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It is Time for Clinicians to Engage: Let’s Criticize Less and Dare Greatly More

John Haughom MD whiteWhen I write or speak about healthcare transformation, I am often asked why I do not criticize more. Criticize health system leadership. Criticize governmental policies. Criticize burdensome regulations. It’s a long list. Why avoid criticism? The answer is simple. Discerning emerging solutions is much more productive and fun.

We are living during a very interesting period in the history of health care. No doubt, it is a time of great transition. We are passing from one time to another. Transition periods are important, yet they are hard to define because it’s difficult to determine exactly when they start and when they end. To understand the transition healthcare is now experiencing, we must do our best to understand what is on either side of it.

The traditional approach to delivering care has served us well and accomplished great things over the past century. Yet, it is also being overwhelmed by complexity and producing inconsistent quality, unacceptable levels of harm, too much waste and spiraling costs.

The traditional method of delivering care is struggling and another is emerging to take its place. Because the traditional approach has served us well and accomplished great things, we want to believe that the present state will continue forever. Because conditions have changed, this will not happen. We are in need of a new approach. An approach that carries the best of the past forward, yet also addresses present day challenges. It just might be that on the other side of this current transition is potentially a time unmatched by any other in the history of healthcare. Thanks to visionary clinical leaders at institutions across the country, there is growing evidence this is not only possible; it is likely.

Who does the future belong to? If we look closely at other transition periods in history, two groups of people are apparent. The first are what we recognize as critics. They are people whose response to the need for change is criticism. Critics always exist, but in a time of transition they tend to multiply. What do they criticize? They criticize the new, they criticize the change, they criticize the change for being unnecessary or too fast, or they criticize the change for being too slow. They criticize anything and everything. Critics are abundant. The question we should consider is, “Will criticism solve problems?” Typically, it does not.  While constructive criticism has its place, it alone is not likely to accomplish much especially when the world is yearning for innovative solutions.

The second group of people that major transitions yield is leaders. They are men and women of vision, courage, persistence, integrity, creativity and enthusiasm. They see transitions as periods of opportunity. They have the ability to ignore the turmoil, confusion and difficulties that characterize transitions, and remain focused on the task at hand. They look into the future and imagine new possibilities.  Yet, they spend the majority of their time in the present working tirelessly to bring a new vision to reality.

They eagerly share their vision and enlist the support of others in pursuit of the vision. They tend to be excellent communicators both in word and action, and their presence alone energizes and inspires people. No matter what the odds, doubts, and criticisms, they carry on, and eventually, they are recognized as heroes. Is there evidence of this happening now? Yes, there are many. Let’s examine just two.

With the help of good data and modern quality improvement methods, clinicians at North Memorial Health Care reduced elective inductions by 75% within just six months. In the process, they improved the quality of care, reduced harm and received a six-figure payer partner bonus. Using advanced analytics, team-based processes and evidence-based best practice, clinicians at Texas Children’s reduced appendectomy postoperative length of stay by 36 percent, dropped average variable direct costs by 19 percent, increased evidence-based order set adoption by 36% and increased the percentage of patients receiving recommended antibiotic as first antibiotic by 53 percent. There are hundreds, perhaps thousands, of other examples.

The future belongs to people such as these. They are leaders. One rarely hears them criticizing anything or anyone, because they are too busy getting the job done, deigning a new and better way of delivering care. In the process, they are defining what is on the other side of the transition.

The future will be what we make of it. Leadership is not a special class. It is a role each of us can assume. It is a position of influence. No doubt, some people are able to exert more influence than others, but all of us can have an impact, especially collectively. The voice of clinicians can be profound, particularly if our sincere goal is improving care for patients.  People will hear what we say. They will listen and be affected. Many are eager for clinicians to act in this fashion. They need us to be confident, optimistic and visionary. Let’s not disappoint.

We should not fear the proclamations of critics. In the face of criticism, I like to carefully reflect on a quote from a 1910 speech by Theodore Roosevelt.

 

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”

 

It is time for leadership in health care. Let’s criticize less and dare greatly more.

 

John Haughom, MD, former senior vice president of clinical quality, safety and IT for PeaceHealth, is a senior advisor to Health Catalyst and the author of Healthcare: A Better Way. The New Era of Op

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asad42John HaughompcbJake Ralstonallan Recent comment authors
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asad42
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asad42

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John Haughom
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John Haughom

The simple statement that we ought to “criticize less” (NOT criticize ever or criticize never) – just criticize less and constructively build more certainly generated a lot of interest and comment!!!

Don Levit
Guest

Saurabh and Allan:
I was directed to this blog, but Saurabh’s comments were not posted.
Allan, if you received them, if Saurabh is close to being accurate in his comments, I would leave it as it is.
Saurabh:
I hope you can hold 2 contrasting ideas in your head at the same time: how the world is, and how it should be.
As far as the extremists on the left and right, if one goes too far right, he sees the same idiots coming around from the left.
Don Levit

John Haughom, MD
Guest
John Haughom, MD

Don… Thank for you thoughtful and refreshing comment.

Saurabh Jha
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Saurabh Jha

Don,

I’m just observing! That’s all.

