In this NeuroLeadership Edge podcast episode, host Claire Hayek interviews Neil Marshall, co‑founder of Health Search Partners, about the critical importance of a leader’s first 90 days. Drawing on 30 years of experience and over 10,000 executive interviews, Marshall explains that early‑stage success hinges less on strategy and more on the brain’s response to symbolic actions that signal safety and trust. The conversation covers a personal story of Marshall’s departure from a previous firm, the concept of a “values threat” that triggers the same neural circuitry as physical danger, and vivid anecdotes—such as a new hospital CEO moving into the facility, swapping out terrible mattresses in a single day, and an interim CEO bussing plates at a board dinner—to illustrate how small, intentional gestures generate oxytocin, build trust, and create a magnetic leadership presence. Claire ties these stories to neuroscience, emphasizing that behavioral evidence outweighs verbal promises, and that trust must be established before any strategic plan can be effective. The episode concludes with a rapid‑fire segment where Marshall shares core leadership habits (intentionality, pulling rather than pushing, modeling the best, and attracting talent) and promotional calls to action for a free leadership diagnostic, Claire’s upcoming book Calm Under Fire, and ways to connect with Marshall. Key take‑aways: 1. The first 90 days shape a leader’s long‑term impact because the brain treats misaligned values as a survival threat. 2. Symbolic, concrete actions (e.g., fixing mattresses, bussing plates) produce neurochemical trust signals that cascade through teams. 3. Trust is a prerequisite for strategy execution; without it, even the best plan fails. 4. Effective leaders are intentional, pull rather than push, model top performers, and naturally attract people and resources. 5. Marshall’s research methodology involves asking candidates to recount specific first‑90‑day tactics, revealing a pattern of intentional, trust‑building behaviors across successful executives.
Chapters
30 years, 10,000 executive interviews, and the pattern Neil Marshall kept seeing had nothing to do with strategy or credentials or track record. Surprisingly, it had everything to do with what a leader does in the first 90 days. What they notice, what they fix, what they say. Well, or maybe how they behave, right? Today, Neil breaks down why the first 90 days can make or break a leader and what the brain is actually doing in those early weeks that most executives never account for. Stay with us. Welcome to the NeuroLeadership Edge. I'm Claire Hayek, NeuroLeadership expert. TEDx speaker and founder of Mind Soul Purpose Team Building. I spent more than 20 years leading high-stakes projects and teams under pressure. This podcast exists for leaders who want to perform at the level they are built for, even when everything around them is uncertain, is fast-moving, and high-stakes. The 3 things you are going to walk away with today. One, why the first 90 days of a leadership role shape everything that comes after. And what's your brain is— what actually your brain is doing during that window that most leaders just don't even think about. 2, the science behind why symbolic actions carry more weight than strategic announcements. And 3, what it looks like to lead with trust as a system.
Yes.
Trust. My guest today is Neil Marshall, Chairman and Co-Founder of Health Search Partners, a national executive search firm focused exclusively on mission-driven healthcare leadership. Neil has spent 30 years in this space. He has personally interviewed more than 10,000— 10,000, yes— healthcare executives. He is the architect of the First 90 Days Leadership Series, a body of work that examines what the most effective leaders do and do intentionally in the earliest and most critical phase of any new role. Neil, welcome to the NeuroLeadership Edge. How are you doing today?
I'm good, Claire. Thanks for having me.
Lovely having you. Now, let's dive right in. I would like to start with something real that happened really. You spent years rising through ranks at a major national search firm. You're senior, established, and then something happened. Tell us a little bit more about that.
Sure. Got a, got a new boss. And frankly, I got crossways with her. And for whatever reason, we were not going to work. And so I made a decision to leave the organization. She thought that that would be okay, but the CEO of the organization went nuts and said, no, you need to get back and do whatever it takes to keep him. So what she did was basically try and coerce me into staying. And I said, no. As I told you before, I told her that I would rather drive a bus than work for her. And no offense to any bus drivers, but I— and so I left the organization. I needed to pivot and start my own firm, which I did. That morphed into a couple other partnerships, which then morphed into HealthSearch Partners.
And how long ago was this?
So probably about About 2004 or 2005.
And so when you look back at that moment and connect the dots, what do you feel? How do you see it now, looking back, that moment?
