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  • Writer's picturePaul DeChant MD, MBA

First Do No Harm

A Maxim for Physicians - Why Not For Healthcare Leaders?

Last week my blog post introduced the concept of Burnout-Proof Leadership, and I committed to diving deeper into explaining the concept and specifics about how to lead in a way that reduces the drivers of burnout. I'd like to start with a basic principle of Burnout-Proof Leadership - First, Do No Harm.

Early in medical training, physicians are introduced to key values that serve as a foundation to properly caring for patients. One of the core values, often attributed to the Hippocratic Oath although not specifically stated therein, is "First, Do No Harm".

As stated in Wikipedia, "It reminds physicians to consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit."

Physicians take this maxim to heart. We weigh the benefits and risks of our diagnostic and treatment options, with a particular focus on reducing the risk of harm to our patients.

Do No Harm Leadership

Like many healthcare leaders, I gradually transitioned from full time clinical practice to full time administrative work. As a clinician, the principle of "Do No Harm" was built into my decision-making process for my colleagues and myself in caring for patients.

Something changed as I moved into administration. My administrative colleagues would consider the principle of "Do No Harm" in decision-making, but this did not play as prominent a role in the decision-making process. I see this as a major defect in healthcare leadership.

Let me be clear, I'm not talking about healthcare leaders minimizing potential negative impacts of their decisions on patients. I'm referring to a lack of attention to the negative impacts of administrative decisions on the workers, particularly physicians. And too often the physician executives are the worst offenders.

Why Do Physician Leaders Struggle with Do No Harm to Clinicians?

There are a number of dynamics at play here:

  • "Do No Harm" is taught as a core value in medical school, not in business school. As physicians get MBA training, and as they spend more time with non-clinician colleagues, the values of their peer group change.

  • Executives think differently. We need to be considering a wide array of factors, impacts, and outcomes when making strategic and operational decisions, usually with much less adequate information than physicians have about a patient and treatment options.

  • Many executives do not understand that making decisions protecting workers from harm achieves better results than decisions that put workers are risk. (For a good example of this, see my post on Paul O'Neill, the former CEO of ALCOA.)

  • When the pressures of of healthcare leadership increase, an easy default is to get the doctors to work harder, to produce more revenue, without thinking deeply about the root causes of the problems or exploring collaborative ways to solve for them.

Analogies to Caring for COVID-19 Patients in Crisis

The challenge of making business decisions with inadequate information is not unlike the challenges of caring for COVID patients early in the pandemic.

Clinicians inadvertently did harm patients as they learned about this rapidly escalating and horrible disease. We made mistakes regarding ventilator management, patient positioning and proning, fine tuning anticoagulation, and the use of treatments such as hydroxuchloroquine and azithromycin.

Over time, clinical care improved, caused less harm, and resulted in better outcomes, as experience and knowledge improved.

Learning "First Do No Harm" Leadership

Traditional top-down, command and control management can produce good results - for a short while. It also results in the epidemic, no make that pandemic, levels of burnout that we see across the world for physicians and nurses today.

Healthcare is too complex, and post-COVID under too much stress, to lead with an old industrial management mindset. We now know that by putting people first instead, particularly the highly educated and skilled knowledge workers who are our physicians and nurses, leaders achieve excellent results.

Leading with Respect for People not only reduces burnout and improves engagement, but also improves quality, safety, patient satisfaction, access, and financial performance.

I'll dive deeper into how to be a values-based leader committed to the principle of Do No Harm for your clinicians, and achieving great results, next week.

If you want to get started thinking more about this, check out chapter of our book Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine, available on Amazon, or schedule a half hour introductory call with me to see how I might help your specific situation.

And please feel free to leave a comment to expand the discussion of Do No Harm Leadership.



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