One of the unexpected things that happened after I left neuromonitoring wasn't simply that I started my own consulting company. It was the conversations I began having with other healthcare leaders who had done the same.
Many had built successful businesses after leaving their executive positions. Some had sold companies. Others had stepped into industries that seemed to innovate far faster than the one we all came from.
Eventually, one of them asked me a question that caught me off guard.
“Why don't more clinicians start companies?”
I answered almost instinctively. “Because our industry trains the entrepreneur out of them.”
The moment the words left my mouth, I paused. I hadn't planned that answer. But the more we talked, the more convinced I became that it was true. Not because healthcare lacks intelligent people, and not because clinicians aren't creative, but because the system rewards something very different.
We spend years learning to follow the rules
The conditioning starts early. In school we're rewarded for finding the correct answer. Follow the instructions. Pass the exam. Stay inside the lines.
Clinical education reinforces the same behaviors. Protocols. Guidelines. Standards of care. Checklists. None of these are inherently bad. In fact, they're essential.
I still remember my first week of training to become a neuromonitoring tech. The CEO came in and told us that if we didn't follow the protocols, they wouldn't cover us if we got sued, and that we could cause a patient harm, or even kill someone. Gulp.
Message received, permanently.
Don't get me wrong: patients deserve consistency, evidence-based medicine saves lives, and standardization prevents mistakes. In developing devices and new tech, even more so.
The problem isn't that healthcare values protocols. The problem is that, over time, many people begin treating every problem as one that already has a correct answer.
Innovation becomes risk. Curiosity becomes uncertainty. Questioning becomes uncomfortable.
And eventually compliance stops being a safety mechanism and becomes a mindset.
Healthcare builds walls around new ideas
Over time, healthcare creates barriers that make innovation increasingly difficult.
The first wall: language
Healthcare and med-tech have their own vocabulary: acronyms, certifications, reimbursement models, regulatory terms, clinical shorthand. To insiders, it's perfectly normal. To outsiders, it's nearly impossible to understand.
When someone from outside healthcare asks what feels like an obvious question, the response is often predictable: “They just don't understand healthcare.”
Sometimes that's true. Other times they're asking the question no one inside the industry has thought to ask in years. Fresh perspectives expose assumptions we've stopped noticing.
The second wall: hierarchy
Healthcare has one of the clearest organizational hierarchies of any profession. Everyone understands where they fit. Everyone understands who carries authority. And everyone understands the potential consequences of challenging it.
When speaking up feels risky, silence becomes the safest career decision. Unfortunately, silence also hides the very problems leaders most need to hear.
The people at the top have all the authority and none of the insight into what isn't working. The people on the ground have all the insight and none of the authority to change it.
Physicians experience it too
This isn't only true for nurses or allied health professionals. Physicians face their own version of the same challenge.
Recently my friend Dr. Phil Louie, a spine surgeon at Virginia Mason Medical Center in Seattle, wrote about the transition from operating room leadership to organizational leadership. One sentence stayed with me.
“Instincts that serve me in the operating room… work against me in a conference room.” (Dr. Phil Louie)
That observation captures something important. The operating room rewards decisiveness. The leader is expected to have answers. Organizations require something different. They require leaders who create space for other people to contribute.
Dr. Louie also described another challenge: many physicians hesitate to move into leadership because they worry how their peers will perceive them. Will they still be seen as a physician? A leader? Or will they become “just another administrator”?
Healthcare often reinforces this tension. We celebrate clinical volume. We criticize administration. We sometimes treat improving the system as less valuable than working inside it. Young clinicians notice these signals long before anyone talks to them about leadership.
What safe innovation looks like
Permission, granted out loud
Ironically, one of the best examples I've seen comes from Dr. Louie himself. I've worked alongside him as both a neuromonitoring technologist and later as a med device representative.
Before every procedure, he asks everyone in the operating room to introduce themselves. Then he reviews the surgical plan. He discusses contingencies. Most importantly, he asks every member of the team whether they feel comfortable continuing to advocate for the patient throughout the case.
Everyone. Not just the fellow or PA operating alongside him. Not just anesthesia. Everyone.
That small act gives the person with the least authority explicit permission to speak.
That's what safe innovation looks like. Not abandoning protocols. Not encouraging people to go rogue. Creating an environment where people can question, contribute, and improve within a system designed to protect patients.
Leadership must stop confusing silence with alignment
Healthcare doesn't need more leaders telling employees to “think outside the box.” Most healthcare professionals have spent years learning exactly what happens when they do.
Instead, leaders must create environments where thoughtful contribution is expected, protected, and rewarded. That begins with a few challenging questions.
Are people encouraged to question how work gets done?
Do they know which standards are non-negotiable, and where experimentation is welcome?
When someone identifies a problem, do leaders get curious or defensive?
Are decisions informed by the people closest to the work, or only by the people with the biggest titles?
Because when a room goes quiet, leaders often assume everyone agrees. Sometimes they do. Most of the time, they've learned that speaking up isn't worth the risk.
The future requires both standards and curiosity
Med-tech and healthcare cannot function without standards, and patients deserve reliable, evidence-based care. But we also cannot create the future of healthcare by teaching highly intelligent people to follow instructions for decades and then wondering why innovation feels so difficult.
Leadership means building an environment where safety and innovation exist together. Excellence is clearly defined. Standards protect patients. And every person, regardless of title, feels safe enough to say:
“I see a problem.” “I have a question.” “I think there may be a better way.”
The people who notice the issues aren't the problem. They're the solution.
But only if we're willing to listen…
Logan McKnight
Logan McKnight spent nearly 20 years in healthcare and med-tech, from the operating room to the CEO seat. She now helps healthcare and medtech leadership teams turn potential into action and innovation.
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