Healthcare execs: focus more on developing tightly aligned clinicians and less about achieving still greater organizational scale
I've long admired Jeff Goldsmith, PhD's commentary. As a well-regarded futurist and keen observer on the intricacies and inanities of the American healthcare non-system, Jeff consistently offers good insights -- almost always expressed in an especially pithy and memorable way. I was reminded of this ability when I came across a piece Jeff had written for the October 22 edition of The Health Care Blog entitled "The Clinical Enterprise is the Beating Heart of Health Systems". Here's a sample:
(C)lincians of all stripes but particularly physicians feel a deepening sense of alienation from the expanding care system in which they work. In many "wanna-be" health systems, the clinical "enterprise" is a loosely connected roll-up of independent practices held together by a RVU-based compensation plan and a common corporate logo on the door.
He goes on the describe, by contrast, the 5 characteristics that comprise a successful "Clinical Enterprise"; ie, the characteristics that define a true health system vs. a loosely connected roll-up:
A common value set
Rigorous quality and safety standards
High levels of collegiality and mutual trust
Effortless communication and consultation
Inspirational leadership
Goldsmith concludes with this statement:
"It is not mass or scale, or weath, that will determine who survives and prospers in this coming healthcare environment, but the ability of clinicians in the clinical enterprise to work together to meet our needs. The health and vitality of the clinical enterprise is the single most important factor in the success of the health care enterprises large and small."
I wholly endorse Jeff's emphasis on what constitutes the clinical enterprise and, especially, his conclusion about the strength of the clinical enterprise -- not mass or scale -- which will determine future organizational success.
The lack of alignment between the C-Suite and front-line clinicians is becoming increasingly apparent in a growing number of organizations. Cutting back on one's scheduled availability is one manifestation of the lack of alignment. So is turnover. Ditto burnout. Still another indicator: physicians becoming unionized. My colleague Paul DeChant, MD. MBA and I too often find that healthcare systems are more focused on achieving greater scale and a larger clinical footprint rather than assuring that their clinicians feel connected to and invested in their organization's future success; and making sure that their clinicians have a sense of agency. What does having greater agency or efficacy look like? It's the ability of clinicians to not only act in the best interests of their patients without unnecessary delays or encumbrances BUT ALSO to have the ability and means to participate in decisions about their workflow and practice environment.
Solutions for Hospitals, Health Systems, and Medical Group Practices: Leadership-Driven Changes
The locus for curing clinician burnout and staffing shortages runs through the C-suite. Here are examples of leadership-driven changes to the workplace that my colleague Paul DeChant, MD, MBA and I often recommend:
> Regard clinicians as knowledge workers who are given significant latitude to make clinical decisions without unnecessary administrative encumbrances or delays
> 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
> Expect all leaders, but especially senior executives, to do periodic job shadowing of front-line staff (where observing and deep listening are emphasized) in lieu of "rounding" (a largely ineffectual, if widely practiced activity)
> 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
> Judiciously 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
> Support near-continuous optimization and remediation of the EHR (there's no such thing as "it's all set")
> 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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