Better Systems, Not Tougher People

WEBVTT

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It's the wooga wooga.

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Wooga wooga wooga wooga.

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Now we get all casual.

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Now we're like, all right, now relax.

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Lisa Flexner is back on the show live

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here at APTA CSM.

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How's your conference going is the

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question everybody asks.

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It has been amazing.

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I never know how to answer that question.

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How's your conference going?

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Chaotic?

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The conference has been chaotic and

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nonstop as it always is.

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And I love every second of it.

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I have a fancy intro for you.

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Can I do the big fancy intro?

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Oh, goodness.

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Most workplaces technically work,

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but aren't working for the people inside

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them.

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It's not good.

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Our next guest helps leaders fix systems

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instead of blaming burned out humans.

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If you've ever thought,

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it shouldn't be this hard to do good

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work, this conversation is you.

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Lisa Flexner, live from Anaheim.

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How'd the intro go?

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The intro was fantastic.

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Thank you very much.

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So why are,

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we've had this conversation on LinkedIn or

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other discussions, but I don't think it's,

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we haven't solved it yet.

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But why are burnout problems really system

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problems?

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Burnout is always an individual response

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to a systems problem.

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It shows up in an individual's motivation.

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It shows up in an individual's emotional

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health.

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It shows up in their exhaustion,

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their cynicism.

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But it's actually a response to different

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levels.

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So you've got your individual, and yeah,

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there are individual things that are going

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to contribute to burnout.

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But you've also got the interpersonal

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leadership skills, management skills,

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maybe a mismatch between how somebody

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likes to be managed and how their manager

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style is.

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You've got organizational issues that can

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be addressed that are contributing to

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burnout that, you know,

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we've got a lot of tech that is

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helping with this now, which is great.

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But a lot of some places are slow

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to adopt or can't afford to adopt.

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Or can I point out the other end

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of the spectrum?

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Are you familiar with Notion?

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Notion, yes.

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Notion AI?

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Yeah.

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But it's a database, right, super helpful.

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And I remember working for an

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organization,

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and I remember asking a human a question,

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and the answer was, it's in Notion.

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And I was like, all right.

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It wasn't very easy to find it.

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No.

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So I coined a little phrase, which is,

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Notion is in the ocean.

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I'm sure it is, in fact, in there,

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but it's going to take me six months

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to find it.

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Or you could just explain it to me.

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Right.

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Or can you share with me?

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Exactly.

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tech a problem.

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This wasn't a giant problem until we

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teched it.

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That was the problem.

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Absolutely.

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And, you know,

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what do we do that makes workflows better

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or worse too, right?

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Whether it's, you know,

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it's just easier to ask you than to

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go and search Notion for five hours.

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Or are we creating workflows and systems

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between, say,

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our clinicians and our front desk that are

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actually creating more challenges and more

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disruption

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and less patient throughput.

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Yeah.

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Seeing things I would imagine from more

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than just your point of view.

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Yes, my front desk,

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this is easier for them,

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but it just put a lot of annoyance

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or effort on the patient or vice versa.

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Right.

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And you have to look at it from

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multiple points of view.

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Why am I filling this out again?

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I just did.

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Isn't there a way to fill this out?

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Well,

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this system doesn't talk to this system.

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From the guy who now goes to a

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lot of doctor's appointments with his dad,

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I don't want to hear it.

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I just filled this out eleven times.

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I'm not filling it out a twelfth time.

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You do it.

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Write the information down.

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You copy.

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You transcribe that over.

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Exactly.

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Why do we have patients do a whole

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medical history and then walk in and be

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like, hey,

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so tell me about your medical history.

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What the hell did I write it down?

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Lawyers?

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I don't know.

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Why did I take that time?

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So think about that from within the

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organization now,

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not just the patient experience,

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but also

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the provider experience or the front desk

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experience.

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And I'm not here to talk Jerry Durham's

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job.

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That's his gig.

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He'll fight you for it.

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Yeah, I know.

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He will.

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And he does an amazing job.

