Health care leaders’ roles in pandemic recovery: Caring for caregivers  [PODCAST]

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“These are extraordinary times. Leaders have the opportunity to seize the day, to lean into this turning point in health care delivery, to drive organizational transformation, and to emerge from the devastation of the pandemic with an organization in which patients and clinicians thrive.

You simply have to ask yourself, are you willing to change? Are you willing to dive into the fray and adapt to save your clinicians with the same commitment that your clinicians have demonstrated throughout the pandemic?

If you are, your organization will succeed beyond what you think is possible.”

Paul DeChant is a family physician and health care consultant.

He shares his story and discusses his KevinMD article, “Caring for caregivers post-pandemic.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Paul DeChant. He is a physician and health care consultant. He wrote the KevinMD article “Caring for caregivers post-pandemic.” Paul, welcome to the show.

Paul DeChant: Kevin, thank you so much. It’s a great pleasure to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Paul DeChant: Sure, I appreciate it. I’m a family physician. I’ve practiced for 25 years. I never thought I would go into leadership roles, but I couldn’t stand it when things didn’t work well in my office. I would speak up, got put on committees, ultimately chaired committees, became a medical director, and finally became a CEO for a 300-physician medical group.

When I got to that position, I realized we had an opportunity to make practice better. So I used Lean as a management system and culture to drive change in this 300-physician group, with the theme of returning joy to patient care. Five years later, we actually got recognized by Consumer Reports and the California health care improvement group as the highest performing out of 170 groups in the state of California, two years in a row. And we moved our physician satisfaction from P45 to P87 on AMGA’s provider satisfaction survey. So we knew what we did worked.

I then, about seven years ago, went into consulting, working with health system leaders around the rest of the country to help them address this issue of physician burnout and focus on what changes they can make in their organizations to get to the root causes of burnout and truly, effectively address those.

Kevin Pho: So on this podcast and on my blog, I have a lot of physicians that I encourage to step into leadership roles, because in order to make change, I think physicians need to do it themselves. What would you say are the biggest challenges in that transition from a clinical role into a CEO or other physician leadership role?

Paul DeChant: First of all, moving from being a clinician to being a leader is a very different way to function. We’re used to just taking control, quickly assessing a patient, figuring out what’s wrong, taking an action, making a change. Leadership takes longer, and you have to work more collaboratively with a group of people to do that.

Secondly, as you move into higher levels of leadership, you end up working with non-clinicians who don’t have the same clinical background, experience, and thought processes that we do as clinicians. It’s about learning to understand that and understand their needs as you’re proposing ideas. We have great ideas to fix things, but sometimes they’re not well understood by the non-clinician leaders unless we can couch them in ways that are important to them. So when we think about a problem, even like burnout, some of the more important things that you’ll get response from non-clinician leaders on is if you’re looking at the financial impact, so that people who are worried about keeping the doors open and the lights on see a benefit from their needs as well as from the physicians’ needs in addressing those issues.

Kevin Pho: Now, for those physicians who want to go into leadership roles, do they need to get, like, an MBA degree, or are these leadership traits something that can be learned on the job?

Paul DeChant: You can learn it on the job. Generally, as health care organizations have gotten more complex, the more knowledge you have about that, the better. So if you’re serious and you’re relatively early in your career or mid-career, I’d really encourage you to pursue some degree. It doesn’t have to be an MBA. It could be an MPH. It could be some other degree similar to that. But pursuing the degree makes sense.

I think the other thing that’s really important if you’re considering leadership: Do it for the right reason. If you’re doing it to escape the burnout of your drudging day-to-day patient care, that’s not a great reason to do this. If you’re doing it because you want the title of being a CEO, that’s not a great reason to do this. If you’re doing it because you know you can make change and you want to be a positive participant in that change, then by all means, I encourage people to get involved.

Kevin Pho: And what would be some of the character traits in an individual physician that would make them great physician leaders?

Paul DeChant: First of all, someone who cares about their colleagues and about the patients and about their community. Caring is a very important one. Somebody who is a system thinker, who can see beyond the immediate problem but understand the implications across an organization or across a community. I found myself kind of naturally drawn to reading as much in business books as in medical journals, to really get that different sense of what was happening.

So if you find that you really care about your colleagues, you care about and wonder how organizations work, and you like to have that intellectual exercise of delving into that, and if you’ve experimented by joining committees and find value in participating in committees and making change happen, then those are good indications that this would be the right track for you.