You know, it was really, really hard going through it. They literally even asked me to sit down with an executive coach to tell them. And Claire, I'm a big guy, right? I mean, I'm crying like a baby. But I'm like, I just want to leave. Okay, in a positive professional manner. I can't work. I can't work with this woman. And there's just, it's not gonna happen. I can't work for somebody that tries to coerce you into something. I mean, it's just not appropriate. But yeah, I'm sitting there crying with a coach saying, just tell them I want to go. Leave me alone. Let me go do my own thing. Right.
And, you know, this is actually what you describe is something the brain registers as a values threat, which is it hits the same neural circuitry as a physical threat. So, you know, you did— your body moves into protection mode. And basically, people, you just wanted to get out. And it's very understandable. A lot of people don't think about the values threat, but it is out there. Well, it is registered as survival. So it makes sense how you felt and you didn't belong. And, you know, some people, even some people that stay, it doesn't mean anything. It doesn't mean that it's wrong or right or whatever. I mean, it's everybody's decision to, to move a certain way. But it is a thing. So people could stay but still feel that pressure because they feel like they still feel under threat.
Yeah. And I couldn't work for somebody That, that threatens.
And totally understandable. So you have now placed hundreds of senior leaders into some of the most complex healthcare organizations in the country. And you noticed something that changed the way you run your firm. The placement was not really where the whole thing ends. Tell me about the shift.
Sure. It happened. There were probably a couple of steps. One was one of my favorite CEOs who I had, who was— we put him in a situation where we thought it was the right place and the right time, and he was the right person. And it went off the rails in a very short period of time.
Okay.
Really, I really wanted to dig and figure out what— so what happened, right? Why did this happen? Because we really felt like Right place, right person. They felt like right those. So what happened? So that coupled with an interview I had with, with one of my candidates where he talked about one of the things that he did when he took on new CEO assignments.
Okay.
And that was he spent the night, moved into the hospital and spent the first, he said, 90 days. And that was that. So, the 90 days and then this other thing, put them all together. I started interviewing people, not just for specific jobs, but for what do you do in the first 90 days?
Right.
Give me a tactic that you've done. What are positive things you've done? What are negative things? And just continuing to do research to come up with what we feel like is a plan Very few people tend to go into their first— into a job as intentional as we'd like them to.
And so tell us a little bit more about that specific, basically, leader. You don't have to mention any names. You know, we— something about bought mattresses.
Oh, this— the one that moved in. So he says, Neil, I moved into the hospital. And I was like, Richard, you know. And he said, no, I move in. And I'm like, well, okay, so tell me what, what, tell me more. And he said, just like you did, he said, my first day there, first night I woke up and residents typically sleep. It's basically a residence dorm, right?
Right.
And so he said, the residents woke up, they were making coffee the next morning. And he said, Neil, like all old people, I asked them, how did you sleep? And one of them popped off and said, it was horrible. These mattresses are horrendous. You know, you slept here, you should know that. And he said, you know what? He said, they were, and you're right. And you know what? I know somebody that can fix that.
Hmm.
And he pulled up his cell phone and he called the VP of facilities who now worked for him and said, we're going to change out all the mattresses in the residence dorm. We're doing it today. Find 5 pickup trucks. We're going to Costco. I'm going with you. And by the end of that day, there were brand new mattresses. And he said that the day that he left there 7 years later, and this was a big hospital system, we're talking about 22 hospitals, $10 billion in revenue, a major place. He said they still talked about it. There were people that were still talking about the fact that he lived in the hospital.
That's amazing.
The first 90 days.
And it makes sense if you think about it biologically. The brain actually loves behavioral evidence and values it more, far more than verbal statements. People just saying words, right? It's all in the action. So, when a leader acts, especially early on, you're building something. Maybe even if it's a small gesture like what seemed like a big gesture. But still, just asking, how did you sleep? That was already great. But then, he acted on it. So, the brain registered this data as, wow, safety. So, one symbolic action literally biologically produced a lot of oxytocin around him, the trust chemical. And it just pretty much just traveled across the team. This is really very impactful. And it's these small little things that people sometimes underestimate. So, you work inside a lot of complex organizations every day. There's a new leader that just pretty much inherited a new team. For them, it's a new team. Culture may be shaky. It's uncertain. And I know you've said something I think it's worth talking about. You said, you actually told me you believe trust matters more than strategy. When in a complex environment, we just kind of touched a little bit neuroscientifically on that. But I'd like you to walk us through it a bit more from your experience, how that trust level up compared to strategy and elaborate a bit more on that.
