It’s dire out there these days for healthcare providers:
Hospitals and medical groups are short-staffed, down as much as 20% with reports of more attrition of doctors, nurses, and other caregivers coming.
The workload keeps piling up, making those who are directly caring for patients further overburdened and burned out.
Most health system margins are negative, leaving senior leaders scrambling to reduce expenses while their people are in desperate need for more support.
Disruptors like big tech and private equity firms are circling around looking to help with the latest innovation (big tech), or to snatch up the few remaining profitable sectors of care delivery at bargain prices (PE).
Healthcare has not seen times of such stress in my career, which began as an operating room orderly in the mid-1970’s, and includes 30 years of caring for patients as a family physician combined with 30 years of progressive leadership roles from frontline manager to CEO. For the last eight years I have coached health system senior leaders on improving leadership, operations, and clinician wellbeing.
The status quo is clearly not sustainable. This can lead us all, clinicians and administrators alike, to feel as though there is no good solution.
One thing is for sure, we won’t get through this by intensifying the same approach to leadership, management, and care delivery that we have had in the past.
What is the alternative?
How do we beat burnout and build the bottom line?
The Professional Fulfillment model from Stanford WellMD provides a good way to categorize the array of actions that are needed to drive this change into three areas of focus:
Personal resilience
Efficiency of practice
Culture of wellness
Let's review each of these briefly here, and then go into them each in more depth in subsequent posts.
Personal Resilience
Back in 2014 the major focus on reducing burnout was on enhancing clinician resilience, helping clinicians cope with a bad situation.
While resilience support is absolutely necessary due to the significance of clinician distress, it is also absolutely insufficient to fix the underlying root cause of burnout – demanding people to perform highly in what is essentially an undoable job. As they say, “You can’t yoga and yogurt your way out of this.”
Efficiency of Practice
The demands of the job for most doctors and nurses far outstrip their capacity to meet those demands. This leads to work overload – the first driver of burnout as defined by Christina Maslach, PhD, and Michael Leiter, PhD, leading researchers of modern burnout theory. Their research also shows that overload directly impacts exhaustion, which is the first manifestation of burnout.
There are many opportunities to redesign work to reduce work overload and thereby increase capacity and improve clinician’s personal and professional lives. Few health systems have invested in this enough to make a real difference.
Those leaders that understand this and make the investments in workflow redesign will transform their organizations for the better.
Think of this as “Flipping the Ratio”. Studies show that physicians spend about 1/3 of their time on activities that are both meaningful and worthwhile. 2/3 of physician time is spent on administrivia – entering data, pursuing prior authorizations, approving safe medication refills, reviewing multiple reports, etc.
Imagine the potential for physicians to regain their personal lives, provide better care, and see more patients, if we could eliminate half of the administrivia, and enable physicians to spend 2/3 of their time on meaningful work, and 1/3 on necessary administrivia.
Making this change will require significant investment, which leads us to the third component of the Professional Fulfillment model – Culture of Wellness.
Culture of Wellness: AKA Transformational Leadership
The Professional Fulfillment model is right to focus on culture. My concern is with the term “Culture of Wellness”. It feels too soft to connect with business-oriented C-level executives.
Leading transformational change in healthcare is hard work that requires a combination of vision, courage, collegiality, determination, and empathy.
Leadership and management impact the other five drivers of burnout – lack of control, insufficient rewards, breakdown of community, absence of fairness, and values conflict. Maslach and Leiter have shown that these drive the second manifestation of burnout, cynicism. These drivers have everything to do with how you lead – whether you lead a group as small as 3 or 4 people, or a health system with 30,000 to 40,000 employees.
Health system senior leaders, as well as mid-level managers, are now as burned out as the clinicians they lead. The pressure to produce immediate results makes it feel like top-down, command and control management is the only viable option.
But top-down, command and control management, doesn't work when managing knowledge workers. Doctors and nurses are exemplars of knowledge workers who don’t respond positively to being “managed”.
Leadership in healthcare requires empowering and aligning clinicians – giving them the autonomy to improve their workplace while aligning everyone around enterprise-wide success.
This is not easy at first, no major change is. It is also the most effective way to create “organizational resilience” – the ability of an organization to rapidly adapt to changes in the environment and thereby survive and ultimately thrive. I know it works. I’ve led such a transformational change with great results.
Let’s explore all of this in subsequent posts. For now, I’m happy to talk with you if you are interested. Just reach out to me below, or at paul@pauldechantmd.com.
And thanks for all you do to make healthcare better.