Coach Your Physician Leaders To Think Inside The Box

A “short list” of priorities placed on physicians today looks a little something like this…

  • Increasing revenue

  • Attending committees

  • Mentoring, teaching, and education

  • Researching and publishing

And for physician leaders, there are additional responsibilities, including budgeting and space management to name a couple. 

Is it any wonder that burnout is causing physicians to experience burnout, heightened depressive episodes, and worse still, increased suicide rates?

While it may be tempting to push all the responsibility of adapting to this mountainous pile of duties onto the physicians and physician leaders themselves, there is a better solution…

Inside the box thinking.

SWEEPING HEALTHCARE CHANGE IN DOUBLE TIME - A CASE STUDY

Twelve weeks.

That’s as far in advance as I was given to implement a multi-million-dollar EMR implementation a few years ago.  

The platform included 25 applications, from scheduling to revenue collection. Our team trained over 17,500 employees for the transition.  A significant part of the training effort included 4,100 clinicians (physicians, house staff, medical students, allied health) across 137 specialties in both inpatient and ambulatory workflows. 

Many of the clinicians needed multiple specialty apps to support their practices. That factor alone necessitated over 32 hours of training in the classroom. 

The new system shifted coding work from a dedicated coding group into the physician’s hands directly. Which meant the physicians had to learn how to operate a new and unfamiliar internal patient communication platform.

As you can imagine, the go-live period was chaotic, upending decades of muscle memory for clinician workflows, and changing fundamental interactions with patients and colleagues.

There wasn’t much of an anticipated decrease in projected revenue or the patient pipeline during the first 90 days. At which point we figured it would be a good time to check in on the new system.

THE 3-MONTH FEEDBACK

A few months after going live we began debriefing meetings with the clinicians. They were exhausted and confused, feeling angry and helpless. The word burnout was an understatement.

In those meetings, I frequently heard senior medical officers say to the room, 

“We can survive this and succeed…We just have to start thinking ‘outside the box’ regarding these new demands.”  

I didn’t think that statement was particularly helpful to these overworked, weary colleagues. Judging by the response in the room, they didn’t either.

Over the past decades, physicians have faced increasing demands on their time and energy aside from the EMR and patient documentation.

Much of this added responsibility has come at the cost of personal time, well-being, adequate sleep, and rest and recovery.  And physicians are the last to ask for help when they need it, which is evidenced by increased burnout and an escalating suicide rate.  

Add the COVID-19 pandemic ripple effect, and I believe we’ll soon experience a major shift in how clinicians view their work, and how they find meaning in their lives and careers. 

It’s plain to see how this could create a crisis in healthcare as clinicians decide to pursue more meaningful roles outside of hospital systems. So, how can we help them feel better within the systems they currently work inside?

WORKING FROM THE INSIDE INSTEAD

Asking clinicians to think “outside the box” is not supportive when many of them do not know what the box looks like, or what is inside. It also can make them feel as if the responsibility for their current situation is entirely theirs, or that they are doing something wrong.  

These resourceful, smart, and caring clinicians are lucky enough to get through the day or to even know who they are supposed to talk to in their appointment or meeting.  

Physician wellness is an ecosystem of support, not a solitary endeavor.

The institution, physician leadership, wellness teams, and coaches should help clinicians think “inside the box.” Inside the box are the conditions within which they must find meaning and achieve balance if they and the organization hope to succeed long term.

INSIDE THE BOX 

Exploring their current “box” is the first step.

  • What are my current responsibilities both professionally and personally?

  • Which ones focus on people interactions and which are more administrative and task-oriented?

  • Which ones are important to me? To the institution?

  • How effective am I at the ones that are important?

Once they have defined their “box,” they can then begin to refine it and make decisions that can support their wellness and balance going forward.

  • Are my responsibilities balanced between people-oriented interactions and administrative tasks?

  • What is in the box that does not add value, that I can let go of? Can I delegate it or outsource it?

  • Am I doing things just because I have always done them?

  • What is missing that I desire?

Taking them through this exercise helps them define their current box so they understand their existing scope and can make room for what is necessary and meaningful.  

They may discover that some of what is in the box is not helpful for them any longer. That’s ok…Both for them and the institution.  

POSITIVE OUTCOMES FROM THE INSIDE OUT APPROACH

Wouldn’t we rather have clinicians who are happy and engaged staying for the long term rather than those who are slogging through the day? Perhaps there’s another role for them in the organization or another way to shift some of their responsibilities?

Clinician wellness must be a strategic imperative and a partnership between the clinician, the leadership, and the institution.  

However, the clinician must first take the opportunity to explore thinking “inside the box.” 

In fact, this is the perfect tool for physicians and physician leaders to do just that. 

The “Inside the Box” coaching conversation is not meant to provide answers. What it can do is help the weary clinician take a few valuable moments to reflect and discover their own innate wisdom about what is necessary and meaningful in their life and career. 

Once they’re comfortable “inside their box” they can begin to explore what is exciting and meaningful outside it.

Cory Colton