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But where I really come from in terms

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of burnout is that we have some basic

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fundamental human needs that we need to

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have met

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in our workplaces, in our family settings,

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where we are.

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And if the workplace is not looking at

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those basic fundamental human needs,

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then it's going to be not as fulfilling

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and more likely to promote burnout.

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And then, now, let's not stop there,

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because, hey man, suck it up,

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that's what I pay you for,

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but you'll probably lose people,

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which will cost you money.

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You won't get the most out of those

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people that'll cost you money.

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Probably other things I'm not thinking

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about on the fly,

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but I know you might be thinking,

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it's a suck it up,

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it's a you problem.

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My man,

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that is gonna show up on your PML.

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It shows up on your bottom line,

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absolutely.

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So a lot of people look at the

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direct cost.

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They look at what's easy to measure.

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Like what the tech costs?

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Not just the tech.

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So they look at their direct costs in

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terms of like, oh, I've had turnover.

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It's going to cost me one and a

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half times that person's salary,

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except that the indirect costs to the

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organization,

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thinking about the issues of how the team

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works,

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the additional productivity demands that

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are put on the people that are left,

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the additional chaos that's created by not

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having that

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team environment,

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then your actual indirect costs plus

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direct costs,

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more like two to three times that person's

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salary.

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Plus like, you know, collateral damage.

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I'm doing that person's job for a month

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or now I got to train up a

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new guy.

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I'm not assigned to train them up and

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I'm working with them.

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So I get how it works.

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I train them up now.

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Exactly.

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So you're really hemorrhaging money that

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you can't track in that regard.

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So one of the things that I do

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that I work a lot on is not

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just burnout prevention,

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but how do you create a workforce and

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a workplace that's really geared toward

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humans?

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Because we are humans working in the

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system,

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working with humans as coworkers and also

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with patients.

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OK, well, belonging,

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basic fundamental need.

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We all want to belong.

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and healthcare has a belonging problem.

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We show up at,

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let's say our shift starts at seven.

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We might show up at six forty-five,

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maybe six fifty-five.

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We sit down, we get our stuff together,

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we start seeing patients,

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we work with patients,

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we work through our lunch charting,

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we work with patients,

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and we get out of there as soon

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as we can.

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We might be there two hours,

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but we're still charting,

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not talking to anybody.

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Or we're leaving at the second that we're

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done, running home,

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taking care of our kids,

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taking care of dinner, whatever,

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connecting with our partners,

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and then charting until the late nights.

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I wonder why people are looking for the

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door.

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Exactly, because there's no team.

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You're a bunch of co-working people,

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right?

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I didn't sign up to be a co-worker.

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I didn't want to go to a co-working

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space.

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I'm not at WeWork.

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I want to go to my office where

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I have a team and where I can

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connect with people that I see every day.

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It's great to connect with patients,

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but those patients leave.

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In an outpatient setting,

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those patients leave on average eight to

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twelve weeks.

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So now you have to spend energy

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reconnecting with new people.

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It's great.

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It's fun.

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I'm an extrovert.

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I love it.

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But at the same time,

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I want those long-term connections.

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I was talking with somebody earlier today,

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Elizabeth Rogers out of the Seattle area.

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And she was talking about how she hung

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out this weekend before the conference

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started with all of her PT school friends

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and her first job friends.

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We don't have time to make friends in

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the workplace very often.

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So that's a very easy thing that doesn't

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cost a lot that workplaces can do is

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how do we build the community of our

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colleagues so that we're not just

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coworkers.

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You can work anywhere.

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I'm going to have to work somewhere.

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Maybe you want to work here.

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When you're talking with the right company

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that you consult for,

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how do you sort of –

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How do you explain that investing in all

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the things you just talked about is

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actually going to bring them the thing

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which is what they want?

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Well,

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what we all need in health care right

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now is stronger margins, right?

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Our reimbursement sucks.

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We're working on that.

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APTA has made that their number one

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priority now, which is fantastic.

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And so we're working on the reimbursement

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side.

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We're working on the systems that are at

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the higher level outside of our direct

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control.

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But what do we have direct control over?

