Is YOUR organization Physician Friendly?
“When a workplace becomes toxic, its poison spreads beyond its walls and into the lives of its workers and their families.”
In our work helping thousands of over-stressed doctors recover from burnout, here is one of the most frustrating scenarios:
A coaching client and I work together to stop the downward spiral and get their energy and attitude back … and yet they are trapped inside a flagrantly toxic workplace.
We have to fight the same battle with burnout every day because the conditions at work are not physician-friendly.
They are working on themselves to build more life balance and a more ideal practice, hope returning, feeling better.
And each work day pounds them back to the bottom of the mountain in a marathon of inefficient systems, clueless leadership and sometimes outright hostility towards physicians and the basics of the practice of medicine.
It can be very disorienting, especially if your leaders say one thing and your experience of working here is completely different. Are you really seeing this?
So let's get objective, here and now:
Here is a 19-Item Physician Friendly Organization Scorecard.
How does your employer stack up?
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Download the Scorecard Worksheet or Grab a pen and a piece of paper. Here are 19 questions to help you calculate your organization’s “Physician Friendly Score". (you will have a very good idea of your organization's score after just the first 6 questions)
=> The higher your final score the better.
=> It is possible to receive a negative score on each of these items. Negative scores mean these factors actively decrease wellness and increase burnout by creating a workplace that is actively hostile to physicians and the practice of medicine.
=> When you have your final tally, ANY positive score is excellent.
[ These questions come from Quadrant III of Burnout Prevention MATRIX. ]
The Physician Friendly Organization SCORECARD
1) Your Organization’s Mission
Take a look at your organization’s Mission Statement.
Do the doctors and staff appear in the mission statement in any way?
Most organizations fail to acknowledge the existence of the workers who are providing the care, focusing every word on the patient. This self awareness blind spot puts everyone in the group at higher risk for burnout.
- If the doctors appear in your Mission Statement … is there any mention of their satisfaction or health? Unless the health and satisfaction of the physicians appears in the Mission Statement (assuming your group has one), they are not a priority for your administrators/leaders.
- If you do see a phrase supporting physician health in your Mission Statement – does your organization live that philosophy? Are actions consistent with the stated mission? Is there any objective evidence that your leadership is aware of – and actively working to improve – your working conditions, health and satisfaction?
+3 if physician health appears in the Mission Statement and your group is actively doing something about it.
-1 if physicians do not appear in the Mission Statement.
-2 if physicians appear in your Mission Statement and nothing is being done about it.
-3 if you have no Mission Statement.
2) Standing committee to optimize the physician experience
- Do you have a standing Physician Wellness / Satisfaction / Health / Burnout Prevention or similar committee?
- Does this committee have a budget?
- Are they actively in charge of improvement projects in the workplace?
- Are the committee's projects having a positive impact on burnout / wellbeing for you and your colleagues?
+3 if you have a Physician Wellness committee and it is having a positive impact.
-2 if you do not have a Physician Wellness Committee - or if that committee is actually in charge of dealing with impaired physicians only.
-3 if you have such a committee and you can’t remember the last time they met or who the chair is.
3) Consistent focus on physician health
Is there a standing agenda item regarding Physician Wellness / Health / Burnout Prevention for the Executive Committee or Board of Directors Meeting?
- 3 if you have never seen or heard of such a thing.
+ 3 if you have Physician Wellness standing agenda items in senior leadership meetings, information is presented in those portions of the agenda that reflects reality in your practice and decisions are made that have a positive impact on your practice, your team or your experience of working here.
4) Visible and involved senior leaders
Does senior administration get out of their offices and into the front line clinical settings – clinics, hospital wards, etc.? Are they regularly rounding on and shadowing physicians and staff, asking questions and using this information to create improvement projects in the facilities?
- Or are they like the Unicorn … something you have heard about (and even know its name) but have never seen?
- 3 if your C-level people never leave their dedicated offices or meeting room. Or the only time you see them is when you are in trouble.
+ 3 if your C-suite and the rest of the leadership team are required to shadow on physicians as they see patients for at least 3 hours, twice a month - it is a standing requirement of their leadership position - and you know of improvement projects developed out of their learning from their shadowing sessions.