Perry
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Perry

Yes pcb, and contrast that with this:
http://www.medscape.com/viewarticle/830845

Granpappy Yokum
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Granpappy Yokum

Our thought leaders have brought us the PCMH, pay-for-performance, and assumption of risk by physicians. The recent Health Affairs article shows that none of these correlate with a low rate of preventable hospital admissions: that desirable goal is seen only with physician-owned small primary care practices, which our thought leaders are trying to destroy.

Is it any wonder that we “criticize the new, criticize the change, criticize the change as unnecessary or too fast . . . ?”

pcb
Guest
pcb

http://onhealthtech.blogspot.com/2014/08/the-study-youll-never-hear-about.html

Maybe we can keep talking about this and force those holding the purse strings to talk about this study?

Perry
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Perry

“The ACA represents insurance coverage reform. It does little to substantively improve the process of care for the patients we serve.”

Well, that is for sure. Why can’t we leave the poor government out of all this?

Jake Ralston
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Jake Ralston

I’ve never heard so much criticism of criticism in my life.

Mert Kramer
Guest

In this day and age we can no longer be content to criticizes, but DARE to DISRUPT. The economic environment is changing quickly and no business including the healthcare industry will need to change also

allan
Guest
allan

“It is Time for Clinicians to Engage: Let’s Criticize Less and Dare Greatly More”

I’ve learned a lot in life and one of the things I learned is when people want others to withhold criticism they generally have something to hide or they are trying to sell something.

Talos
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Talos

In the movie Ratatouille, Anton Ego, the food critic, states the following about critics: “In many ways, the work of a critic is easy. We risk very little, yet enjoy a position over those who offer up their work and their selves to our judgment. We thrive on negative criticism, which is fun to write and to read. But the bitter truth we critics must face, is that in the grand scheme of things, the average piece of junk is probably more meaningful than our criticism designating it so. But there are times when a critic truly risks something, and… Read more »

docanon
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docanon

Rather than grapple with the fundamental issues underlying the criticism that bothers him, Dr. Haughom criticizes the act of criticism itself.

I think the word we’re searching for is “irony.”

I’ll also throw in “straw man” since I don’t think anybody believes criticism alone solves problems. But it does identify problems, which is the first step in solving them. Dismissing or belittling criticism will lead inevitably to festering problems, not solutions. Witness the VA’s recent crisis. Remind me, how did the VA deal with its internal critics again?

MerrileeFullertonMD
Guest

“Remind me, how did the VA deal with its internal critics again?”
You hit the nail on the head. Thanks.

Granpappy Yokum
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Granpappy Yokum

“The growth in clinical leadership roles has skyrocketed in recent years (e.g., CMOs, CMIOs, CNOs, etc.). The demand greatly exceeds the supply for these positions”

And most of us in the trenches would refer to this as ever-increasing administrative bloat, taking time, money, and human resources away from true patient care.

Perry
Guest
Perry

Too many Chiefs, as the old saying goes.

Granpappy Yokum
Guest
Granpappy Yokum

That anyone can think that the growth of CNOs is a good thing totally beyond comprehension.

LeoHolmMD
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LeoHolmMD

No kidding! There is no doctor shortage, just a shortage of doctors who actually want to see patients. There is a whole ocean of committees, consultants, board members, observers, cheerleaders, desk surfers, quality talkers and general morons. Get a job for cripes sake! These parasites are going to run out of places to attach to the host.

Granpappy Yokum
Guest
Granpappy Yokum

Bend over, grab your ankles, and DON’T COMPLAIN!

Prestor Saillant
Guest

Regarding the post above, I should have said “proportional relationship” relating cost and quality.

Prestor Saillant
Guest

Love the dialog! Some appear to think the current health care system is the “evil empire” that will either implode or be beheaded by the people. Others like the post author are arguing that we should look on the bright side because there has been progress over the last 100 years when compared to the previous 6000, and that we are moving into an era of potentially huge changes as incentives of providers and payers moves into closer alignment. Either way, there is an exciting road ahead for the future of health care, but I think the path of continuous… Read more »

Karen Sibert MD
Guest

Savings in length of stay, when examined critically, are turning out to correspond to increases in the cost of post-acute care. Often, these so-called improvements are simply pushing the balloon in and then watching it bulge out in another spot. As a clinician working 100% of the time in the trenches, my suspicion and distrust of “thought leaders” grows by the day. They’ve supplied me with disposable laryngoscopes that are so bad I can’t intubate with them, and have had to go back to carrying my own with me. They’ve decreed that sutures and other necessary OR supplies have to… Read more »

MerrileeFullertonMD
Guest

Very well said.
Health care is like a balloon. Squeeze one area and another bulges…but if you aren’t looking or cannot measure all areas simultaneously you will miss the “equal and opposite effect”.

John Haughom, MD
Guest
John Haughom, MD

You are making a good point, Merrilee. In the first Appendix of my recently published book, I talk about the role of complexity theory in healthcare and how healthcare is very much a complex adaptive system. As a result, you need to be careful when you try to fix one problem, you do not cause a worse one. As a complex adaptive system, healthcare requires an entirely different style of leadership. Much more sophistication and much, much better control of data to be sure you know what you are doing and the consequences of your actions. There is a lot… Read more »