Leadership Under Load: Why Your Best People (Including You) Can’t Sustain What They Start
The laptop is open. The Notion board is loaded. Fourteen medical bills sit in a column labeled “To Process.” Some have been there for months.
I know what needs doing. Upload the bills. Assign them to the right person. Dispute the mistake. File the receipts. It should take twenty, maybe thirty minutes. I’ve handled strategy for Fortune 500s. I’ve rebuilt surgical protocols under pressure. This isn’t hard.
I close the laptop. Walk to the kitchen. Open the fridge, stare, close it. Check my phone. Sit down again. Open the laptop. Look at the board. Close it.
This has been going on for years.
It’s not just medical bills. It’s every bill. Taxes. Insurance claims. Anything that means logging in, fighting a bad portal, grinding through work that gives nothing back. The late fees add up. The number would change how people see me.
I know exactly why.
Adults with ADHD have real differences in how their prefrontal cortex works. Low-stimulation tasks aren’t just boring. They’re distressing [1]. Dopamine and norepinephrine run low when the task offers no novelty, no challenge, no feedback [2]. So the brain avoids. The relief of putting it off feels better than the dull ache of doing it. The consequences compound. Researchers call this the “ADHD Tax.” Adults with ADHD are four times more likely to have arrears in things like utility bills and road taxes [2].
That fits.
But this isn’t an ADHD newsletter. Under chronic load, bad sleep, or lasting stress, every brain starts doing this [3]. The prefrontal cortex degrades for everyone. Executive function isn’t a personality trait. It’s a resource that wears down under pressure. Leadership is one of the fastest ways to wear it down.
How do you keep yourself and your team doing the work that needs to be done? Especially when it’s boring, thankless, or just hard?
That’s a Capacity question. Not how you work on a good day, but how you show up when things get heavy.
The Gap That Nobody Talks About
You’ve seen this in every company you’ve worked in.
The VP who nails investor pitches but hasn’t finished a performance review in months. The task gives her nothing. It sits on her list, quietly accusing, while she builds another deck.
The product lead who ships features fast but avoids the team dynamic that’s falling apart. Hard conversations get the same treatment as my insurance portal.
The parent-executive who starts every morning in triage mode. By the first meeting, their brain is already spent on logistics, emotions, and a six-year-old who refuses shoes.
The standard answer? Be more disciplined. Build better habits. Stay motivated. I hear this from leadership coaches who charge by the hour, from LinkedIn thought leaders who post about things they have never experienced firsthand, and from an industry that sells “morning routine” programs to people who haven’t slept properly since 2019.
All three are real tools. But they serve different jobs at different stages, and using the wrong one at the wrong time is why most behavior change fails [4][5].
Willpower doesn’t last.
The “Strength Model” of self-control says willpower is a finite resource, like a muscle that tires. It was tested across 23 labs and 2,141 people. The effect was zero [6][7]. What actually happens when you feel “depleted” is simpler: your brain shifts effort away from unrewarding tasks toward rewarding ones. Not depletion. Reallocation.
Every coach who says to just push through is using a model that failed in real testing.
Leadership makes it worse. Job Demands-Resources theory shows that managing people, conflict, coaching, emotional labor, and decision volume increases the cognitive burden beyond the task itself [8][9].
You’re carrying your whole team. Then someone asks about your expenses. Good luck pushing through that.
The Week It All Fell Apart
Last year, before the sabbatical, I got pulled to a client meeting in Tokyo on short notice. Red-eye from Europe, eight-hour time difference, a full day of sessions on arrival.
Back home, I had a calendar block that had been working for weeks. Wednesday mornings at 8am: family admin. Bills, school forms, insurance follow-ups. My wife and I had agreed on it. The block was protected. The cue was simple: Wednesday, coffee, laptop, admin folder. Done by 9am, move on.
In the Tokyo hotel room, Wednesday morning didn’t exist. I woke up disoriented, eight hours ahead, already behind on client prep. The calendar block was still there, blinking on my phone. I swiped it away and started answering emails.
Three days later, I landed back home to a wife who was not happy. While I was in Tokyo, being diligent about client work and negligent about everything else, a school deadline had passed. She’d caught it, handled it herself, absorbed the stress of fixing it on a tight turnaround. The look she gave me when I walked through the door said more than any feedback conversation I’ve ever had at work.
The system worked for weeks. One trip and it broke.
The research predicts this. Habits depend on context [11][12]. Same cue, same place, same sequence. Change the context, and the behavior goes from automatic to deliberate. Even a three-hour time-zone shift, or an unexpected overnight, can be enough to break the chain and force your brain to make every step a decision again. Now it competes against everything else demanding your attention.
It loses. Every time.
What Actually Sustains Performance
Three tools. One order. Get it wrong and everything breaks.
