The National Academy of Medicine has launched an Action Collaborative on Clinician Well-Being and Resilience, but there is one missing stakeholder. On July 14th, NAM hosted its first public meeting on establishing clinician well-being as a national priority. The inaugural sponsors include nearly many medical specialty societies, the major insurance companies, the American Associations for hospitals, nurses, physicians and medical colleges, Johns Hopkins, Mass General and my employer — IBM Watson Health. It is great to see the growing recognition of clinician burnout as a problem and the growing collaboration between multiple stakeholders. The missing stakeholder is the The American College of Healthcare Executives (ACHE).
Why am I concerned about the absence of health care executives in the early stages of this effort? Reducing burnout in the health care workforce will take resources. The executives in the C-suite control the resources — the staffing, time and money — that are needed in addressing this complex problem.
The cause of burnout develops when a highly motivated professional, particularly in a caring profession, is placed in a workplace that is so poorly designed, it is difficult to succeed without heroic effort — without “going above and beyond.”
In health care, there are significant issues with:
- the nature of the work itself — requiring in-depth knowledge, critical reasoning and dealing with life and death
- the culture of medical training — historically a “blame and shame” approach in which bullying was thought to increase student commitment to learning
- connection to purpose — doctors’ and nurses’ passion to provide high-quality care to their patients
- workplace dysfunction — broken workflow processes that frustrate clinicians and make it difficult to stay connected to purpose
- changing external demands — that have grown significantly in the past 10 years
The most important of these is the workplace. Most hospitals and clinics are designed in a way that clinicians face growing barriers and frustrations as they strive to provide excellent patient care. Removing these barriers and frustrations is the hardest change to make and the one that has received the least attention until recently.
Burnout impacts executives
It’s not easy being a C-suite member in a hospital or health system. Many experience burnout themselves. Recall that burnout manifestations as defined by Maslach include:
- emotional exhaustion
- cynicism (depersonalization)
- lack of sense of self-efficacy
There is likely not a day that goes by that some member of the C-suite in every hospital does not experience one of the above.
Clinician burnout also directly impacts executives ability to succeed. Clinicians who are exhausted, cynical and feeling low self-worth as they struggle to care for patients with the levels of quality, safety and personal caring that drive hospital performance metric success.
As work-life balance worsens, clinicians are reducing their workloads to maintain some personal control, which has a direct impact on a hospital’s net revenue. Most health systems work on a narrow operating margin, so a small percent decrease in revenue can have a large impact on net income, making it harder to keep the hospital financially solvent.
The missing stakeholders are missing the most important factor in burnout
Most executives don’t realize it, but they have the most important role to play in fixing the most important cause of burnout. Operations are ultimately the responsibility of the leaders of the organization. If operations are dysfunctional, the workers will try to fix things but rarely succeed without support. Middle managers are the closest to the front line challenges. They often try to provide support to the front lines, but without getting support from those they report up to, they struggle as well. Executives are that missing stakeholder.
The C-suite has the ultimate power to ensure that managers have the support they need to properly support the clinicians at the point of care as they work to solve problems and remove barriers to quality patient care. The interesting thing is, the C(X)Os don’t have to have the solutions to the problems. In fact, it’s best if they don’t. They simply have to develop a management system and culture that empowers the front line workers to solve their own problems. Doing so addresses the classic drivers of burnout:
- work overload
- lack of control
- inadequate reward
- breakdown of community
- absence of fairness
- mismatch of values
While executives worry about physician engagement, the real opportunity is executive engagement. Executives are still the missing stakeholder.
Paul DeChant is a health consultant who blogs at Preventing Physician Burnout through Lean Done Right.
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