Arianna Huffington recently wrote on LinkedIn, “45% of U.S. workers wouldn’t wish their job on their worst enemy. We’re in a crisis of purpose and meaning, not just burnout.”
This occupational phenomenon has also reached crisis proportions in the health care industry. In a recent study on physician burnout, Dr. Christine Sinsky reported the highest rates of burnout (>60%), emotional exhaustion, and the lowest rates of professional satisfaction since 2011. Every 2 out of 3 physicians are experiencing signs of burnout, and only 1 in 3 feel professionally satisfied. Hospital CEOs who resigned between 2020 and 2021 have nearly doubled. We are all aware that medical errors are a real problem, and these errors occur because of the convergence of multiple factors, including burnout and system failure. Recently Birmingham hospitals in the U.K. were in the news for the death of 20 patients due to failure in systems and toxic culture. These problems are real, and the lives of health care workers and patients are at risk. The surgeon general wrote in his advisory, “the stakes are high. If we fail to act, our nation’s health will be at increasing risk.” Due to continuous changes in health care delivery and increased administrative complexity, health care systems are run with physicians and administrators working in partnership. But in recent times, since the number of administrators added to the health care system has outpaced the number of physicians, there appears to be a shift towards more challenges in this partnership impacting patient care and overall productivity.
Languishing to great resignation, quiet quitting, great reflection, career cushioning, and now great renovation are our realities. People want their reality to change. What is missing from workplaces today, including hospitals, is “happiness” because of these strained relationships, which in turn cause failure in systems and loss in productivity due to a lack of partnership between physicians and administrators! Mending these broken relationships is essential to bring “happiness” back into our workplaces, thereby reducing burnout.
As a craniofacial orthodontist, with the excellent clinical training I had received, I could imagine how my practice should operate, but I needed more ability to see the path we had to take to bring it to fruition, especially in a hospital that did not provide any other dental services. Shannon Driscoll – vice president of operations, when she joined hands with me, things began to change instantly because of her ability to see. As Simon Sinek recently wrote – “greatness happens when someone who can imagine partners with someone who can see!”
In this article, Shannon Driscoll and I will share the 3 Is of partnership that helped us turn our practice around and retain craniofacial orthodontics as one of the service lines at Rush Medical center in Chicago.
Trust is the core foundation of any relationship, and it is decreasing at alarming levels between physicians and administrators. An American Board of Internal Medicine Foundation study reported that 30% of physicians do not trust their health care organization’s leadership and executives.
The first step in building a partnership between physician and administrator is rebuilding the broken trust. Because people who trust each other will seek input, discuss their successes and failures without inhibitions, and know they will not be taken advantage of or manipulated. Moreover, there is enough data in the literature about how people at high-trust organizations experience 74% less stress, 106% more energy at work, 50% higher productivity, 13% fewer sick days, 76% more engagement, 29% more satisfaction with their lives, 40% less burnout.
Shannon was invited to one of our meetings along with other administrators and leaders for a general discussion; she was not the administrator overseeing my practice. After the meeting, she promptly followed up with me, asking how she could help me and how I was doing. She not only stepped down from her role but also outside of her role to come alongside to help me. There were times I would reach out to her asking for help beyond the scope of her role, but she, without hesitation, would lend a helping hand. Craniofacial orthodontic practices barely break even due to the complex, lengthy treatments we provide, with poor insurance coverage. What made the difference was that my practice and I mattered to Shannon. And that was the start of the beautiful trusting partnership we have today. Trust, respect, and mattering are fundamental values when initiating partnerships in a workplace.
In the immersion phase, physicians and administrators spend time together as a group or as individuals to understand each other’s roles, limitations, and challenges. Immersion allows one to know somebody or a group beyond their professional cultural differences and helps prevent the blame game/reciprocal scapegoating due to a lack of alignment. These misalignments usually stem from fundamental differences – Physicians are trained to think at a more individual level, i.e., one patient at a time, while administrators are trained to think at a more organization/systems level.
Physicians’ challenges are usually around decreased autonomy, flexibility, and loss of control over their work. Changes impacting clinic workflows, staffing, laborious documentation, and reduced academic engagement. On the other hand, administrators’ hands are tied by bureaucracy, regulatory compliance, boards, and ever-changing goals and targets of the health care industry, while not forgetting the daily job pressures of putting off fires. After the pandemic, with an acute staff shortage, administrators were forced to get more involved in day-to-day operations, leading to an increase in burnout reported at 74% in health care executives.
I appreciated that Shannon set aside time for us to discuss and understand our challenges and have honest conversations. She wasn’t leading from the board room or the so-called corner room. She stepped forward, leaving behind her title, and was willing to be in the trenches with me, which inspired me to be “ME.” At the end of our immersion phase, she promptly announced a reboot for my practice and began working with me to rebuild the practice from the ground up. She won a high-energy player back because she treated me as an asset, not a commodity, was authentic, and invested in building a real human connection!
After the immersion phase, for continued interest and growth of both physicians and administrators, they must continue to experience the connection between what they do and what they care about, known as engagement. Gallup defines employee engagement as the involvement and enthusiasm of employees in their work and workplace, and only 15% of employees worldwide and 35% in the U.S. fall in the “engaged” category.
Shannon and I work as a dyad, pooling our talents together. Asking questions to each other such as “why do you think this is happening?” or “how do you feel about it?” allows us to actively participate in decision-making rather than having to follow the rules passively. While I discuss care delivery, she shares about resource allocations and policies, and together we work towards a shared vision to serve our patients. Although each has defined roles and responsibilities, we are flexible in helping each other. Shannon has given me autonomy and empowered me to make decisions.
Entrusting employees with greater autonomy, we expect a greater degree of satisfaction, fulfillment, and engagement at work because the outcomes are likely to be perceived as the result of their ability and help them perform better. Support for activities beyond patient care increases engagement as well. Physician engagement has become a key metric for health care leadership because engaged physicians are more productive, make fewer medical mistakes, and do not leave the organization.
In this article, we have proposed ways to prevent occupational distress due to relational breakdown. To transform health care, we need more leaders who can be authentic and establish real human connections with physicians! Arianna Huffington, in her newsletter, predicts that in 2023 executive roles for such authentic leaders will only continue to grow in importance – “given the people needs— including burnout, mental health, engagement, productivity, and retention.”