The Inevitable Resistance: Turning Innovation Critics into Your Greatest Assets
Joshua Tamayo-Sarver, MD, PhD, FACEP, FAMIA
When Reality Crashes the Imagination Party
For this latest effort, I was armed with enthusiasm and equally brave souls around me, so we built a prototype. The first reality check came swiftly: generative AI did not write a chart in my voice. Once we modified it to write in my voice, no other physicians wanted to use it — it wasn’t their voice.
What emerged after our first development sprint was not the seamless, intuitive system I had imagined but a clunky interface that resonated with only a few souls. The gap between vision and reality felt not just wide but possibly unbridgeable.
This is when something interesting happened — something I’ve since recognized as a predictable pattern in innovation.
The Voice of Doubt Takes Center Stage
“I told you this was too ambitious for our infrastructure.” “The physicians won’t adapt to another system.” “The ROI doesn’t justify the development resources.” “We should focus on more achievable optimizations.”
These voices came from colleagues, yes — but the loudest and most scathing critic was the one inside my own head. The inner voice that had once spun beautiful possibilities was now cataloging inevitable failures. This wasn’t garden-variety doubt; it was a systematic dismantling of confidence that felt like an internal sabotage operation.
Research in organizational psychology identifies this phenomenon as “innovation resistance” — a predictable response when new ideas challenge established norms. Studies show that change initiatives fail, not because of the ideas themselves, but because of resistance to implementation.
What’s particularly interesting is how quickly we internalize external criticism. The academic literature on “internal terrorists” within organizations documents how negative feedback loops can sabotage innovation from within, creating fear-based decision-making that crushes creative risk-taking. The metaphor is apt — these thoughts plant explosive devices along the path of progress.
The Anatomy of Innovation Resistance
The inner critic doesn’t just question the idea; it questions your competence, judgment, and sometimes your very identity as an innovator. “Who did you think you were? Did you really believe you could solve a problem that has stumped an entire industry?”
What makes this phase particularly treacherous is how rational it sounds. The terrorist doesn’t speak in emotional outbursts but in reasonable-sounding assessments that appear to be protecting you from further disappointment. “Let’s be realistic,” it says, as though realism and innovation have ever been compatible concepts.
During this phase with our documentation project, I found myself mentally calculating how to minimize embarrassment rather than how to overcome the technical challenges. I rehearsed conversations about “valuable learnings” and “pivoting to more achievable goals.” The project wasn’t just stalling; it was being actively dismantled by my own thoughts.
The Fork in the Innovation Road
Innovation literature shows a clear divergence at this juncture: approximately 60% of initiatives are abandoned during this phase of doubt, while the remaining 40% find ways to persevere and iterate toward viability. The difference isn’t the quality of the initial idea or even in the resources available — it’s in how teams respond to the internal and external resistance.
The solution wasn’t to abandon the dream but to recalibrate the path. The voice of the innovation terrorist must be acknowledged and addressed. “Most clinicians think this sucks,” was factually correct. But not all, so we focused on those that found it useful and built out from there. We went back to the users to see what was working and what wasn’t. As with so many tools we’ve deployed, most complaints about the interface and performance were coming from people who had never even tried the tool. We could tell — they had never logged on. So really, they were complaining about how their fantasy of our product compared to their fantasy of a solution. Pretty fantastical. But not worth much attention.
Finding Possibility in Imperfection
The system we actually deployed bore little resemblance to my original vision from 2009. It wasn’t comprehensive, seamless, or nearly as great as my fantasy. But it did dramatically reduce the documentation time for the 70% of clinicians who chose to use it.
This is where many innovation narratives end — with a compromised but functional solution that delivers modest value. But the reality of innovation is that this is just the midpoint of the journey, not its conclusion.
Taking Arrows from All Directions
With our modest success came a new wave of challenges. As usage expanded, we discovered bugs in edge cases. New feature requests multiplied. And as always, success itself generated resistance: “If this works so well, why isn’t it doing more? Why doesn’t it handle medication reconciliation too? Why is the interface so basic?”
The pioneers of any innovation take arrows from two directions: from reality, which always reveals unforeseen complexities, and from expectations, which inevitably outpace what’s currently possible. The same people who questioned whether something could be done at all quickly shift to questioning why it isn’t doing more.
