0:00:02 - Intro/Outro

Welcome to Practice Freedom. What if you could hang out with owners and founders from all sorts of healthcare private practices, having rich conversations about their successes and their failures, and then take an insight or two to inspire your own growth? Each week on Practice Freedom, we take an in-depth look at how to get the most out of both the clinical side and the business side of the practice, get the most out of your people and, most of all, how to live the healthy life that you deserve. I'm Mark Henderson Leary. I'm a business coach and an entrepreneurial operating system implementer. I have a passion that everyone should feel in control of their life, and so what I do is I help you get control of your business. Part of how I do that is by letting you listen in on these conversations in order to make the biggest impact in your practice and, ultimately, live your best life. Let's get started. 

0:00:52 - Mark Henderson Leary

Welcome back practice leaders, Welcome back to another great interview and a great conversation. I think you're going to enjoy it. Dr Paul DeChant Chant sorry, he corrected me and get it right Dechant but 25 years as a family practitioner, you know understanding what it is to practice medicine Truly Through his adventurous life, wound up as CEO of Sutter Gould Medical Foundation, which was large enough to be $9 million in the hole, and he needed to turn it around, which he did, and a great story there. And so right he does. Now he's the co-founder of Organizational Well-Being Solutions and he's really obsessed and focused on workplace burnout, particularly physician burnout, and what it is to heal this art of healing because there's so much working against the impact and effectiveness. And so he talks a lot about his approach, which is very simple, and we talked about the balance between his secret ingredient, which is giving back some autonomy to people who are really, you know, incapable is the word I'm looking for of making the biggest impact. Give the power to the people who can make the biggest impact, in balance with this idea of clear vision and clear purpose and we kind of go back and forth on that because I think that purpose thing is kind of a superpower of his and it comes natural and so he's really putting energy into this empowerment, autonomy component. 

So we talk a lot about that. We talk about the culture and the mindset that works against that. We definitely talk about, you know, the culture overall, how that affects and the efficiencies and things go with that. It's a great, great conversation. I think you'll get a lot out of it. I think it's a simple set of concepts that hopefully manifests as things that you can understand and implement. 

Before I let you in, as I always do, just a reminder it's an absolute tragedy if you feel like you could have this high value culture, this high value practice and organization that heals people on a daily basis, where everybody in the organization feels that it is doing that and it's effective and gives you the life you deserve as a leader, as a human, as whatever role you want to take. But if, for some reason, you're stuck or you're not getting it, you wish you could get it and you're hitting that ceiling, please don't stay there. Please reach out, Get on the calendar. We'd love to talk about what a first or next step could look like for you to get to the next level and get that life you deserve through the practice, that the world deserves you to create. Schedule a time with me at practicefreedomcom. Slash schedule With that and no further ado, Dr Paul DeChant. Well, good morning, Paul. It is great to finally have some time where we're not in a hurry to really talk. 

0:03:47 - Paul DeChant, MD, MBA

How are you? I'm doing well this morning, mark, thank you. How are you? 

0:03:53 - Mark Henderson Leary

I'm well, I'm, yeah, I just could have. You know it's been busy. I do a lot and I hurry, and now it's time to sort of settle down and unpack some of the things that I think you and I are both passionate about Now. Your experience is very different than mine, but we share a passion for doctors, physicians, healthcare providers making the biggest impact possible and living a life they deserve Fair. 

0:04:20 - Paul DeChant, MD, MBA

Fair enough. 

0:04:23 - Mark Henderson Leary

Fair enough. So I do that from a perspective of teaching leadership and management tools to run great, healthy practices with clear vision and purpose and right people, right seat and clear accountability, and getting clear on what we want from the organization and making sure we're taking steps to get there. How do you approach it? How did you? Because you've got a very, a lot more experience in the healthcare world than I do. 

0:04:46 - Paul DeChant, MD, MBA

in that sense, Sure you know I might be able to. First of all I love the way you approach things and but my history probably led me to my approach. So I spent 25 years practicing as a family physician in multiple settings across the country Suburban family practices. I worked in a mountain resort as a small town family doc and the ER doctor at the base of the ski hill for eight years. I worked in a rural setting for a number of years and over 25 years I was practicing family medicine, kind of slowly burning out and knowing there was a better way to do things. 

0:05:24 - Mark Henderson Leary

Now were you burning out as a ski doctor? I got to know because that sounds awesome. 

0:05:31 - Paul DeChant, MD, MBA

Not nearly as much, although at times when there were fewer, we were literally two of us that were covering a practice essentially 24-7. So it was a lot of fun but it was a lot of work, but we had pretty good control over what we were doing and that's really kind of the key thing. You know all those as most physicians, almost every person who's thoughtful in their work. Now we see things that are wrong in the way the work gets done. We're creating the autonomy to fix those things and we often don't get it. And then after those 25 years, I had progressive management roles in health systems but eventually I became the CEO of this 300 physician group and while I had craved autonomy for those 25 years, all of a sudden the thought of 300 doctors all being autonomous and independent it scared me that we could fall, apart from entropy, if we weren't careful. 

0:06:23 - Mark Henderson Leary

Oh gosh, yeah yeah, because I described that as sort of like the academic model. It's like it's you know, the autonomy is one thing to have some, some power, but like go your own way. Like no, no, you can't go your own way, it's I from a research and like education perspective. We want to create an experimental model where efficiency isn't the entire, isn't the only goal, but in a business it's like no, we want to create an experimental model where efficiency isn't the only goal, but in a business it's like no, we have to be profitable, we have to have consistent outcomes. 

0:06:53 - Paul DeChant, MD, MBA

Right. Well, if everybody's going a different direction, they're pulling the rest of the staff apart. They don't know where to go, which creates big problems. And at the time I took that CEO position, we were $9 million of the whole. The pressure on me to turn that around was intense and it was really tempting to issue mandates and micromanage to get out of that hole. But I knew in the long run that would be more destructive to the group and we would not be successful over time if that's the approach we took. Because physicians are knowledge workers. They need autonomy in order to do their job well, because they have to innovate all day long. Even when you're doing the same thing, each patient is different, so you have to approach them differently. And finding that that autonomy for each person in a large organization and keeping the organization successful at the same time was key. And fortunately I managed. I wasn't thoughtful. I didn't know what I was doing as we started into it like really thoughtfully, had this intent? Had it mapped out? But we found a way through to get there. 

