You must choose whether you want to be a critic or a playwright. This choice seems like a trap. My suggestion that you have to be one or the other is a bit artificial, of course; but, at the end of the day, playwrights have to put words on paper and be ready to live with the criticisms of the critics. In life in general and healthcare in particular, there are no perfect solutions that make everyone happy. The "playwrights" have to propose strategies that as many stakeholders as possible can live with. The critics have to point out all the problems with them.

I want to emphasize that I am not using "critic" pejoratively. You need both critics and playwrights, and you can't have great playwrights without great critics to keep them honest. I think the "playwrights" (often leaders who are also managers in healthcare) should accept that critics are playing an important role and not take their criticisms personally. In the same vein, critics should understand that choices among unattractive options have to be made, and at some point criticism can blur into sabotage.

I encourage younger colleagues to consider carefully whether they really want to be a playwright. Is conflict with colleagues unbearable to them? Are they willing to work on unpleasant topics such as efficiency? Can they take criticism that they are not being visionary enough? Jim Mongan has often said to me, "You are not being a leader if you are not in front of your troops, but you are not being a leader if you are too far in front." The implication is that if no one is following you, you are not really leading.

My bottom line is that we need both. We need critics who are willing to be too far in front and who have the courage to point out that we are tolerating what is actually intolerable, or trying to sustain the unsustainable. And we need playwrights who are willing to take on responsibility for making everything work.

There have been times in my career when I have written idealistic pieces that my academic colleagues called inspiring but that caused me to be viewed as sanctimonious when I went back to my "day job." Both adjectives were deserved. When I recognize the choice today, I opt for being the quiet playwright rather than the visionary critic. But I am glad (and a little jealous) when others choose differently. More.

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