In this week’s post, I break down why physicians should Stress Strengths rather than Strengthen Stress in order to combat physician burnout.
Last week, I was speaking with a medical director at a large practice who was telling me that he couldn’t understand why the physicians in his group were having trouble getting their charts done on time. I asked him what sorts of strategies he’d employed to try and make the situation better, and he told me he had 1) Issued email warnings, 2) told physicians that their pay would be docked if they didn’t do better, and 3) posted comparison charts of members of the group. He could not fathom why performance wasn’t improving.
I also recently sat in on a meeting with a client of mine (an internist) and her non-physician supervisor. To my disappointment, the entire meeting was focused on patient wait times, an area where the supervisor determined she was not meeting targets. Not one word was spoken about the internist’s improved Press Ganey scores, the gains she’d made in consistently starting her day on time, and the positive comments staff had made about her performance. At the end of the meeting, my client broke down in tears.
“How can anyone expect me to succeed when all they do is point out my shortcomings?”
Physicians are hyper-focused on their own flaws; we don’t need a supervisor to point them out for us. Negative reinforcement is an old and outdated leadership approach. A person’s path to growth and improvement lies in mobilizing their areas of strength.
Meeting with “the big bully” and seeing the “wall of shame” erode self-esteem and don’t lead to improvement. If you’ve been on the receiving end, you have no difficulty understanding how damaging these strategies can be.
Here’s what the research shows:
Gallup conducted a study when they analyzed over one million work teams. They found that only 9% of employees who are forced to work in an area of weakness are engaged, while 74% of their counterparts who are allowed to work in an area that uses their strengths are engaged. This isn’t a minor difference either; the gap is staggering.
Engaged employees tend to be more productive and happier at their work. One of the easiest ways to increase employee engagement is to help them align with their strengths.
Let’s try a simple exercise.
Think of a task you’ve been putting off completing. Imagine that you’re sitting down to do it right now. For 60 seconds, think about all the ways you believe you’re inadequate to get this task done:
- I’m not smart enough
- I’ll never get this all done
- I’m not as disciplined as others
- I’m a great procrastinator
Don’t hold back, pick your poison!
Now, mindfully, check-in with yourself. Rate your level of motivation to do the task on a scale of 1 to 10, where 1 = no motivation at all and 10 = let me at it!
Next, switch your focus to all the ways you’re more than adequate:
- I’ve gotten this type of thing before
- I am accomplished and well-regarded
- I’m good at this type of task
- Even when I procrastinate, I always cross the finish line
Sweeten the pot a little more by giving yourself an extra 30 seconds to think how good you’ll feel once the task is off your list.
Now check-in with yourself again.
Want to combat physician burnout but not sure what your strengths are?
While you may be used to focusing on your weaknesses, in your roles of physician and family member I can assure you that you have many. You simply could not have made it this far without them.
An easy way to find your strengths is to complete a basic personality traits test like the one provided by the University of Pennsylvania Department of Psychology.
How this relates to physician burnout
I’ve written about physician leadership and burnout in the past, and it’s clear that a deficit, weakness-based focus, and burnout go hand in hand.
If we want to avoid burnout or find out how to combat physician burnout, the strategies I mention in this article are key:
- Stop focusing on what went wrong and start focusing on what went right
- Help others see their strengths
Want to learn how you can reduce physician burnout and promote healthy physician leadership?
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Data confirms high rates of physician burnout, but it doesn’t tell us how burnout can be avoided. In fact, data on preventing physician burnout is almost nonexistent. One thing we do know, however, is that physician leadership is a key variable. Physician leaders can make or break a workable culture. A 2015 study from the Mayo Clinic found that qualities of physicians’ leadership accounted for 47% of the variation in physician satisfaction and 11% of the variation in physician burnout. Looking at their study, a number of leadership attributes stand out that can be helpful in avoiding physician burnout
Treating physicians with compassion
Compassion is a core value for most physicians but is increasingly bypassed in medical practices. Recently, I coached a 47-year-old Internal Medicine medical director who oversaw 80 primary care physicians. Much of the stress of his job was conveying edicts from the administration to the physicians he supervised. At the end of a particularly terse medical director meeting, the Chief Medical Officer bluntly told the medical directors that, in addition to recent cuts, they would need to inform their physicians of a further 10% pay cut. There was no discussion of the impact this would have and the news was delivered in a cut and dry fashion. My coaching client felt morose, defeated, like a cog in the wheel of the healthcare factory. The communication had flown completely in the face of compassion, a core value for him. He wondered how much longer he could go on in his position. He noted that if the same news had been delivered with concern for the impact it would have, while the consequences would still be painful, he would have experienced a greater sense of hopefulness and community. I coached him around maintaining his values by learning from this experience and never repeating this type of conduct. We continued to focus on making sure that each and every one of his communications conveyed the compassion he knew first-hand was vital in maintaining morale and avoiding physician burnout.
