The American Hospital Association (AHA) is the largest trade association/membership organization for hospitals in the US. For virtually the entirety of my 40 year career in healthcare administration, I was active in and a big supporter of the AHA. I still support the great policy and advocacy work of the AHA in advancing the interests of patients, communities, and the hospitals which serve them. However, I am deeply disappointed by the AHA's anemic response to the epidemic of burnout which is roiling hospitals, health systems, and healthcare organizations of all types, sizes, and locations.
Take a look at the following two AHA-produced graphics. What do you see? Is something off?
Well, the first graphic is "right on": it's taken straight out of the pioneering research work by Christina Maslach, PhD about the factors or "drivers" of burnout. Implicit in Dr. Maslach's paradigm -- reinforced by the World Health Organization's definition of burnout -- is that burnout is an individual response to systemic issues in the workplace. It's an occupational condition. The genesis of burnout is not a lack of resilience on the part of employees, most especially on the part of physicians and nurses, but rather is caused by conditions and practices in the workplace. The AHA graphic hints that conditions in the workplace may contribute to burnout but does not squarely state the causal workplace:burnout relationship.
AHA's Identified Factors Associated with Healthcare Burnout
OK. Now take a look at the second graphic; ie, the AHA's recommended response to a problem which affects as much as 70% of all physicians and nurses and is nearly as prevalent among executives. Or, put slightly differently, the "staffing challenges" problem (recruitment, turnover, retention, and burnout) which the American College of Healthcare Executives (ACHE)'s annual survey of CEO's has listed as the number 1 concern of its members for 3 years in a row. Or, consider that 400 physicians a year die by suicide.
AHA's Recommended Key Steps in Hospitals' Well-Being Journey
Anyone see a problem with number 2? Do you see any hint of urgency? No. Does the reader walk away with a clear, informed sense of direction? Again, no. With the exception of the first and last steps -- both essential -- there is nothing here about WHAT to change or HOW to actually change the conditions in the hospital which cause burnout. Nada. Zip. Sure there ought to be a strategy and framework for action -- just like everything else. Yes, there needs to be shared accountability and administrative support -- just like everything else. Step number 4 gives new meaning to the word "nebulous". The related case studies and resources listed by the AHA on its website provide very little specific, actionable information. In short, on what may be the most significant issue affecting the availability, stability, and wellbeing of a precious resource -- clinicians -- the AHA serves up a nothing-burger.
The AHA can and should do better. Its members should insist upon getting meaningful insights on how to gauge the extent and particular drivers of burnout down to a department-specific level in their organization. What extant data sources (HR records, prior surveys) and/or additional data (site visits/observational walk-throughs, confidential 1:1 or small group interviews) should be plumbed to further analyze the underlying causes of burnout? How to create -- and what should be contained within -- an effective action plan? What are specific examples of changes in workflow, administrative policies, staffing solutions, and leadership practices that have been shown to be effective in ameliorating burnout? Where can AI be helpful? Who should lead this effort?
As the saying goes, "success has many parents while failure is an orphan." This long-time friend of the AHA would like it to successfully guide its members in tackling burnout with the same vigor, specificity, and positive results as it has in so many other areas.
Organizational Wellbeing 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 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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