Do you think it's possible to fix burnout and the bottom line? Can we return Joy to Patient Care and ensure financial viability for our healthcare provider organizations. Most people don't think it's possible.
Physicians are wary. They see any attempt by management to improve financial performance as likely including cuts to support staff, expectations for greater productivity (i.e. "see more patients") or both. Many are barely hanging on as it is. The thought of doing more with less is unacceptable when they are already giving their all, rushing through their days with hardly time to go to the bathroom, let alone eat, and then taking 2-3 hours of work home each evening.
Executives are equally wary. They see any attempt to reduce burnout to mean that doctors and nurses will work less, see fewer patients, and reduce the volume of (billable) services delivered. Many hospital and medical group margins are already razor-thin with no room to absorb a reduction in revenue. They are struggling to "keep the doors open and the lights on."
Both physicians and administrators have heard the old saying, "No margin, no mission." The thing is, if approached properly, we should turn this around to read, "No mission, no margin." In fact, we need to pursue both to be effective.
A Five Step Plan to Fix Burnout and the Bottom Line
Based on my 30 years of patient care and operational leadership, followed by 3 years of executive coaching in C-suites of health systems around the country, and writing a book on Preventing Physician Burnout, I've come to the conclusion that anything short of the five step plan outlined below will result in only partial success, or worse, outright failure to improve one or both of these vital goals.
The five steps to fix burnout and the bottom line include:
A diagnostic evaluation
A session to develop the burnout transformation plan, which will include focused efforts to improve
Enhancing clinician wellness and resilience
Changing the corporate culture and management system, and
Improving practice efficiency
We can't treat a patient without examining them first. We shouldn't treat a challenge like burnout without examining the organization. The diagnostic should include:
A burnout survey. There are many options. I prefer those that can identify the nature and degree of burnout across the organization with specifics by department. Ideally the survey can also identify which drivers of burnout are most impactful, so we understand better what changes are needed.
A review of the organization's Key Performance Indicators (KPIs). These include the outcome metrics that are important because CMS or other payers are using them to rate the quality of the organization. We must ensure the performance metrics improve as we improve burnout.
A Return on Investment (ROI) analysis. We must understand the true cost of burnout due to turnover and reduced productivity. This is key to determining the appropriate amount to invest in the overall burnout improvement effort.
A Leadership Assessment - The quality of leadership is a key determinant of burnout. At a minimum, the primary leadership team (C-Suite and key physician leaders) should all be included in this survey. This process should include a self-evaluation and evaluations by the leaders' direct reports and the leader's one up.
A "Gemba Walk" and interviews with key stakeholders. While surveys and spreadsheets provide valuable information, ultimately this work is about changing hearts and minds. We must connect on a human level to understand the importance of this work. In any change effort, there will come a time when it feels like it's not worth the pain. Deeply understanding the human impact of burnout in your organization may be the key to continuing this work when the going gets toughest.
Burnout Transformation Planning Session
Burnout has worsened gradually over the last 10-15 years, due to multiple external factors that have been introduced a few at a time until the sum total impact has become more than most of us can bear. If we are serious about how to fix burnout and the bottom line, it can't be assigned to a VP of one department. It takes full engagement of the C-suite.
This session should be two days long and include most C-level leaders as well as key physician leaders and a few members of the Board of Directors. It should ideally not have more than 10 participants.
The process starts with developing a clear statement of the problem agreed to by all in the room. This is followed by an analysis of the information from the diagnostic to understand the current state. The group then agrees to a target state of "what good looks like." This is followed by a deep dive into the understanding the root causes of the gap between the current and target states.
The group must commit to actions that will address those root causes. Most of those actions will fit into one of three areas of focus - improving wellness and resilience, transforming the management culture, and improving practice efficiency. Each organization will need a different approach for each of the areas.
The planning session is completed when there is a high level plan for each area, a specific implementation plan that specifies timeline and responsibility for each component of the high level plans, and a process to track improvement in burnout scores and outcome metrics over time. This should include a commitment from the group to have at minimum a half day review each quarter to ensure the implementation plan is proceeding and metrics are improving.
Enhancing Clinician Wellness and Resilience
There are many options to enhance clinician wellness and resilience. A few key elements include:
A proactive approach - letting everyone know that front line clinician self-care is important to the organization's leaders.
Offering individual coaching
Offering small group meetings in a variety of formats
Implementing meaningful recognition and reward processes - not just an annual gala, but also incorporated into daily work
Changing the Corporate Culture and Management System
This is the most overlooked component of programs to fix burnout and the bottom line. I'll explore why this is in a post diving deep into this component of the program. For now, it's helpful to realize that key elements that make a difference here include:
Hard wiring the principles of Respect for People and Continuous Improvement
Recommitting to the organization's Vision, Mission, and Values Statements
Developing an Organization Compact which, based on the organization's values, clarifies what physicians can expect from their organization align their work with the values, and what the organization can expect from each physician to ensure the values are being honored.
Designing a management system that
Empowers clinicians on the front lines to identify problems and work as a team to solve the problems
Ensures that problems that need escalation are quickly elevated to the level needed to achieve the solution
Aligns everyone in the organization around key values, metrics, and strategy
Physician leadership education, to fill in knowledge gaps that have likely not been part of their prior education or experience
Improving Practice Efficiency
While this work focuses on making clinical practice more efficient, the goal is not efficiency in the way most people think of it. The goal is to increase the amount of time physicians and nurses spend directly engaged in caring for their patients. Our most important activity is the healing interaction that takes place between a clinician and a patient. It is the essence of our personal missions and the thing that most drives professional fulfillment.
So many things now divert clinician attention away from their patient - interacting with the EHR, pursuing prior authorizations, worrying about patient satisfaction rankings, completing notes that meet billing requirements, the list goes on.
When our clinical teams work together to redesign care processes, we can remove many of these distractions, allowing physicians to spend more time with each patient while having the capacity to care for more patients. With redesign, a doctor's total effort per patient is significantly reduced, by removing those activities that have not value, and developing a team with members who can handle much of what doctors do today that they don't need to be doing personally.
Putting It All Together
We can't fix burnout and the bottom line with separate, one-off efforts. Individual efforts do help. I don't mean to diminish them. But if we are serious about fixing our workplaces to reduce burnout, we must take a coordinated systems approach.
I've outlined the common themes to this work. Yet, what works specifically in one organization will not be the same in another. Each hospital or medical group must tailor this work to their particular issues and challenges.
Over the next five weeks I'll dive deeply into each of these five components of the process. If you have specific questions, feel free to post them in the comments section, or contact me directly. I'm always curious about people's challenges and what they've done to succeed.
If you commit to this approach, you can make a difference.