5) Active physician leadership
Does your group have an active pool of physician leaders in all major committees of the organization?
- Or are you managed by non-physician administrators?
-3 if you do not have physician representation and are managed by non-physician administrators.
+3 if you have an active and engaged physician leadership team with active participants at all major leadership and management meetings.
6) Respect for physician leadership time and energy
If you have physician leaders in place, are they paid for their administrative/leadership tasks?
- Or do they suffer the double whammy of actually being penalized for choosing to play a leadership role – losing income every hour they spend in important meetings rather than seeing patients?
- 3 if doctors are not compensated for their leadership roles and responsibilities
+ 3 if your physician leaders have protected time and administrative assistant support and pay equal to the pay for patient care activities when they serve in their leadership role(s).
7) Concern for and awareness of physician health
Does your organization routinely survey doctors and staff for:
- Symptoms of burnout
- Stressors in their work day
- Your level of satisfaction with the workplace
- Suggestions for improvements?
If that has happened in your workplace in the last year, were the results published and have any projects been launched in response to the survey results?
+ 3 if your group performs regular surveys, is transparently communicating results and working improvement projects based on the survey answers.
- 2 if your group does not survey doctors and staff.
- 3 if there was a survey once – a while back – the results were never reported and nothing was ever done with them (this is a powerful way to destroy physician and staff morale).
8) Celebration of the physicians and staff
Does your organization publicly celebrate accomplishments by physicians and staff? Things such as write ups in your company newsletter and press releases to local media when a wing achieves excellent patient satisfaction scores or a staff member graduates from a training program or someone accomplishes something outside of workplace – such as running a marathon, etc.?
+ 3 if your group cheers your people on.
- 1 if you don’t.
-2 if there are multiple ways staff members get positive feedback from colleagues and patients but no such feedback is given to the physicians.
- 3 if you have a regular organization newsletter and celebration / gratitude / acknowledgement is absent from this publication.
9) Asking for input from the workers
Is there an active “suggestion box” system by which physicians and staff can identify problems and bring them to the attention of management? If there is such a system, is anything done with the ideas or is that where suggestions go to die?
+ 3 for having a suggestion box system and you have seen projects come from these suggestions.
- 3 if there is no such active seeking of feedback on the systems of care.
10) Complete physician on-boarding support
Is there an adequate on-boarding system - orientation to the systems and a peer mentor - for new hires? Are physicians taught everything about the EMR and all other systems that impact the quality and quantity of care they provide within the first 60 days of starting their new position?
Does a senior partner systematically show them the ropes (at work and in the community) for the first year and make sure they get a solid start?
- Or does your group just show them how to use the EMR, introduce them to their nurse, open the doors and let the patients in?
+3 if every new doctor is thoroughly on-boarded to the systems of care and provided with an effective peer mentor.
-3 if all you get is login to the EMR and an a full slate of patients on day one.
11) Regular physician support groups
Does your group have regular, ongoing support / mastermind / Balint groups for physicians who would like to participate.
+3 if these groups are present, active and supported by administration and you have the next meeting of the group you attend on your calendar right now.
-3 if they are absent and the group culture is "if you need a group like that, there must be something wrong with you."
12) Specific outreach in times of need
Do you have a “bad outcome outreach team” – a group of physicians who reach out to colleagues who have suffered a bad patient outcome – to quickly and consistently offer support and caring?
How did your leaders respond proactively to the COVID surges in the past several years? Did they double down on rounding on you and asking how they could help or did they lock themselves in the ivory towers?
+3 if your group is more involved in times of need and actively supports physicians who are struggling or have suffered bad outcomes or home/family hardship.
-3 if it does not.
13) Physician specific crisis hotline
Is there an anonymous, physician-specific crisis “hotline” doctors can call 24/7 for support … regardless of their reason for doing so?
- Does everyone know about this service and the number?
- Does that service triage and refer doctors to a reputable group of therapists and other professionals with experience evaluating and coaching physicians?
+3 if this hotline is in place and everyone knows about it, especially if you have a business card with you and a refrigerator magnet at home that are each printed with the hotline number.
- 2 if there is a hotline in place and it is referred to as the Physician Wellness Program and there are no other wellness / burnout prevention activities in your group (this is a suicide prevention hotline and not a means to your administration checking the “wellness program” box).