0:07:58 - Mark Henderson Leary

I just think about something about the speed with which you connected the words like family physician, ski doctor, ceo, $9 million in the hole. Like that's a journey, right? Or was it an accident? Or was it one day you woke up in the wrong room? How did you get that's a very interesting journey. 

0:08:21 - Paul DeChant, MD, MBA

How did I get there? So two things I, I think, got me there. One was a sense of adventure, and the ski doctor thing came out of an opportunity that I was not looking for. It just presented itself, and my wife and I both we were living in California at the time, we had both met in Colorado and this opportunity came up. I went and talked to her and we said, yeah, let's go for it. 

The most of my other moves actually were a result of me advocating for, in fact be pushing for, change, and within an organization that wasn't ready to change at the pace that I felt the need to change. And so, as I was pursuing these changes, I'd often have great success with the unit that I was leading, but it was I was pushing the limits of comfort for the people that I reported up to, and they had varied ways of, either directly or indirectly, letting me know that I probably wasn't in the best position for that organization. Now, it wasn't because we weren't performing. In fact, in most cases we were performing better than any other unit in that organization. In fact, as CEO of this 300 physician group, we found this way. 

Actually, what we did was we provided local autonomy, we trained the physicians on how to identify and solve their problems, to act locally and solve the problems in their offices and to think globally by aligning around the values that brought meaning to our work and over the course of about four years we really succeeded. 

In fact, consumer Reports rated us as providing the best quality patient care across the entire state of California, better than 170 other groups across the entire state of California, better than 170 other groups, and they did it a second year in a row. So we were successful. But that approach of leading through empowerment and aligning as opposed to micromanagement, is still and I think to this day still is done it enough with the common and overriding management approach that it creates a lot of discomfort for senior leaders in organizations and, as a result, it's not always that the results that you get that determine your future. It's more how well you fit within an organization, an organization. I've spent my career trying to thread that needle of pushing for change, advocating for change because we have to approve Things are very messy and almost everywhere but at the same time doing it at a pace or in a way that doesn't threaten the overall organizational dynamics and power function. 

0:11:04 - Mark Henderson Leary

So I hope and I make sure this is really in bold because I don't want to necessarily get stuck in the recipe, because the recipe is crystal clear to me Purpose and values that drive, that steer and direct the autonomy, give them the latitude, with clarity, of what great looks like and that's a little bit oversimplified. But and I beat the drum of my clients over this you cannot over empower and let things go off the rails without absolute clarity on why we're here and what we're here to do, and vice versa. You cannot just scream at them and say you're doing it wrong. You have to have both, and I guess I do. There's two dimensions of it. Maybe it's unpacked a little bit so we can get some specifics about how you manifest both of those. 

But then in the back of your mind, I want to. I want to understand some of the forces at work that that make that hard, because it sounds like when, when you get successful, you find headwinds and I want to know more about that. But let's go back. So you're right. What are the ingredients you put in the recipe? I won't forget. I know there's a lot in that. Let's go back to the secret recipe. How do you get crystal clear and, in fact, in fact, I think the autonomy might speak for itself how do you get all those doctors crystal clear on why you're here and what you're doing? Because I don't think that it is obvious and unspoken. 

0:12:31 - Paul DeChant, MD, MBA

No, it's not obvious or unspoken. So the way overall, the way we approached this, actually hired a lean consulting firm. It wasn't a firm that came in and told us how to cut waste. They didn't come in and say, here, here's this way you're supposed to do this job, not the way you're doing. They came in with their first principle being respect for people and really honoring. Recognizing everyone is a brilliant knowledge worker and needs. That needs to start from there. They know what's going on, they have great ideas about how to fix things. They just rarely get the opportunity to actually put those ideas into place, practice them and then deploy the ones to work. But the re so the respect for people part is key and oftentimes isn't there. The continuous improvement part is about teaching people how to solve problems effectively and efficiently and that's a whole other discussion we'll get into To align everyone around a strategy. 

A part of lean that I really find helpful, particularly at a senior leadership position, is strategy deployment. 

So not just simply designing a strategic plan, but it's thoughtfully approaching how that plan gets deployed so it works effectively. And that takes a process of, first of all, eliminating a lot of things that you can't do the saying I used to love to tell my kids is you can do anything you want, you just can't do everything you want. You've got to decide, because you could do anything you want, you just can't do everything you want. You've got to decide what things are most important so you can put your limited energy into those things and then intentionally not pursue the other things that you've decided aren't as important at the time. They might become later, when you've got more capacity, but they're not at that moment and then think through how we're going to deploy that throughout a large organization. 

So, for example, within the system I was in, you know every healthcare system has a system dashboard or scorecard with outcome metrics that are big picture things at the top patient satisfaction, financial stewardship, quality, safety, et cetera. How do you actually deploy that and turn it into a process metric that people on the front lines can understand and improve directly? And it's a process of committing to which specific things at the outcome metric we're going to pursue and then thoughtfully understanding what people on the front lines can do, as that will produce an outcome metric that they can work on. So if we're trying to improve productivity, what we worked through was this decision let's fill in empty spots in the schedule. 

We didn't come in and say everybody has to add two hours to their day. We said let's, you know let's. Every team in a local office can work on finding ways to fill in empty spots, because every office ends up with some empty spots in its schedule, unless they're so over put that they never get a. 

0:15:29 - Mark Henderson Leary

You know they never get a chance to breathe or go to the bathroom? 

0:15:32 - Paul DeChant, MD, MBA

Yeah, that's not fun for anybody. 

I know, uh, so it's that it's thinking through along each dimension like that. How do we do better patient service? Well, you know we're gonna to expand it. There was a system-wide initiative to expand scheduled hours by 7% outside of 8 to 5 on your Friday. 

