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Reducing Physician Burnout without Reducing the Bottom Line
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.

When people think about how to reduce burnout, they think about one of two approaches:

  • Reduce the workload
  • Provide wellness programs that include counseling meditation, and exercise.

Both of these approaches help.  And both come at a cost that can be a challenge for healthcare organizations that already run on thin financial margins.  The thought of a reduction in revenue from a reduced work schedule can lead a CFO to recommend against such action and a CEO to take the CFO’s advice.  Wellness programs do have a cost, but the benefits are worth the investment.

There is a viable alternative to reducing simply productiivty that will not hurt the bottom line – Leading with Lean.

The Drivers of Burnout

As identified by Maslach and Leiter in The Truth about Burnout, the drivers of burnout include:

  • Work Overload
  • Lack of Control
  • Insufficient Rewards
  • Breakdown of Community
  • Absence of Fairness
  • Conflicting Values

It makes sense to think first about reducing the amount of work to reduce work overload.  But if we recognize the five other drivers of burnout, and take action to reduce the impact of each of those, we can achieve a significant reduction in burnout without reducing productivity.

The Lean Management System

How does Lean help in this approach?  A Lean Management System has four key components:

  • Strategy Deployment, which identifies the values of the organization and its long term goals, creates role clarity and alignment for everyone from the C-suite to the front lines, and does this with a catchball process that gives everyone a voice in determining their responsibilities.
    • This addresses Lack of Control, Absence of Fairness, and Conflicting Values.
  • Value Stream Improvement, which engages the people who do the work in redesigning their work to remove the waste, barriers, and frustrations that they deal with every day. This work is done in teams, with trained coaches, and guidance from leadership.
    • This addresses Work Overload, Lack of Control, and Breakdown of Community. In most organizations the Report Out at the end of a weeklong improvement event includes recognition and celebration, addressing Insufficient Rewards as well.
  • Daily Improvement, which is driven through tiered huddles that empower the front line workers to identify and solve problhuddle-boardems, and provide the mechanism to escalate problems that can’t be solved on front lines to the level needed for resolution within a day, even to the level of the CEO if needed. The huddles include team members recognizing each other for the good work they do.This addresses Lack of Control, Insufficient Rewards, Breakdown of Community, Absence of Fairness, and Conflicting Values.
  • Lean Infrastructure, which is the team of coaches and mentors who support leaders and front line workers through the Lean transformation.
    • This addresses Lack of Control and Absence of Fairness.

When fully deployed, the Lean Management System creates a workplace where people are treated fairly, in control of their jobs, working together as a community, sharing aligned values, and being recognized for their efforts.

Such organizations achieve higher productivity without work overload, significantly reducing physician burnout.

What’s keeping you from getting Lean to reduce burnout?  Please share your thoughts.

4 Responses to Reducing Physician Burnout without Reducing the Bottom Line

  1. Thank you for this excellent post. Like many emotional issues burnout is a tragedy not only for the individual but also for those in the environment around the person who is suffering. In healthcare that environment most importantly includes the patient. Effectively addressing and ameliorating burnout may be one of the most effective ways of improving the experience of the patient.

    • Thanks Gene. I agree. It is management’s job to take care of the care givers on the front lines so that they are best able to take care of the patients.

  2. Interesting piece. To Paul’s point, as a new mid-level manager, and following a rudimentary kaizen, our medical group agreed to implementing simultaneous and multi-facitated steps to re-structuring and re-deploying staff. It was done for a number of reasons, but they were due to data that showed the processes we had in place were inefficient, for patients and physicians alike and only existed because of a long standing culture and poor infrastructure. Background info also showed that 66% of our physicians were burnout suing the MBI. This was in 2012-13.
    Lean intervention in 2013-14 tackled poor load balance. After a pilot study, published in JHM 2015 showed the group was more efficient and made the hospital more productive, we were given FTEs to permit the intervention to occur all 12 months of a year, vs just -8 months. The investment in human capital removed this constraint, and had an ROU of 400%.
    The morale of the group has improved annually. sInce 2012 baseline mean of 24 points. Despite a statsitical increase in divisional volume, our annual average dropped to 20, 18. 15, and 15, with only 30% of our group having MBI scores greater than 18. While not perfect, LEAN works to improve provider burnout scores by putting them in the patient value stream through Kaizen events. Since the primary drivers of burnout are inefficiency, ineffectiveness, lack of input and appreciation, it makes perfect sense that satisfaction would be in the wake of a lean intervention.

    • Thanks Michael.

      There are a growing number of examples of Lean reducing the drivers of burnout while improving the organization’s long term financial stability. In fact, if health care organizations don’t make changes to reduce physician burnout, they are putting their long term viability at risk, despite short term financial performance.

      If others have success stories along these lines, please share them here. Thanks.

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