Leadership is often discussed in broad strokes: some leaders are structured and precise, while others are flexible and improvisational. But behind those visible styles lie quiet personal and generational histories, the emotional terrain that shaped how we learned safety, trust, and control. I’ve come to see that these histories profoundly influence how we lead and how we’re perceived as leaders, especially in health care, where the stakes are high and human stories run deep.
For some, particularly those who grew up in unpredictable or high-stress environments, structure becomes a form of safety. Predictability is not about perfectionism; it’s about protection. Rules, plans, and checklists can feel like a lifeline. These leaders have learned that carefulness creates calm, that preparation builds trust, and that precision can prevent pain. Their leadership reflects the wisdom of survival: steadiness as safety, clarity as compassion. Others, often shaped by environments where mistakes were repairable and exploration was safe, may move through leadership with greater ease. They trust that the ground beneath them will hold. Improvisation feels natural. Flexibility feels secure. These leaders see structure as helpful but not defining, a framework, not a fence.
The Adverse Childhood Experiences (ACEs) Study reminds us that the conditions we grow up in (whether turbulent or stable) shape how we respond to stress, authority, and uncertainty throughout life. Those early lessons echo in the way we lead teams, handle conflict, and make decisions under pressure. Leadership, viewed through that lens, isn’t just a skill set. It’s an expression of adaptation. In health care, we often celebrate resilience without asking where it came from. But resilience has roots; and sometimes, those roots are in survival. Leaders from complex backgrounds may carry finely-tuned awareness, empathy, and vigilance. Those from more permissive upbringings may bring openness, optimism, and trust. Each has value. Each carries wisdom.
What matters is awareness. The structured leader can learn to trust the process without needing to control it. The flexible leader can learn to ground their creativity with reliability. Both can recognize that their default mode (whether cautious or spontaneous) began as a strategy for safety, not just a personality trait. When we understand the quiet histories beneath our leadership, empathy expands. We begin to see beyond behavior and into story. We stop labeling some leaders as “rigid” and others as “unfocused.” Instead, we see that each is carrying an origin story, one written long before the job title appeared.
For organizations, this awareness changes everything. It encourages trauma-informed leadership: cultures that value both steadiness and adaptability, precision and creativity. It allows for curiosity instead of judgment. And it reminds us that the best leadership development work is not just about competencies; it’s about compassion. Because in the end, leadership isn’t about mastering other people. It’s about understanding ourselves, and the histories that brought us here.
Brooke Buckley is a physician executive.
