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  • Writer's pictureBruce Cummings

Yet Another Data-Rich Case Study Highlighting the Nexus Between the Workplace and Health

The McKinsey Health Institute has produced yet another groundbreaking piece of research on health and its relationship to the workplace.  


Before I get to McKinsey's report, I want to recap our strongly held view, backed by evidence, that burnout is an occupational phenomenon -- an individual response to toxic conditions in the workplace.  Put differently, burnout is NOT caused by a lack of resilience on the part of the worker, but rather occurs because of persistent structural and/or systemic issues within one's place of employment.  The 3 manifestations of burnout -- exhaustion, cynicism, and inefficacy -- are a personal reaction to a toxic work environment.  The 6 workplace conditions driving burnout are: excessive workload, lack of control, insufficient reward and recognition, loss of community, a perceived lack of fairness, and conflict between one's personal/professional values and those of the employer (C. Maslach).


This is why my colleague, Paul DeChant, MD, MBA, and I are critical of organizations which mistakenly proffer workplace "wellness" courses and programs (e.g., yoga, meditation, gym memberships, recharge rooms) as an antidote to worker burnout.  While such offerings do have intrinsic value, they have little or no impact on the conditions that actually cause burnout.  In short, the drivers of burnout arise not within the worker, but rather from the workplace itself.  At the same time, however, employment -- and employers' policies, priorities, and practices -- can and do have an impact on one's personal health and wellbeing, too.  The distinction between burnout (a specific occupationally caused condition) and the broader employer-personal health relationship is subtle but important.  Here's where McKinsey's path breaking research is revelatory.


Various Factors Associated with Employment Affect Health and Work-Related Outcomes


Noting that "the average person spends a third of their life at work (more than 90,000 hours in a lifetime)", McKinsey looked at 26 workplace factors across some 30 countries to assess how various factors associated with employment affect health and work-related outcomes. 


"[McKinsey's] research showed there are important differences between the workplace factors that lead to poor health and those that lead to good health. Our analysis found that employee self-efficacy, adaptability, and feelings of belonging at work were top predictors of good health, whereas toxic workplace behaviors, role ambiguity, and role conflict at work were top predictors of poor health.


Previously, researchers at the University of Oxford’s Wellbeing Research Centre analyzed data from more than 15 million employees on their well-being and the underlying workplace factors driving it.(4) The researchers identified and tested 11 factors, including compensation, flexibility, purpose, inclusion, achievement, support, trust, belonging, management, and learning. The three top factors for the companies that scored best on well-being were feeling energized, belonging, and trust. Interestingly, they are different from the top drivers that employees think will make them happy and drive well-being at work: pay and flexibility.


Together, all the research led us to identify six drivers of health that employers can most easily influence: ... social interaction, mindsets and beliefs, productive activity, stress, economic security, and sleep.


It's not possible within the constraints of a blog to explore each of the 6 employer-inflected drivers, so I encourage you to read the article in its entirety.  But the conclusion is clear:  employers which place a premium on promoting workers' health, safety, and wellbeing; demonstrate attention to the 6 factors cited by McKinsey; and, consistently look for ways to directly engage employees in improving the workplace and workflow, will see not only less burnout and less absenteeism but also better employee health along with higher rates of retention and better operational performance.


McKinsey's Business Case Methodology


"In addition to contributing to increased productivity at work, our calculations indicate that investing in employee health and well-being provides a positive opportunity for attracting and retaining talent. As noted in McKinsey research, employees facing mental-health and well-being challenges are four times more likely than others to want to leave their organizations.(8)


Better health correlates with higher productivity across countries and workplace settings and is also strongly correlated with workforce participation at all ages.(9) Every 1 to 3 percent increase in global workforce participation is worth a further $1.4 billion to $4.2 billion,(10) benefiting employees, their health, the societies in which they live, and government finances.(11)


To capture these economic benefits fully, employers need to move from a sole focus of protecting against incidental risk and illness to helping employees achieve more optimal health. This is particularly important when considering that employees move along a continuum of health over time and may draw upon different workplace resources throughout their employment with a company. Ultimately, a focus on improving health could lead to a virtuous circle of positive change, as employees gain health literacy, and employers in turn respond to employee health concerns."


Organizational Wellbeing Solutions for Hospitals, Health Systems, and Medical Group Practices:  Leadership-Driven Changes


By changing both administrative and clinical practices in the workplace; streamlining workflow to eliminate bottlenecks, excessive data entry by clinicians, and non-value added tasks; and reinventing/inflecting the managerial culture of the organization, senior leaders can simultaneously address clinician burnout and foster the type of organizational wellbeing described by McKInsey. Here are examples of leadership-driven changes my colleague Paul DeChant, MD, MBA and I often recommend:


  • expect all leaders, but especially senior executives, to do periodic job shadowing of front-line staff (where observing and deep listening are emphasized)

  • create and require leader standard work (LSW).

  • develop and deploy a sophisticated, deeply ingrained, and rigorous daily management system (DMS) supported by visual display boards or monitors

  • consistently apply one or more of the improvement sciences (Lean, six sigma, operations research, agile, design thinking) in consultation with front-line staff to improve workflow and reduce delays, waste, inefficiency, and job skill mismatches

  • judiciously invest in AI/ML solutions -- selected, tested, and endorsed by front-line staff -- that eliminate or at least markedly reduce data entry, administrative requirements, and/or repetitive tasks that are non-value add

  • support near-continuous optimization and remediation of the EHR (there's no such thing as "it's all set")

  • regard clinicians as knowledge workers who are given significant latitude to make clinical decisions without unnecessary administrative encumbrances or delays

  • get rid of superfluous or outdated policies, procedures, redundant approvals and other stupid stuff (GROSS)

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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