Buy-in.
It’s one of those words that sounds simple… until you actually need it.
Buy-in hits differently depending on the situation — and honestly, depending on your gender.
We’re often taught that if the work is good enough, if the data is strong enough, if we just explain it well, people will come along.
But leadership doesn’t work that way.
Buy-in isn’t just about logic. It’s about influence. It’s about sponsorship.
And learning this lesson changed how I approached every project after that.
Today, I want to talk about why getting a sponsor first — not last — can make or break your ideas… and why so many smart, capable women learn this the hard way.
Sponsorship is a Key to Strong Buy-In
Let’s talk a little bit about gaining Buy-in and the lesson I wished I learned earlier.
Buy-in spreads faster when someone with influence is invested in your success.
This shows up everywhere:
- Grants
- Hospital initiatives
- Cross-department projects
- Culture change
- Even negotiations
A sponsor isn’t just someone who likes your idea. It’s someone who:
- Has credibility beyond you
- Benefits if the project succeeds
- Can prioritize it when resistance shows up
Leaders are Supported in Training
In fellowship, I took on a massive project — building the business case to open an observation unit in the emergency department.
I put in hours of tireless work:
- Tons of research
- Strong financial modeling
- Clear benefits for patients, the hospital, and the health plan
And it all came together. That unit is still open today — and I helped open another one at my next hospital.
Why? Because my sponsor was built in.
As a fellow, the structure protected me. The credibility wasn’t just mine — it was shared.
At the time, I thought:
Wow, I must be really good at this.
I may have been, but I was also supported in ways I didn’t fully recognize yet.
Learning the Hard Way
Fast forward.
I’m a junior attending at a new hospital. I want to launch a cross-department initiative.
This time, I did what many of us do:
- I met all the players
- I warmed them up to my idea
- I tried to get informal buy-in
And then… I hit resistance.
That’s when it clicked.
I had skipped a crucial step. I didn’t have a sponsor who could:
- Prioritize the work
- Remove friction
- Signal that this mattered
So I went to the top. And let me tell you — I was terrified.
No one really knew me yet. I wasn’t even a partner. The imposter feelings were loud.
But I prepared the business case anyway. And she bought in. That sponsorship is what got the project off the ground.
That moment became a core leadership memory for me. Not because it was easy, but because it taught me something I’ll never forgot. Every initiative needs a sponsor.
Then when great projects have the chance to spread — regionally, system-wide — it’s best seek out the most influential sponsor first.
Did it always work? No. Not every project goes as far as we hope.
But seeking sponsorship first, consistently increased the odds of success.
Hospital Based Example of Sponsorship
Antibiotic stewardship is a perfect example.
These programs only gain real traction when hospital leaders recognize the importance and signal that it is a priority.
Only then does it feel safe — and worthwhile — to approach other attendings and teams about changing practice patterns.
Without that buy-in? It stalls. Because it is hard for people to change.
Where Buy-In Gets Tricky
Even with sponsorship, buy-in from the front line gets tricky.
Having been a business major and training in Lean Methods, throughput and efficiency are some of my favorite problems to work on. It’s also helpful that hospital leadership loves these projects. They have:
- Trackable metrics
- Financial gain
- Clear operational wins
But here’s the disconnect:
Most physicians don’t wake up excited to shave two hours off a patient’s length of stay.
It doesn’t feel meaningful—unless you translate it.
Because the people doing the work are the ones who actually have to change:
- Their flow
- Their habits
- Their daily decisions
And change is hard.
The Leadership Skill
This is where buy-in really lives.
You have to connect the goal to our shared purpose.
For example:
- Shorter stays → more capacity for the neediest patients
- More capacity → fewer transfers out
- And patients staying put → helps them stay closer to home
Now it’s not all about efficiency. It’s about the patients – the ones who need us.
This is the same skill required in negotiation, implementation, and culture change:
Know what motivates the people who are doing the work.
In medicine, that motivation is almost always patient-centered.
Questions to Ask
Let me leave you with this:
If you’re frustrated that your ideas aren’t moving…
If you feel like you’re doing all the right things and still hitting walls…
Pause and ask yourself:
- Who actually has influence here?
- Who benefits if this succeeds?
- Who needs to sponsor this work?
Buy-in doesn’t come from effort alone.
It comes from alignment, influence, and speaking to what people truly care about.
And learning that can change everything about how you lead.