As part of my ongoing series on the drivers of physician burnout, and examples of provider organizations that are taking action to reduce those drivers, today’s post is a vignette from our book, Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine, featuring a group that has focused on physician leadership.
The Oregon Medical Group is an independent, physician-led, 135-provider multispecialty group located in the Eugene, Oregon area. According to Karen Weiner, MD, MMM, a pediatrician and chief medical officer of the practice, several years ago, when serving on the board, she saw that physician burnout was a substantial barrier to achieving their organizational goals. She told us that the effects of health care reform and the onslaught of new mandates had brought physicians’ morale to an all-time low. The suicide of a pediatrician colleague brought home the urgency of the problem.
In 2013, Weiner was promoted to medical director, a full-time position created to address low physician satisfaction and morale. The group supported Weiner’s leadership training; she completed a Master’s degree in medical management to better understand how to develop a physician-supportive organization. The capstone project of her degree program was assessing physician burnout in the group and identifying ways to address the problem through organizational redesign.
Weiner’s project has been instructive on many levels. She has learned about the important role of leadership in preventing burnout. “Most executives don’t know what burnout is or how to prevent it. Leaders must understand burnout and the organizational factors that contribute to burnout. Some of the key factors are control, fairness, rewards, and values.” She’s learned about the connection between lack of control and burnout. “Some physicians have preconceived ideas of the causes of burnout and don’t think it can change. They get stuck in eddies and stop thinking about solutions, because they feel they have no control.”
Weiner has also developed a deeper understanding of disruptive physician behavior. She cites a joint RAND/American Medical Association study that identified perceived barriers to providing quality care as the number one source of dissatisfaction among physicians. (Friedberg 2013) “Inappropriate responses or angry yelling happens because the physician feels unable to provide the quality of care they want. One of the greatest contributors to burnout is doing work that doesn’t honor your personal values or feeling that your values are not honored in your daily work.”
Weiner sees physician burnout as a signal of underlying organizational issues. “If the leader of an organization has a lot of dissatisfied physicians, it’s showing that the physicians are perceiving barriers to providing quality care. It’s a strong indicator that something’s wrong.”
Weiner believes that interventions are needed at four levels to address physician burnout: individual, professional, organizational, and societal. She tries to keep leaders of the physician group focused on the organization-level interventions. “Mindfulness and other individual solutions are a great resource, but if you only give physicians these solutions, it’s like saying, ‘If you only knew how to swim better, this toxic ocean wouldn’t be a problem.’ Getting sidetracked on the individual solutions can prevent leaders from doing anything about the organizational interventions.”
Weiner believes that one of the most important organization-level interventions to help address physician burnout is increasing the number of physician leaders. “Filling in the depth and breadth of physician leadership is a must. I’m very concerned to see some organizations are cutting back on education for developing physician leaders.”
The practice group began expanding physician leadership by providing physicians with a view of the future state of the organization and enabling them to collaboratively create a shared vision based on that future state. Leaders and physicians worked together to craft and individually sign a compact that outlines the responsibilities of the organization and the physicians to each other. The compact also delineated new rules of engagement. Once this foundation work was completed, leaders worked with physicians to redesign many aspects of operations and clarified physicians’ roles in improvement projects, specifically ensuring that all projects have clear endpoints. Subsequently, physicians’ participation in improvement projects increased dramatically. The group has begun to implement Lean, with a focus on removing waste as a barrier to patient care and on maximizing the impact of physicians’ work.
Participation in successful improvement projects has fostered greater interest among physicians in taking leadership roles. Over the course of about two years, the group has undergone a significant culture change. “We now have a collaborative culture within our group. There is a sense of excitement and momentum in the work now.” For the past several years, the group has measured physician burnout, anonymously by department, using the Maslach Burnout Inventory (MBI). Because the MBI provides prevalence rates but does not indicate causes, the group also implements the American Medical Group Association’s physician satisfaction survey to identify problematic areas. If a department has high burnout scores, Weiner meets with the physicians as a group and one-on-one to identify the specific causes of burnout. Since the increased attention to physician leadership and implementation of fixes to specific workplace issues, the group’s average physician burnout score for emotional exhaustion (EE) has dropped from 27.7 to 23.1, well below the threshold of “high degree of burnout,” which is defined as an EE score of 27.
Although these improvements stem from many interventions, a primary one, according to Weiner, is the expansion of physician leadership.
What do you think? Have you seen examples of physician leadership making a difference in physician burnout?