Yeah, and strategies. And don't get me wrong, strategy is important. But strategy is a long-term And what we, what we really feel like is that coming into a new situation and focusing on the trust factors and building trust and getting to understand the culture and all of that, make sure that the strategy that you end up putting in place is going to, is going to work. Because frankly, if you haven't built trust, you can have the greatest strategy ever. And if your team's not going to implement and help you implement it, then it's not going to do you any good at all. We had one CEO that talked about the board was really focused on, we need a new strategic plan. We need a new strategic plan.
Right.
We need a new strategic plan. So, this CEO was walking around talking about this new strategic plan. And he got up to the ICU and there was a nurse there. And sometimes nurses have a tendency to tell the CEO exactly what they need to hear. And he started talking about the strategic plan. And she looked at him and she said, Mr. CEO, we don't need a new strategic plan. We need ICU pumps that work. And he said, well, tell me more. And she did. And they ended up fixing it and they ended up getting it right. But what she was worried about was a neighbor who was a patient Right down the hall and making sure that the pumps worked so that she got better, so that she got to go home with her family.
That's amazing. It's the little gestures like this that really speak a lot. I'm actually going deep into that in my book. The book I'm writing presently and wrapping up pretty much will be released in September, Calm Under Fire. And basically, and my research actually shows that The leaders that build the most durable teams and the teams that are able to function under pressure and be aligned, focused, and that don't silo, they actually really pull together, are the ones who develop that trust. That, you know, where they're also the leaders that have like a nervous system that is contagious. So, it calms everybody around them and creates that sense of safety. And it's so underestimated. And it's Little gestures. So speaking of actions, let's go a little bit deeper on the symbolic actions because I think this is where leaders often miss the point. It's easy to kind of say, ah, it was just a small thing. It's easy to dismiss it, right? The parking spot, the mattress story you told us about. But these things are huge. They carry enormous, enormous impact, enormous weight. What have you seen in 30 years of working with senior healthcare leaders? When a leader gets that right, those symbolic actions, what have you seen happen? What have you seen shift? Any stories, anything you want to share with us?
Yeah, I mean, it moves the needle. And I will tell you that I really don't believe— because over the last year or two, I've asked people, tell me about a symbolic act that either somebody's done A leader that you work for or vice versa. And the number of people that can't say anything, right? And I literally thought of one this morning that I'd forgotten about. I was working with a hospital CEO. We were, we were doing the search to replace him. He had retired. The CEO that replaced him left. So we were, so he was back in an interim basis.
Okay.
So he was an interim CEO. We were meeting with the search committee of the hospital, which is board members and some physicians. And we were interviewing. And the first interview came in, did it, left, and then we had a dinner break. So we all, you know, they served us in the boardroom, we had dinner. And as we were ending, the former CEO got up and started taking our plates.
Oh.
Okay. And he bussed the table while everybody else was talking about, you know, What we were going to do next, what we had done before, all these things. The CEO busts the table.
Wow.
And, and I actually, when he did it, I kind of felt bad. So I hopped up and started helping a little bit too. Right?
Right.
Yeah. But then the next morning, see, we had 2 more interviews. After the first one, we had breakfast. He did the same thing. And I realized that was that he had to be of service. And he was going to be of service, not just to the patients, but to his board members, to his physicians, to everybody, including me. And he literally is one of the finer CEOs I've worked with from a true leadership capacity. But that was a— I love that one. If you want another one, one of my favorite—
Yes, please do.
Was literally one of the first job I had coming out of college. I was in an executive training program. And there were 5 of us and they fired our president, our CEO. And so our new CEO was coming in the next day or that day. And so he pulled up in the parking lot and we all looked out the window to see who he was and, you know, to watch him. And he got out of his car and he walked through the parking lot. He picked up garbage, walked into the warehouse, threw it away, never said a word. Right? But he knew that he was on stage and we were watching, and he knew the kind of people that we were because that's the last time Grover Martin ever picked up a piece of garbage. Because every single one of us showed up 10 minutes early from then on. We walked the parking lot. We made sure that he never had to pick up another piece of garbage.
