Stress is an internal response, a feeling that occurs in reaction to an external challenging situation. For leaders, stress is not a personal wellness issue; it’s a performance variable. Unmanaged stress mimics mental health conditions, worsens existing ones, and leads to burnout, while quietly degrading decision-making, communication, and team outcomes. Managing stress well is therefore a leadership strategy, not an afterthought.
The Nature of Stress
Understanding the nature of stress and how it affects us is the first step in managing it. Yet for healthcare leaders, that first step is rarely taken. The demands keep moving, the next decision is already waiting, and stress is quietly shaping how we think, decide, and lead. But stress is going unexamined because there’s no time to examine it.
That’s the silent strain that does not announce itself. It accumulates.
In a previous blog, I wrote that stress is essentially an internal response, a feeling that occurs because of an external challenging situation. This installment expands that idea, because for leaders accountable for teams, patients, and performance, understanding stress is not optional. It’s operational.
What Is Stress Really?
A widely used academic definition holds that stress occurs when the demands of a situation threaten to exceed the resources of the individual. What stands out in nearly every formal definition is the role of perception. The danger is not always physical. It can be a project deadline, a staffing gap, or a board conversation. The body doesn’t distinguish between a wild animal and a project deadline, so the amygdala triggers the fight-or-flight response whether we like it or not.
This is the distinction that matters for leadership: Stress is an internal response to external pressure. External stressors are real and tangible, not imagined, but the stress itself originates inside, in how we react. While we can manage our responses to some extent, stress itself isn’t something we feel we can fully control.
This is why a leader can sit in the same meeting as a peer and walk out depleted while the other walks out energized. The meeting was identical. The internal response was not.
Stress management is the bridge from pressure to resilient, joyful performance.
Why Do Leaders Skip Their Own Stress Management?
There’s a reason stress goes unmanaged at the executive level. In our LinkedIn survey, 50% of respondents named a lack of time as the primary barrier to self-care, with workplace demands and stress being significant additional barriers.
Read that carefully.
The very conditions that make stress management necessary, such as time scarcity, workload, and pressure, are the same conditions leaders cite for not addressing it. Stress becomes self-reinforcing. The busier and more strained a leader is, the less likely they are to do anything about it.
Breaking that loop goes beyond being a personal indulgence. It’s a performance decision.
What Are the Two Types of Stress?
Most stress falls into two categories:
- Acute stress is when we perceive immediate danger. It’s typically short-lived and subsides once the perceived threat or stressful event — a difficult conversation, a near-miss, an urgent escalation — has passed. We can experience acute stress temporarily without developing a medical condition, but persistent symptoms can result in a diagnosis of acute stress disorder. In a healthy system, acute stress spikes and resolves.
- Chronic stress is the kind of stress that lasts for a long time without a break. It’s often caused by ongoing pressures such as persistent unmanageable workloads, ongoing conflicts or relationship issues, or being in a toxic work environment day after day. The defining feature of chronic stress is that, unlike the stress that builds before a big event and then subsides when it is over, chronic stress does not go away. It’s there all the time, and it can cause serious problems, including high blood pressure, heart disease, anxiety, depression, and a weakened immune system.
In healthcare leadership, chronic stress is the more common and dangerous variant. Because the workload does not reset, and the next crisis is already scheduled.
The Stressors That Don’t Go Away
Chronic stress is extremely common. In response to the effects of COVID-19 on mental health, the American Psychological Association conducted a survey called “Stress in America 2023.” On a scale of 1 to 10, nearly one-quarter of adults surveyed rated their average stress between 8 and 10. The most common sources were money and the economy, health problems, family responsibilities, housing costs, and personal safety.
Notice the pattern in those answers.
They don’t go away.
That is the operational insight for leaders: The stressors driving our workforce, and us, are not episodic. They are structural. A leadership strategy built around the assumption that stress is temporary will consistently underestimate its effect on performance.
How Does Stress Affect Performance?
The way we handle stress significantly impacts our overall health and well-being. While a strong work ethic and commitment to a mission are admirable qualities, these traits can become detrimental when combined with a toxic environment. If stress is left unchecked in these conditions, it can lead to serious consequences.
This is why stress is an essential topic in workplace mental health:
- Chronic stress can mimic a mental health condition.
- Unhealthy stress can worsen preexisting mental health conditions.
- Prolonged, high-level stress can lead to burnout.
