BUZZ! e-Newsletter: January 2017
Happy New Year 2017! We enter this year with hopeful optimism.
We are pleased to present the January 2017 edition of TLD Group Buzz, our quarterly e-newsletter designed to share important topics and trends impacting the health ecosystem. As organization development consultants, seasoned executive coaches, and academicians, TLD Group’s team strives to weave the latest trends into our customized client solutions.
You can’t scan the clinical and healthcare discourse these days without hearing about physician burnout. A million patients a year lose their doctor to suicide1, and physicians are showing high, system-collapsing rates of burnout2. Digging a little deeper, we recognize “burnout” is not a physician phenomenon. It happens to nurses, administrators, CEOs, and at all touch points of our healthcare ecosystem, and it’s inviting us to think hard about the individual and systemic dynamics of stress and adaptation in our organizations.
You begin to understand the profound tension in our clinical environments when you ask a physician or a clinical team to tell the story of their best team experience and its results and subjective perceptions. They light up. They affirm and are affirmed by the work, the results, the purpose, the people. Then you ask them to describe their worst experience and its results and subjective reality. Their body language sags. They relate a story of bad results, bad communication, feelings of inadequacy, powerlessness, distrust, denigration, and guilt. Right before and among them is their well-being and “burnout,” their contribution and their despair.
If a couple of people have burnout, we could think about the solution at an individual level, just as we could if a few people had diabetes. But when major percentages have burnout, or diabetes, we are in the realm of systemic solutions. After we fix the EMR and we all become really good at mindfulness, will burnout decrease? Maybe, for some. The scale of the problem suggests a truly systemic symptom whose dimensions requires a systemic investment in the vaccine and antidote to burnout: resilience.
We can define resilience as a biological property: the capacity to adapt over time in the face of sustained stress. Rocks don’t have it; healthy populations of organisms do. Resilience is a dynamic between the stimulus of stress and the adaptation of response. No stress, no adaptation; too much stress, and you get degradation of the ability to respond (practicing holding your head under water can help you learn to hold your breath longer, which is building resilience; just leave your head under water without recovery, though, and you will quickly degrade, which is death). Resilience can be metabolic, as with runners; or behavioral, as with teams who are able to respond to negative challenges or results; or relational, as we seen in partnerships that are able to grow and improve through difficulty. Resilience entails the ability to keep responding in similar and different ways, to different stresses, over time.
If our emerging understanding of patients and populations, clinicians and healthcare organizations, and current and future landscape challenges are telling us anything, it’s that resilience at the individual and population level – of both healthcare personnel and patients – will be necessary if we are to meet the dual challenge of organizational rigor: better results and sustained, energized people to create them.
You can find really resilient individuals, of course, and this is where much of our attention tends to go. Elite athletes are resilient, people with growth mindsets are resilient, sports teams can be resilient. As doctors, we love patients who are resilient. We call them “hard to hurt,” as in able to weather clinical insults that might collapse another patient “system.”
We know the elements of building resilience from both old knowledge and new science, and we’re learning more all the time:
- Deepening a physical, mental, and emotional reservoir helps us to better endure pain points and carry the capacity to creatively fashion adaptation to stress;
- Mitigating stresses to a level where they become formative, not degrading, is essential (so addressing the EMR counts);
- Meaning-making grants us the capacity to frame our clinical relationships and our organizational experience within a broader context;
- Adaptation becomes a skill and a practice, individually and collectively held;
- Honesty, acknowledging reality (again at the individual, team, and organizational level) appears to be key;
- Healthy relationships in our work are requisite, because we are social beings who biologically require valuing and being valued, learning and teaching, connection and belonging
The emerging clarity about the basis of resilience gives us some ideas about how to be personally resilient or even resilient in our team. But our organizations are now vast, so personal and even team resilience, in isolation, can have some isolated healthy outcomes that are nonetheless ominous for our larger work, both the logistical work and the meaning of the work. To be more resilient, a nurse might just leave and start a flower shop, or a physician might cut her time down to half-time. Doctors will retire sooner or reduce their work commitment. (No problem – there are more where those came from, except there aren’t.) Teams can be healthy in isolation, but now they are either an untapped source of “resilience diffusion,” or they’re living in antagonism to the larger organization and so strengthen silos and barriers. In other words, an individual or team commitment to resilience risks potential fragmentation of organizational efficacy.
