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.
The result was the Kaiser Permanente South Bay Physician Collegiality Program. The core of the program is a four-hour workshop that brings together physicians from two departments that regularly work together—the emergency department and orthopedics for example. The workshop is held during the monthly dedicated group education time and attendees receive CME credit for attending. Prior to the workshop there is a one-hour prep meeting in which Mistry, the chiefs of the two participating departments, and Shefali Mody, MSOD, a leadership development consultant, identify examples of less-than-collegial behavior, which are used to create case studies.
At the beginning of each workshop, Mistry explains the why underlying the program by sharing his personal story about the effects of lack of collegiality or asking one of the chiefs to tell his or her story. Shefali Mody, then presents learning tools, such as a model for understanding the causes of dysfunctional teams. Next, Mistry presents the case studies, which he identifies as the “secret sauce” of the program.
The group discusses the case studies and then creates a joint collegiality agreement. The agreement delineates specific ways in which physicians from the two departments will interact going forward. For example, the agreement between the ED and the orthopedics department specified the circumstances under which the orthopedic surgeons would be contacted and whether that contact would be immediate or placed as a referral for the following day.
According to Mistry and Mody, the program does more than clarify expected behavior. The collegiality agreements provide department chiefs with a tool for having conversations with physicians who continue to act in a less-than-collegial manner. In some cases, the conversations have revealed personal hardships for which the chief can facilitate getting help for the physician.
So, does it work?
The organization tracks collegiality metrics every two years with a 6-item survey that requires responses to statements such as “I am treated with respect by physicians in this department.” In the first measurement since the program was initiated two years ago, 69 percent of departments improved their collegiality scores. Eight of the 36 departments in the organization showed double digit improvement in scores. According to Mistry and Mody, the eight showing the greatest improvement were those with the lowest initial scores. “The program has level-set people. It has created a baseline expectation for behavior.”
Mistry’s hope is that collegial behaviors will become hard-wired into the organization’s culture. In addition, he hopes that in the future the department chiefs will be able to convene meetings without a professional facilitator where physicians can discuss potential sources of conflict and come to resolution and agreement—all with the ultimate goal of improved patient care.