How I am leading doctors through change


Here’s a leadership challenge: Get a group of highly independent, intelligent individuals to come together to build a boat.  But imagine the blueprint for that boat is vague and untested.  Now imagine that this boat must be built in choppy, progressively inhospitable waters, while said individuals are frantically treading water to stay afloat.  Convincing these smart people that there’s a problem isn’t the issue.  Convincing them to abandon their desperate and crucial self-preservation activities long enough to create a viable way out of the situation is.

The current practice of medicine is presenting on-the-job hazards not previously encountered. It seems that daily, physicians are challenged with yet another required change to the work they presently do.  We wonder out loud, “What is so wrong with the way I’ve been doing it all these years? How on earth did the field of medicine survive without an electronic health record, without measuring patient satisfaction, without data telling us how many patients followed through on recommended screening tests and without annual wellness visits?”

Three years ago I stepped into a leadership role in my organization because I wanted to help do something about physician burnout and help my colleagues navigate the changing landscape.  We have spent the last three years redefining our culture and figuring out what we need to do, not only to survive, but to thrive as we move from episodic patient care toward a model of population health management.  While I know we are making incremental improvements and our burnout scores have improved, my daily work is to champion projects and initiatives that present yet more painful change for my physician colleagues.  Knowing that the long-term impact of these initiatives on the group and those we care for will be positive does not make the implementation any easier.  Despite communicating a vision of the future that improves both the lives of physicians and the care of patients, the reality is that the pace of change is triggering a degree of stress and loss that can be overwhelming.

Referencing Ronald Heifetz’s work, Leadership without Easy Answers,  Dr. Jack Silversin writes in his book, Leading Physicians Through Change, about the difference between technical change and adaptive change.  In contrast to the straightforward and low-stress nature of technical changes, he describes adaptive changes as those that tap into loss, anger, disappointment and frustration which can lead to work avoidance.  Adaptive change lacks any roadmap defining the best way to achieve success.  It often comes with the need to think about things in a different way and generally requires a new way of interacting with one another.

The changes that physicians are facing in rapid succession are adaptive changes, creating a degree of stress that is contributing to frustration and burnout reported by over half of the physician workforce. Leaders need to understand the unique challenges of adaptive change.  I spend my days analyzing the big picture and anticipating what organizational competencies we need to develop next: Standardization of workflows? Care gap closures? Care management?  More pharmacists?  Primary care teams?  And if so, which team model is right for us? But figuring out the necessary new direction we must take is less than half of the challenge.  John Kotter, in his book Leading Change, makes the case that change won’t occur unless the pain of the current state exceeds the pain of change itself.  Establishing a sense of urgency for this change among physicians who are already struggling to survive the status quo often feels like a cruel joke.

The increasing volume and changing nature of our workload is another major source of stress and dissatisfaction.  Physicians want to care for their patients, not interact with computers and click boxes.  An obvious way to address this burden is to remove clerical and other non-physician work from our plate.  The problem is, work can’t be delegated unless it is standardized. Otherwise, there is no way to assess if that work is done correctly.  Standardization requires physician input and collaboration.  Collaboration requires engagement.  The opposite of engagement is burnout. And this is where the majority of the physician workforce is: burned out and treading water frantically, too focused on immediate survival to engage with their peers to build that boat.

As a leader, effectively communicating a promising vision is essential.  But convincing highly trained professionals that “change or die” is their new reality comes at an immediate cost.  The irony of the situation is that the pursuit of new solutions is creating an unprecedented sense of loss; loss of control and loss of the status quo.  The challenge is to acknowledge the denial and anger all of this change is generating while encouraging movement forward toward a better place, all the while knowing that you are likely the target of much of this anger, being perceived by your peers as the source of the change-generated stress.

I accepted this leadership role because I care deeply about my colleagues and their well-being. Competent physician leadership is needed in order to create a vision of the future and successfully navigate through this rapid succession of changes brought on by health care reform.  There is no going back. We’ve got to acknowledge the frustration, acknowledge the loss, and then focus on building the boat.

Karen Weiner is a chief medical officer.

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