The First 90 Days of Your Leadership Legacy

Kurt Mosley and Neill Marshall bring over three decades of experience advising healthcare organizations and conducting more than 600 senior-level executive searches. Through their ongoing 90-Day leadership series, they have interviewed CEOs and senior leaders across the country to uncover what actually separates successful leadership transitions from those that fall short. Their work focuses on a critical truth: the first 90 days are not about proving yourself, they are about positioning yourself. Early behaviors, not intentions, define credibility, culture, and long-term success.

Their message:

1. The first 90 days are make-or-break This window sets the tone for everything that follows. Not because of strategy, but because of what people experience from you early on.

2. Earned Authority beats assigned authority Your title gives you a seat. Your behavior earns you the right to lead.

3. Be quick, but don’t hurry Move fast to learn. Move deliberately to act. Sequence your speed.

4. Behavior matters more than words It’s hard to talk your way out of something you behaved yourself into. People believe what they see, not what they hear.

5. Listen before you lead change The leaders who succeed early are the ones who observe, ask, and understand before they act.

6. Symbolism matters Small, visible actions carry outsized weight. Sleeping in the hospital. Picking up trash. Rounding on holidays. Those moments send a louder message than any town hall.

7. You are on stage at all times Every interaction is being watched and interpreted. Make sure your audio matches your visual.

8. Early wins build momentum You don’t need big wins. You need visible, meaningful wins that show progress and build confidence.

9. The middle is watching, win them early 25% are with you. 25% are not. The 50% in the middle decide your success. Focus there.

10. Trust before performance. You don’t get sustained results without trust. And trust is built through consistency, presence, and follow-through.

The Interview Transcript

Hugh Ballou

Greetings, this is Hugh Ballou, and here we are. It’s The Nonprofit Exchange, which we’ve done every Tuesday for 10, almost 11 years. So today’s guest is, I have two guests on here, and I have to look, I got Neill Marshall and Kurt Mosley. Now, their company is HealthSearch Partners. It’s an executive search, and Neil’s got more than 30 years, what Kurt will tell us about himself. In 600 senior level assignments, they’ve done this, they know it. So they’ve advised healthcare. which are nonprofits, but the information they will give us today applies to any organization, any leadership. So the first 90 days in an organization are really critical. So our conversation today is about earned authority, the first 90 days of your leadership legacy. And this explores why a title may assign responsibility, but only consistent behavior, listening, presence, and follow through earn the trust required to lead. So Neill and Kurt, what led you to focus so intentionally on this first 90 days of a leader’s tenure? And why do you believe this period has such a lasting effect on the leadership legacy?

Neill Marshall

Yeah, I’ll answer that, Hugh. Our background and what we do is executive search. And for search professionals, traditionally, our job was to go help the search committee find the right person for the right organization at the right time, sign the deal, and then we were done and we were gone. And that’s what we did for a long, long time. And two things happened. One is one of my favorite CEOs moved to a new place and stumbled. and he stumbled badly and it just bothered me because I liked him, liked him, like him so much. And so I really, Kurt and I really dug into why that happened. The second thing was we were interviewing a gentleman by the name of Richard Parks. He was a CEO of a 22 hospital system out in West Texas. I mean, huge place, $10 billion in revenue. And we were talking to him and said, He said, well, when I take on a new position, my wife stays home to sell the house and I move into the hospital. And we both said, yeah, yeah, rolled our eyes. And we said, yeah, Richard, everybody works hard their first 90 days. And he said, no, I move into the hospital for 90 days. I move into the hospital. Most big hospitals have residence dorms. He moved in. And he told us stories of what happened after he moved in. He said, and at this place, Lubbock Methodist, after eight years, he left. And he said they still talked about when he lived in the hospital. And that just got us thinking, and we just kept exploring, started talking to, we probably talked to 50 hospital executives and found the things that they had done in their first 90 days and hence the strategy.

