How an Old Story with Fresh Lessons Can Guide Healthcare During Turbulent Times

We in healthcare collectively make millions of decisions every day at every level of our organizations. Some involve individual patients, while others involve administrative choices. In our busy lives as healthcare professionals, how often do we pause to deliberate before choosing a course of action? I would humbly suggest it’s not as often as we should.

We can shore up this skill and derive inspiration from a somewhat unlikely source — Sophocles’ play “Antigone,” written around 500 B.C. It provides a potent leadership lesson that is as relevant today as it was when it was written millennia ago.

As a quick refresher back to high school English days, “Antigone” is a tragic story of choices gone wrong. To begin, the brothers of the play’s namesake kill each other in a civil war. Antigone then defies the new king, Creon, by burying her brother Polynices, who is deemed a traitor and forbidden from receiving a proper burial. Her act of defiance leads to her imprisonment and eventual suicide. This, in turn, causes a chain reaction of tragedy that includes the deaths of Creon’s son, Haemon, and his wife, Eurydice. Very dark stuff.

But even amid all the carnage of “Antigone,” there are lessons to be learned in deliberation and thoughtful leadership. 

Creon’s decision is guided by duty to authority and country. He sees himself as good and regards others as evil, drawing on internal feelings of hubris, pride and revenge. 

On the other hand, Antigone is guided by duty to family and the gods. Yet neither consider motivations or perspectives beyond their own, making prudent decision-making impossible. The result: tragedy.

In contrast, we know from our own work in healthcare today that good deliberation should be communal and messy, viewing the problem from multiple dimensions or lenses. A well-thought-out decision in our world involves many perspectives — the patient, the care team, the organization, the operational impact, as well as regulatory, financial and public concerns. Good decisions require outward-facing values of humility, curiosity and compassion — or what we shouldn’t be afraid to call “love.” Sophocles, in fact, believed good deliberation involves love, a deep devotion and concern for others. Indeed, in “Antigone,” the Chorus intones, “Where is the equal of love? Where is the battle he cannot win, the power he cannot outmatch?”

Meaningful deliberation requires us to look beyond ourselves to understand others’ thoughts and feelings. And it takes leadership. To guide a truly deliberative process, effective leaders must be as complex and richly human as the situations in which they find themselves. At the same time, they must communicate the inherent complexity of healthcare in the simplest way possible. It’s a difficult tightrope to walk — to serve both the needs of the public and those of medical experts — and it takes time. But a true, deliberative decision is always worth it.

Healthcare faces many challenges today, as we know. And while disruption is a certainty, the ultimate destination is not. By using a vigorous deliberation process in our daily work — one that focuses on others and includes multiple ways of looking at issues — we’ll be on strong ground as healthcare leaders in making wise decisions. By looking at the example of “Antigone,” we can revive an old story with enduring lessons to navigate our future.

Peter J. Pronovost, MD, PhD, FCCM is the Chief Quality & Clinical Transformation Officer and the Veale Distinguished Chair in Leadership and Clinical Transformation at University Hospitals.