And the cost is not contained to the individual. When leaders allow stress to take over without a plan to grow resilience, it leads to higher levels of distress under pressure, hopelessness in the face of difficulty, worry, and fatigue. Sleep disruption follows, and with it comes higher employee turnover, increased workloads, and lost productivity.
Stress at the top does not stay at the top. It compounds downward through the system.
There is a further complication: Many upper-level managers and C-suite executives tend to deal with workplace stress in unhealthy ways: overworking, neglecting rest, and withdrawing from support. The people most responsible for organizational performance are often the least equipped in practice to manage the strain that erodes it.
Resilience: The Capacity to Stay Strong Under Strain
When we talk about resilience, we’re really discussing the ability to stay strong in the face of stress. Our perceptions of stress are crucial because the body’s fight-or-flight response activates at any level of stress. By choosing how we perceive a given stressor, we can better manage our reactions to it. That shift in perception and response enhances resilience, allowing us to handle stress more effectively and maintain our well-being.
One form of this is intellectual resilience, the capacity to undertake challenges head-on while focusing on solutions and maintaining progress toward specific goals and a future vision. It involves adaptability, problem-solving, and a commitment to personal growth. At its core, intellectual resilience is grounded in knowing who we are and what we want to achieve.
A leader anchored in that clarity reads pressure differently. The deadline and the staffing gap are real, but they register as problems to solve rather than threats to absorb.
The Interplay Between Stress and Joy
The Keane Insights® thesis becomes operational at the intersection of stress and joy. Joy is not the reward a leader earns after they handle stress. Joy is part of how they handle stress.
In our work, we’ve found that dialing up your why and the joy within it counteracts stress. When a leader is connected to purpose and joy, stress may not vanish, but it is outweighed. As Josh Landay frames it, “If there’s no why within the work, then it’s only stress . . . Dialing up the purpose and the joy within it proportionally lowers the strain.”
This is why joy and a strong sense of self function as the foundations of sustainable performance, not byproducts of it. When we operate from a state of joy, we manage stress far more effectively, which allows us to lead in a more purpose-driven way.
DJ Irie spoke to a related point: the power of the human mind to solve problems. That capacity is the engine of a growth mindset, and changing our perspective on mistakes to view them as opportunities rather than failures significantly reduces the stress of making errors. It’s often through, not in spite of, our imperfections that breakthroughs emerge.
How Is Stress Affecting You?
Stress is something we collectively have to be aware of and prepared for, and we can do that only when we slow down and pay attention to how stress is impacting our lives.
For a leader, that begins with an honest inventory. Where is the strain accumulating in your thoughts, your body, your time, your work, and your relationships? And what is it costing the system you lead?
The leaders who manage stress well are not the ones who feel it least. They are the ones who have looked at it directly. Take a moment to reflect on the things, people, and events that are currently causing stress, either in your leadership or in your organization.
FAQs
What is stress, and how does it affect leadership performance? Stress is an internal response, a feeling that occurs in reaction to an external challenging situation. For leaders, it’s a performance variable: Unmanaged stress degrades decision-making, communication, and engagement and compounds downward through teams as turnover and lost productivity.
What is the difference between acute and chronic stress? Acute stress is short-lived and subsides once a perceived threat or stressful event has passed. Chronic stress lasts for a long time without a break, and, unlike acute stress, it does not go away. It can contribute to high blood pressure, heart disease, anxiety, depression, and a weakened immune system.
Why is stress an essential topic in workplace mental health? For three reasons: Chronic stress can mimic a mental health condition, unhealthy stress can worsen preexisting conditions, and prolonged, high-level stress can lead to burnout.
Can leaders actually control stress? Not entirely. Because stress is an internal response to external pressure, stress itself cannot be fully controlled, but leaders can manage their response to it. Choosing how to perceive a stressor and dialing up our purpose and joy strengthens our resilience and lowers the strain.
Put This into Practice
Assess where stress is affecting you. Take the Keane Insights Resilience Assessment to see clearly where strain is concentrating across your leadership — and where your resilience is strongest.
Equip your team with practical tools. Explore the Keane Insights Content Licensing library, including the Stress Triggers® tool and the Joy Toolkit, the latter of which holds research-backed resources built to help leaders and teams manage stress and build resilience.
Bring this work to your organization. Schedule a consultation to discuss how the Ready, Set, Go® framework can help your leaders address stress as a performance strategy. Or, invite Nicole to speak at your next event.
For organizations ready to address stress as a performance strategy, not an afterthought, explore the Keane Insights® approach to building resilient, mentally healthy, and highly productive teams.