Research on disruptive innovation shows this “expectation inflation” is a consistent pattern across industries. Clayton Christensen’s studies demonstrated how quickly users adapt to innovations and then develop increasing expectations that outpace development capabilities.
During this phase, our team found itself in daily firefighting mode — fixing bugs while simultaneously fielding enhancement requests that would have essentially required rebuilding the system from scratch. The stress was significant, but contained within it was a validation we hadn’t anticipated: users were engaging enough to care about improvements.
Embracing Productive Dissatisfaction
Rather than viewing this feedback as failure, this is evidence of engagement and future development opportunities. Albeit generally articulated in loud voices that may include some four-lettered words.
The literature on innovation diffusion identifies this approach as “managed expectations” — creating frameworks that acknowledge current limitations while establishing clear pathways for evolution.
The Magic That Emerges From Persistence
Eight months after we first launched at one brave site, we have robust data showing that clinicians who use the tool are more productive, have better operational metrics, better patient satisfaction, and save several hours a day on documentation. This wasn’t the revolutionary transformation I had initially imagined, but it was something that hadn’t existed before — tangible time returned to clinical care.
The system evolved not according to my original vision but through a collaborative improvement process that produced something more resilient and user-centered than I could have designed alone. This is the counterintuitive magic of innovation: the final product is almost never what was initially envisioned, yet often solves problems in ways the original concept couldn’t have anticipated.
The Unexpected Benefits of Resistance
Looking back, I can now see that the resistance — both internal and external — shaped the solution in essential ways. The critics forced us to focus on core value rather than comprehensive features. Technical limitations pushed us toward simplicity. User demands guided prioritization in ways market research never could have.
Had we proceeded with my original comprehensive vision, we likely would have created an elegant solution to the wrong problem, or a complex system that addressed theoretical rather than actual pain points.
Transforming the Innovation Journey
Innovation isn’t a linear path from brilliant idea to perfect implementation. It’s a messy, iterative process of dreaming, building, doubting, persisting, and eventually discovering that you’ve created something of value — though rarely the exact value you initially imagined.
The research on healthcare innovation shows that successful innovators develop specific psychological tools to navigate this tension. For me, I continue to work 6 shifts in the emergency department each month. Witnessing the resolute physicians, nurses, techs, and staff that show up everyday to do their best to care for a fellow human in need regardless of the barriers and obstacles, is humbling and inspiring. If they can keep showing up to work against those odds day in and day out, I think I can withstand a critic or two.
Embracing the Full Cycle of Creation
If you’re currently in the dreamer phase, cherish the uninhibited creativity but prepare for the inevitability of implementation challenges.
If you’re in the creator phase, watching your beautiful vision collide with complicated reality, remember that this disappointment is not just normal but necessary. Perfect execution of flawed concepts leads nowhere good in healthcare.
If you’re hearing the terrorist’s voice — questioning your judgment, competence, and the value of continuing — recognize this as a signal that you’re doing something meaningful. Insignificant changes don’t activate resistance. Listen to its concerns, use them to refine your approach, then politely tell it to get out of your way.
If you’re taking arrows as a pioneer, wear them as evidence that you’re breaking new ground. The absence of resistance typically signals the absence of meaningful change.
And if you’ve reached the magician phase, creating something that genuinely improves healthcare in ways large or small, remember that your most important role isn’t celebrating success but mentoring others through their own cycles of innovation — especially when they’re facing their own terrorists..
Dr. Joshua Tamayo-Sarver, MD, PhD, FACEP, FAMIA, develops and deploys technology solutions in the healthcare ecosystem as a clinician, business leader, software engineer, statistician, and social justice researcher. As the Vice President of Innovation at Inflect Health and Vituity, his unique formula of skills has helped develop over 35 solutions and scale multiple new healthcare products, including the first AI occult sepsis tool with FDA breakthrough designation. Dr. Tamayo-Sarver oversees corporate venture, internal incubation, and advisory services for AI-driven healthcare solutions, blending consumerism and clinical quality to fit the delicate balance of patient desire, user experience and quality medical care. A Harvard graduate, he holds degrees in biochemistry, epidemiology, and biostatistics, as well as a medical degree from Case Western Reserve University. He is a Mentor in the Emergence Program at Stanford University.
