Quadruple Aim FAIL Diary: How to Sabotage Your Physician Wellness Program From the Start

Posted by Dike Drummond MD

physician-wellness-quadruple-aim-sabotage-physician-leadershipQuadruple Aim FAIL Diary:
How to Sabotage Your Physician Wellness Program From the Start

Healthcare's new Quadruple Aim recognizes happy, healthy patients can only come from happy healthy doctors. Quadruple Aim leaders understand that taking better care of your doctors is mandatory for successful organizations in the future.

Quadruple Aim Core Blog Post Library

If you are a quadruple aim leader and step up to the plate to launch a wellness intervention of any kind

90% of physician leaders fall into a blind spot our leadership skill set and sabotage their wellness programs from the start. Don't let this be you.

Even the best of intentions will fail if you don't understand this physician-specific blind spot before you launch your project

In this article - let me show you three key learning points critical to the success of any physician wellness project.

  • This physician leadership blind spot 
  • The decision that will sabotage even your best intentions - and how to avoid it
  • A case study of a Mindfulness Program FAIL that illustrates this concept perfectly

meeting facilitator's manual

The Invisible Fork in the Road

When you and your leadership team finally make the decision to do something about burnout - you will be standing at the most important decision point for the whole project. Unfortunately this decision point is rendered invisible to almost all physicians because of the programming of our medical education.

Here's that choice.

Do it TO the physicians
Do it WITH the physicians

If you make the wrong choice ... even a Mindfulness Program can blow up on you. I will give you an example of just such a FAIL at the end of this post.


First, let me show you your programming

Realize that physicians make naturally lousy leaders when it comes to running projects - like your wellness program - for a simple reason. Our default leadership style doesn't work in this arena.

You must recognize and change your leadership style for success in your Quadruple Aim efforts. 

Physician Leadership 101

  • We are taught to Diagnose and Treat
  • Once we think we have the Diagnosis, we Give Orders
  • We expect the Team to Obey
  • and the Patients to Comply

That is appropriate if you are the undisputed expert, with the single "right answer" and the smarts to coordinate the implementation of that solution. You are not that person when you are leading a wellness project.

When it comes to preventing physician burnout, there is only one way to understand what to do ... 




Any wellness program that is not specifically requested by the front line physicians will struggle -- and most will fail.

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Outline of a Wellness Program FAIL ...

  • Leadership says, "We need to do something about burnout."
  • A committee is formed and charged with figuring out what to do
  • The members of the committee use their physician programming to Diagnose and Treat
  • They perform a literature review
  • From within the committee meetings, they name what they see as the problem
  • In the same meetings, they come to consensus on a solution - "This is what we need to do to/for the doctors"
  • The program is launched onto the physicians
  • The Wellness Committee sits back, expects the program to work and the physicians to be thankful
  • and it all blows up for a very simple reason...

It was done TO the physicians - not WITH them

Your project is just one more thing for the physicians to squeeze into their already overloaded day. They didn't ask for it. For a number of them, your program will be the last straw that tips them over the edge into burnout.

It can be very confusing to see your program go down in flames, especially since you know your heart is in the right place.

You really do want to help. Your physician leadership blind spot just blew up your project. You didn't see it coming. And now burnout is worse rather than better.

The even bigger tragedy...

The leadership team can quickly give up on being able to do anything about burnout and moves on to more pressing financial issues.


Don't make this classic physician leadership mistake

physician-wellness-physician-leadership-quadruple-aim-program-failsAlways work with the physicians in the front lines to design your wellness interventions.

If you ask them, they will tell you exactly where to focus your efforts.

1) Ask Questions about their sources of stress
2) Make a list and help them choose just ONE to address
3) Work with them to implement a positive change
4) Repeat

Simple, right? Step outside of your Diagnose and Treat programming and become a Servant Leader instead. Let THEM tell you what to do. 

Working WITH your physicians provides several huge benefits

  • It is less work for you as the leader
  • The projects are always targeted on key stressors
  • Your project is much more likely to have a meaningful impact on your doctor's quality of life
  • Your physicians are bought in and participating from the start
  • There is a cascading effect where success builds on success and the culture begins to shift
  • Listening to the doctors is a powerful way to show you care about them and understand the true meaning of the Quadruple Aim

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Mindfulness Program FAIL - Case Study

You would think it's difficult to fail with a mindfulness program ... right? I was at a wellness seminar last year with Dr. Tait Shanafelt as one of the key speakers. He was asked about wellness projects that failed and cited this one - where he is a co-author.

This is a study of medical students using a mindfulness curriculum that had been successful in previous studies. Why did it fail here?

mindfulness-program-fail-physician-leadershipThe Impact of a Required Longitudinal Stress Management and Resilience Training Course for First-Year Medical Students
J Gen Intern Med. 2017 Dec;32(12):1309-1314

The answer is simple. It was done TO the medical students.

The only difference between this protocol and previous deployments of the same training was in this study the mindfulness program was mandatory! In previous studies, the subjects were volunteers. They wanted to learn mindfulness rather than being forced to comply with a mandate.


Remember, Always Launch Wellness Programs WITH Your Physicians 

  • Ask what is stressing them
  • Listen 
  • Address their concerns
  • Make participation voluntary

And watch the difference it makes.



Have you seen wellness programs fail in this way?
When you have seen programs succeed, were they deployed WITH or TO the doctors?


Tags: physician wellness, Physician Leadership