Reduce Physician Burnout and Increase Collaboration Where It All Begins: In Medical School!

“Burnout” in healthcare has reached epic proportions.

Progressive organizations such as The Cleveland Clinic have gone beyond most healthcare organizations, who are still struggling to even define and identify the conditions leading to physician burnout. They’ve actually made an organization-wide cultural commitment to preventing (not just reacting) to potential burnout using a crisis intervention model called Code Lavender, with timely support given at all levels of leadership and staff. It’s a model yielding impressive results (although one observer stated most of the codes were for nurses, rather than physicians – but that’s another post!).

We applaud this effort and ask: what if we applied a proactive approach to where burnout begins in medical school?

Medical students must have training in leadership from their first year of education.

 

Physicians who are social media contributors, most notably at KevinMD, are consistently raising red flags of warning regarding how the medical school and resident expectations set physicians on the path toward burnout (and decrease patient safety). Most agree it will take much more than changing the MCAT to transform the “lone expert” model historically rewarded by medical schools. In Things we should be teaching in medical school, but aren’t, Dr. Alexandra S. Brown states 4 essential elements currently missing from the average medical school curriculum:

  1. The current financial state of US Healthcare
  2. The tremendous variation in how we practice medicine
  3. Quality controls cost
  4. It’s impossible to keep up

 

PLI supports all of Dr. Brown’s suggestions for adding to the med school curriculum, but it’s #4 that best communicates what’s wrong with medical school: medical students aren’t told, nor ever allowed to admit, they feel “it’s impossible to keep up”.

At PLI, we ask:

  1. What does society stand to gain by upholding an impossible standard for medical students, residents, and physicians to Know All and Be All, achieve singular excellence, and ignore that they as humans need other humans to succeed?
  2. Why do we as an industry still allow this traditional med school recipe to produce clinicians, only to watch highly capable ones crash and burn, at times blamed for “not being cut out for the job”?

The med school message of “individual infallibility equals excellence” must be named and ended. Certainly, the stakes are high, and that is how this tradition of unrelenting stress on individual clinicians was born. Yes, the success of an individual physician can literally be a matter of life and death for a patient, and that cannot be understated. At PLI, we say this is all the more reason to equip med students with self-awareness, leadership, and collaborative skills, from their very first year, that will enable them to thrive (not just survive) during medical school and beyond.

 

So what will this look like?

Research shows medical students show an alarming drop in empathy, a critical component of “emotional intelligence,” between their first and third year of training. This must be solved for. The “broken covenant” in healthcare further increases this cynicism in physicians, sapping the motivation needed for collaboration, patient-centric care, organizational commitment, and leadership qualities, and ultimately, leads to burnout.

It’s now time to ask deeper questions about changing the entire culture of how physicians are prepared, both in clinical and non-clinical capacities.

An integrated approach is needed for medical schools and residencies integrate physician leadership into their curriculum. We strongly recommend the adoption of a PLI Leader-ist Med School Model:

PLI Leaderist Med School Model

This is just the beginning of the conversation and change effort that must happen. It’s not just the admissions committees and College of Medicine presidents that own this problem and its solution: it’s all of us.

We applaud the physician leaders who are getting the word out about what’s missing in medical schools, residencies, and fellowships, and how providing leadership development from the very start can create a collaborative culture and help stem the tide of physician burnout. We also applaud the American Medical Association – Residents & Fellows initiative to increase wellness among physicians in training for their surveys and other support efforts.

 

We are here to support the physicians of tomorrow.

The framework of a medical school curriculum will have to become one of personal, as well as professional, transformation. Healthcare now has enough specialists, we need more Leader-ists!

Write to us directly or join the conversation with us on Twitter @MD_Leaderist and #changemeded

Teach Communication Across Your Organization to Reduce Burnout and Increase Collaboration

Do physicians in your organization walk into a meeting blaming everyone else about an issue? Or do they come in and say, “Let’s identify the solution together?”

 

The former blame game is a symptom of the lack of collaboration and alignment between the physician and the organization. In addition, such communication that includes blaming and “venting” actually increases, rather than decreases, the risks of stress leading to burnout.

