Physician Leadership Skills: The Missing Piece in the Physician Burnout Puzzle

by | May 2, 2017 | Physician Burnout, Physician Leadership

Data confirms high rates of physician burnout, but it doesn’t tell us how burnout can be avoided. In fact, data on preventing physician burnout is almost nonexistent. One thing we do know, however, is that physician leadership skills a key variable. Physician leaders can make or break a workable culture. A 2015 study from the Mayo Clinic found that qualities of physicians’ leadership accounted for 47% of the variation in physician satisfaction and 11% of the variation in physician burnout. Looking at their study, a number of leadership attributes stand out that can be helpful in avoiding physician burnout.

If you’re a Physician Leader or Executive looking to bolster their management and physician leadership skills, learn more about my Physician Leadership skills and Executive Coaching services.

Physician leadership skills and physician compassion

Compassion is a core value for most physicians but is increasingly bypassed in medical practices. Recently, I coached a 47-year-old Internal Medicine medical director who oversaw 80 primary care physicians. Much of the stress of his job was conveying edicts from the administration to the physicians he supervised. At the end of a particularly terse medical director meeting, the Chief Medical Officer bluntly told the medical directors that, in addition to recent cuts, they would need to inform their physicians of a further 10% pay cut. There was no discussion of the impact this would have and the news was delivered in a cut and dry fashion. My coaching client felt morose, defeated, like a cog in the wheel of the healthcare factory. The communication had flown completely in the face of compassion, a core value for him. He wondered how much longer he could go on in his position. He noted that if the same news had been delivered with concern for the impact it would have, while the consequences would still be painful, he would have experienced a greater sense of hopefulness and community. I coached him around maintaining his values by learning from this experience and never repeating this type of conduct. We continued to focus on making sure that each and every one of his communications conveyed the compassion he knew first-hand was vital in maintaining morale and avoiding physician burnout.

Facilitating engagement

Employee engagement has been hailed as the single most important factor in determining levels of satisfaction with work. In a 2012 meta-analysis of research studies, Gallup found that compared with the bottom quartile, companies in the top quartile for engaged employees had 22% higher profitability, 10% higher customer ratings, and 48% fewer safety incidents.

Engagement is the antithesis of burnout. The many administrative burdens physicians face making it difficult for physicians to engage fully with their most important task: caring for patients. Physician leadership skills makes a pivotal difference. Given the many metrics coming down the pike, leaders need to constantly orient their approach around such questions as: “While metrics need to be pursued, how can I focus on how hard my physicians are trying rather than whether they’re meeting each specific target?” “What actions can I take today to help my physicians feel more energized and engaged.” “How can I facilitate my physicians performing at their best?” Sometimes small actions go a long way to facilitating engagement.

Recognizing a job well done

Everyone wants to feel valued and recognized for their contribution, yet in the current healthcare environment, too often the emphasis is on areas of deficiency rather than successes. A Chief Medical Officer I coached worked with her team to achieve large improvements in productivity. To remain competitive, however, metrics revealed that further improvement was needed. While her tendency was to focus on the gap between where clinicians were and where she wanted them to be, I coached her to focus on the gains rather than the deficits. She worked to ground each communication with her physicians on the strides they had made, identifying what strengths and skills they had used to make improvements, and assisting them in utilizing similar approaches to glean greater success. In a subsequent satisfaction survey, her physicians gave her the highest scores.

Communicating with positivity

We spend most of our waking hours communicating with others, but very often the rush keeps us from doing so in a respectful and positive manner. In a 2004 study of 60 top management teams engaged in annual strategic planning, the single most important factor in predicting organizational performance was the ratio of positive to negative communications. The research revealed that in high-performing organizations, the ratio of positive to negative communications in their top management teams was 5.6 to 1. By contrast, in low-performing organizations, the ratio was 0.36 to 1. In a recent physician resilience retreat I led, I asked the audience how their risk of burnout would improve if their leaders focused more on the positive. The responses were instructive: “It would be infectious,” “I’d be more productive,” “I’d be less irritable,” “There would be less spill-over with my family.” Anecdotally and empirically, the evidence for positive communication is high.

Open listening

A principle of effective leadership is listening affirmatively and supportively, being open to the input of others, and not jumping in with one’s own opinion and advice. Leaders who inspire dedication, sacrifice and grit are ones who listen openly. As noted by Stephen Covey, effective leaders communicate with the goal of seeking understanding. A key skill is to ask open-ended questions.  Open-ended questions communicate a deeper interest in the person’s response, increasing their sense of being heard. By shifting from questions that suggest a right and wrong answer, open-ended questions encourage others to respond more fully, contributing to greater engagement.

