By: Natalia Dorf-Biderman and Felix Ankel (@felixankel)
You are an associate dean for medical education at an academic health system. Residency directors have done an incredible job navigating their programs through the Covid-19 pandemic. You have helped lead successful institutional and residency accreditation reviews, residencies are able to recruit top candidates, and faculty and residents have met unprecedented challenges. Yet you see that programs are struggling. Faculty and resident surveys show a high degree of burnout despite local and system efforts to increase joy at work. Where do you start? What mental models do you consider? You decide to adapt a “governance as well-being” framework into the clinical learning environment to consider opportunities for growth.
WHY: Well-being as participative leadership and shared governance
When clinicians are granted a platform to voice their opinions, offer suggestions, and collaborate with leaders in co-creating the future, they gain a sense of agency and ownership over their work and their life. In the ever-evolving landscape of medical education and clinical practice, demands on residents have become increasingly complex and challenging. The concept of participative management has emerged as a powerful tool not only for organizational success but also for resident wellbeing. By establishing structures that facilitate participation and engagement, individual teams and healthcare organizations create a sense of belonging and purpose.
Shared governance structures and participative management styles foster partnership, equity, accountability, and ownership. When residents have a say in the procedures and workflow designs that govern their daily work, they are more likely to feel a sense of ownership and control. This empowerment can lead to increased job satisfaction, reduced emotional exhaustion, and a renewed sense of purpose. Moreover, shared governance and participative management create an atmosphere of mutual respect between residents and administrative leaders, fostering open communication and trust. This collaborative environment is a breeding ground for innovative solutions and best practices that contribute not only to patient outcomes but also to the overall wellbeing of the residents and the clinical learning environment.
WHAT: Understanding participative management and shared governance
Participative management involves the inclusion of frontline clinicians (trainees in this case) and healthcare staff in the decision-making processes that directly affect their work environment. This approach acknowledges that those who provide care at the bedside possess valuable insights and experiences that can lead to more informed and effective decisions.
Shared governance is more than just a management style; it is a dynamic structure and process that embodies partnership, equity, accountability, and ownership. This approach acknowledges the diverse expertise present among clinicians, administrators, and stakeholders, and seeks to integrate these perspectives into decision-making processes that shape the organization’s direction.
HOW: Operationalizing participative management and navigating shared governance
Implementing requires a deliberate and strategic approach. To put this paradigm shift into practice, residencies should give precedence to a cultural overhaul that encourages residents and staff to actively participate in decision-making processes. This entails establishing clear avenues for involvement to specific aspects of patient care workflows, team operations, and policy development. In other words, “nothing about us without us”. At the heart of this transformation lies the commitment from healthcare organizational leaders to embrace a culture shift that centers on collaboration and develops methods to enhance bidirectional or multidirectional communication between front line staff and leaders at all levels of the organization.
Explicit leadership support plays a pivotal role in driving this transformation forward. Their support signals to residents that the organization is committed to empowering them and valuing their input. When leaders endorse the concept, it becomes more credible in the eyes of residents, who are more likely to participate and engage in the process.
Ultimately, when leaders actively engage IN THE PROCESS ITSELF, wellbeing happens as a byproduct of creating the conditions for dialogue, trust, innovation, and teams feeling seen, heard, and respected.
Question to consider.
- Have you evaluated the governing structure for your local clinical learning environment? Graduate Medical Education Committee? Departmental or residency leadership structure? To what degree are health system leaders engaged in this governance process?
- How do you support governance structures and processes that maximize resident participation and engagement? What metrics do you use to measure this?
About the authors:
Dr. Dorf Biderman, is an attending physician and hospital medicine internist and serves as Chief of Staff at Methodist Hospital in Minneapolis, MN. As the Senior Medical Advisor for Clinician Wellbeing at HealthPartners she develops and implements strategies that support physicians, clinicians and trainees throughout the organization. With more than a decade in many leadership roles at HealthPartners / Park Nicollet and her community, Dr. Dorf Biderman, an immigrant, integrates a multicultural perspective into her work, fostering diversity and innovation in healthcare.
Dr. Felix Ankel is an attending physician at Regions Hospital in Saint Paul, Minnesota, and Professor of Emergency Medicine at the University of Minnesota. He is a former residency director, Accreditation Council of Graduate Medical Education (ACGME) designated institutional official (DIO), and Council of Emergency Medicine Residency Directors (CORD) board member. He currently serves as a director for the American Board of Emergency Medicine.
The views and opinions expressed in this post are those of the author(s) and do not necessarily reflect the official policy or position of The University of Ottawa. For more details on our site disclaimers, please see our ‘About’ page