5 Mistakes Physician Leaders Should Avoid
Recently on the blog, we’ve explored the concept of flow and the differences between organizational and individual engagement. Today we’ll unpack five mistakes physician leaders should avoid when creating engagement programming for their teams.
Approximately 29% of healthcare organizations have an engagement program (MGMA 2018), which sounds like good news. The problem is that typically these programs are disjointed and separate from other programs that have direct bearing on physician engagement. For example, hospitals will have a burnout of wellbeing program that is completely separate from an engagement program, which ignores the important truths that, one, burnout is the opposite of engagement and, two, engagement is a fundamental element of wellbeing. Since we know that burnout and engagement are the opposite ends of the same spectrum (Maslach et al, 2014), we must keep in mind both burnout and engagement when designing a program to engage physicians.
While many physician leaders and organizations are aware that something needs to change when it comes to physician engagement (or, more likely, lack of physician engagement), many don’t know where to begin. Alternately, when they do devote time to improving physician engagement, they fall prey to one of these five mistakes.
1. Lumping all Physicians Together
Engagement is an individualized and personal experience, especially for physicians. Each one is a separate human being, who has spent years accomplishing some of the most demanding physical and intellectual tasks to get to this point in their career. Each has their own reasons for becoming a physician, and has spent years honing their skills. Their physical, emotional, financial, and spiritual needs are distinct from each other. And in the same way, their experience of feeling engaged at work is individual as well. To help each physician find flow daily, a leader must understand their unique needs and challenges. A fresh graduate with a young family has vastly different engagement needs than a physician nearing retirement.
Additionally, each physician on a leader’s team contributes anywhere from a few hundred thousand dollars to a few million dollars to an organization’s revenue. Horse owners with champion horses who garner this kind of revenue have special diets, groomers, caretakers, and strategies for each of their horses. Owners understand each one’s individual temperament and design care around the horse’s needs. They would not expect a win from a poorly fed, overworked, and neglected horse. Especially one whose individual needs were disregarded and ignored. Although much more complex than horses, the comparison is solid, and physicians must be considered individual assets in a similar way. Which leads to another mistake often made by healthcare leaders.
2. Ignoring the Business Case
To ignore the financial aspect of physician engagement, or lack thereof, is a rookie mistake. No margin, no mission. As stated, each physician is a clear monetary asset to an organization. This is a data driven world and no emotional appeal holds water against the realities of money in an organization. Engaging physicians undeniably improves an organization’s bottom line by boosting productivity, reducing turnover, improving patient outcomes, improving patient satisfaction ratings, reducing violence in the workplace, reducing medical errors and litigation, and lowering burnout. Currently, healthcare organizations spend copious amounts of money to improve patient experience, with new clinics and buildings but there is a fairly low pay off received from process improvements like that. Buildings and patient experience cannot have a lasting impact with a team of disengaged and burned out physicians.
3. Searching for the Perfect Survey
A survey is the starting point for many physician engagement initiatives, and rightly so. Whatever gets measured, gets the money. In fact, the process of getting the survey done properly will give a leader the first flavor of the things to come. However, many leaders get sidelined by searching for the perfect survey, wasting months of precious time. Of course there must be planning that goes into how the survey will be administered – how to ask physicians to complete the survey, how to encourage participation, and how to communicate the results – these are all elements that should be undertaken thoughtfully. Additionally, leaders should consider using a survey with an included action plan. For example, Maslach Burnout Inventory, measures both burnout and engagement, and its twin, the Areas of Worklife Survey, measures the big mismatches to target to create engagement. Both provide actionable data. Another actionable option is Gallup’s short, twelve question engagement survey, free and publicly accessible. Incidentally, an excellent survey implementation guide also comes from Gallup. Find a link in the reference appendix.
