About two years ago, I had an experience that opened my mind to the wider possibilities of professional coaching. After interviewing one of its founders, I participated in the Novant Health Leadership Development Program, which involves small group coaching in a 3-day, off-site retreat. I saw that coaching can change individual clinicians’ lives AND organizations. When cohorts of physicians received formal coaching in small groups, the process eventually reshaped the organization. Physicians and staff became more collegial and more willing to talk about how they’re doing. And, because they had more energy and bandwidth, they started engaging in improvement and fixing system problems, creating an EHR optimization team, for example.
Before participating in the Novant program, I was steadfast in my belief that the only way to reverse the epidemic of physician burnout is to fix our broken health care system—the toxic culture, the inefficient processes, the work arounds, miscommunication, errors, gaps, and chaos.
Coaching, to my mind, was one of those individual solutions that organizations tend to throw first at the problem of burnout. Like mindfulness training, yoga, and meditation, coaching could help folks become more resilient to chaotic workplaces but it didn’t change the chaos. While valuable, it failed to fix the real problem. Or so I thought.
I love the idea of turning a negative approach to improvement in health care—looking for problems—on its head. Appreciative inquiry, a process of focusing on a group’s inherent strengths and fostering positive interactions among group members, is one way of fostering change with a positive approach. Positive deviance (PD) is another.
Basically, PD involves identifying what’s working and usual local solutions owned by the people involved to make improvements. According to Leading Change in Healthcare: Transforming Organizations Using Complexity, Positive Psychology, and Relationship-centered Care, a fascinating book I’m currently reading, PD was first developed as a way to address malnutrition in poor communities—by looking for children who were healthy despite the limited resources, learning what the mothers of these children were doing differently (the “deviance”), and creating opportunities for other mothers to practice these different behaviors.
What if we were to apply positive deviance to the problem of clinician burnout? What might that look like?
When I left clinical practice, I thought I was prepared for the change in my identity.
I was shocked by the degree to which my sense of myself and my value in the world were rocked by leaving the profession. After all, I left practice less than seven years after I could legally write M.D. after my name. In residency and when practicing (and even to some extent as a medical student), I had reveled in the admiration of people I met at social gatherings—without realizing it. When I introduced myself as a physician, strangers leaned into the conversation, their faces lit up, with questions that were brisk and enthusiastic. Later, when I introduced myself as a writer, the response was completely different. I might get a question about what I wrote or where I was published, but the energy was pretty lackluster. And I saw how much I had basked in the shininess of the physician identity.
Eventually, I learned I could be perfectly happy without the adoration of fellow guests at dinner parties. I saw that my value in the world is not defined by my title or job description, but by how close I come to being the kind of wife, mother, daughter, sister, writer, consultant, coach, community member, and world citizen that I aim to be. It’s about who I am and how I am, not my degrees or title or position or credentials. I wouldn’t have faced this question of my value in the world if I hadn’t experienced burnout and left clinical practice.
Or maybe I would have.
Many of the physicians I’ve spoken with who have tackled the question of whether or not to leave because of burnout have faced this same question of identity—and facing the question seems to be essential to their being able to make different choices in how they practice. The experience of two physicians immediately comes to mind.