17 - Paul Dechant - 5 steps to systematically reduce or eliminate burnout in the workplace

Welcome back Uncommon Leader Podcast Nation. I've got another first for you. This episode. I have my first repeat guest in Dr. Paul Dechant. Way back in episode one, Paul and I discussed a growing concern in healthcare and industry overall, the topic of 'burnout in the workplace.  Here is a link to that first episode.

While in that episode we talked about the symptoms of burnout, this episode focused on the way to reduce or prevent burnout. It's an important topic. Since he and I chatted about six months ago, a new trend is broken out called 'The Great Resignation.'

I really liked how Paul talked about the opposite of burnout in this episode, which is professional fulfillment. Throughout the episode, Paul discussed  five steps to addressing burnout:
1) Diagnostic - Understanding the current state of the organization
2) Visioning - developing a plan of what good looks like
3) Wellness
4) Changing the corporate culture through leadership from the Boardroom to the exam room!
5) Improving efficiency through implementing a continuous improvement system like Lean

So Paul is all in and steadfast on this mission. I hope that he's successful.

Links:
The Healthcare Burnout Symposium in January 2022

Paul Dechant's website


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Transcript

0:29

So welcome back uncommon leader, podcast, nation. I've got another first for you. This episode. I have my first repeat guest in Dr. Paul Deshaun way back in episode one, Paul and I discussed a growing concern in healthcare and industry. Overall, the topic of burnout, I'll put a link to that episode in the show notes. While in that episode, we talked about the symptoms of burnout. This episode focused on the way to reduce or prevent burnout. It's an important topic. No doubt. Since he and I chatted about six months ago, a new trend is broken out called the great resignation. So this I hope is the great conversation. Oh, sorry, play on words there, but anyway, hope you enjoy it. My second conversation with Paul Deshaun. Here we go. Hey, Paul Deshaun. Welcome back to the uncommon leader podcast. It's good to have you as the, really the first repeat guest on the show. And I think it's kind of funny. I talked about early on with some folks how this would go and I look back maybe. One of the shows that I have watched some episodes on learning interviewing was the Johnny Carson show. And you can appreciate that a little bit. And I was wondering like, who's going to, who were guests? They were always on the Johnny Carson show. And I bet you didn't know this, but the number one, repeat guests on Johnny Carson, you know, who. Nope. Joan Rivers was on the Johnny Carson show. 89 times. She was on, she was a guest 89 times on the Johnny Carson show. Anyway, it's kind of fun to go through it, but I appreciate you being back here. Let me know how you're doing and tell the group how what's been going on for the last six months. Yeah, well, hopefully I'll be more like Robin Williams then Joan Rivers will see the so, so it's great to be back. Thank you so much for having me. It's, you know, I just miss connecting with you. Cause we used to work together so closely for the last six months, you know, might concepts around burnout and how to address it. I've continued to mature while I focus mostly in healthcare. Those concepts apply really in any. And w one of the bigger ones that's conceptually happening for me now is understanding a few core root causes and how those root causes can be used to inform a an, the interventions to address a burnout. And healthcare, there's a model for professional fulfillment. And when we think about professional fulfillment is the opposite of burnout. It's that ability to do what is most meaningful to us for most doctors that's deeply connecting to their patient, certainly for surgeons and other proceduralists is doing those procedures that they're great at and our life changing. It's for educators, it's teaching residents and medical students, and for innovators and researchers that's discovering and implementing new knowledge when we can spend our time deeply focused on those things that are most meaningful to us, we really don't burn out. But in healthcare, at least about a third of our time, we're able to do that in two thirds of the time are caught up in administrivia data entry and other ways. And that's where lean becomes such a great opportunity to address those problems too, to just flip that, imagine flipping that ratio and having two thirds of our time deeply in what gives us professional fulfillment and meaning. And only one third of our time on waste, the opportunities to increase access, to increase productivity, to reduce burnout because people are more fulfilled. They're just pretty amazing when you think of. That professional fulfillment model has three key components. The first is individual personal resilience, which many people think that's what burnout is all about. That's what we need to focus on. And that makes the difference. When in reality doctors are already some of the most resilient people in the world and we work in a very challenging environment. And the challenge is to fix that environment, not fix the doctors because. To fix the environment. There's really two key other approaches in this professional fulfillment model. The first is, is actually called practice efficiency. It's what most of us think of as lean, which is let's make things more