People Are Not Cogs: How We Can Be GREAT in Healthcare

by Francine Gaillour, MD

in Aligning With Values & Purpose,Transformational Leadership

A piercing and entertaining article in Harvard Business Review online, “People Are Not Cogs,” by Nilofer Merchant, author of The New How, offers keen insights worth considering by healthcare executives and physician leaders.

Merchant makes some incisive points about how industry has traditionally measured productivity and hence factored in the ‘value’ of the individuals on the ‘production line’:

“In spite of a forest’s worth of academic papers and rafts of best practices published by the likes of HBR on the importance of the “soft” stuff, most companies continue to treat people as inputs in a production line.

“…most organizations still operate much as they did in the industrial age. We manage the measurable, rather than the things that create meaning that fuels creativity, that enables innovative thinking and that helps any company to outpace the market.”

In healthcare one could argue that in addition to “productivity” we also measure “quality” and “patient satisfaction” and therefore we’ve covered all the bases.  However, extrapolating from Merchant’s thinking, an important set of metrics is still missing—metrics that reflect our capacity for greatness.

Merchant’s commentary articulates what I observe in our “real world” of doctoring. Physicians  WANT to create meaning, to be engaged and connected with their patients and with each other.  Yet the real pressure to see more patients, to cut the time between waiting room and exam room, to be more efficient, makes doctors feel like “cogs” rather than healers.  We used to be physicians, now we’re providers.  Our patients are now consumers.  Yes, we’re lean, but we we’re not great.

A “great” physician-patient relationship transcends the metric of “minutes shaved off the visit” in the name of efficiency. A great relationship and opportunity for healing  is CRAFTED over a period of multiple visits, phone calls, reflection over the case, collaboration among physician, consultant and nurse, and the heart-to-heart talks with the patient’s family.

Merchant argues that “greatness” can be decoded—it’s not a mystery:

“It includes all of us having confidence that we’re making a difference. It’s asking questions that let us reimagine what could be. It’s feeling motivated. It’s about being challenged within our capabilities. It’s all of us having a rich, intense sense of joy at work. It’s trusting ourselves, and our ability to learn. It’s about being trusted by others. It’s when we can say to each other: I believe in you.”

How do we introduce this capacity for imagination and trust—-really, for collegiality—among physicians and clinicians?  From my experience as a coach and facilitator for physician groups, it requires a deliberate approach to:

1) Learning communication skills and agreements that enhance our relating to each another and our staff

2) Integrating into established forums, such as weekly and monthly staff meetings, structures for enriching the experience — making those times we commit to coming together a joyful experience

3) Learning together around topics such as personal leadership, emotional intelligence, team building, innovation

Let’s start talking about how we  build this capacity for greatness as physicians and leaders.  I have no doubt the by-product of engaged physicians will be a healthy bottom line.



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