Look at health care today and it barely resembles the traditional solo, small practice era, where physicians held almost all of the decision making power and unbound independence. The environment where physicians practice has starkly shifted from working with small teams, with a clear clinical hierarchy and independence to working in complex, matrixed teams of large healthcare organizations. These are challenging times for physicians, as this progression of the healthcare industry has left many feeling left behind, a loss of autonomy, relegated to simply being “cogs in a machine.” The various impersonal and quantitative metrics physicians are now held to, such as measures of cost, Relative Value Units (RVU’s), how quickly they respond to health record inbox messages, amongst others, have overshadowed the traditional methods of feedback that physicians derive purpose and meaning from, appreciation and respect from patients and colleagues. All of this culminates in increased physician burnout and physician leaders who cannot buy into the mission of their organization or see how it aligns with the values of their profession.
Seemingly the central dogma of what constitutes successful leadership and quality for healthcare in these large systems is the elimination of variability and the promotion of standardization, which handedly feeds into the “cogs in a machine” mindset. In response, many progressive leadership approaches and the authors (Shanafelt, Trockel, Rodriguez and Logan) of the article published in Academic Medicine, “Wellness-Centered Leadership: Equipping Health Care Leaders to Cultivate Physician Well-Being and Professional Fulfillment” challenge this dogma. The strongly held belief that all variability is waste, washes away the intricacies and nuances within healthcare, the unique individual needs of patients and the differences between physicians both in the demands of their personal lives and responsibilities. Shanafelt et al, assert that while physicians are being thrust into these leadership hierarchies of large healthcare organizations, many have not had the necessary prior leadership development or experience to adequately prepare them for these roles. The detail-oriented clinical leadership of a physician, oftentimes contradicts the need for critical, long-term, broad-scale leadership of administration, which manifests through less-than-desirable actions such as micromanaging and perfectionism.
goShadow and experts such as Shanafelt et al, recognize these issues as organizational leadership issues, where ultimately healthcare systems are underutilizing and underestimating the talents of some of the most motivated and purpose-driven professionals in healthcare. In their groundbreaking paper, Shanafelt and colleagues propose a new integrative leadership model that blends together various leadership approaches published throughout the last 70 years. Wellness-Centered Leadership (WCL) focuses on cultivating leadership behaviors to promote engagement, professional fulfillment, and key skills for not just growing physician leaders but all leaders. WCL aims to develop leaders, who then uplift others, to exemplify “inclusion, keeping people informed, humble inquiry, professional development, empowerment of individuals and teams, and tap into intrinsic motivators rather than extrinsic rewards or punishment.” The WCL is a 3 elements approach forming a pyramid building off a foundation of simply “Caring about people always,” funneling into “Cultivating individual and team relationships,” all of which allows leaders to “Inspire change.”
The vision for “Caring about people always” is to “emphasize integrity, servanthood, and seeking the best for people,” sounds like a simple task for physicians whose calling is to care for patients. However, in the WCL framework being able to truly care for others on a team begins with self-reflection and self-caring. For leaders to respect, empathize, be curious, and seek to understand and validate needs and contributions of individuals and teams, they must first nurture these qualities within themselves. Only after, can leaders recognize how their behaviors can affect professional fulfillment, vitality and wellness of team members and create the solid foundation to “Care about people always.” goShadow challenges leaders to take this a step further, to take a personal interest in “What Matters Most” to themselves, their staff and their patients. Create the opportunity and go off script for positive and meaningful conversations with others.
“Cultivating individual and team relationships” is to go beyond self-development and the needs of people to develop the vision and mission for the team, guiding the process by seeking input from others. WCL views people as inherently capable of growth and improvement, people are individuals, each with their own strengths, obstacles, motivators and ambitions. A leader’s job is to translate oftentimes broad and vague directives from above, to a goal that you can align with your team’s mission and goals, while serving double-duty as the mouthpiece for the team. Successful alignment of values and goals, injecting purpose into work is an important step to combating burnout and fatigue. With evidence pointing towards individuals who spend just 20% of their professional time on tasks they have a passion for, being at a significantly less risk for burnout. Physicians find an advantage here as they typically approach their work with a sense of calling, dedication and commitment, deriving strong purpose in their work. Tapping into the reasons why physicians do what they do in the first place, is a powerful inspiration for those around them.
Finally, after successfully cultivating the first two elements, leaders are allowed the privilege to “Inspire change” encouraging teams to think beyond the status-quo and empowering them to be innovative. Instilling within them the trust that they can make a difference. Succeeding here means providing team members with the greatest possible flexibility and control over how they accomplish their goals and meet their needs while following best practices. WCL organizations primarily rely on intrinsic motivators to drive results (meaning, purpose, values, voice, input, control, and professional development), rather than extrinsic (financial incentives, titles, awards – carrot & stick models) which have diminishing effectiveness that overtime, lower motivation, and simultaneously deconstruct passionate work into work for a paycheck.
Altogether, the rapidly changing nature of healthcare has left an important piece of our system feeling forced to play a smaller part, exposing issues of leadership and trust. It is thus up to leaders to give all stakeholders a voice in steering the organization, while also having a duty to develop leadership capacity not just for physicians but all those involved in administration. Training programs and opportunities to build skills of WCL need to be incorporated into leadership development programs. If cultivated properly, “WCL will empower individuals and team performance to address the current problems faced by health care organizations as well as iterative innovation needed to address challenges that may arise in the decades to come.”
Source: Shanafelt, T., Trockel, M., Rodriguez, A., & Logan, D. (2021). Wellness-Centered Leadership: Equipping Health Care Leaders to Cultivate Physician Well-Being and Professional Fulfillment. Academic Medicine,96(5), 641-651. doi:10.1097/acm.0000000000003907
September 24, 2021