In many conflict style assessments, physicians tend to fall into one of two: they either completely avoid conflict, or confront it like a bull in a china closet. Physicians, in their medical training and credentialing, are often given no exposure to productive and healthy conflict resolution. This results in either avoidance behavior (where nothing productive happens) or a confrontational style (where things may get done but everybody’s angry). Both communication styles block team building and organizational alignment.

So what can be done?

You can reduce burnout and increase collaboration across your organization by teaching COMMUNICATION.  

To help guide physicians on their journey to leadership, the American Hospitals Association published a comprehensive guide called Physician Competency Development (PDF).

This AHA competency set is a valuable tool providing a framework for assessing and supporting physician leaders in their communication skills development. Their analysis shows common gaps in critical areas of communication for physician leaders:competency gaps

Note that the most frequent gaps for physicians appear twice under “interpersonal and communication” skills!

 

So, if “knowing” this need for interpersonal communication skills in healthcare is half the battle, what’s the other half?skills required

The AHA cites evidence that “members reported success with using 360-degree feedback” to work through these gaps. 360 assessment provide a mirror into which physicians can see how they perceive themselves versus how they are perceived by others. This self-awareness is the first step toward the development of the skills required for the next generation of care delivery.

At PLI, we use evidence-based tools like the 360 to assist physicians in getting started, but we take it much further! We go beyond awareness so they can create a personal communication strategy, take action, and get results.

During this deeply reflective work, we assess and coach physicians to know:

  1. strengths and weaknesses
  2. work style
  3. how well they work with others
  4. what their personal values are
  5. and in what areas they can contribute the most

The feedback we receive from participants in this process, and the outcomes we have seen from their investment of time and energy, continue to impress and drive us forward to serve more physicians in this way!

Physician Leader CommunicationSkills

 

Now, we’ve covered physicians. But what about the communication required on an organizational level to decrease burnout and increase collaboration?

While this is a topic for another post, we at The Physician Leadership Institute encourage organizations to start now by 3 crucial questions:

  1. How are you getting your physicians aligned with the mission, vision, and values of your organization?
  2. How are you a showing commitment to getting physicians engaged and feeling ownership each day for bringing that mission to life, within themselves and their teams?
  3. What is your deliberate strategy to channel this alignment and engagement into transformational opportunities for physician leadership?

In our work at PLI, we find the organizations that succeed are those who foster strong relationships between physicians and other staff members, starting at the top. They use these 3 questions establish a shared purpose with common goals like improved patient satisfaction and clinical outcomes.

Most importantly, they increase physician engagement and decrease the risks of burnout through open communication and trust between physicians, administrators, and staff at every level.

Need help getting started on opening the lines of communication within your organization to increase collaboration and decrease the risks of burnout? We would love to hear from you!

Teach Relationships to Reduce Burnout and Increase Collaboration

Physicians are trained to DO

In the ever-changing field of healthcare, there are consistent, specific weaknesses that must be addressed: being empathetic and building relationships has not been historically emphasized in medical school, residency, nor in practice.

The paradox is the “expert” culture that has been created in healthcare is often in opposition to the collaborative culture that is required to actually succeed in meeting care, cost, and quality goals.

 

At the heart of the issue is a rampant inability of physicians to appreciate the role of others in their success; they’ve been trained to be solo superstars, not to build collaborative teams.   Physicians tend to focus their energy and time on clinical problem solving and dealing with the increased demands for documentation and performance; leaving less (if any) time for building relationships with their peers, clinical team, and administrative team. And yet it is relationships that are essential for building trust and high retention rates on clinical teams, which lowers the risk of burnout.

The Physicians Leadership Institute is fortunate to work with both established and up-and-coming physician leaders. What we repeatedly find present in the success of these leaders is illustrated by a recent interview with the MGMA CEO, Halee Fischer-Wright, MD,  conducted by Becker Hospital Review: it all comes down to RELATIONSHIPS!

Highlights from their interview:

Q: What are some of the most important lessons you’ve learned from your past experiences practicing medicine, managing a physician group and serving as a CMO? How do these influence your approach/strategy at MGMA?

