Redesigning Clinical Workflows to Return Joy to Patient Care
Sharpening the Saw to Prevent Burnout

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Sharpening the Saw to Prevent Burnout

I hear it all the time, Doctors don’t have time for huddles or improvement events!”

Really??? Have you heard the story of Sharpening the Saw? It stresses the importance of taking the time to ensure your tools are at working as well as possible, so that you can be most effective in your work. It’s an important message for burned our physicians and the executives who lead their organizations. In fact, Steven Covey includes this as the Seventh Habit in his Seven Habits of Highly Effective People.

The Story of Sharpening the Saw

There are a variety of stories regarding Sharpening the Saw. Some describe a man walking in the forest who encounters a woodsman working furiously at sawing down a tree, but making little progress. Another describes a competition between two lumberjacks, one of whom immediately begins sawing down trees while the other takes time to first sharpen his saw. A third includes a quote attributed to Abraham Lincoln effectively saying, “If I had eight hours to chop down a tree, I’d spend the first six sharpening my axe.”

In each case, the work goes better and faster after “sharpening the saw”. The moral of the story is that we tend to favor being busy and working hard to achieve the task at hand rather than properly in order to work most effectively. We waste a lot of effort if our saw blade is dull. The time spent sharpening the saw is more than made up for because we are more efficient when the blade is sharp.

What Does Sharpening the Saw Have to Do with Burnout?

A root cause of burnout is putting a highly motivated professional into a work situation where success requires constant vigilance to fix barriers and frustrations. I describe this as a toxic workplace, because that constant vigilance is unsustainable and leads to burnout, and to high rates of physician depression, family dysfunction, substance abuse, and suicide.

The best way to fix this is not to provide physicians with resilience training to better cope with the toxicity, but to detoxify the workplace by fixing the defects and workflow problems that cause the frustration. This seems obvious. Yet most organizations struggle to find the time to do this improvement work, and doctors are often the last to join in and participate in improvement work.

Why is it Hard to Invest Time in Improvement?

We all know why. As things are now, we don’t have any spare time. Most of us are working 12 hour days, 70-80 hour weeks. And we still have significant access problems with delays of weeks or months for patients to get an appointment, or delays of many hours to be seen in the emergency department or get admitted to a hospital bed.

How can we possibly make someone wait longer so that we can take time for improvement work? For physicians, the thought of giving up 15 minutes for a huddle when we could have seen another patient, or worse yet give up a week for a kaizen-type redesign event, seems like it will only make things worse. Let others do improvement work. We physicians are too important for that! We have patients to see.

Ways Physicians Sharpen the Saw

Do you take time for vacation? Do you take time off for CME? Of course you do, or at least I hope you do. It’s important to take time off to replenish yourself, to regain inner energy. It’s important to ensure your knowledge and skills are current in order to provide your patients the best care possible.

Do you also take time to participate in daily huddles or occasional week-long workflow redesign events? If not, why not? If you are like most physicians, your days are filled with barriers and frustrations. Huddles can fix the small frustrations you encounter on a daily basis. Week-long improvement events can redesign work in ways you didn’t think possible, significantly improving your efficiency and giving you more capacity to focus on your patient.

In fact, if you don’t invest the time in huddles and improvement events, you are wasting the benefits of vacation and CME. You are not getting the full benefit from being rested after vacation or able to apply your new knowledge as effectively when your clinical workflows are still broken. And redesign may make things worse if physicians are not there to ensure your concerns are understood and your improvement ideas are included in the solution.

How Do You Find the Time for Improvement?

OK, so you know this is important, and yet it’s still hard to find the time. Change is hard. Doing it right takes:

  • Analysis of the situation to be sure you understand the issues and implications
  • Consensus building with key stakeholders, including your leaders, colleagues, and support staff, and
  • Experimentation to work out the bugs.

First, executive leaders need to commit to their physicians participating in huddles and events. This means protecting their time and income if they are on a productivity-based compensation model. Second, clinical leaders need to commit to organizing the huddles and events to be of true value to the physicians, prepping well and ensuring the focus stays on improving patient care. Third, physicians need to participate – raising their concerns about daily problems, and being engaged and present in the room during longer events.

Try It, You’ll Like It

I have yet to meet a physician who didn’t find value in participating in huddles and improvement events that are properly prepared and effectively run. In fact, most often physicians are surprised by how helpful these are, and become the strongest advocates among their colleagues.

My call to action, whether your are an executive, clinical leader, or front line physician, is to commit to making this happen. Why are we tolerating the waste of a physician’s skills, knowledge, and commitment when our clinical workflows are rife with barriers? We can fix this if we work together.

Make the time for improvement.

Sharpen your saw.

Decrease the need for constant vigilance, and increase the joy of working effectively, finding more time for your patients.