Motivation is a catalyst. Behavior connected to your values predicts engagement [13]. Behavior driven by guilt or pressure predicts burnout [14]. There’s a formula: motivation equals value times expectancy. You can value family admin enormously. If the experience of doing it is miserable, motivation collapses. That’s math, not weakness [14].
Discipline is a bridge, not a lifestyle. It’s about controlling your attention: set up the right environment, cut friction, reframe the work [7]. The leader who logs out of Slack for deep work isn’t slacking. They’re using the only kind of self-control that works. If you still need willpower after two weeks, the problem isn’t you. It’s the system [4][5].
Habits are the goal, but they take longer than anyone says. You want behavior that runs on autopilot. Cue, action, done [11][15]. Everything else is just a bridge. The timelines in self-help books are fiction. Real research says the median is 59 to 66 days, sometimes up to 335 [11][16]. Most people quit around day 40, right before it sticks. The 21-day habit is marketing, not reality.
The order is simple: motivation picks, intentions translate, habits automate, discipline catches the exceptions. Most people try to get motivated, then stay disciplined forever. The data says that doesn’t work [4][5].
Leading Others Through the Same Science
If this applies to you, it applies to every person who reports to you.
If you assign tasks with pressure and surveillance, you get burnout [14]. Give people autonomy and a sense of competence, and it flips [13]. Cut meetings that go nowhere. Stop always-on communication hiding behind the word culture. Protect recovery time. Demands drain people. Resources fuel them. If your team looks burned out, check the system before you question their commitment.
Incentives work for boring, measurable tasks. For creative work, they backfire by killing the motivation people already had [17][18]. Don’t gamify your team’s thinking. No one ever had a breakthrough because of a leaderboard.
Team-level habits follow the same logic. “After Monday standup, each person writes their top three priorities.” “After every 1-on-1, the manager sends a three-line recognition note.” The leader models the system, not the grind.
Two Operating Modes
The Stable Week is your Build Mode: this is where you focus on building habits. The context stays the same. Line up your work with your body clock [19]: do the hard stuff in the first eight hours after waking, lighter work later, and protect your evenings for recovery. Morning routines live here. Shutdown rituals live here.
The Variable Week is your Protect Mode: this is about protecting habits when routines get disrupted. Travel, kid chaos, deadlines. Time-based cues break. Use event-based cues instead: After I put my suitcase down. After I brush my teeth. After my last meeting. These survive chaos [11][12]. Drop to the minimum version. Two minutes of movement counts. A few admin tasks count. The goal isn’t performance. It’s keeping the habit alive, so one missed day doesn’t turn into a collapse.
Ask yourself: which mode is my team in right now? Are we using the right tools for it?
Try This Today
Temptation Bundling for Dread Work. Pick something you enjoy (a podcast, audiobook, or good coffee) and save it for the tasks you hate most. This raises follow-through by 10-14% [21]. I have a podcast I only get while doing admin. The bills still annoy me. The podcast makes them bearable.
Two-Layer If-Then Planning. Layer 1: Wednesday at 8am after coffee, family admin. Layer 2: If my morning gets hijacked, ten minutes after my last meeting. 94 studies confirm this works [4]. Pre-loading the decision removes the willpower cost. For travel: When the plane lands, hotel gym before email. For meetings: When the call ends, stand and walk for five minutes.
Never Miss Twice. Expect failure. When a habit breaks, call it a data point, not a character flaw. Do a two-minute minimum version the next day. Anchor it to an event, not a clock. After I put my suitcase down, beats at 6pm. One missed day is noise. Two missed days is when the brain starts telling you a story about who you are [20]. Don’t let it.
The Weekly Review. Same day each week. Fifteen minutes. Two questions: What broke the cue? What friction can I remove? I do mine on Sunday evenings while the kids argue about what to watch. Might as well make the noise useful.
Back to the Board
Here’s something I’ve never said publicly. I’ve had an executive assistant at work for well over a decade. They kept me on track and flagged what I was avoiding. At work, the system ran. My personal life had no such safety net. The bills piled up. The school forms got missed. My wife picked up what I dropped, and she kept score. Rightfully so.
This week, I hired a personal assistant for the first time. Starts Monday. If you’ve been waiting for an email from me, there’s hope.
The Kanban board is still there. Fourteen bills down to nine. The late fees haven’t stopped yet, though.
The version of you that’s unstoppable when focused doesn’t need systems. They just need something they care about. But the other version, the one staring at the admin board, fresh off a red-eye, whose morning blew up before 7am because a barefoot six-year-old is running the house, needs structure.
Build it. For yourself. For your team. Not because discipline failed you, but because you stopped pretending it was enough.
Stay healthy.
Andre
References
[1] Barkley, R. A. (2012). Executive functions: What they are, how they work, and why they evolved. Guilford Press.
