Clinicians — physicians, APP’s, nurses, pharmacists, therapists — are knowledge workers. All knowledge workers possess specialized training and expertise, but clinicians have a special relationship with and obligations to their patients. The desire — no, the expectation — for professional autonomy and personal agency are hallmarks of clinicians generally and of physicians in particular. When clinicians are consistently unable to apply the full measure of their skills, expertise, and professional judgment because of problematic systems, burdensome process issues, or poor management practices in their work environment, the stage is set for clinicians to develop the 3 manifestations of burnout: inefficacy, exhaustion, and cynicism. Cutting back on one’s schedule, seeking another employer, or leaving the profession altogether are among the most common consequences for the hospital or medical group practice, to say nothing about the likely adverse impacts on the affected clinicians.
Leaders can make the situation better or worse according to how they make decisions, about the priorities they set, and how they view, communicate, and interact with clinicians.
Effective Healthcare Leadership & Quiet Management
In my January 23 blog I cited the 8 qualities of an effective leader as posited by Harvard Business School Professor Rebecca Knight in the December 12 issue of the Harvard Business Review. I went on to suggest the addition of a 9th trait or management style — “quiet management” — a term of art coined by fellow blogger and healthcare leadership coach, Adam Broda, as being particularly helpful in addressing the workforce crisis confronting most healthcare organizations (ie, improving retention, reducing turnover, assuring appropriate and safe staffing levels, and reducing burnout). Here’s a brief excerpt from Brody’s description of “quiet management”:
“Quiet Managers operate with a high level of trust in their employees, and don’t micromanage. This way, the job becomes more of a support role and gives managers the time to get out in front and lead by example instead of by structure and administration.”
I wanted to return to these themes of effective leadership traits because of an excellent article, “Why the Future of Leadership Will Look to Introverts”, written by Kara Dennison, CEO of Optimized Career Solutions, and published in the February 14 issue of Forbes.
While Dennison’s analysis is about companies and leaders in general, I believe introverts (disclaimer: I am one) can be especially effective in addressing the workforce crisis engulfing most hospitals, health systems, and group practices. I’ll explain the basis for this view in just a moment. But first, here’s why Dennison makes the case for introverts generally.
Introverts as Hospital and Healthcare Leaders
Citing recent Boston Consulting Group research, which showed that 62% of US companies have adopted remote and hybrid work arrangements, Dennison comments that “no demographic is happier for the new arrangement than introverts”. She explains that introverts are especially productive and can better harness their energies when away from “noisy offices and packed meetings”. Fair enough, but the positions that are most at-risk for burnout and turnover — and the most consequential roles for hospitals and other care settings — are front-line clinicians. So this particular observation is not especially applicable to healthcare. (Yes, I know, some hospitals have created remote consultative and/or administrative roles for nurses and physicians that rely on telehealth applications. But the vast majority of hospital-based patient care is still rendered in-person to acutely ill patients who need direct, hands-on care. Yes, there are several non-patient care corporate functions that lend themselves to remote work; e.g., revenue cycle, compliance, corporate communications, scheduling). But Dennison goes on to discuss introverts versus extroverts as leaders. Here she makes what I think is an important observation relevant to the workforce crisis:
“[E]xcellent leadership is not based on whether the individual is extroverted or introverted. Instead, it depends on the leader-employee relationship. Additionally, businesses face complex challenges today. Leaders who can understand nuances and analyze problems thoroughly before acting are required. That's why having introverted leaders who can listen and process before deciding and acting are key. … Introverts bring the abilities of assessing, analyzing, evaluating, and making thoughtful decisions.”
Dennison then proceeds to outline 3 specific attributes of introverts in leadership roles (edited for brevity):
1. “Introverts have a thoughtful approach to communication.
…Unlike extroverts who typically listen to respond, introverts listen to understand. They aren’t just active listeners. They’re engaged in conversations, seeking understanding, and listening for nuance….Their ability to pick up subtle cues comes in handy in today’s data-heavy industries. Information can be misconstrued, making their skills especially useful.”
2. "Introverts make good writers.
The rise of remote and hybrid models has made excellent writing skills much needed for clear and more effective communication. This is where introverts naturally thrive. Whether it’s daily emails or goal setting, introverted leaders do so with dexterity. This allows their team members to stay updated and informed. It also gives them a clear roadmap to work with. This minimizes confusion and allows for increased team efficiency."
3. "Introverts often excel at improving team performance.
[I]ntroverts thrive in one-on-one interactions and focused conversations in smaller groups. In contrast, extroverts thrive in larger groups. During conversations, introverts are less likely to interrupt. Instead, they focus on the speaker’s words and emotions, letting them fully express themselves. This can go a long way for employees that may have not felt heard by previous extroverted leaders.
Introverted leaders also ask thought-provoking questions to continue that deep dive processing. They actively listen to the responses. After exploring the ideas and issues at hand, they offer well-considered solutions. They've thought through their solutions. In a leadership role, these skills are essential because they enable leaders to understand their employees on a personal level."
Only a Part of Solving the Workforce Crisis
Of course, when it comes to successfully overcoming the workforce crisis in healthcare, neither personality type nor leadership style alone will carry the day. Self- and situational- awareness, empathy, deference to expertise, and effective communication — hallmarks of introverts — have to be combined with meaningful actions such as these:
expect all leaders, but especially senior executives, to do periodic job shadowing of front-line staff (where observing and deep listening are emphasized)
create and require leader standard work (LSW).
develop and deploy a sophisticated, deeply ingrained, and rigorous daily management system (DMS) supported by visual display boards or monitors
consistently apply one or more of the improvement sciences (Lean, six sigma, operations research, agile, design thinking) in consultation with front-line staff to improve workflow and reduce delays, waste, inefficiency, and job skill mismatches
invest in AI/ML solutions -- selected, tested, and endorsed by front-line staff -- that eliminate or at least markedly reduce data entry, administrative requirements, and/or repetitive tasks that are non-value add
invest in EHR remediation and optimization
regard clinicians as knowledge workers who are given significant latitude to make clinical decisions without unnecessary administrative encumbrances or delays
get rid of superfluous or outdated policies, procedures, redundant approvals and other stupid stuff (GROSS)
Ready to transform your hospital or workplace?
Are you frustrated by adversarial relationships between front-line clinicians and senior leadership? Organizational Wellbeing Solutions was formed to enable senior leaders to identify the specific drivers of clinician burnout in their organization; and to support leaders in designing and executing a comprehensive plan to stop clinician burnout, increase retention, and improve operating results. A hallmark of our consultancy is correcting the all-too-frequent distrust and alienation clinicians feel toward the c-suite generally and the CEO in particular. Let us help you help your organization and its clinicians develop a more trusting, aligned, and productive working relationship.
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