On a sunny day in July, I dutifully ensconced myself at my desk and connected to a half-day National Academy of Medicine conference on burnout. All the speakers were interesting, but my ears really perked up toward the end of the event, when Jo Shapiro, MD, director of the Center for Professionalism and Peer Support and Chief of the Division of Otolaryngology in the Department of Surgery at the Brigham and Women’s Hospital in Boston and an Associate Professor of Otolaryngology at Harvard Medical School, spoke about the connection between leadership and physician well-being.
Her comments resonated with questions I’ve been contemplated a lot lately: What role do leaders have in addressing burnout among their physicians? And how do we compel them to do so, when they have so many conflicting priorities? Too often, leaders don’t seem to grasp the importance and severity of burnout, especially among their physicians. Most of the physicians with burnout whom I’ve interviewed describe little if any effective action from leaders to address the underlying causes of burnout.
I contacted Shapiro, who generously agreed to a phone interview. Here’s a recap of our conversation.
Q: What do you say to leaders and board members in health care organizations to encourage them to support changes to reduce physician burnout and increase well-being?
A: I tell them there are two basic reasons for providing the resources to improve wellness. First, it is the morally right thing to do. Physicians—our colleagues—are suffering. Second, it supports the outcomes they care about. Leaders care about patient safety and the patient experience. We know that burnout is associated with increased medical errors and less compassionate care. Leaders care about maintaining an effective workforce. We know that a toxic work environment has a negative effect on clinicians. We have evidence in health care settings and in other workplaces that the well-being of employees influences variables like morale, productivity, recruitment, and retention. When physicians leave, it is expensive to replace them.
Q: In your NAM presentation, you mentioned “respectful leadership.” What is it?
A: The essence of respectful leadership is cultivating trust with and among those you lead. It includes having transparent and relational conversations with the people you’re leading, conversations that provide a forum for dialogue and assure the people you’re leading that they’re being heard. It includes keeping health care’s mission of providing optimal care to patients at the forefront. It means not letting competing priorities always trump that mission. It also includes taking actions that show those you’re leading that you have their best interests in mind and take their perspective and needs into account when making decisions that affect them.
Q: Why should a leader adopt respectful leadership?
A: Being treated with respect is correlated with increased job satisfaction and decreased burnout. It is in the organization’s best interests to care about their workforce. Relationships matter. People matter.
Q: How can an organization foster this type of leadership style?
A: I think there are three basic actions an organization can take to enable respectful leadership. First, the organization can recruit into leadership positions people who have demonstrated relational skills. Second, the organization can build and support these skills once the leader is hired—providing professional development opportunities not just about managing budgets but about giving feedback, conflict resolution, fostering teamwork, and other relational skills. Third, organizations can hold leaders accountable for outcomes related to these behaviors. If they develop these skills but are held accountable only for budgetary activities and outcomes, that will serve to undermine the spread of this type of leadership.
Q: Who’s responsible for shifting to respectful leadership?
A: Adopting respectful leadership is the responsibility of the top levels of leaders at an organization, plus members of the board. Both groups need to ensure that these leadership skills and values are part of the equation in hiring and compensation of the organization’s leaders. In some cases, these groups need education about clinician burnout. I recently spoke with an accountant who coaches health care leaders and has sat on several hospital boards. He had no idea burnout was so widespread and such a significant problem. Leaders and board members need to know it is not just “physicians whining,” it has serious implications for their organization, and there are steps that leaders can take to address it. We need to get that message out.
Note: if leaders need more specific suggestions on steps to take, the Mayo Clinic has published data showing which leadership behaviors are associated with lower rates of physician burnout.