to reflect on how discussion and decision-making unfold.
To put this into practice, McKinsey suggests framing dissent as a service to the organization, intentionally creating space for opposing perspectives, responding with curiosity rather than defensiveness, visibly acting on feedback, and tracking where dissent is coming from across the organization.
2. Clearing “withholds” with transparency. “Withholds” refer to issues that go unspoken — such as frustrations, unmet expectations or broken commitments — that can erode trust over time, according to McKinsey.
Leaders can address this by creating regular opportunities for teams to share both appreciation and concerns, balancing positive feedback with constructive critique, ensuring clear follow-up and accountability, and making recognition a consistent practice.
3. Bringing performance clarity to everyday interactions. The most effective leaders distinguish between the objective elements of performance — such as metrics, timelines and goals — and interpersonal factors like tone, timing and intent.
McKinsey recommends reframing reviews as alignment conversations, keeping facts separate from interpretation, focusing feedback on actions rather than personal traits, and maintaining frequent check-ins.
4. Building a culture of honest feedback. Employees who receive regular, specific feedback are more engaged, and effective leaders treat feedback as an ongoing dialogue.
McKinsey recommends leading with recognition before critique, delivering feedback close to when events occur, asking for actionable feedback in return, and following through to demonstrate accountability.
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