HFW: Every important lesson that I’ve learned in the multiple different settings that I’ve been in every capacity have taught me that everything is about relationships. If you’re having problems, it’s about your relationship. If you’re doing well, it’s about the relationship. If your organization is thriving, it’s about the relationships within the organization and the culture. It doesn’t matter what iteration when I reflect back, but what I would say is that medicine is a customer service business, and we are in the business of relationships. It doesn’t matter if you’re a staff member, physician or administrator, or if you’re running a large healthcare association with 33,000 members, it’s about the relationships.

Q: What is the most memorable piece of advice you have ever received?

HFW: My mom always said, no matter what, do your best. What I think about most is that I have this amazing organization with 115 employees that has been relatively quiet for five years. How do I help to create — because I can’t do it myself — an organization that is the best place to work and inspires people to be their best and change healthcare? I know I can’t change healthcare without creating the best place to work. What I think about day in and day out is how can I create a place where people give their discretionary effort and feel fulfilled and happy in the work that they do?


PLI logoThis is the same message we at PLI have heard in our own interviews, most notably with The Iowa Clinic’s C. Edward Brown:

Q: How does your organization create alignment between strategy and execution?

CEB: The Physician Leadership process has strengthened our culture, and improved our ability to adapt to change because we have “physicians leading physicians.” We have dramatically improved our internal capabilities. There are so many change imperatives and initiatives that our folks have had to embrace and through this process our physicians have learned that “culture eats strategy for breakfast.” When physicians develop answers together, they build solutions even as they strengthen their own relationships amongst each other. They believe in the objective because they own it.  The ability to execute becomes exponentially greater when you have a strong bond of trust in a common culture, with a common way of approaching challenges and opportunities.

 

Daniel Kollmorgen, M.D., is the medical director of the John Stoddard Cancer Center, as well as a practicing Iowa Clinic surgeon and PLI Fellow. Dr. Kollmorgen provided his insight regarding leadership and relationship skill building:

My key takeaways from the Physician Leadership Institute experience were that leadership is about listening, relationships, and self-awareness. These skills are not necessarily developed or maintained in our practice of medicine. I believe the future of medicine will depend on us as physician leaders who can look beyond their daily routines, understand and apply leadership concepts in patient care, administrative roles, and in our personal lives.

Q: How does physician leadership impact work performance? Have you changed how you behave?

DK: I think empathy from a leader is as important as command and control. When I’m in the OR, it’s the captain-of-the-ship model, the buck stops with me. But I’ve learned the importance of relationships; being correct every time is not as important as maintaining relationships.

Relationships build success for the long run. How do you help others get to their goals? In the leadership class I learned about myself and how I’m perceived, and it’s not the same for everyone. I became far more aware of how others perceive me, getting feedback on how my actions impact the team.

If physicians want to maintain or have any say in the future direction of healthcare, they are going to have to see the bigger picture. If you can’t lead, engage and participate, you’ll become just a cog in the wheel. I think that physicians know what’s best for the patients and that without physician leadership we won’t be able to make our voices heard. Physician leadership can eliminate barriers between disciplines and the administration. Again, the importance of relationships cannot be stressed enough.

After attending the Physician Leadership Institute, Dr. Kollmorgen’s stated: I now admit that listening is the #1 leadership skill… Soft stuff is my weak spot… Life is about relationships… I want to live in an enlightened state, not just someone who has the wisdom, but someone who has a big picture view.

 

At The Physician Leadership Institute, we teach skills that result in effective, trust-based relationships.Communication skills

A true physician leader is dependable, treats others with respect and builds trust through everyday actions. The physician leader relates well to people at every level by showing consideration and empathy. His/her attitude and demeanor motivates fellow workers and colleagues.

 

As illustrated through these interviews with physician leaders and our additional conversations with many more, those who develop relationship skills can create, and then communicate, a purpose that inspires, engages, and influences people to collaboratively deliver tangible results. It is through relationships that trust is built, high retention rates are realized, and the risk of burnout is nearly eliminated.

 

We look forward to hearing from you about how you are developing relationship skills in your healthcare community!

