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  • Writer's picturePaul DeChant MD, MBA

Fix the Clinical Workplace, Not the Clinicians

Updated: Sep 4, 2022

Burnout is the manifestation in an individual of significant dysfunction in that person’s workplace. Clinical workplaces today are rife with barriers and frustrations that drive burnout.

Healthcare leaders who are serious about reducing burnout by fixing the clinical workplace engage with their clinicians by leading in a different way. It’s tempting to pursue top-down, command and control management when dealing with the myriad of challenges today’s healthcare leaders face, including:

  • Revenue reductions due to volume and reimbursement rate decreases

  • Staffing shortages forcing tough decisions to restrict services

  • Increasing competition from private equity and consolidating health systems

  • Inflation impacting supply expenses exacerbated by supply chain failures

​Top down management does not work with knowledge workers

What's a knowledge worker? According to Peter Drucker, known as "the father of modern management", a knowledge worker is someone who know more about their work than their manager does, and whose job requires them to have the autonomy to make decisions independently and innovate quickly.

That sure sounds like a physician. What other professions requires one to ace organic chemistry just to get accepted into a postgraduate education process that will last 7-12 years before one is ready to start their first "real job"? We gain a lot of knowledge during those years, in order to be able to act independently while caring for our patients.

Leading with empowerment and alignment works

During my 25 years of practicing family medicine, I wanted the autonomy to be able to fix things that were not working well in my clinic. I knew what the problems were. I had good ideas about how to fix them.

During the five years I was CEO of a 300-physician medical group, the thought of 300 doctors all autonomously fixing their problems independently, the way that they saw fit, made me worried that entropy would tear our group apart.

Fortunately, I found an approach that empowered all of our physicians to collaborate on fixing the clinical workplaces while aligning them around our enterprise-wide success. They achieved the professional fulfillment that they deserved. And our patients received the highest overall rated care among 170 medical groups across the State of California, at least that's how Consumer Reports and the California State Health Performance Information system (CSPI) rated us.

Leading with empowerment and alignment mitigates the drivers of burnout:

  • Work overload - fixing problems reduces redundancy and waste

  • Lack of control - empowerment by definition gives people control

  • Insufficient rewards - autonomy is one of the intangible rewards we expect for dedicating so much of our lives to our profession

  • Breakdown of community - alignment is best achieved by collaborating with colleagues, working together in community

  • Absence of fairness - the social compact that we thought we signed up for when we entered the profession is violated by top down management and honored by empowerment and alignment

  • Conflicting values - autonomy is one of the most strongly held values of physicians, and we feel the conflict when we are under command and control management

Getting started

Leading in this way requires strength and humility, accompanied by a clear vision of future for your organization. It requires great communication skills and emotional intelligence to connect with your people and overcome their initial skepticism. It requires building a leadership team you can count on.

It's hard work getting started, but once in place it is a far easier and more enjoyable way to lead. And it gets better results.

If you would like to learn more about how to get started, or keep such a process going, feel free to reach out to me at or click on the book appointment button and schedule at time to talk.


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