In part one of this series, we covered the four foundational practices that distinguish high-performing leadership triads from those that struggle to gain traction. Drawing on findings from a recent industry pulse survey conducted by Kirby Bates Associates in partnership with Jackson Physician Search, we outlined what it takes to build a strong triad from the ground up: intentional alignment around shared definitions of success, a communication cadence that goes well beyond monthly check-ins, psychological safety as a prerequisite rather than a nice-to-have, and shared accountability structures that replace siloed goals with collective ownership.
Those four practices give a triad its footing, but footing alone doesn’t carry an organization through the long haul. The most effective triads aren’t static. Healthcare is too dynamic, organizational challenges are too complex for a set-it-and-forget-it approach, and leadership teams are too, well, human. What separates the triads that endure and improve over time from those that quietly revert to traditional hierarchical structures is a sustained commitment to the principles we’ll cover here:
- Investing in relationships, because trust is the foundation of successful triads
- Pursuing continuous development, because triads work the best when each leader understands the other’s perspectives
- And finally, building in the flexibility to adapt as conditions change, because this is healthcare: change is inevitable.
So, if your triad is on a strong foundation, take it to the next level by building the pillars that will support it through whatever storms the nature of healthcare can muster.
5. Invest in Relationships, Not Just Meetings
In part one, we discussed how crucial meetings really are to a successful triad, which is to say vital. And we noted that these meetings aren’t just monthly updates; they’re dedicated weekly sessions. In addition, the most successful triads supplement those meetings with daily touch-bases. Even so, there can be a misconception embedded in how some organizations think about triad leadership, with a notion that simply showing up to the right meetings fosters a strong working relationship.
The truth is that the kind of trust that lets a nursing leader push back on an administrator’s cost-cutting proposal without fear, or lets a physician leader admit uncertainty in front of their peers, develops through something more organic than a shared calendar. It develops through consistent interaction, honest follow-through on commitments, and a genuine understanding of how each member thinks and leads.
Consequently, this is why the most effective triads deliberately invest in the relationship itself, not just the work the relationship is supposed to produce. With that in mind, here are ways to go beyond an idea and take the actions that strengthen your triad’s relationships.
Go Beyond the Agenda To Foster Deeper Trust
Meetings are where a significant bulk of your triad’s work will take place, yet they aren’t the most conducive environment for building deeper relationships. We’re talking about a kind of relationship that’s more substantive than those built through pre-meeting banter. Building a resilient working relationship requires the triad’s leaders’ relationships to be honed both professionally and personally.
Have Frequent and Informal Check-Ins
As trite as it sounds, sometimes the smallest interactions can have the biggest impact. Your organization has seen it play out thousands of times. Saving a dollar during daily processes can add up to millions over a year; minor management changes can increase clinician satisfaction, saving a second can save a life.
Informal check-ins are one of those small changes, too, and they can be immensely impactful for leadership triads. These moments are your triad’s equivalent of water cooler chatter, and, like water cooler chatter, it exerts a surprisingly large impact on your triad’s success. Research has found that informal communication enhances a team’s affective commitment, or how invested they are in their team’s success.
Although your triad’s structured meetings are critical, don’t underestimate or neglect these quick, low-stakes chats. They’re instrumental in building trust in a way that structured meetings simply can’t replicate. And think about it: if you’ve ever had a frustrating or anxiety-inducing experience, you can likely attest to the way a quick talk with a colleague can help alleviate that feeling (or at least make you feel like you’re not alone).
These hallway conversations, calls to flag concerns early, before they become crises, or candid debriefs after difficult board meetings reinforce that your triad functions as a genuine partnership rather than simply a leadership structure.
Physical Proximity Matters
Physical proximity also matters more than it’s often given credit for. Leaders who share space, even occasionally, can develop an intuitive read on each other’s pressures and priorities. That type of relationship is hard to achieve through scheduled interactions alone.
This doesn’t mean co-location is a requirement. In fact, in scaled healthcare systems and organizations, leaders will often find themselves dispersed even when they’re not miles apart. What it does mean, however, is that triads that operate entirely at a distance should be more intentional about creating those informal touchpoints through other means. The good news is that, as remote work has proliferated, there are more tools than ever to help your triad facilitate these interactions.
