Redesigning Clinical Workflows to Return Joy to Patient Care
Toxic Workplaces

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Toxic Workplaces

Why do we tolerate toxic workplaces?

  • Would patients be admitted, or people be allowed to come to work, in a hospital that had Legionnaire’s disease spreading through it’s HVAC system, or cryptosporidium in its water supply?
  • When there is a unusual smell associated with headaches and nausea in a surgical unit or emergency department, do people continue to work there and show up for their next shift as though this is status quo?

Of course not.

Why is it different for burnout?

Burnout manifests as emotional exhaustion, depersonalization (cynicism), and a sense of inefficacy. It progresses to serious sequelae for clinicians, as they  develop depression, substance abuse, and family dysfunction. For 3-400 physicians each year as these problems worsen, it leads to death my suicide. Shouldn’t workplaces that are causing such significant morbidity and mortality be considered toxic workplaces? Doesn’t this deserve a significant response?

A key cause of burnout is placing highly motivated professionals into a clinical workplace in which they have inadequate support, and in which they cannot care for their patients properly without constant sustained vigilance and focus. The level of vigilance and focus required is unsustainable over the long term. Eventually this takes its toll and burnout ensues.

According to Christina Maslach, PhD the workplace drivers of burnout include:

  • Work overload
  • Lack of control
  • Insufficient reward
  • Breakdown of community
  • Absence of fairness, and
  • Conflicting values

These conditions are endemic in most clinical workplaces. When placed in these conditions, over half of physicians manifest the symptoms of burnout and are at high risk to progress to the serious sequelae noted above. A recent piece in The Saturday Evening Post explores this in great detail.

Why is there so little action by healthcare leaders to address toxic workplaces?

In March of this year 11 CEOs of major US health systems posted a Health Affairs Blog titled, “Physician Burnout Is A Public Health Crisis: A Message To Our Fellow Health Care CEOs“. From what I have seen, too many of their fellow health care CEOs have missed this call to action.

I work in many health care systems (30 in the past 3 years), sharing my message about burnout, its root causes, its impact, and, most importantly, what these systems can do to address the root causes and reduce burnout. The chief medical officers and medical directors are all engaged. Most process improvement teams are engaged.

It’s a different story for the rest of the administration, particularly the non-clinical members or the C-suite. More often than not, they are not present or distracted. It’s a bit ironic, as often they have asked for my help to get physicians engaged in process improvement work. They know they need the physicians to help fix problems in their clinical operations.

I can understand some of the reasons why. CEOs are under significant pressure to ensure the financial stability, and enhance the strategic position, of their organizations. They have to make choices about which meetings to attend and which stakeholders to spend time with to address these needs. These become the priorities.

What will it take to get CEOs engaged in burnout?

Most CEOs don’t seem to understand that burnout in their medical staff is one of the greatest financial and strategic threats facing their organizations. Why don’t they respond appropriately? Is it  because:

  • they have not recognized the real impact?
  • they don’t know what actions to take to address the challenge?
  • addressing the challenge will require them to change their management approach?

We all know that change which isn’t easy for anyone. Most of us won’t change until the pain of the current condition is worse than the perceived pain of the change.

How much worse will these toxic workplaces have to get, and how many more physicians will have to experience depression, substance abuse, family dysfunction and suicide, before health care leaders feel enough pain and we see effective responses from all health care CEOs?

What do you think?

Attention CFOs – Do You Know the Financial Impact of Burnout?

As the CFO, are you aware of the financial impact of burnout? Can health care leaders afford to take actions preventing burnout in physicians?  Perhaps the better question to ask is, can they afford not to? The Mayo Clinic Experience of the Financial Impact of Burnout In a recent letter published in the Mayo Clinic… Continue Reading

Do Compensation Plans Cause Burnout?

One of my good friends and leadership mentors, Dr. Tony Marzoni, had a great saying. “Every medical group has a culture committee. They simply call it the compensation committee.” I’ve been in plenty of heated compensation committee meetings and board meetings where tempers flared due to compensation disagreements. When we realize the high stakes, personal nature, and burnout drivers that are impacted by compensation decisions, it’s not surprising. Continue Reading

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… Continue Reading

Physician Leaders Need to Get Angry

I’m on my way home from the Annual Meeting of the American Association for Physician Leadership in New York.  Three hundred physician leaders came together from across the nation to share their challenges and learn from great keynote speakers and from each other. Among the 35 breakout sessions were five on physician burnout, including a… Continue Reading

Servant Leadership

How do you approach Servant Leadership?  Do you aspire to serve those you lead?    I’ve struggled a bit with what the concept of servant leadership truly implies. A servant’s master can command the servant to perform tasks that primarily further the master’s self interest.  If, as servant leaders, we must obey the physicians and staff no… Continue Reading

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.… Continue Reading

Diagnosing Burnout – Not as Easy as You Might Think

How would you diagnose a physician experiencing burnout?  The classic definition includes a combination of emotional exhaustion, depersonalization (often manifesting as cynicism), and a sense of inefficacy (reduced personal accomplishment).  If he/she presented to you as a patient, and as a result of your workup your treatment recommendation included reduced work hours to time off from work,… Continue Reading