Sharp Conversations with Paul DeChant, MD, MBA
“Advising health system leaders on how they can best fix the workplace, not fix the worker”
Janae Sharp: Today, you'll see me having some real struggles with my headset
Subha Airan-Javia, MD, FAMIA: You know, all that's gonna get cut out.
Janae Sharp: No, I feel like - feel like people should see the struggle?
Subha Airan-Javia, MD, FAMIA: No, no, no, too much! It was too much. Hi, everybody. I'm Subha
Janae Sharp: Hi, I'm Janae Sharp with Sharp Conversations.
Subha Airan-Javia, MD, FAMIA: We're super excited to have Dr. Paul De-Chant here - Or is it Paul De-Chant or Paul De-Chaunt?
Paul DeChant, MD: I answer to anything, so don't worry.
Subha Airan-Javia, MD, FAMIA: Talking to us about his extensive work in the area around burnout and really excited for this conversation. Dr. DeChant -
Paul DeChant, MD: Thanks, Subha, I am so grateful to be connecting here on this podcast with both of you. I've gotten to know both of you over the last few years. I'm so impressed with the work that you each do in this field. My work focuses on advising health system leaders on how they can best fix the workplace, not fix the worker because we know that the problem with burnout lies in the workplace and the drivers of burnout that are there. It's not a question of a lack of resilience. Healthcare and healthcare workers, particularly physicians are some of the most resilient people in the world. There's literature that demonstrates that anybody who's been through medical school and residency knows it in their heart. So really, there are so many opportunities, though, to fix the way workflows are, so that we can spend the majority of our time focused on doing what's meaningful to us - connecting to patients, doing procedures that make a difference in people's lives, educating people who are coming up through the ranks, and working on research and innovation to improve healthcare. Those are the things that are meaningful to us. The challenge is, that we often only spend about a third of our time focused on meaningful things, two-thirds of our time caught up in administrivia, data entry, and other things that interfere with that. So my work focuses on fixing that, as well as addressing the culture in health systems as well. Creating a management system and culture by which the fantastic knowledge workers that doctors and nurses are, can actually use that knowledge work and become empowered to address problems and fix problems and do it in a way where everyone's aligned around helping the entire enterprise.
Subha Airan-Javia, MD, FAMIA: I have not heard the term "knowledge worker" before. I really like that.
Paul DeChant, MD: The definition of the knowledge worker, Peter Drucker is a famous management consultant, he defined a knowledge worker, as somebody who does work that they know better than their manager does.
Janae Sharp: Oh, that's fascinating.
Paul DeChant, MD: Even though I'm a family physician, I became the CEO of three a physician group. My knowledge workers, you know, I couldn't tell the neurosurgeon how to do their job, there's no way. So it's all a matter of how do you work with people who are brilliant, who are doing great stuff, and give them the support they need so that they can do that work well.
Subha Airan-Javia, MD, FAMIA: I would love if you could share something that you think has worked really well?
Paul DeChant, MD: Sure. One of the best things actually, that we're seeing is a daily huddle. And a lot of people say, oh, yeah, we do huddle thing. You know, that's okay. Don't, that's not going to make any difference. It didn't really help us at all. But the huddle has to be constructed in a specific way to truly make a difference.
Janae Sharp: Oh, that's interesting, I didn't know that.
Paul DeChant, MD: Just really background on burnout. Burnout is exhaustion and cynicism, and a sense of inefficacy. What Maslach showed was, that there are six drivers of burnout.
The first is work overload, there's just too much to do. It's a chaotic work environment.
The second is lack of control, particularly when we're overloaded. And we need to be able to take control, that's what knowledge workers do, they know what to do, and they should have that control.
The third is an insufficient reward, which is very common, and we're very harsh on each other in healthcare, compared to some other industries, where co-workers actually are very supportive, and we're very supportive of our patients. Quite often within a health system, or even within an office, people can be hard on each other.
Janae Sharp: I've never seen it!
Paul DeChant, MD: Next is a breakdown of community when we can't connect with each other well. Doctors and nurses are great people, we'd love to hang out with each other, but there's so little opportunity for that these days.
