Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

What Characterizes the 21st Century Clinically Excellent Clinician?


The truly clinically excellent clinician of tomorrow cannot only give excellent care one-on-one to each patient they encounter. They also need to have the knowledge and skills that enable them to work collaboratively and effectively to improve the healthcare systems in which they work.

In 2013, Dr. Catherine Lucey pointed out that it is insufficient to be a personally expert sovereign physician, the type of physician we have been training for over a century. The physician of tomorrow should also be a collaboratively effective systems physician as well. Most, if not all of us, have worked in systems that hinder the accomplishment of great health outcomes for the populations of patients we care for, whether it is caring for diabetic patients, ensuring the best surgical outcomes, transitioning patients between sites of care, or something else. These systems also reduce the joy of medicine and increase burnout.


At a community or societal level, it has been made abundantly clear that the U.S. healthcare system delivers suboptimal and comparatively poor health outcomes. What Dr. Lucey is talking about has been taken up by numerous educators and healthcare leaders, who advocate for training physicians not only in basic and clinical science but also health systems science.  The latter includes healthcare delivery and process, systems design, quality improvement, clinical informatics and technology, population health, high value health care, patient safety, teamwork and collaboration, social determinants of health, leadership,and systems thinking and complexity science.


Going forward, truly excellent physicians / healthcare providers should be skilled in working with others to develop and advocate for healthcare systems, at least at the local level, that improve patient outcomes. This is a challenge for health professional education and healthcare delivery systems at all levels. It is also a challenge for each of us individually to develop the skills that help us to effectively contribute to systems improvement.


What one can do to improve health systems will vary depending on one’s expertise in the various health systems sciences and position in the health system.


Here are 3 things almost all of us can do as clinicians:



Wear a health systems hat: notice a health systems issue that, if addressed, could improve health outcomes.



Think of possible / feasible systems improvements



Collaborate with others who have interest, expertise, or position within the system to achieve better outcomes.


In so doing, we may improve our skills as a “collaboratively effective systems physician.”