Learn Each Other’s Leadership Styles
Beyond proximity, each triad member benefits from understanding how their counterparts actually lead. Behavioral assessments and structured conversations about leadership styles can be effective tools for building empathy.
For example, say a triad’s administrative leader processes information and makes decisions very slowly and deliberately. Not badly, but slowly. Watching this thought process play out in real time can border on excruciating for a very action-oriented physician leader colleague. However, when the physician leader understands that their colleague isn’t trying to be obstructive, but rather is trying to manage risk, their knowledge enables them to be patient rather than frustrated.
Strong Relationships Are What Carry Triads Through Hard Moments
When healthcare organizations face rapid change, such as a sudden shift in payer mix, leadership turnover, or a quality event that demands an immediate response, triads without strong foundations of trust and communication are at greater risk of fracturing. Realistically, triads without those foundations are always at risk of breaking. Still, the stress of a tough moment can expose whatever misalignments and fault lines were always there, even if they were manageable during calmer periods.
Conversely, triads that have invested in the relationship ahead of those moments are prepared and poised to navigate them more effectively. They know how to communicate with each other under pressure, and they’ve already established enough trust to be direct with one another. Accordingly, their relationship becomes a resource for navigating the challenge rather than merely an arbitrary leadership structure.
6. Commit to Ongoing Learning and Development
In part one, we honed in on the point that high-functioning triads are developed, not declared. Announcing a triad structure and assigning three leaders to lead together doesn’t automatically equip them to do so, and doesn’t confer any of the advantages of real triad leadership. Leadership, within a triad or otherwise, is a skill set. And that skill needs investment and deliberate cultivation over time.
Despite the importance of that development, many organizations don’t allocate the funds for their triads to carry it out. In many cases, when the triad model is implemented, a group’s early wins are celebrated and, riding the wave of that satisfaction, formal development is deprioritized for the expediency of the organization’s moment. A triad set up this way might skate by for some time. However, gaps remain, manifesting as limited cross-functional fluency, underdeveloped conflict-resolution skills, or blind spots regarding one another’s operational constraints. Eventually, those gaps can’t be papered over, and they begin to show up in how the triad functions.
Instead, to see true long-term success, leaders need to develop continuously. Only then can they get the most out of the triad structure. The more each leader knows about the others’ domains, the better they are at either meeting each leader’s needs or finding areas to compromise while still staying aligned with the organization’s mission.
Build Cross-Functional Fluency
One of the most common sources of friction and frustration in a leadership triad is a genuine lack of understanding about how the other domains operate. For example, physician leaders may underestimate the financial modeling that drives an administrative leader’s decisions. Administrators may not fully appreciate the clinical tradeoffs embedded in staffing ratios. And nursing leaders may be unfamiliar with the credentialing and scheduling dynamics that shape physician behavior. This is precisely why the triad model is necessary: healthcare is far too complex for a single leader.
Cross-functional education, whether that’s through formal rotations, structured learning sessions, or simply building time into triad meetings to explain context, closes those gaps. So, when each leader develops working fluency in the other two domains, the triad’s approach to decision-making can be less focused on protecting a perceived territory and more on collaboration. When your nursing leader can engage meaningfully in a margin discussion, or the administrator can speak credibly to clinical quality concerns, the result is a triad that operates as an integrated leadership team, not three domain experts who occasionally tolerate each other’s presence.
Likewise, the more members of a triad are able to engage in discussions using the language of their counterparts’ domains, the less likely they are to fall into pseudo-conflict, where actual agreement is lost beneath differing ways of speaking about a topic or issue. This means a triad can reach important decisions faster, enabling the organization to be leaner and more agile.
Invest in Broader Leadership Development
Cross-functional education addresses what triad members know about each other’s domains, and it’s an area where each member of the triad will have a similar learning journey. Conversely, leadership development addresses who the triad members are as leaders. Both are equally important.