We didn't go to our docs and say, okay, everybody's going to open at 7 am. We said in each office, figure out what's best for you, and then for each doc, figure out what's best for you. But the offices have the autonomy to figure it out. So for pediatrics it was actually better to be open additional later in the day because kids could take care of school and parents wanted to bring them in For internal medicine. It was better to be open first thing in the morning because patients would want to come in and get their physical done before they got to work for the day, so they didn't miss a day of work. But we let each office figure that out. As long as they achieve that 7% additional space outside of that, you know they achieve the goal without having to be dictated to exactly what they how they would achieve that. 

0:16:35 - Mark Henderson Leary

So a couple of things come to mind. So, for one is that the metrics are so similar, right, it's like what are you going to do? Like well, we're going to fill the schedule oh really, I've never heard that before. Like no, every single practice has to fill the schedule and every single practice has to have a process of managing reschedules and managing, you know, physician time off and all these things. Like this is not a shock. This is a small organization, the smallest optometry practice to the largest, you know, family practice hospital system has this situation, and so we're coming back to some basics and and, and we'll, let's just give you some positive messaging around hey, you know, what can you do to improve it? Like hey, by the way, it's important, you know, it's important, Right, and? And getting people clear on those important things, and it sounds like some of those times it's just an awareness conversation. Is that, is that fair? 

0:17:26 - Paul DeChant, MD, MBA

Uh, it is to to get it started, to have people be willing to support those goals. Yeah, it is an awareness conversation. You know, getting those, those shared values that bring meaning to the work. They're people. Do we all really care about having you know for this schedule Do we have? Do we care about having a viable organization? If we want to be able to provide people salaries and benefits that create a meaningful life, we connect that to the schedule of filling in and then it helps people to understand that and support it. 

And the other thing we did was we put that goal. Achieving that goal did have bonus benefits associated with it, but it wasn't individual bonus benefits, it was a bonus to that local team. So the whole office had to work together to achieve that together. We didn't have people pursuing their own, which might have been in conflict with each other. It really was about how that team worked together. So the supervisor of that office became a coach who wasn't simply rewarding star players by doing it on their own. They were really motivated to get the team to work together and have the team be supportive of each other in the process. 

0:18:36 - Mark Henderson Leary

Yeah, and the team were working together. Some of these connections though I don't know if are always so obvious, and I talked about like it's driving awareness. But I think scheduling is such a good example because sometimes people don't snap, or at least it looks from my perspective. People don't snap that, you know, two hours open this afternoon is not necessarily about oh, we've got a doctor who's burning money, burning salary, and there's 15 people just not doing anything for two hours and there's 15 people just not doing anything for two hours. It's also about, you know, ms Smith really wants to get in to see Dr Smith and there's now a chance you can go make Mrs Smith's day by getting her in this afternoon. This is amazing, and so that's hopefully something that these people already want to do. I guess. What do you find? Have you found any situations where, like, the culture just doesn't care, and have you done anything with that? 

0:19:36 - Paul DeChant, MD, MBA

That's a really good question and it really leads into this other issue which I'm passionate about, which is burnout, because burnout is, you know, people's event, when we don't, just don't care. That's one of those dimensions of burnout, it's the dimension of cynicism. 

You know, it's like I don't care about my patient anymore. Really, what's gotten you to the point where you committed your life to this profession to take care of people and now you don't care? Well, you're burned out, you know. You're overwhelmed and exhausted, you're cynical and you even start to wonder if you're making any difference at all. That sense of inefficacy. And there's plenty of times when, as a physician, I look at my schedule and it's like, thank God, there's a book in here. I just need room to breathe. 

And if things are not designed well enough so we're not, if we're constantly overwhelmed, then that break is seen of value because we need a chance to breathe. If we're not constantly overwhelmed, if we're actually, if the system is working well and things are happening on time and we're not that stressed, then that opening is seen as my gosh. We're missing an opportunity to serve our patients. You know they can't schedule a routine appointment for three weeks or three months, but here's open space in the schedule. Let's bring them in early. Like you said, let's make their day by surprising and delaying them with that opportunity. But as physicians or a nurse, anybody really is in a position where they're so overwhelmed that they get a break. They're going to appreciate it and when they don't care because that's just been beaten out of them. You know that burnout becomes pervasive and really destroys the effectiveness of the practice. 

0:21:21 - Mark Henderson Leary

Yeah, it kind of goes to the very simple formula that I teach a lot is that morale is 100% synonymous with the feeling of winning, and if you're not winning, because winning it's another. The analog and the analogy is are you making progress Like, are you progress towards a goal? And so much of that message is what's the goal? And if and if you're making progress against a set of goals that are then devalued by leadership and the context, whether you don't feel like a winner. And so, as a leader, the responsibility to your culture is to give them chances to win by defining wins that are possible and rewarding for when that happens, and so so, once that, once the culture feels like their efforts yield wins, yield results as intended, that's a positive feedback loop into doing more of it, and people want to win together and do and help each other out, because people help them back, and that's the cultural cycle we're trying to create, and it looks like you're lighting up around some of that subject. 

0:22:23 - Paul DeChant, MD, MBA

Well, you know it's true, and so I'm. One of the things I've done to try to build people's awareness of me is get on TikTok. I don't know if you've done it, of all places. 

0:22:33 - Mark Henderson Leary

It's so addicted to TikTok I was like once a quarter I'm on it for like 10 minutes. I'm like, ah, I got to stop this. So I get away from it and run away. 

0:22:41 - Paul DeChant, MD, MBA

Well, you know it's surprising. There's actually a lot of physicians, nurses and even leaders on TikTok and I just did a post yesterday about how one of the key things a leader of a team needs to do is to make, not only assign individual goals to each team member, but to make sure all the other team members are aware of each other's goals and are supporting each other. And that comes down. That that's how you, that's how you win, that's how you, you know the team wins when everybody's working together. I had one comment back that said well, what about individual goals? Aren't those important? And and they are, and it's really got. 

