Today’s Posting on Conflicting Values is the sixth and final in my series on the drivers of physician burnout as described in The Truth About Burnout by Maslach and Leiter. Physicians place great value in their ability to provide compassionate quality care to their patients. Health system leaders similarly proclaim a dedication to compassion and quality in patient care. Their role also requires a commitment to growth and the financial viability. At times, these responsibilities either distract their attention away from a focus on quality, or require them to act in ways that may appear to contradictory. Front line physicians interpret such actions as disingenuous and conflicting with their own values. In reality, leaders are struggling to balance multiple fiduciary responsibilities.
Conflicting Values Hurt Physician Engagement
Shared values are key to creating a sense of community in the workplace. This is one reason most organizations invest significantly in developing vision, mission, and core value statements. These are often lofty aspirational goals, and they should be so considering health care institutions are dedicated to caring for their fellow human beings in their hours of greatest need.
Physicians and leaders differ in perspective and focus, leading to significantly different day-to-day realities within the same institution. They may share the same goals and values at a high level. Achieving those goals requires an organizational strategy that addresses the harsh realities of the external environment impacting hospitals and medical groups. The reality of government regulations, reduced reimbursements, increasingly diverse and complex patient populations, and accelerating technologic innovations cause challenges at the front lines of patient care, where physicians feel the impact deeply and personally.
Most leaders feel the impact in boardrooms, executive meetings, or contentious medical staff meetings. They rarely have personal experience with the impact on the care givers on the front lines. Leaders may make rounds, asking workers about how their day is going, about family or personal achievements, or about what they need to make their jobs go better. It’s far more unusual for the CEO to shadow a physician trying to keep up in the cacophony of daily rounds or while falling behind in their office schedule. So physicians think that administrators “just don’t get it.”
How Lean Can Help with Conflicting Values
Strategic decisions are made in the C-suite for the good of the organization. The impact of these decisions on patient care, both positive and negative, cannot be fully understood by reading reports and spreadsheets. Lean leaders “go to the gemba” intentionally to truly understand the implications of their actions. Similarly, physicians make clinical decisions for the good of their patients. The impact of these decisions on the viability of the organization cannot be fully understood from observing the outcome of each individual patient. Physicians must make the effort to understand the impact of their individual clinical decisions across the entire organization.
A Lean Management System effectively addresses conflicting values:
- Strategy deployment ensures that goals are aligned from the CEO to the front line caregiver.
- A Daily Management System ensures that front line caregivers are supported by organizational leadership, with a focus on solving, not ignoring, problems on the front lines.
- Value Stream Improvement work brings together leaders and front line workers to develop a common understanding of work flow processes.
- Infrastructure to support the Lean Management System, including engagement from HR, finance, business intelligence, and IT facilitates all of the above.
This coming Wednesday I’ll post a vignette from our book Preventing Physician Burnout: Curing the Chaos and Returning Joy to Patient Care which describes the approach that Dr. Patty Gabow took as CEO of Denver Health. Patty is passionate about values we all aspire to – quality, service, and equity. She implemented a Lean management in Colorado’s safety net system that improved the care of those most in need while engaging the entire workforce AND saving the State of Colorado hundreds of millions of dollars. Don’t miss this inspiring message!
Have you experienced conflicting values in your organization? Please share your experience and your thoughts about how to fix this challenge by clicking on the “Comments” link above.