You cannot work in medicine today without being inundated with burnout statistics and commentary on your feed, coming to your inbox, or spoken from stages about the state of medicine we are in. The data is dire: we are disengaged, we are making mistakes, we are not heard, and we are not empowered to make decisions.
There’s passionate debate on whether it’s individual versus institutional changes that will save medicine from the state it is in. If you care about your patients, your job, and your colleagues (not to mention your own wellbeing and livelihood) you can’t ignore the truth: we are not well in medicine, we continue not to be well, and we are all struggling to filter through the blame, the data, and the noise to figure out how to help ourselves, STAT.
I speak nationally on burnout and publish on it as well. I am by no means the expert some are, but I am well-read on the subject and stay up to date on the data. From my travels speaking to health care workers both in administration and in the front lines, it seems to me that most of us are sick of it. I lead a large group of women physicians (10K) who are honest about their work lives and most of who tell me at the end of their day in medicine, they have little left to give.
But being sick of a topic, or tired of feeling the blame, or launching the blame back on the “system” isn’t getting us anywhere.
I’m a strategist. I’m also a realist. And if I had to summarize my own thoughts on fixing the culture of health care, it would come down to two main problems – two distinct areas that require rapid, yet sustainable, change.
Two spaces we can all tend to – and two areas that require immediate leadership. Leadership that extends from the top all the way down to the nitty-gritty of our health systems; from those in the C-suite making hard decisions to the people who come to work each day trusting they are making the right ones.
I would grab every dean, chair, and CEO in every health system in the country, put them in a room, and say this:
1. Physician leadership. We are the link between our patients and health systems. Period. We must elect and encourage physicians to lead system change. We need physicians to speak in real-time – and we need what I call hybrid physicians – those physicians who work clinically AND who have a foot in leadership. Why? They are bilingual – they know the issues, and they get the problems. They are willing to be there and change the system, to lead the change. We also need administrators and top leaders to empower those physicians. Listening is great; but action is where power is. Physician leaders understand what is driving our failing systems and our cultural demise.
But guess what this will require? You. All of us. Why? Think about what often happens to hybrid physicians: we often cut their salaries and expect them to engage in administrative duties at the cost of their salary, and don’t pay them for their time or expertise. We – as physicians and administrators – must recognize the value that physician leaders bring to us and support them. We must get real with the way we support them and stop the “He is never in the operating room anymore” or “she is out of touch; she does not work as hard as me.” I hear this often. We don’t just eat our young in medicine; we also fail to support those who lead. We have to look hard at our bottom line and at our current culture, and support those who are chosen to both help patients and help our systems by leading.
Our current systems of leadership models are not working. We need teams of physician leaders whose singular focus is culture change; disruptive and in the right direction.
2. A culture of equity. There is a reality in health care where not every voice is heard. Not every idea is valued; not every person is paid equitably. A colleague may see something and is afraid to speak up due to retribution. There’s an underlying current of who is valued, and who is not. Each organization has a list of unspoken rules; how you must act for your concerns to be heard, when to stay quiet to not anger those in power, and how to fly under the radar to assure you get paid for the work you do. If a process can be improved, who do you tell? Will it matter? When do you try and change it? At the end of your day, when you’ve cared for people all day long?
The truth is, we need all of us to be engaged to fix health care, but for that to happen, we have to feel valued. We have to feel that when we go the extra mile for that one single patient’s family and allow each member to come into preop before surgery and hug them goodbye, we won’t get in trouble for missing our “first case on-time start.” We have to feel that ethics come before efficiency metrics, and safety comes before the bottom line. We have to applaud those – at every level – who are #braveenough to speak up and call out discrimination, bias, and errors in judgment. We have to embrace the fact that we aren’t perfect institutions, and recognize areas that we need to improve and ask the front line for help to fix it.
We need to change our culture of pointing fingers at errors – which happens, and embrace a culture of equity and encouragement.
Can you imagine if you went to work, and felt encouraged?
Can you imagine logging into Epic, and receiving a thank you for the life you worked 16 hours to save, instead of a red flag alert for the one unit of blood to you didn’t document perfectly out of the 30 you transfused?
Can you imagine if leadership asked you how they can improve your workflow and efficiency, and change processes to allow you to focus on patient care?
We are broken. Yet we are the healers. We fix people all day, and we face problems we would never THINK of not trying our best to solve.
We can fix us. We have to.
Elect physician leaders who understand the problems. Support them, stay connected to them. Make sure they are diverse thinkers and who promote equity.
Build cultures that encourage ethical care above efficiency. Elect leaders who value people more than policies and protocols. Let’s create environments where it’s ok to seek out our ignorance and blind spots without judgment and value each person who works alongside us.
Sasha K. Shillcutt is an anesthesiologist who blogs at Brave Enough.
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