Managing and leading teams requires many skills that are similar to those used in the clinical setting. Communication skills are chief amongst these. Leaders need to be comfortable working with, and talking to, staff or colleagues individually or collectively, with executive decision makers – in the NHS as a whole as well as to individual patients. You might think that you are a good communicator and be baffled when others do not understand what is perfectly clear to you. It is sometimes said that a message is the reaction it evokes in the listener – but we tend to think of it as being what we say. In the gap between leader and team, funny things can happen to that message if you are not careful.