efficient, remove the waste and help us work more effectively. Sometimes that scares doctors who think you're just trying to make me work harder, but when we briefly re frame. And this concept of no, we're trying to get rid of that two thirds of the time you're wasting on administrative and data entry and let you focus on what's most meaningful. Then we can get people in here. And that really addresses the people think that burnout is all about being overloaded with work and being exhausted, which is one key component of burnout. But by working on efficiency like that, we can make that difference in with lean value stream analysis and mapping redesign along with daily management to fix small problems, both of those directly address that component, which is the beauty of the connection. The third component in the professional fulfillment model is described variously as culture of wellness. I like to think of the management system and culture that really drives engages and aligns everyone in the organization. And empowers frontline clinicians who are really amazing knowledge workers, but often get constrained because of traditional management roles. So this is really the management focus, the, the respect for people component of lean, which is sadly lacking in to, to the potential. It could be in many health care organizations. People think we do, but when we really look at it carefully, we don't necessarily. And so. And the opportunity there actually comes in not only of value stream management, but other components of lean like leader standard work and strategy deployment, to be sure that we really are. But using the frontline empowerment with daily management and value stream mapping, to then help people realize greater opportunities in the work they do. You know, as a CEO of a large group, I, I, as a doctor, individual doctor, I always wanted empowerment to be able to do things the way I knew I could fix things. I just needed the, the ability and the freedom to do it as a CEO that scared the crap out of me because they didn't want people going off and doing all their own thing. So there's a thing about empowerment and alignment that makes it. For the, for applying that to burnout there's along with work overload, there's five other drivers of burnout. I think we've talked about those last time. Lack of control, insufficient reward breakdown, a community absence of fairness and con conflicting values. Those all drive citizens. And the opposite of cynicism is engagement. And that that's where using things like leader standard work, humble inquiry strategy deployment can have a big impact on that cultural wellness component. So the parallels between these and the opportunity to understand that and integrate that work is really powerful when people deeply engaged in. No, I appreciate that. And it certainly sounds that you've been busy then over the last six months, since we chatted and start to frame this in a different way, because I know it hasn't changed. Let's use a holistic look at what has not changed if you will, in the industry, whether it's healthcare or frankly, whether it's, whether it's leadership, you know, we've still been trying to work our way out of what would be considered the COVID started in March, 2020, or we're never starting. We, we keep going through these ebbs and flows of coming out of it, but one of the new. I don't know terms that's popped up. If you will. Over the last six months, since we chatted last, was this the great resignation and the healthcare industry. Many other industries are experiencing this where this burnout that you talk about is actually just come to crescendo. And people said, I'm tired of dealing with that anymore. I actually like how you used, you know, the opposite of the opposite of burnout really is professional fulfillment or that whole person leader, not only what's happening in the workplace. But what's happening outside the workplace as well is so important. And before we get into solutions, I guess, you know, what is. I's Paul over the last six months, what's, what's made this worse. What, what is it that continues to make this more challenging, I guess, to implement? And then we'll talk about the solutions that we didn't get a chance to talk about last time, you know, the, I think part of what's made it worse is there's just so much still uncertainty. You know, when COVID first hit, we were slammed into this VUCA. Right. You know, the environment that, that term that comes from combat volatility, uncertainty, complexity, and ambiguity. We just don't know. There's so many variables. You don't know what the right thing to do is, and you're just hanging on that's and you're counting on everybody on your team to make instantaneous decisions that can't go up to the top to get direction. They just have to be able to function. That's still the case. It's not as intense as it was, but it's still the case yet. One of the initial responses to that in healthcare systems was to start to have. At least once, if not two or three times a day, an incident command center meeting that addressed the problems across the entire organization is COVID Wayne. Those got less and less frequent. And yet there were still, you know, they originally got developed in response to essentially an existential threat, both to us individually as a life-threatening illness, as well as the organization, feeling that strain people became complacent thought, well, we don't really have that much of an existential threat. Now we don't need to meet two or three times