This is really fortuitous today thinking about this, because it ties right into that discussion. Yeah, you need people who can perform well. You don't want to hire, you don't want to put on your team a bunch of people who can't succeed. But if you put on your team a whole bunch of superstars and you don't have them work together, that team's not going to be successful either. It's that it's finding that way. And then what does? What does working together mean? Once they understand each other's roles and how they support each other, that's where the magic can really happen, even in a doctor's office. 

0:23:50 - Mark Henderson Leary

Yeah, I love that. I teach this tool called the accountability chart and it's really about getting clear on who's accountable to what, and it's an antidote to an org chart which is connecting egos and status and isn't usually very effective in terms of clarity of accountability. So we get the accountability chart clear. One of the biggest immediate impacts is role clarity. People are counting on me for these things. 

But the second, most and just close right behind it in terms of value, is knowing what other people are supposed to be doing, so you can help them, so you can hand it off to be doing, so you can help them, so you can hand it off to them, so you can stop doing stuff like you go like oh, I don't need to do that anymore because joey's got that and so really important. Understand, like, if on the football team, if you don't know who's supposed to catch the ball, then you're gonna have eight people running for the ball like no, no, you have a job, you're the block, you're supposed to throw the ball. Only a couple of people's job is to catch the ball. Oh, this is going to be a lot easier. 

0:24:50 - Paul DeChant, MD, MBA

Yeah, well, it is so true that and I have seen senior leadership teams in major health systems where the CEO has not made sure that all of his direct reports knew each other's goals and even knew each other's goals, let alone were supporting each other on their goals and we wonder why some of these systems are failing. Yeah, it just blows you away. And why is that CEO leading that way? Well, they really probably never got good education about how to be a leader. So much of what happens in healthcare is somebody's a star performer and there's an opening to lead that team, and they get put in that slot, irrespective of whether they have leadership capabilities, and certainly you're not gonna then go back and help teach them and guide them and coach them on how to be a leader, my God. And you can't waste time on that. You know, if there's free time, they gotta be out there producing, and so we perpetuate this cycle of ineffective leaders developing other ineffective leaders, and it's rife throughout healthcare. 

I see it everywhere all the time, and it's really unfortunate because there's so much potential to fix things, particularly in healthcare. My God, we consume 20% of the GDP. At least a third of that is waste. We have people who are brilliant, getting paid high salaries, and they're not passionate about and urgent about fixing that. It's just inexcusable. And yet the system just feels stuck and then outside players look at it and say, well, I can fix that. And of course they don't. 

They're complexly healthcare enough to come in and fix it. So they try to apply the point solution and it works for a little bit and then it comes up to work as well. But there's just such a lack of quality leadership People in those positions getting the support they need so that they can leave effectively. You know no doctor walks in and knows how to do a surgery day one and no leader walks in and knows how to leave day one. And you know everybody needs a coach throughout their career to really do particularly these high-level jobs effectively. 

0:27:04 - Mark Henderson Leary

Yeah, well, to that point, one of the notes I wanted to go back to is the optimistic approach of we give them purpose, we give them clarity of the objectives. We resistant part of any particularly at scale healthcare organization is we've got 20 docs and four of them are toxic. What are we going to do about that? We're going to fret about that. That's what we're going to do. It's like no, that's not going to work, we've got to get them out of there. That's my me as the non-clinical guy. I'm like we've got to fire those people. 

No, no, that's the only specialist in that particular retina surgery. We got to keep them Like well, then you got to fix them somehow because we cannot have them gumming up the culture. What's your response to like getting the right people, particularly those scarce, valuable? 

0:27:57 - Paul DeChant, MD, MBA

untouchables. I think you have to understand why they are that way. Most of them don't start out with that being their attitude, and this is not to excuse the person who's dangerously disruptive. No, nobody should be allowed to verbally or physically abuse a patient or another member of the care team, which happens Like. 

0:28:21 - Mark Henderson Leary

I don't want that to sound like so obvious, like, oh, obviously we can't do that. That is real. The doctors will be abusive towards the mid-levels and the nurses and the non-licensed. They will do that for whatever reason. 

0:28:33 - Paul DeChant, MD, MBA

Yeah, well, it's part of our culture growing up as physicians. I might go out on a limb here, but there's a term that every doctor understands and some non-physicians find offensive. As we're getting trained and we're going out of rounds, you know, and there's on routes there's a you know the top guy, that or a woman that headed to that you're attending, and then there's fellows and there's residents and there's interns and some. When you stop at each patient's bed, somebody gets identified to be asked all of these questions about that patient's condition and we drill down and drill down, and drill down until you leave that person unable to answer a question and they're kind of just like a pool of quivering, massive, feeling incapacitated, and it's called getting kumptan rounds and the and every doctor we see in that term. If you ask, if you ask any doc, they'll know what it is. That's our seminal leadership, modeling and education and and the concept is Humility, humiliation. 

0:29:29 - Mark Henderson Leary

Is that the idea? It's like teaching. You don't know it. 

0:29:31 - Paul DeChant, MD, MBA

Yeah, yeah, If you don't, if you don't intimidate somebody like you, take these highly motivated people that managed to get themselves into medical school and if you don't humiliate them somehow, they're not going to be motivated enough to learn what they need to learn to be a good doctor. It's starting to change, but it's still deeply ingrained and so that's part of it. The other part of it is you take these, the really high performers. They are motivated and they're the ones who do see the stupid stuff in the office that they want to fix and they feel like they can't fix it and nobody's really listening to them about how they could become more efficient or how they could do more with this piece of equipment. And then, as they act out more, they get more alienated People. It's harder to sit down with them and have a conversation about shared goals and shared values and how are we going to work together? 

So a few things that I have found effective. One is just taking time to actually empathize with them and get to know them at first. Secondly, go shadow them while they're working, Watch what they're doing and see the barriers and frustrations that they run into, Because quite often there are things there that they just don't you know? It's hard for them to articulate it. They understand so while they can't even tell you, they just get upset and out of doubt. And it's not going to work every time, but often you can find ways that if they know somebody's listening, they're starting to make improvements. It starts to bring them back around and get on the team. 

