Self-Awareness and Trust in Healthcare Leadership:
Leading From the Inside Out

Transforming Healthcare Coaching Podcast, Episode 126: How Self-Awareness Builds Trust in Healthcare Leadership with Dr. Jess Bunin. Host Lillian Liang Emlet, MD MS CHSE CPC ELI-MP, in conversation with Jess Bunin, MD MHPE, physician, leadership coach, and author of Self-Awareness and Trust. Published September 14, 2026.

Jess Bunin, MD MHPE: I thought everything in the world could be solved with therapy and mentoring, and I didn't believe that this skill of coaching meant it. And I had seen a lot of lifestyle coaches that were not great and hadn't done the self-awareness work first.

Lillian Liang Emlet: So what do you do when you feel like you've had a really great day, you've led the team well, you've run a resuscitation, and then you go to your afternoon meeting and you keep your mouth shut. You don't actually put your ideas on the table, and you wonder, the real version of you? So our guest today on the Transforming Healthcare Coaching Podcast is an amazing physician, leader, and coach, retired Colonel Jess Bunin, and we're so lucky to have her today. And so I just wanted to say hello to our guest.

Jess Bunin, MD MHPE: Thank you so much. It's thrilling to be here. I'm really excited to chat with you.

Lillian Liang Emlet: Yeah. Yeah, so I think you've had a very interesting and distinguished career, both in the military and in the physician world, and in teaching and leadership and development of people over time. And it's really exciting to see, I guess both of us, moving into this other world trying to really change healthcare from the outside and alongside organizations and people. And so I'm curious would you, whether you'd be willing to tell us a little bit about your journey, because you have practiced more than one clinical specialty. You have, redesigned your experiences and morphed over time into a place where there is one thread of consistency, right? You're always helping. You're always helping people to become better versions of themselves. But I'm just curious to how your story evolved from psychiatry to critical care to now as a speaker, author, and coach.

Jess Bunin, MD MHPE: Yeah. Well, I will say that there's one theme that brings it all together, and I have to credit my father with it. And he said, "You will never regret additional education. Never regret learning more." And that has been a really consistent theme in my life. So starting at the time, went to West Point, was a chemistry major there with a mechanical engineering minor. I was afraid of that combination upfront, but again, my dad was like, "You'll never regret that education." And then the next biggest shift for me was I went into my residency as a psychiatry intern. But my first month was in the ICU, and I fell in love with the ICU. I loved the teamwork. I loved the pace. I loved end-of-life conversations. I loved saving people's lives. I loved every aspect of it. And so I had to switch right away to a med psych residency, but I was terrified 'cause it's five years, which normally it would be, like, three and four if they were sequential. And so in five years, I had to learn all this material, and my dad said, "You will never regret the education." And so I did it, and I'm so glad I did it. So as a psychiatry intern in the Army, I was obligated for my first duty station to be as a psychiatrist. So I was an outpatient psychiatrist at West Point for three years, knowing that I wanted to come back and do critical care through that time. But it shifted who I was and how I saw people and how I had conversations, and I bring a lot of that psychiatry background into all of my teaching. So then I'm a med psych resident, then I'm a psychiatrist, and then after three years of outpatient psychiatry, I came back to do a critical care medicine fellowship, which was terrifying. I don't think I had a good night's sleep for about six months 'cause I was afraid that I was killing someone all the time. And so after six months, it finally hit and was all coming together. Like, I knew how to do my procedures again. I was confident in that. I knew how to lead the teams again. I was confident in that. So at six-month point, it really turned around. So I stayed on at Walter Reed for a little while after my residency as an intensivist, and I liked it a lot, but I had the opportunity to move to Hawaii, and who doesn't take that opportunity? You have to do it.

Lillian Liang Emlet: Yes.

Jess Bunin, MD MHPE: So I took a position as the chief of critical care out there and then the associate program director for the internal medicine residency. So I spent five years on Oahu loving it. It was just a great experience. But during that time, I took advantage of every time I could come back to the mainland to do some sort of education. And in that I did a week of education around quality improvement that changed my career trajectory. I did a week of learning how to be a faculty developer that changed my trajectory. And then after my five years there, I came back as the critical care program director for the fellowship at Walter Reed and the assistant dean of faculty development at the Uniformed Services University. And it was like two dream jobs simultaneously that all came together because I met people while I was doing that QI course, while I was doing that fac dev course. And so all of that education came together to bring me opportunities I never would have had otherwise.

