What if the Patient Doesn't Come First?

It’s the topic on everyone’s mind: The State of the Workforce. We’re facing staffing shortages and struggling with employee retention and recruitment. Physician and workforce burnout are at an all-time high. We’ve heard leaders across industries lament, “no one wants to work” and that the job market is madness.

The facts are clear and the feelings are valid. But what if we’re also wrong? What if people do want to work, but differently than they’ve done in the past? What if it feels like insanity because it is?

Einstein defined insanity as doing the same thing over and over, expecting a different result. For so many years - decades even - the narrative has been patient-centric. The Triple Aim, however well intended, seeks to put patients and quality first, but completely disregards the well-being of clinicians and staff providing the care associated with those outcomes. As Bodenheimer & Sinsky show, the health and wellbeing of staff and clinicians correlates to the health of patient satisfaction and outcomes. They also argue burnout “imperils” the Triple Aim, and call for an expansion to a Quadruple Aim that adds “the goal of improving the work life of health care providers, including clinicians and staff.”

We talk about the patient experience, patient outcomes, patient-centered care, and patient safety. These are all good in principle and when executed in the correct order. But I have to wonder, if like many things that started out so well intended, we’ve gotten ourselves into a backwards, malignant version of what used to be benign or even healthy.

What if we’ve forgotten the fact that nothing about the patient can happen without you - without physicians, PAs, NPs, nurses, MAs, and staff at every level of clinical and admin support? What would it look like if we took the patient out of the center of the experience and instead centered our clinicians and staff? What if by putting the patients at the center we’ve disconnected from ourselves and each other?

We can all recite the airline safety directive: put on your own oxygen mask before helping someone else. Why don’t we have a similar patient safety directive? Take care of yourself and your team first before helping the patient? What if we borrowed from Sir Richard Branson, who said, “Clients do not come first. Employees come first. If you take care of your employees, they will take care of the clients.” What if we began running our healthcare organizations by the philosophy that the patient doesn’t come first? Do we have anything to lose?

What if we focused instead on happy physicians, and happy staff? Google “happy employees = happy customers” and you’ll find a plethora of articles showing other industries have been talking along these lines for some time. Dr. Prabhu wrote for healthmanagement.org, arguing happy staff don’t just = happy patients, but safe patients. Where healthcare has been slow to adapt, both the Quadruple Aim and legislation such as the recently passed Health Care Provider Protection Act, seek to start changing the priority and care we provide those providing care.

I know this bucks the narrative we’ve all lived by for so long. I would argue ideas like ‘patients first’ aren’t working, and we are past due for a change. What can change look like? What does Team First organizational behavior look like?

A 2022 McKinsey & Company survey reports the top 5 reasons people are quitting (in order of importance): lack of career development, inadequate total compensation, uncaring & uninspiring leaders, lack of meaningful work, and unsustainable work expectations.

Some of the top solutions then, would be: Better professional development budgets and programs at every staff level. Leadership training for physicians and organizational leaders. Increased organizational meaning and corresponding internal marketing and education to communicate and give meaning to the work we’re asking staff to perform. Educate administrators and physician leaders on the best use of benchmarking data, starting with busting the myth that benchmarking = best practice, particularly on metrics like staffing levels.

You and your teams are your best investment. Put them first.

References:

McKinsey & Company results: Click here

Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. The Annals of Family Medicine, 12(6), 573–576. Click here

Happy Staff, Safe Patients: Click here