As we look inside and outside our organizations, onto a societal landscape that promises to bring stress and change at scale and pace for years to come, we can’t relegate resilience to individual practice or process improvement if we want both people and organizations that are truly resilient – healthy, productive, committed, adaptive, sustained and sustaining. These qualities must describe every individual, every process, and every effort if an organization is to both execute and survive strategically and its people are to survive, sustain, restore, and adapt personally.
It’s time. There is a way, and it’s not to decrease all the stress, nor is it to ask people to just “work on their resilience.” We know habits spread like disease and are influenced by the nature of interpersonal connections and network structures. These can be bad habits and bad disease, like syphilis and violence, but they can also be “good disease,” like agility and adaptation. Epidemics have principles, which imply that we need to focus at individual, interactive and organizational levels, emphasizing what works and what doesn’t in our responses, and mitigating the degrading intensity of stressors – attitudinal, operational, relational, or contextual.
At the Board and Executive level, it’s time to make resilience a priority as a key capacity of the organization. How? Integrate resilience metrics into workflow at every level: are we more able to do this again, did we get more adaptable, is this work relevant and meaningful, how are we focusing on what counts? Support resilience practice at the individual, team, and organizational levels, not just away from work, but in the work. Focus on reflection, gratitude, awareness, humor, and honesty. Design and test workflow relentlessly to eliminate the unnecessary distractions that flow relentlessly to the bedside teams. Develop a leadership culture that celebrates and practices adaptation in both response and mitigation of needless barriers, that leads with a growth mindset, and embodies a focus on meaning and fulfillment.
Treating burnout at the individual physician level, from an organizational perspective, is like giving Tylenol to a patient in sepsis. Likewise, expecting the dynamic healthcare results we all seek without investing in system-wide resilience is like asking an ICU patient to run a marathon. The root cause, or root solution, is to make resilience a strategic responsibility. This is now the work of Boards and CEOs, leaders and teams, doctors and administrators, and it will profoundly change your organization’s capacity, performance, vigor and well-being.
1 Wible, P. 1 Million Patients Lose Their Doctors To Suicide Every Year. National College of Physicians. Retrieved from https://www.ncnp.org/journal-of-medicine/1782-why-1-million-doctors-kill-themselves-every-year.html#sthash.EC7Ho4as.dpuf
2 Shanafelt, T. D., Hasan, O., Dyrbye, L. N., Sinsky, C., Satele, D., Sloan, J., & West, C. P. (2015, December). Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. In Mayo Clinic Proceedings (Vol. 90, No. 12, pp. 1600-1613). Elsevier.
TLD GROUP UPDATES
Reading Health will be kicking off a second Applied Physician Leadership Academy (APLA™) for a new group of emerging physician leaders on January 24, 2017. APLA™ is TLD Group’s customized physician leadership development program grounded in our research-based physician leadership success model, focusing on developing physician leaders to execute on strategies for organizational success. Four leadership clusters, namely leading self, leading others, leading for results, and leading change, will be developed over the course of this 18-month program through interactive learning modules, assessment and coaching, and action learning. Click here to learn more about APLA.
An "ecosystem" approach is about prioritizing population and community health through the collaboration of the interests, values, and points of views of various, and often competing, healthcare sectors (e.g., payers, providers, pharmaceuticals). One key step in preparing for and confronting competing interests is for sector leaders to understand the perspectives of other sector leaders to enable alignment of values, challenges, and goals. To this end, we have designed a research survey in order to better understand the challenges, interests, and preparedness of organizations from all sectors within the healthcare industry to lead with an "ecosystem" mindset. If you are a leader in the healthcare industry and are interested in contributing to our research, please contact us at firstname.lastname@example.org.
December 2016 Video Blog
TLD Group President & CEO Tracy Duberman interviewed David Carmouche, who is the current President of Ochsner Health System, and previously served as the Chief Medical Officer and Executive Vice President of External Health Plan Operations for Blue Cross Blue Shield of Louisiana. David’s experience leading in the health ecosystem spans both within and across the provider and payer sectors. In this interview, David discusses how he had developed and implemented cross-sector initiatives designed to organize care, improve quality, and increase affordability.
