People naturally sort and organize information at different levels of abstraction. Some of us gravitate toward big-picture vision. Others prefer understanding how systems connect. Still others want concrete details and specific next steps. This is drawn from a concept called “hierarchy of ideas,” and is critically important in leadership—especially in healthcare, where miscommunication doesn’t just cause frustration, it derails initiatives and impacts patient care.
Think of it like three people observing a cathedral under construction. One sees the grand vision—a sacred space that will serve the community for generations. Another sees the architectural systems—how flying buttresses distribute weight, how stained glass filters light. The third sees individual stones—each one needing precise cutting, correct placement, and secure mortaring.
All three perspectives are essential. But here’s the leadership challenge: you can’t point at clouds and inspirational sketches and expect someone to lay bricks. Nor can you hand someone a pile of stones and expect them to understand the sacred space you’re creating.
When we fail to communicate across these levels, we don’t just create confusion—we create an environment where people feel unseen and undervalued. This is where trauma-informed communication becomes essential. When someone operates at the stone level and you only speak in cathedral language, the implicit message they receive is: Your concerns don’t matter. Your reality isn’t valid. That experience of being dismissed, especially repeatedly, can be deeply destabilizing and erodes psychological safety.
How This Shows Up in Clinical Specialties
The different ways we sort information aren’t random—they’re shaped by our training and daily work. Understanding these patterns illuminates why interdisciplinary communication sometimes feels like speaking different languages.
Surgeons chunk down to concrete specifics. Their work demands procedural precision, exact measurements, and step-by-step protocols. They’re master stone-layers, and that precision saves lives.
Emergency physicians operate at the mid-level—protocols, algorithms, and rapid pattern recognition. They see the architectural systems that allow them to manage chaos effectively.
Family medicine and primary care physicians develop a uniquely multilevel approach. They hold the big picture—whole-person health, life trajectories, prevention strategies—while simultaneously managing care coordination and addressing today’s specific complaint. Their strength is seeing how the stones build into systems that create long-term health.
Pediatricians organize information around developmental frameworks and trajectories. They think in patterns across age groups and family systems, comfortable with “let’s watch and see how this evolves” in ways that might make a surgeon uncomfortable.
Hospital administrators and CMOs think at the cathedral level—population health, strategic initiatives, organizational culture. Their job is to see the big picture and set direction.
A surgeon is trained to see and place each stone with precision. An administrator is hired to envision cathedrals. Neither approach is wrong—they’re essential to their roles. The problem emerges when they try to communicate across these levels without recognizing the gap. And when that gap isn’t bridged, people feel fundamentally misunderstood—their way of thinking delegitimized rather than honored.
Recognizing How You and Others Sort
Cathedral thinkers use words like vision, transformation, mission, and purpose. They talk about ultimate impact and get energized by big-picture possibilities.
Systems thinkers use words like process, workflow, integration, and coordination. They focus on how pieces connect and influence each other.
Stone thinkers use words like specifically, exactly, step-by-step, and when. They want concrete examples and need to know what to do Monday morning.
Here’s a simple self-reflection: When you get excited about a new initiative, what do you naturally talk about first? The inspiring vision? The elegant integration of processes? Or the specific actionable steps?
Your answer reveals both your strength and your communication blind spot.
The Leadership Challenge
Leadership roles almost always require operating at the cathedral level—setting vision, inspiring purpose, thinking strategically. That’s your job. But your team may be operating at the stone level—managing daily workflows, solving immediate problems, handling the concrete realities of patient care.
If you only communicate at the cathedral level, your team experiences “death by vision statement.” They’re thinking: That’s beautiful, but I have 23 patients scheduled tomorrow. Which stones do I lay differently?
The inverse problem is equally damaging. Leaders who only operate at the stone level become micromanagers, unable to help their teams understand why the work matters.
Effective clinical leaders must become multilingual—able to communicate fluidly across all three levels. This multilingual approach is inherently trauma-informed because it honors how people actually process information and creates safety through being truly heard.
The REMAP Framework: Practical Strategies for Bridge-Building
Building bridges across these levels isn’t just good communication—it’s inclusive, trauma-informed leadership. The REMAP framework gives us a structured approach to honoring how people think while creating the psychological safety teams need to thrive.
R – Recognize, Reflect, Respect
Recognize which level you naturally operate at and which level others are speaking from. When someone asks a question, listen for their level:
“Why are we doing this?” = cathedral question
“How does this connect to other initiatives?” = systems question
“What exactly do I do differently?” = stone question
Reflect back what you’re hearing to ensure you’ve understood correctly. “It sounds like you’re asking for the specific workflow changes—is that right?”
Respect that all three levels are equally valid and necessary. The physician asking “exactly how?” isn’t being difficult—they’re operating from their trained way of thinking, and that precision matters. Respecting their level is respecting them.
This recognition and respect is trauma-informed communication in action. When people feel their way of thinking is valued rather than dismissed, they experience psychological safety. They feel seen.
E – Emotional Awareness, Flexibility, Courage
Emotional awareness means noticing when communication breakdowns create frustration, anxiety, or feelings of being undervalued. If you’re speaking cathedral and seeing glazed eyes or tension, that’s emotional data telling you to shift levels.
Flexibility is your willingness to move between levels rather than insisting everyone come to yours. Before sharing your cathedral vision, acknowledge the stones people are currently laying: “I know you’re managing complex patients, heavy documentation burdens, and staffing challenges…”
Courage means being willing to get specific even when you’re more comfortable in big-picture thinking, or to articulate vision even when you’d rather just give people a checklist. It takes courage to meet people where they are rather than where it’s comfortable for you to communicate.
