Redesigning Clinical Workflows to Return Joy to Patient Care
Sharpening the Saw to Prevent Burnout

Category Archives: Burnout

Sharpening the Saw to Prevent Burnout

I hear it all the time, Doctors don’t have time for huddles or improvement events!”

Really??? Have you heard the story of Sharpening the Saw? It stresses the importance of taking the time to ensure your tools are at working as well as possible, so that you can be most effective in your work. It’s an important message for burned our physicians and the executives who lead their organizations. In fact, Steven Covey includes this as the Seventh Habit in his Seven Habits of Highly Effective People.

The Story of Sharpening the Saw

There are a variety of stories regarding Sharpening the Saw. Some describe a man walking in the forest who encounters a woodsman working furiously at sawing down a tree, but making little progress. Another describes a competition between two lumberjacks, one of whom immediately begins sawing down trees while the other takes time to first sharpen his saw. A third includes a quote attributed to Abraham Lincoln effectively saying, “If I had eight hours to chop down a tree, I’d spend the first six sharpening my axe.”

In each case, the work goes better and faster after “sharpening the saw”. The moral of the story is that we tend to favor being busy and working hard to achieve the task at hand rather than properly in order to work most effectively. We waste a lot of effort if our saw blade is dull. The time spent sharpening the saw is more than made up for because we are more efficient when the blade is sharp.

What Does Sharpening the Saw Have to Do with Burnout?

A root cause of burnout is putting a highly motivated professional into a work situation where success requires constant vigilance to fix barriers and frustrations. I describe this as a toxic workplace, because that constant vigilance is unsustainable and leads to burnout, and to high rates of physician depression, family dysfunction, substance abuse, and suicide.

The best way to fix this is not to provide physicians with resilience training to better cope with the toxicity, but to detoxify the workplace by fixing the defects and workflow problems that cause the frustration. This seems obvious. Yet most organizations struggle to find the time to do this improvement work, and doctors are often the last to join in and participate in improvement work.

Why is it Hard to Invest Time in Improvement?

We all know why. As things are now, we don’t have any spare time. Most of us are working 12 hour days, 70-80 hour weeks. And we still have significant access problems with delays of weeks or months for patients to get an appointment, or delays of many hours to be seen in the emergency department or get admitted to a hospital bed.

How can we possibly make someone wait longer so that we can take time for improvement work? For physicians, the thought of giving up 15 minutes for a huddle when we could have seen another patient, or worse yet give up a week for a kaizen-type redesign event, seems like it will only make things worse. Let others do improvement work. We physicians are too important for that! We have patients to see.

Ways Physicians Sharpen the Saw

Do you take time for vacation? Do you take time off for CME? Of course you do, or at least I hope you do. It’s important to take time off to replenish yourself, to regain inner energy. It’s important to ensure your knowledge and skills are current in order to provide your patients the best care possible.

Do you also take time to participate in daily huddles or occasional week-long workflow redesign events? If not, why not? If you are like most physicians, your days are filled with barriers and frustrations. Huddles can fix the small frustrations you encounter on a daily basis. Week-long improvement events can redesign work in ways you didn’t think possible, significantly improving your efficiency and giving you more capacity to focus on your patient.

In fact, if you don’t invest the time in huddles and improvement events, you are wasting the benefits of vacation and CME. You are not getting the full benefit from being rested after vacation or able to apply your new knowledge as effectively when your clinical workflows are still broken. And redesign may make things worse if physicians are not there to ensure your concerns are understood and your improvement ideas are included in the solution.

How Do You Find the Time for Improvement?

OK, so you know this is important, and yet it’s still hard to find the time. Change is hard. Doing it right takes:

  • Analysis of the situation to be sure you understand the issues and implications
  • Consensus building with key stakeholders, including your leaders, colleagues, and support staff, and
  • Experimentation to work out the bugs.

First, executive leaders need to commit to their physicians participating in huddles and events. This means protecting their time and income if they are on a productivity-based compensation model. Second, clinical leaders need to commit to organizing the huddles and events to be of true value to the physicians, prepping well and ensuring the focus stays on improving patient care. Third, physicians need to participate – raising their concerns about daily problems, and being engaged and present in the room during longer events.

