Solving Healthcare with Dr. Kwadwo Kyeremanteng

Dr. Mamta Gautam: Innovation, Leading Change, Failing Fast & Managing Burnout

Episode Summary

Key Takeaways Change in medicine happens very slowly. This is not necessarily due to a lack of innovation, but rather due to barriers that prevent the broader dissemination and adoption of these innovations in the healthcare system. These barriers include a very risk averse culture, an environment that does not tolerate failure, and perhaps the perfectionist attitudes that are selected for in the admission process. Covid-19 has been the great disruptor and accelerator in medicine, forcing the entire system to adopt sweeping changes in a matter of weeks and months, something that would have seemed impossible before the pandemic. When we leave our comfort zone and enter what Dr. Gautam calls the stretch zone, a whole world of growth and opportunities is unlocked. Dr. Gautam and Dr. K share their stories about leaving their comfort zone and the positive impact it has had on both of them. Dr. Gautam explains that physician wellness is the product of three elements: 1) individual factors; 2) the culture of medicine; 3) the healthcare system in which they work. While we have more control over individual factors, without positive change in all of three elements we will fail to achieve the desired level of physician wellness. She also shares the 5Cs of fostering and maintianing individual resilience. A Closer Look Innovation and the barriers to change in medicine We know from studies that only 1 in 3 change processes succeed, so change is not easy. During her executive MBA, Dr. Gautam had the opportunity to travel to Silicon Valley to witness how the region has been so successful in fostering innovation. She explains that the whole environment is set up in such a way that supports innovation. Calculated risk taking is encouraged, failure is tolerated and accepted. It is essentially the opposite of what we see in medicine. The selection process for medical school selects for people who are risk averse, avoid failure, and who tend to be perfectionists. Our training reinforces these tendencies as we learn to make decisions very analytically, with data and strong evidence. These are all good things, but they limit our ability to create change and innovate when there is no clear evidence. Our training and culture need to change to allow failure and encourage calculated risk taking. Dr. Gautam’s thesis explored why innovations for a more positive patient experience aren’t being implemented. One important barrier identified was the failure to communicate the benefits of the change and why it is necessary to those who must implement that change (i.e., physicians, nurses, etc.) A second area that can lead to the failure of change is poor stakeholder engagement. Engaging with those who are most impacted by the change as well as those resisting change actually improves outcomes. When the people who are critical of the change are engaged, it improves the innovation while also making it easier to convince them to transition and adopt the change. While there are formalized frameworks for creating change, Dr. Gautam explains that many changes fail in the transition stage. To overcome this obstacle, we need to engage stakeholders, as mentioned above, but we also need to assist people during the transition. She explains that the process of change is a process of loss leading to something new. As such, it can be viewed through the lens of grief, where people move through the stages of denial, resistance, protest etc. If we acknowledge this and assist them through the transition, we will have better outcomes. Change in the era of COVID-19 In the era of COVID-19, change is all around us which makes this conversation even more relevant. One of the few positives to come out of the pandemic is that resistance to change is decreased. It has forced our system out of the denial phase and people are adopting a change mindset, giving us a unique opportunity to create change in the healthcare system. Leaving the comfort zone Stepping out of our comfort zone can be challenging, but it is incredibly rewarding. Dr. Gautam describes this as entering the stretch zone, which provides numerous learning and growth opportunities. People are often afraid to step out of their comfort zone for fear of failing. This is where Dr. Gautam says we need to encourage a failing fast mindset in medicine. Failing fast encourages a mindset whereby if there is a failure, we take the time to process it, understand it, and learn from it, but do not to dwell on it. The faster we fail, the quicker we can get back to growing and learning. Dr. Gautam stepped out of her comfort zone when she ran for the leadership of the CMA. Although she ultimately came in second place behind Dr. Sandy Buchman, she learned a lot from the experience, and she would do it all over again if she could. Similarly, Dr. K. shares his experience stepping out of his comfort zone to address the Black Lives Matter movement and racism in medicine. Difficult as it was, the opportunities that have come out of it, and the impact it has had have been amazing. They both agree that physicians and trainees should be encouraged to step out of their comfort zone and embrace a failing fast mentality. Though older physicians may think that embracing change is for younger trainees, Dr. Gautam believes the older physicians have a level of confidence that can allow them to embrace change and take risks in ways younger trainees cannot. Physician wellness from a doctor’s doctor As a psychiatrist, Dr. Gautam’s focus is the care of other physicians. As the doctor’s doctor, she is an expert on physician wellness. She explains that physician wellness is the product of three things: 1) individual factors; 2) the culture of medicine; 3) the healthcare system in which they work. As a result, attaining physician wellness requires effort in all three of those components. That said, individual factors are the ones we can more easily control. That is why Dr. Gautam recommends fostering and maintaining resilience at the individual level. She does this through the five ‘Cs’ : Control (focus on what we can control) Commitment (what about our work makes it meaningful) Connections (the people in our personal and professional lives who supoprt us) Calming (calm our feelings and deescalate when things get stressful) Caring (care for ourselves like we would for our best friend) The culture of medicine makes it so physicians often feel as though they are being selfish if they take care of themslves. Dr. Gautam recommends thinking of it as an investment. If the physician is well, they will provide better care which patients will benefit from. Another trick she recommends are the ABCs of calmness. A (allow the emotion to be felt), B (burn it off with exercise) and C (use calming techniques.) These are techniques that don’t take a lot of time, but when incorporated can make a huge difference. In the words of Dr. Gautam: “We have to get to a point where it is okay to not be okay” Mamta Gautam is a psychiatrist at the Ottawa Hospital and in the Department of Psychiatry at the University of Ottawa, and president and CEO of PEAK MD. Dr. Gautam is an internationally renowned clinician, consultant, researcher, speaker and author in the areas of physician health and leadership. Sponsors Low Carb & Ketogenic Approaches to Health: Solving Healthcare and the Resource Optimization Network present our first virtual summit! Purchase the recorded summit:

Episode Notes


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