Lillian Liang Emlet: That is incredible. I completely agree that the more education you get and the more opportunity, it just opens new doors and new ways to think. And so you're a testament to why we always feel that education is the very first step. It isn't the only step. And so the reality is going back to how I started the episode, a lot of times we stay quiet in action. We don't speak up. It's really actually hard to be a follower in a team. We always talk about leadership, leadership, leadership. But we also recognize on the team it's really hard to be a follower. It's hard to be a team member. And so a lot of times we talk about the fact that we watch someone stay quiet it's gonna cost something. And so I don't know if you can give an example from a leadership perspective of how that hurts the whole team or how that hurts the whole, hurts the leader, that if we stay quiet and aren't able to have the communication skills, the confidence, whatever, to be able to do the right thing and say the right thing in the moment.

Jess Bunin, MD MHPE: Well, there were, I have two different perspectives on that question, and the first that I would like to say is during the change in administration, our institution had to do a lot of changing of our policies and our practices, and then following quickly on the heels of the political administration change, we also then had a government shutdown and had to change our policies and had to change our practices. And when we came back from that, at one of our meetings, some of our senior leaders said, "Well, no one's coming to us with questions anymore, so everything must be okay." And it broke my heart. I think the second people stop coming to you with questions, you've stopped being a leader. They don't trust you anymore. They don't feel like you have their best interests in mind, and it's disastrous. And so that was a huge conversation starter with me with some of my leaders, because it was not okay, and people were suffering. And I, at the time, was a dean of community, so I had become an unofficial ombuds for people, and so I was hearing the complaint after complaint after complaint that folks were not bringing to the leadership. And so I think that was devastating. But I think the danger as an individual who's a follower of not speaking your mind is you lose every ounce of influence you have. I do not believe that you need to have a title to be a leader. You do not have to have any formal authority to be a leader. Everyone can exert their influence, and if we're not speaking up in meetings, even when it's scary, we're losing every ounce of influence we had. So that's one danger of it, and then the other danger of it is that we harm ourselves. We harm our self-confidence. We harm our belief that we should be communicating to leadership. We think of leadership as this thing over here, and we're over here, and we're not allowed to mix anymore, and when we get that level of fear and that level of division, then we, it starts affecting our self-confidence.

Lillian Liang Emlet: Yeah, so true. I always think about the things I hear from frontline clinicians where they always talk about the executive or the C-suite or management, and they put someone else into another box, and we've already made them the other. Well, those others are actually our friends and colleagues who we have chosen or were selective. Well, somebody's got to lead the team, right? So somebody's got to do this other administrative work. And yes, they might do a little bit less in the trenches and frontline night shifts with some of us. But someone's got to worry about procurement and making sure that we're protected from policy and that we have sustainable practices and new people coming to our group and HR and equity. Someone has to worry about these things for the whole entire group. And I always think about the fact that when we other even within our own profession, it's always hard to. I always watch nurses between different floors.

Jess Bunin, MD MHPE: For sure.

Lillian Liang Emlet: The other group, and I'm always surprised about how we treat and we internalize some of these, these thoughts.

Jess Bunin, MD MHPE: Yeah. So that actually, if I might jump in, that takes me to what has become my passion for the last three to four years, and actually became the reason that I felt the need right now to crank out a book and get this information out there. But at the institution I was working at, we had two student groups that wouldn't communicate with each other at all. So our Christian student group and our LGBTQ student group wouldn't talk to each other in social settings, professional settings, nothing. They were, like, at war with each other. And someone who was unrelated to this problem brought this to me and said, "This is affecting all of us now. It's not just me. It's a broad problem across not just those two groups. I'm not the only one who's seeing it. Like, it's really a problem. Can you help us solve it?" And my initial reaction was, man, those students, they all learned behind screens during COVID. They never learned their communication skills. They don't know how to do it. And so I was putting together some student curriculum and working on bringing teams together and doing some conflict management between these two groups. None of it really moved the needle. So I took it to a dean staff meeting, and without fail, everyone in that room stopped me and said, "This isn't a student problem. Like, this is us. We are not role modeling good civil discourse and good communication across difference. We are not teaching it in our curriculum. It's nowhere to be found. Like, how do we magically expect students to know how to communicate in an interdisciplinary fashion if we as faculty are having trouble between staff and leaders, if we are having trouble between students and teachers, if we are having problems between military and civilian, between clinicians and basic scientists?" Like, all of these areas, we were breaking down communication 'cause we weren't working on it or thinking about it. And so we started a curriculum for staff and faculty, and that really made the difference.