0:30:50 - Mark Henderson Leary

I love that because that's a great highlight on one of the biggest gaps between the physicians and healthcare providers and the non. It's like we make a lot of assumptions, like well, just be better, like you can't talk to them like that and I do think it can close the gap. Like you know, just follow me, like see what I'm up against and see if you wouldn't be pissed off too. 

0:31:10 - Paul DeChant, MD, MBA

Oh, it's one of the most powerful things. One of the things that drives me crazy is when a leadership team decides we're going to, we're going to go on rounds in the hospital, and so you get a. You know whether it's an individual or a group of senior leaders. Usually they're dressed in the suits and they're out walking around the hospital and stopping to talk to people, or they might look at a board that shows some representation of activities that's going on, and they ask people how it's going. And when I was practicing and I'd look down the hall and see these people coming, I instantly knew I had two choices, because they were going to ask me that question how's it going? I'm probably already half hour behind, and I can either lie and say it's going fine and try to stay on time, or I can stop and tell them the truth. But no, I'm going to be an hour at least behind if I do that, and in that. So it's very hard for senior leaders to actually know the truth. People don't want to tell you bad news, and especially if you haven't opened the door to it and really appeared open to it, and so it's even harder to make a good decision about what's going to help the people who are on the front lines. 

The other thing in healthcare is nowadays, as the business has gotten bigger, the thought is we need business people running this large enterprise, Somebody who understands finance, marketing strategy, et cetera. Those people, many of them, have never had clinical experience. So you have senior leaders who do not understand their operations, making decisions that have huge impact on operations, either intentionally or unintentionally making these impacts. So this is why it's so important to do that to actually get out and see the work as it's being done, not from, and just observe and observe with empathy and curiosity. And it's hard to do. 

It's intimidating for somebody in a position of power to put themselves into something that's pretty vulnerable, to be there not knowing really what's going on, just trying to learn. So we have to do that carefully as well. It takes a specific approach, very careful coaching, to make that work out all the way around very well. You know, when the CEO shows up, usually everybody's thinking oh, what went wrong? What screwed up? What's going to happen to us? This person of power is here Not. Oh, thank goodness. Thank goodness she's here, so she'll learn about what her challenges are and can help us. 

0:33:33 - Mark Henderson Leary

Yeah, she's there to be put in trouble, put in time on that. So, to that point, you talk about leadership. That, to me, what you described there, is a massively imbalanced leadership model and it's really not leadership at all. It's management and we're trying to keep things on budget and I think that's a component. That's a component of discipline. It's a measurement system that is missing the like. At what cost approach? And we have something higher to deliver than simply monetary outcomes. Monetary outcomes are good measures towards our goals. They are not our goals. 

I mean, jack Welch is famous for talking about that we talked about. You know, the purpose of an organization is not to increase shareholder value. Increasing shareholder value is a measurement of our achieving our purpose, and so we need to know what the purpose is. And so I'm curious about if this is a good segue into every time you seemed to gain really significant traction by developing culture and creating autonomy and creating that space for people to really make an impact. You got resistance. Is you know? Is that you know? Talk about that? Is that part of the same problem? 

0:34:43 - Paul DeChant, MD, MBA

You know, I think it comes back to leaders. There's so few good role models for leadership and I think particularly in healthcare it's also a lack of understanding of the deeper dynamics. You know that the major challenges health systems have these days are around staffing shortages and fine lines and when we think into the deeper root causes of those, burnout really sits there. Uh is one of those deeper causes and most people think that burnout is just being overworked and exhausted. In fact, christina Manzluck and Michael Leiter, the original researchers in burnout over 40 years ago, identified those dimensions of burnout exhaustion, cynicism and inefficacy. They also identified what most people don't know. They identified six drivers of burnout exhaustion, cynicism and inefficacy. They also identified what most people don't know. They identified six drivers of burnout. The first one is exhaustion and they show stop the presses. When you're overloaded with work you're exhausted. Like we could all figure that one out, but most of us just stop there and that's what we think burnout is. They've shown five other drivers of burnout and those are a lack of control, not having the autonomy to and how you work and what you do to fix the stupid stuff that you know is there that people tell you to just put up with. There's a lack of recognition and appreciation. You know people are working their butt off, nobody notices, you don't get thanked. Services you don't get thanked. There's a breakdown in community and collegiality connection, which going to remote work certainly made things worse, but often even in meetings people are paying more attention to devices than they are to each other. There's absence of fairness, which we see a lot in every industry, but certainly in healthcare. Your opportunities are limited or you're treated differently, not based on your quality of work, but based on things you don't have control over, like gender, race, entry of origin, age or sexual orientation. And, lastly, values conflicts, when your personal values actually are at odds with your organization, or you perceive the organization's values are not aligned with yours, or you have to actually even witness or participate in activity that violate your values, which certainly during the pandemic happened a lot for frontline clinicians. 

Those other five driving you burnout have everything to do with how you manage, whether you're supervising a team, a smallest, two or three people, or you're the CEO of a 20 to 30,000 employee organization. And when you manage in ways that exacerbate and worsen those drivers, when you micromanage, you drive cynicism. And that's the opportunity is to recognize your leadership behaviors around those drivers and go the opposite direction. Because when we go the opposite direction and we do actually empower people and align them, then we get great engagement. And when I look at you know they've had people. They know leaders are appropriately concerned about engagement but their approach to engagement is to run a little gauge on survey that asks a lot of questions that have nothing to do with what we just talked about and then assume we're going to address those and hold our managers accountable to addressing these specific questions that came out of an engagement survey. That's not the way to do it. It's training managers to understand how their role in these drivers, no matter what they can do if they do have to. 

0:37:57 - Mark Henderson Leary

Well, it's also a root cause thing. I mean, what I like to say is, when you start complaining about how somebody's late, the issue is not that they're late. That is way down. I mean, you have a lot of compassion for somebody who's performing at a high level, you know, oh, you're late. No, our problem, you're a beer. You know, beer the next hour? Okay, no problem. But it's like you're late, like the frustration behind that is they're underperforming in some other way. Their attitude's terrible there. You know there don't have enough snacks in the break room. Like, well, that's not the issue. You know what do you do with that? 