Kevin Pho: Let’s transition into the KevinMD article that you wrote. It’s titled “Caring for caregivers post-pandemic.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to write it?

Paul DeChant: In the work that I do, I see a lot of disconnect between C-level leaders and frontline clinicians. In addition, in this work, I have a daughter who’s been a resident in New York City over the last couple of years. So she went through this incredible experience of being someone in the heat of this existential threat that has come into health care. When this first came up, I saw it in her, and I saw it in connections I have across the country, of people that were doing heroic things. As they became, quote, heroes, at first there was something noble about that. But as time went on, a lot of people began to question, “Should I? Is it worth me being a hero in this situation? I’ve put myself on the line, but I’m not sure that my leaders actually have my back.”

We saw some cases, certainly, where there are fantastic organizations. Those leaders were there shoulder to shoulder with the clinicians, helping to figure out the challenges of unprecedented situations. But there were others where the leaders really were disconnected, or as they got frustrated with the response, the justifiable response of clinicians to this challenge, they actually pushed back. They didn’t support their clinicians. Some even penalized clinicians for speaking up about the lack of PPE.

But I can tell you, as someone who, my wife and I were doing everything we could to get PPE to our daughter in New York, across the country from us. My wife started making masks. We were buying goggles and sending them to her. There was such a crisis. We need leaders who are supporting our clinicians on the front lines. Some did, some didn’t, and you can see the difference in performance as a result of that.

Kevin Pho: Go into a little more detail. So those leaders who did not support their clinicians, who penalized their clinicians for speaking up about the lack of PPE, what were some of the impacts on their organizations?

Paul DeChant: Oh, well, it’s demoralization. It’s higher risk for the patients. It’s higher risk for the staff. There have certainly been a number of well-known cases of clinician suicide as a result of the intensity of the pandemic. And so the ability to support caregivers, that’s really the CEO’s role.

As I moved from being a frontline physician to being a CEO, I realized that the most important thing that happened, that drove the operations and the financial return of my organization, was direct patient care. That’s where things happen. As a CEO, I’m not providing that care, although my best value is when I am supporting the people who do provide that care. And yet it’s easy to get disconnected when I’m also worrying about contracting and reimbursements and other issues. But we have to stay focused. If we understand the needs of the frontline clinicians, that’s where the difference happens.

Some organizations had their CEOs and other C-suite members actually going through the halls, helping and supporting. Others really kind of retreated away. It was natural in a way. Everybody was supposed to work remotely if at all possible, but that was not healthy for the top leaders to be connecting to people who were truly putting their lives and their families on the line.

Kevin Pho: Now, as a CEO yourself, do you have any insight on those CEOs who may have a disconnect from their clinicians? Do they pause and reflect on the demoralization that they may be causing, and I guess, do they ever learn from that going forward?

Paul DeChant: Some do. It’s also not easy being a CEO. Five or six years ago, burnout rates among CEOs were about the same as the general public, whereas we know physicians are at least 50 percent higher. In fact, now many people in the C-suite in health systems are also seeing those same burnout rates, because that job is hard also.

One of the big challenges, though, is without understanding the actual operations of patient care, it’s easy to get disconnected. I think the first thing, the most important thing, if a leader does one thing to address burnout and to improve their operations, is to spend time in the clinical setting. Actually go and shadow clinicians while they’re working. When you do that, you understand at a deep, visceral level, which there’s no way you can understand by reading spreadsheets and reports, sitting with a committee in a conference room.

Kevin Pho: Now tell me about burnout, especially during the pandemic. I know the statistics: Even before the pandemic, 50 percent, of course, of physicians experience symptoms of burnout, and I’m sure that number has only risen. Now, you are a burnout expert, so can you comment on the toll burnout has right now on the health care profession?

Paul DeChant: So right now, even before the pandemic, I’m getting ready to give a presentation to a leadership academy, and I found a slide I did in 1918, where I started off talking about burnout by saying, “Imagine if there was a pandemic that affected over 50 percent of the population and negatively impacted the health of yourself, your family, and your patients, and that this was spreading and not well checked.” And then I ended it, “Welcome to physician burnout.” Well, then, of course, the pandemic hit a year later, and that just became clear. That’s the issue.

So this was a serious problem before. The pandemic was an existential threat. Burnout was an existential threat before the pandemic came along. When the pandemic hit, health care systems responded amazingly to the existential threat. We made changes within a week we never thought we could do in a year or more, moving to telemedicine almost 100 percent, taking med-surg wards and ambulatory surgery centers and turning them into ICUs. Things that we thought we couldn’t do, we did instantly.

