When I chose to pursue medicine, I was never concerned about the potential for Breakdown of Community being a challenge later in my career. One of the big draws of practicing medicine back in the “good old days” was the opportunity to join a group of colleagues who could I could count on to collaborate with me in caring for patients. That was a given.
Those old days of collegiality have changed. Collegiality is not gone, but it’s much harder to experience, particularly across the broader group of physicians in a large group or on a large medical staff. Physicians are indeed experiencing a breakdown of community.
- Doctors’ lounges in many hospitals are ghost towns compared to how they used to be.
- Radiologists, who used to see most attending physicians every day as they came by the “reading room” to review films, now toil away at a screen with only occasional in person interactions with attendings.
- Hospitalists spend a lot of time in a room together, but sit side-by-side focused on the computer in front of them entering notes and orders, not interacting with each other.
- Consultations are ordered through a smart set in the chart, rather than a phone call to the specialist.
- Staff meetings are less well attended, particularly the evening meetings in which the social hour is often more valuable than the meeting itself.
- And we interact less with our extended colleagues in patient care – nurses, technicians, and other support staff – required to perform Computerized Physician Order Entry (CPOE) which takes us away from talking with the rest of the care team.
Breakdown of Community Drives Burnout and Creates Risk
Why does this matter? Because Breakdown of Community is the fourth driver of burnout as described by Maslach and Leiter in their classic book, The Truth About Burnout. This impacts the personal relationships and teamwork that are so important in delivering quality patient care and ensuring patient safety.
With Breakdown of Community, things are more miserable. The deep personal relationships with colleagues are key to managing oneself through the stressful times of a tough case, a too-busy shift, or a patient in crisis, particularly when we can’t save that patient. And, when we work together consistently, our work is easier, because we intuitively know what to expect of each other.
When community is weakened, conflict is more common, particularly in the VUCA (Volatility, Uncertainty, Complexity, and Ambiguity) environments that have engulfed healthcare. (We also see these situations in many other aspects of our society as well.) Conflict among people who should be colleagues is time consuming, expensive, and dangerous.
Breakdown of Community creates a risk we cannot afford in healthcare today. Patient safety requires teamwork. Clinician resilience and mental health require collegiality. Our institutions live on thin financial margins that can’t afford to waste time and/or money on dysfunctional interpersonal relationships.
The Leader’s Role in Restoring Community
And yet, we don’t pay much attention to this important driver of burnout. In many hospitals we manage by implementing “best practices” and expecting people to “do their job” in following that practice. When things go wrong, we review the incident to see where someone strayed from the best practice, and “hold them accountable.” This is considered the responsible approach of doing the “hard work” of management. When community breaks down, we don’t operate from baseline assumption of empathy and Respect for People, but instead look for what the individual did wrong.
Nothing could be further from the truth, or more damaging to the clinicians involved. Healthcare is complex and fraught with risk. Our job, whether administrator or clinician, is to collaborate to design patient care practices in ways that ensure clinicians can do the right thing reliably. When things go wrong, we must first collectively ask, “What is it about the way we have designed the job that makes it hard for a person to do the right thing?”
Rebuilding community is everyone’s responsibility. It must start from the top – from the leaders of the organization demonstrating their commitment to creating a culture of respect and collaboration. This is hard to measure and may seem to “touchy-feely”, but in reality this truly is the “hard work” of management.
There is a straightforward approach that works. It’s called Lean. A Lean management system and culture is based on the principle of Respect for People, focuses on a drive to solve problems and improve the way the work is designed, and uses huddles and improvement teams that by their nature build interpersonal relationships and community. It’s not easy to transform an organization’s management culture and processes on Lean principles. It is hard work. But it’s worth it.
The thing is, no one can do this alone. It has to be done in a community…
What About You?
What are your experiences with Breakdown of Community?
What do you think is driving it in your organization?
Have you found a way to rebuild community?
What will YOU do this week to begin to make a difference?
Please share your wisdom in the comments below.