In this post, I'd like to dig a little deeper into the concept of management as the root cause for burnout in the information age. This is not to blame executives for clinician burnout, but to explain how it is hard to truly improve burnout unless we change:
the way we do things around here - a common definition of culture, and
how we lead - moving from top-down to servant leadership
Burnout comes from putting highly motivated individuals (doctors and nurses) into a clinical workplace that is so poorly designed that it is nearly impossible for clinicians to provide safe, high quality care without being constantly vigilant and focused.
We clinicians are good in situations requiring vigilance and focus, but we also need time to let our guard down and recover. Constant vigilance is unsustainable and damages clinicians, resulting in burnout and its sequelae - depression, substance abuse, family dysfunction, and suicide. Physiologic studies show it negatively impacts brain and cardiovascular function.
Who is responsible for the conditions in the workplace that require such vigilance? It's the people who control:
The budget
Staffing
Equipment and supply purchases
IT and EHR services
Hiring, and
Process improvement
Ultimately, it's the CEO and direct reports in the C-suite. A key problem is that as healthcare has become more complex, management processes have not kept up. So we see the use of industrial age management techniques in a rapidly changing clinical workplace that has moved well into the information age.
Industrial age management focuses on controlling the way workers do their jobs, with best practices designed by the administrators who "know best" how a job should be done and expect workers to follow their instructions. The workers are little more than human machines.
Now in the information age, our clinical environments are complex and rapidly changing, to the point that no one person can possibly know what the best practice should be in all cases. In fact, as the famed management guru Peter Drucker said, "Health care is the most difficult, chaotic, and complex industry to manage."
So, how does an executive effectively manage in the information age? There are many ways the approach has to change:
Top-down directive management does not work. Those doing the work know best what works and what doesn't. Information age executives must approach their clinicians respecting that knowledge, empowering clinicians to make changes that can fix local problems.
It's impossible to understand the challenges in the clinical workplace simply by reading reports and analyzing spreadsheets. Information age executives must get close to the work, shadowing clinicians and attending front line problem-solving huddles in order to deeply grasp the challenges their clinicians face.
External conditions change so quickly we must change the way we collaborate. Aligning everyone in the organization around common goals is more important in the rapidly changing information age. Leaders are more successful when they clearly identify and communicate key metrics, ensuring that the clinicians understand their impact on metric performance.
Such an approach directly addresses the drivers of burnout:
Work overload is reduced by redesigning workflows.
Lack of control is reduced as clinicians gain the ability make changes that address their pain points.
Inadequate reward is addressed by the respect leadership shows clinicians when they are given authority over their workplace.
Breakdown of community decreases as people work in teams, solving problems in huddles, and redesigning workflows with a group collaborating over 3-5 days.
Fairness improves when people collaborate and treat each other with respect. (Respect for people is the first of the two key principles of Lean.)
Values conflicts dissipate when leaders clearly define, communicate, and honor the organization's vision, mission, and values.
If you are a leader and are not sure where to start, act like a physician. Diagnose the situation by doing a workup and develop a treatment plan. We can help you with our approach.
If that sounds like a bit much, start by shadowing a doctor or a nurse, to see the reality of their challenges. I guarantee you that you will learn something you were not aware of.
If you are a clinician, invite a leader to shadow you.
These options are the first steps to making real change, and healing healthcare organizations.
I'd truly appreciate your thoughts on this issue. Feel free to leave a comment.
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