Hugh Ballou

Love it. So for nonprofit leaders, what’s the difference when you inherit some issues like financial pressure, staff fatigue, board conflict, or declining confidence that you’ve inherited from the first other former leader? Would you ask that again, Hugh? So we inherit some things, you know, lack of confidence, financial pressure, staff fatigue. You know, there’s some underlying conflict. So what advice do we have in the first 90 days for a leader to understand what they’re inheriting?

Neill Marshall

Yeah. Personally, I like what Jay Robinson did. Jay Robinson runs two systems for Kaiser up in the Pacific Northwest. And what he did is he had 252 leaders in his organization. And in the first 90 days, he went and interviewed every single one of them. And he interviewed them in their offices. 252 interviewed them in their offices. The key was the last question, and that was, if we’re successful in the first 90 days, what is different? What has changed? And then he took all that, and he bubbled up all the important things, the 10 most important things for the people, for his leaders, and that’s what he attacked.

Hugh Ballou

You know, that’s such, such sage advice. So I’m a conductor. I got a little baton. I’ve got the position of influence. And people think it’s a dictator. Well, you got a bunch of union musicians, you don’t tell them what to do. But they’re going to respond to your authority. So what’s the difference between earned authority and the title that you have?

Kurt Mosley

Go ahead, Kurt. No, I was just saying, what’s the real difference between assigned authority and earned authority? I think assigned authority, Hugh, comes with a title. It’s the office. It’s a reporting structure. It’s a board resolution that you have that position. Earned authority comes from trust, consistency, humility, competence, and follow through in those first 90 days. And people really tend to comply with positional authority because they must, but they commit to earned authority because they choose to, because they want to follow you. And a leader really cannot demand earned authority. It accumulates the repeated behavior during that first 90 days.

Hugh Ballou

And there is sometimes an isolation of the leader when they have this, they’re on this pillar, people put on a pillar and they’re not accessible because they didn’t, like what you talked about, Neill, the story they’ve earned by building relationship with people and listening. So I want to let’s let’s capture you talk about be quick, but don’t hurry So many leaders want to rush in and change things So be quick and don’t hurry. So what practice does a leader need to have in terms of listening and diagnosing?

Kurt Mosley

You know before you start doing things sure I hear that that quote came from John Wooden, who was a Hall of Fame basketball coach at UCLA, you know, one of the winningest coaches ever and he told that to his players. He kept saying, be quick, but don’t hurry. And people said, what does that mean? Well, it really means that new leaders, they have to have an urgency, but urgency is not the same as recklessness. Don’t just come in like a bull in a china shop. Listening, observing, and diagnosing are productive activities, not signs of weakness or indecision. And moving quickly on reversible decisions and obvious problems, but slow down when a decision will permanently affect people and culture. understand the culture here before you earn the right to change it. And the goal is not to avoid action, it’s to make better informed action possible. We had one of our CEOs, we interviewed Matt Fry, before he officially began his position, he walked the hospital campus as if he were a patient or a visitor. He was sort of like, you know, the the hidden boss, and he looked at signage, entrances, parking, navigation, how people got around in the hospital. And he gathered all this information without announcing himself and relying only on his interpretation, not experts at the hospital. And his preparation enabled him to move quickly later because he’d already begun to understand the organization firsthand before he got there.

Hugh Ballou

So what foundation, you know, there’s some things that are time-bound, some things are truly healthy urgent, but some things are not urgent. There’s a little book called The Tyranny of the Urgent, how sometimes urgency drives us to make bad decisions. So how do we decide, in that first 90 days, people want to see some action. So how do we decide what’s urgent and what needs some thought before acting on it?

Kurt Mosley

Well—yes.

Neill Marshall

Go ahead. No, you go ahead. Um, I think, I think you resist the knee jerk and you resist the urgent and you really, you, you, you slow people down and you know, I’ve, I’ve had boards ask me, well, but we want them to, you know, to do, to, to make all these changes. Do you really, do you really, wouldn’t you rather than make the right changes? And sometimes that means slowing down. And that means not doing anything or perceived not doing anything in order to make sure you do the right thing. Because one of the things that we say a lot is it is better sometimes to do nothing than to do the wrong thing, especially in the first 90 days. Because if you stumble in the first 90 days, there’s a chance you don’t ever recover.