Employee engagement has been hailed as the single most important factor in determining levels of satisfaction with work. In a 2012 meta-analysis of research studies, Gallup found that compared with the bottom quartile, companies in the top quartile for engaged employees had 22% higher profitability, 10% higher customer ratings, and 48% fewer safety incidents.
Engagement is the antithesis of burnout. The many administrative burdens physicians face make it difficult for physicians to engage fully with their most important task: caring for patients. Physician leadership makes a pivotal difference. Given the many metrics coming down the pike, leaders need to constantly orient their approach around such questions as: “While metrics need to be pursued, how can I focus on how hard my physicians are trying rather than whether they’re meeting each specific target?” “What actions can I take today to help my physicians feel more energized and engaged.” “How can I facilitate my physicians performing at their best?” Sometimes small actions go a long way to facilitating engagement.
Recognizing a job well done
Everyone wants to feel valued and recognized for their contribution, yet in the current healthcare environment, too often the emphasis is on areas of deficiency rather than successes. A Chief Medical Officer I coached worked with her team to achieve large improvements in productivity. To remain competitive, however, metrics revealed that further improvement was needed. While her tendency was to focus on the gap between where clinicians were and where she wanted them to be, I coached her to focus on the gains rather than the deficits. She worked to ground each communication with her physicians on the strides they had made, identifying what strengths and skills they had used to make improvements, and assisting them in utilizing similar approaches to glean greater success. In a subsequent satisfaction survey, her physicians gave her the highest scores.
Communicating with positivity
We spend most of our waking hours communicating with others, but very often the rush keeps us from doing so in a respectful and positive manner. In a 2004 study of 60 top management teams engaged in annual strategic planning, the single most important factor in predicting organizational performance was the ratio of positive to negative communications. The research revealed that in high-performing organizations, the ratio of positive to negative communications in their top management teams was 5.6 to 1. By contrast, in low-performing organizations the ratio was 0.36 to 1. In a recent physician resilience retreat I led, I asked the audience how their risk of burnout would improve if their leaders focused more on the positive. The responses were instructive: “It would be infectious,” “I’d be more productive,” “I’d be less irritable,” “There would be less spill-over with my family.” Anecdotally and empirically, the evidence for positive communication is high.
A principle of effective leadership is listening affirmatively and supportively, being open to the input of others, and not jumping in with one’s own opinion and advice. Leaders who inspire dedication, sacrifice, and grit are ones who listen openly. As noted by Stephen Covey, effective leaders communicate with the goal of seeking understanding. A key skill is to ask open-ended questions. Open-ended questions communicate a deeper interest in the person’s response, increasing their sense of being heard. By shifting from questions that suggest a right and wrong answer, open-ended questions encourage others to respond more fully, contributing to greater engagement.
If you’re a physician leader, take heart in knowing that your actions can have a significant impact in mitigating physician burnout. Even if you’re suffering from physician burnout yourself, you can help motivate physicians to overcome the challenges they face. If you are a front-line clinician, please feel free to forward this post to your physician leadership. Many physician leaders are excellent clinicians or researchers and bemoan the fact that their leadership skills are limited. Most are happy to learn ways that they can improve.
To download my Anti-burnout Leadership Checklist:
In this hands-on 1-hour webinar, Dr. Gazelle was a featured expert on practical strategies to build resilience in physicians and physician executives
It’s that time of year again when many people are already feeling a sense of inadequacy around their New Year’s resolutions. While yearly resolutions help some, the tradition is often unsuccessful. The goal may be too big, it can be challenging to maintain motivation by oneself, and the tendency toward self-criticism are but a few of the factors that combine to make realization of one’s goals a daunting task. The good news is that simple strategies can help you reach your goals. Try these 10 tips:
- Start small.
Taking on a large goal is tempting, but it’s also the most sure-fired way to fail. If the goal is too much of a stretch, it can fuel a downward cycle: lack of achievement, decreased motivation, and self-criticism. By starting small, you increase the likelihood of taking the vital action steps, and each “win” helps build your belief that you can achieve your goals. This creates an upward spiral of confidence, motivation, optimism, and competence: all key ingredients of self-efficacy and success. Gary Hamel, author of the 2007 Amazon best business book of the year, The Future of Management, defines the key to success as “win small, win early, win often.”
- Envision success.
Envision a day in the future where you’ve accomplished your resolution. Close your eyes and sit for a few minutes, letting yourself bask in the experience of having reached your goal. Experiencing this wonderful state is much more motivating than berating yourself over something you weren’t able to accomplish. It can help you shift your focus to self-motivating questions such as “what small step can I take TODAY to help me get to this feeling?” and “what is a new way of thinking about my goal that will help me experience more of this feeling?”
- Let go of old goals.
If you haven’t moved forward on a goal year after year, it’s time to think about what’s holding you back. Putting something on the list after years of not succeeding can start the year off with a sense of shame and disappointment. One option is to include a resolution to forgive yourself for things you didn’t accomplish and start taking credit for all that you do achieve.
- Keep your list short.
Would you rather succeed at three out of three resolutions or one out of ten? It’s much easier to focus on a small number of goals than a long list. And think of the satisfaction you’ll have checking each one off!