4. Not Having an Engagement Plan
Worse than administering a poor survey is taking no action afterwards. Before the survey, leaders should have a preliminary plan in place, then use survey data to adjust implementation as necessary. A physician would not take a patient’s temperature or order an MRI without a plan in place about what to do with the results. A leader risks increasing cynicism and lowering engagement by not having a plan in place, and not communicating or implementing it. Another common mistake is an unending search for a “perfect” plan. In organizational psychology, there is a phenomenon called the Hawthorne Effect, which “concerns research participation, the consequent awareness of being studied, and possible impact on behavior” (McCambridge, Witton, and Elbourne 2013). A similar effect is often seen in clinical trials where attention and observation alone improve clinical outcomes. Akin to the well-known placebo effect, what does this mean for a physician engagement plan? Simply, that any plan is better than no plan. A strong leader may begin with a pilot and adjust along the way, but the fact that any attempt is being made will have its own positive effect.
5. Short-Term Approach
An effective engagement plan takes time. Time for physicians to trust the goodwill of both the leader and organization. Time for physicians to share their pains and observe what leaders do with that information. There are no shortcuts. The most energy, effort, and perseverance is needed up front when doubt is high and trust is low. During any space shuttle launch, for example, the most energy is spent in the first phase of takeoff. Once the shuttle is in orbit, it takes very little energy to stay there. Implementing a physician engagement program is similar. Think of executing an engagement plan as an S-curve. It is a steep climb in a short period to go from the lower curve of the S to the upper one. But, eventually, the system previously functioning at a lower level begins to function at a higher level with much less time and energy overall.
Further evidence to keep in mind...
“I was at this hospital for two years. I saw patients from four states because I was the only pediatric neurologist within 150 miles in any direction. I was busy and every month there was one more thing I was told to do. Nobody asked me what I thought of it. I had many ideas how we could make things better. My staff was always leaving because they would get more money somewhere else. One of them wrote me up when I tried teaching them their work. That was the last straw. I didn't want to be labeled a disruptive physician. I said the heck with it. I can’t take it anymore. When I told them I was leaving, there was nothing they could offer me that could’ve kept me there.”
—Pediatric neurologist who later sought coaching for burnout
If you’ve fallen prey to one of these common mistakes, don’t despair. There are ways to avoid these pitfalls in the future. And there is still time to create engagement among your team members, saving them (and yourself!) from burnout at work. In fact, we have created just the program you need to succeed. If you’re ready to maximize your leadership potential and provide opportunities for your team to thrive in the workplace, I invite you to participate in my 5-Day Challenge: Coach Yourself! Becoming a leader is not an overnight process, but a slow and steady commitment to create and fortify a culture of learning and growth in the workplace -- starting with you.
References and Resources:
Geirland, John.
2017. “Go With The Flow.” Wired. Conde Nast, June 4, 2017. https://www.wired.com/ 1996/09/czik/.
Goleman, Daniel.
2013. “Focus: The Hidden Driver of Excellence.” New York: HarperCollins, 2013.
Jain, Saurabh.
2018. “Education Needs Flow.” Medium. Medium, January 13, 2018. https://medium. com/@skjsaurabh/education-needs-flow-bdc08c659baa. Used with permission from Saurabh Jain. fun2dolabs.org.
Liddel, Henry George, and Scott, Robert.
2007. “A Greek-English Lexicon.” London: Simon Wallenberg Press. http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057% 3Aentry%3Dkairo%2Fs1. Retrieved 3 September 2020.
Maslach, Christina, and Michael P. Leiter.
2014. “The Truth about Burnout: How Organizations Cause Personal Stress and What to Do about It.” San Francisco: Jossey-Bass Publishers, A Wiley Imprint.
Scott, Susan.
2017. “Fierce Conversations: Achieving Success at Work and in Life, One Conversation at a Time.” London: Piatkus.
Seligman, Martin.
2018. “PERMA and the building blocks of well-being.” The Journal of Positive Psychology. DOI: 10.1080/17439760.2018.1437466
McCambridge, Jim, Witton, John, and Elbourne, Diana R.
2014. “Systematic review of the Hawthorne effect: New concepts are needed to study research participation effects.” Journal of Clinical Epidemiology. March 2014.
Medical Group Management Association (MGMA).
2018. “Practices are slow to adopt staff engagement programs.” Post: February 20, 2018. Accessed August 3, 2020. https://www.mgma.com/data/data-stories/mgma-stat-poll-practices-are-slow-to-adopt-staff.