There is an existential threat of burnout pre-pandemic, which is only worse now. The PTSD that I think we’re going to start to see emerge as people recover from the intensity of what they’ve been through is going to be significant. The Washington Post had an article just recently: 30 percent of clinicians are seriously considering leaving the profession. We’re already understaffed. Losing another 30 percent of our clinicians, we’ll all have to fear for our own health care, for access to quality care.

Kevin Pho: We’re talking to Paul DeChant. He is a family physician and health care consultant. He wrote the KevinMD article “Caring for caregivers post-pandemic.” Paul, whenever I talk about physician burnout to people on this podcast, and a lot of physicians write on KevinMD, they feel that burnout is more of a systems issue, that they’re forced to do more in less time, they’re forced to check all these checkboxes on the EMR. And sometimes, if you bring those issues up to health care leaders, they tell physicians to do more resiliency training, have them take yoga, implying that the problem of burnout is with the individual physician himself or herself. So there’s clearly a disconnect there. So I was wondering if you could comment on that and whether there’s a path forward to resolving this issue.

Paul DeChant: Yes. First of all, health care workers, particularly physicians, are some of the most resilient people in the world. Who else takes organic chemistry and survives that just to get into being able to apply for their job? And there have been recent publications demonstrating that not only are physicians more resilient, but even the most highly resilient physicians have about a 30 percent rate of burnout. So it’s not a lack of resiliency. The problem is the workplace environment. The problem with burnout is the workplace, not the worker. And our health care workplaces are incredibly chaotic, time-pressured, with information overload now becoming a significant issue as well. When we get into those situations, we lose control, and that’s important to us.

So it’s fixing the workplace that is absolutely key. There’s so much opportunity to redesign the workplace so that we can spend our time focused on our patients, which is where we find professional satisfaction, not focused on administrivia and data entry. And when leaders can understand that and support that, you realize that the ratio these days between the time we’re focused on our patients versus the time we’re doing wasteful administrivia is two-thirds administrivia and one-third with our patients. If we simply redesign the work so that it’s two-thirds patient-focused and one-third administrative, we can dramatically release opportunities for productivity, opportunities to increase access for patients, just to create an entirely different health care delivery. And health care leaders who can understand that have tremendous opportunity to make a difference in their organizations.

Kevin Pho: Now, what are some of the obstacles for health care leaders to understanding that perspective?

Paul DeChant: First of all, many of them haven’t been clinical themselves, or they’re so far removed from it that they’ve lost that perspective. Secondly, they have stresses. They’re just trying to make sure they meet their bottom line, keep the doors open and the lights on, and financial stresses have been significant as well throughout the pandemic.

So if the approach to burnout is, “I need to work less so I have less burden, and I need emotional support,” which costs money, those both will make it harder for an organization to meet its bottom line. But if we redesign the work so we can spend time in what gives us professional fulfillment, while we actually can see more patients but get home at night to see our family and take care of ourselves, which is doable, and I’ve actually worked with organizations where we’ve achieved that, then we address both problems. We create a resilient organization that’s financially stable and performing at a high level, while we have personal resilience and are performing at a high clinical level as well.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Paul DeChant: The problem with burnout is the workplace, not the worker. And those in leadership have the most opportunity to improve the workplace, and those leaders who actually understand that and take that opportunity will be the ones who will succeed in the long run, who will actually not only survive but thrive through the tremendous changes that are going to continue to happen in health care in the future, because you’ll have an engaged workforce, empowered, high-knowledge worker clinicians on the front lines who are aligned with you and supporting you in that process. When we create that, we’ve got a resilient organization. As Darwin said, it’s the organism that can best adapt to change that will survive. And by creating an organizational culture that supports that, that’s the key.

Kevin Pho: And how can people reach you?

Paul DeChant: I have a website at www.pauldechantmd.com. I welcome you to go there. You can contact me through that. You can also just email me, [email protected]. I’m on Twitter at PaulDeChantMD. I’m on LinkedIn as well. So any of those ways. And I have written a book. You’re certainly welcome to find this book on Amazon, and if you reach out to me directly, I’d be happy to connect with you and send you, myself, a signed copy of it.

Kevin Pho: Paul, thank you so much for sharing your time and insight, and thanks again for being on the show.

Paul DeChant: It’s been great, Kevin. I appreciate you. Thanks.

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