Dan Shapiro, Ph.D. on LinkedIn: Last year I went to visit the physician leader of a large health care… (2024)

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What an amazing place to be in healthcare.

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We love when our clients invite us to assist their entire healthcare workforce as there are powerful interdependencies we miss when we only focus on physicians, APP’s or nurses. When food service workers are shortstaffed nurses end up delivering trays - on top of everything else…

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“I tour our inpatient units all the time.” A hospital president told me. He wore a crisp bespoke suit and leaned in, like a master criminal sharing his biggest score.“And when I find coffee cups or big gulps or other beverages, I seize them... and leave behind my card.” His eyebrows went up and he nodded. My face froze, and while he went on to explain where he kept everyone’s cups I imagined being a nurse, anticipating the relief of a sip, returning from one of my patient’s rooms only to find the oat milk ice latte in my Yeti had been confiscated by my boss’s boss’s boss. I realize now he’s partially to blame, but there’s someone even more culpable. That’s right, OSHA, I’m looking at you. Permit me one more quick illustration.If you happen to join the army - right after they shave your head they will issue you, among other things, a canteen and teach you how to use it. Even how to drink from it while simultaneously using a gas mask. A few weeks into boot camp, you will find yourself on a six-mile run and, on the way back, there’s a good chance your sergeant will ask for your canteen and if it’s still full, guess who’s hands will be grinding into the pebbles and dirt while doing push-ups? That’s right, you.Because our armed services have realized that soldiers are assets and to maintain readiness, they must have shelter, food, and especially hydration and that water is doing you no good if it’s still in the canteen. Hydration is important for readiness because a dehydrated version of you thinks slower, less clearly and you are likely to feel fatigued and have worsened mood too. Put simply, you are less ready for everything.Certainly less ready to take care of our most vulnerable patients as a nurse. OSHA has tons of standards.There are standards for infectious diseases and handling patients, workplace violence and all variation of hazards including avoiding exposure to blood borne pathogens. But OSHA does not have a standard requiring employers to ensure workers have a safe place to store and consume liquids. In fact, in their latest comments on this matter – a 2006 letter, OSHA’s Director of Enforcement wrote to a nurse, one Barbara Caporusso, RN and told her employers are under no obligation to permit the consumption of beverages. This is why our group is still finding, in 2024, large swathes of nurses who are dehydrated and have no access to water. OSHA needs to publish a standard forcing every healthcare employer to have safe water storage on every unit. It's not that hard to have a water station where people can keep their cups, yeti's, mugs, and cans. There is no excuse. Let’s go people, pen to paper now. Let's drink up.

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I’m sitting in the cramped office of our Chief Medical Officer. If he hadn’t bought a massive table the office would be fine, but now it barely fits the CHRO, the president, the practice plan president, and the chair of surgery. Also, the CMO loves the wooden chair his former institution gave him for 25 years of loyal service but my bottom has too little padding and after arriving late from a meeting across the campus, I’m stuck here. We’re at “Faculty Matters,” a purposefully vague name for addressing potential toxic problems. Recently a division chief in a large department has been “acting out,” meaning forcefully advocating for his people and threatening to take the entire division somewhere else if they are not treated better. He recently shouted down his chair at a department meeting. From my perspective and that of a few of us, the situation is mixed. He’s right that they haven’t received the resources they’ve lobbied for and asked for repeatedly, but there are other venues outside of threats to make his opinions known.I know some of his points are valid and say this.The CMO leans back and says, “he’s got the non-compete, right?” The leader of HR, sitting next to me, pulls his signed letter and holds it over the table by the corner like a recently caught fish. “Yep,” She says.“He’s not going anywhere soon, at least not inside of 50 miles. Doesn’t he have kids in the schools here?”And that was that.I was tasked with telling him to stop yelling at his chairperson and he and his team stayed.***A few weeks ago the Federal Trade Commission issued a non-compete rule. You are forgiven if you thought the rule was written for tech companies and Wallstreet darlings, you have may have missed that the FTC was especially targeting health care, and further, physicians. The FTC observed that up to 45% of physicians are covered under non-competes and, despite the AHA screaming that they are “an agency run amok” and the Federation of American Hospitals suggesting it will “destroy access to high quality healthcare for millions of patients,” the FTC was unmoved.In fact, the FTC included 14 case vignettes in their introduction and 4 were healthcare workers including 2 physicians who had written into the FTC asking to be released from non-competes, one from an underserved area of Appalachia and one who signed with a system that had been purchased by another with entirely new religious principles (pgs 11, 12). There are four states where non-competes are already illegal, including California, and we have clients in a few and believe me, burnout and turnover still exists there.That said, I can’t help but think we’d have taken the complaints more seriously and urgently when that physician threatened to leave, maybe before his frustration poured over.Maybe we’d have had a little more talk and that physician wouldn’t have been so angry if the leverage were more balanced. Stay tuned…