There are countless ways to invest in leadership development, but a few good places to begin include:
- Behavioral Assessments: Behavioral assessments give triad members a shared vocabulary for discussing how they approach conflict, how they communicate under pressure, and where their instincts as leaders might diverge.
- Leadership Coaching: Leadership coaching, whether individual or as a group, helps triad members identify the habits and blind spots that affect their contributions to the triad.
- Peer Learning: Failure is a great way to learn. The problem is that in healthcare, failure is expensive and dangerous. Fortunately, your triad can look to peer healthcare organizations that have navigated triad leadership. Observing what has helped, what has led to failures, and its less obvious success factors provides a perspective that internal reflection alone can’t generate.
The goal of all this development isn’t to make triad members uniform. On the contrary, your triad’s diversity of perspective and expertise is what makes the leadership model work. The goal of continued leadership development is to make you more effective collaborators. The more self-aware each leader is and the more fluent you are in each other’s constraints, the better you’re equipped to navigate the tension that is, as we noted in part one, a feature of the triad model rather than a flaw.
7. Be Patient and Stay Adaptable
Triad leadership, done well, is a long game. The alignment, trust, communication rhythms, and shared accountability that define a high-performing triad take time to build, and they require ongoing maintenance even after they’re established. Organizations that approach the triad model expecting rapid, automatic results are likely to become frustrated before those results arrive.
So, in the triad leadership model, patience is an active commitment to staying with the model through the uncomfortable early period when things aren’t yet working as intended, when the triad is still figuring out how to make decisions together, and when the pull toward familiar hierarchical structures is strongest.
Build In Regular Reflection
Triads that sustain themselves over time don’t assume that what’s working today will continue to work tomorrow. They build in regular opportunities to step back, assess how the partnership is functioning, and surface the issues that can otherwise fester beneath the surface.
These structured debriefs create the space for honest reflection. What decisions were we slow to make, and why? Where did we feel the alignment break down? What would we do differently? These are the conversations that aren’t easy, yet are crucial for a triad that’s still being established. As uncomfortable as they may be, they keep a triad from drifting back into siloed, reactive patterns.
Likewise, gathering feedback from the broader organization through charge nurses, department heads, surgeons, and administrative managers who are downstream of the triad’s decisions daily adds a dimension of perspective that internal reflection misses. Your triad might feel well-aligned from the inside, yet your organization more broadly could be experiencing something quite different from the outside.
Adjust As Conditions Change
Scaled healthcare organizations don’t operate in a stable environment. Leadership transitions, shifts in patient volume and payer mix, regulatory changes, and new service line priorities all create conditions that require your triad to continuously adapt both its decisions and its organizational structure to lead.
A triad that served an organization well during a period of growth may need to reallocate responsibilities, redefine shared goals, or renegotiate communication norms when the organization shifts into a period of financial constraint. Rigidity in your leadership triad, whether in roles, processes, or approaches, is ultimately incompatible with the complexity of the healthcare sector.
The triads that adapt most effectively are those with the relational foundation and developmental depth to have honest conversations about what needs to change, and the psychological safety to raise those concerns before the situation demands it.
Triad Leadership Is a Commitment, Not a Configuration
The triad model works. Our survey data is clear on this, and so is the experience of healthcare organizations that have implemented it intentionally. However, leadership triads are effective because the leaders who inhabit them treat them as a continuous commitment rather than a one-time structural decision left to run.
The fundamentals of a leadership triad, which we covered in part one, enable it to survive. Still, that triad will need to invest in their working relationships, continuously develop their cross-functional views, and improve their adaptability and flexibility. Only then can they thrive.
Building a triad that endures requires patience, investment, and a willingness to keep working at something that is often more challenging than leading alone. However, the organizations that make that commitment are the ones positioned to lead effectively through whatever comes next.
About Kirby Bates Associates
Kirby Bates Associates is a leader in healthcare executive search and nurse leadership development. With over 30 years of experience exclusively serving the healthcare sector, our recruiters and leaders have what it takes to help your organization meet the moment.
Whether you need to find the right healthcare executive to step into a triad role or a trusted and experienced advisor to elevate your nursing leaders, KBA is your partner. To start the conversation, contact us today.