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Leadership · 2018–2026

Seven Years in Healthcare UX

Twelve reports across eight locations and three continents, two years with no promotions on the table, and one closing question that kept the conversations honest.

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Overview

I joined Cerner in 2018 as a UX designer on the revenue cycle product. Over the next nearly eight years I moved through three phases — revenue cycle, the Terra design system, and design management — and came out on the other side of an acquisition. This case study is about the third phase.

Running alongside all of it, on the volunteer side of my life, was Wood Badge — the Boy Scouts of America’s adult leadership program. The program taught me how to lead. The management chapter was where I got to use what it had taught me.

The question I brought with me

I went through Wood Badge starting in 2015 and stayed with the program through 2022, staffing courses after my own training was done. The curriculum covers team development, situational leadership, conflict management, change management, and underneath all of it, servant leadership.

The most useful thing I picked up from Wood Badge wasn’t in the official curriculum. It came from other adults I taught alongside, and it was a practice rather than a framework. Every one-on-one — every Scoutmaster conference with a Scout about how their progress was going — you close with the same question:

What can I do to make your experience better?

I started using it as a Scoutmaster two or three years before I joined Cerner. By the time I had direct reports of my own, the question was instinct. I asked it at the end of every one-on-one I ever ran with a designer who worked for me. Not only when something was wrong. Every time.

It does small structural work. It inverts the default shape of a manager-and-report conversation, where the manager is the one evaluating. It asks the report to evaluate you, and it tells them — every time — that their experience is a thing you are responsible for and want feedback on. Asked once, it’s a gesture. Asked in every one-on-one for years, it becomes the channel the actually-difficult asks arrive through.

I didn’t know how much I was going to need it.

Management

I moved into design management in mid-2022. I’d managed a three-person design team at an agency years earlier — enough to know management wasn’t the same job as IC, but not enough to prepare me for twelve reports across eight locations, three continents, and a company going through a $28B acquisition.

Oracle’s acquisition of Cerner changed the philosophy of design management quickly. Managers were expected to operate as 80% IC, 20% manager. Over time, the team contracted through attrition and restructuring — people resigned, roles were restructured. I went from twelve reports to five: three in Kansas City, one in New York, one in North Carolina.

The shift also changed what design management meant. At Cerner, managing designers was the job. Under Oracle, it was something you did on the side of your “real” work.

The drought

For the first two Oracle years, during performance review cycles, there were no promotions or raises on the table. For anyone. Not a cap, not a slowdown — just not available.

I still had to run performance reviews and not have anything at the end of the conversation to offer them for exceptional work. People who had genuinely earned recognition — the kind you’d normally signal with a promotion or a raise — were getting neither, and they knew it, and I knew it, and there was no version of the conversation where we could pretend otherwise.

The closing question was what kept those conversations honest.

I couldn’t promise a promotion. I couldn’t promise a raise. I could ask what I could do to make their experience better — and most of the answers were things I could actually do. Shift a project. Push back on a meeting cadence. The things a manager can do unilaterally, I could still do.

The question also created the channel for the harder answers. Sometimes a report would use it to tell me they were hitting a wall, or that the promotion drought was doing real damage to how they thought about their career, or that they needed me to go advocate for something they couldn’t advocate for themselves. I couldn’t always fix those.

What I Protected

During that same window, I got three of my reports promoted — with pay raises.

It required building airtight justification packages and advocating through layers of new leadership who had no context on these designers’ contributions. It was the most important management work I did at Oracle, and none of it shows up in a portfolio as a deliverable.

These were also people who happened not to have been promoted in the two years leading up to the acquisition. Ordinary at the time. By the time I was pushing their cases through, those two years had become the front end of a three-to-four-year stretch with no movement. The one-on-ones told me where the pressure was. What ultimately moved the three promotions was documentation, elapsed time, and the willingness to keep pushing after the standard answer came back as “no.”

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