At Mayo Clinic, leadership is broken down into three facets: leading self, leading others, and leading organizations. Stephen Swensen poses hypothetical scenarios to Christine Sinsky and Tait Shanafelt that place them in these roles.
You’ve just been appointed Director of the Centers for Medicare and Medicaid Services, Swensen tells Sinsky, and Congress has given you carte blanche for your number one priority: joy in practice. What’s your most important first step — at the systems level — that you think could turn the tide?
“There are a handful of urban myths and regulatory pain points that are holding professionals back from meeting their aspirations,” replies Sinsky. “And if we could debunk some of those urban myths and release some of those regulatory pain points, we would really go a long way toward seeing that pent up professionalism.” For example, complying with meaningful use does not mean the physician has to be the one who physically types in orders.
There are several other myths Sinsky would also like to debunk, along with areas where we need to change regulation. “[The regulation] was well-meaning,” she says, “but it’s not taking into account these new models of teamwork, such as allowing staff to be entering elements of the HPI.”
Switching to Shanafelt, Swensen tells him: You’ve just been appointed president and CEO of a system of 127 hospitals, and you can do what you need to do for your number one priority: reducing burnout and growing joy and engagement in work. What will you do?
“The first thing, from the perspective of the C-suite, is, don’t buy into the myths that this problem is so big that it’s a national epidemic. What can we really do locally?” says Shanafelt. The second myth to ignore is the fallacy that solving this problem costs a lot of money.
There are also two categories of taking action within an organization. “The first are the things that raise all boats — and there are limited activities in that category,” says Shanafelt. For example, Mayo Clinic has seen success in working to build community and collegiality within physician groups.
The second category gets down to the work unit level. Shanafelt recommends beginning by measuring, with external benchmarks, dimensions such as well-being, engagement, burnout, and satisfaction in all work units. Once you have that information, identify the units where there is the greatest opportunity to improve.
“What we find is that all the ideas are out there,” says Shanafelt. “The physicians on the front line, it’s so obvious to them what changes need to be made to improve things. They’re simple, many times. They’re achievable. But they’re also stuck in the work units.”
At the organizational level, once you’ve identified the divisions or departments that are struggling, this reduces burnout to a manageable problem for the CEO, who can then work with the leaders of those units and help them engage their physicians to devise solutions. “To be honest, it comes down to trusting your doctors, listening to them, empowering them to put their ideas into action, and seeing whether it works,” says Shanafelt. “Even when it doesn’t work, you now have an engaged group of physicians who are willing to take the opportunity to try the next thing. And you’re working together toward a common goal.”
From the NEJM Catalyst event Leadership: Translating Challenge to Success at Mayo Clinic, June 2, 2016.