As Healthcare Organizations Get Bigger, Healthcare Workers Feel Small

There are two trends hitting healthcare right now, and they’re not unrelated. One is consolidation. The other is healthcare worker burnout. And the sooner we uncouple them, the better off the industry will be—and the more likely healthcare organizations will be to provide patients with the quality care they need.

To review the latest headlines:

Elevance is acquiring Blue Cross Blue Shield of Louisiana.

Blue Cross Blue Shield Michigan and Vermont are combining.

Amazon has acquired One Medical.

CVS Health has acquiring 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 bring more than 13 million lives under Kaiser’s management. This all comes after years of consolidation and the creation of many local, regional, and national mega-systems.

To be clear, the size of an organization doesn’t always correlate with its ability to provide people with quality care. Some organizations choose to remain small, which enables them to maintain an intimate atmosphere among staff and patients alike. In the best of circumstances, red tape is the exception and care is streamlined.

Likewise, many large organizations are able to provide quality care at a lower cost because they’re able to use their size to take advantage of economies of scale. This is, in fact, one of the key reasons the organization I lead, SCAN, is combining forces with CareOregon to form the HealthRight Group.

Large organizations can also improve care by implementing standardization at scale. A big health plan or hospital chain can analyze its data to determine the best policies and then implement them 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-born infections. Likewise, large health systems can engage in group purchasing around pharmaceutical and medical devices and leverage standardization and economies of scale to yield better outcomes at a lower cost.

Invisibility

There is, however, a pitfall that many large organizations can easily fall into. Too often, healthcare professionals who work inside large organizations feel invisible. Inside their workplaces, standardization becomes a burden. When an employee tries to do things differently or to tailor care to an individual patient’s needs, they’re told, “The policy is the policy.” The are transformed from highly trained professionals into line workers.

These sorts of administrative burdens aren’t unique to large organizations, but it’s easy for large organizations to implement them in the name of risk management and compliance. And as they do, the care professionals at the heart of their missions feel isolated, disempowered and unable to affect positive change inside those institutions. This, in turn, leads to the too-common phenomenon of burnout.

Much has been made about the problem of physician burnout. Recent findings published in Mayo Clinic Proceedings show that 63 percent of physicians are experiencing burnout. Just 30 percent say they’re happy with their work-life balance. These numbers, of course, aren’t entirely surprising. Highly educated, rigorously trained men and women who sought joy and career fulfillment through interactions with patients increasingly find themselves working for ever-larger, bureaucratic organizations where they spend hours each day updating EHR’s—which is jargon for “paperwork.”

To be clear, that time isn’t spent making notes during consults: 33 percent of physicians spend two hours or more each day completing documentation outside work hours. But physicians are by no means the only ones burning out. Roughly 100,000 registered nurses quit nursing because of the Covid-19 pandemic. Nearly 800,000 nurses — about one-fifth of the workforce — say they’ll quit the job by 2027.

Overall, more than 230,000 physicians, nurse practitioners, physician assistants and other clinicians quit their jobs in 2021. Yes, some of the exodus was due to the rigors of treating Covid patients.

But dive deep and you’ll see that workers repeatedly point to their invisibility and their lack of agency as the source of the problem.

One nurse in Minnesota says, “There’s not enough time and resources to care for patients the way they deserve to be cared for…I’m not burnt out, I’m morally injured. It doesn’t help anyone that large organizations typically refer to all of the clinicians in their employ as “providers.”

When large institutions ignore the very specific and important roles they each play in patient care, it’s not hard to see how they begin to feel invisible. I’ve worked alongside truly brilliant nurses, physician assistants and pharmacists in my career; surely we can do better than to lump them all together as “providers.”

Becoming Visible Again

The mergers, acquisitions and overall trend toward larger health organizations will not likely slow down. So, what can be done to support clinical workers in their ranks? Put another way, how can we make them visible again?

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

They should stop referring to everyone who sees a patient generically as a “provider. They should push technologists and regulators to reduce the onerous burden of bureaucratic paperwork and instead maximize every opportunity for clinical workers to interact with patients. And they should ensure that clinicians at every level are key members of their organizations’ leadership teams, involved at every step in determining the future of their organizations. Moreover, they should remember that the product that they are delivering to patients is the people.

Yes, policies and standardization are necessary to reduce risk and can improve care. But patients have unique needs, and healthcare workers are best able to determine those needs. Rather than rote recitation of policies, healthcare organizations should consider rapid governance processes so decisions can be made quickly. An administrator or key decision-maker should always be on duty so that when questions arise about policy-exceptions, an empowered leader is available to help cut through red tape and drive towards common sense solutions.

Last—and perhaps most important—health leaders need to employ a different leadership mindset when it comes to interfacing with the clinicians in their organizations. They should make it clear (beyond giving out meaningless tchotchkes at the endless parade of appreciation days) that they are open to commonsense reforms. Those leaders should give their personal cell numbers and make themselves available to everyone on staff. They should have regular forums at which employees can meet with them, ask them questions, and even feel free to challenge their decisions.

I’ve never met anyone who decided to go into medicine in order to work for a big organization that makes them feel like they don’t matter. Our healthcare organizations are growing. But no matter their size, they can’t provide care to patients without a dedicated team of clinical workers who feel like their contributions to their patients are valued by the organizations for whom they work.

Healthcare leaders would do well to pay as much attention to their clinical employees’ needs as they do to their need for growth.

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