Recently, I have been reflecting on this issue, and here’s what I’ve come up with. Executive presence isn’t about charisma or confidence tricks. It’s about demonstrating a specific set of communication competencies that signal you can handle the complexity of leadership (Goffee & Jones, 2000). And the fastest way to reveal those competencies? Master the art of navigating difficult conversations in real time.

As a health communication professor and patient advocate, I’ve heard the experiences of my clients in which countless medical errors follow this predictable pattern. A critical safety issue arises, feedback is delivered poorly, the stress response is triggered, and for the next 26 minutes, the very people responsible for patient care are operating with compromised cognitive function.