Lillian Liang Emlet: Fascinating. And so in this curriculum, what kinds of things do you cover to try to bridge that gap?

Jess Bunin, MD MHPE: Yeah. Well, I think there's a chicken-and-egg phenomenon whereas you have to have community, you have to have relationships, you have to have buy-in to have good communication, and you have to have good communication to develop relationships. So y- you have to work on both of those areas. It's not okay to focus only on one without the other. So our curriculum spent half the day working on restorative practices like community building, and learning about how to use restorative practices to do conflict management. So to think about, how do we optimize our environments? How do we make them better? How do we fix what's broken? How do we do that with restorative practices? With really that primary focus on how do we develop the community and the relationships when folks aren't going to lunch together anymore, they're not going to dinner together anymore, they're not getting coffee together anymore. How do we bring that back? So that was the first half of the day, and then the second half of the day focused specifically on civil discourse and what's required for communication to be successful in that realm. And we spent the next four hours working on that. And in doing those two skills we saw that there was an increased sense of belonging. There was an increased hope for the future. Folks who had bitched and moaned a little bit about having to give up their whole day to do it, we had like a 97% of folks who said that it was an effective use of their time. So that was m- my favorite data point we got, but I feel like belonging and hope are two pretty huge areas that we all wanna improve.

Lillian Liang Emlet: Yeah. And I think the one thing too is what it t- says from an organizational perspective is that across different professions and teams, you actually are investing in, that it's worth paying you to arrive together to create the space to do this type of work. And it's actually a strategic move from the highest levels to be able to say that it's worth spending the time to come together and rediscover who we are as humanity, regardless of whatever output or product is. Because at this point, most people feel like they've just been productized, that w- they are just worth their clinical shift or just showing up for work or just putting their clinical wRVUs in.

Jess Bunin, MD MHPE: One of our associate deans came up to me afterwards and said, "I just realized that the guy that was in my circle, I've walked by him probably 100 times, and our offices are on the same hallway, and we have never said hello.

Lillian Liang Emlet: Oh my goodness.

Jess Bunin, MD MHPE: We have never had a conversation, and I will have a conversation with him every time I see him now because we had this opportunity." And so then that changes the collegiality and the collaboration and the work output for those people because now they have relationships to do it together and to build on it. So you're exactly right. It changes the efficacy of the whole institution to have people communicating safely across difference and to have the community and the relationships built.

Lillian Liang Emlet: So right now you came through a military system and that often is very hierarchical and very much similar to unspoken cultural rules that it's so sad to 20 years in to see the medical students complaining about the same kinds of things that you and I went through. And it's bizarre to me the type of things that are still said stereotypically. And so I guess I'm curious if you're building this whole world systematically on rank, how does how do we either dismantle the hierarchy or how do we equalize the playing field, or how do we even know when it's safe to speak when we're in these interprofessional hierarchical environments?

