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Burning out? Do you need a new boss?

July 2015
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PHYSICIAN LEADERS who get high marks for reaching out and connecting with their staff are associated with lower burnout rates, according to a new study.

The research, conducted at the Mayo Clinic in 2013, asked more than 2,800 doctors to report their own degree of burnout and to evaluate their immediate supervisor. They rated their bosses (all of whom were physicians or scientists) on 12 questions using a five-point scale.

Forty percent of respondents reported at least one symptom of burnout. But for every point increase in how doctors favorably rated their supervisors, there was a 3.5% decrease in reported burnout and a 9.1% average improvement in career satisfaction. Those results bolster the idea that front-line leadership affects physicians’ job satisfaction and well-being.

“It didn’t surprise us,” says Stephen J. Swensen, MD, coauthor of the paper, which was published in the April issue of Mayo Clinic Proceedings. “But it affirmed our core belief that the people with whom you work make a big difference, and we quantified that in a statistically significant way.”

Sea change in medicine
Long geared toward physician autonomy and independence, medicine has a history of moving doctors up the administrative ladder based on criteria such as academic rank, Dr. Swensen points out.

“Many medical or academic organizations still find it more important for someone to be famous and internationally recognized than for that chair to have social capital with his or her staff,” he says. A radiologist, Dr. Swensen is medical director for leadership and organization development for Mayo in Rochester, Minn.

The study notes that choosing a leader based on clinical acumen, scientific expertise or reputation alone “creates a circumstance in which an individual who has not been well-prepared to lead is thrust into a very challenging leadership situation.”

Moreover, Dr. Swensen says, that strategy can’t work in an era of increasing physician employment and public accountability.

The transition to a different kind of leader represents a sea change for medicine. Instead of what he calls a cottage industry of low reliability and high variability, Dr. Swensen says that today’s medical model is post-industrial with an emphasis on teamwork, social capital, standardized work and patient centeredness.

Social capital translates into trust and respect, he explains, which drive the ability to lead. “Leadership is a social process, and being world famous in an area of medicine doesn’t help with social process,” he points out. “Selecting leaders relates to social and emotional intelligence, not their IQ.”

Leadership qualities
What qualities make leaders effective in terms of reducing burnout risk in the physicians they supervise?

The key is the ability to engage staff, according to Dr. Swensen. While this is well-established in business sectors as a best practice for leadership selection and performance, he says, “medicine is a little late to that party.”

Effective leaders, he explains, are engaged in a positive, productive mentoring and coaching role. Further, they are interested in each physician’s career and opinion and show that concern genuinely. They also treat each physician with respect.

Effective leaders also take pains to address what Dr. Swensen says are the five drivers of burnout: workload, work-life balance, work inefficiencies, control over life, and meaning and purpose.

Once leaders engage colleagues and look at these drivers of burnout, the next step is action. “Those are pebbles in the shoe that we can remove,” Dr. Swensen says.

The payoff for staff physicians? “You are substantially and statistically significantly more likely to be satisfied and engaged, and less likely to be burned out.” In addition, he adds, engaged leaders work better as part of a team with nurses, pharmacists, social workers and administrators to deliver quality care.

Creating a process
But finding and nurturing leaders can be challenging. As Dr. Swensen explains, Mayo’s approach includes developing a succession pool characterized by readiness as well as ethnic and gender diversity. Division and department chairs serve no more than eight years.

When candidates are being considered for a leadership role, Dr. Swensen recommends that they have a face-to-face conversation with all colleagues who will be supervised. It’s also important for candidates to meet with staff from other affected service lines and departments.

“That’s a way to get at the social capital of that person ” trust and interconnectiveness,” he says. “What do colleagues think of this person?”

Next, evaluate candidates’ institutional perspective: Can they promote the mission of the organization and not just that of their department or division? Patients’ needs are best met by an integrative approach, he says, rather than by leaders who just represent what they see as the interests of their own department.

Dr. Swensen also suggests evaluating candidates according to the 12 leadership dimensions noted in the study. (See “What makes a good leader?,” this page.) All of these components, he points out, have a statistically significant association with less burnout and more satisfaction. “Fulfilling those 12 dimensions tells you that’s the right person,” he says.

Don’t put too much stock in formal class work in leadership, he warns. “The least effective way to prepare for leadership is going to a course to get an MBA or equivalent,” he says. And while education is important, just having had a course on leadership doesn’t make you ready for the job.

Instead, research shows that 90% of readiness happens through on-the-job training with opportunities for mentoring, feedback and assessment, Dr. Swensen notes.

“We give an emotional intelligence assessment so leaders can reflect on themselves as a leader and their role on a team, then modify behavior,” he says.

While Mayo’s process of identifying good physician leaders works well, Dr. Swensen acknowledges that it isn’t perfect. Although leaders partner with administrators and nursing leaders, he says, sometimes they’re not up to the challenge.

“If it doesn’t work, we support that person with a mentor or coach,” he points out. And if that doesn’t work? “We get a new leader.”

Paula S. Katz is a freelance health care writer based in Vernon Hills, Ill.

Published in the July 2015 issue of Today’s Hospitalist