Self-Awareness in Leadership: It's the Skill That Makes Leadership Possible

What Is Self-Awareness in Leadership?

Self-awareness is essential to strong leadership. It is the ongoing practice of noticing what is happening inside you, including your values, emotions, biases, and physical signals. It requires understanding how those forces shape your judgment and impact the people around you. It is a skill that can be built. Individual work on asking the hard questions, reflecting, and practicing self-compassion can contribute, but you cannot build it alone. Some of what drives us is invisible from the inside, and it often takes a nurse willing to say "you look exhausted" or a colleague pointing out a bias to show us what we could not see ourselves.

This is not the version of self-awareness we hear about in wellness seminars, where it often means simply checking in with your feelings once in a while. The harder version asks you to notice what you have normalized, trace it back to where it came from, and find the courage to share it with someone else.

A Story From My Own Career: The Cough Drops in My Pocket

A few years ago, I put my hand in the pocket of an old fleece jacket and found three cough drops. I remembered instantly. The last time I'd worn that jacket in the ICU, I was genuinely sick. Not mildly congested. Not inconvenienced. Sick enough that if I had been my own patient, I would have told myself to go home, rest, and stay away from other people until I recovered.

Instead, I rounded. I staffed critically ill patients. I made high-stakes decisions with a mask on and cough drops in my pocket as a quiet workaround for my own physiology.

Nobody stopped me. The system didn't catch it. I didn't catch it either, not until years later, standing there with my hand in that pocket, asking myself a question I should have asked much sooner: Where did I learn that pushing through illness was what professionalism looked like?

I see now that physicians cannot pour from an empty glass. In retrospect, I would have called in a peer for assistance to avoid making others ill or prolonging my own illness. I also see the importance of role modeling self-care for those around us. This role modeling is essential to shifting our profession toward a more sustainable career.

How a Lack of Self-Awareness Shows Up in Leadership

I saw the cost of skipping self-awareness again in my own office. A resident I had mentored since his internship sat across from me one morning and told me, through tears, that he didn't want to be an intensivist. He had already started his critical care fellowship application. It took him that much time and effort to say something different out loud.

I wasn't upset that he didn't want to do critical care. I was upset because I hadn't seen it coming. Sitting with him, I realized something I hadn't let myself see before. I had taught him how to excel clinically, but I had never taught him how to reflect and choose. I had focused on his performance and his opportunities, and somewhere along the way, without ever saying it directly, I had let him believe the goal was to become a more polished version of me.

There had been cues. There are always cues. I missed them because I was moving too fast to notice, and moving too fast is exactly what a lack of self-awareness looks like in practice. It doesn't look like disengagement. It looks like unexamined momentum, and it is just as easy to fail your team by racing forward as it is by standing still.

Self-awareness does not only impact one individual at a time. When I was a senior clinician and Army Colonel leading a residency program, I failed to realize the impact of psychological size. I was unaware of how the residents experienced me and the courage that was required to approach me. I saw myself as approachable and therefore thought they would indeed approach me if they needed anything. This lack of awareness kept me from filling gaps in the program and from ensuring that residents' needs were met by someone who they felt safe talking with.

Why Self-Awareness Is a Discipline, Not a Personality Trait

Here's what all of these moments taught me. Self-awareness isn't a mood or a personality trait. It's a discipline, and it depends on reflection and reflective discourse. These are both skills that require practice to develop. Reflection is the skill of looking back on our experiences to identify not only the steps we took, but also the emotions we carried. This can be done through visualization or journaling. Reflective discourse takes this a step further. This asks us to describe our experiences and learning points with others, such as peers or mentors, to identify gaps and blindspots. Without practicing both reflection and reflective discourse, experience piles up, but learning doesn't. We keep repeating patterns we don't fully understand and call it commitment.

The Cost of Skipping Self-Awareness as a Leader

Leaders who skip this step don't become worse people. They become people who mistake endurance for excellence and who unintentionally reward the same blind spots in everyone they lead. The resident who cried in my office wasn't failing. I was the one who hadn't paused long enough to ask him the right questions, or to ask myself why I hadn't asked them sooner. The residents who did not feel safe approaching me were denied adequate support during a challenging time in their lives because I was unaware of how they experienced me. I am certain that being more aware of this blindspot would have improved the well-being of the residents within my program as well as the program itself.

How to Start Building Self-Awareness as a Leader

If you lead people, the work starts with a question most of us would rather avoid: What have I normalized that I haven't actually examined? What have I been carrying forward without asking whether it still serves the people in front of me? What cough drops are in your pocket right now?

As concrete actions for you today, identify a peer or mentor who you trust. When you have done this, have a heart-to-heart conversation around the following question: "What would it look like to treat reflection and reflective discourse as an essential part of our leadership practices?"

You can also set aside ten minutes at the end of each week to write down one moment when you weren't sure you handled something well. The goal is not to judge yourself. The goal is to notice the pattern, the same way I eventually noticed the cough drops in my pocket.

Conclusion

That conversation is where real leadership begins. The people you lead absorb what you model, whether you intend it or not. When I worked through illness, I thought I was only making a choice for myself, but I was setting the standard for every resident watching me. When you take the time to notice your own patterns, you give the people around you permission to notice theirs. That is how self-awareness grows from a personal practice into a culture.

You do not have to do this work alone, and you should not try. I built my own self-awareness with the help of mentors, colleagues, a therapist, and a nurse who was willing to tell me I looked exhausted. That same combination of reflection and honest feedback is at the heart of my healthcare leadership coaching and training for clinicians. If you are ready to go deeper, claim the free Self-Awareness and Trust resources to start uncovering the blind spots that may be hiding in your own leadership. Then bring what you find to the person you trust. That is your next step.