Hugh Ballou

I want to remind people that there’ll be a full transcript. So good sound bites like that are so important and you’ll have that on the on the site when you go to the nonprofitexchange.org that is, you know, we got gray hair because we’ve learned I’ve learned from a lot of my mistakes. Let’s talk about authenticity, our behavior, and our language. Those need to match up. And you say it is hard to talk your way out of something you behave yourself into. So, what leadership behaviors create the most lasting early impressions?

Kurt Mosley

Well, that’s a quote. I know it’s been out a lot to you, but my father gave that to me when I was in college when he said, it’s hard to talk your way out of something you behaved yourself into. But we always caution our CEOs to make sure that their audio matches their visual. And what do I mean by that? Their actions correlate with what they’re talking about. So it’s explaining that listening is the first phase of a leadership plan. Asking consistent questions, being visible in the hospital, being out, letting people see you. Because in a lot of cases, people don’t remember your emails you send out. when you first get to an opportunity, but they should remember your behavior, what you do in that first 90 days, who you talk to, who you understand are the leaders, who are everybody that you interact with and taking time to interact with them and answer their questions. They remember that more than any edicts or any new policies or strategic statements you make in that first 90 days.

Neill Marshall

You know, we had one CEO, Hugh, that In healthcare today, one of the things that is kind of a mantra is he who can attract and retain employees is going to win. Because you can’t pay more, you can’t do a lot of other things, you have to be able to retain and attract employees. And so this CEO started, and his first day, he pulls up to the hospital, big, major academic medical center. And his parking space, along with his whole executive team, was all right there next to the hospital. So he parked, and he went up for his first meeting with his executive team. And he kind of set him up. He said to him, hey, what are the most important things? And he got him to basically say, well, our employees are the most important thing. And he said, then why are we parking right next to the hospital while our employees have to park a mile away and walk across the parking lot? So he changed it. There was no more executive parking. That parking now was for each of the department directors of the month, got to park right next to the hospital. And he made his executive team park at the very end of the last parking lot. And he said, but what we need to do then is use that time to greet our employees every morning. Use that time as you’re walking in to greet your employees. And he said, We’re not going to tell them that they’re more important than we are. We’re going to show them every single day by walking farther than they walk.

Hugh Ballou

We teach in Center Vision Leadership Foundation that the basis for leadership, for communication, and for funding is relationship. Do you agree with that?

Neill Marshall

Yeah, absolutely.

Hugh Ballou

Absolutely. So here’s an example. So I had a friend that worked as a head maintenance guy in one of the major airlines, Chicago, you can guess. And he got a new boss, MBA. Came in, said, come in my office, opened the manual, says, hey, Phil, this is how we’re going to do things now. Phil did this. He said, I wrote that manual. So the guy didn’t take time to do what you’re talking about. Get to know people. And the other paradigm is, I talked about the conductor, so what I get is what they see. So the culture is a reflection of us, the leader. So we often blame our children for doing things. we forget that they were modeling us. So we do set an example. So going a little deeper into this, make sure your audio matches your visual. What are some examples of how that should look?

Kurt Mosley

Well, I remember that we had one CEO in the First 90 days, they were stressing to him to come up with a new strategic plan. At the end of week two, the board said, how are we working on the strategic plan? He said, I’m fine, but I want to make sure I understand the organization, the hospital, before I make any decisions. And he was doing his rounds, and he was going all over and talking to a lot of people. And one night, he was in the nurse’s station, and a nurse came up to him and said, are you the new CEO? And he said, yes, I am. And she said, I heard you work on our new strategic plan. I said, yes. And she said, well, how’s it going? He goes, we haven’t done it yet. And she goes, can I offer a suggestion? He said, sure. He said, we need working IV pumps for our patients to get better. We don’t need a new strategic plan right now. So from him walking around saying, listen, yes, I’m charged with a new strategic plan, but I’m more interested in what you feel we have to do to take care of our patients. And it was to get new IV pumps to get the patients better and get them out of the hospital quicker.