- 3 if there is no such hotline service.
14) Training to complete your medical education
Does your group provide training to physicians to fill in the gaps in their medical education around:
- Stress management and burnout prevention skills
- Team leadership skills
- Communication skills training focused on communicating with patients and with staff
- How to understand your group’s financial reports
- Meeting facilitation skills?
+3 if this is training in place for your physicians and staff, it is a routine component of onboarding and you have 24/7 access to video-on-demand burnout prevention training in your organization's website.
-2 if you have never received burnout prevention or leadership skills training from your organization.
-3 if you have received such training, but it was useless ... they talked about the subject but did not provide actionable tools and skills.
15) Communication skills training for the most difficult conversations
Is there a formal training program to teach the communication skills of:
- Dealing with angry and upset patients
- Telling a patient about a new, terminal diagnosis
- Telling the patient about a medical error
- Telling the patient and/or family about a bad outcome
- Saying you are sorry to a patient or family without influencing your malpractice risk.
+3 if this training is in place
- 2 if it is not
-3 if it is in place and they talked about these difficult conversations but did not provide actionable tools and skills.
16) Constant focus on front line process improvement
Does your group constantly refine the systems for patient flow, documentation and billing to keep them from causing excessive stress on the doctors and staff? Is your administration aware of how much the systems get in the way of a quality doctor patient interaction and actively working to minimize this interference?
+ 3 if your group is consistently improving systems based on physician and staff feedback. They do not implement changes without consulting with you at all stages of the project.
- 3 if you are constantly having new systems and workflows dumped on you without any attempt to get your input or feedback. The only time leadership listens is in response to a true crisis or a sizable physician/staff revolt.
17) Flexible scheduling options
Does your organization support maternity/paternity leave and part-time and flexible physician work schedules?
- Or are schedules rigid and the group’s culture treats anyone less than full time like a second class citizen?
+ 3 if your group has a generous maternity/paternity leave benefit and supports flexible staffing for those who make a reasonable request.
- 3 if your group is rigid - the only time is full time - does not offer reasonable maternity/paternity leave and the culture considers part time physicians and those on leave to care for newborns or other family members second-class citizens.
18) Numbers transparency
Is your organization transparent in communicating the financial health of the organization and the budgeting process?
- Or are the numbers and budgets the responsibility of a chosen few who operate behind closed doors?
Do you understand your production numbers and the compensation formula?
Or is there no one who can explain it to you adequately?
+ 3 if all physicians see and understand all the numbers on their production and the financial health of the organization.
- 2 if the numbers are shared but you don’t know what they mean and no one has attempted to explain them to you.
- 3 if the P&L, Balance Sheet and Budget Process are not shared with all physicians.
19) A culture of trust and caring
- Do you personally feel that the physician leadership and administration “has my back”?
- Do you trust that they are operating in full awareness of your experience at work and consistently working to provide you with everything you need to do your job right?
- Are you confident they care about you as more than a production number in the CFO's spreadsheet?
+5 if you answer all three of these with a “YES”
-5 if you give this three “NO”s in a row
NOTE: A yes on the questions in #19 is a natural result of your group passing a number of the previous questions in the scorecard.
When you feel your group “has my back”, that level of trust is a multi-factorial and precious outcome – and a competitive advantage for the groups that create it amongst their doctors.
How did your organization do?
If your score was a positive number … Congratulations!
You are working in an enlightened organization that understands the whole business of medicine is constructed on a foundation of healthy doctors. You are in a rare situation indeed. Please contact me and let me know more about your organization. I want to interview you and/or your leadership team to learn the secrets to your success.
If your score was a negative number … don’t lose heart.
The questions are based on an ideal organization that I have never seen – at least not to this point. These questions are things we all aspire to. Here is what I recommend …
Look at the questions and choose the one item that you think would make the most difference in your organization and contact me here for some suggestions on how you and your leaders can get started.
PLEASE LEAVE A COMMENT
- How does your organization stack up?
- Are you happy about your score or is some other emotion at the top of the stack right now?
- What do you think about these questions being used as a scorecard for the quality of your experience working in your organization?