Breakdown of Community - Burnout Driver #4
Today’s post takes a deep dive into Maslach and Leiter’s fourth driver of physician burnout – Breakdown of Community.
Breakdown of Community results from the first three drivers of burnout. When people are overloaded, lack control, and receive insufficient reward, they begin to act in ways that protect themselves as individuals. Individual self-protection leads to Breakdown of Community.
Why is Breakdown of Community increasingly common in health care today?
Health care is complex. Providing compassionate quality care for complex conditions requires the combined expertise of many caregivers with differing training and skill-sets. When doctors, nurses, technicians, and leaders with different expertise are unable to work together effectively, patient care suffers.
There are a number of factors that are driving breakdown of community in health care today, including:
“Working separately together” – One of the unintended consequences of the EHR and Meaningful Use regulations is the impact on interpersonal relationships among professionals who care for patients. Doctors enter orders into the computer for nurses to read, rather than discussing the patient directly with the nurse. Hospitalists can be found sitting side-by-side entering notes and orders into a computer, lacking the time to discuss interesting cases the way they used to, or even to spend time with the patients they are caring for.
Consultations - It is far less common for a specialist to receive a call from a referring physician requesting a consult. Instead the order has been entered into the EHR without an introductory conversation between referring physician and consultant.
Radiologists rarely see the other specialists in person like they did when films were analog and attendings came to the imaging department to review films every morning.
Layoffs - Health care system leaders often turn to layoffs as a way to reduce expenses and maintain a viable operating margin. Layoffs cause those remaining to work harder while they are fearing for their own jobs. This results in less time to collaborate as a team. Those remaining may suffer from survivors’ guilt while also fearing that they will be next.
Changing goals – We are in the era of “moving from volume to value”. Workflow processes that ensure success in the “volume world” often result in failure in the “value world.” Workers are confused about what they should be doing. Leaders struggle to provide the clarity needed to bring a team together around a common goal.
Fragmented personal relationships – Physicians are working longer hours, lacking the time to meet each other in the doctor’s lounge or lunchroom. These rooms used to be vibrant places full of colleagues discussing challenging cases or proudly sharing the latest news of their children and spouses. These opportunities are dwindling rapidly in most hospitals.
How can Lean help with Breakdown of Community?
A Lean management system and culture reduces the risk of breakdown of community in a number of ways.
The Lean principle of Respect for People requires us to listen to each other, attend to each other’s’ needs, and build closer personal relationships, strengthening a sense of community.
Redesigning workflows to ensure everyone is working at the top of their license often leads to team approaches to care. Care givers with different skill sets work together as a team, and even co-locate, driving a stronger sense of community.
A “No Layoff” philosophy helps workers feel more secure, and more ready to invest in developing relationships with co-workers, feeling it’s worth getting to know fellow workers who are likely to be around for quite a while.
Clearly defined and communicated “True North Metrics” help everyone in the organization see how they are aligned in working together to achieve common goals.
What is your experience with Breakdown of Community?
Have you experienced breakdown of community in your hospital or medical group?
Have you experienced an effective approach to countering breakdown of community?
Check back on Wednesday when I’ll post another vignette from our book, Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine, which features work the Oregon Medical Group has done to build community by enhancing leadership.