Carolyn McClanahan, MD Emergency medicine is tough. The world expects perfection, and we know perfection isn’t possible. Complicated patients and a dysfunctional health care system make matters worse. The sad outcome is that too many physicians are unhappy, burned out, and the rate of suicide is higher than ever.
What makes it worse? Physicians are mean to each other.
How can we fix this? We can change the culture of medicine.
The culture of medicine starts with the dog eat dog world of medical school, extends to the competition in residency, and continues with the turf wars of private practice. I’ll never forget the female surgery attending who announced, “It is time for us to go to the family malpractice floor.” It shouldn’t be like this. We should be helping each other.
What do we want out of medicine?
What do physicians want out of medicine? Most started in this profession with big dreams and they cared about people. Because of medicine’s unhealthy culture, physicians become unhappy, cynical, and perpetuate the bad behaviors they are taught.
Many physicians call me and ask how they can change professions. And as I see in my financial planning practice, too many choose to escape through overspending. Others resort to drug or alcohol abuse or even suicide. The joy was squashed right out of them. It doesn’t have to be this way.
And sadly, do you know what patients want? They want to be cared for, they want the system to work, and they want the truth when it doesn’t work. This is the cornerstone to fixing our malpractice woes. If we didn’t act so infallible, patients would give us some grace. We have to show our humanity and practice some humility. We have to change our culture so we can be allowed to be the good human beings we were meant to be.
How do we change culture?
The key to changing culture is to clearly spell out the desired culture through the use of engagement standards, make it known that everyone is expected to adhere to the stated culture, and call it out when someone is not walking the talk. This is not hard to do and it takes work.
I changed careers from medicine to finance. The culture of finance is just as bad as the culture of medicine. The only difference is people generally don’t die when financial planners make a mistake. When I entered finance, I worked for an organization with horrible culture and quickly realized the only way to be in a place with good culture was to open my own business and create the culture I wanted.
After a couple of years my business was going gangbusters but out of control, and I decided to hire a business coach. She instructed me to list all the client behaviors I loved and the behaviors that drove me nuts. From that, I created “client engagement standards” – this listed what clients could expect from me, and likewise, what I needed from clients to do a good job. These worked like magic.
As my firm grew, I had to hire people and I had no clue how to be a boss. But one thing I knew is that I wanted a great culture. I wanted people to have fun, love their work, and do a fantastic job for the clients. So I thought, why not create “corporate engagement standards” to set the tone?
We created these as a team. Simple concepts are clearly spelled out – open communication, encouraging laughter, being our best, acting with full integrity, and always telling the truth are just a few of what we expect. I’ve included our engagement standards for all to see.
How does this translate to emergency departments?
How can this translate to larger organizations like emergency departments? Big organizations are made of groups. And groups act like small companies. Create engagement standards for each of the groups – a set between attendings, a set between residents and attendings, between ancillary personnel and doctors. These agreements ideally should involve everyone, even custodial staff. We are all important.
What are some pointers for emergency departments directly? They should include a few key concepts.
- Kind, open, and honest communication is paramount. No secrets, no drama, no talking behind each other’s backs.
- It needs to be okay to say, “I don’t know” with confidence and without fear.
- Attack problems, not people.
- Errors need to be admitted immediately.
- Complaints are okay and come up with possible solutions to the complaints.
What if you already have a toxic situation? Get an objective third party to help the team sort it out. And I highly recommend communication training – “Fierce Conversations” by Susan Scott should be “must reading” for everyone in this country.
Finally, the best thing about engagement standards is they are a great tool to hire people. Hiring people with good culture makes keeping good culture in the workplace much easier.
My dream for you? Workplace joy. By setting the tone through the use of engagement standards, you can start the road to repair and create the culture you deserve.
Take a listen to my talk – engagement standards can change the world. Please feel free to reach out if you need help getting started and please share with me the story of your path.
Check out Life Planning Partners Corporate Engagement Standards here.
Watch her FIX 18 talk below!