a day. We don't need to have a need to meet once a day. We can meet once a week. And now we're seeing this other. Existential threat growing, which is the loss of the physicians, the nurses, the other support staff in health care systems. We've already been on a critical level of staffing. And if we truly lose another 15 to 20% or more physicians and nurses. This is an existential threat to each healthcare system into our, in our national health system. Overall. I mean, all of us will be impacted by this. This is why it is so important for leaders who truly understand and engage in it to, to find a different way to lead, because the way we're leading now really is not working. No, I, I appreciate that as well. I think, and I think I smiled when you can, we won't see that on the podcast, in terms of that smile, when you talk to. During the crisis. For some reason, it was okay to meet up to two or three times a day. And now we don't see the need to do at once a week, even though we know that the value of that daily improvement, we know that from a lean standpoint, we know that from working together, we know that, but that communication. That exists inside of that space to make it better, but ultimately whether it's remote or in person bringing the team together and having a chance to chat, instead of you know, that as an opportunity as well, to hear what's on everybody's mind is very important. And so, you know, the value of that should always exist, but the crisis has to be redefined as a need for change. One of the things that I talked about, and now you and I have heard this you've, you've had many quotes you've given me that I continue to use. You know, the pain of remaining the same has got to be greater than the pain of the change. And you make the change during the crisis. Why can't you make the change during regular time as well? Because you know, the value that's in that that's, that's not just by the way and in healthcare, that's in your life as well in terms of exercising and nutrition and all those things and the habits that we need to create as leaders, leaders, standard work to make powerful change. Yeah. And if we apply lien in its entirety into an organization, it becomes a huge competitive advantage. We know this and yet. You know, healthcare is just too complacent. For many reasons. We don't need to go into the house. We can do another one on that if you want. Okay. John I'll know I'm going to call you Robin Williams. So we'll have y'all many times. All right. So let's that's. That's cool. Okay. So last time we did talk about the barriers and too often, we do, we do spend time talking about the obstacles, but the important part is how do we fix some of these problems? How do we put the things in place? And we didn't really get to that as much as I like to last time. So. Well, let's let's encourage my readers, that there is a way to reduce this burnout and to increase professional fulfillment. What's the methodology you think exist today. What's the methodology you use that gives us the best chance of, of eliminating burnout. Yeah, so I think of it as a five-step process and you'll see that it's not exactly five steps, but we'll get the picture here. The problem, everybody, every organization, healthcare or not deals to some degree with. And yeah, and the concepts underlying burnout are the same, but each organization is individuals. So we can't come in with a blanket, you know, fixed process that if you do this, you're going to solve your burnout. We can apply the concepts, but they have to be applied specifically to each organizations. So the first step, just like taking care of a patient is to do a diagnostic, to work that you know, work the organization up the same way as a doctor, I would work up a patient, you know, if somebody has got a cough and they're short of breath, I don't know exactly what's causing it, but I've got a lot of once I understand it better than I've got ways I can address it. So. And that evaluation should include some form of either a burnout survey or satisfaction with work survey. I'm not a big fan of most engagement surveys because they don't really get at the root cause drivers of burnout. You need a survey. That really addresses these issues, you know, do I, you know, am I overloaded? And if so, can you, can I get a better understanding of why that is? What level of control do I really have? Am I on my rewarded and recognized for the good work I'm doing? Or am I able to truly work collaborative with my team? Am I treated fairly? And how are my values aligned with the organization and ask those in really direct ways? Not too many engagement surveys are the kind of dance around. It was issues rather than address them specifically and it leaves a gap. And then it doesn't also give people the direction they need to go. So starting with that survey is important. Also understanding the other key performance metrics for the organization. What are the true north metrics around. No service, quality safety finance, productivity, access, you name it. We want to track those because in the vast majority of cases, as we know, when we address the things that drive burnout, when we engage and empower employees, well, those that all those other metrics improve as a result of that. But we want to know where we're starting. So we don't hurt those too often. Particularly people who don't understand what we're doing will think, oh, okay. You're worried about burnout. I know the way that you want to fix burnout is to reduce the workload. So