Hugh Ballou

That’s so brilliant. When I do a strategy for a company, I talk to the secretary who answers the phone, I talk to the janitor, because they know things nobody else knows. And we tend to isolate ourselves from the people that can give us the data we need, and then we don’t listen to it. So—Hugh, if I can add.

Kurt Mosley

Sure. You’re always on stage. General Patton said this so much during his tenure in World War II in Europe, but he said, Every day I’m on stage, everybody watches my behavior. When I go to the latrine, they watch my behavior. When I go eat at the commissary, they follow me. So I’m on stage all the time. Every leader has to understand you’re on stage 24-7, no matter where you are, especially for a hospital. In the hospital as well as in town, people know who you are.

Hugh Ballou

So we have influence on a lot of people and I understand. I’ve heard this several times. What’s your take on people don’t leave a company. They leave a leader. Is there truth to that?

Neill Marshall

Oh, I think that that if they can absolutely that they will leave leaders and they also stick with leaders. One of the things is I’m evaluating doing search, right? As I’m evaluating a CEO, I want to find out how many people have gone with him from place to place to place. If he has to recruit a new team every time and it’s all new people, I’m a little suspect. CEOs that attract people and that people will follow them from place to place, that’s a big thing.

Hugh Ballou

Talk about transparency. I was coaching executive one time and he said, I’m going to this board meeting and I got these things I don’t do well. What do I do? I said, why don’t you tell them? Pause. He said, I can’t tell them I have weaknesses. I said, and you think they don’t already know? So we tend to pretend too much that we’re supposed to know things. So talk about transparency. Why does that build trust and why is that so important in this whole picture?

Neill Marshall

Well, I think first, because if you’re hiding it, especially if it’s bad, eventually it’s going to come to the forefront. And the folks that can do it and can be transparent and be transparent early and then tell them how they’re going to fix it are much better off.

Kurt Mosley

And I feel that if you do make a mistake, And that’s sometimes, you know, that’s sometimes not on purpose, but own up to your mistake. Admit you made the mistake. You know, say, I really didn’t read the room right. Here’s what I’m going to do to change it in the future, and I’m going to make other mistakes, but I want you to be able to approach me if you feel I’ve made a mistake and help me lead you to be a better leader. Help me to find my weaknesses, whether it’s communication, whether it’s interaction with other employees, and help me because we’ll all work together on this. We’ll all be better off.

Hugh Ballou

Now that’s perceived by a lot of people as a leadership weakness, but you’ve reframed it into a strength. The transparency is gaining the support of those around you because they know you might as well just say it, right?

Neill Marshall

Yeah. I mean, Kurt tells a story all the time of a CEO, Jim Decker. who told us the story of his first week in a new place, getting ready for his big leadership meeting. And he decided he was gonna switch, he was gonna supply donuts, but he was gonna switch who they got donuts from. Because Dunkin’ Donuts had just opened a place in town, right? And he’s like, well, Dunkin’ Donuts are the hottest things around, we’re gonna buy Dunkin’ Donuts. And he goes in, and he supplies Dunkin’ Donuts, and you could have heard a pin drop. Because nobody liked Dunkin’. What they liked was Mama’s Donuts from around the corner that they had been going to for the last 30 years. And when he discovered that, somebody pulled him aside and said, nobody likes Dunkin’. We like Mama’s Donuts. And he said, well, next time I’m going to Mama’s Donuts, and I’m going to ask Mama to put the list together of the donuts that everybody likes. And that’s what we’re going to do.

Hugh Ballou

Lessons learned. We’ve talked about the listening and discovering the culture in the first 90 days. So how do you know there’s the trust built and you’ve got the understanding? And what kind of metrics do we need to have that we know it’s time to start making some changes?