Try It, You’ll Like It

I have yet to meet a physician who didn’t find value in participating in huddles and improvement events that are properly prepared and effectively run. In fact, most often physicians are surprised by how helpful these are, and become the strongest advocates among their colleagues.

My call to action, whether your are an executive, clinical leader, or front line physician, is to commit to making this happen. Why are we tolerating the waste of a physician’s skills, knowledge, and commitment when our clinical workflows are rife with barriers? We can fix this if we work together.

Make the time for improvement.

Sharpen your saw.

Decrease the need for constant vigilance, and increase the joy of working effectively, finding more time for your patients.



Do Compensation Plans Cause Burnout?

One of my good friends and leadership mentors, Dr. Tony Marzoni, had a great saying. “Every medical group has a culture committee. They simply call it the compensation committee.” I’ve been in plenty of heated compensation committee meetings and board meetings where tempers flared due to compensation disagreements. When we realize the high stakes, personal nature, and burnout drivers that are impacted by compensation decisions, it’s not surprising. Continue Reading

Maximizing ROI and Work Life Balance

“Doctor, you need to see more patients.”  Too often these days physicians hear this from their CEO or CFO and think, “I can’t do any more without cracking.”  In a recent post directed to CFOs I discussed the financial impact of burnout on hospitals and health care systems. Physicians are cracking under the strain.  Today’s… Continue Reading

Tight-Loose-Tight Leadership and A3 Thinking

Are you a “results-oriented” leader?  I hope you are, because you need good results to be successful.  How do the people you lead feel about your focus on results? Are they empowered or feeling burned out? The “Tight-Loose-Tight” approach to leadership can ensure results while empowering your team. The basic concept of “Tight-Loose-Tight” is for a leader to… Continue Reading

Servant Leadership

How do you approach Servant Leadership?  Do you aspire to serve those you lead?    I’ve struggled a bit with what the concept of servant leadership truly implies. A servant’s master can command the servant to perform tasks that primarily further the master’s self interest.  If, as servant leaders, we must obey the physicians and staff no… Continue Reading

The EHR – A Root Cause of Physician Burnout

The most important thing that we do in health care is the healing interaction that takes place between a caregiver and a patient. The opportunity to participate in that sacred relationship, and to be of service to others, is why most every doctor went into medicine. The EHR, as we currently use it, is breaking that relationship and damaging our ability to heal. Continue Reading

Reducing Physician Burnout without Reducing the Bottom Line

How can you reduce physician burnout in your workplace without hurting the bottom line? When most people think about burnout they think about its primary manifestation – exhaustion.  Burnout also manifests as cynicism, which damaging to the person and those around him/her, and as inefficacy, the sense that what you do doesn’t make a difference.… Continue Reading

Diagnosing Burnout – Not as Easy as You Might Think

How would you diagnose a physician experiencing burnout?  The classic definition includes a combination of emotional exhaustion, depersonalization (often manifesting as cynicism), and a sense of inefficacy (reduced personal accomplishment).  If he/she presented to you as a patient, and as a result of your workup your treatment recommendation included reduced work hours to time off from work,… Continue Reading

I recently was asked to work with a health system that is struggling with physician engagement in their Lean program. Nothing new about that. Doctors are so busy trying to take care of higher volumes of increasingly complex patients that they can’t afford the time to fix the dysfunctional workflows that stand in the way… Continue Reading

“Respect is Like Air…”

“Respect is like air… if you take it away, it’s all people can think about. The instant people perceive disrespect in a conversation, the interaction in no longer about the original purpose – it is now about defending dignity.” (Crucial Conversations, by Patterson, Grenny, McMillan and Switzler). Dr. Monica Broome, MD, shared this quote today… Continue Reading

In their recent Perspective piece in the New England Journal of Medicine entitled “Medical Taylorism”, Drs. Pamela Hartzband and Jerome Groopman make a fundamental attribution error. They equate Lean as practiced according to the principles of the Toyota Production System that empowers workers to solve problems, with the approach used by Frederick Taylor over 100… Continue Reading

Did you see this recent post on MedPage Today? “Burnout: Is Medical School the Staging Area? Burnout prevention starts in medical school” If not, you can find it here. The article describes important new work at the University of Chicago Pritzker School Of Medicine to improve medical student resilience. It’s great to see medical schools… Continue Reading