Physician Resilience – a stronger canary is never enough
In my work with thousands of over-stressed physicians and over 140 healthcare organizations, I have learned one lesson over and over -
Resilience training alone is not sufficient to rein in the epidemic of physician burnout.
If you believe like I do that physicians are the canary in the coal mine of medicine.
Then it is clear the epidemic of physician burnout is an indictment of the conditions of the mine, not the resilience of the canary.
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Organization-Wide Burnout Prevention Strategy
If you focus on physician resilience training and don’t de-stress the workplace at the same time, you are missing half the leverage points to prevent physician burnout. You are focused only on building a stronger canary and sending the message that it is every provider is on their own – no one has their back – on this job site.
I define resilience training as the acquisition of any burnout prevention tool the physician puts to their own individual use. The tool increases the physician’s resilience in the face of the stresses of their practice and workplace systems.
Training to promote physician resilience has value, however that value is limited by the following three factors:
1) Resilience is a hostile concept for front line caregivers.
When you roll out “resilience training” to your people, or tell them they need to be more resilient, here’s what the little voice in their head is saying.
“Why? What are you going to do to me now?”
It only increases everyone’s free floating anxiety about what’s coming next.
2) Resilience training can actually increase physician burnout and physician leadership frustration.
If you drop a mandated physician resilience training on your people without giving them protected time to participate, you are increasing time demands and stress levels. They have no time, energy or bandwidth for your new initiative. No matter how good your intentions, trying to force them to attend another program they did not ask for, will only make things worse.
You introduce a classic Mindfulness Based Stress Relief training for your primary care physicians. You are concerned about burnout and all the research shows that mindfulness helps with physician resilience. The class is three hours once a week and a half day silent meditation retreat as the final session. You make participation count for some citizenship points in the compensation formula and make clear that you expect everyone to attend.
How would you expect your physicians to respond?
You would have minimal participation because of the time commitment. Those who do participate will find the extra burden a challenge, dropout rates will be high. Many providers will see this as just one more thing they have to fit into their week. For some this will be the last straw.
As the leader you will be extremely disappointed. You know your heart was in the right place. You brought them a program you know will work and they didn’t participate.
Remember that 50% of your providers are suffering from burnout today. The rest are walking that cliff edge. Your people are not sitting around with hours of free time, twiddling their thumbs and waiting for your resilience program to come along.
You are asking them to contribute time and energy they don’t have -- for a program they didn’t ask for. You are doing this TO your doctors, not WITH or FOR them.
Their failure to participate is not about you, your program or even about them and their desires. This is a simple physics equation that obeys the first law of physician burnout. “You can’t give what you ain’t got”.
This is how well-intentioned physician resilience programs. but wait, there's more. This failure can have other negative consequences.
Leader’s must check your attitude here. If you try a couple resilience programs with your physicians and they fail to participate, notice how you might start wondering, “What’s wrong with our doctors? We bring them programs to help and they are not engaged.” This is the beginning of a toxic relationship between leadership and the front line providers.
Don’t let this happen to you.
The key is to ask the physicians what they want first. Don’t Lone Ranger this and try to figure out what to do for them. Just ask and they will tell you what they want. When you provide the tools that match their desires, engagement and participation is automatic.
3) Please remember, resilience is only necessary in a hostile environment.
The only reason you are thinking about physician resilience in the first place is because the workplace is hostile to the health and wellbeing of your doctors. Remember that physician resilience is just one half of a two-part equation.
If you don’t simultaneously improve the workplace systems, you are just building a stronger canary and stuffing her back in the very same coal mine day after day.
You are not alone here. ALL workplaces are hostile to the physician's ability to spend an adequate amount of quality time with the patients. This is a fundamental feature of the collision between patient care and documentation requirements taking place within any healthcare workplace. Most of the time we try to ignore the challenge. We assume there is the promised land where the providers sail through the day with perfect patient satisfaction and all their charting done only 30 minutes after the last patient leaves.
Resilience training alone won't get you even close to this version of Nirvana.
4) Physician resilience training only works when it is part of a one – two punch.
If you do provide physician resilience training it is vitally important you follow with the second punch immediately. Your people need a continuous process to de-stress the work flow on behalf of the physicians and staff in the system.
You have a stronger canary, now build a better mine
You must devote some portion of your leadership bandwidth to the continuous pursuit quality improvement focused on helping your people get their work done with less stress and get home sooner.
This second step must follow your physician resilience training - ideally within three months - or you lose all impact and credibility
Most organizations provide some form of physician resilience training
- Physician burnout education
- Mindfulness training of some sort
- Finding Meaning in Medicine or other Balint-like support groups
… but they stop there.
The average healthcare employer will make changes to the work flow, but it is always in response to some outside mandate. ICD-10 and Meaningful Use are examples. What you don’t often see is a serious attempt to poll the physicians on their major stressors and work improvement plans to address their concerns.
The other shoe must drop here. The organization must play its roll to de-stress the workplace ASAP after your physician resilience training.
A Framework for the Quadruple Aim and current best practices in preventing physician burnout
If you want a comprehensive strategy for your entire organization - both the Canaries and the Coal Mine, take a good look at the Quadruple Aim Blueprint, our 4-part strategy for a system wide, proactive burnout prevention program.
This program is designed to provide a powerful one-two punch of resilience training and organizational quality improvement activities aimed right at the bull’s eye of lowering your people’s stress and getting them home sooner.
It is possible to build both a stronger canary and a less toxic mine - to equip your people to be much more resilience and stop simply dumping more and more responsibilities on their back. The knowledge and implementation are here today.
PLEASE LEAVE A COMMENT:
What resilience training have you attended?
How has this training helped you and your practice?