Organisations that prioritise optics over outcomes will eventually pay the price, in avoidable harm, in staff attrition, and in lost public trust.
We say that we prize candour, transparency and patient-centred care – yet all too often our public behaviour and private realities sit at misaligned angles.
The most corrosive of these contradictions is a quiet, socially-sanctioned hypocrisy – the expectation to publicly praise organisations that may not uphold the behaviours they’re being awarded accolades for.
Picture this: a well-known large healthcare service accepts an award for “excellence” on a polished stage while, in the preceding years, more than one of their employees who raised safety concerns were quietly removed and a cluster of preventable patient deaths confidentially hushed up.
Now, the social media posts and the press release celebrating this accolade glows. The industry rushes in, falling over themselves wanting to be seen to be the first to applaud and congratulate.
Meanwhile, those who know the reality of what occurs behind the closed doors of this organisation quietly face a moral dilemma: being expected to publicly celebrate in the face of overwhelming hypocrisy.
This isn’t a rare occurrence. And it forces good leaders into uncomfortable territory. Do they:
- Applaud the award and feel complicit in the hypocrisy?
- Stay silent and risk being seen as disloyal?
- Or speak up and risk their careers?
The dissonance here isn’t merely problematic, it’s dangerous. It degrades trust with staff, with patients, and with the very systems that claim to uphold cultures of truthfulness and transparency.
Succumbing to industry pressure to applaud undeserved organisational accolades not only paints leaders as hypocrites, it perpetuates a false reality that can harm the very integrity of healthcare that we are sworn to uphold.
But why is this polite hypocrisy so prevalent and persistent in healthcare?
Because it is useful.
While awards and praise may be a facade that masks the ugly realities, the truth is that awards, rankings and glossy narratives are currency and power in the health industry. And those who are seen to be supportive of the organisation’s public narrative are protected, promoted and heralded as “being professional”.
This is why boards and executives often prioritise optics over honest self-appraisal and transparent disclosure. This is why we feel compelled to congratulate and praise even when the hypocrisy of it may be glaringly apparent.
And this is why when we add to this a culture where speaking up risks careers, a very clear pattern of expectation emerges: speak loudly about “values” and “authentic leadership” but act quietly to preserve your reputation and safeguard your livelihood at all times.
There are three main interlocking dynamics here that work to create and sustain this problem in our industry:
Reputational risk trumps learning from failure
Organisations treat bad news like a contagion to be contained rather than a signal to be investigated.
Leaders rationalise that minimising negative exposure preserves the system’s ability to function.
The unintended consequence then is a system that discourages reporting, erodes psychological safety and discourages the very introspection and excellence that awards are actually supposed to recognise.
Our incentives are misaligned with our purported values
Accreditation requirements, media coverage and political emphasis on certain performance metrics, create incentives to display only the favourable narratives.
And when success is effectively then measured by the shine of an award, the underlying work of cultural change, which is often tedious, slow, and expensive, is naturally deprioritised.
So, leaders strive to succeed in headlines, even if it comes at the risk of failing in substance.
People self-preserve
Clinicians, managers and staff very quickly learn the accepted social script: applaud publicly and look the other way, because escalating and calling out any hypocrisy is going to risk your job and your professional reputation.
Over time, this silence and partial truth-telling then become adaptive behaviours, which goes on to be defended as “professionalism” in an attempt to justify the hypocrisy.
It’s important to recognise that while these rationalisations may be human, they are certainly not ethical.
The individual and collective costs are real. Good leaders struggle, and experience moral distress. They become disillusioned and lose hope. They helplessly watch the contradictions between mission statements and practice play out with no capability to change the narrative.
If they choose silence, they risk being complicit. If they speak out, they risk ostracism or reprisal. Either way, they are forced to compromise, in order to desperately preserve their professional identities.
So how should health leaders then respond on occasions when applause is expected by the organisation and the industry, even in the face of serious shortcomings? How do we call out this hypocrisy without ending our careers?
Here are practical, principled approaches that can combine courage with craft.
Name the tension without weaponising it
Draft your public statements and applause to affirm only what the organisation does well, while acknowledging gaps.
This approach allows you to show support while preventing hypocrisy and protects the individual from being branded a saboteur.
Related
Document, escalate and make the record visible
Meticulous documentation of concerns, recommendations, and responses transforms private anxiety into visible records.
When escalation is necessary, use multiple routes: internal governance, external regulators, peak industry bodies or trusted professional networks.
Visibility and transparency is crucial because publicly looking the other way while anonymously whispering your concerns rarely changes systems and structures.
Form coalitions
Truth-telling is safer when done together.
Build alliances across clinical, nursing and operational lines and, where possible, with patient advocates.
Collective voice dilutes personal risk and strengthens the credibility of concerns.
Use data as your ally
Anecdotes are easily dismissed.
Rigorously collect data such as near-miss logs, incident trends, patient outcome metrics.
This anchors the concerns in evidence and focuses the conversation on remediation rather than accusation.
Be strategic about when and how you go public
Going public is sometimes necessary but is highly consequential.
Before doing so, exhaust internal avenues, ensure the facts are watertight, and consider the strategy: is your goal reform, whistle-blowing, or protection of patients?
Each objective requires different tactics.
Understand your boundaries and plan for them
Decide in advance what level of harm, suppression or hypocrisy you’re willing to tolerate.
That decision, made calmly and strategically, protects both your integrity and your capacity to act effectively when it matters.
This is not an invitation to recklessly complain or to exhibit unprofessional conduct. It is a call to be authentic. To be honest. And to be brave in ways that are tactical, principled and sustainable.
The moral authority of healthcare here rests on leaders who refuse to blindly follow industry expectations that risk hypocrisy, in the name of self-preservation.
Changing this social culture requires authentic leadership at every level.
Boards must demand honest reporting and create clear protections for those who raise concerns. Regulators and funders should question the metrics they reward and prioritise evidence of learning cultures over optics.
And all of us as leaders must stop defaulting to blind, meaningless praise when we know it may be masking harmful realities.
The final truth is rather blunt: applauding without accountability is not just irresponsible leadership, it’s the deliberate perpetuation of damaging propaganda.
Healthcare organisations that prioritise optics over outcomes will eventually pay the price, in avoidable harm, in staff attrition, and in lost public trust. Organisations that prize truth-telling, even when uncomfortable, will build resilience, attract principled people, and earn awards that actually mean something.
If you are a healthcare leader reading this, ask yourself this simple question: does the accolade that you’re applauding truly reflect the reality or are you just doing it to cement your position in the organisation and be seen to be “onside”?
If the answer is uncertain, the responsibility is yours to change it.
Start small, start by aligning your rhetoric with your values. Because the alternative of continued polite hypocrisy, is a cost we cannot afford and a falsehood we shouldn’t build our healthcare system on.
Now that is the kind of leadership that’s worth applauding.
Dr Sidney Chandrasiri is the CEO of the Australian Institute of Health Executives.
This article was first published by the AIHE. Read the original here.