Executive Leadership and Physician Well-being

These are challenging times for health care executives. The health care field is experiencing unprecedented changes that threaten the survival of many health care organizations. To successfully navigate these challenges, health care executives need committed and productive physicians working in collaboration with organization leaders. Unfortunately, national studies suggest that at least 50% of US physicians are experiencing professional burnout, indicating that most executives face this challenge with a disillusioned physician workforce. Burnout is a syndrome characterized by exhaustion, cynicism, and reduced effectiveness. Physician burnout has been shown to influence quality of care, patient safety, physician turnover, and patient satisfaction. Although burnout is a system issue, most institutions operate under the erroneous framework that burnout and professional satisfaction are solely the responsibility of the individual physician. Engagement is the positive antithesis of burnout and is characterized by vigor, dedication, and absorption in work. There is a strong business case for organizations to invest in efforts to reduce physician burnout and promote engagement. Herein, we summarize 9 organizational strategies to promote physician engagement and describe how we have operationalized some of these approaches at Mayo Clinic. Our experience demonstrates that deliberate, sustained, and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference. Many effective interventions are relatively inexpensive, and small investments can have a large impact. Leadership and sustained attention from the highest level of the organization are the keys to making progress. a 2016 Mayo Foundation for Medical Education and Research n Mayo Clin Proc. 2017;92(1):129-146 From the Director of the THE CHALLENGE FACING HEALTH CARE EXECUTIVES Program on Physician Well-being (T.D.S.) and President and Chief Executive Officer (J.H.N.), Mayo Clinic, Rochester, MN. T his is a challenging time for health care executives. Increasing price competition, narrowing of insurance networks, and a greater proportion of patients with noncommercial insurance (eg, Medicare, Medicaid) due to the Affordable Care Act have all resulted in declining reimbursements. In parallel, requirements for “meaningful use” of electronic health records have resulted in large capital expenditures and dramatically increased clerical burden for staff. These financial challenges have, by and large, been addressed by increasing productivity expectations for physicians (ie, caring for more patients with the same amount of time/resources), efforts to improve efficiency, and expense reductions to decrease the cost of care delivered (doing more with less). Mayo Clin Proc. n January 2017;92(1):129-146 n http://dx.doi.org/1 www.mayoclinicproceedings.org n a 2016 Mayo Foundation for M Health care organizations are also facing a variety of other threats. Increased mergers and consolidation of competitors place contracting at risk and are a perpetual, existential threat to organizational survival. The implementation of new quality metrics and requirements for public reporting necessitates greater attention to measures of system safety and increased resources to count, track, and report these dimensions. The national shortage of nurses and physicians in many specialties makes it challenging to maintain adequate staffing. Assessment of patient satisfaction and ubiquitous ratings of hospital “quality” creates incessant pressure to keep up with competitors in the technological “arms race” and to invest resources to maintain a state-of-the-art physical plant. Attacks from cyber criminals and nation states are a constant threat to information security as well as the trust of patients and the public. 0.1016/j.mayocp.2016.10.004 edical Education and Research 129