My First 90 Days in Leadership: Learning to Lead Before Leading to Change

Gabrielle Poole, DMSc, PA-C

Chair, Department of Clinical Sciences, Medical University of South Carolina.

Three months ago, I stepped into a new leadership role with a lot of excitement, a long list of things I wanted to accomplish, and, if I’m being honest, a little bit of pressure to prove myself.

I think that is natural when you step into a new position. You want people to know that you are capable. You want to make a difference. You want to identify problems and fix them. You want to demonstrate that the decision to put you in that role was the right one.

But three months in, one of the biggest lessons I’ve learned is this:

Your first 90 days aren't necessarily about proving yourself. They are about learning.

As a PA, I was trained to assess before I act. We gather a history, listen to the patient, do a physical exam and maybe some labs or imaging, consider different diagnoses, and then develop a plan. We don't make decisions based on one piece of information or what we assume is happening.

Leadership requires much of the same discipline.

When you step into a new organization, there is a history behind almost everything you encounter. There are reasons processes developed the way they did. There are people who have invested years into programs and initiatives. There are things that have been tried before. There are successes worth protecting and challenges that may not be immediately visible from the outside.

It can be tempting to walk in with fresh eyes and immediately start changing things.

I’ve learned that sometimes the better approach is to slow down long enough to understand.

That doesn't mean avoiding difficult decisions or delaying change. It means making sure that before I decide what needs to change, I understand what I am actually looking at.

I’ve spent these first few months asking a lot of questions (and in a lot of meetings!) I’ve listened to people describe what is working, what isn't, and what they wish were different. I've tried to understand the culture, the history, and the perspectives of the people I now have the privilege of leading.

And that brings me to the second lesson I’m learning:

Change happens with people, not to people.

There are always things that need to change in an organization. Sometimes the need is obvious. Sometimes the change is difficult. Sometimes the path forward is not yet clear.

As a leader, it can be very easy to fall into the trap of thinking, I know where we need to go. Now I just need to get everyone there.

I’m learning that leadership is much more about bringing people alongside you.

That means explaining the “why.” It means creating space for people to ask questions. It means being willing to hear perspectives that challenge your own thinking. It means recognizing that the people closest to the work often see things that leaders cannot see from their position.

And perhaps most importantly, it means giving people an opportunity to help shape the solution.

That doesn't mean every decision becomes a consensus decision. Leaders are still responsible for making decisions. Sometimes we have to make difficult choices even when not everyone agrees.

But there is a meaningful difference between telling people what is going to happen and helping people understand why it needs to happen and inviting them to be part of how it happens.

People are much more likely to embrace change when they feel like they are part of the journey rather than simply the recipients of a decision.

I think my clinical training prepared me for this more than I realized.

PAs are trained to work as part of a team. We don't practice in isolation. We rely on the expertise of others, recognize what we don't know, and understand that the best plan is often developed through collaboration.

Those same skills matter in leadership.

I don't have to be the smartest person in the room.

I don't have to have every answer.

And I certainly don't have to prove that I know everything.

My responsibility is to ask good questions, listen well, create clarity, bring the right people into the conversation, and help us move forward together.

Three months into this new chapter, I’m realizing that leadership is less about having all the answers and much more about creating the conditions for good answers to emerge.

I’m still learning. I suspect I always will be.

And maybe that is one of the greatest lessons of all.

The goal isn't to walk into leadership with everything figured out.

The goal is to be curious enough to learn, humble enough to listen, and courageous enough to bring people with you when it’s time to move forward.