Neill Marshall

Well, I think starting to make changes. Look, if you’re running down the hall and there ain’t nobody around you and you got to look back and everybody’s back there, then you know, you know what, we’re moving too fast, I’m doing too many things. You start seeing if people are gonna start pushing you a little bit, right? You just see whether you read the room and figure out is everybody with me or am I out here all alone? You know, I had a CEO friend who they started He came in with kind of a for-profit mentality into a not-for-profit, thinking that they were in deep trouble and that he really needed to make all these changes. And he did, man. I mean, he cut costs, did this, did that, did all these great things. And then figured out he was on an island all by himself and he was the only one. And he didn’t survive.

Hugh Ballou

Wow. Let’s talk about nonprofit boards and the, quote, search committee, well-meaning people who don’t really have the skill to do that. So beyond the credentials and the one-dimensional résumé, what are some of the other factors they need to consider? And in my multiple 40 years of working in churches, I only applied for one job. People came to me. But that one, I really had to teach the committee what to ask me. So what do committees and boards need to consider beyond what they see on the resume?

Neill Marshall

Well, number one, what I hear a lot with search committees is they’re pulling out a certain circumstance from another time and putting it on other candidates, right? I see times where they think that the CEO or the new person, the new executive can handle the transition by themselves, and they really can’t. I think that understanding that a search committee typically has only done it one time, maybe two times in their career on the board, where there are people, well, you know, don’t want to toot our own horns, but like Kurt and I, where we’ve done it 600 times. I’m not saying we’re always right, but I got to tell you, we’ve seen it 600 times versus you only seeing it one time.

Hugh Ballou

You’ve probably seen the bad side of a misfit there. So tell us what’s your website? How can we find you? Sure. It’s healthsearchpartners.com. So people are listening on an audio, but there’s some people looking. So walk us around. What will people find when they get there?

Neill Marshall

Well, you know, who are we? What is our expertise? Which is hospitals and health system search. If you’re a candidate, you can go in and send us your resume. We also have, we call it insights, but it’s all of our, all of our things that we’ve written articles as one of our article series, you would absolutely appreciate you is how to deal with a search committee interview. It’s an eight-part article, goes from here’s why you do a search committee interview to here’s how you prepare, here are the things that you do and don’t do, and then here’s how you close it and get the job. And then all of our different podcasts and all the different articles.

Hugh Ballou

Yes, and I’ll give the URL again. So let’s have some fun. I’m going to do a few rapid fire questions, and whoever answers first gets to take it. Are you game?

Neill Marshall

Absolutely.

Hugh Ballou

One word—one word. And you can both answer this. What one word should define a leader’s first 90 days? Trust. Trust. Listening. Ah, one habit. What daily habit most helps a leader earn authority?

Neill Marshall

What I would say is walk the organization, talk to somebody whose work you don’t understand, seek first to understand them.

Kurt Mosley

I would say end every important conversation by confirming what you heard and what you’re going to do next.

Hugh Ballou

Oh, this is good stuff. One warning. What early warning sign should a new leader never ignore?

Neill Marshall

So out of the blue, your chairman of the board suggests you need an executive coach.

Kurt Mosley

I would have to say when every answer comes from the same small group of people.

Hugh Ballou

Yes, as an executive coach, I wish I had known that when I was in some of these turmoil situations. So, Neill and Kurt, thank you. You’ve helped us understand the leadership legacy begins long before the strategic plan or even gets there. So, this is helpful for both the people looking for a new position and those people seeking to promote somebody. So, assigned authority may open the door, but earned authority is built through listening, consistent behavior, meaningful early wins, and promises kept. Learn more about this organization, Health Search Partners, and earned authority, and all those other resources you heard about at healthsearchpartners.com. You will find this episode on the The Nonprofit Exchange, including that link. Neill and Kurt, this has been a treasure trove of wisdom today. Thank you so much for being my guest today on The Nonprofit Exchange.

Neill Marshall

Thanks Hugh, really enjoyed being here.

Kurt Mosley

Yeah, Hugh really enjoyed it, enjoyed being with our listeners today. Thanks for inviting us.

Neill Marshall

Thank you.