0:38:29 - Paul DeChant, MD, MBA

My leadership team, yeah, yeah. 

0:38:33 - Mark Henderson Leary

And so I love, because to me it just kind of lights up. There's a million ingredients in a healthy team and at least and it certainly applies outside of healthcare but certainly in these pressurized, especially as they grow larger institutional organizations If you can apply autonomy, you give that one nutrient back to them that allows them to sort of self-select ways to solve for the others. You put them in control and you don't have to know the answer and it's like the one thing we're holding back. If we could. There's lots of things you need to have, but this one is the limiting reagent that if we, as soon as we run out of this, the rest of them don't work, but if we can get that in there, we get 10 times more value back in the other ways that we're not even sure what the status of them is because they self-correct. 

0:39:19 - Paul DeChant, MD, MBA

Yeah, and people want to come to work where they have. That you know they're not. They're far less likely to be late if they really want to be there, because when they're there they're feeling valued, they're feeling good, and that's, you know, late again. 

0:39:37 - Mark Henderson Leary

like you said, there's a lot to being late. It's a symptom of other problems in most cases, yeah for sure. So back to this issue of the headwinds. Though, like you as a leader have demonstrated success. Why do you? Why do you think that boards governing boards other? I don't know who? Who are these evil people are, but they're evil. Let's be clear about that. Who? Who are they? And why are they so evil? What's their justification for being on the dark side? 

0:40:00 - Paul DeChant, MD, MBA

So my second favorite management consultant is Nicola Macchiarelli, the Italian philosopher, and because he had a. He had a statement that said one of the most dangerous things to do is to introduce change into the current order of things, because the people who benefit from the way things are will fight you tooth and nail and that people who benefit from the idea that you're presenting uh will not support you as strongly, for two reasons. One is they haven't experienced it themselves yet. So there's their. Their intensity of uh, fear and push for it is not as strong. And secondly, the people that are clinging to the past are so intense that it intimidates the people that would might support change and that when we're leading in a different way, we're leading, we're, we're as trying to change the prevailing management culture. And you know I, I get it when somebody's been working it for 20, 30 years. They finally get to brass room, they're in the c-suite and they've done it by leading in a certain way. And then a lot of times you know we're a little me saying, hey, man, let's try it a different way. Why would you do that? Why would you comfortably cruise for the next five years to your retirement instead of really up into your world and yet and that's what's lacking that's why it's so hard, particularly in crisis. You know, we did see one of the. I think your approach and mine are probably similar in this way too. One of the and I think your approach and mine are probably similar in this way too. 

There are mechanisms you could put in place that can even in a large, complex organization, you can connect the front lines to the C-suite very quickly and efficiently and effectively. But when we present those concepts to people generally they'll say, oh, that sounds good, but it's pretty hard to do here. Well, four years ago, during the pandemic with an existential threat, those mechanisms got put into place. Now, maybe we didn't call it whatever management system we call it, but the people in the C-suite knew what was going on in the front lines and were doing everything they could, as fast as they could, to get people at the front lines the stuff they needed to be safe and to help save as many patients as possible. 

We, if we're faced with a crisis, we do respond, but as soon as that existential personal crisis of potentially losing your own life was over, people have reverted back to the old way. They still say there's a financial crisis. They still say there's a quality crisis, but we're a staffing crisis. But people are not acting as though there's a crisis and we know how to do it, because we just did it four years ago. Now we don't have to be at the level of intensity, with command center meetings three times a day, seven days a week, like either Western and Temet, but certainly there could be more than what's happening these days. 

0:42:45 - Mark Henderson Leary

Yeah, I mean it's interesting just to hear your description because I imagined I don't know misguided leaders not disinterested with the outcomes and the purpose. You know the MBAs, you know it's definitely the blue suits, you know like they just don't care and you know your way is scary. But that's kind of what you described and and. But I also, as you started describing, I was like well, this is the same problem when anybody leaves any kind of institutional organization and goes to more entrepreneurial organization. Most, most of the organizations I work with are very entrepreneurial and they want thinking and autonomy and and it's and they're encouraging autonomy. 

And there are people who come from the institutions who have sort of the resume and there's just like this we get comfortable hiring types of positions and titles, and so these people come out of institutions and they show up autonomous and free thinking and growth oriented and they resist it as individuals are like I was never taught anything like this. So entrepreneurial organizations become very skeptical of hiring people out of institutions who can't tell the story of yeah, I was in this institution for a while but I never felt like I fit. So those are the ones you want to hire. But if it's the people, yeah, I loved it. 

I loved the bureaucracy. I loved that every day was predictable. I loved that color tan and gray, everything is. That's not somebody who fits in an organization who really wants to add high value and build people up. 

0:44:20 - Paul DeChant, MD, MBA

Yeah Well, you know and that's a great thought process you just went through there on the entrepreneurs, because entrepreneurs do have urgency you know there is an existential threat. Your entrepreneurial endeavor can only last so long. If you're not starting to produce revenue, doing something that actually feeds it and keeps it going, it's not going to. The initial investments aren't going to last forever. So you've got to get on quickly and make a difference. And you know large, you know these large bureaucratic organizations. It takes a long time before they start to implode. So that level of urgency isn't there. 

0:44:57 - Mark Henderson Leary

Oh, I've loved this conversation. It could go on for a long time. What did we miss? And I it brings. It brings anything to the conversation that's kind of that's built up that we haven't expressed, and if we, you know, if we cover it, we've covered it. 

0:45:09 - Paul DeChant, MD, MBA

But you know, for me, a lot of what I've been thinking about lately is are these issues about those five drivers of burnout, that drive cynicism, that have everything to do with how you lead and manage? And comparing that to other management philosophies, like particularly servant leadership, which is so key to creating the culture in which people can have the autonomy and yet a servant leadership is can be very off-putting term, because people hear the servant real loud. They don't often hear the leadership very loud, so they think that, yeah, you know it's, it's somebody who's going to let the, let the inmates run the asylum. What is nothing like that? What it's done right. So I think that's a really key concept. 