that means less productivity, less revenue, or you want to spend money on wellness programs for my staff. That's going to have, because more than. My margin is too thin already. I can't afford to reduce revenue and add expense. So we, we have to make a commitment that we're not going to negatively impact those other metrics. It is important to understand leadership. So I survey if the big survey doesn't include a good leadership assessment, there should be a leadership assessment done as well, particularly for key leaders that you're addressing. We liked, we liked to look at technology certainly within. The EHR, the electronic health record, that's a huge impact on wellbeing. And in other industries that varies how much that the tech has a negative impact, but it's something certainly to be aware of because those operating systems are things we all work with in these days. And then lastly, actually in truly in fashion, we like to get the leaders to actually go to the gemba and see. The what's going on. And, and as much as they can actually go and shadow people while they're working in addition, we've learned a lot by doing interviews, multiple interviews of mid-level leaders in an organization. It's a step below, certainly at the C suite is helpful, but get down a step or two below the C-suite. And spend some time talking to those people about what they see, the challenges and stresses are. We learned a lot in that process. So pulling together all of those things. Now we've got our diagnostic done. We take that to a planning session, just like once we've done diagnosis as a physician, I'm going to then develop a treatment plan. But this treatment plan, obviously to develop it by bringing together a top level leadership plus. Thought leaders in whatever that group is. So this would be like going to health in a hospital would be the C-suite plus the physician leaders and some nurse leaders and spend, you know, in my ideal world, I spend a two day transformation plan development event. Oftentimes, it's hard to get that level of commitment. And if I can't, then we can work out ways to do it somewhat more wise and which we've done and had that work relatively well. Once we've got the plan, that plan really should be built around three key components and they really follow. Professional fulfillment model, and we should have a process to provide, you know, ensure we're supporting the well-being of the workers in healthcare. Even if the processes and culture were perfect, we deal with high-risk issues. We deal with high intensity, high emotional problems with our patients. When you deal with traumas and difficult deliveries or Mo family crises, where all the workers are always going to need some level of emotional support. So it's. It can't, it's not sufficient on its own, but it also we, we have to have it, it's important to continue it's vital. But then the second thing is to look at workflow efficiency and start to make a difference there. So developing daily management systems, where you can solve problems on a small basis, but frequently, sometimes it's easier to get started than a full value stream. Cause you can spread daily management huddles across an organization far faster than you can spread a redesign of. One workflow process. But if you can do both that that's all the better. And then the third component is this whole concept of the management system and culture. What's the culture of wellness. How do we address that? And that's where engaging with. In in leader standard work and redefining the way that the executive teams work and redesign, you know, working on strategy deployment. So we've clearly identified. What's most important. We know we've played catch ball with the people we're assigning that strategy to. So they've got the capacity to do that job. And then in making sure that the, all of the members of the support services, finance, HR it, and the. Understand their role in supporting this work? I don't know when we put all that together, you know, that's going to vary organization by organization, their strengths and weaknesses, so, and pace of issues around pace and capacity. And so we've, that's where developing that plan really specifically, who's going to do what by when to address each of these issues that we've prioritized as our most important. Is that the point is that second step, the step, you also have to set the goals then as well. So it's the what to do, but it's also, and how much are we going to improve it based on, right, right. So, so part of it, you know, it's really, it's a nine step Tupac process if you want for a few minutes. Cause you've got. The left-hand column is the problem statement. Current state and target the middle column is all about that's where you get creative, you know, w what are the root causes? If we, then we, you know, how are we going to map out where are we going to focus? What's, what's our biggest priorities. And then, you know, then on the right-hand column, block seven is the implementation plan. Who's going to do what? Buy one box eight, the track. No, we've, we've identified, these are our major metrics. We're going to track this progress over time. And so we follow that initial planning session up with a quarterly, every, you know, every quarter having it reviewed and make sure that we're on track. On-track like that word I'd use. You talked about as the kind of visioning session, if you will. That plan in that setting the vision for whether it's 12, 18, 24 months out and setting those targets and those goals