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To learn more about solving burnout through physician leadership, visit https://physicianleadershipbook.com and our series of prior blog posts:

Teach Physicians to Lead Others to Reduce Burnout and Increase Collaboration

burnoutIt’s well known that the healthcare industry suffers an extremely high rate of burnout relative to the general population. Much has been written about how doctors need to find meaning in their work in order to remain engaged in their organization’s mission. Common wisdom states that without such meaning, the risk of burnout runs high.

But did you know that a far greater risk of burnout comes from physicians being led by incompetent leaders?

 

Over 75% are now employed by large healthcare organizations, requiring sacrifices in their prior autonomy and a new level of accountability to large-scale organizational leadership.

We see the challenges of this transition playing out across social media, including blogs like  “Confessions of a burnt-out physician” by Anonymous Pediatrician on KevinMD:

“As a part of the middle management administration at my health care organization, I sat in meetings week after week where the physicians in the organization were referred to as “lazy, whiny, irresponsible, and unmotivated.”  I gazed through the picturesque windows in the large administrative offices and chuckled at the irony that money is too tight to upgrade or expand space in clinics to improve the workplace environment.  I seethed quietly as I listed to the mantra that we need to see more patients, more efficiently, and work longer hours as if I were listening to the drumbeat at a funeral march.”

“The articles on physician burnout cite the need for physicians to develop coping strategies to deal with the daily stressors incurred in the office.  I think it is not only a physician’s responsibility to take care of ourselves, but the scaffolding of the health care system needs allow for practices that will sustain those of us at its very core.”

Mayo Clinic Proceedings

Mayo Clinic Proceedings – Click image for full report

 

 

In a recently published study by the Mayo Clinic, entitled Impact of Organizational Leadership on Physician Burnout and Satisfaction, nearly 3,000 physicians were surveyed regarding their supervisors’ effect on their wellbeing. 

The finding of this study are essential reading for those seeking to reduce burnout and increase collaboration in healthcare. You will note that within the Mayo Clinic study, “all supervisors were themselves physicians/scientists.” There is absolutely a dearth of physicians trained as leaders who can contribute to the organization’s strategic vision and use their clinical skills along with leadership expertise to communicate that vision.

Click here for a video of the Mayo Clinic faculty member and lead author, Tait Shanafelt, M.D., introducing this important study:

Dr. Tait Shanafelt

 

 

 

 

 

 

 

 

 

Be sure to review the study’s “Discussion” section, which should be taken to heart by every healthcare leader!

So what can be done to decrease physician burnout from poor leadership?

 

At The Physician Leadership Institute, we know that leading physicians is not easy. Advancing a highly successful clinician to a leadership role requires so much more than public accolades and a promotion. It is essential for physicians to be formally trained as institutional, service line and front line clinical leaders, specifically on engaging and communicating well with others. Without this, frustrations will run high for both the leaders and staff and a negative feedback loop is set in place, one that affects costs, quality of care, and turnover.

A tool called the Maslach Burnout Inventory defines burnout as a three-dimensional syndrome made up of exhaustion, cynicism, and inefficacy. But Maslach also defines the antithesis of burnout as engagement. Engagement is characterized by energy, involvement and efficacy.

We know through our first-hand experience, across the multitude of our client partners, that engagement is made possible through well-trained physician leaders! Creating a culture of engaged physician leadership results in a lower risk of burnout, greater care coordination, and shared accountability for cost and quality outcomes across the organization.

 

The PLI Physician Leadership ModelPLI Five Disciplines of Leadership

At the Physician Leadership Institute, we examine the personal, organizational, and socio-cultural interventions necessary to address physician burnout and increase collaborative engagement through the use of our Physician Leadership Model. This deeply transformative training includes:

  1. Reconnecting physicians with their purpose of WHY they are in medicine
  2. Dealing effectively with difficult situations and having courageous conversations
  3. Managing personal productivity
  4. Engaging and influencing others
  5. Maximizing effectiveness in team communications and productivity

 

As demonstrated by the Mayo Clinic study, the impact of workplace culture on burnout levels cannot be overstated. (Click for study Conclusion)

“The leadership qualities of physician supervisors have a direct effect on the personal well-being of the physicians they lead. These findings have important implications for the selection and training of physician leaders. The results also provide new insights into organizational factors that impact physician well-being.”

