What if there were a paradigm shift in executive incentive compensation plans?
Lost in the mist of time are the origin stories and/or authors of two oft-cited leadership bromides: "If you don't measure it, you can't move it"; and, "One measures what one values and values what one measures". I was thinking about these two phrases today in connection with how to stem the rising tide of clinician burnout in hospitals and health systems.
There is, of course, no shortage of folks who are active in the field of clinician burnout: academics, clinicians who recognized they were burning out and charted a different career path, wellness officers, medical staff and/or nursing leaders, professional associations (think American Nurses Association or the American Medical Association and its well regarded "Steps Forward" and “Joy in Medicine” programs), foundations (e.g., Dr. Lorna Breen Heroes Foundation, Schwartz Center for Compassionate Healthcare), staff satisfaction and/or burnout survey companies (e.g., Press-Ganey, Mayo Well-being Index, Mini-Z, Maslach Burnout Inventory [MBI]), benefits/"total reward" managers, lifestyle or wellness gurus, and consultants and coaches of various stripes. Suffice it to say that it's a long list of actors achieving mixed results, at best.
The American College of Healthcare Executives (ACHE), the professional association for hospital and health system leaders, has for 3 years in a row cited "workforce challenges" -- which includes burnout along with turnover, recruitment and retention, and staffing levels -- as the #1 concern of healthcare executives. So good news: there's a high degree of awareness, concern, and activity occurring in most hospitals and health systems, albeit to varying degrees and with mixed results.
So here's today's thought experiment: with 75% of all practicing physicians now employed by a hospital, health system, medical group practice, or an insurer, what would happen if executive compensation plans now routinely included specific goals -- actions and outcomes to go from current state to target state to ideal state -- tied to remedying clinician burnout in their organization? What impact do you think a change in executive incentive compensation would likely generate in terms of executive engagement with clinicians, understanding the 6 drivers and 3 manifestations of clinician burnout, and fostering a sustained focus on addressing problems inherent in the clinical workplace? My guess: is it would be transformative.
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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