To fix healthcare, we first have to fix the culture; that means a lot of doing and undoing in our work
It was a perfect storm. Emily was in labor and not progressing. Richard had a fever and was unresponsive to antibiotics. Felipe needed to be intubated and transferred to a larger facility. As the situation escalated, the attending ran from the ER to the labor deck, shouting orders to move Felipe. When the physician returned to discover that the patient hadn’t yet been transferred, he snapped. The demeaning verbal onslaught was blistering and accusatory.
In the context of healthcare, most of us have been there—either delivering the censure or as victims of it. For those in charge, we blame the meltdown on some combination of inexperience and overwhelming workload. For those on the receiving end, there’s little to do other than take it. And for one of us— the attending in the room—I cringe at the memory.
Regardless of our role, our behavior has lasting consequences on the dynamics of our teams—influencing moods in the moment, as well as shaping (and eroding) our ability to deliver care when the stakes are high and trust and communication are key.
Today, as leaders of physician engagement for one of the nation’s largest medical groups, we spend less time interacting with patients. Instead, we care for providers. And for healthcare leaders across the industry, caring for providers—ensuring they can get back to their core calling to care for patients—may be the most important work we do. And it starts by focusing on culture. In the context of medicine, the seeds of our culture were sown long before talk of bundled payments and value-based care. Indeed, beliefs foundational to our profession have well-established, often proud, histories. From the lone, male doctor in a rural locale to the 100-hour workweek, medicine worships the individual. In an interview in the New England Journal of Medicine, organizational development pioneer Edgar Schein said, “We’re all about individualism … and we associate great performances with great leaders. We pay lip service to teamwork, but it’s the individual … who fascinates us.”
This professional image exists against a backdrop of working conditions that include erratic hours, oppressive documentation, scattered workspaces, shifting team compositions, and the stress of life-and-death decisions that activate our primal (less congenial) tendencies. It’s no wonder these pressures manifest as young doctors berating those around them—who are ashamed of their behavior, blind to it or simply say they’re “doing their job.”
But providers haven’t reached this point because of intrinsic shortcomings. Our culture is suffering because we’ve tolerated working environments that contradict our human need for relationships, connection and respect. Even fleeting fulfillment derived from patient interactions isn’t enough to curtail external, negative forces. We came into this work as healers, and yet, just one look at the National Academy of Medicine’s Conceptual Model for Clinician Well-Being reminds us of the magnitude of systemic barriers that distance us from that higher purpose.
As leaders, then, we have the challenge of both actively undoing many of the mores of our profession—the isolation, shame, hierarchy and perfectionism—while concurrently creating a new set of norms that dismantle environments that are blatantly toxic or passively aggressive.
This is the hard work of culture-building.
And if rising suicide rates and declining fulfillment among providers aren’t enough to compel a focus on culture, then let’s do it for our patients. Ours is an industry where employee satisfaction is directly linked to patient satisfaction and outcomes. Evidence reveals that the better the provider feels, the better the patient does. And while we don’t always have a great deal of control over patient behaviors, leaders have a tremendous influence on culture. We can create a workplace that’s as diverse as our patient population, inclusive of all talents, and empowers clinicians to provide the best care for their patients and their peers. ●