A tale of two Boston-area medical news stories: One powerful and destructive phenomenon links them together.
Two seemingly disparate stories, both reported in the Boston Globe, are, in fact, connected.
The first news item, published on January 24, is about residents and fellows at Boston's Beth Israel Deaconess Medical Center voting overwhelmingly (407 to 85 or 83% in favor) to join the Committee of Interns and Residents of Service Employees International Union (SEIU). In addition to BIDMC, residents at UMass Medical Center, Boston Medical Center, and safety net provider Cambridge Health Alliance are also now represented by SEIU.
The second news story, " ‘Their lives are awful’: More doctors are quitting medicine, citing burnout and workplace issues" by reporter Kara Miller, appeared on February 3. Ms. Miller's article highlights the career-changing decisions of 3 physicians to illustrate the growing number of physicians with established practices who have decided to exit medical practice altogether. According to Definitive Healthcare, some 17,000 physicians -- 6% of the nation's total -- left in the period 2021-2022. A December 2023 study by the AMA found that of 19,000 physicians surveyed, 33% indicated they were looking to leave medicine.
The connection? Burnout or its antecedents.
Whether one is a physician in training or one who completed training multiple years ago, most healthcare workplaces are breeding grounds for the 3 manifestations of burnout: exhaustion, inefficacy, and cynicism. Hospital and health systems are fraught with systems, policies, and practices that while likely unintentional nevertheless militate against the ability of physicians to deliver the care for which they were trained. As knowledge workers, physicians -- indeed, clinicians generally -- want and expect to have professional autonomy and a sense of personal agency. Organizations that continue to evince top-down decision-making, have sclerotic bureaucracies, and rely on problematic EHR's are almost perfectly designed to produce physician unionization and/or turnover -- the end results described in these two articles.
It doesn't have to be this way.
Solutions for Hospitals, Health Systems, and Medical Group Practices: Leadership-Driven Changes
The locus for curing clinician burnout and staffing challenges 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 mistrust or even 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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