 

We at The Physician Leadership Institute could not agree more.

We invite you to contact us and share how you are implementing strategies to decrease burnout and teaching physicians to lead others in your organization!

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Reference:

Impact of Organizational Leadership on Physician Burnout and Satisfaction

Tait D. Shanafelt, MD, Grace Gorringe, MS, Ronald Menaker, EdD, Kristin A. Storz, MA, David Reeves, PhD, Steven J. Buskirk, MD, Jeff A. Sloan, PhD, Stephen J. Swensen, MD

Mayo Clinic Proceedings Volume 90, Issue 4, Pages 432-440 (April 2015)  DOI: 10.1016/j.mayocp.2015.01.012

 

To learn more about solving burnout through physician leadership, visit https://physicianleadershipbook.com and our series of prior blog posts:

Congratulations to The Class of 2015 Clinician Leadership Institute at TriHealth!

These graduates began their journey to transformational leadership in 2014 and have now demonstrated the skills to Lead with Purpose, Lead Self, Lead with Strategy, Lead People, and Lead for Results!

TriHealth Grads 2015

 

About TriHealth

Bethesda North and Good Samaritan Hospital joined together to form TriHealth in 1995, bringing together two of Cincinnati’s finest health care organizations. Through these two acute care hospitals and more than 130 sites of care, TriHealth provides a wide range of clinical, educational, preventive and social programs. TriHealth’s non-hospital services include physician practice management, fitness centers and fitness center management, occupational health centers, home health and hospice care.

 

About The Clinician Leadership Institute at TriHealth:

With a commitment to creating a model leadership development program for its physicians and staff, TriHealth engaged the Center for Transformation and Innovation to deliver a comprehensive leadership transformation program: The Clinician Leadership Institute at TriHealth (CLITH). The goal of the CLITH is to produce the next generation of transformational leaders, and to provide the leaders with the skills necessary to make a lasting impact on the organization. Its focus is to identify and develop high potential leaders by growing and improving their ability to lead TriHealth in fulfilling its mission.

 

The Approach

  1. Customization and Alignment: CTI studied the TriHealth mission, vision, and values, as well as current and potential future challenges, the organization’s strategic imperatives, healthcare trends. From there, a personalized Leadership Success Profile (LSP) was created that contained leadership competencies and behaviors.
  2. Assessment and Baseline: A confidential, online 360° Assessment was performed to provide feedback on the participants’ leadership competencies and behaviors from multiple perspectives that include ratings by a manager, peers, key stakeholders, direct reports, and a self-rating. The 360° Assessment identified the individual and the group top strengths and leadership development needs.
  3. Customized Curriculum: Based on the group development needs identified in the 360° Assessment, a curriculum was customized over monthly sessions via a variety of teaching modalities were used to ensure high participation and engagement.
  4. Coaching: Participants were matched with business coaches based on their 360° Assessment results. Coaches helped them construct personalized development plans. Throughout the engagement, they had meetings and phone calls every other week to work on specific development actions.
  5. Strategic Action Projects: To maximize leadership potential, collaborative skills, and to apply leadership learning, Clinician Leadership Institute at TriHealth and CTI initiated strategic action projects. These projects included an executive sponsor (project champion), and a project coach. The projects were strategic in nature and impacted the TriHealth culture, future direction, and service line optimization.

 

Tangible improvements were seen in the participants’ ability to effectively lead by example, drive results, develop internal teams and collaboration, lead change and foster innovation, think strategically and make sound decisions, manage conflict, and communicate with and influence others.

 

 

The Clinician Leadership Institute at TriHealth was a transformational journey that enriched the participants at a personal and professional level, and in turn, benefits the organization and patients they serve. The institute served as TriHealth’s ongoing commitment to excellence in healthcare through the investment and development of physician and healthcare leaders. Again, we extend a warm congratulations to the graduates of 2015 and look forward to their continue success!

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