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What can you do about the burnout crisis? Don’t wait until a problem is a big issue before taking action.
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Don’t Walk By: One Way Leaders Can Promote Joy in Work

By Christina Gunther-Murphy | Tuesday, June 14, 2016

Don't Walk By

Burnout in health care is a big issue, but the small things matter more than you might think.

IHI and the IHI Leadership Alliance have been developing recommendations on what senior leaders can do to promote joy in work and reduce burnout. One way senior leaders can improve morale is to hold themselves accountable to the values and culture of their organizations. How? By not walking by when they see something that isn’t right.

Dr. Parag Bharadwaj, Chief of Palliative Care Medicine at Leadership Alliance member Sentara Healthcare notes, “We often hope that problems will get fixed by themselves. We tolerate a situation for a while and wait until something becomes a big issue before we act.”

Examples of problematic behavior are many:

A manager uses a condescending tone of voice when answering questions from a new nurse. A prominent surgeon is disrespectful in the OR. A veteran nurse belittles a resident. Members of a management team criticize one another behind each other’s backs.

The key to the leader’s response, Bharadwaj believes, is communication. “If you see something that doesn’t seem right,” he asserts, “have a conversation and try to figure out what’s getting in the way of an optimal outcome, or of an ideal work environment.”

Bharadwaj recently decided against “walking by” a situation with one of his colleagues. He heard a clinician giving what he worried was an overly simplistic explanation to a patient, and it took him by surprise.

The patient was from a culture and educational background different from Bharadwaj's, but shared by his colleague. “The facts he shared were accurate,” he remembers, “but it was not the way I would have done it.”

At first, Bharadwaj was going to let it go, but he then decided against it. “I later asked, ‘Would you explain to me what happened?’” he recounts. “I said, ‘Can you help me understand why you used the approach you chose?’”

Once his colleague explained his rationale and his intentions, “It made perfect sense.” By framing his question as being curious about what we had witnessed, he approached the situation with humility. He also avoided putting his colleague on the defensive. “I learned that it was not only important for me to hold others accountable,” Bharadwaj explains, “but it was important for me to hold myself accountable by not walking away with incorrect assumptions.”

The behavior of senior leaders sends a message. If they let small (but important) things go unchecked, they give them their tacit approval. Instead, leaders should use their own conduct to reinforce their organization’s values.

While it can seem overwhelming at times to contemplate how to improve morale in health care, remember that good leaders can start today — right now — to make a difference.

Christina Gunther-Murphy is an Executive Director at the Institute for Healthcare Improvement (IHI) and oversees IHI’s Person- and Family-Centered Care Focus Area.


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Civility Is Everyone’s Responsibility

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