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Writer's pictureBruce Cummings

Increasing retention, decreasing burnout, and improving operational results: (re)building clinician-executive trust

Updated: Jul 30



Part I


Focus on Fixing the Workplace, Not the Worker


Doctors

Clinician-Executive Trust Building


Trust. It’s easy to describe, but increasingly difficult to find in hospitals and health systems. Nowhere is the trust deficit more evident than in the strained, often even toxic relationship between clinicians and healthcare executives.


How did we, health professionals all, get here?


Both the causes and the consequences are relatively straightforward. The mystery is why so few hospitals and health systems are taking a comprehensive, sustained approach to examining and treating the trust deficit.


A quick recap of the causes of clinician-administration trust issues:


1) The Communication Gap (or, Why Clinicians are from Venus; Executives are from Mars)


Effective communication is a precondition for creating and maintaining trust, but is often lacking between clinicians and administrators. In large, complex bureaucracies such as hospitals, health systems, and multi-specialty clinics, administrators typically consult with and principally rely on reports and recommendations from the organization’s formal/appointed physician leaders (ie, CMOs, chairs, and chiefs) — sometimes exclusively so. However, these designated clinical leaders may not be viewed by front-line clinicians as truly having a current, in-depth understanding of their specialty-specific day-to-day concerns.


Clinicians and administrators also typically operate in separate silos with distinct workflows and scheduling priorities within the hospital. This, too, can lead to limited interaction and deep understanding of the complexities and peculiarities of each other’s work, roles, and challenges.


Both have their distinct jargon and acronyms.


Miscommunication or a dearth of communication can and does result in misunderstandings and mistrust. Clinicians may feel that their input is not highly valued or reflected in decision-making processes, while executives can often perceive clinicians as inherently resistant to change, lack appreciation of the organization’s limited resources, and/or imagine they are just refractory by nature.


2)  Differing Priorities


Chances are, if asked, any administrator or clinician would give the same response to the questions: “what business are we in?” and  “who is our number 1 priority?”  The answers from both would likely come quickly and be identical: patient care; and, patients.  


Great, we’re both on the same page, right?  


But a major source of distrust between clinicians and administrators is the actual pursuit and expression of their supposedly shared priorities. Clinicians are primarily focused on patient care and clinical outcomes. Their training and professional ethos emphasize the optimal outcome and well-being of individual patients, often advocating for the best possible treatment or the latest advancement in care regardless of cost or other limitations.  


Meanwhile, hospital administrators are responsible for the financial health and operational efficiency of the organization; meeting state and federal regulations, accreditation and professional association standards, and insurer requirements all while also avoiding tax, legal, or other compliance issues (eg, prohibitions on IRS private inurement, Stark laws, antitrust strictures). They must balance budgets, manage resources, and ensure the institution’s sustainability at a time of remarkably limited reimbursement updates juxtaposed with rising cost pressures, and between escalating patient demands, societal pressures (eg, DEI, Social Determinants of Health [SODH], price transparency, social and workplace violence) and resource constraints. 


This fundamental difference in day-to-day priorities can lead to conflict, as clinicians may perceive administrators as prioritizing cost-saving measures or other needs over patient care, while administrators might see clinicians as being indifferent to financial constraints and market, legal, socio-political and regulatory realities.


3) Culture Clash


The hierarchical nature and complexity of healthcare organizations can exacerbate distrust. Clinicians are knowledge workers for whom decision-making, agency, and autonomy are hallmarks of their training and professional identity.  But they are often placed in a work environment where they have little or no involvement with or direct impact on day-to-day administrative decisions or governance. This lack of meaningful involvement in operational decision-making/governance can lead to a sense of powerlessness, disenfranchisement and frustration — key ingredients of burnout and predictors of turnover.  


For their part, administrators may struggle to engage front-line clinicians in designing and executing organizational initiatives, interpreting clinicians’ lack of participation as apparent disinterest or opposition rather than a response to time/productivity pressures and/or feeling chronically excluded.  


Clinician-Executive Trust Building requires addressing these cultural clashes and fostering a collaborative environment where both parties can work together effectively.



Ready to transform your hospital or workplace?



Are you frustrated by adversarial relationships between front-line clinicians and senior leadership? Organizational Wellbeing Solutions was formed to enable senior leaders to identify the specific drivers of clinician burnout in their organization; and to support leaders in designing and executing a comprehensive plan to stop clinician burnout, increase retention, and improve operating results. A hallmark of our consultancy is correcting the all-too-frequent distrust and alienation clinicians feel toward the c-suite generally and the CEO in particular. Let us help you help your organization and its clinicians develop a more trusting, aligned, and productive working relationship.



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