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Budget season reminds me of something Dr. Randy Pausch once said. In his last lecture he recounted a seminal moment. As a University of Virginia assistant professor, he harbored ambitions for an unconventional sabbatical, but had already received a deflating and skeptical ‘probably no’ from one leader. The sabbatical held significant personal importance to Randy, constituting a lifelong dream. Now, he approached a second leader, a dean and the true decision maker.There were valid reasons to deny Randy this sabbatical, including intellectual property issues, and Randy could sense his dream slipping away. "Do you think this is a good idea?"Randy started the high stakes conversation. The Dean responded, “I don’t have much information, but what I do know is that one of my star faculty thinks it’s a good idea.So I want to learn more.” Randy reflected on this exchange as a critical juncture in his career. Both leaders expressed uncertainty, but in radically different ways. Importantly, his dean acknowledged Randy’s value first. There are many brief but seminal moments in an employed physician or nurse’s career – when the institution, as represented by a leader, wants or demands diverge from their own desires. Gruff leaders will often leave those employees feeling undervalued or like mere cogs in the system. Saying “no” while still ensuring individuals feel valued is an advanced leadership skill. In recent weeks, through our focus groups and open-ended survey responses,I’ve heard a series of stories from nurses, physicians, and APP’s from different esteemed institutions.These singular moments have strongly colored how workers feel about their institutions. During this budget season, leaders nationwide must decide where to allocate limited resources. Many health professionals willinevitably be disappointed to learn that the help they hoped for isn’t coming. I’m always surprised when leaders hide behind bureaucracy to deliver high stakes “no’s” instead of personally reaching out to remind frontline workers that they matter, even if the expense doesn’t seem justifiable today. Many leaders are shocked when feedback from focus groups and open-ended comments reveals that employees have drawn significant conclusions from a brief “no” delivered years ago, more so than from any other message, benefit, compensation change, or celebration. We generally hire Chief Financial Officers for their business acumen, their expert ability to wring the truth from thousands of data points, their steadiness, and long-term strategic thinking. We don’t test how well they can say “no.” But right now, amidst tight budgets and pressing needs, as we all try to stabilize the workforce, we need leaders who can say out loud what is often overlooked in small meetings: “You matter. I’m trying to get you help. Because it’s important to you, it’s important to me.”

