Many leaders of health care organizations are navigating tricky waters these days. Most now recognize that clinician burnout is a problem but are unsure what to do about it. Some avoid surveying clinicians because they don’t want to unearth problems that seem impossible to fix. Others schedule a resiliency retreat or mindfulness training. Individual solutions like these are a great start but if leaders go no further in addressing the systemic problems, they may face backlash from physicians who are angry at the implication that the problems they face are of their own doing.
Given how difficult it can be for organizations that have acknowledged burnout among their clinicians to determine how to address it, I was intrigued to hear how one physician leader, Chief Physician Experience Officer and Executive Medical Director for Patient Experience at UCSF Medical Center, Diane Sliwka, MD, has steered this largely uncharted path.
Did leaders adapt best practices from other academic health systems and institute them at UCSF? Did they pick a handful of specific interventions to try? Did they offer the standard individual-based solutions? Did they attempt to identify and address the systemic causes of burnout? And, of course I wanted to know what kind of results they’ve seen.
Recently, I had an opportunity to drop in on two of the foremost researchers in physician burnout, Sara Poplau and Mark Linzer of Hennepin County Medical Center in Minneapolis. We chatted about various aspects of the current burnout crisis and exciting new initiatives on the horizon. Then we spent some time contemplating a frustrating truth: leaders in health care often fail to acknowledge a reality that leaders in other industries have long embraced: treat your employees well, prioritize their wellbeing and safety, and you will reap benefits in your most important performance goals. It’s a proven strategy for success.
But try to convince board members and the C-suite of a hospital, health system, or large physician practice to free up the resources to prevent burnout and you may find yourself out of breath and red in the face. Despite the fact that burnout costs so much—more medical errors, worse patient satisfaction, less engagement in improvement initiatives the direct costs of recruiting and replacing physicians and nurses who have left—few leaders are ready to invest in prevention. We shook our heads in collective dismay.
Linzer walked to his desk and held up a framed watercolor. Painted by Linzer’s brother, Daryl Wofford, “The Scribe,” depicts three individuals in an exam room: on the right side, a physician and a patient in conversation, and on the left, a young man typing on a laptop.
“This is our goal. This is what we want.” Linzer said. “A physician, freed from typing by the scribe, who is connecting with her patient—and a patient, who is happy because she is getting what she came for—a healing connection with her care provider. Relationships drive satisfaction. And that’s true for patients and care providers.”
I asked about the scribe program at Hennepin County.
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.