Three: The Behavioural Determinants of Clinician Wellbeing
Updated: Sep 27
Article 3 of the Compassionate Competence series.
"What got you here won't get you there"
Marshall Goldsmith spent his career working with people at the top of their fields. His best-known line, "What got you here won't get you there", captures what happens when leaders realise the skills and habits that made them technically excellent are now getting in their way in a new role. I think about that line a lot when it comes to clinical education.
The bar is high. The academic demands, clinical mastery, competition and years of delayed reward it takes to become a doctor set medicine apart from almost any other career.*
More and more, though, the research suggests that training left something out. Something that matters for clinicians' wellbeing, and for the outcomes they're trying to achieve for patients.
Singer and Klimecki have elegantly demonstrated that all healthcare professionals exist in an environment where pain and suffering are abundant. Their research shows that when clinicians observe suffering, pain circuits activate -- and over time, habituate. The clinician feels the pain of others.
This is empathy. Empathy on it's own is not sustainable.
They went on to show that clinicians with the mindset and skillset to practice compassion experienced a transformation. When experiencing compassion, these same clinicians saw pain circuits quiet and reward circuits activate. Over time, these too will habituate.
That gives us a clear view of one of the main reasons clinicians lose wellbeing and satisfaction. Nobody trained them to experience anything else.
Which leaves a real choice. You could go to work today, tomorrow and for the rest of your career training your brain toward pain, and carry that cost. Or you could close the training gap and build a practice that trains it toward reward, in every interaction. For yourself, and for the people you work with?
Three determinants
A 25-year longitudinal study of medical careers found that academic performance, the capacity that facilitated entry to Medical School and carried them through, did not predict career satisfaction, wellbeing, or lasting clinical effectiveness. Not significantly. Not at all.
What did predict them were human things: emotional intelligence, resilience, a sense of meaning and connection in the work. What worries me is that the capacities training assumed would just appear actually decline through medical training and practice.
If clinicians never get the chance to address that gap, they're set on a path that wears away both their effectiveness and their wellbeing.
So here's a question to sit with: What decides whether a clinical career keeps you going?
In my work with clinicians, we come back to three things. You'll see these represented in the Healthcare Bridge framework.
Trusted Connection. When interactions affirm the intrinsic value of each person and foster psychological safety, an emotional foundation for care is created. This is not a personality trait or style -- it is a variable underpinning effective care.
Without it, technically excellent care can miss the mark, or be compromised where a lack of trust between patient and clinician has produced a structurally incomplete picture of the issues. Research demonstrates that Trusted Connection is bi-directional: when it is established, clinicians are more able to experience the reward of providing expert care.
New Capability. New Capability is the practice of fostering capacity in others without overfunctioning: supporting patients, colleagues, and trainees in a way that leaves them more able, not more dependent. Adapting to mistakes or fears in ways that do not fuel them.
New capability builds on itself. As people grow, everyone on the team can focus on the most valuable parts of their own role and stay flexible enough to spot opportunities.
Many clinicians know what it feels like to sacrifice new capability for the comfort of immediate efficiency. These same clinicians often recount the frustration of being micromanaged. This is just one aspect of how behaviour can undermine not only growth, but long-term satisfaction and wellbeing. By building on New Capability, the long-term satisfaction and career progression of clinicians is supported.
Therapeutic Journeys. Building on Connection and Capability, Therapeutic Journeys introduces what both require to be sustained: healthy accountability. It is a consistent behavioural practice of maintaining momentum, trust, and boundaries across the duration of a clinical relationship. Without it, strong Connection can tip into enmeshment, and strong Capability into dependency. With it, the hardest parts of medicine become a journey of shared responsibility, and the clinician can stay in them.
Each of these three practices applies inward as well as outward. Self-compassion, in this framework, means practising the same things for yourself: Trusted Connection with your own experience, growth without self-rescue, and accountability that holds without becoming self-criticism.
The elegance is that what sustains you also sustains patients and colleagues.
When the determinants are missing
These pillars are not ideals, they are predictors. Research demonstrates what happens in their absence, and identifies that the changes in thinking and behaving that predict this red line journey occur as early as the second year of a doctor’s undergraduate training.
When Trusted Connection isn't built, or isn't supported by the organisational environment, clinical expertise becomes questioned rather than requested. Disconnection follows. Not because the clinician stopped caring, but because the channel through which care becomes effective keeps closing.
If you’ve ever felt unsafe to speak, or too rushed to listen, you’ve experienced what it’s like when Trusted Connection isn’t present.
When New Capability isn't fostered, interactions build dependency rather than growth. The clinician carries what should be shared. Disengagement follows, quietly, over time, as the reward the work used to offer fades.
If you’ve ever felt like you’re surrounded by idiots, or being treated like one, you know what it’s like when New Capability is absent.
When Therapeutic Journeys aren't supported, when there is no framework for healthy accountability, no way to maintain or return to high standards, outcomes suffer. Despite everything clinicians work so hard to achieve, the gap between aspiration and what the system makes possible widens. That is what discredited looks like: Character and commitment have nothing to do with it. The system produced a training gap and never closed it.
If you’ve ever seen accountability weaponised, or a fear of being blamed deter growth and sacrifice progress, you know the costs of conflating accountability for behaviour with a person's worth.
Distrusted. Disengaged. Discredited. That's not a diagnosis. It's a direction, and it's where things predictably lead when the behavioural determinants of wellbeing are left to chance, or to an organisational environment that doesn't support them.
The distance between Trusted Connection and Disconnection, New Capability and Disengagement, Therapeutic Journeys and Discredited care: that's the non-technical skills training gap.
Getting there
Research also demonstrates something very different from how technical skills are trained and assessed: perfection is not the goal, humility is. In this context, humility is simply the ongoing practice of reflection, practice, and accountability to one another for our behaviour.
Goldsmith wasn't saying "here" isn't worth reaching. His point was that if you stay there, using tools built for a different job, they won't carry you to future excellence or satisfaction.
Research also shows that clinicians who develop these skills are more likely to be viewed as leaders by their peers. It turns out that the determinants of clinical effectiveness, of clinician wellbeing, and of clinical leadership share a common thread.
The determinants of clinical effectiveness, of clinician wellbeing and of clinical leadership share a common thread.
The three determinants I've described are trainable. They show sustained gains when developed deliberately. They are not reserved for exceptional personalities or ideal conditions. They are skills that compound in the direction of the green line just as their absence compounds in the direction of the red.
Where you go next is predicted by the mindset and skillset you apply to shape each interaction, and cumulatively, your trajectory. Research demonstrates these are learnable, and transform the trajectories of clinicians, along with the patients and colleagues they collaborate with.
Stretch that over a whole career and you can watch clinicians' paths split apart, and the effect of the training gap grow.
A note for leaders and administrators
Many of the clinicians we have worked with were, or have gone on to become, leaders and administrators. They arrive in those roles, to these new responsibilities, with the same intent they brought to clinical practice: to improve outcomes, and to heal. What the research is only now making clear is that they may inadvertently carry with them the same training gap. The behavioural determinants of effective clinical care are also the determinants of effective leadership and organisational culture. The gap wasn't closed then. It can be now.
*While it is an open question whether the requirements for selection to medical school and subsequent training should include evaluation of non-technical skills, it should not distract from the fact that these skills are trainable -- like any others a person will learn over the course of their career.
If this resonates with what you've experienced in your own practice, your team, or your training I'd welcome the conversation. You can contact me below. To access the research white paper, Communication as Care, contact us, or complete the free assessment, Healthcare's Hidden Variable.
700 Healthcare Compassionate Competency 2026
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