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In a few weeks I’ll teach a few sessions at an executive training program for rising leaders in academic medicine. One exercise we’ll do together is action plan in response to a few real dashboards from blinded institutions. Our dashboards are derived from surveys and use Maslow’s hierarchy to categorize actionable factors that impact retention and burnout. We make the attendees practice high stakes leadership in the face of realistic workforce challenges, giving them a modest mock budget and asking them to respond to the dashboards forces them to think through what they most value, and how they will dedicate scarce resources to look after their people.One dashboard item summarizes MD ratings of local leadership. When the groups see mediocre ratings, someone inevitably offers an immediate action plan that sounds like, “FIRE ‘EM!” I encounter this eagerness to throw leaders overboard frequently and it puzzles me.Of course, when group ratings of leaders are poor, sometimes it’s because the leader is not very good. But not always. Imagine that I ask you to lead a small group of a few disruptive, entitled narcissists. Maybe you’ve gone to HR and are slowly working through personal improvement plans. You could accumulate bad ratings from those who think you’re doing too little too slowly. Not to mention ratings from the narcissists themselves.Or maybe we hired you to improve the performance of a unit that doesn't work hard enough. Maybe you’ve been very direct with this group that there’s a new sheriff in town and things are going to shape up! Poor ratings.Or if we’re short staffed, as has been the case in nursing, particularly in recent years, you, as the nurse manager, may need to see patients AND run your unit, likely making you less accessible than managers with better staffing. Poor ratings. The opposite is also true. When units are showered with resources it’s easy to get strong leader ratings. I’ve known several specialized surgeons who ran tiny departments of super high paid physicians who worked in special surgical suites with teams ready to satisfy every wish. They routinely earned stellar ratings. But when promoted to lead larger groups of physicians from other specialties they floundered – because they had never led with real constraints.The internet is full of gurus offering leadership generalizations that bely a lack of sophistication about context. Group ratings of leaders are one valuable source of data but without context, not much more. When someone tells you a leader is unpopular, ask about the situation that leader inherited and what they’ve done with it. Ask about our investment in them. Look at the real performance data of the group and the stresses they’ve faced. Ask about the people. Imagine yourself trying to lead in those circ*mstances. Maybe then we can judge.

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Not even an ice storm with its glazed dangers could prevent my team and the leadership team atThe Chickasaw Nation from gathering for a full day of listening and action planning in Ada, Oklahoma, last month. TheChickasawNation has an impressive record since becoming one of the first tribes in the United States to compact with Indian Health Service to assume administration and delivery of health care to First Americans in 1994. Today, theChickasawNation’s leadership remains deeply committed to getting first rate health care toChickasawcitizens, other First Americans in the region (there are five tribes with service units in this part of Oklahoma) and even underserved non-First Americans who needed assistance during the pandemic, for example. They are remarkably successful, but the need is great, so the burden on the health professionals there, many of whom are alsoChickasawor First American, are not trivial.Last month, Dr. Charles Grim, theChickasawNation Secretary of Health responsible for health care for theChickasawNation, sat at a table with leaders of the five groups of health professionals identified in our recent surveys and focus groups for in-person listening sessions. These groups have higher burnout, mental health needs or turnover intention than we would predict given national and local comparisons. This was unusual for me because it was the first time an executive leader had given us a full afternoon – eager to listen with no idea of what he might hear or be confronted with (this despite his recently replacing a knee and the icy sheets covering the parking lots).Over the next hours, we heard from pharmacy leaders who led the teams who filled nearly 1.5 million prescriptions last year, dentists who frequently work with patients needing meticulous care, lab workers who did heroic work throughout a relentless pandemic and others. Throughout it all, as we dug into the drivers of burnout, Dr. Grim was fully engaged, asking clarifying questions, referencing people and issues he knew of already and taking notes.When he could, he referenced additional resources he would try to bring to bear, and when he couldn’t, he opened his hands and just expressed his gratitude. He didn’t emit even an ounce of defensiveness. A few times he indicated he would talk to other services who had a role, but with the wisdom of a seasoned leader, when necessary, he also noted that he wanted to hear all sides of an issue.When I think about what helps frontline workers feel appreciation, it strikes me that it isn’t muffins, pizza parties, “Superman” costumes or banners. Appreciation comes from knowing in your bones that your leaders have genuine interest in your daily work and are always searching for ways to help make it better. The fact that Dr. Charles Grim invested this time despite the ice and wind, and his tricky knee, on a gray Oklahoma day spoke louder than any bold typeface banner announcing muffins ever will.

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