Jess Bunin, MD MHPE: Yeah. Well, don't look now but I think medicine is the exact same hierarchy as military medicine and as the military in general. There is the same amount of fear for a first-year or a fourth-year student to talk to a senior attending in military medicine as there is in civilian medicine. And it's the same for a private to talk to a sergeant or to talk to an officer. There's that same level of fear no matter where you look at it. So I think when we talk about medicine, we should almost think of it like that degree of a hierarchical structure, 'cause it really is there in every institution. So my training was largely at a civil- at civilian institutions. I went to Tulane for medical school, and then my fellowship program, I was at Baltimore Shock Trauma and Washington Hospital Center, all the c- local civilian institutions mainly. And it's the same everywhere, right? The hierarchy is not different. I didn't feel different in a civilian institution than otherwise. And so one of the things that is fascinating to me and I'm fascinated by it 'cause I first fell a victim to it, honestly, is that as we progress through the system, we become brainwashed or memory zapped or something. Like, we completely forget how frightening it was approach someone. And I was a lieutenant colonel at the time when this became blatantly obvious to me. And I approached a student who I had heard they were having all these problems, and I said, "You know, why didn't you come to me?" And they're like, "Are you kidding me? You're a lieutenant colonel. Like, I would never come to you for this. I would never bring it to you." And then I started asking around to all of my trainees, and it was the same response. I thought I was so open and available and it didn't even occur to me that it didn't matter if I had an open door policy if they were terrified of my rank. And then I see this over and over and over in other institutions. So for example, students would come to me as this unofficial ombuds because they were afraid to go to Student Affairs because I was wearing civilian clothes at the time, and our folks that are in Student Affairs were all colonels. So as high as 90% of doctors will ever, 95% of doctors will ever get is a colonel, and it's terrifying to see a full bird. And so people think, "Well, we're open. This is what we're for. We are Student Affairs. We're here to help students." But you're also a colonel, and folks have forgotten what it's like. And again, same in the civilian world. So I was at an Association of American Medical Colleges conference, and there was a student at the table, and she said, "Oh my God, I would never talk to the doctors about that." And I'm like, "It's this exact same thing that we're talking about," which really opened my eyes to how the, how similar it is everywhere.

Lillian Liang Emlet: Yeah. So I want to get into your new book, which came out this week. And I love the title, Self-Awareness and Trust. And I like it because so many of our clients and so many people don't want to own the fact at the end of the day, the only way to truly change begins with yourself, and that we have so much more agency. The public narrative and the media hype is, of course, that the system is horrible and evil, and I don't want to say that the system is great. It isn't. Also, the reality for any of us to get through and make change is gonna be first in both of those two skills. Tell us a little bit about the why behind the book and, like, why you titled it the way you did, because it's a little provocative, right? 'Cause I don't think people necessarily really want to self-awareness. For some people, they may actually just say, "I'm not gonna read that."

Jess Bunin, MD MHPE: Yeah. Well, it was a process. When I sat down to write the book, it was gonna be only about what I told you about earlier, which is that community building and civil discourse. And I hold this passion for those two topics because I see it broken everywhere, in families, in institutions in patient-doctor relationships, all of it. It's broken that trust. And so then when I sat down to think about how do I write this book and make it meaningful so it's not just my describing an acronym, it's, like, actually meaningful to everyone, then it hit me, like, when did I learn about this? And where did it affect me in my stories growing up? And so the book actually generated from that. And then I decided really just like I, in thinking about writing the book, had to really deal with that self-awareness part it reminded me of pulling in my psychiatry background and how important that is and pulling in the self-awareness. And so the first five chapters are about self-awareness. The middle five chapters are about how trust breaks down, 'cause I was seeing that in real time, how trust can be rebuilt, and then how we use that influence and power and all those things to optimize the systems we're in. And then the last five chapters are about how do we take all of that and build a less broken system as we move forward, because you have to do all of that to be leaders, and we need great leaders to figure out how to fix the system. And so each individual chapter is half my story that I bring to the topic, and then the other half is the leadership lessons and how to apply this leadership topic, whether it's civil discourse or whether it is bias or values or any number of things. Each of them is a significant story of my life. So you'll definitely get to know me if you read it.

Lillian Liang Emlet: I love this. And so I think spoke, this book to me is and what you just said is really an example of, like, coaches when we were trained, we have to go through the coaching process,

Jess Bunin, MD MHPE: Yes.

Lillian Liang Emlet: Yourself. And I think I still laugh at the first time we ever had a chat where you talked about how kicking and screaming and skeptical, you went in like a typical physician into the Center for Executive Coaching training and came out converted partly probably because as coaches, we all have to go through the process ourselves. And so all of this, fundamental, is this very first step, is self-awareness and trust. And for us at Transforming, this is the first part of my model as well. A is for awareness. Like, if you're not aware, you j- aren't willing to take some kind of inventory, whatever, what framework or what assessment you wanna do, but you need to take some kind of inventory of where you are in this moment so that you can begin to see yourself more clearly, rationally, with emotional intelligence. There's obviously many assessments that can help you get there. But it's that first, and I will also argue the self-trust is also really important 'cause if you can't trust yourself, it's no wonder you have toxic leadership. No wonder you have this perfectionism or imposter syndrome, these, all the other negative constructs. If you have these first two things that you describe in your book, you'll find your North Star every single time.