are very important to go through it. So you think about that as the, there's the process that you go through. Where, where is the, where does the individual come into play? What role does that individual leader who's suffering the burnout? Where, where do they come in and really have an impact on this step as well? Yeah. Well, it really depends on what level you're at in your leadership role in the organization. You know, I've been playing around with this concept that we need to address burnout you know, from the board. To the X all the way down to the exam room and every level in between. Because we, you know, we're going to be more successful dealing with it. And particularly now with the great resignation and existential threat, if C-level leaders aren't fully engaged in this, there's no way that organizations going to succeed are certainly going to nuts, will not succeed as well as it could. And to get the C-suite engaged, if the CEO's not engaged, then it really gets to the board members are, you know, are the board. Following their fiduciary responsibility to ensure that this organization is positioned as well as it is in executing as well as it should from the C-suite. Then it's a matter of, you know, looking at every level, whether you're a VP, a department director, a manager, a supervisor, or even a person who is on a team on the front lines. You can think about those drivers of burnout and opportunities to address that. Now you have loved different levels of control each step along the way, but there are ways that people in front lines can start to fix little problems in a daily huddle. So they're addressing work, you know, reducing the work overload in that. The ways we can work together as a team to be able to recognize and reward each other, to collaborate better, to make sure we're treating each other fairly. It's a matter of just finding where you're at. One of the key thing I think we may have, you mentioned this last time Yeah. And most levels people have. If they're in leadership roles, they have direct reports and we've been trained in top command and control management. That that's how we think of those folks. But in reality, we should be thinking of them as direct supports, you know, in my leadership role, I should be supporting the people who report up to me so that they can be as effective as, as they can be. I need to understand what they need so they can see. And that's a different mindset than the traditional management mindset, but it is the mindset that's going to empower people. And if we build that empowerment in, while we build in alignment with clarity around here are, here's where we're going from a strategy standpoint, here's the areas we're going to focus. Here's the metrics we're going to follow. This is how we'll know if we're winning or losing and what the metric that's at. The C level is generally an outcome metric, but the metric that's at the front line. It's usually a process metric that drives the results of that outcome metric. And in between, at some point you see a transition from more outcome focused metrics to more process focused, focused with. No, I love that because that's, as I was listening through, you know, the journey again, depending on what level you're at, as the leader, that daily huddle has so much power. I mean, you've talked about some of the things, you know, to solve problems and where the C-suite or up at the top gets engaged in that as Hey is setting the goal so that the individuals who are working in those huddles. Knows that what they're doing has an impact on the organization. Right. But secondly, recognizing good or giving them a methodology to solve that. You talked about a nine box, a three methodology, but giving them a methodology to solve problems, let's watch driver parade or whatever that methodology is for that daily huddle that they use. And then thirdly, you talked about the gemba is get out there as a leader and be with. In the workplace where those daily huddles are occurring. Again, even if they're remote by being a part of that, to recognize the efforts that are going in place so that they know you as a leader care as well, it goes a long ways to changing the environment and helping you to, again, move from going all the way back to beginning of our conversation, moving from burnout to professional fulfillment and whatever the role is that we do on a daily basis. I think it ties in really well, that management system overall. And I've seen you draw that picture so many times I might even put a picture of it in the, in the podcast notes, just to, so people see with regards to the triangle in the hierarchy of, of bringing those goals down the organization and then cascading those back up through the management system that is created to make these really powerful, the fixture that ties together more. What I've talked about at the start, I'll send that to you. You can put that on. Yeah, well, and just quick aligning incentives as a key part of this, because if, you know, in fact with burnout there's a big movement, a big, it's a starting movement now to put on the, on the performance bonus rewards for the C-suite, the wellness of the frontline workers. Because if that, if they're not, if they're not, if they don't have skin in the game, if the CIO, the CFO, the chief strategy officer don't have skin in the game to promote wellbeing for the frontline workers. Then they're going to the, CFO's going to think, I don't want to spend money on this. The CIO is going to think I got to put, I