I'm the new CEO of a regional hospital system that desperately needs reform. Quality scores are dropping, staff morale is terrible, and three of our five board members are blocking every change I propose. They're old-guard, connected to donors, and more interested in their own legacy than patient outcomes. I have two paths: I can try to win them over through patience, relationship-building, and demonstrating results. My COO calls this "leading by example" and thinks it's the only sustainable approach. Or I can use the leverage I have—I know about some questionable contracts they've approved, and the major donor who recruited me has offered to help push them out if I give the word. The gentle path could take years we don't have. The hard path could work but might make enemies who torpedo us later. How do you create change when the people in power won't be moved by reason or example? — The Resistant Board in Baltimore

From Life of St. Francis of Assisi

"Preach always; use words only when necessary—transform through example, not force"

I faced bishops and cardinals who thought me a fool or a threat. I did not fight them with their own weapons. I simply lived what I believed, and in time, even popes knelt to listen. Your leverage is not power—it is poison. Use it and you become what you oppose. Be the hospital you wish to create, and others will follow.

From The Life of Bismarck, Private and Political: With Descriptive Notices of His Ancestry

"Great questions are decided not by speeches but by iron and blood—and shrewd timing"

Patients are suffering while you contemplate your soul. Politics is the art of the possible, and what is possible depends on power, not virtue. Use your leverage—not crudely, but strategically. A quiet word about those contracts, properly placed, will move mountains that prayer cannot. You were hired to fix this hospital, not to become a saint.