- Focus on “wants” instead of “shoulds.”
Focus on what you truly want to achieve, rather than on things you believe you “should” be achieving. To be successful at any life change, you have to really want it. It pays to take the time to consider what it is that you truly want, teasing out the things others have said you should do or stop doing. Similarly, Ryan and Deci’s theory of self-determination tells us that intrinsic motivation is much more powerful than that generated by external forces.
- Resolve to “be” instead of “do.”
Make sure to include resolutions that involve “being” and not just ones that require “doing.” For example, a resolution could be: “This year, I will have more moments of being present with my family, times where I’m not focusing on all the work I have to get done.” “Being” resolutions are ones that you can achieve at any time. Even if you stray on a “being” resolution, you can accomplish it the next day… or even in the next hour.
Start every day off by planning one small step you’ll take to get closer to your goal. This method of breaking down the larger goal into more feasible parts is a great way to make incremental change. It also reminds you that you, truly, are in charge of your fate.
- Find an accountability partner.
Whether it’s your spouse, a friend, a coworker, or a coach, it’s much easier to follow through on goals if you have a buddy. In the best-case scenario, you’ll hold one another accountable. Tell your partner to go big on the cheerleading and championing as it’s much easier to succeed when there’s someone rooting for you and shouting, “I know you can do it!”
- Don’t use your resolutions as a means to beat yourself up.
This is an area where many people falter. If you’re like most people, you probably have plenty of inner critics badgering you as it is. New Year’s resolutions provide fodder for these pernicious and ever-present gremlins. It’s much easier to move forward from a place of competency and strength rather than one of deficit and inadequacy. Try to keep your focus on what you are accomplishing instead of what you are not.
- Don’t let a sense of failure stop you.
It’s all too easy to swing from the high of “this is the year I’ll accomplish X” to the low of “I just did the opposite of X; I’ll never achieve my goal.” In reality, every day represents a new opportunity to move toward your goals, so go ahead and be sure to seize an opportunity. This is true for New Year’s resolutions and true for any goal in your life. If failure presents a major hurdle for you, you can always think back to #6 and try to “be” instead of “do.” You might be surprised at how a change in perspective—viewing failure as a platform for growth instead of for sinking—can help you achieve different aspects of your goals.
Go forth and decide what steps you’ll take today. Even if you falter from your path, every moment of your life can be used to institute change. Remember, self-improvement is always within your reach.
Dr. Gazelle was a featured expert on burnout in physicians and physician executives
How much time do you spend on mental comparisons? Looking on Facebook and thinking everyone else has better relationships and is much happier than you? Thinking that everyone in your peer group is smarter than you? Or fretting about how much more fit, thin, smart, or successful you were at a different point in your life? Much of our stress, frustration, disappointment, guilt, and regret is the result of comparing ourselves to preconceived ideas about how we should be acting, how we should be looking, and how our personal successes are perceived by others. Theodore Roosevelt once said that comparison is the thief of joy. Indeed, comparisons often keep us in a mental hamster wheel of self-doubt and lack of confidence. To combat physician burnout, it is critical to decrease the tendency toward comparisons.
You may believe that comparisons keep you on your toes. Let’s test this out. Think about any times you’ve compared yourself to someone else in the past week. Did the comparison help you feel good about yourself and your circumstances or did it send you into a spiral of self-critical thoughts? Did you feel energized and optimistic about your circumstances or did you feel defeated, inadequate, and that your life would be forever deficient?
Like advertisements, comparisons hold us in the belief that if we only had product or service X, we’d be happier, feel and look younger, and be the king or queen of our world. While it’s always good to work toward life improvement, comparisons typically leave you unable to focus on the satisfaction inherent in your current circumstances. Comparisons push your focus onto either the past or the future, or simply what’s wrong with the present. Comparisons keep you from being content and perhaps more able to accept what is. Right now.
As a physician coach, here are four steps I teach to overcome the pull to comparisons:
- Start tuning in to your own thought processes. Simply begin noticing when you are going into comparison-oriented thinking. Try not to judge yourself. Jot these instances down so you can begin to see how often this occurs.
- Once you’ve noticed that you’re making a comparison, name it to yourself. Say to yourself “there I go comparing myself again.” Doing this begins to create a distance between the comparison you’re focusing on and the reality of the situation. Having that distance and separation is vital in having choice and control over your own thoughts.
- Now ask yourself: What is the cost of this thought process? What would I gain if I spent less time on these mental comparisons? Journal about these questions.
Now for the challenge. When you find yourself making a comparison and coming up short, push yourself to think of at least three ways you, your circumstances, your thoughts, and your actions are right and adequate just as they are. Your mind will call you back to the land of comparison and self-criticism. Your job in this step is to exert equal and opposite force in the other direction! Definitely take notes here.
These steps take a lot of practice. What you will gain, though, is the ability to see your own strengths and accomplishments. You’ll find yourself experiencing more calm and a stronger sense of your own self-worth. Harkening the words of Theodore Roosevelt, you may even find yourself experiencing more joy.