Health care leadership is not for the faint of heart. In a landscape of competing priorities and limited resources, leaders strive to navigate complex systems while driving meaningful improvements. Every decision they make impacts patient care, their colleagues, and the future of the health care system. Yet, too often, leaders at all levels of our profession encounter a troubling feedback culture that can be harsh and unsupportive, exacerbating moral distress and undermining trust. To create sustainable improvements in health care, we must cultivate a culture of constructive feedback.

Moral distress is a reality for many of us. It arises when we recognize the right course of action but are hindered by systemic barriers. This distress is compounded by external factors, such as financial constraints, staffing shortages, and bureaucratic roadblocks, as well as internal pressures from colleagues who are experiencing their own moral distress. Each physician operates within their own sphere of difficulty, and when these pressures collide, trust can erode, and leadership becomes an isolating endeavor. A culture of respectful, kind, and constructive feedback, acknowledging that physicians lead with good intentions, can pave the way for system improvements without causing isolation and burnout.

While patient well-being is a core mission in health care, we cannot overlook the health and safety of those providing patient care. Workplace violence in emergency departments, exhaustion from long shifts, and the mental toll of navigating life-or-death decisions are just a few of the challenges physicians face. Leaders, too, experience feeling unsafe—not necessarily in a physical sense, but in the form of moral distress.

I submit that all leaders strive for transparency, accountability, and communication but often fall short of meeting the needs of all interest holders. The moral distress a leader feels when unsupported or unheard can result in withdrawal, hesitation in making bold decisions, or difficulty advocating effectively. If we are to foster trust, collaboration, and well-being in health care, psychological and physical safety must be at the forefront—for everyone.

Transforming health care requires courageous leadership, but to be courageous, we also need compassion. It is possible to challenge inefficiencies and shortcomings while also recognizing the dedication of those working to improve the system. Many leaders already bear the weight of moral distress, often in silence, as they strive to balance competing priorities. By fostering a feedback culture rooted in kindness, we create an environment where leaders are supported rather than broken down, where trust is reinforced rather than diminished, and where systemic improvements emerge through collaboration rather than division.

We must champion psychological and physical safety at all levels of health care—from frontline providers to senior leadership. A system that values constructive feedback, genuine support, and tangible efforts to enhance safety will thrive now and in the future.

For meaningful progress, we must be tough on the problems but gentle on the people who are working tirelessly to solve them. Only then can we build a health care system that is effective, compassionate, and sustainable—for patients, providers, and the leaders striving to make a difference.
—Charlene Lui, MD
Doctors of BC President

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