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.
As a physician who left clinical medicine because of burnout and as a writer, I’m drawn to stories of physicians whose professional and personal lives have improved after reasoned interventions. So my ears jumped to attention earlier this month when a colleague at a summit on physician burnout described the positive results his practice had achieved in reducing burnout. Read Pierce, MD, is interim director of the Hospital Medicine Group (HMG) and is the associate director of the Institute for Healthcare Quality, Safety and Efficiency at the University of Colorado.
Leaders in HMG, a hospital-based internist group that includes 85 physicians, physician assistants, and nurse practitioners, conducted a detailed survey three years ago as the first step in an effort to better understand the existing culture at work. The survey gathered information from frontline clinicians on engagement, satisfaction, burnout, mentorship, safety culture, and other topics. Results indicated that 45 percent of clinicians were experiencing some degree of burnout. Initially, leaders were unsure how to respond to the results, but they made a firm commitment to action, in part based on frustration with prior institutional surveys in which similar challenges were identified but little definitive change followed.
Pierce told me that the group sifted through the data and brainstormed on possible interventions. Over time, they chose 13 (an interesting number!) to take on. Here are three of them…
My co-author, Paul DeChant, MD, MBA, and I had the privilege of presenting a workshop at the Institute for Healthcare Improvement’s Annual Forum in early December with Stephen Swensen, MD, medical director for Leadership and Organization Development at the Mayo Clinic.
I was so intrigued by the work that the Mayo Clinic is doing to prevent burnout and restore joy among the work force. I’ll mention here three of the strategies that Swensen described: one overarching approach and two more focused initiatives.
On the large scale, Mayo Clinic has focused intently on the quality of leadership throughout the organization. Every physician rates his or her direct supervisor on a 12-item scale, agreeing or disagreeing with statements such as “My supervisor empowers to do my job” and “My supervisor is interested in my opinion.”
Leaders who rank in the lowest tier are provided with additional leadership training. Those who remain in the lower ranks after training are removed from direct leadership responsibilities.
Why so much focus on leadership? Several reasons, according to Swensen, including the fact that Mayo Clinic research has demonstrated increased rates of burnout among physicians supervised by leaders who score lower on this metric.