[2] Mowlem, F. D., Rosenqvist, M. A., Martin, J., Lichtenstein, P., Asherson, P., & Larsson, H. (2019). Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. European Child & Adolescent Psychiatry, 28(4), 481-489. See also: CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder). (2023). Understanding executive function deficits. Retrieved from https://chadd.org
[3] Lowe, C. J., Safati, A., & Hall, P. A. (2017). The neurocognitive consequences of sleep restriction: A meta-analytic review. Neuroscience & Biobehavioral Reviews, 80, 586-604.
[4] Gollwitzer, P. M., & Sheeran, P. (2006). Implementation intentions and goal achievement: A meta-analysis of effects and processes. Advances in Experimental Social Psychology, 38, 69-119.
[5] Gardner, B. (2014). A review and analysis of the use of “habit” in understanding, predicting, and influencing health-related behaviour. Health Psychology Review, 9(3), 277-295.
[6] Hagger, M. S., Chatzisarantis, N. L. D., Alberts, H., Anggono, C. O., Batailler, C., Birt, A. R., … & Zwienenberg, M. (2016). A multilab preregistered replication of the ego-depletion effect. Perspectives on Psychological Science, 11(4), 546-573.
[7] Dang, J. (2018). An updated meta-analysis of the ego depletion effect. Psychological Research, 82(4), 645-651.
[8] Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The job demands-resources model of burnout. Journal of Applied Psychology, 86(3), 499-512.
[9] Tummers, L. G., & Bakker, A. B. (2021). Leadership and job demands-resources theory: A systematic review. Frontiers in Psychology, 12, 722080.
[10] Bakker, A. B., & Demerouti, E. (2023). Job demands-resources theory: Taking stock and looking forward. In P. L. Perrewé, D. C. Ganster, & C. Rosen (Eds.), Research in Occupational Stress and Well-Being. Emerald Publishing.
[11] Lally, P., van Jaarsveld, C. H. M., Potts, H. W. W., & Wardle, J. (2010). How are habits formed: Modelling habit formation in the real world. European Journal of Social Psychology, 40(6), 998-1009.
[12] Gardner, B. (2012). Habit as automaticity, not frequency. European Health Psychologist, 14(2), 32-36.
[13] Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68-78.
[14] Gagné, M., Parker, S. K., Griffin, M. A., Kashyap, V., Tyber, M., Nuber, C., & Holterman, L. A. (2022). Understanding and shaping the future of work with self-determination theory. Nature Reviews Psychology, 1, 378-392.
[15] Wood, W., & Neal, D. T. (2016). Healthy through habit: Interventions for initiating and maintaining health behavior change. Behavioral Science & Policy, 2(1), 71-83.
[16] Singh, B., Olds, T., Curtis, R., Virgara, R., Szeto, K., Maddison, R., … & Maher, C. (2024). Habit formation in health-related behaviours: A systematic review and meta-analysis. Healthcare, 12(3), 283.
[17] Deci, E. L., Koestner, R., & Ryan, R. M. (1999). A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychological Bulletin, 125(6), 627-668.
[18] Cerasoli, C. P., Nicklin, J. M., & Ford, M. T. (2014). Intrinsic motivation and extrinsic incentives jointly predict performance: A 40-year meta-analysis. Psychological Bulletin, 140(4), 980-1008.
[19] Huberman, A. (2021). The science of making and breaking habits. Huberman Lab Podcast, Episode 53. Stanford University.
[20] Marlatt, G. A., & George, W. H. (1984). Relapse prevention: Introduction and overview of the model. British Journal of Addiction, 79(3), 261-273.
[21] Milkman, K. L., Minson, J. A., & Volpp, K. G. M. (2014). Holding the Hunger Games hostage at the gym: An evaluation of temptation bundling. Management Science, 60(2), 283-299.
A note for new readers:
I’m a trained reconstructive facial surgeon, medical doctor, and dentist. Before launching this newsletter, I had a varied career: competitive freestyle wrestler, management consultant (McKinsey), entrepreneur (Zocdoc, Thermondo, and docdre ventures), and corporate executive (Sandoz). Today, I’m a Managing Director and Partner at BCG.
Husband of one. Father of three. Split between Berlin’s urban pulse and our Baltic Sea retreat. I’d rather be moving than sitting. Not just hobbies. Research. My body is my primary laboratory; I’ve been conducting experiments for decades.
If this is your first time here, welcome. I’m excited to share what I’ve learned and will continue to learn with you.
DISCLAIMER:
Let’s get one thing straight: None of this, whether text, graphics, images, or anything else, is medical or health advice. This newsletter is here to inform, educate, and (hopefully) entertain you, not to diagnose or treat you.
Yes, I’m a trained medical doctor and dentist. No, I’m not your doctor. The content here isn’t a replacement for professional medical advice, diagnosis, or treatment.
If you have questions about your health, talk to your physician or a qualified health professional. Don’t ignore their advice or delay getting care because of something you read in The Upward ARC. Be smart. Do your research. And, as always, take care of yourself.