Can management be a root cause of workforce challenges such as staff shortages and burnout?
It plays a role. It's hard to truly improve staff engagement and burnout without changing:
the way we do things around here – a common definition of culture, and
how we lead – moving from top-down to servant leadership.
Burnout manifests when highly motivated individuals (doctors and nurses) are working in a clinical workplace that is poorly designed, where it is nearly impossible for clinicians to provide safe, high-quality care without being constantly vigilant and focused.
Clinicians are good in situations requiring vigilance and focus, but also need time to let relax and recover. Constant vigilance is unsustainable and damages clinicians, resulting in burnout and its sequelae – depression, substance abuse, family dysfunction, and suicide. Physiologic studies show that burnout negatively impacts brain and cardiovascular function.
How to Improve Health Practice Workplace Conditions
Who has the most opportunity to improve the conditions in the workplace that require such vigilance? It’s the people who control:
The budget
Staffing
Equipment and supply purchases
IT and EHR services
Hiring, and
Process improvement.
Ultimately, it’s the CEO and direct reports in the C-suite. A key problem is that as healthcare has become more complex, management processes have not kept up. So we see the use of industrial age management techniques in a rapidly changing clinical workplace that has moved well into the information age.
Industrial Age Healthcare Management
Industrial age management focuses on controlling THE WAY workers do their jobs, with best practices designed by the administrators who “know best” how a job should be done and expect workers to follow their instructions. The workers feel like little more than human machines.
Information Age Healthcare Management
Information age management recognizes that clinical environments are complex and rapidly changing to the point that no one person can possibly know what the best practice should be in all cases. In fact, as the famed management guru Peter Drucker said, “Health care is the most difficult, chaotic, and complex industry to manage.”
So, how does an executive effectively manage in the information age? There are many ways the approach can change:
Top-down directive management does not work. Those doing the work know best what works and what doesn’t. Information age executives must approach their clinicians respecting that knowledge, empowering clinicians to make changes that can fix local problems.
It’s impossible to understand the challenges in the clinical workplace simply by reading reports and analyzing spreadsheets. Information age executives must get close to the work, shadowing clinicians and attending front line problem-solving huddles in order to deeply grasp the challenges their clinicians face.
External conditions change so quickly we must change the way we collaborate. Aligning everyone in the organization around shared values that bring meaning to the work is more important in the rapidly changing information age. Leaders are more successful when they clearly identify and communicate key metrics, explain their connection to shared values, ensuring that the clinicians understand their impact on metric performance.
Such an approach directly addresses the drivers of burnout:
Work overload is reduced by redesigning workflows.
Lack of control is reduced as clinicians gain the ability make changes that address their pain points.
Inadequate reward is addressed by the respect leadership shows clinicians when they are given authority over their workplace.
Breakdown of community decreases as people work in teams, solving problems in huddles, and redesigning workflows with a group collaborating over 3-5 days.
Fairness improves when people collaborate and treat each other with respect. (Respect for people is the first of the two key principles of Lean.)
Values conflicts dissipate when leaders clearly define, communicate, and honor the organization’s vision, mission, and values.
The First Step to Managing Workforce Challenges
If you are a leader and are not sure where to start, act like a physician. Diagnose the situation by doing a workup and develop a treatment plan. We can help you with our approach.
If that sounds like a bit much, start by shadowing a doctor or a nurse, to see the reality of their challenges. I guarantee you that you will learn something about the operations of your organization that you were not aware of.
If you are a clinician, invite a leader to shadow you.
These options are the first steps to making real change, and healing healthcare organizations.
If you'd like to learn more about leadership approaches to drive staff engagement, resolve workforce challenges, and decrease burnout, you aren't alone. My partner, Bruce Cummings, MPH, LFACHE, and I formed Organizational Wellbeing Solutions specifically to help leaders develop resilient organizations in which the business, and the people, thrive.
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