The Champion Paradox in Healthcare: Finding Balance and Sustainability
Updated: Jul 20
A change champion in healthcare quality improvement is an influential clinician or staff member who promotes and supports new initiatives. They often act as informal leaders among peers (Punia et al, 2026). Champions help drive change by engaging colleagues, offering mentorship, overcoming resistance, and ensuring new practices fit into everyday clinical work. By connecting teams and securing necessary resources, they play a key role in turning improvement ideas into practical, sustainable outcomes.
Being designated a champion is rightly seen as an achievement and an honour. Champions tend to be among the most committed, experienced, and values-driven people in the organisation. This is exactly what makes them good at turning policy into everyday practice (Miech et al, 2018). However, carrying the champion role often comes at a cost.
The Champion's Dilemma: Effectiveness vs. Vulnerability
A recent paper in Implementation Science Communications examined how organisations sustain change over the long term. It described what its authors call a "champion paradox" (Stark and Page, 2026). While the study focused on education programmes rather than healthcare, the mechanisms it describes will feel familiar to many clinical leaders.
A service that only works because people are overextending themselves isn't a success story.
The qualities that drive champions to make things better can create a vicious cycle. The more a champion holds things together, the less visible the case for investing in systems becomes. Eventually, the champion can no longer hold it together.
Patterns of Pressure
Three patterns tend to emerge in this scenario:
The champion becomes the informal safety net for gaps in the system. They strive for change while also acting as a temporary “sticking plaster.”
Without the authority, staffing, or resources needed to bridge these systemic gaps, pressure builds on the champion. This leads to extra hours, heightened vigilance, and emotional labour, often invisible and normalised.
The gap between what good looks like and what can actually be delivered creates moral distress (Maunder et al, 2023).
A Familiar Story: The Cost of Commitment
Factors that make champions effective—such as credibility, clinical expertise, strong relationships, and personal investment—are the very ones that put them at risk of burnout (Bonawitz et al, 2020). This isn't just about one person's resilience running out; it's a familiar story. You know the one about a programme that was never given the infrastructure to run without its champions. It’s a story that demands a different ending.
The qualities that make you a champion are exactly the qualities your organisation should be protecting.
Consider a scenario many senior clinicians will recognise. A palliative care consultant champions the rollout of a new advance care planning process across their trust. It's a genuine success: earlier conversations, better-documented preferences, and families reporting they feel more supported. However, two years on, the consultant is still the only person training new staff on the process. They are still the go-to person when a conversation goes awry, quietly checking documentation because the system doesn’t prompt for it. All of this has been absorbed into an already full clinical workload. The alternative is watching standards slip. They are exhausted, disillusioned, and unable to sustain the positive impact—not because it doesn't matter to them, but because they are the infrastructure that makes it work.
Reframing the Champion's Role
None of this means champions should be removed or that the people doing this work aren't valued. It means the role needs to be redefined from a long-term carrier of the work to a transition lead. This new focus should be on distributing knowledge, training others, and embedding processes so quality doesn’t depend on any one person's presence (Miech et al., 2018).
The story about individual resilience running out demands a different ending.
If you recognise this situation in yourself or others, the answer isn't more resilience training. This is usually the first thing to be offered, but it’s not the solution. It doesn’t mean gritting your teeth or powering through another change initiative, innovation call, or service redesign. It means not only calling attention to the existence of “the bridge” (that means you, Dr Champion, or Nurse Champion, Pharmacist Champion…) but also screaming out loud that it is about to collapse under the weight of a load it was never meant to carry permanently.
If This Is You: Strategies for Sustainable Change
Here are some ways you can harness your powers as a champion for yourself and your fellow champions:
Implement a Succession Plan: Deliberately and intentionally implement a succession plan from the beginning. State clearly when your tenure will end and start thinking about what your legacy will be for the person who will follow you.
Document Expertise: Explicitly document the expertise that is accrued over the life course of the project and pass it on. This knowledge should not be implicitly held by one person.
Clarify Your Role: Document unambiguously that your role is to work with others to distribute knowledge, build capability, and embed processes that reduce reliance on any one person. Make these areas the framework for meetings and reports, and regularly check your team’s performance against these areas. If necessary, remind everyone when your tenure will end (circle back to point 1 if needed).
Acknowledge Your Worth: Remind yourself that you are enough. Champions do not have superpowers. Do not be beguiled by silver-tongued managers suggesting otherwise.
Build Resilient Systems: Be clear to yourself and anyone else who needs to hear it that the goal was never to build a system that depends on champions. It's too risky. The goal is to build systems that don’t need champions at all.
Find Connection and Reflection: Finally, find structured spaces for connection and reflection with others. At times, being a champion can be a lonely place. Nothing is better at reminding you why you answered the call to improve than being with other people. Listen to each other with an open heart and an open mind. This is where you’ll find your why.
Need More Support?
You may have read this and recognised that you’re the bridge that’s about to collapse. You might fear what could happen if it does. Perhaps you’ve already approached your organisation’s support services, or maybe you can’t drop the champion persona when it’s in-house.
I’ve been that champion. I know how it feels. I found a path through it that kept me true to my purpose and helped me regain my health and happiness. Book a free and completely confidential call with me to start you on your own path to more balance and fulfilment in doing what you do best.
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