Next is the absence of fairness
There are many ways that there that happens, but basically, if you're not being treated the same way that your co-workers are being treated, or very commonly now, and it's hard for me to talk about, as an older white gentleman, I haven't been in situations where my quality, my competence has been questioned based on things. I have no control over like my gender, the color of my skin, or my country of origin, but so many people in the healthcare workforce deal with that on a daily basis.
Lastly, is conflicting values
Are my values really aligned with the values of the organization? So those are the drivers - within a huddle, they should never be more than 15 minutes because we can't take away from the time we're taking care of patients. If we start that off, right, it makes the rest of the day go so much better and actually enhances every other interaction.
Janae Sharp: That's a good point, they can't be all day.
Paul DeChant, MD: Oh, no, no, and learning how to do huddles, well, sometimes, you may not get through it completely. But that's alright, you're starting, you're learning by the end of it, you'll be able to get through all the steps.
The first step we like to see is actually some reward and recognition.
Who did some good yesterday that really helped out let's acknowledge that person, and thank them, you don't have to get everybody every day. That would take more than 15 minutes, probably right there. So it's, it's more a matter of something that's really meaningful that happened, that you want to thank someone for, and it shouldn't really take more than about a minute of that. 15 minutes.
Secondly, is planning for the day
What's the demand on us compared to the resources? More time gets spent on preparing for the day. Do we have the resources to handle the demand that's coming at us today? Do we have the staff we need? Do we have the supplies? Is the equipment here? And is it working? And if it's not, then we know at the start of the day, so we can develop contingencies rather than get surprised by it in the middle of the day and have to really scramble.
The next step is to fix little problems
What things went wrong yesterday that you don't want to keep having gone wrong, and they drive you nuts when they first happen. You go to a place where you're supposed to get a supply and it's not there, or the printer is out of paper or something isn't working. Those would drive me so crazy. It's where I'd never gonna let that happen again. By the end of the day, I was so exhausted, that I forgot about it and didn't come up again until a week later it happened again. By taking those when they happen - you don't have to solve them at the moment. But you just make a note that we're going to talk about it in the huddle tomorrow, probably put a note on the board or something like that. Then the team can decide in that huddle, is this a big enough issue, we want to work on it? If so who's going to do it, a couple of people go work on it come back a week later with some solution, those little problems, call them pebbles in your shoe, the more you take those out, the easier it is to walk through your job and get things done.
Lastly, looking at metrics
What are the systems metrics that they pay attention to, and every health system has focused on quality, safety, patient experience, access, productivity, financial stability, and the experience of the workers as well? And so looking at what do we do at the front end that impacts those outcome metrics. Oftentimes, at the front end, in the huddle, we're looking at something that's more of a process metric. Are we doing things properly? You know, is there something we can do differently in terms of taking care of a patient, in terms of doing a schedule and just tracking those things. From that, then we start seeing improvement in the metrics overall. That's basically it. The leader of the unit also has they're seeing all of these happen, they can follow up throughout the day, with everybody in the unit, check in with them and make sure that what was brought up is being handled properly. It's acknowledgment, preparing for the day, fixing small problems, and tracking metrics.
Subha Airan-Javia, MD, FAMIA: You know, it's really interesting, it's very similar to the SCRUM methodology when you're doing Agile development.
Paul DeChant, MD: Yes, and we do it at a visual management board. You know, if it's in a unit where everybody's together, you can just be a board on a wall. It's very structured with all those key components. But you can also do huddles virtually. So there are lots of virtual whiteboards and other ways.
Janae Sharp: I like virtual whiteboards
Paul DeChant, MD: Having the visuals there, then you don't have to spend a lot of time explaining people in a look in an instant, know what you're talking about. And that makes a difference. One of our clients we're working with right now, started implementing huddles a few months ago, they had a horrible problem with turnover in their offices. In every office where the huddles have started, once they started the huddles, there's been no staff turnover.
Janae Sharp: Really?
Subha Airan-Javia, MD, FAMIA: That is really interesting.
Paul DeChant, MD: Yeah, we even heard from some people who said they were ready to leave. And once the huddle started, they got a chance to speak at the huddle, and then their manager would follow up with them later in the day. They said, "wow, it feels like somebody actually cares about me here, I haven't ever felt that."
Subha Airan-Javia, MD, FAMIA: Wow.
