Healthcare leaders are no strangers to immense pressure.
From staffing shortages and meeting financial targets to difficult conversations and constant decision‑making, stress is part of the job. But according to leadership expert Steve Gutzler — who will take the stage as the opening keynote speaker at the 2026 MGMA Financial Conference — it’s not the everyday stress that defines leadership; it’s how leaders respond when experiencing peak pressure.
On this episode of the MGMA Insights Podcast, Daniel Williams, Senior Editor and host of the MGMA Podcast Network, spoke with Gutzler about emotional intelligence, self‑regulation, and what he calls the “17% moments” that shape a leader’s reputation, influence, and long‑term impact.
What are the “17% moments”?
Gutzler’s work centers on a deceptively simple idea: Most leaders perform well most of the time — but what separates good leadership from great leadership is how we show up under pressure.
“I became fascinated with leaders that can sustain great behaviors, influence, and impact,” Gutzler said. “And what I began to notice is it wasn’t so much their strategy or their vision or their ability to execute; it really had to do with self‑regulating emotions under high‑stress moments.”
Drawing on research he attributes to Harvard, Gutzler explained that 83% of leadership moments involve manageable, day‑to‑day stress. The remaining 17% are the moments people remember.
“The 17% moments [are] when stress spikes or you face a challenging relationship,” he said. “And how you as a leader handle that moment will determine your true influence, your reputation, and your lasting impact.”
Why healthcare leaders are especially at risk
Healthcare attracts leaders who care deeply about people — and that commitment can become a liability without intentional self‑management.
“In healthcare and other fields, you get into almost what I call compassion fatigue,” Gutzler said. “You get exhausted. You’re faced with so many human dynamics that your own emotional batteries run kind of low and dry.”
He noted that leaders often ignore warning signs in themselves that they would never ignore in their devices or systems.
“We take better care of our cell phones,” he said. “When we get down to one bar, it’s like, ‘Man, I’ve got to plug it in.’ But we will push through all sorts of warning signs of our own emotional health imbalance that puts us at risk.”
That risk shows up most clearly in moments of emotional overload.
Recognizing emotional hijacking before it takes over
A key theme of the conversation was the idea of emotional hijacking — when stress hormones override rational thinking. “When you’re hungry, angry, lonely, or tired, you’re at risk,” Gutzler said, describing what he calls the HALT state.
Leaders often feel emotional hijacking physically before they recognize it cognitively. Williams shared examples likely familiar to many MGMA members: Rapid heartbeat, tightness in the chest, shallow breathing, or a sense of mental shutdown.
Gutzler added his own markers: “Sweaty palms, dryness of mouth — I feel it in my chest."
"My wife goes, ‘I can always tell when you get emotionally hijacked,'" he chuckled. "'There’s a vein in the side of your temple that comes out.'"
Those signals matter because they indicate a biological shift that affects judgment.
The 18‑minute rule: Why pausing works
One of the most actionable insights from the episode was the science behind emotional recovery.
“The 17% moments are closely linked to about 18 minutes,” Gutzler explained. “Studies indicate that cortisol overtakes your rational brain for about 18 to 20 minutes.”
During that window, emails get sent, comments get made, and decisions get locked in — often with regret.
“If you can manage 20 minutes, 18 minutes, and rather than resend the email, rather than respond to the text, rather than jump to judgment, remain calm, get some composure, recenter yourself,” he said. “Often the cortisol levels come down and the rational options go up.”
For leaders accustomed to immediate responses, the discipline to pause can feel uncomfortable — but it’s often the difference between escalation and resolution.
Calling a timeout in heated leadership conversations
Pausing doesn’t always mean silence. Sometimes it means naming the moment.
“I’ll even say things like, ‘Hey, I know there’s a lot of heat and emotion around this conversation,’” Gutzler said. “‘Can we table this for even a couple hours or till tomorrow?’”
He emphasized that acknowledging emotion doesn’t weaken leadership — it strengthens it.
“I want to validate your feelings,” he said. “But I don’t want to overreact.”
That approach applies to meetings as well. “I’ve even called timeouts in meetings when [they've] gotten kind of heated,” he said. “‘Hey, guys, I don’t think we’re accomplishing much at this point. Why don’t we go to lunch?’”
Breaks matter more than leaders realize. “Lunch alone, even just a break alone, lowers cortisol,” he said.
Leading with empathy
Medical practice leaders aren’t just managing their own stress — they’re very often absorbing the stress of others.
“I used to think of empathy as a soft skill,” Gutzler said. Now he thinks of it "as a hard‑edge leadership skill."
When someone is emotionally charged, logic isn’t the first solution.
“You don’t close the understanding gap with facts,” he said. “You don’t close it with logic. You close it with listening and labeling their emotion.”
Acknowledging what someone feels can immediately de‑escalate a situation. “If you can listen and say, ‘I can understand the emotion you’re feeling,’ it begins to close the gap,” he said. “It actually lowers their cortisol.”
Only then does problem‑solving become possible.
Handling financial pressure and missed targets
Financial leaders at medical practices often face an added layer of stress when numbers don’t meet expectations.
“Failure, setbacks — all of that can wear on us,” Gutzler said. “And it can lead to depletion.”
His advice starts with self‑leadership. “If you’re a leader, you’re giving out a lot,” he said. “And if you don’t have inputs, if you don’t have fountain inputs, your emotional reserves are going to be totally depleted.”
Preparation matters, too. “I like to script,” he said. “I like to literally script out some of my thoughts ahead of time — my three or four core essential message points.”
Visualization and rehearsal help leaders remain grounded when conversations turn difficult.
Setting the "emotional thermostat"
As the episode concluded, Gutzler returned to the idea that leadership is emotional whether leaders intend it to be or not.
“Leaders don’t just read the thermostat,” he said. “They set the thermostat.”
Emotions spread quickly through teams — especially under pressure. “[Leaders] understand that emotions are contagious,” Gutzler said. “And [they] set the tone.”
For MGMA members navigating uncertainty, change, and high expectations, mastering the 17% moments really isn’t optional. “If we can harness the power of self‑regulation during the 17% moments,” Gutzler said, “this next year is going to be successful.”
Resources
- 2026 MGMA Financial Conference
March 1–3, 2026 | Phoenix, AZ - Steve's Keynote Session:
“17% Moments: Discover the Brain Science of Emotions and High‑Performance Leadership”
MGMA Financial Conference Opening Keynote
Sunday, March 1 | 3:45 - 5:00 p.m. - Steve Gutzler website
Leadership and emotional intelligence resources