Amazing. This is amazing. I love that we're talking about these small Symbolic gestures. I think you might be a leader listening to this right now. You might be doing these already and not thinking about it and not making a thing about it. But maybe you're not. And sometimes, it just really brings forward your personality, your authenticity, your human side. And that you cannot replace that. There's no leadership school that can teach you that. Or nothing you could rehearse or say that would replace that. Gestures are literally registered in the brain at a whole different level. And so these are great stories, Neil. I love that. And I think stories also stay with us. As we listen to you share these stories, we feel it and we connect better with the story and we can relate more and understand fully when you tell a story as opposed to like theories about this is what you need to do in order to, right?
Right.
So thank you so much for sharing these stories with us. So we are at the rapid fire. These are short answers. First thing that comes to mind. And I'm going to start with the first one. Ready?
Go!
All right. The one leadership habit you protect no matter what.
What comes to mind is intentional. Meaning, be intentional. Everything you do is being watched. Be intentional.
Okay, great. Something you believed early in your career that you have since changed your mind about?
Yeah, I used to believe that you could push. But the problem is, is when you push, all you do is knock people over and things over. And what I learned how to do is pull. And pulling is leading, right? You're walking backwards and people are— I call it the crawfish. You're walking backwards and people are following you. That's when you're a leader.
Amazing. Best piece of advice you ever received from a leader you've actually worked with?
Yeah. He said, I mimic the greats.
That's all. Yeah.
He said, I find, I find whoever's the best at something and I find out what they do. And that's what I do.
Model the best. And finally, so 30 years in, 10,000 interviews, what is the one thing that best leaders all have in common, in your opinion?
That they attract because of who they are. They attract. What do they— they attract people, they attract accolades, they attract good things. They attract.
So kind of also like brings us back to what you said about being the magnet, right, as opposed to push. And right, and you've seen that that's a common thing.
They attract.
From all these leaders. Wow. Okay, very, very insightful. Uh, this has been, Neil, it's really been one of those conversations that, that is rich in, in content and stories. And, um, pretty much, I mean, you cannot replace 30 years of experience of watching leaders succeed and fail in real conditions. And this is just a very, very insightful conversation we've had today with you. Thank you so much for being here. If you're a leader listening right now that is managing a team and you are not sure where pressure is quietly costing your performance or your team's performance, I have a 4-minute diagnostic that maps exactly that, The Gap. It is free. It gives you instant results across 5 pressure profiles specific to leadership teams and the leader, him or herself or themselves. Go to clairehayek.com/pp-scorecard. And as I mentioned earlier, I'm also finishing up a book. It is coming out in September 2026. I'm building a small curated group of senior leaders who will read the manuscript before it launches and basically give your feedback and help shape it in a way. If that actually sounds like you, well, I'd love for you to be part of it, including you, Neil, by the way. No pressure. You can go to clairehayek.com/book and sign up. It takes 30 seconds. Just 2 questions. Email your name and your title. Finally, please do subscribe to the NeuroLeadership Edge. Every single subscriber does matter. It will help the show grow. And why is that important to you? Well, because if the show is growing, it's going to reach further and it's going to attract the caliber of guests and conversations that actually make impact. And I've been blessed to have amazing guests just like Neil today. But imagine what we could do together if you help me help you. All right. So, do subscribe and share it. And finally, Neil, any last words? I'd love to give you the floor before I wrap up here.
I guess the only thing I would say, Claire, is if, if there are healthcare leaders out there, especially because that's our focus, and you either need to help attract new leaders to your team or you're contemplating making a move, let's talk. Definitely.
How can we find you, Neil? On LinkedIn?
Yeah, I'm on LinkedIn, Neil Marshall, or Obviously on the web, healthsearchpartners.com, just like it sounds.
Healthsearchpartners.com. And Neil Marshall is 2 L's, N-E-I-L-L Marshall. And we will include those links in the description as well. So you're not looking for it and it makes it easier to reach Neil. Again, thanks, Neil, for being on the show. Thanks for the stories and Sharing your insight, and everyone else listening and watching us lead boldly, stay human, and don't forget to turn every challenge into a gift. I had to turn one big challenge last week into a gift, and I'll tell you, it took me five minutes of really pulling my hair out because I'm like, I don't see the gift. And guess what? I did find it, and it's amazing how it shifts our perspective instantly, and it serves us. So.
