I recently stood inside a Danish cathedral, watching a five-hundred-year-old clock mark the hour. A wooden figurine danced, a mechanical dragon squealed.
It has done so — uninterrupted — for more than 500 years. Without electronics. No fancy software or smart algorithm. Just pure craftsmanship built on first principles — deep knowledge about mechanics, precision and physics.
On the way home I thought about my ten-year-old espresso machine that still pulls perfect shots, and my Italian boots I’ve worn almost every day for a decade. All of them still work — not because I care for them obsessively, but because they were built to last. They were built with me the customer in mind, not the company building it.
It made me reflect: How much of what we build today — in medicine, in business, in life — is designed to last? Maybe even outlast us. How much is built to keep working when we’re no longer there to fix it?
The Leadership Parallel
We talk a lot about innovation, rarely about sustainability. Yet leadership, when looked from this perspective is the art of building clocks, not alarms. The craft of building sytems that keep ticking because they’re built on principles, not personalities.
The best teams don’t need constant supervision.The best departments don’t collapse when a leader is away. The best organizations don’t rely on adrenaline and pressure to function.
In healthcare especially, we’ve built too many alarms — urgent, reactive, human-dependent. And that has it’s place in high-stakes acute situations. But even there medicine works better, when it has been built like a clock: reliable, self-calibrating, graceful under pressure.
Constraints Are the Compass
Every system has at least one bottleneck. As do our own lives.
Professionally, mine currently is clear: too few consultants to meet surgical demand. But that’s only the superficial bottleneck, there is a tighter one hidden underneath — it’s in the system itself.
In Denmark, referrals and patient flow are centrally governed and this defines how cases loop between providers, how inefficiencies compound. Parts of these constraints have to be solved with policymakers.
So I’ve been working at the political level to change what’s possible. But that takes time. Meanwhile, we need all hands on deck in the OR, in the clinic.
Which means, that I can’t delegate parts of my workload. And suddenly I have become the bottleneck.
The question isn’t how to remove all constraints. It’s which one to optimize for right now.
Identifying where the bottleneck actually is, and what to do about it - that is already half the equation.
But here’s what I learned the hard way: If you want things to work like a clock, you have to built them without yourself as the coo-coo jumping out of your little black forest hut every other minute.
I inherited a microsurgical unit built around deep specialization — one surgeon, one approach, one way of knowing. It worked brilliantly while that structure held. But the moment it changed, the system faltered.
So from day one, I started re-building like a clock — teaching, assisting, rotating with my colleagues, creating as much redundancy as possible. Not because the old way was wrong, but because I wanted to build a clock that ticks whether I’m in the room or not — a system that survives transitions.
I see that as the biggest test of my leadership: not having the answer, but having the patience to build a system that can find it.
And there’s more to that: building a system that doesn’t depend on you or any particular person means building one that doesn’t isolate either. Often when we build pinnacles we remove these people from the “herd”. Yet we are all social beings and despite differences in personality can neither we nor the group thrive in isolation.
I’ve been thinking about the etymological difference between loneliness and being all-one - alone. One isolates, the other integrates.
The same is true for systems. A healthy department, like a healthy human, needs solitude and connection —focus and exchange.
And to foster that we need to create joint routines, create places for communication and sharing. In ultra-optimized healthcare and remote work, this becomes both more important and harder.
One of the few fix points we cling to almost religiously is our joint morning routine. The team gathers for handover from night shift, we look at the day ahead, the next day. We discuss cases, rotate through educational pieces and mini journal clubs.
It’s persistent in its rough structure — the ritual itself is sacred —but we’re constantly evolving and adapting within it.
That’s the clock: reliable rhythm with built-in flexibility to adjust for timezones.
Another lesson I learned while improving systems: Start with gratitude and appreciation. Every system has been set in place originally because it helped a problem at that point in time. Usually not everything is bad. It means appreciating what currently works while improving what can be improved.
It helps to accept the status quo as is and take everyone with you on the journey of change.
Kindness and Clarity
And doing so with kindness is key. The people and mentors who have impressed me most were the kind ones. The ones that have reached the top but stayed humble. That talked to the housekeeping personell the same way they talked to administration. I recently watched Alex Hormozi - successful entrepreneuer - diagnose a failing business in an hour with ruthless precision, but absolute kindness.
That combination stayed with me. This is what we need, not only with our patients - diagnosing and treating with ruthless precision and absolute kindness. It is the same for leadership and change management.
We serve nobody when sugarcoating essential flaws. And we serve everyone when pointing it out with loving kindness. And the go do something about it.
Like a clock, marking every hour ruthlessly, but with a sort of loving kindness.
That’s what I want to build — in my department, in my work, in my life.
Not alarms that scream for attention every hour, but clocks — quiet, elegant, enduring clocks — that keep time long after I’m gone.
What in your world still runs beautifully — simply because it was built right? And what would change if you led today with a craftsman’s patience instead of a sprinter’s urgency? Where are you currently the bottleneck, and what one constraint, if addressed, would let your team move without you?
to more from life
Nicco
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