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…
Earlier this week, I was asked an intriguing question by an interviewer: “If you had a magic wand and could have one wish for improving the well-being of clinicians and addressing burnout, what would it be?”
My response? Respect. Respect for the humanity of everyone who touches the health care system—patients, family members, administrative staff, organizational leaders, clinical staff, clinicians, cleaning staff, parking valets, pharmacists, lab technicians, front desk staff, and the folks who answer the phone and help with appointment scheduling.
My answer was not really a fair one. I believe that respect of this sort triggers a wide array of improvements and is only possible on an organizational level when all sorts of other support structures are in place and working well. So it was cheating on my part to choose one wish that encompasses many.
If we truly respect the humanity of everyone in health care, how would this change our approach to clinician well-being?
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.