Dr. Jeff Comer, Hospital CEO

I have spent the last 20 years of my life as a hospital CEO. I have been CEO at small, rural facilities and larger urban settings. I have focused much of my career on completing short term CEO assignments at hospitals requiring immediate turnaround tactics to keep them open. I also pursued a journey of completing doctoral education in psychology. My research interests in psychology have been centered on stress reactivity and effective stress mitigation techniques. As a result, I have the background and passion to help hospital administrators learn to manage stress more effectively, leading to more fulfilling careers and personal lives.  

From a psychological standpoint it may be hard to believe, but many research articles have reported that speaking in front of people is more stressful than death! And from my perspective, I used to agree. When I first started this career as a hospital CEO, I would become nervous with dread as soon as I was told I had to speak, immediately envisioning my audience detecting my nervousness and feeling awkward. And on the day of the event, my stomach would become knotted, I would sweat, my voice would quiver, and I would picture myself stumbling over words and doing a poor job. It was a very stressful situation for me. Many of you know exactly what I felt. But as a hospital administrator you have to speak – to large groups, small groups, and everything in between, often on a daily basis. I’m proud to say that after 20 years of speaking hundreds, if not thousands, of times, I’ve come to enjoy speaking. So how did I convert a trauma to an enjoyment? Let’s start by discussing why public speaking is so stressful in the first place from an evolutionary psychological framework. 

Why Speaking Can be Stressful

Public speaking invokes an evolutionary biopsychosocial process referred to as stress reactivity. Stress reactivity is a complicated psychological and physiological pathway that primes your body for action. Your body’s sympathetic nervous system goes into overdrive by increasing your heart rate, blood pressure, respiration, transfer of fatty acids and glucose to your muscles (which leaves you with the feeling of butterflies in your stomach), and body temperature (causing perspiration). Additionally, your endocrinological system excites, leading to secretion of hormones, including cortisol, testosterone, estrogen, and oxytocin (in differing levels for men and women). All of this is designed to protect you from a predator or emergent stressor that can kill you. Of course, public speaking won’t kill you, but the key is that your body does not know that. Your body is doing what it has been programmed to do from an evolutionary concept: to enable you to fight, run, or freeze, none of which is effective when presenting to a crowd! 

An additional critical evolutionary psychological concept that drives considerable human behavioral patterns, norms, and variants involves clan acceptance. For many generations, humans had to be part of a clan structure to live. Without a clan, humans did not have the ability to survive predators, weather, sickness, and enemies. Although civilization has progressed past clan structures in the developed world, our psychological schemas and unconscious survival patterns have not. We still migrate to people with similar interests and beliefs, seeking safety, approval, and acceptance from them. Similarly, from the context of public speaking, we seek acceptance and approval from the audience. We want to be liked and receive positive feedback on our performance. Disapproval is cognitively processed as rejection, which produces tremendous cognitive dissonance. From an evolutionary pattern of thinking, most of which is subconsciously processed, rejection from an audience can generate unconscious evolutionary fears and concerns for safety and belonging, leading to stress reactivity and nervousness about public speaking to begin. This is certainly maladaptive; however, it is real, nonetheless. 

Finally, in other articles and videos I’ve covered how being a hospital administrator can be a very lonely job. Public speaking is the epitome of loneliness. You, and you alone, are exposed in front of a group of people who may be strangers, skeptics, or even hostile. This can make you feel a perceived isolation at a time when you are exposing your background, thoughts, opinions, plans, and recommendations to an audience. Often you are presenting a proposal that requires direct approval from an audience (such as a board), which adds another level of fear of rejection.

An example of a particularly difficult speaking situation will highlight this best. There was one particularly difficult turnaround situation I did as an interim CEO at a small, rural hospital in a close-knit community. When I arrived, the hospital was literally weeks from complete closure. The Board wanted me to take immediate action to save the hospital. With only a few weeks to work, there were few options other than layoffs and non-profitable service line closures. I enacted very tough actions, which included laying off 35% of the workforce and closing the OB service line, which had questionable quality as well. Actions such as these can be tough anywhere, but in a small town it is devastating. A community forum was called. Roughly 900 people showed up in a stadium type of auditorium. I had to present and take questions with an angry, hurt, confrontational crowd of people who were all related or closely connected. This also included a one-sided, hostile media presence. I used the techniques I will share below and projected as much confidence as I could, but inside I was truly nervous beyond explanation. Most hospital administrators do not spend a career doing brutal turnarounds like I have done, but the point is that we all face speaking engagements that produce stress simply because we feel alone in front of a group of people, making us feel isolated in the spotlight while simultaneously harboring perceived fears of disapproval and rejection. So how did I manage this situation specifically, and ultimately, come to find enjoyment in public speaking? 

What You Can Do to Become More Comfortable Speaking

There are literally hundreds of books, organizations, and articles with specific tips on how to speak more effectively. My focus takes a slightly different approach in this article. From an underlying psychological concept, public speaking is all about managing stress reactivity. And frankly, no one, including me can tell you how to manage your own stress. Your stress is unique to your personality, psychological development, schemas, cognitive distortions, mindsets, and situations. You have to use trial and error and determine what works for you. However, I will share four concepts, from a psychological perspective, that have helped me as a hospital CEO to overcome my fear of speaking, and believe it or not, to actually come to find enjoyment from it. 