Janae Sharp: One thing that I got from what you were saying is about connection, they were about to leave, and it really took being seen and being recognized. I've been shocked. Maybe it's just lately or maybe it's like where I'm at in my life. I've been shocked how many people are feeling disconnected from their community, from their job. Even though I moved across the country, this is not as easy as I thought it would be. To me, that is sad, that all it took for them to not want to quit their job was a tiny bit of recognition.
Paul DeChant, MD: Now, in the huddles, certainly there's recognition, I think the other things, and they may not have been as obvious to the people even experiencing them is, as you do this, the work overload actually decreases some because there's less mess and confusion.
Janae Sharp: Oh, that's a great point,
Paul DeChant, MD: You gain some control, because you had a problem, and you get to actually help fix it. You come together as a team, so you're creating more community, it feels like it's fairer, if you're being asked to do a job, it's almost undoable, you've got some input into getting some control over it. You can see the alignment in values as you look at the metrics, when you're trying to improve those we can see those are important to me, and they're important to my patients, and they're important to our organization.
Janae Sharp: You don't always realize what's been changed when things are better.
Subha Airan-Javia, MD, FAMIA: That's interesting.
Paul DeChant, MD: It's hard for a whole team to come together and really get that started, without some kind of external guidance and support and coaching, or at least education about how to do that. It can sound very exciting and say, well, let's get everybody together. Let's work on this. The first huddle that ever started somehow was how it was done. And people have figured it out and refined it. But particularly as you're trying to do this in a way that's effective, one thing we don't want to do is waste time, particularly for the physicians who are already time-stressed to start with. So the more we can implement them effectively, the better. In fact, when we first started doing them, we did not insist that the physicians attend because we were learning how to do the huddles effectively, we worked with the support staff, receptionists and medical assistants, nurses, they came together, and addressed their day. We didn't insist the doctors come until we got it so it was really working effectively and efficiently. Otherwise, nothing will turn off a doctor faster than being forced to do something that they don't find value in.
Janae Sharp: Or anyone.
Subha Airan-Javia, MD, FAMIA: Can't imagine what you mean, Paul
Janae Sharp: I've never seen that.
Subha Airan-Javia, MD, FAMIA: Take this piece of information and document it in 10 places.
Janae Sharp: Like, you know, let's just try it. Actually, I don't want to copy and paste. I'm going to retype it.
Subha Airan-Javia, MD, FAMIA: I want to write it on paper and then write it again. It's amazing.
Janae Sharp: What change would you like to see? If you saw someone new in the space? What would they be bringing?
Paul DeChant, MD: Yeah, what I'd like to see is leaders, top-level leaders, truly understand the challenges that the people on the frontlines have. For a leader to go and observe and shadow and watch the clinician work. See all of the frustrations and challenges, then they can understand more, if they're asking for something, what the implications of that are, and better tie their decision making about what really needs to happen because they've experienced that. That can do a lot to break down that disconnect and cynicism that's really strong. Oftentimes, I get done with one of my presentations, people will ask, "well, what's one thing we can do? You talked about all these things you can do with management systems and culture and fancy workflow, Value Stream Map redesign. What can I do next week?". And I say, "if you're a leader, go shadow a clinician. And if you're a clinician, invite a leader to come to shadow you."
Subha Airan-Javia, MD, FAMIA: I love that. Great, so huddle. And listen, those are our two things.
Janae Sharp: Watch and learn.
Subha Airan-Javia, MD, FAMIA: All right, well, I had a great time. So thank you for sharing your experiences with us.
Janae Sharp: Paul, how can people connect with you that are watching?
Paul DeChant, MD: I have a website, PaulDechantmd.com. You just Google my name, and you'll find all that. My email address is Paul@PaulDeChantmd.com. So you can find me there as well. And I'm on Twitter, I'm on LinkedIn. I look forward to any of those opportunities to connect with people.
Subha Airan-Javia, MD, FAMIA: Great.
Janae Sharp: Thank you for being part of our Sharp Conversations. I hope everybody can subscribe and leave us comments about things that you've seen that are successful.
Subha Airan-Javia, MD, FAMIA: Have a great day.
Paul DeChant, MD: Thanks, guys.
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