The other is, when we put all these processes into place, what we end up with is an organization full of, you know, brilliant problem solvers who are all aligned around common goals and values. And when you have that, you can rapidly adapt to changes that are happening in the external environment From a standpoint of strategic success, then market share, or size or diversity, even the ability to rapidly adapt to changes in the external environment it's what Darwin taught was key to survival. So you know, you can be strong, you can be smart, but if you can't adapt, you're not going to survive. And creating that adaptability? You know, in burnout everybody focuses on personal resilience, which in a way drives me crazy, because you take some of the most resilient people in the world. What does it take to get into med school or to be a nurse? And, you know, spend all day caring for people. You are resilient. And then you offer the resilience training. It's the hand shirt, it's the hamster. 

It's just it's breakfast, it's, it's it's Abuse training, abuse, conditioning. Well, it's, it's offensive, but, but having so personal resilience, really it's. It's helpful to get through a crisis, adapt to change. That is worth everything, because then you create an organization that can go forward and can achieve what you're welcome to achieve. 

0:47:33 - Mark Henderson Leary

Yeah, so I loved everything about this conversation and all those points. The thing I want to really highlight here is that the secret sauce for you has been how to cultivate autonomy, judgment and bring out the optimism and empower the people who have the biggest horsepower, and so as so, as so often is the case, our strengths are things we take for granted, and so the counterpart I want to make sure is really unmistakable to the listener is that if we empower people and give them autonomy and no clarity of where we're going, that is terrible. That is definitely how we get very unpredictable results and we get frustrated and it moves us back into micromanagement. The only way this works is with absolute crystal clarity on purpose vision. You know what are the objectives. You know I'm not, I'm not concerned how you get there, but this is where we're going, and if you're and if you think that's a good place to go, you're on the right boat. You have my support. If you don't like that destination and you're on the wrong boat, let's get you someplace else, but I can't. I'm hearing this conversation. I'm suspecting that it is kind of a superpower of yours to make sure everybody's aligned and where we're going and you don't have to think real hard about it, but a lot of people do. 

A lot of you talk about this leadership gap where we don't have those good leaders. That's part of it and part of it's not just maybe it's not bad leaders. There are bad leaders, for sure, but there are underdeveloped leaders, leaders, great leaders, who have underdeveloped their vision or the way to communicate it or the specifics of what the vision looks like. Where are we going? I mean, especially in an entrepreneurial organization where, as a lot of change, we can have to digest in a short amount of time Organization that's very large and institutional, the vision might be clear. You've got a brand for cancer treatment. That's not a shock if you're MD Anderson. But if you're a 100-person organization and we're not really sure what specialties we're moving into and what geographies we're going to move into, that really matters. 

And if you don't have clarity of that vision and you say, do what you want, who knows what they're going to do? You need to have absolute clarity on what the objectives are and then apply this cultivation of empowerment and letting some people choose the methods to get there and never tolerating for a second a violation of that vision. Hey, this is our culture. We are an optimistic culture of people who develop and grow people. What you did, dr Smith, yesterday was entirely counter to that and that is not acceptable and you'll be working somewhere else very soon if you continue to behave that way. But choose your way to behave in this cultivating, empowered, optimistic way. However you wanna show up optimistic is entirely up to you. As long as you show up optimistic, yeah, that's a cultural attribute. 

0:50:23 - Paul DeChant, MD, MBA

Yeah, the other thing we've I think one of the things that was most effective for us and actually have deployed it in other organizations I've worked with is a daily huddle that has four key components. It has a minute of appreciation for something somebody did the day before to address that insufficient reward driver burnout. We get ready for the day. Look at the capacity versus the demand to address that insufficient reward driver burnout. We get ready for the day. Look at the capacity versus the demand to address work overload. 

But then we look at metrics and those metrics are process metrics at the front line that are cleanly tied to values that bring meaning to our work and people understand those. And then if the metric is off track of where we're hoping it to go, then that moves us into the last component of the hella, which is problem solving. How do we get that metric back on track? And it's not the people from outside coming into that team telling them how to do it, it's the local team figuring it out as much as they can themselves or solving some little problem that went wrong yesterday that you don't have go wrong again. But putting together appreciation, prep for the day, values aligned or outcomes aligned to values and problem solving is so much power to help the team feel like they have control and to have them aligned with the organization-wide efforts. 

0:51:40 - Mark Henderson Leary

So let me ride up a huddle, and so huddles are come up a lot with my clients as a potential tool and some teams. They're really important and some teams are massively distracting. So in yours, the ones that worked, who was there, how many people, how long were they and how? 

0:51:54 - Paul DeChant, MD, MBA

often were they there's. Ideally, you want the whole team that's working together there, if possible. It can't always be possible, particularly because, yeah well you know, there's different schedules, there's different things. So during the course of the week we hope everybody gets to it at least once or twice and we try to time it during one in the day when it can work that way. 

0:52:13 - Mark Henderson Leary

It might be 10 people. It might be eight people larger than that. 

0:52:16 - Paul DeChant, MD, MBA

It's occasionally larger than that Somewhere. Probably between five and 15 is about right. Daily, Daily 15 minutes, never more than 15 minutes. Some people try to shoot for a seven minute huddle. If you are really efficient, maybe you can do it in that time. But I worry that people start to lose effectiveness if they're trying to do it too fast. 

A lot of physicians will object, and understandably so. Wait a minute. They tell me you want to be more productive. Productive Now you're taking away 15 minutes. Thought I could be seeing a patient and you're making me come to this damn huddle. It's, the huddle's not working well, it's not serving your purposes. They have every valid right to make that complaint. And at first, as you're learning to do huddle, maybe you don't have every physician come, but ideally you do. So everyone learns together how to do them, so they get better. We see this the teams that huddle are far more productive than the teams that don't, even though they theoretically lose a 15 minute lot that they could be seeing a patient because the rest of the entire day goes so much more effectively. But that's yeah and it is. It takes discipline, it takes regular work and it takes support from above, the senior leaders, above. The people that are on that team should be showing up periodically coaching, observing, helping and supporting. 

