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Lack of Control as a Driver of Physician Burnout

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Lack of Control as a Driver of Physician Burnout

Most physicians are feeling an acute sense of Lack of Control in their work these days. This is the second driver of burnout identified by Maslach and Leiter. Last week I discussed specific issues related to the first driver of burnout – Work Overload. Work overload leads directly to Lack of Control. When one is working in the type of time-pressured chaotic work environments most physicians face these days, it’s hard not to feel out of control.

In many professions, people have a sense of control over their workday. They have a pretty good idea of when their workday will start, what will happen during the morning, what their lunch break will be like (including knowing they will get lunch), what will happen in the afternoon, and what time they will go home at night. For most physicians it’s different. We often, but not always, know when our workday will start. We don’t know what will happen in the morning, if we will get lunch (not likely as we finish up from the morning), how the afternoon will go, and when we will get our work done. Of course, many of us bring this work home to do after spending some time with our family. It’s OK to have an occasional day like that, but when it is the norm, it wears us down.

Control is important to physicians. We spend more years in training than nearly any other profession in order to gain the knowledge and skills needed to take control in an emergency. Our patients are counting on us to do so when needed.

That same training provides us a unique skill set that can be applied in other situations as well, including operational workflow improvement, strategic planning, and budget development and financial management. Unfortunately, it’s much less common for physicians to participate in these activities, and as such, have lost control of crucial aspects of delivering care to their patients.

As an example, this past week I was visiting one of my previous partners, a family physician who has been caring for patients in his small town for over 3 decades. Like many primary care physicians of his era, he started in a solo practice, added a partner or two, merged their small group into a larger group in the area, and eventually merged into a large health system. He recognized that with each step along the way he was trading off some personal control of the practice in order to gain control over other aspects of his personal and professional life. He is OK with that.

He was not OK with what the health system did to his practice and his patients at the first of the year. The system, in an effort to make physician charges consistent across their network, and to position themselves to more effectively negotiate with insurers, essentially doubled the prices he had been charging. And they did not tell him until a staff meeting few days after the change went into effect.

The leaders responsible for this chain of events are not bad people. They certainly are not lazy. They do care. They themselves are overwhelmed by the demands of creating a cohesive medical group following a series of practice acquisitions that consumed much of their time.

That said, this cannot be an excuse. If leaders expect their physicians to be professional, they must treat them as professionals. They must listen to the physicians, respond appropriately to what they hear, and include physicians in making the decisions that affect their practices. Anything less and physicians experience the second driver of burnout – Lack of Control.

We can return control to the leaders and the physicians at the front line of care with a Lean Management System. Such systems include:

  • Strategy Deployment to align all physicians in the organization so they help develop and understand system changes,
  • Value Stream Improvement to remove the barriers that make if harder for physicians to focus on their patients,
  • Daily Management Huddles that rapidly solve problems the physicians encounter, and
  • Infrastructure (process improvement coaches, HR, finance, and business intelligence) to support the work in the first three.

As physicians experience an increase in control over how they care for their patients, they see that the organization they belong to is treating them with respect. Such Respect for People is the most important principle of Lean.

Please share your thoughts by clicking here:

  • How have you experienced a Lack of Control that surprised you?
  • What would you like to see your leadership do to improve your level of control?
  • Have the leaders in your organization done something that you can share with others?
The Lean Lifestyle, Personally and Professionally

There are surprising similarities between getting Lean personally (losing weight) and getting Lean organizationally. Both are hard to get started, take a while to show significant results, and require personal change sustained over time. The benefits of both are also significant. Continue Reading