The power of purpose and community

By: John Neil, MD, EVP, chief physician executive and network strategy officer

As I reflect on 2023, I’m grappling with a feeling of cognitive dissonance.

I don’t care what role you play within the healthcare provider ecosystem – being a healthcare provider is, to put it politely, really hard. Yet in the midst of the stress, frustration and fatigue, why have so many of us made the choice to serve in this profession, why do we continue to make this choice, and why do we do it at HonorHealth?

The fact that being a physician can feel debilitating and frustrating is old news to me.  I grew up with a father who was a general practitioner in a small town.  He would round on his patients in the hospital from 6:30 – 8:00 am, see patients in his clinic from 8:30-5:00 pm, and then head back to round on his inpatients again from 5:30-7:30 pm.    That looked really, really hard.

When I was a full-time practicing interventional radiologist, I experienced the daily challenge of long days (and longer call nights) filled with complex and stressful procedures.

• Most of the procedures went well, but despite my diligent efforts the results were sometimes less than optimal, causing additional hardship for patients and families, accompanied by intense self-flagellation and personal duress.
• Most patients and families were delightful, but some were extremely challenging to deal with, and on rare occasions even threatening.
• The IR suite usually ran effectively, but on some days, there were staff shortages, newly trained and/or less competent staff, lack of appropriate supplies, etc.
• Days typically ran extremely long, oftentimes for reasons out of my control, and much of the seemingly endless off-hours work seemed avoidable if there’d been better operational planning and care team collaboration.

Yes, healthcare felt really, really hard, through my relatively narrow lens as an IR physician.

In my current role, the aperture in my lens is much wider. This broader view has provided an interesting and, in many ways, humbling perspective on the difficulties people face when delivering healthcare services, and the complex difficulties of juggling the endless obligations and priorities of a community-focused not for profit healthcare system.

The layers of learning and humility have been numerous:

1. The frustrations I faced as an IR physician were no worse, and in many instances relatively trivial, compared to the stresses, inconveniences and hardships faced by so many other physicians:

• The emergency department physician who consistently deals with verbally or even physically abusive patients, and at the same time struggle to reach paid on-call consultants who don’t want to accept calls.
• The hospitalist who is dealing with ever-increasing patient acuity, is being constantly cajoled to deliver better coding and documentation, and is scrutinized for anything less than top decile patient experience scores.
• The surgeon whose patients are presenting with increasingly complex comorbidities, and whose schedule and work-life balance feel as if they are at the whim of OR availability and timely anesthesia coverage.
• The anesthesiologist who is potentially being exposed to the uncertain risk of an aerosolized virus, is constantly under scrutiny to increase the efficiency of OR throughput, and who feels that their work hours are often driven by the needs of the surgeon’s schedule!
• The primary care physician who struggles through a daily schedule of 15-minute appointments, followed by a nightly schedule of charting and MyChart message responses.

1. Within the healthcare delivery realm, there are challenges faced by so many others: Nurses, therapists, food service workers, informaticists, quality and safety staff, Medical Staff/CVO personnel, front desk staff, supply chain workers, call center staff, marketers and so on. The list is endless. It has been incredibly eye-opening to see how hard all of these team members work, often under tremendous pressure to perform, and typically with (relatively speaking) little public recognition or financial remuneration.
2. I’ve learned more about the inexorable demands of running a healthcare system, whether that be at a unit level, a facility level or a network level. It turns out that the problems faced by doctors and nurses 24/7/365 also require responsiveness and attention from managers, supervisors, directors and senior executives across the organization, oftentimes on the same unyielding schedule as our clinical staff. The constantly escalating and seeming inextricable financial pressures, which result in a never-ending juggling of priorities, is exhausting/

Through the lens of any of these people, healthcare is really, really hard.

My cognitive dissonance exists in the fact that in the midst of all of this daily stress and rigor, why am I increasingly grateful to be a physician and increasingly grateful to be a health system physician executive leader? How can it be that in the midst of this sometimes unrelenting stress and rigor we show up each day to do this work, and our employee engagement and physician engagement rankings are impressively high?

For me, the answers lie primarily in the noble purpose of our work, coupled with the power of our community.  

I know it is cliche, but in comparison with almost any other profession, there is a subjective and objective humanistic quality to serving in a healthcare setting that is unique, enriching and meaningful. The purpose of service on behalf of others is most directly manifest in the work of our bedside caregivers, but it does extend well beyond the individual doctor, nurse or therapist diagnosing or treating the individual patient. All those whose work is focused on creating the infrastructure where our bedside clinicians work are also deeply attached to the purpose of playing a role in serving others via our healthcare and wellness mission. Attaching to this purpose, in an intentional way, serves as a great elixir to the hardships of being in healthcare delivery.

This shared purpose serves as the bedrock of HonorHealth, and helps to catalyze the creation and growth of our HonorHealth community. I’ve increasingly come to recognize power and energy that comes from being connected to that community.   Despite all the frustrations and imperfections, it  is an honor and a privilege to work within a community of caregivers and team members who prioritize supporting and caring for one another, and do so to help accomplish the mission of serving the health and wellness needs of our neighbors, friends and loved ones. Committing to be a dedicated part of this community of caregivers, and remaining cognizant and appreciative of the critical and difficult role that each team member plays, makes me appreciate the opportunity address all of the challenges we face together.

As we exit 2023 and move into 2024, my goal for HonorHealth, and my hope for each of you, is that we take time to better appreciate and take pride in the purpose we serve, and to authentically embrace the community of people we serve with. Yes, healthcare is hard, but as a community we control the narrative that exists at HonorHealth; let’s focus on being the place where people find the most joy in doing this hard work.