In a previous post I mentioned Leading Change in Healthcare: Transforming Organizations Using Complexity, Positive Psychology, and Relationship-centered Care, as an interesting take on creating positive organizations. I had an opportunity to speak with one of the book’s editors, Anthony L. Suchman, MD, MA. In this post I share a condensed version of our conversation. Many thanks to Dr. Suchman for his time.
Q: How did you become interested in organizational transformation?
A: During my training, I was attracted to general internal medicine in part because it involves developing ongoing relationships with patients. After residency at University of Rochester, which is especially strong in patient interviewing, I completed a fellowship in Behavioral and Psychosocial Medicine. I continued at the University as a faculty member and became interested in the impact of organizational environments and culture on the quality of care and health professions education. Later I helped to launch a physician hospital organization and began applying the principles of relationship-centered care to administrative processes.
Q: I’ve heard of relationship-centered care. How does this approach fit with leadership?
A: Rather than approaching an organization a like machine, as traditional management theory does, relationship-centered administration approaches the health care organization like a conversation. It’s a gigantic conversation between patients, clinicians, staff, payers, regulators, and others. Thinking of organizations like conversations changes how we approach transforming organizations.
Relationship-centered care focuses on the relationship between clinician and patient, with the idea that the relationship is an entity worth considering in addition to considering the individuals involved—the whole is greater than the sum of its parts. We apply this same idea to leadership. Relationship-centered administration is a way of leading that focuses on relationships and partnering. Its goal is creating a workplace that enables the full engagement of staff and supports creativity in their work.
My guest post appeared on January 23, 2019 in Patient Safety Beat, a blog of the Betsy Lehman Center for Patient Safety.
Health care organizations are moving to address clinician burnout with a real sense of urgency. It is now commonly accepted that burnout is widespread among health care professionals and has serious repercussions for patient safety and the quality of care. A report released last week by several major Massachusetts health care organizations labeled the situation “a public health crisis” and warned about the adverse impact “on the health and well-being of the American public.”
And though there is currently little evidence about how to effectively tackle the problem, the experience of hospitals and physician practices with various initiatives – and the lessons learned – provide a roadmap for beginning to address a crisis that is having a profound effect on the health care system.
While the term “burnout” is often used informally to indicate fatigue or boredom, it has been defined by psychologists as including three components: emotional exhaustion, depersonalization, and inefficacy, or a low sense of personal accomplishment in one’s work.
The definition may be relatively clear, but there is little agreement about how to identify individual clinicians with burnout. The most commonly used survey tool was developed for research into causal factors, not for the diagnosis of burnout in individuals and the term burnout is often loosely used to include other associated but distinct conditions, such as depression, professional dissatisfaction, moral distress, and substance misuse. As Steven Adelman, M.D., Director of Physician Health Services in Massachusetts, notes, “Several different diagnoses have been conflated into the term ‘burnout.’ The word is often used as a catchall.”
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…