As healthcare organizations get bigger, healthcare workers feel small

There are two trends in healthcare right now and they are not unrelated. One is consolidation. The other is burnout in caregivers. And the sooner we disconnect them, the better the industry will be – and the more likely healthcare organizations are to provide patients with the quality care they need.

To view the latest headlines:

Elevance acquires Blue Cross Blue Shield of Louisiana.

Blue Cross Blue Shield Michigan and Vermont combine.

Amazon has acquired One Medical.

CVS Health acquired Oak Street Health and Signify.

And of course, just a few weeks ago we learned that Kaiser Permanente plans to acquire Geisinger Health and form Risant Health. That deal will put more than 13 million lives under Kaiser’s control. This all comes after years of consolidation and the creation of many local, regional and national megasystems.

To be clear, the size of an organization is not always related to its ability to provide quality care to people. Some organizations choose to stay small, which allows them to maintain an intimate atmosphere between staff and patients. At best, red tape is the exception and care is streamlined.

Similarly, many large organizations are able to provide quality care at a lower cost because they can leverage their size to take advantage of economies of scale. In fact, this is one of the main reasons why the organization I lead, SCAN, is to join forces with CareOregon to form the HealthRight Group.

Large organizations can also improve care by implementing standardization on a large scale. A large health plan or hospital chain can analyze its data to determine the best policy and then implement it across all of its facilities for the benefit of patients. For example, requiring every employee who enters a hospital room to wash their hands reduces the spread of hospital-acquired infections. Similarly, large healthcare systems can engage in group purchasing around pharmaceuticals and medical devices, leveraging standardization and economies of scale to achieve better outcomes at lower costs.

Invisibility

However, there is a pitfall that many large organizations can easily fall into. Too often healthcare professionals working within large organizations feel invisible. Within their workplaces, standardization becomes a burden. When an employee tries to do things differently or tailor care to the needs of an individual patient, they are told, “The policy is the policy.” They are transformed from highly trained professionals into line workers.

These kinds of administrative burdens are not unique to large organizations, but it is easy for large organizations to implement them in the name of risk management and compliance. And as they do so, the healthcare professionals at the center of their missions feel isolated, powerless, and unable to drive positive change within those institutions. This in turn leads to the common phenomenon of burnout.

Much has been written about the problem of physician burnout. Recent findings published in Mayo Clinic Procedures show that 63 percent of physicians experience burnout. Only 30 percent say they are satisfied with their work-life balance. These figures are of course not entirely surprising. Highly educated, rigorously trained men and women who have sought joy and career fulfillment through patient interactions are increasingly finding themselves in ever-larger, bureaucratic organizations where they spend money hours per day updating EPDs– which is slang for ‘paperwork’.

To be clear, that time isn’t spent taking notes during consultations: 33 percent of physicians spend two hours or more a day filling out documentation outside working hours. But doctors are by no means the only ones with burnout. About 100,000 registered nurses stop nursing because of the Covid-19 pandemic. Nearly 800,000 nurses – about a fifth of the workforce – say they will retire by 2027.

General, more than 230,000 doctors, nurse specialists, physician assistants and other clinicians have quit their jobs in 2021. Yes, part of the exodus was due to the rigors of treating Covid patients.

But dive deep and you’ll find employees repeatedly pointing to their invisibility and lack of agency as the source of the problem.

A nurse in Minnesota says, “There is not enough time and resources to care for patients the way they deserve to be cared for…I am not burnt out, I am morally wounded. It helps no one that large organizations typically refer to all clinicians on their service as “suppliers.”

When large institutions ignore the very specific and important role they each play in patient care, it’s not hard to understand how they begin to feel invisible. I’ve worked with really brilliant nurses, physician assistants and pharmacists in my career; we can certainly do better than lumping them all together as ‘suppliers’.

become visible again

The mergers, acquisitions and general trend towards larger healthcare organizations are unlikely to slow down. So, what can be done to support clinical workers in their ranks? In other words, how can we make them visible again?

Simply put, the leaders of hospitals, health systems, and health plans should make their large (and growing) impersonal institutions feel small again, organizing them into intimate, smaller units where people feel ownership and empowerment.

They should stop referring to anyone who generically sees a patient as a “provider.” They should push technologists and regulators to reduce the heavy burden of bureaucratic paperwork and instead maximize every opportunity for clinical staff to interact with patients. And they must ensure that clinicians at every level are key members of their organization’s leadership teams, involved every step of the way in determining the future of their organization. In addition, they must remember that the product they are providing to patients is the people.

Yes, policy and standardization are necessary to reduce risks and improve care. But patients have unique needs and healthcare professionals are best placed to determine those needs. Rather than repeating policies from memory, healthcare organizations should consider fast governance processes so that decisions can be made quickly. An administrator or key decision maker should be present at all times so that when questions about policy exceptions arise, an empowered leader is available to cut through red tape and seek common sense solutions.

Finally, and perhaps most importantly, health leaders need to adopt a different leadership mindset when it comes to interacting with the clinicians in their organizations. They need to make it clear (beyond handing out meaningless tchotchkes during the never-ending parade of valuation days) that they are open to common sense reform. Those leaders should give their personal mobile numbers and make themselves available to all staff. They should have regular forums where employees can meet them, ask questions, and even feel free to challenge their decisions.

I’ve never met anyone who decided to go to medical school to work for a large organization that makes them feel like they don’t matter. Our healthcare organizations are growing. But no matter how large they are, they cannot provide patient care without a dedicated team of clinical staff who feel that their contribution to their patients is valued by the organizations they work for.

Healthcare leaders would do well to pay as much attention to the needs of their clinical staff as to their need for growth.