top of page
  • Writer's picturePaul DeChant MD, MBA

Absence of Fairness

Today marks the fifth entry in my series reviewing the six key drivers of burnout described in Maslach and Leiter’s classic book The Truth about Burnout – Absence of Fairness. They state “A workplace is perceived to be fair when three key elements are present: trust, openness, and respect.”

This makes intuitive sense. When we trust the people we work with, we can be more open about our feelings and our performance. This openness with each other is not possible without mutual respect.

Employees often don’t trust that management cares about them

Frontline employees experience a workplace that does not work. As they try to do their best, they run up against barriers and frustrations to doing excellent work. They conclude, rightly or wrongly, that upper management must not care.

  • Why else would things be so screwed up?

  • Why else would the top executives espouse excellence, yet fail to provide workers what they need to perform excellently?

Respect for People

Respect for people is a core principle of Lean. When corporations take actions to that show more concern for protecting their bottom lines than for the basic

human needs of their employees, they violate this principle.

The most damaging of these are layoffs. Layoffs are common enough in healthcare that it is a rare institution that will implement a “No Layoff Policy”. Yet such policies are absolutely critical to a successful Lean transformation. We can’t ask people to remove waste and the need for staff, if we can’t guarantee them they won’t lose their jobs as a result. What could be more unfair than helping to improve a process only to get laid off as a result?

According to a study by VITALWorkLife, 82% of physicians think that the executives in their health systems aren’t doing enough to help them do their work. This is about the same percentage as in the general population. This feels highly unfair when coupled with knowledge of the executives’ salaries – which for not-for-profit executives are often published in the local newspaper. It doesn’t have to be this way.

Shadowing Clinicians Can Reduce Absence of Fairness

Leaders can reduce the sense of absence of fairness if they so desire. Shadowing frontline clinicians is a great place to start. Go to the offices and patient care units and spend time with your people as they do their work. Listen to them and observe their challenges.

They won’t expect you to fix everything if they trust that you care. Be open with them about the challenges you face - the constant barrage of external forces demanding that we

  • do more,

  • do it better, and

  • do it in a more challenging environment,

  • while reducing expenses and reimbursements.

As you build their trust, you can enlist their help to deal with those challenges. As you show them that respect, you will earn their trust.

So here is my challenge to you as a leader. Make room in your schedule to spend time with your front line workers. Do this intentionally and consistently. You’ll be amazed at the results.

The increasing diversity of the healthcare workforce created brings another dimension to the issue of absence of fairness. I'll address that in my next post. Stay tuned...



bottom of page