got to focus my attention on HR optimization. You know, it's when everybody's truly aligned together, then we see the real power of this. And if there's not that alignment, it's very difficult to get the whole team working together, but you can build that alignment and every step, just like, you know, we've talked about the metrics and spilled the incentives in at every level. At Sutter Gould where I was CEO, I kind of stumbled into that unwittingly, but once we realized what we were doing, as it was amazing, it was, this was so powerful to make a difference and help us move forward. Well, I know Paul, the work that you did is set our gold was so important and the success and. Here, the good things that are going on there as a result. So that's the legacy piece of what you left is still happening, which is a good thing I want to ask. I know that the work that you do is so important and you're working on an event that's coming up in January and next year. So I want to give you a chance to chat about this healthcare burnout symposium that you're co-chairing. Tell me a little bit about that and where my listeners and others can learn more about the healthcare burnout. Yeah, so you can just Google healthcare burnout symposium, and you'll find it. It's stop healthcare, burnout.com, but just Google healthcare burnout symposium. You'll get it that way. I really appreciate the chance to talk about this. It's going to be January 24th through 26th, an in-person event in San Francisco at the Hyatt Regency Embarcadero. For those of you who are Alfred Hitchcock fans going back to old TV or movies this was the hotel where. Was filmed. I was one of the first hotels with open window elevators in it. And it's this huge lobby that goes up 20 stories. And Jimmy, Stewart's looking out the window going, ah, it's a pretty cool old hotel right in the heart of San Francisco. But more importantly, the speakers that are coming are really amazing. We've got Robbie, Pearl, the ex CEO of Kaiser Permanente. We've got Mike who's a neurologist. I'm sorry. Psychiatrist. The university of Rochester has done amazing work. With human factors, engineering and burnout, and just fascinating stuff. Corey Feist, who's the head of the Lorne of Brene foundation. Who's leading this whole effort around all in for healthcare. Chris, Sinsky the VP for the AMA on professional fulfillment and practice sustainment. A really insightful deep thinker has been in this work for many, many years. Christina Maslach burnout inventory, Tait Shanafelt from Who's been the leader in the chief wellness officer efforts around the country, leading physician, burnout researcher. Interesting person, Jeff Pfeffer, he's a professor at the graduate school of business at Stanford. He's not in healthcare per se, but he's written throughout his career on the fact that if you treat your employees while your business does better, which seems like a pretty straightforward idea. It's amazing how few people get it. And in fact, one of his more recent books was. Dying for a paycheck, talking about how corporations mistreat their employees and what the potential is. So he'll bring a fascinating additional perspective. We have Steve Pearson from practicing excellence. Amazing, amazing guy. I'm trying to think of who else we've got. It's just a, it's it's quite a little, we've got a specialist sequence just on chief wellness officers, for those who are interested in that I'll be doing a session with an executive coach. I've worked with closely on how we can, how we do that work most effectively. So yeah. At that that gentleman's name is Michael O'Brian is really is great. So we just have a whole array of, of great people coming to visit. It sounds like it sounds like a fascinating lineup of great speakers. And I know that you are excited about putting that in place, so that stop healthcare, burnout.com. As I looked it up myself and found it pretty quick as I Googled what you told me to Google and make it work. So I hope that's going to be a great event for you in January. As you look forward to that. And Paul, I just want to take the opportunity again, to thank you for being on again, as a guest of the uncommon leader podcast. I hope that we get to do it again real soon and that you have a great holiday coming up this year. Take care. Thank you. Thanks Jen. I'm so excited and I'm so excited that this podcast is going well and that people are catching on because it is incredibly valuable. You're doing great work. Thanks. I appreciate it, Paul. Thanks. Well, I met each time I talk with Paul Deshaun. It's a very informative discussion. I really liked how Paul talked about the opposite of burnout in this episode, which is professional fulfills. That professional and fulfillment is uncommon. Throughout the episode, Paul discussed five steps to addressing burnout, different topics you talked about for evaluation. To transformation, planning or visioning what good looks like basically setting the targets, three enhancing clinician wellness for changing the culture of the environment. And finally, number five, to be able to improve efficiency or eliminate waste in the processes that exist today and making it easy. a simple five step system, but it's not easy to implement. We all know they would have done it already. So Paul is all in and steadfast on this mission. I hope that he's successful That was a lot of fun. If you enjoyed this episode, I hope you'll share it with a friend or someone who needs to hear about it until next time let's go and grow champions.