Redesigning Clinical Workflows to Return Joy to Patient Care
Toxic Workplaces

Tag Archives: Root Cause

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?

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… Continue Reading

Resilience or Redesign: What Are You Doing About Burnout?

A question for healthcare executives – are you addressing physician burnout by investing in resilience or redesign? Same question for physicians – are you addressing burnout for you and your colleagues by investing in resilience or redesign? While most work on physician burnout still focuses on resilience, there is an increasing, and much needed, focus… 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

The EHR – A Root Cause of Physician Burnout

The most important thing that we do in health care is the healing interaction that takes place between a caregiver and a patient. The opportunity to participate in that sacred relationship, and to be of service to others, is why most every doctor went into medicine. The EHR, as we currently use it, is breaking that relationship and damaging our ability to heal. Continue Reading