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So looking at assessing where that

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organization is,

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making sure that it knows where are its

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leaks.

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not just financial,

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but also employee leaks,

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where is the emotional energy being

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drained, then aligning the organization,

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or assess, sorry, totally blanked,

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because I did three talks yesterday,

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and I have no brain left,

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so I'm still working on the coffee.

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So getting in and assessing and then

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aligning the organization and then

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activating the organization.

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So you're assessing the organization to

00:08:53.359 --> 00:08:54.580
see where are those leaks,

00:08:55.020 --> 00:08:56.863
aligning on what do we do next,

00:08:57.003 --> 00:08:58.845
and then activating it, making it happen.

00:08:58.965 --> 00:09:00.706
You have to get several people probably in

00:09:00.767 --> 00:09:01.948
different departments to agree

00:09:03.472 --> 00:09:04.452
That this is a problem.

00:09:04.634 --> 00:09:06.433
Hello, I'm Jimmy and I have a problem.

00:09:06.653 --> 00:09:07.514
And we have to agree that this is

00:09:07.554 --> 00:09:09.216
a problem and that we are gonna invest

00:09:09.255 --> 00:09:09.995
in this solution.

00:09:10.275 --> 00:09:11.296
Yeah, absolutely.

00:09:11.856 --> 00:09:13.596
So what that comes down to is it's

00:09:13.636 --> 00:09:15.197
not like, oh wow,

00:09:15.258 --> 00:09:16.578
I really wanna be nicer to my people.

00:09:17.698 --> 00:09:18.600
Most people have that.

00:09:18.759 --> 00:09:20.640
Most of us go into this profession because

00:09:20.660 --> 00:09:22.783
we care about humans and we're altruistic.

00:09:23.102 --> 00:09:24.183
So we're going to go for that.

00:09:24.344 --> 00:09:24.965
Absolutely.

00:09:25.504 --> 00:09:26.605
And at the same time,

00:09:27.547 --> 00:09:29.168
it really comes down to how does this

00:09:29.268 --> 00:09:31.330
impact your business outcomes?

00:09:31.529 --> 00:09:33.230
How does this impact your KPIs?

00:09:34.072 --> 00:09:36.232
Are you measuring the right things for

00:09:36.273 --> 00:09:37.153
your KPIs?

00:09:37.594 --> 00:09:39.255
I made a spicy statement in one of

00:09:39.275 --> 00:09:40.155
my talks yesterday.

00:09:40.235 --> 00:09:42.857
Ooh, spice it up.

00:09:42.998 --> 00:09:43.219
Yeah.

00:09:43.259 --> 00:09:44.318
And it got some reaction.

00:09:45.220 --> 00:09:46.841
I fundamentally believe that productivity

00:09:46.860 --> 00:09:47.501
is the wrong measure.

00:09:47.929 --> 00:09:48.370
What is?

00:09:48.551 --> 00:09:49.371
Okay, keep going.

00:09:49.471 --> 00:09:50.212
What is the right measure?

00:09:50.312 --> 00:09:52.556
You have to think about what drives

00:09:52.596 --> 00:09:54.298
productivity, right?

00:09:54.317 --> 00:09:56.039
Because measuring productivity,

00:09:56.059 --> 00:09:57.100
which is something that physical

00:09:57.140 --> 00:09:57.741
therapists,

00:09:57.861 --> 00:10:00.384
the clinicians themselves have really very

00:10:00.445 --> 00:10:01.547
little control over,

00:10:02.226 --> 00:10:04.190
measuring productivity doesn't really

00:10:04.289 --> 00:10:05.851
incentivize more work.

00:10:07.014 --> 00:10:09.394
What does incentivize more work is a

00:10:09.434 --> 00:10:11.235
shared goal, a shared mission,

00:10:11.654 --> 00:10:15.035
a sense of belonging, good communication.

00:10:15.436 --> 00:10:19.037
And so measuring things like net promoter

00:10:19.076 --> 00:10:21.496
scores from your employees, so ENPS.