November 2016 Blog
With the tsunami of changes occurring in the healthcare industry today – ranging from increasing cost of care, shifting government regulations, technological advances, and the move from volume- to value-based care, the need to focus on population health holds utmost importance. Undeniably, all healthcare sectors hold the same shared goal of providing the best care to consumers, but each of the different (and often competing) sectors also holds varying interests, values, and points of view. In order to be best positioned to meet that shared goal of improving health outcomes and quality of life, industry leaders must foster an ecosystem view, which prioritizes population and community health through cross-sector collaboration. Click here to read more.
TLD Group will be presenting at the American College of Healthcare Executives’ 2017 Congress on Healthcare Leadership on March 27-30, headquartered at the Hilton Chicago/Palmer House Hilton. Our session, entitled “A new RX for building leaders for a VUCA (Volatility, Uncertain, Complex, and Ambiguous) future” will discuss how healthcare systems are leading transformative change through emerging leadership roles, as well as how to design, assess, select, and develop leaders using a success profiling and strategic succession planning process. We will provide attendees with a roadmap for developing success profiles, as well as methods for assessing, selecting, and developing candidates to align their talent strategy to their business strategy. Click here for more information about ACHE’s Congress on Healthcare Leadership.
TLD Group will be presenting with Alan Conrad, MD, (VP, Physician Integration) and Leslie Solomon (VP, Culture and Talent) at the American Association for Physician Leadership (AAPL) 2017 Annual Meeting, April 21-23, 2017, in New York, New York. Our presentation, entitled “Innovative Solutions for Engaging, and Retaining Top Physician Leaders” will describe the journey of Palomar Health in engaging and integrating high performing physician leaders as change agents through a physician leadership development process. Click here to learn more about AAPL’s annual meeting.
On November 7, 2016, TLD Group presented an AHA Physician Leadership Forum Webinar, which explored practical strategies for enhancing resiliency, reducing burn-out, and improving overall well-being of physician leaders. Click here to view the presentation.
We are proud to once again support Vital Voices Global Partnership, a nonprofit organization whose mission is to identify, invest in, and bring visibility to extraordinary women around the world. On December 5, Vital Voices held their “Voices of Solidarity” Awards Reception in New York City to present the Solidarity Award to remarkable men who have shown courage and compassion in advocating on behalf of women and girls in the United States and around the world. Click here for more information about Vital Voices.
HEALTH ECOSYSTEM HIGHLIGHTS
As a firm dedicated to developing leaders who inspire change and can execute business strategy across the health ecosystem, we invite you to review the following articles which explore how successful leaders within the subsectors of providers, pharmaceuticals, and payers, are addressing talent and engaging in strategies to align talent to execute strategy.
How to Overcome the Biggest Barriers to Health Care Alignment
Hospitals & Health Networks
While it is commonly expected for different hospitals and health systems in a given area to be in competition, the leaders of two California-based hospitals have come to the realization that aligning their hospitals and working collaboratively in fact drives the success of both organizations. In this article in H&HN, Rich Afable, the president & CEO of St. Joseph Hoag Health, discusses his experience in aligning St. Joseph Health and Hoag Hospital into a regional alliance of two formerly competing healthcare organizations.
Traditionally, pharmaceutical companies focused their marketing efforts on educating patients and promoting access to needed medications and therapies. However, product-centric approaches are not as effective in this day, where a focus on the patient experience has begun to take rise. This article from PharmaVOICE emphasizes the need to address the whole patient, including not only knowledge and access but their psychosocial needs as well, which promotes better health outcomes by improving the overall patient experience.
How Payers Should Prepare for Value-Based Reimbursement
Health Payer Intelligence
The shift from fee-for-service to value-based reimbursement has been a topic that has received much attention in recent years, as health insurers are incentivizing providers by reimbursing for the quality of care rather than volume. This featured article in Health Payer Intelligence provides insights into the importance of value-based reimbursement for cutting costs, and suggestions for how payers can make this critical shift.
Trend to Watch: Payer-Provider Joint Ventures
Managed Healthcare Executive
Payers and providers could realize great benefits from joint ventures, following the example of Aetna and Texas Health Resources as they work in collaboration to create a new health plan that combines the strengths of both healthcare sectors. In this article in Managed Healthcare Executive, leaders from both organizations discuss the drivers of this joint venture, the perks of partnerships, and the expected patient outcomes, and provide advice for payers and providers seeking to establish joint ventures of their own.