First, cognitive reappraisal is an important psychological concept that can lead to reduced stress. Essentially, cognitive reappraisal is reframing how you think about, define, and label events such as an upcoming speech. Do you interpret a speech to be stressful, to provoke nervousness or fear, or to cause you to feel anxious? Do you catastrophize it, making it seem much more stressful and intimidating than it really is? I would challenge you to reframe the words and concepts you use to define it. Physiologically, nervousness and excitement have the same indicators – what differs is our conscious and unconscious psychological interpretation of the bodily sensations through our schemas, memories, stories, and labels.  In other words, we can define our feelings about a speech as nervousness or we can change our cognitive interpretation and say that we are excited about the speech. The body doesn’t care – it will produce the same physiologic responses no matter what you call it. 

It is important to accept that we have an intrinsic ability to make different choices – one choice can lead to stress and anxiety or one choice can lead to energy and passion. You can choose to be excited that you have been recognized as having knowledge and experience that an audience wants or needs to hear. The choice of how you label a speech and frame it is entirely within your control. This concept takes practice. But over time it can completely change your experience with speaking even when you may have to face confrontational speaking engagements. For me at the community meeting I mentioned, yes, I was tremendously nervous, but I told myself that I am also excited to have the opportunity to share why we were taking these actions, and that as painful as they were, that they were necessary to keep the hospital open. This cognitive reappraisal eased my tension and gave me an intrinsic motivation to provide clear, honest communication. 

Second, acknowledge and resolve the concept of perceived isolation and fear of clan (audience) rejection. This concept entails powerful, unconscious evolutionary psychological schemas that are outside of your direct control (and even awareness). However, you can reduce feelings of isolation and potential rejection by including the clan even during difficult messages. For me, I always try to engage my audience in some manner every time I speak. This tactic can make the audience feel a connection and also get the spotlight off of me if even for a few brief moments. Like most people, my most nervous time is right when I walk in front of a group, no matter how small or large. By taking a moment to engage the audience I can give myself time to become comfortable in the setting, realize the audience is not trying to reject me, and make the audience feel a personal connection with me. For example, I once was speaking at the local chamber. The chamber President gave a long introduction, listing off my accomplishments. This made me feel under the spotlight, isolated, and a bit self-conscious. So, when I took the podium, I began by asking the chamber members to tell me why the hospital was important to them. This made them feel engaged in the talk, acknowledged the importance of the hospital to their community (their clan), and gave me an important opportunity to learn what they thought about the hospital. Listening to them got my thoughts off of my perceived nervousness and also allowed me to tailor my comments to the feedback they provided. This mitigated my spotlight isolation, helped to build a relationship with the audience by listening to their input, and reduced my fears of rejection. 

Third, embrace the psychological concept of primacy and recency. Essentially, this means that people pay attention to, and are more likely to remember, what happens first and last in any encounter or event. As a result, when you speak, the first and last two minutes are the most important time to get your message across. It can be a bit frustrating, but what you say in the middle does not get the same level of attention from your audience. So, by engaging your audience, as previously discussed, at the start and conclusion of your speech, you can have a much more lasting impact. This is the time to make your approach personal so that the audience can feel an important relationship with you and make the assessment that you are genuine. After the speech, most people will recall how you conveyed your message much more than what you conveyed. In other words, from a psychological framework, you are remembered more than your message. Take advantage of primacy and recency and you will be remembered as delivering a successful message that resonated with your audience. 

Finally, take advantage of the psychophysiological mind-body connection. Learn to project confidence even when you don’t feel confident. This will help you to counter the physiological effects of stress through the power of the mind-body connection. Walk in front of the group in a slow controlled manner. Hold your head high, pull your shoulders back, and keep your arms relaxed. Make eye contact with those close to you.  Most importantly, keep a genuine smile on your face (you are excited, remember?). It is next to impossible to be physiologically or psychologically nervous or harbor detrimental emotions when you have a genuine smile. By portraying confidence even when you don’t feel confident, your mind will believe it and your physiological sensations will follow. This is a simple, easy psychological trick that can help immensely. And it’s entirely within you control. 

In Summary

There are certainly many specific techniques of speaking that can be covered, but my focus in this article is on some of the key evolutionary psychological drivers of fearing public speaking and what you have within your psychological control to address them. Cognitively reappraise yourself as an energetic speaker, who engages the audience early on, and portrays confidence. By using these concepts, and tailoring them your unique personality and settings, you can also make public speaking an exciting, enjoyable experience. And always remember, even though speaking as a hospital administrator can feel lonely, I’m right there with you, telling myself that I am excited and not nervous every day. 

About Dr. Jeff Comer, Hospital CEO and Stress Management for High Performers

Jeff Comer is the son of a hospital CEO and has spent 20 years as a CEO himself. He leads small, rural hospitals and large urban medical centers. He focuses much of his career on short-term turnarounds where he works to save hospitals from closure. Seeing the stress in hospital administrator roles, Jeff pursued his doctoral education in psychology with research interests in stress reactivity. He enjoys blending his background as a hospital CEO with his expertise in stress management, helping colleagues to find more fulfilled professional and personal lives. Please see Dr. Comer’s website at www.wjeffcomer.com.