I have spent most of my career behind the scenes, working on projects, participating in meetings, and helping make the decisions that eventually become buildings, budgets, schedules, contracts, equipment lists, and, if everyone has done their job, places where people can actually receive care. I have been very comfortable there. There is a particular kind of satisfaction in doing work that does not need your face attached to it. The project opens. The department moves in. The problem gets resolved. The decision is made. The work speaks for itself, or at least that is what I have told myself for years.
Then someone turns on a camera, and suddenly I would rather discuss a complicated construction claim with six attorneys than speak into my own phone for 90 seconds. I have cringed at the idea of putting myself on the internet for years and not mildly resisted it. Cringed. I could stand in front of a room, teach a class, lead a difficult meeting, challenge a recommendation, or present millions of dollars in capital needs. But a small black circle at the top of my phone? Apparently, that was where courage went to die.
Naturally, I had reasons. I was busy. It was not the right time. I did not have the right setup. I needed to be clearer about what I wanted to say. I needed a better plan, better lighting, a more defined platform, and perhaps a completely different personality. All very reasonable. Also, if I am honest, all excuses.
When Quiet Becomes Hiding
Being behind the scenes is not the same as being afraid. Much of the most important work in the built environment happens there. It happens when someone notices that the budget and the scope are no longer describing the same project. It happens when a planner asks the operational question missing from the design conversation. It happens when the right person connects two decisions no one else realized were related. That work rarely needs an audience. It needs judgment.
There is something honorable about being more invested in the outcome than in being seen producing it. I still believe that. I am not interested in turning every meeting into content or every lesson into a performance. Some work should remain quiet, and some rooms require discretion. But somewhere along the way, I began using the value of quiet work to justify keeping all of my thinking quiet too. Those are not the same thing. You can respect the work without disappearing behind it. You can protect confidentiality without withholding every lesson. You can be serious about substance and still allow people to know who is doing the thinking.
Competence Is a Comfortable Place to Hide
Competence, I have learned, can become a very comfortable hiding place. When you know how to do the work, there is always more of it available: another problem to solve, another document to review, another meeting to prepare for. Sharing publicly was always the task that could wait until the “real work” was done. The problem is that real work is never done. There will always be another deadline, another project, and another perfectly defensible reason to postpone the thing that makes you uncomfortable.
Waiting can look remarkably responsible when it is dressed as preparation. I told myself I needed to know exactly what I was building before I began speaking, but clarity does not always arrive before action. Sometimes it is the result of action. You learn what you think by trying to articulate it. You discover which ideas have weight by putting them into conversation. You find your voice by using it. This is deeply inconvenient for those of us who would prefer to perfect it privately first.
The Cost of Invisible Thinking
There is also a subtler cost to remaining behind the work. People see the outcome without understanding the thinking that produced it. A successful project can make a difficult decision look obvious. A meeting that runs smoothly can hide the preparation behind it. A problem avoided leaves no dramatic evidence that it was ever there. Good judgment often erases its own fingerprints.
Over time, I realized I had accumulated more than completed projects. I had accumulated ways of seeing. I had stories about what happens when teams skip the uncomfortable question, lessons about how small planning decisions become expensive construction problems, and opinions about leadership, contracts, capital, healthcare real estate, operational readiness, and the strange group project required to make a building work. Keeping all of that safely behind the scenes was comfortable. It was also beginning to feel wasteful.
Moving Before I Feel Ready
I am now at an interesting transition in my life. For the first time in a long time, I have the opportunity and the responsibility to decide what I want the next chapter to look like: what I want to build, what I want to teach, which conversations I want to start, and how I want to show up. Apparently, showing up now includes talking to my phone.
This is not the reinvention story in which I woke up fearless, bought a tripod, and became someone who casually says, “Let’s film some content.” I remain suspicious of that sentence. I am not suddenly confident on camera, and I cannot tell you exactly where this will lead. What I do know is that I no longer want confidence to be the admission price for participation.
Confidence is often described as the thing that allows us to act. I suspect it is more often the thing we build because we acted and survived being awkward, uncertain, or new. The first recording does not prove that you are ready. It proves that readiness was not required.
Practical Audacity in Real Life
That may be what Practical Audacity looks like in real life. It is not performative fearlessness or having every answer. It is movement in the presence of discomfort. So I am stepping out from behind the work. I am not doing this to make myself more important than the work, but to make the thinking available. I want to talk about the places where healthcare happens and the decisions that shape them. I want to examine the questions we skip, the consequences we pay for, and the very human reasons smart teams still get things wrong.
I expect this to be challenging, probably a little messy and certainly one heck of a ride. But perhaps the next chapter does not begin when I finally feel ready to be seen. Perhaps it begins here, while I am still uncomfortable, no longer hiding and willing to go first.