Learning how to manage healthcare's 'boiling point'

  | April 25, 2017

Managing workplace conflict is a goal for every industry — and it has pressing consequences in healthcare. A national survey of physicians, conducted last year by athenaInsight, revealed that burnout is endemic: Only 20 percent of doctors feel engaged in their work.

But the survey also suggested a way to make physicians more connected to their organizations: Build trust between doctors and non-physician leaders, through communication and strong face-to-face relationships.

That's easier said than done — but it's the focus of a seminar from Physician Health Services, a non-profit medical education organization built to support physicians under the aegis of the Massachusetts Medical Society.

Physician Health Services director Steven Adelman, M.D., says that as he trained doctors to manage their frustration in recent years, he realized many conflicts were stemming less from individual anger than from the institutional stressors of modern healthcare. He cites increased reporting and oversight, more teamwork requirements, a lot more regulations, diminished profit margins, and the adaptation to electronic medical records as the major stressors.

“Anger management has morphed into conflict everywhere," says Adelman, a former physician leader and a clinical associate professor of psychiatry at the University of Massachusetts Medical School. “We all have a boiling point, but things boil over more and more because of all this heat and pressure."

So Adelman adapted a course about disruptive physician behavior — intended to help physicians “smooth their rough edges" — into a program about the rough edges of institutional medicine, and productive ways to improve communication within healthcare systems.

The fourth installment of the two-day seminar takes place June 8 and 9 at the offices of the Massachusetts Medical Society. Participants will earn continuing medical education credits as they learn techniques to improve relationships with physician leaders, colleagues, coworkers, and patients — and improve the quality of the overall work environment.

“We realized that the ability to manage conflict and anger was becoming a necessary set of competencies for every healthcare professional," Adelman says.

This course uses real but anonymous workplace conflicts, which attendees provide before the sessions. Through presentations and role-playing, clinicians and practice leaders explore ways to assess difficult relationships and stressful situations, and try out techniques to minimize conflicts and improve communication.

Adelman brought on new faculty with expertise in both medicine and conflict resolution, to help shape the program. They include Diana L. Dill, Ed.D., a coach, educator, and clinical psychologist; Jo Shapiro, M.D., director of the Center for Professionalism and Peer Support and chief of the Division of Otolaryngology in the Department of Surgery at Brigham and Women's Hospital; Les Schwab, M.D., a primary care physician and certified coach; and Melissa Brodrick, the ombudsperson for Harvard's medical school, school of dental medicine and school of public health, who teaches skills in dispute resolution and collaborative negotiation.

She “really knows the territory, alpha males and females who are not getting along," Adelman says.

Compared to the previous course, Adelman says, this curriculum puts more focus on the organizational and environmental issues that lay the foundation for conflict.

“It helps leaders understand the larger picture by building an understanding of how conflict is baked into this world," he says.

Bringing physicians and leaders together also changes the dynamic and opens minds, he says. A seminar may contain an anesthesiologist who “lost it" one day sitting next to a chief of surgery from a different system.

“They can have a conversation from both sides," Adelman says. “I am not saying we are doing couples therapy, but we do have both perspectives, and that is really unique."

Adelman says the course also emphasizes the importance of coaching — something he thinks should become more common throughout the healthcare industry.

“Coaching is client-centered. It focuses on goals, not on pathology, not as psychotherapy," he says. “Doctors with these challenges learn that there is nothing wrong with them. This is the coin of the realm now. We are in a profession that demands high levels of performance, and like athletes, we need a trainer or coach to optimize performance."

Dill agrees.

“Burnout is a workplace phenomenon, not a personal lack of resiliency," she says. “Workplaces are becoming unmanageable for physicians, and they can use some help understanding what is happening to them."

In the course, Dill provides what she calls a “systems frame of view" to afford a better look at organizational conflict.

“Are you seeing everyone on the team is grouchy? Are they all working till 8 at night? Is the problem universal or is there a particular conflict?" she says. “You may think, 'Maybe this is a systems issue, rather than a personal failing of mine.' That is comforting."

Schwab says it's rare to find a course that brings doctors and managers together to examine what the industry has wrought.

“There are courses in having difficult conversations with patients, but not much that teaches physicians and their managers how to have productive conversations," Schwab says. “I have a career in medical management, so I know what skills are involved for mutual advantage. But most do it by the seat of their pants, when there really is a skill set. This course provides good, productive ways to go forward."

David Levine is a regular contributor to athenaInsight.

Learning how to manage healthcare's 'boiling point'