The Front Lines of Care – What’s Keeping Leaders Away?
The Front Lines of Care – What’s Keeping Leaders Away?

Why don’t leaders spend much time at the front lines of care (FLOC)? Why don’t they Go to the Gemba?

In this post I’m not asking a rhetorical question to tee up a few paragraphs of my thoughts on the subject. I’d like you to share your thoughts, because it’s something that many of us think about, and we haven’t yet figured out how to make it happen.

This week, I was privileged to present a webinar on clinician burnout for the American College of Healthcare Executives (ACHE). Presenting a webinar is a curious affair, sitting at my computer in my home office, talking as I advance the slides, unable to “read the crowd” of attendees except for questions being posted in the chat function. (I avoid looking at those during the presentation, as I could easily get distracted from my main message.)

At the end of the presentation, the moderator then asked me the questions that were posted. The first question is one I get frequently, “What’s the most important thing that someone in a leadership position can do to get started improving burnout?” I love this question! It is exactly the right question to ask!

The most important thing a leader, at any level in an organization can do, is to go to the front lines of care. Let’s talk about why, and try to understand why it’s so hard for leaders.

Why Go To The Front Lines of Care?

How can going to the front lines of care help leaders to lead more effectively? There are many reasons:

  • This is where the most important work is done.
  • It shows Respect for People, a key Principle of Lean Done Right.
  • Leaders are smart people who have a lot to offer those we lead, being there gives us that chance.
  • Leaders gain deep understanding and insight from observing work directly at the FLOC.
    • While committee reports and spreadsheets provide information on the results of the work done at the FLOC, they don’t capture the reality of the work like being there in person does.
  • Being present in the reality of the FLOC has dual impacts.
    • It can lead to anxiety and depression when a leader sees how dysfunctional our clinical workflows are.
    • It can also be deeply moving and uplifting to observe the thousands of wonderful healing interactions that take place between care givers and patients every day.
  • Most importantly, it can enlighten and motivate a leader to take real action to fix the mess they see there.
    • As the mess gets fixed, it facilitates improvement in the key performance metrics most hospitals track – safety, quality, patient satisfaction, growth and access, financial performance, and, most importantly, the physician and employee engagement that ensures improvement in the other metrics.

Why Not Go the Front Lines of Care?

What keeps leaders away? Again there are many reasons:

  • Leaders are busy.
    • There are only so many hours in a day being consumed by an ever growing number of demands, many of which are presented as so urgent they push aside the “soft stuff” of spending time with patients and care givers.
  • Leaders may feel uncomfortable.
    • Many leaders have extensive business training and experience, but little clinical experience. It’s not easy for them to put themselves into a situation where they are not the expert and don’t have the answer.
    • It’s hard to see clinicians frustrated by the many things that go wrong as they care for patients – searching for supplies, equipment malfunctioning, realizing the wrong medication was delivered to the bedside. Good leaders know they have a level of personal responsibility for these issues.
    • If there is not trust between the leader and those working at the front lines of care, it takes courage as a leader to take the first step, go to the FLOC, and take risk of beginning to heal that relationship.

What Do You Think?

What have you found that works?

Here’s one way, it’s called Immersion Day, and it’s featured in our book on Preventing Physician Burnout.

I’d love to hear your thoughts in the comments below:

  • What works?
  • What have you tried that didn’t work?
  • And what would you like to try but can’t figure out how?

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