When my co-author and I interviewed Christina Maslach, PhD, social psychologist and professor emerita of psychology at the University of California, Berkeley, for our book, I was struck by her observation that of the six domains she and her colleagues had identified as drivers of professional burnout, one seemed to be the most potent. It was community. She told us that workers who feel like their team mates or peers “have their back” are less likely to experience burnout, whereas workers in a toxic, competitive environment are at significantly higher risk. Interesting, but how do we build work environments that embody community? I recently learned about an innovative program to do just that.
​
Sunit Mistry, MD, a pulmonologist and assistant area medical director at Kaiser Permanente South Bay in Southern California, a 500-physician medical center, was inspired to launch a collegiality initiative after he personally experienced the downstream effects of an ineffective connection between physician colleagues. Weekends that a certain rather unhelpful colleague was on call, Mistry would arrive on Monday to find an onslaught of new cases. Referring physicians had delayed calling for a consult (and their patients’ care was delayed) because he or she didn’t want to tangle with that particular physician. Mistry was told, “I will never consult that doctor again…they always yell at me.” Hence he began searching for ways to bring collegiality back. 

Health care organizations are moving to address clinician burnout with a real sense of urgency. It is now commonly accepted that burnout is widespread among health care professionals and has serious repercussions for patient safety and the quality of care. A report released last week by several major Massachusetts health care organizations labeled the situation “a public health crisis” and warned about the adverse impact “on the health and well-being of the American public.”

And though there is currently little evidence about how to effectively tackle the problem, the experience of hospitals and physician practices with various initiatives – and the lessons learned – provide a roadmap for beginning to address a crisis that is having a profound effect on the health care system.

While the term “burnout” is often used informally to indicate fatigue or boredom, it has been defined by psychologists as including three components: emotional exhaustion, depersonalization, and inefficacy, or a low sense of personal accomplishment in one’s work. 
​
The definition may be relatively clear, but there is little agreement about how to identify individual clinicians with burnout. The most commonly used survey tool was developed for research into causal factors, not for the diagnosis of burnout in individuals and the term burnout is often loosely used to include other associated but distinct conditions, such as depression, professional dissatisfaction, moral distress, and substance misuse. As Steven Adelman, M.D., Director of Physician Health Services in Massachusetts, notes, “Several different diagnoses have been conflated into the term ‘burnout.’ The word is often used as a catchall.”

I was intrigued when I read in Beyond the Wall of Resistance by Rick Maurer about Douglas McGregor’s theories on leadership. (Apparently, McGregor wasn’t the first to put forth these theories, but was the first to name them, back in the 1950s.)  McGregor was a social psychologist interested in how human factors affected organizational behavior and organizational outcomes.

In short, McGregor’s work described two approaches to leadership. Theory X maintained that workers need to be led. That without tight oversight, workers will become unmotivated, unambitious, and resistant to change. In contrast, Theory Y put forth that workers were not passive and under the right conditions, the average adult will accept responsibility and engage in work with creative energy.  

McGregor described the difference between the two approaches this way, “Theory X places exclusive reliance upon external control of human behavior, whereas Theory Y relies heavily on self-control and self-direction. It is worth noting that this difference is the difference between treating people as children and treating them as mature adults.”

Theory X dictates the need for a dictatorial style of management. It’s the old “top-down, mandating” type of leadership that is about control. It fuels a lack of engagement and fails to extract the full potential of employees and of the collective whole. Theory Y treats workers with respect and engages them fully in their work.

From my observations, Theory X seems to be a lot more prevalent in health care. And there is evidence it contributes to clinician burnout. A 2015 Mayo Clinic study showed that certain behaviors of leaders predicted a lower risk of burnout among physicians. These behaviors, such as “Encourages employees to suggest ideas for improvement,” are consistent with Theory Y.
​
Where can we find theory Y? There are a number of leadership philosophies that embrace it. For example…