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; big healthcare organizations are getting even bigger. The other is burnout. And the sooner we realize the connection between them, the better off the industry will be.

To review the latest headlines:

Elevance is acquiring Blue Cross Blue Shield of Louisiana.

Blue Cross Blue Shield of Michigan and Blue Cross Blue Shield of Vermont are combining.

Amazon has acquired One Medical.

CVS Health has acquired 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; care is streamlined; and the familiarity of healthcare team members with one another enables better care coordination and outcomes.

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 or lowering costs. A big health plan or hospital chain, for example, can analyze its data to determine the best policies and then implement them across all of its facilities for the benefit of patients. 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.

The Price of Getting Bigger: Invisibility

There is, however, a pitfall into which many large organizations can easily descend. Too often, healthcare professionals who work inside large organizations feel deeply 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.” Bigger does not feel better. The are transformed from highly trained professionals into invisible line workers. There is a loss of agency that can be painfully numbing.

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 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 electronic health record’s—the modern-day equivalent of “paperwork.”

While workload is often blamed for “burnout,” people didn’t become healthcare professionals by not working hard. Rather, it is the nature of the work and how they are treated by healthcare organizations. Dive deep and you’ll see that workers repeatedly point to their invisibility, lack of agency, and the ways in which their needs are ignored 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.”

Only surgeon with whom I spoke said, “We are within an environment that is becoming carcinogenic. There are infinite demands on me with no relief in sight. We are constantly asked for more and no one cares that we have no more to give.”

“It’s one thing to be a cog in a wheel when you work in a factory and you know that’s your role. But when you are expected by patients and yourself to be a leader, but when you don’t feel like a leader, nothing feels worse. Administration asks for more and often fail to do their part to help us do it.”

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 when lumped together as “providers.”

The Obligation of Leadership: Making People 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, in fact, 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—always keeping in focus what is truly in the best interest of the patient.

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. 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 clinicians 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 the needs of their people as they do to their need for growth.