Redesigning Clinical Workflows to Return Joy to Patient Care
Resiliency Training – Important but Not Nearly Enough

Did you see this recent post on MedPage Today? “Burnout: Is Medical School the Staging Area? Burnout prevention starts in medical school” If not, you can find it here.

The article describes important new work at the University of Chicago Pritzker School Of Medicine to improve medical student resilience. It’s great to see medical schools addressing burnout and equipping students with valuable coping mechanisms.

As the post states, “One way to do this is to induce a greater resiliency in physicians in training. The Association of American Medical Colleges is now encouraging schools and residency programs to cultivate resilience in young physicians. Among its “intrapersonal competencies” for entering residents the AAMC includes “resilience and adaptability.” That is, a doctor who can demonstrate tolerance of stressful or changing environments or situations and adapt effectively to them.”

28851143_sI absolutely agree. Physicians need training in coping with the stresses of the profession, and support when they are unable to cope. There were few such offerings when I went to medical school in the late ‘70s.

Unfortunately, they are missing a huge opportunity by not including a focus on fixing the work environment.

As Dr. Tate Shanafelt reports in the December 2015 issue of the Mayo Clinic Proceedings, physician burnout rates have risen by 10% between surveys conducted in 2011 and 2014. Ten percent in three years!

In the discussion section, Shanafelt notes that 75% of physicians are now employed in large health care organizations. They struggle to succeed in a toxic environment. He recommends that “Health care organizations should focus on:

  • improving the efficiency and support in the practice environment,
  • select and develop leaders with the skills to foster physician engagement,
  • help physicians optimize “career fit,” and
  • create an environment that nurtures community, flexibility, and control,

all of which help cultivate meaning in work.” (Bullets added for emphasis.)

This recommendation includes the key elements of a good Lean management system:

  • Value Stream (VS) improvement work provides the means to increase efficiency.
  • Managing for Daily Improvement (MDI) with tiered huddles to escalate problems quickly provides the support that is often lacking and trains front line workers to solve problems locally.
  • Strategy Deployment (SD) creates alignment from the C-suite to the front lines, which helps to cultivate meaning and connection.
  • VS, MDI, and SD depend on servant leaders who foster physician engagement.
  • All the components working together, and rooted in the Lean principle of Respect for People, nurture the sense of community, flexibility, and control that are key to minimizing burnout.

While resiliency training is absolutely vital to help the >50% of physicians and physicians-in-training who are suffering from burnout, such self-help training alone is not enough.

lush-gardenHealth care leaders must do more. It’s wrong to take our best and brightest and put them into training and work environments that make it hard for them to the right thing for their patients, and burn them out in the process. And now we have documentation that the problem is getting worse.

Lean provides a way to prevent burnout by reducing the toxicity of the work environment. Implementing a Lean management system, that is true to the Lean principle of Respect for People, that supports physicians redesigning their own work, will increase physician well-being and improve quality, safety, service, and financial performance. It nurtures the care givers and helps them to flourish.

Many people misinterpret Lean, and think its primary intent is to remove waste, increase throughput, and do more with less. These are results of Lean. The driver of success in Lean comes from empowering the people who do the work to improve the work. And we all know that there is plenty of room for improvement in the work we do in healthcare.

I’ve seen it happen, and seen joy return to patient care. Have you? It is a wonderful thing to experience.

What do you think? Please share your thoughts, questions, or success stories with a reply below.

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