A few years ago, I was leading the training workstream of a multi-million-dollar EMR implementation. The platform included 25 applications, from scheduling to revenue collection, and we trained over 17,500 employees in 12 weeks prior to go-live. A significant part of the training effort included 4100 clinicians (physicians, house staff, medical students, allied health) across 137 specialties in both inpatient and ambulatory workflows. Many of them needed multiple specialty apps to support their clinical practice, which necessitated over 32 hours of training in the classroom. The new system shifted coding work, previously the responsibility of a dedicated coding group, into the physician’s hands directly and provided a new internal and patient communication platform that was unfamiliar.
As you can imagine, the go-live period was chaotic, upending decades of muscle memory for clinician workflows and changing fundamental interactions with patients and colleagues. There was not much of a planned decrease in expected revenue or patient pipeline during the first 90 days. A few months after going live, we started holding debrief meetings with the clinicians. They were exhausted and confused, feeling angry and helpless. The word burnout was an understatement.
In those meetings, I frequently heard senior medical officers say to the room, “We can survive this and succeed. We just have to start thinking ‘outside the box’ regarding these new demands.” I did not think that statement was particularly helpful to these overworked, weary colleagues. Given the response in the room, they did not find it helpful either.
Over the past decades, physicians are facing increasing demands on their time and energy, aside from the EMR and patient documentation: increasing revenue; attending committees; mentoring, teaching, and education; doing research; and publishing. For physician leaders, there are additional leadership responsibilities, budgeting, and space management as well. Much of this added responsibility has come at the cost of personal time, well-being, adequate sleep, and rest and recovery. And physicians are the last to ask for help when they need it, which is evidenced by increased burnout and an escalating suicide rate. Add the COVID-19 pandemic, and I believe we will soon experience a major shift in how clinicians view their work and how they find meaning in their lives and careers. This could create a crisis in healthcare, as clinicians decide to pursue more meaningful roles outside of hospital systems. How can we help?
Asking clinicians to think “outside the box” is not supportive when many of them do not know what the box looks like, or what is inside. It also can make them feel as if the responsibility for their current situation is entirely theirs, or that they are doing something wrong. These resourceful, smart, and caring clinicians are lucky enough to get through the day or know who they are talking to in their next encounter or meeting.
Physician wellness is an ecosystem of support, not a solitary endeavor; the institution, physician leadership, wellness teams, and coaches should help clinicians think “inside the box.” Inside the box are the conditions within which they must find meaning and achieve balance if they and the organization hope to succeed long term.
Exploring their current “box” is the first step.
- What are my current responsibilities, both professionally and personally?
- Which ones focus on people’s interactions and which are more administrative and task-oriented?
- Which ones are important to me? To the institution?
- How effective am I at the ones that are important?
Once they have defined their “box,” they can then begin to refine it and make decisions that can support their wellness and balance going forward.
- Are my responsibilities balanced between people-oriented interactions and administrative tasks?
- What is in the box that does not add value, that I can let go? Can I delegate it or outsource it?
- Am I doing things just because I have always done them?
- What is missing that I desire?
Taking them through this exercise helps them define and refine their current box so that they understand their existing scope and can make room for what is necessary and meaningful. They may discover that some of what is in the box is not helpful for them any longer. That is OK … for them and the institution. Wouldn’t we rather have clinicians who are happy and engaged staying for the long term rather than those who are slogging through the day? Perhaps there is another role for them in the organization or another way to shift some of their responsibilities?
Clinician wellness must be a strategic imperative and is a partnership between the clinician, the leadership, and the institution. However, the clinician must first take the opportunity to explore thinking “inside the box!” The “Inside the Box” coaching conversation is not meant to provide answers, but can help the weary clinician take a few valuable moments to reflect and discover their own innate wisdom about what is necessary and meaningful in their life and career. Once they are comfortable ‘inside their box,” they can begin to explore what is exciting and meaningful outside it.
Cory Colton is an executive coach.
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