Not Every Good Idea Should Come First

Recently, I have attended a presentation by a colleague about his specialty. It was well delivered. He explained how his service could improve patient outcomes, expand services, and even generate significant revenue for the hospital. By the end, it was easy to believe that his department deserved the next investment!

The interesting part is that I have heard the same presentation from many different specialties!

Cardiologists, neurologists, orthopedic surgeons, intensivists, radiologists, emergency physicians… every specialty has a strong case. Every department can show unmet needs, waiting lists, and opportunities to improve care. Most of them are right.

The problem is that healthcare has limited resources. We cannot build everything at once.

This is where leadership becomes difficult. The question is rarely whether a specialty is important. The real question is what the healthcare system needs first?!

Physicians naturally advocate for their own fields. There is nothing wrong with that. We see the patients in front of us and the gaps in our own services. To reduce this bias, some organizations leave these decisions to non-physician leaders. While the intention is good, another problem often appears: without a structured clinical framework, priorities may be influenced by financial returns, persuasive presentations, or the loudest voice in the room.

The answer is not to exclude physicians from these discussions. It is to agree on how decisions should be made.

Healthcare should be built in layers.

Everything starts with strong primary care. Family medicine prevents disease, manages chronic illness, and keeps patients out of the hospital whenever possible, and then the expansion can be initiated step by step.

This is not a rigid formula. A tertiary referral center will have different priorities from a regional hospital. Still, the principle remains the same: foundations come before expansion.

Revenue should be part of the conversation, but it should never drive it. A service that prevents hundreds of hospital admissions may create more value than one that performs a smaller number of highly profitable procedures.

Perhaps every proposal for a new service should answer the same questions:

• How many patients will benefit?
• Does it reduce death or disability?
• Is there already access to this service nearby?
• Do we have the workforce to sustain it?
• And what are we giving up by funding this instead of something else?

That last question is probably the most important.

Leadership is rarely about choosing between a good idea and a bad one. More often, it is choosing between several good ideas when only one can come first.

Every specialty matters. The challenge is deciding which investment creates the greatest benefit for the population today, while laying the foundation for everything that comes next.