Jess Bunin, MD MHPE: Yeah, you are absolutely correct. So two things I want to comment on. At the beginning of that, you said, "I went in kicking and screaming." And it was even worse than you said. It wasn't even about doing the self-awareness part. I went in kicking and screaming to a coaching class because I didn't believe in the art of coaching at the time. I had spent years as a therapist. I had spent years doing mentoring, and I thought everything in the world could be solved with therapy and mentoring, and I didn't believe that this skill of coaching meant it And I had seen a lot of like, a lot of lifestyle coaches that were not great and hadn't done the self-awareness work first. And so I didn't believe in it until I went to the training and did it all, and then I was like, "Oh, this is a whole nother amazing skill that works really well if we do it right and we learn what we need to learn as coaches." So I think that part I don't want to dismiss at all about, I think there's a conceptualization of coaching is for bad kids, or there's this lifestyle coaching that's woo, or whatever it is, and I don't believe that's what coaching is.

Lillian Liang Emlet: Yes.

Jess Bunin, MD MHPE: And then, on the self-awareness part, you're right on. Like, you can't do any of the work if you haven't done the self-awareness work first, and we see this a lot in teaching and working with bias. The folks who haven't done the inside work first end up doing damage by doing bias training, whereas the folks that have really examined their own biases and have taken time to have someone else look at it with them, those are the folks that can do it and teach it well and make a difference. So I don't even think that the self-awareness part is only a self skill. I don't believe that you can gain self-awareness by yourself. Think you need a partner or you need a coach or you need a peer, someone who is going to help you by pointing out those blind spots so you can work on the blind spots and help you understand your impact on others. Because particularly if you have imposter syndrome, you don't understand the positive impact you may be having on others, and you need someone else to clarify that for you. So I think a lot of self-awareness is you have to do the internal work, absolutely, but you need someone to help you do the internal work.

Lillian Liang Emlet: And I do think that coaching is a little bit different from mentoring. We can go back to all the different other episodes that we've done in terms of trying to debunk the myths and help people understand that coaching actually is reserved only currently for the high performers and also for the executive leadership that all of us now having access to these services is hopefully a great democratization of what's needed in healthcare in general because there are so many people. And I think the other thing for people to understand is that coaching is very much based in positive psychology. There is an Institute of Coaching at McLean Hospital, a Harvard Medical School affiliate, which is all about healthcare, coaching, and leadership development. There actually is a whole bunch of science behind all of it, and there's lots of studies in how AI is gonna affect it or not affect it. And, there's tons of people who've been working for decades on this construct in general. And I think what's amazing to me is that, again, it's now offered to frontline junior faculty as they're developed, which is why I started Transforming and why I'm sure you started our All Levels Leadership because we're realizing that we're all in this together, and that doesn't matter what profession, it doesn't matter what discipline you are or what specialty. We all have a chance to actually make each other better either through these 360s like you're commenting on or on just individual private work. 'Cause we understand that some people are like, "We're never gonna do any of this in public." It's highly confidential, and it does require someone who's trained in helping you in that very specific way.

Jess Bunin, MD MHPE: Yeah. And the other interesting part about that, even though there's decades of research pointing to how effective that is, I think the medical field is really starting to ramp up the amount of research about it and how effective it can be in a number of arenas. Our team just did a group of GME coaching for folks who were new program directors or new associate program directors and how it impacted them, and it gave them this sense of authority. It allowed them to claim their leadership. What we were talking about earlier with that sort of fear of communicating with leadership, they realized, "Oh, wait, I am leadership. I can reach out to anyone I need to reach out to. I don't need permission. Like, I can lead." And so I think a lot of the new research is gonna show us that over and over again it is beneficial. But what you're talking about with, like, only senior level, I think even at the senior level at some institutions, it's only the problem children that are getting coaching. Like, you're a chair, someone complained, we're gonna get you a coach. And it's not a remediative tactic, right? It is truly a development tactic for everyone, and that is exactly the mentality that went into All Levels Leadership because we saw exactly what you're seeing, which is people get a lot of leadership training when they're about to go in the C-suite. Sometimes people get training in medical school or residency, maybe a little, but those junior staff are just left to figure it out, and it's not okay.

