Redesigning Clinical Workflows to Return Joy to Patient Care
Executives – The Missing Stakeholders in Preventing Burnout
Executives – The Missing Stakeholders in Preventing Burnout

The National Academy of Medicine has launched an Action Collaborative on Clinician Well-Being and Resilience, but there is one missing stakeholder.  Last Friday, July 14th, NAM hosted it’s its first public meeting on establishing clinician well-being as a national priority. The inaugural sponsors include nearly many medical specialty societies, the major insurance companies, the American Associations for hospitals, nurses, physicians, and medical colleges, Johns Hopkins, Mass General, and my employer – IBM Watson Health.  It is great to see the growing recognition of clinician burnout as a problem, and the growing collaboration between multiple stakeholders. The missing stakeholder is the ACHE – The American College of Healthcare Executives.

Executives are a Mission-Critical Missing Stakeholder

Why am I concerned about the absence of health care executives in the early stages of this effort? Reducing burnout in the health care workforce will take resources. The executives in the C-suite control the resources – the staffing, time, and money – that are needed in addressing this complex problem.

The root cause of burnout develops when a highly motivated professional, particularly in a caring profession, is placed in a workplace that is so poorly designed that is difficult to succeed without heroic effort, without “going above and beyond.”  In health care there are significant issues with:

  • the nature of the work itself – requiring in-depth knowledge, critical reasoning, and dealing with life and death
  • the culture of medical training – historically a “blame and shame” approach in which bullying was thought to increase student commitment to learning
  • connection to purpose – doctors’ and nurses’ passion to provide high quality care to their patients
  • workplace dysfunction – broken workflow processes that frustrate clinicians and make it difficult to stay connected to purpose
  • changing external demands – that have grown significantly in the past 10 years.  (See my blog post, “The Last Straw”, for more info on this.)

The most important of these is the workplace. Most hospitals and clinics are designed in a way that clinicians face growing barriers and frustrations as they strive to provide excellent patient care. Removing these barriers and frustrations is the hardest change to make, and the one that has received the least attention until recently.

Burnout Impacts Executives

It’s not easy being a C-Suite member in a hospital or health system.  Many experience burnout themselves. Recall that burnout manifestations as defined by Maslach include:

  • Emotional exhaustion
  • Cynicism (depersonalization)
  • Lack of sense of self-efficacy

There is likely not a day that goes by that some member of the C-suite in every hospital does not experience one of the above.

Clinician burnout also directly impacts executives ability to succeed. Clinicians who are exhausted, cynical, and feeling low self-worth struggle to care for patients with the levels of quality, safety, and personal caring that drive hospital performance metric success.  As work-live balance worsens, clinicians are reducing their workloads in order to maintain some personal control, which has a direct impact on a hospital’s net revenue. Most health systems work on a narrow operating margin, so a small percent decrease in revenue can have a large impact on net income, making it harder to keep the hospital financially solvent.

The Missing Stakeholders Are Missing the Most Important Factor in Burnout

Most executives don’t realize it, but they have the most important role to play in fixing the most important root cause of burnout. Operations are ultimately the responsibility of the leaders of the organization.  If operations are dysfunctional, the workers will try to fix things, but rarely succeed without support. Middle managers are the closest to the front line challenges.  They often try to provide support to the front lines, but without getting support from those they report up to, they struggle as well. Executives are that missing stakeholder.

The C-suite has the ultimate power to ensure that managers have the support they need to properly support the clinicians at the point of care as they work to solve problems and remove barriers to quality patient care.  The interesting thing is, the C(X)Os don’t have to have the solutions to the problems. In fact, it’s best if they don’t. They simply have to develop a management system and culture that empowers the front line workers to solve their own problems. Doing so addresses the classic drivers of burnout:

  • work overload
  • lack of control
  • inadequate reward
  • breakdown of community
  • absence of fairness
  • mismatch of values

If you are curious, I posted specifics about how the Lean management system/culture addresses each driver, starting with an introductory blog on New Year’s Day. You can start there and read the short posting each week following to better understand the issues and read some great solutions that have worked for others.

Some Great Resources

If you are a health care executive who would like to learn how to get started, or if you are a manager or clinician who would like to learn how to engage your executives, here are some great resources in addition to the links above:

  • An article I published in the Group Practice Journal in April
  • Our book on Preventing Physician Burnout, which is written as a handbook for health care leaders and physicians, available in paperback and kindle
  • The Simpler Healthcare website, which introduces you to more options, and
  • You can reach out directly to me through this website, or by entering a comment below.

While executives worry about physician engagement, the real opportunity is executive engagement. Executives are still the missing stakeholder.  I’m here to help, to provide positive support. It’s the thing I’m most passionate about at this point in my career. Try one of these options, you’ll be happier (and less burned out) as a result!

One Response to Executives – The Missing Stakeholders in Preventing Burnout

  1. Spot on, Paul. Any transformation required, like the implementation of a true Management System that reduces physician & staff burnout, and moves companies toward the Triple-Aim requires commitment from the top leadership of the organization. And, as we know there is a big difference between being ‘interested’ in doing that and committed to doing that.

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