If you’re a physician leader, take heart in knowing that your actions can have a significant impact in mitigating physician burnout. Even if you’re suffering from physician burnout yourself, you can help motivate physicians to overcome the challenges they face. If you are a front-line clinician, please feel free to forward this post to your physician leadership. Many physician leaders are excellent clinicians or researchers and bemoan the fact that their physician leadership skills are limited. Most are happy to learn ways that they can improve.

If you’re suspecting a colleague may be suffering, here’s how to respond to physician burnout in a colleague.

  1. Embrace uncertainty

When you stop and think about it, uncertainty and change are the only things that are certain. Impermanence is one of the basic laws of our world.

After all, everything changes. Our relationships change. Our kids grow up and change. Our bodies age and change. Our environments change. Our planet changes.

All too often, however, we forget this basic truth. We somehow expect things to be predictable and stable.

The problem is that this expectation sets us up for difficulty. It leaves us struggling unnecessarily when something shifts. It adds a layer of suffering above and beyond that caused by all the VUCA around us.

What I’m getting at is that we have a choice. We can meet uncertainty with reactivity or we can meet it with mindful understanding.

More than meditating on a remote mountainside, mindfulness helps us have the calm, steadiness, and clarity we need to work constructively with all the change and uncertainty.

At the same time, while we can find ourselves resisting change, we can remind ourselves that it does not have to mean something bad! Just take a moment right now to think of all the difficulties you have faced in your life and work that are now resolved and far behind you. This can help you see how change has actually been quite the positive.

  1. Respond to complexity with compassion

Even knowing that change is the only thing that is certain, it can still be difficult to weather. Living in such a VUCA time is difficult. You deserve compassion for managing all the challenges.

With mindful awareness, we can bring ourselves compassion for what we’re going through. There is increasing evidence that self-compassion is a powerful antidote to stress and even burnout. From where I sit, I think that it is actually one of the most powerful medicinals available to us.

  1. Take purposeful pauses

With mindfulness, we are aware of what is going on within and around us. We tune in and pay attention to our experience. We learn to utilize our breath to take us out of the fears, worries, stories, and preoccupations our minds are so good at generating about what might come next, and bring us back to the present moment. Here in the present, we leave that overly activated limbic state and can experience a sense of calm.

A pause also serves to allow our prefrontal cortex to come online. It creates a critically important space between our emotional response and conscious, intentional action.

Once we have paused, we can then see more clearly that fear had taken hold. 

With a pause, we become the witness of our experience as opposed to the one trapped by it.

  1. View VUCA as opportunity

I don’t know about you, but I can find myself reacting to the VUCA environment with something of a fixed mindset. With a fixed mindset, I am telling myself things like ‘it shouldn’t be this way’ and ‘why is this happening?’

When I can utilize mindful awareness, I can see that I’ve boxed myself in with a fixed mindset. I can challenge myself to grow. By grow, I mean challenging myself to see whatever difficulty I’m experiencing as an opportunity to learn.

Here again, mindfulness again throws us a lifeline. Mindful awareness involves leaning into curiosity.

I can flip the script and ask myself:

What can I learn from this experience?

How can I use this to be a better version of myself?

How can I help others cope in this VUCA environment?

What do I want to look back and see about how I acted?

In summary, while VUCA is definitely the order of the day in healthcare and beyond, you don’t have to succumb. You don’t have to live in fear. There are constructive actions you can take to help you cope with uncertainty, build calm in chaos, and even thrive in chaos and VUCA. While we can’t control much that is contributing to the VUCA time, with mindfulness we can control how we respond to it.

I hope you’ll try out these 4 mindfulness strategies as I have seen them help countless people. I’d love to hear how it goes.

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To learn more about how mindfulness coaching can help you cope with this VUCA time, please reach out for a complimentary consult.

6 Free Resources To Help You During COVID19 And Beyond.

  1. 14-day meditation series 
  2. Imposter No More PDF
  3. Resilience Book Chapter
  4. Leading In Crisis PDF
  5. Balance To Burnout PDF
  6. 30-minute consult

Take advantage of one or more of these valuable resources created for clinicians and non-clinicians.