00:10:22.258 --> 00:10:24.518
Measuring quality of life at work,

00:10:24.557 --> 00:10:26.178
so using the Gallup Q-Twelve,

00:10:26.219 --> 00:10:27.658
Fred Gilbert from Gallup.

00:10:27.958 --> 00:10:29.720
movement x does checking in with your

00:10:29.759 --> 00:10:31.621
people to see what's going to work best

00:10:32.101 --> 00:10:35.283
what do they need more of um and

00:10:35.344 --> 00:10:37.885
finding low-cost ways to do that because

00:10:37.926 --> 00:10:40.748
it doesn't have to be expensive and it's

00:10:40.827 --> 00:10:42.769
not a pizza party you talked about this

00:10:42.869 --> 00:10:44.451
last week i made a i made a

00:10:44.551 --> 00:10:46.432
very successful video about six months ago

00:10:46.491 --> 00:10:47.852
where i did one of those where you're

00:10:47.873 --> 00:10:49.494
like you're playing two characters and

00:10:50.221 --> 00:10:51.461
It apparently resonated with people

00:10:51.501 --> 00:10:53.062
because apparently pizza is the go-to.

00:10:53.543 --> 00:10:54.543
Pizza is the go-to.

00:10:54.623 --> 00:10:55.283
Yeah, pizza's great.

00:10:55.303 --> 00:10:56.004
I'm from New York.

00:10:56.024 --> 00:10:57.443
Listen, love me some pizza.

00:10:57.504 --> 00:10:58.063
That is not a,

00:10:58.083 --> 00:10:58.985
that's not a fan date.

00:10:59.225 --> 00:10:59.404
Yeah.

00:10:59.764 --> 00:11:01.865
I have a friend who's a clinician in

00:11:01.965 --> 00:11:05.265
a large hospital system.

00:11:06.466 --> 00:11:08.626
And their holiday party used to be this

00:11:08.706 --> 00:11:10.908
big fancy thing at a local,

00:11:11.087 --> 00:11:11.967
I live in Bend, Oregon.

00:11:11.988 --> 00:11:12.908
We have lots of resorts.

00:11:12.969 --> 00:11:14.729
So they would rent out this big local

00:11:14.769 --> 00:11:16.690
resort through this big bash and

00:11:17.350 --> 00:11:19.371
And then that was every year.

00:11:19.432 --> 00:11:20.614
And they felt really celebrated.

00:11:20.653 --> 00:11:21.815
They felt really valued.

00:11:22.355 --> 00:11:24.118
And the next year, one year,

00:11:24.177 --> 00:11:25.919
it suddenly changed to like lunch.

00:11:26.600 --> 00:11:27.601
And then the following year,

00:11:27.642 --> 00:11:28.822
it was pizza in the break room.

00:11:28.842 --> 00:11:30.325
And they were like, what happened?

00:11:30.404 --> 00:11:31.525
It's a cost-cutting measure.

00:11:32.307 --> 00:11:33.967
But what it did was it made everyone

00:11:33.988 --> 00:11:36.229
feel devalued and they hemorrhaged

00:11:36.649 --> 00:11:37.149
clinicians.

00:11:37.188 --> 00:11:39.730
They lost two-thirds of their people in a

00:11:39.769 --> 00:11:41.410
single year after that pizza party.

00:11:41.431 --> 00:11:42.571
It wasn't the pizza party's fault,

00:11:42.890 --> 00:11:44.072
but it certainly did not help.

00:11:44.211 --> 00:11:46.633
Well, it manifested the pizza party.

00:11:46.852 --> 00:11:47.332
It's a symbol.

00:11:47.373 --> 00:11:48.533
And it probably showed up other places

00:11:48.613 --> 00:11:48.873
too.

00:11:49.094 --> 00:11:49.693
Yeah, absolutely.

00:11:49.714 --> 00:11:51.134
It's just the most visible was the party.

00:11:51.153 --> 00:11:51.835
Absolutely.

00:11:51.875 --> 00:11:52.894
So we're doing quick episodes.

00:11:52.914 --> 00:11:53.875
We could talk to you for a while,

00:11:53.894 --> 00:11:54.855
but we're going to do a parting shot

00:11:54.895 --> 00:11:55.155
now.

