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