Lillian Liang Emlet: Right. It is not okay. So I'm gonna just wanna end on your CLEAR I'm curious a little bit about how it helps people whenever you freeze, 'cause I think a lot of us do freeze in the moment, and you're like how you leave the very, that conversation and like kicking yourself. So tell us a little bit about how that framework and what you teach at All Levels about the CLEAR framework.

Jess Bunin, MD MHPE: Yeah. So the CLEAR framework is more for the overall perspective of communicating across difference, but there are parts of it that help exactly with what you're talking about. So just to talk through it real quick so we're all on the same sheet of music about what it is, so the C is creating psychological safety, the L is listening actively, the E is establishing common ground, the A is adjusting your thinking, and then the R is using your skills respectfully at and appropriately. And so there's a, a lot that you can learn and you can use in situations where you go in and like someone just says something I completely didn't expect and I froze. And I'm gonna go back to number one, the listening actively part. It's huge, right? 'Cause if you don't know what to say next, you can always say, "Explain that to me a little bit more. Tell me a little bit more about what you meant." And you let the other person talk and fill the gaps to give you time, right, to process what you wanna say. While you're listening to them, it can take away that fear of that freeze. So I always say turn it back to the person you're talking about. Like, you don't have to fill all the silences. You can think, but also you can allow the other person to talk and really deeply listen to them. So the active listening is super important. But if it's across difference, truly across difference, I think that E is the most important part, establishing common ground. And I say that because if we go into a conversation assuming we have polar perspectives about something, we go in on edge, and we use more glucose because we're gonna communicate with someone we're fearful of, we're stressed about, our cortisol goes up, our adrenaline goes up, all of that, and that doesn't make for a fun, easy conversation, right? But if we start instead with how are we alike, what's our common value, what's our common goal, and then work out from there, that's really helpful. And so those two, I think, are key skills and things to keep in mind as you're doing it. So that listening actively when you for- when you don't know what to say, and that going back to we're at odds, I don't know how to argue about this with you anymore, but I can say, "Can we go back to where we started, which was our common goal of achieving our mission?" And then it can, like, just get you back on track.

Lillian Liang Emlet: Yeah, I love that.

Jess Bunin, MD MHPE: Yeah. And then the final R I think can also help too, which is like the responding skillfully and respectfully part. And that is things like just saying, "Ouch," when someone said something that didn't work, or saying like, "What we've just said in the past couple of minutes has really thrown me off. Can we take a break? Can we take a pause?" And having those skills that you're ready to use in those moments so that you don't say things you don't mean, and that you don't clam up and don't say things you do mean, right? Like all of that becomes really important.

Lillian Liang Emlet: Yeah. That one's, that last one's super hard, right? Because the reality is oftentimes when our amygdala is flooded with our negative emotions, it can be really challenging. But I do really love the how can we get on the same page? And I oftentimes for most clinicians, they see it in the, I know we both want the best for this particular patient or this particular project, and so let's try to reground. And so like taking the I'm concerned and I'm uncomfortable, and so and we move it into like the project management sphere. So have the skills more than we realize, I think. And the hopefully with this conversation, people are inspired to check out what you're working on. So how can people get in touch with you?

Jess Bunin, MD MHPE: Yeah. They can get in touch with me a million different ways, but the best way right now is to go through my website, which is www.jessbuninmd.com. And you can get on my newsletter list there. You can reach out directly to a, with a contact form, and I'll get back to you right away. I am painfully connected to my email, so I'm pretty quick at getting back to folks. So that's the best way to reach me right now. But also at All Levels Leadership, www.alllevelsleadership.com which takes you to our whole team and can give you workshops on these skills. We can do consultation for institutions and organizations. So that's available also. So those are the best two ways.

Lillian Liang Emlet: Awesome. Well, thank you so much, Jess, for being on the podcast, and congratulations on the new book. And we'll put all of this in the show notes below for where you can find the book and get in touch with Jess.

Jess Bunin, MD MHPE: Thanks so much. This was wonderful.

Lillian Liang Emlet: Thanks. And so anything you want to listen, you want us to tackle on this podcast, please check us out and email us at podcast@transforminghealthcarecoaching.com.