Issue link: https://beckershealthcare.uberflip.com/i/1543897
22 HEALTHCARE NEWS 22 When — and why — Adventist HealthCare encourages physicians to say no By Erica Cerutti A s executive vice president and chief medical officer of Adventist HealthCare, Patsy McNeil, MD, delivers an unconventional message to new physicians: the importance of knowing when to say no when asked to take on responsibilities beyond their primary role. She shares that message with every cohort that comes through the Gaithersburg, Md.-based health system's physician leadership academy, where she speaks candidly about the realities of modern healthcare and ever-present pressure to take on more. "A statement I make to them as the highest physician executive in this company is, 'I know you. I am you. What we need you to understand is there will always be a request for more of you — one more patient, one more shi, two more hours, come in early, stay late, be on this committee,'" she said. "I'm going to keep my eye on you and make sure that you're seen and healthy as best I can, but you're going to have to be able to speak clearly about boundaries." For Dr. McNeil, fostering a culture where physicians feel comfortable setting boundaries has become increasingly important to prevent burnout and curb turnover, particularly as persistent physician shortages strain health system workforces. She emphasized that encouraging physicians to speak up isn't about lowering expectations or avoiding responsibility, but about addressing situations where going beyond those expectations becomes routine and unsustainable. When overextension becomes the norm, she said leaders must examine the underlying operational and cultural drivers to prevent physicians from cutting back hours or leaving altogether. Becker's recently spoke with Dr. McNeil about why giving physicians permission to set limits is critical to preventing burnout and turnover, how leaders can distinguish appropriate boundaries from unmet expectations, and what it takes to build a culture where clinicians feel safe speaking up. Question: In an industry defined by scarcity, it can feel counterintuitive to tell physicians to say 'no.' Why is giving clinicians permission to set limits a leadership imperative, and what are the risks when that boundary isn't respected? Dr. Patsy McNeil: It's imperative to say no, and why. e baseline physicians who we have at Adventist Healthcare who I know around not only the United States but around the world are trained to work — they're wanting to work and they're going to work hard as a general rule. When they're saying no, it's not about being lazy. So when they do say no, the leadership competency is to ask "why" and take a good, fresh wraparound look at our operations. Is there any toxicity in the workplace, anything that may be going on that is bridging boundaries that are inappropriate. We have to have a wraparound view of this workforce to make sure that then you can move towards sustainability in the workforce. In an environment of scarcity, it's counterintuitive to allow them to say no, but in a scarcity environment, you also don't want a lot of turnover. It begins to wreck your processes and adherence to protocols because the workforce is not familiar. If they're not familiar — if they're new to what you're trying to achieve, what your strategy, vision and goals are for the healthcare organization — those things begin to scatter when physicians continuously say yes and then their health declines. Or they constantly say yes and then they're so burned out they want to go down to half-time. en you really don't have a full workforce in place. Or they quit. Or they have mental health issues, and that affects everyone around them. Q: Building a culture where physicians can set boundaries without fear of judgment or backlash takes more than messaging. What specific behaviors or norms signal that a hospital is truly getting this right? PM: Tracking. We have a physician engagement survey that we do every year, and we follow this religiously. I read every single comment made by a physician who works within the boundaries of Adventist Healthcare every year. Every single one. e CMOs do the same thing. ey're reported out to executive teams as well as to the physicians themselves. Part of that survey has a resilience score. Every year, our CMOs come together and share insights with each other about things that work and things that don't work. It's an obligation every year to create an engagement plan, and those engagement plans a focus on burnout. One of our hospitals has won something called a Medicus Integra award, which is an award that specifically celebrates what a hospital is doing to address physician burnout. Scoring is one way to do this. Forums in which you sit down and speak with physicians to see how everybody's feeling is another. Sometimes when physicians are struggling and they're overworked, they begin to act out. ey're being abrupt with colleagues, they're perhaps being dismissive of patients or being angry inappropriately. We have a zero-tolerance policy for bad physician behavior. It intimidates everybody around. Nurses feel the backblow of that and may not want to come to work. It can drive nursing turnover. It's a patient safety issue because other physicians or nurses won't want to communicate with the physician because they're angry, and when their patients are getting sicker they don't want to make those interval calls to make sure that they're doing the right things. If physicians begin to display less than stellar professional behavior, we call physicians in. But we don't start with, 'How dare you do this? What's wrong with you?' We start with, 'Are you OK? What's going on? You haven't done this before, or this is new behavior, or this is escalating behavior.' We have a literal stepwise pyramid escalation for when this occurs, but we start with listening to make sure and understand, is it our processes that are driving this behavior and frustration, or is it something else? It's important to have an open- door policy for all physician leaders to come and have a conversation, look at surveys and have a wraparound plan that's not just based on one tool in the toolbox, but a layered approach. at all goes back to them being able to say no. It gets back to psychological safety and frankly, of being able to share when there's a problem. At the end of the day, all of these things are focused toward not only them, but also patients. Physicians and our healthcare organization are driven toward making sure the patients we take care of are taken care of well and taken care of safely. We work at that incessantly, and this is just one piece of that entire puzzle.