00:11:55.176 --> 00:11:56.817
You've already said a spicy statement,

00:11:56.836 --> 00:11:57.697
so you can't reuse that.

00:11:57.777 --> 00:11:58.956
What would your parting shot be now?

00:11:58.976 --> 00:12:00.457
I'm...

00:12:02.105 --> 00:12:03.306
Oh boy, I had,

00:12:03.605 --> 00:12:04.807
that was my parting shot.

00:12:04.846 --> 00:12:06.368
All right, so reiterate this.

00:12:06.508 --> 00:12:06.727
Yeah,

00:12:06.908 --> 00:12:09.210
so healthcare is a belonging problem and

00:12:09.370 --> 00:12:10.750
it also has a hierarchy problem.

00:12:11.451 --> 00:12:13.471
And we need to break the hierarchy of

00:12:13.511 --> 00:12:13.993
healthcare.

00:12:14.493 --> 00:12:16.453
And you know, my last name's Flexner.

00:12:16.955 --> 00:12:17.835
I don't know if you've heard about the

00:12:17.875 --> 00:12:18.655
Flexner Report.

00:12:19.056 --> 00:12:21.357
if not the flexner report was what created

00:12:21.418 --> 00:12:23.340
medical education and our hierarchical

00:12:23.379 --> 00:12:26.243
healthcare system so great we need a

00:12:26.283 --> 00:12:27.884
flexner report two point oh i'm not

00:12:27.903 --> 00:12:29.466
writing it i know some people who should

00:12:29.905 --> 00:12:32.249
um but we need a flexner report two

00:12:32.288 --> 00:12:34.490
point oh that reframes healthcare as an

00:12:34.630 --> 00:12:37.974
interprofessional collaborative experience

00:12:38.354 --> 00:12:41.116
because right now the top down in acute

00:12:41.397 --> 00:12:41.918
health care

00:12:42.378 --> 00:12:43.658
You need that top-down,

00:12:43.698 --> 00:12:45.820
you need that chain of command, right?

00:12:46.620 --> 00:12:49.182
You need physicians to make quick

00:12:49.221 --> 00:12:50.961
decisions and everyone's on board

00:12:51.022 --> 00:12:52.003
following orders.

00:12:52.442 --> 00:12:52.783
Got it.

00:12:53.844 --> 00:12:56.225
We work in chronic issues.

00:12:56.725 --> 00:12:57.966
We don't work in that top-down

00:12:58.005 --> 00:12:58.566
environment.

00:12:59.047 --> 00:13:02.207
We have opportunity to support physicians

00:13:02.307 --> 00:13:03.769
in things like primary care physical

00:13:03.808 --> 00:13:04.249
therapy.

00:13:04.789 --> 00:13:06.129
But because of the hierarchy,

00:13:06.169 --> 00:13:08.370
we're blocked from creating more health.

00:13:09.052 --> 00:13:10.532
So we have a hierarchy problem that we

00:13:10.552 --> 00:13:11.452
need to solve in healthcare.

00:13:11.957 --> 00:13:12.857
If someone wanted to get in touch with

00:13:12.878 --> 00:13:13.678
you, I'll put it in the show notes,

00:13:13.698 --> 00:13:15.359
but where would you send them?

00:13:15.519 --> 00:13:16.178
On LinkedIn,

00:13:16.278 --> 00:13:19.559
lisa-flexner-dpt or

00:13:19.659 --> 00:13:21.701
flexhealthconsulting.com.

00:13:22.500 --> 00:13:23.520
Those are the best ways to get a

00:13:23.561 --> 00:13:24.020
hold of me.

00:13:24.500 --> 00:13:25.581
Get yourself some relaxation.

00:13:25.861 --> 00:13:28.881
Get yourself some human time and enjoy the

00:13:28.902 --> 00:13:29.261
CSM.

00:13:29.562 --> 00:13:30.222
You too, man.

00:13:30.322 --> 00:13:31.302
Lisa Flexner, thanks for coming.