In my work helping hundreds of over-stressed doctors recover from burnout here is one of the hardest parts:
A coaching client and I work together to stop the downward spiral and get their energy and attitude back … and yet they continue to spend 10 hours a day in a flagrantly toxic workplace.
We have to fight the same battle with burnout every day because the conditions at work are not physician friendly. I can help the doctor develop new skills and awareness to become more resilient and balanced … but who has their back at work. In most cases … no one.
It’s every doc for themselves as they run and run and run on their own personal gerbil wheels in their own 3 exam rooms. Feel familiar?
What would it look and feel like in a Physician Friendly Organization?
That is something I am asked every week. “Dike, are there any organizations that ARE physician friendly and take good care of the doctors?” The good news is there are. The bad news is that physician friendly organizations are few and far between. I have discovered only two in the last 18 months that I would give the “HappyMD badge of approval” to.
19 Questions to figure out if YOUR Organization is Physician Friendly
Grab a pen and a piece of paper. Here are 19 questions to help you calculate your organization’s “Physician Friendly Score “.
=> The higher your final score the better
=> It is possible to receive a negative score on many items. When these factors are absent the stress and burnout risk increases, creating a more physician hostile workplace
=> When you have your final tally, ANY positive score is excellent
=> These questions come from Quadrant III in the Burnout Prevention MATRIX Report
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 instead on external factors like quality of care or patient satisfaction. 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? Is there evidence in the structure or actions of the administration that they are 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?
+2 if you have a Physician Wellness committee
+3 if they are actively working projects
-2 if you do not have a Physician Wellness Committee
-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?
+2 if you have Physician Wellness standing agenda items
4) Visible and involved managers
Does senior administration get out of their offices and into the front line clinical settings – clinics, hospital wards, etc.? Are they out talking with doctors 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?
+2 if your C-level administrators are seen in the clinical care wings at least once a week (and actually speak to the front line doctors and staff)
-2 if your C-level people never leave their dedicated offices or meeting rooms
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 have an active and engaged physician leadership
-3 if you do not have physician representation and are managed by non-physician administrators
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?
+2 if your physician leaders are paid for their contributions
-2 if they are not
7) Concern for and awareness of physician health
Does your organization routinely survey doctors and staff for
– Symptoms of burnout
– 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
-1 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) Do you cheer your people on
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.?
+1 if your group cheers your people on
-1 if you don’t
-2 if you have a regular organization newsletter and still don’t (another morale buster)
9) Do you ask for your people’s input
Is there an active “suggestion box” system by which physicians and staff can identify problems and solutions 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?
+2 for having a suggestion box system or its equivalent
-2 if you don’t
10) Physician on-boarding support
Is there a physician peer on-boarding system for new hires? Does a senior partner systematically show them the ropes (at work and in the community) 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 on-boarded with a peer mentor
-3 if this support is not provided to new hires
11) Regular physician support groups
Does your group have regular, ongoing support / mastermind / Balint groups for physicians who would like to participate.
+2 if these groups are present, active and supported by administration
-2 if they are absent
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?
+3 if your group has an active team such as this
-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?
+2 if this hotline is in place and everyone knows about it
-2 if there is no such hotline service
-3 if there is a hotline in place and it is referred to as the Physician Wellness Program (this is a suicide prevention hotline and not a means to your administration checking the “wellness program” box)
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
+2 if this is training in place for your physicians and staff
-2 if it is not
15) Communication skills training for the most difficult conversations
Is there a formal training program to teach the communication skills of
– 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
-3 if it is not
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?
+4 if your group is consistently improving systems based on physician and staff feedback
-4 if things only change in response to a crisis or physician/staff revolt
17) Flexible scheduling options
Does your organization support 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?
+2 if your group supports flexible staffing
-2 if your group is inflexible and the culture considers part time physicians wimps and a waste of time
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?
+2 if all physicians see and understand all the numbers
-1 if the numbers are shared but you don’t receive the training to understand them
-4 if the P&L, Balance Sheet and Budget Process are kept away from the physicians in the front lines
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 in your best interest?
– Are you confident they care about you as more than a warm body and a production number?
+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 with your opinion of the questions here on the physician friendly organization scorecard. Keep breathing and have a great rest of your day.