Life support

Clinician-administrator relationships “on life support” need to be healed

Mmuch has been written about the erosion of several decades of the once strong relationship between patients and their physicians. The implosion of another important healthcare dyad – C-suite clinicians and administrators – has received far less attention, despite the fact that these relationships are on life support.

Overshadowed by all the discussions about health care provider well-being, burnout, and resilience, there is almost no conversation about job satisfaction or burnout among health system administrators and hospitals, or their essential relationships with clinicians. After doing often thankless work before the emergence of Covid-19, leaders have had to find ways to guide their organizations through a global pandemic and all the workflow, policy and financial changes that have come with the invention of completely new ways of working and caring for patients. .

It has been a frantic race for them and clinicians alike, from trying to keep organizations afloat at the height of the pandemic in which dramatic revenue declines turned balance sheets red, through the Big resignation of 2021, and now during fears of an impending recession. Is it any wonder that the number of hospital CEOs who resigned between 2020 and 2021 almost doubled?


Just before the pandemic emerged in late 2019, our organization, X4 Health, conducted research to better understand the mindset of C-suite leaders and the state of the relationship between them and clinicians. This research directly informed one of our social impact initiatives, 3rd Talka national grant-funded program designed to reinvigorate relationships in health care.

The team began by interviewing 10 health care system leaders and administrators across the country. Striking similarities emerged from these interviews.


The 10 leaders said:

  • felt isolated, frustrated and defensive;
  • yearned to connect with colleagues on a deeper level;
  • knew that strained relationships between clinicians and leaders contribute to poor working conditions, turnover and staff shortages; some have acknowledged that these frayed relationships lead to security issues and inefficiencies;
  • were concerned about the impact of leadership on staffing levels, explaining that “people don’t leave organizations – they leave leaders when they don’t feel like they have a relationship of trust.”

Top Challenges Cited by Clinicians in Administrator Roles

As a follow-up, we worked with Edna Luther & Associates, an independent research firm, to conduct a survey of 168 healthcare professionals, primarily primary care clinicians who hold administrator roles. The top three issues cited by respondents as their greatest challenges included, in order (Figure 1):

1) too much time spent on documentation versus patient care;

2) clinician burnout;

3) staff shortage.

Minimum resources to improve clinician-administrator relationships

Despite these challenges, only 33% of survey respondents reported having programs in place to improve clinician-administrator relationships.

These findings were corroborated in a separate investigation of 650 physicians and administrators conducted in June and July 2021 by Jackson Physician Search in partnership with the Medical Group Management Association. On issues of burnout and staffing shortages, the survey found an increase in physicians looking for new jobs, and nearly half of respondents said they were considering retirement. anticipated. Clinicians cited “one-way communication” between administrators and clinicians as a major contributor to burnout and early retirement. Clinician respondents suggested that greater two-way communication would improve satisfaction and retention.

An approach to revitalizing relationships and institutions

Based on these results, we used human-centered design methods to develop and test a program to improve the relationship between C-suite leaders and clinicians. Our hypothesis was that a professionally facilitated forum could be designed to help both groups recognize how much they have in common, create two-way empathy and communication, and identify changes that would collectively help them in their establishments. .

This program was piloted in 2021 by Finger Lakes Community Healtha federally licensed rural health center in New York City, and the University of Mississippi Medical Center. The program involved clinicians and administrators sharing personal stories, connecting as human beings – not just in their professional roles – dealing with the impact of Covid-19 and imagining a better future together.

Conversations that took place during the program and feedback received afterwards indicated three levels of impact of the experience:

Clinicians and administrators personally reset, feeling relief and hope:

  • “I’m glad I’m not the only one feeling the way I feel; I appreciated the opportunity to get things out there.”
  • “It was a really good experience. My career… has been on life support for a while, and I’m hoping things will change.”

Clinicians and administrators are committed to presenting themselves differently to each other:

  • “I have to be more communicative with everyone… Sometimes I can come across as not caring. I’m going to promote that I care.”
  • “I will participate in more of these conversations, so that I can better serve [clinicians]; really engage with them about their profession and what they need.”

Clinicians and administrators committed to acting with each other and for each other:

  • “I will continue to ask for feedback and other ideas to improve what we do.”
  • “We frame [clinicians]Find out what matters to people (whether it’s search, flexibility, schedules, etc.) and respond accordingly.”
  • “I will find ways to involve clinicians in decision-making to ensure that organizational decisions reflect the experiences of frontline clinicians.”

Individual examples of actions taken by participants after taking part in Conversation 3 experiences demonstrated the potential for lasting impact at all levels:

  • One clinician approached ongoing contract negotiations with a new tone and feeling, expressing collegiality and positivity about the negotiations.
  • Another clinician approached his CEO, explained some challenges he’s seen in delivering patient care, suggested solutions, sparked his ideas, and then took action. He had never approached the CEO like this before.
  • One department began to organize get-togethers for clinicians and administrators to interact informally to improve relationships, empathy, and communication.

While these observations are preliminary, they affirm that clinicians and administrators share a commitment to making a difference and show the value of intentionally making time and space to share challenges, frustrations, and hopes. .

We believe that providing administrators and clinicians with opportunities to be explicit about what they need and can offer each other, based on two-way empathy, will play a key role in catalyses larger institutional change efforts, such as patient safety or quality. improvement. We also believe these opportunities are a useful strategy for improving staff and clinician well-being and improving staff retention at a time of significant shortages.

The Covid-19 pandemic has made a lot of things clear for the American healthcare system. Two of them are:

We believe it is time to apply this capability to put humanity first across the entire health care system. Investing in programs that elevate the importance of relationships in health care – between clinicians, administrators, patients and others – can alleviate human suffering within the workforce, address root causes of staff shortages and ultimately lead to better health and well-being for all.

Christine Bechtel is co-founder of X4 Health and co-creator of 3rd Conversation. Lois Frankel leads the 3rd Conversation program at X4 Health. Jennifer Sweeney is co-founder of X4 Health and co-creator of 3rd Conversation. 3rd Conversation is funded by a grant from the Morris-Singer Foundation.

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