Healthcare is changing. Increased consolidation of medical providers, implementation of electronic health records, changes to pay structures and rollercoaster regulatory challenges are putting pressure on an already overburdened institution. Patients are taking greater charge of their own care, with the industry trending toward a stronger role for consumers and less management of those choices by physicians, insurers, employers, and regulators.
Physicians are singularly equipped to lead the healthcare industry into the future. From the first day of their residencies, physicians lead cross-functional teams of doctors, nurses, specialists and other hospital staff to deliver patient care. As the challenges and complexity of healthcare increases, physicians are being called to bridge the gap between practitioner and manager, and to bring their experience and expertise into the boardroom.
Yet, for many physicians, there exists a significant gap between medical expertise and leadership skills that must be bridged. “Physicians are frequently put into leadership roles without any training, nor with appropriate help in project management, lean approaches, etc.” said Adam Dicker, MD, PhD, FASTRO, FASCO. Dr. Dicker is Enterprise SVP, Professor & Chair, Department of Radiation Oncology, Director at the Jefferson Center for Digital Health, and practices at the Sidney Kimmel Cancer Center at Thomas Jefferson University-Jefferson Health in Philadelphia, PA.
Across the industry, top-performing healthcare systems are run by physicians, and a study of 300 top-performing hospitals across the US shows that hospital quality scores are approximately 25% higher in physician-run hospitals than in the average hospital.
“Nearly all physicians take on significant leadership responsibilities over the course of their career,” a group of physicians wrote in the Harvard Business Review. “But, unlike any other occupation where management skills are important, physicians are neither taught how to lead nor are they typically rewarded for good leadership.”
Recently, the AMA reported that strong leadership is essential for preventing physician burnout. This included references to Mayo Clinic findings that physicians with supervisor responsibilities could significantly improve satisfaction and reduct burnout if they practiced effective leadership. Some hallmarks of effective leadership measured in this study were inspiring employees, recognizing good performance, and coaching.
The following are four practices that can help physicians become better leaders and deliver better patient outcomes.
Burnout is a problem in every industry. Gallup found that more than two-thirds of workers report symptoms of burnout, with managers reporting more stress, worse work-life balance, and worse physical health than members of their teams. Among physicians, however, burnout is becoming a crisis. More than 44% of physicians report feeling burned out, and, tragically, physicians die by suicide at twice the rate of the general population.
The effects of physician burnout ripple outward, affecting their subordinates and negatively impacting patient care. A survey by the American College of Surgeons showed that as symptoms of burnout among respondents increased, so did the likelihood that the surgeons surveyed had reported a major medical error in the past three months. Each 1-point increase in emotional exhaustion was associated with a 5% increase in the likelihood of reporting an error.
To become better leaders, and to better treat their patients, physicians need to first treat themselves. And although there are many factors that contribute to burnout, spending too many hours at the office is top among them.
Sleep deprivation is baked into the experience of becoming a physician. Under increased pressure, the tendency for many doctors is to put in increasingly long hours. However, neuroscience has shown this to be counterproductive. The brain depends on downtime to process information.
If spending fewer hours at the office isn’t an option right now, numerous studies have shown that taking moments within each day to meditate, take a nap, take a walk, or simply do nothing can actually help increase productivity, replenish attention span, bolster memory recall, and foster creativity.
As leaders, physicians encounter an incredible level of stress. What other profession requires its leaders to make actual life-or-death decisions, or to face the loss of a patient in the morning then make a presentation to the board in the afternoon?
This stress takes a toll on physicians. How they react to this stress can take a toll on their team. Unfortunately, the culture around how physicians are trained has left many ill-equipped to deal with the emotional challenges of the job. A survey by the American College of Physician Executives revealed that more than two thirds of doctors regularly witness disruptive behavior by fellow physicians, from yelling at subordinates to shoving matches in the OR.
The leadership qualities of physician leaders impact the well-being and satisfaction of individual physicians and other medical staff. In a 2016 survey, 69% of employees said their manager was the main source of stress in the workplace, and a separate study showed that managers account for 70% of the variance in employee engagement scores. Employee engagement, in turn, affects staff attention (turnover in healthcare outpaces other industries at 20%, second only to the hospitality industry) and patient outcomes.
Managing how you show up under stress is fundamental to success as a leader, and it takes a tremendous amount of self-awareness to recognize your ingrained tendencies.
AIIR begins its coaching engagements with a powerful battery of assessments and 360º feedback designed to surface the behavioral blind spots that can make leaders less effective under pressure. If you don’t have access to these tools, make it a practice to ask your colleagues for specific and direct feedback when possible. Armed with this self-awareness, leaders can find healthy ways to cope with stress and mitigate their derailing behaviors.
The structure of healthcare organizations is change. Influenced by the accelerating consolidation of medical systems, the increasing specialization of medical training and the growing complexity of patient care, healthcare is abandoning traditional power structures in favor of more effective interdisciplinary teams. For patients, treatment may involve a multidisciplinary group of physicians, nurses, specialists, and administrative staff across multiple locations.
To deliver exceptional patient care, high-performing teams are essential. Yet, the skills needed to build and maintain high-functioning teams do not come naturally to most people, far less to physicians.
“Working in teams does not come easily to physicians, who still often see themselves as heroic lone healers,” Dr. Thomas Lee, Chief Medical Officer at Press Ganey, wrote in the Harvard Business Review. “Nonetheless, developing teams is a key leadership function for health care providers.”
The hierarchical command-and-control leadership style embraced by the medical system is problematic for several reasons: (1) it forces the physician to do most of the heavy lifting, leading to increased burnout and, subsequently, decreased quality of care, and (2) it ignores the valuable input of skilled nurses and other team members.
Surround yourself with a skilled team and make it clear that everyone on the team shares equal responsibility for patient care, down to the people who change the sheets and clean the rooms. Encourage their input and ask for opinions that conflict with yours. It can be hard to acknowledge that your ideas might not always be the best ones, but it can be tremendously beneficial to the patient.
In her pioneering research on hospital teams, psychologist Amy Edmondson hypothesized that the highest-performing medical teams would report the fewest medical errors. Instead, she found the opposite. The highest-performing teams were reporting more errors than their lower-performing counterparts.
Upon closer examination, Edmondson’s data revealed that the most effective physicians and their teams weren’t actually making more mistakes. Rather, they were more willing to discuss and disclose their errors, which created a culture of continual improvement. Edmondson described this condition as psychological safety — the extent to which team members feel safe both to admit their mistakes and point out the mistakes of others without fear of retribution.
Trouble is, the hierarchy in most medical environments involves significant power distance between physicians and their teams, and studies have shown that perceived power distance is antithetical to creating psychological safety.
To increase psychological safety, physicians must decrease the perceived power distance between themselves and their colleagues. Admitting their mistakes, and pointing out yours, requires vulnerability. Team members have to trust that the physicians in charge have their best interest at heart.
Work to form real connections with the people on their teams. Neuroscience shows that small, intentional interactions with your coworkers in the breakroom and around the watercooler stronger bonds. Make time to ask about your coworkers how their days are going. Make small talk. Celebrate birthdays as a team and facilitate out-of-office social activities when you can. Most of all, work to be genuine in your interactions. If you aren’t feeling the connection, neither are they. And that’s a recipe for lack of psychological safety.
The changes we see in healthcare represent tremendous challenges to the industry. With time and training, physicians can develop the skills necessary to lead to lead the healthcare industry into the future. “I have significantly benefited from a leadership coach for the past 11 years,” said Dr. Dicker, “and only wished I had this earlier in my career”
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