0:53:32 - Mark Henderson Leary

Yeah, I have lots of opinions on huddles and I won't get into all of them for time, but I will say that one of the most important challenges and obstacles in a huddle is that if it's the only time that people get to solve their issues, you can't get it done. It creates a log jam and, especially as a team gets larger, the larger the team, in my opinion, the shorter the huddle, because the less you want people invited to do too much solving, it's a smaller team. You can do more in the way of getting unstuck and that could be helpful. If it's like, how do I get unstuck today? But if you don't have any other meeting where you can say, hey, I've got some real obstacles, then that huddle starts to be that. 

The place where, like I'm trying to figure out career satisfaction and process efficiency in in like a two minute window, like that doesn't work. So you have to pair that up with really like typically weekly in my experience, at least once a month there has to be like a deep dive where we talk at it, you know, in the bigger patterns, really dig in and do true solving, because those huddles are great to unstuck little things, get people connected. Hey, I need five minutes of your time. You available later today sounds phenomenal. Let's we'll talk later, but but, like I said, if it's like we really got to talk about this intake process, like no that's not a whole topic. 

0:54:44 - Paul DeChant, MD, MBA

I completely agree. We don't solve problems in huddles. We identify the problem, we all agree, yes, this is worth pursuing, and then we assign a couple of people to go work on it and bring something back. But you can't, you cannot solve a problem in huddle, unless we have some Nike. Just do it Like, oh, this is so darn obvious, just do it, you know, and let us know if it's not working. Then maybe we go into problem solving. But yeah, you cannot solve a problem in huddle and people easily fall into that trap. 

0:55:11 - Mark Henderson Leary

You know that's great because that's actually a good sort of multiplier around this concept of autonomy. If you're trying to cultivate autonomy and you got people who are not sure what that means not sure you know, they got, they got to wait for permission because they don't know what they're allowed to do A huddle could be either a temporary or potentially permanent way to say like hey, I really want you to make some decisions and to avoid you getting stuck. Bring it up in the huddle and get my, get the thumbs up. Yeah, yeah, absolutely You're on the right track. Go and, and that could be a way to kind of force multiply, changing the culture. Yeah, basically you got it. I love it. That was super helpful. So, man, we're almost at an hour. I would talk another hour or longer and we can do this again in the future. What are you hoping for? What's your plea for healthcare leaders in today's world right now? 

0:56:05 - Paul DeChant, MD, MBA

To healthcare leaders in today's world right now To understand the people, to understand the most important person in the organization and the most important thing that's happening, because the most important person is a patient. Without a patient, there's no reason for the health system to exist. The most important thing that's happening are the people on the front lines who interact with that most important. Who interact with patients. Doctors, nurses, receptionists, transport people, janitors, you name it. Anybody interacting with a patient has a chance to have a healing interaction, reduce anxiety or worry, relieve pain or suffering, teach people to be healthier those. 

As a family doctor for 25 years, I had 100,000 hearing interactions. As CEO, I stopped seeing patients. I wasn't doing the most important thing for the most important person in my organization. My job was to make sure those people on the front lines had what they needed so they could do that well, when leaders understand that and focus all of their energy there, then we will have highly functioning organizations. When leaders think they're all about themselves or managing their budget or managing their team, that might be removed from those front lines. That's where we suffer. 

0:57:12 - Mark Henderson Leary

I love it Seeing the big picture, seeing the force multiplication, seeing that like one patient at a time is a gift, like voting you know one vote at a time. But what if I could help so many other people make that impact and make the machine run that more efficient, instead of seeing you know a hundred thousand myself? It's a hundred thousand a year or a quarter or a month, depending on the size of the organization and how much? Better, so so powerful. 

0:57:37 - Paul DeChant, MD, MBA

Oh, that's great. I didn't really put those that thought together that, yeah, it wasn't just a hundred thousand in a career, but you can have a hundred thousand, you know, yeah, in a day or a week or a month, depending on the size of the organization. Very cool, thank you. 

0:57:50 - Mark Henderson Leary

Yeah, awesome, awesome, love it. Well, great, that's our time and I'm so grateful for the time together. Thank you. 

0:57:57 - Paul DeChant, MD, MBA

Oh, this was fantastic. I I Fantastic. I appreciate the opportunity to share my thoughts, but I really appreciate the opportunity to go deeper with them and really be exposed to some new ways of thinking. I hadn't been thinking before, so this was fantastic, Thank you. 

0:58:17 - Mark Henderson Leary

Awesome, so grateful. If you found this conversation helpful, let us know, give us the feedback. If you think somebody else could use this, please get it in their hands, because this stuff does not float around the Internet by itself, much to the opposite of popular understanding. It's not automatic. So give us the feedback. Anything you've got in terms of verbal feedback in the speak pipe, we'll take that and I'll get right back to you. 

If you've got questions and, of course, like the four or five star reviews and any negative comments, we take those seriously as well. But as a reminder, don't forget that if you're listening to this and you're thinking, I can imagine this great, high value practice that really, really helps people, where everybody loves coming to work every day, the front desk and the healthcare providers, and I can imagine a life where I'm getting what I get, living the life I deserve and making the biggest impact. But you're stuck. Please don't stay stuck. Please reach out. Please get on the calendar practicefreedomcom slash schedule. We can talk about what a first step or next step could look like to get you on the way. And before I forgot to ask how does somebody find you? You're still listening. That was almost going to conclude. Well, how does somebody find you in an easy way a website or something like that that you want to continue the conversation? 

0:59:30 - Paul DeChant, MD, MBA

Oh, I appreciate it. My website is pauldchantmdcom and an email is paul at pauldchantmdcom. I'm also on LinkedIn, as I mentioned. I'm on TikTok. You can find me there. Those are probably the main routes to reach me at this point. 

0:59:47 - Mark Henderson Leary

Awesome, great, and thanks for the subtle correction on my pronunciation of your name. 

0:59:53 - Paul DeChant, MD, MBA

I don't really care how people pronounce it. The trickier part is spelling it. I didn't say it. 

0:59:59 - Mark Henderson Leary

I guess that's true. All right, well, thanks so much. This was our time on Practice Freedom with me, mark Henderson Leary. Thanks so much.

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