The role and value of a CEO in the prevention and management of physician burnout may not be intuitive or obvious. As organizations have grown both in revenue and geography, it has become necessary for the CEO to be somewhat distanced from day-to-day operations. Effective CEOs now delegate many of these tasks to subordinates. It is easy to understand how leaders fall into the trap of thinking burnout prevention should be the responsibility of the CMO, the administrator of the physician practice group, or any number of executives involved in the clinical enterprise. While it might be appropriate to task implementation on such an individual, intentional leadership must be from the top if our physicians are to re-engage and thrive in today’s environment.
An additional trap is to view burnout as a problem to be solved and assign solving that problem to a single executive. Understanding physician wellness is a complex dilemma to be managed, and accepting that this management is an organizational journey over years defines a quite different view of engagement and commitment at the highest level of the organization.
Given the very significant cost (both human and financial) of physician burnout and the criticality of physician engagement to both quality and safety, the CEO should play a key role in managing this dilemma. Effective leadership in this area should not require large amounts of time or energy but does need to be intentional and consistent over time.
Organizations vary widely in their approach to planning. The key concepts in this area are that burnout prevention should be a strategy with measurable goals (included on an organizational dashboard as outlined below) and clear accountability to governance. This sends a strong statement to the physicians that their health and work environment is an organizational priority and provides the necessary focus to achieve the goals.
Key organizational initiatives, such as surveys, new structures or leadership positions created in this space, etc. should be communicated by the CEO in tandem with the key executive(s) in this area. This signals to the physicians a commitment and concern from the highest levels of the organization.
The CEO needs to know the key concerns and issues of physicians, at least at a high, summarized and prioritized level. Creating a method to collect these issues is mission critical and should go well beyond survey instruments that simply measure burnout (you already know the rate of burnout is likely 40-50%) by creating recurring, inclusive, active listening. The results of ongoing listening should be shared with the physicians transparently and fully. The CEO needs to be sure that the priorities uncovered are addressed to the best of the organization’s ability. Seeking feedback from physicians without transparency and explanation of action steps is a certain way to diminish future willingness to provide honest responses and participation.
The CEO should support and insist upon the creation of an effective working group to address physician burnout that supports the health and well-being of the physicians. By empowering the group to make reasonable decisions, pursue proven strategies, and work with the physicians without a maze of approvals, the group will more quickly be perceived by the physicians as a team that can make things happen, thus engaging them in the program. To be effective, the working group will need resources including a budget, a trained and respected leader with ample time to support the group and compensation for member's time. Physicians no longer have time or tolerance for a committee that meets without power or action but will embrace a team that can effectively advocate and execute simple and beneficial change.
Most CEOs track a core set of metrics and keep them top of mind. Measures such as days cash on hand, market share, mortality rates, etc., are core indicators of organizational performance. Physicians impact almost every piece of this data set; therefore, it makes sense that progress on their health, engagement and well-being should also be tracked as a key metrics. The negative consequences of physician burnout have been shown to include lower patient satisfaction, higher error rates, diminished quality, reduced revenue generation and more. These all impair organizational performance in ways that are deceptively hidden if not tracked in a disciplined way.
In the complex world of healthcare today, the competing demands on the CEO are almost overwhelming. Often it seems every initiative seeks priority of attention from senior leadership. That said, the engagement and well-being of the physicians who care for our patients, drive our business and lead our quality and safety efforts is not an optional issue, rather an ongoing part of organizational DNA. Using the steps above to hard-wire the management of this key dilemma, a CEO can balance delegation with effective leadership to create an attractive environment where an organization’s most critical asset, physicians, can thrive. The results of addressing this as a priority positively impacts the entire organization, including financially, and most importantly, the patients.