This flexibility demonstrates that you value people enough to speak their language—a powerful message of inclusion.
M – Modeling and Mirroring, Mend
Modeling means explicitly showing the movement between levels. Make the invisible visible: “Let me share the big-picture vision first, then we’ll get into specifics…” This helps people follow your thinking and learn to bridge levels themselves.
Mirroring is matching someone’s level first before attempting to move them. Answer at their level, then offer to zoom in or out: “The big picture is X. Would it help to talk about specifically how this shows up in your daily work?”
Mend means repairing when you’ve missed someone’s level. “I realize I jumped straight to the vision without addressing your specific workflow question. Let me back up…” This repair work is essential to maintaining trust and psychological safety.
When leaders model this kind of humility and repair, they create cultures where miscommunication can be named and fixed rather than creating lasting disconnection.
A – Acknowledgement, Accountability, Adaptability
Acknowledgement is the foundation of trauma-informed communication. Before you can move someone to see the cathedral, you must acknowledge the stones they’re laying right now. This isn’t just politeness—it’s validating their reality and their concerns.
Accountability means taking responsibility for building the bridge. It’s not your team’s job to figure out how your cathedral vision translates to their daily work—that’s your job as a leader. Build the bridge in both directions:
Acknowledge current stones: “You’re already doing excellent work with patient handoffs…”
Show the system: “…and when handoffs include family context, readmissions drop…”
Reveal the cathedral: “…ultimately creating continuity of care and reducing firefighting…”
Return to specific stones: “Here’s what changes next week, and what stays the same…”
Adaptability is your willingness to adjust based on feedback. “We’re piloting a weekly huddle where you can flag what’s working” signals that you’ll adapt the approach based on their stone-level reality, not just impose a cathedral-level vision.
When people know their feedback will actually shape implementation, they feel valued as partners rather than as resources to be managed.
P – Practice, Progress Over Perfection
Practice means you won’t get this right every time, and that’s okay. You’ll sometimes speak cathedral to someone who needs stones. You’ll sometimes micromanage someone who needs vision. The goal is progress, not perfection.
Progress over perfection means celebrating when you catch yourself and shift levels, even if you didn’t get it right the first time. “Let me try that again—I gave you vision when you asked for specifics” is progress. That self-awareness and willingness to try again models the psychological safety you’re trying to create.
This principle is deeply trauma-informed. Perfectionistic environments where mistakes can’t be acknowledged are psychologically unsafe. Environments where leaders practice, stumble, and try again create space for everyone to do the same.
Seeing It in Action
The Cathedral-Only Approach (What Fails):
“We’re transforming patient-centered care. This is about honoring dignity, creating healing relationships, and reimagining healthcare. I’m counting on you to embrace this vision.”
Result: Inspiring applause, zero behavior change. More importantly, the team feels dismissed—their stone-level concerns invalidated.
The Stone-Only Approach (What Also Fails):
“Starting Monday: Update field 47B, attend the huddle, use the new form, submit reports by Thursday…”
Result: Compliance without understanding. The team feels like cogs in a machine, not valued partners.
The REMAP Bridge-Builder Approach (What Works):
“I know many of you feel rushed, without time to really connect with patients—I hear this regularly. [Acknowledgement, Respect] The current system isn’t serving you well, and that’s not okay. [Emotional awareness, Accountability]
We’ve learned that when clinicians have 3-5 minutes of uninterrupted conversation early in the visit, patients feel heard and visits often become more efficient because you’re addressing the real concern. [Show the system, Modeling]
Ultimately, we’re building a practice where you’re practicing real medicine again, not just processing patients. [Cathedral vision]
Here’s what’s changing: Starting March 1st, we’re adding 5 minutes to new patient slots. Your MA will handle intake ahead of time. The EHR has three new fields taking 20 seconds total. We’re piloting a weekly huddle where you can flag what’s working and what’s not—your feedback will shape how we refine this. [Specific stones, Adaptability]
Here’s the one-page guide. I’ll be in the department Tuesday and Thursday if you want to talk through concerns. [Accessibility, Practice] What questions do you have? [Respect, Flexibility]”
Why this works: The team feels heard and valued. Their stone-level reality is acknowledged. They understand the cathedral vision. They know exactly what to do. They know their voices matter in shaping implementation. This is inclusive, trauma-informed communication that creates psychological safety while driving change.
The Real Work of Leadership
The most effective clinical leaders don’t just see cathedrals or just lay stones—they move fluidly between all three levels using the REMAP framework. They recognize that honoring how people think is honoring who people are.
When you communicate across levels with recognition, emotional awareness, modeling, acknowledgement, and a commitment to practice, you create something powerful: teams where people feel genuinely valued. Not valued in the abstract, but valued in the specific way that matters most—by being truly heard.
Your job as a leader isn’t to force everyone to see what you see. It’s to build bridges between the cathedral and the stones, helping each person understand how their essential work contributes to something magnificent—and ensuring they feel seen, respected, and valued in the process.
Start noticing which level you naturally operate at. Start listening for which level others are speaking from. Start building bridges using REMAP. Practice. Mend when you miss. Keep trying.
The work matters too much—and your people matter too much—not to get the communication right.
Learn more about how to build a culture of trust and safety by expanding the communication capacity of your leaders. Bring Trauma Responsive Communication to your leaders and staff in one of our trauma informed communication coaching cohorts. https://mindremappingacademy.com/courses/ticc-healthcare
