Evidence-based Management in healthcare
Can clinical sites achieve both workforce well-being and organizational outcomes together? An initiative centered around community clinic management with an emphasis on both
Aastha Bharwad, MD; Elisha Brumfield, DO; Robert Badgett, MD
“I have you for your strength and mechanical ability. We have other men paid for thinking.”
attributed to Frederick Taylor c1910
Introduction
Numerous organizations appear to persist with Taylor's paradigm of confining the workforce to obedient execution. Conversely, alternative forms of “enabling leadership” (Uhl-Bien & Arena, 2018) have emerged, advocating a contrasting strategy nurturing proactive employee engagement. Our project addresses whether we can simultaneously improve organizational performance and workforce well-being by using specific, “enabling” management strategy.
Methods
In 2021, we introduced "intent-based leadership," aligning with complexity leadership theory and self-determination theory (SDT) for innovation and engagement, respectively.
Starting in 2020, our clinic annually surveyed staff, while other clinics participated sporadically. The survey measured states of well-being and theory-based antecedents of the states. We emphasized questions that had benchmarks from large populations.
The well-being assessment used UWES-3 to gauge engagement dimensions (vigor, dedication, absorption). The survey includes the single-item burnout questionnaire (SIBOQ). The survey also measured job satisfaction and Spreitzer’s thriving (ongoing learning and improvement). For measuring antecedents of states, the survey was rooted in the self-determination theory of work engagement (autonomy, mastery, membership, meaningfulness) and the job demands-resource model (burden, resources) of burnout.
Additionally, in 2021 we prioritized and started monitoring of 14 HEDIS and MIPS clinical Quality Improvement.
Due to the small sample size, we focused on descriptive statistics.
Results
Response rates across different periods were as follows: 60% (2023), 46% (2022), 75% (2021, internal medicine community clinic only), and unavailability of rates for 2020. Excluding resident physicians, annual respondents in the resident clinic were: 16 (2023), 17 (2022), and 17 (2021), with 9 in 2020.
Following the adoption of intention-based leadership in June 2021, notable trends emerged: 3 QI measures surpassed national benchmarks in 2021, followed by 8 in 2022, and 6 in 2023. Statistical analysis of the drop in burnout revealed a ‘very strong’ although statistically insignificant correlation with a rho value of -0.8 and a p-value of .08.
Conclusion
Our study, despite limited data, underscores that implementing enabling and complexity-based leadership in adaptable settings can bolster both Quality Improvement and well-being. This finding matches our earlier, much larger study that measured a virtuous cycle within the English National Health Service hospitals, where workforce well-being and organizational performance may have mutually reinforced each other (PMID
33051836). Our study also demonstrates the importance of a yearly collection of key performance indicators to monitor changes.
“The difficulty in governing the people arises from their having much knowledge...
The sage (ruler), wishing to be above men, puts himself by his words below them, and,
wishing to be before them, places his person behind them.”
Tao Te Ching (circa 400 BC; Legge translation)
This project is maintained by ebmgt.github.io/