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How Your Hospital Can Avoid A Nomination as a Great Place to Work 


 Image from Los Angeles Times

Earlier this month I read a Wall Street Journal article about Zeynep Ton's Good Jobs Index. Who is Zeynep Ton? She is a professor at the Massachusetts Institute of Technology’s Sloan School of Management who has ranked retailers on employee happiness. This was so positive. It was good to hear about businesses concerned about employee happiness and not just about profits and shareholders.

Two weeks later I was dismayed to read about the bruising work environment at Amazon in the New York Times. The article described a work environment toxic to workers overseen by a CEO who is blind to this view.

I was curious. I work in a hospital. Are hospitals ranked according to employee happiness? My health system is recognized as a Great Place to Work and the Fortune 100 Best Companies to Work For.

Last year I left a hospital that was an ideal model of health care in the President's eyes. Time Magazine had published two articles about that hospital. Yet my experience there as an employee was closer to the abusive atmosphere the New York Times detailed about Amazon. 

I imagine that my old workplace could continue avoiding accolades from its employees by following these 14 steps:

1. Ensure there is a top-down management style. You cannot have middle managers like Department Chairs speaking on behalf of doctor employees. Instead just have the Department Chair spread edicts from higher up down to the masses. Upper management should remain uninterested in employee concerns.

2. Make sure there is no Doctors Lounge. That would only encourage restless employees to congregate and complain about management and the system.

3. Quarterly staff meetings should only be about the CEO and upper management decisions that have already been made for the employee physicians. Pretend to listen to employee concerns but remember, the meeting is really not about them but about upper management.

4. If any employee physician complains of burnout let them know they are welcome to leave and that they are replaceable.

5. Make sure that performance measures are impossible to reach and tie reimbursement and bonuses to these measures. By withholding monetary bonuses from doctors, think of the savings the system will accrue.

6. Since you really cannot measure or quantify caring, you should instead focus on irrelevant metrics that will frustrate your employees.

7. If your doctors stand up to patients by refusing to overprescribe narcotics or use antibiotics for viral illness, then when those doctors get  poor patient reviews, make sure they are singled out to demean them and make them feel worthless. After all, great patient reviews are more important than providing great medical care. 

8. Each year while the hospital cuts expenses, it should demand greater productivity from physician employees. When the doctors ask for more resources, more support staff or extra clinic time, tell them this is impossible because of expenditure cuts.

9. Take away coffee in the Operating Room nurses lounge because this will save the hospital money. That will have little effect on staff morale.

10. Brag that your CEO is a physician like many of his thousands of employees but make sure the employees know their place in the system by paying the CEO 40 times their average salary.

11. Remind your doctors it's more about numbers and quotas than patient care. If they do not meet RVU production targets their job is at risk.

12. When your doctors reach their 60s, don't treasure them. Instead find a graceless way to get rid of them. Younger docs are cheaper to hire. Remember that experience and wisdom are overrated.

13. Managers should set the standard for "work-life" balance by showing it is OK to ignore your spouse and children and OK to spend as much time as possible at work. The proper balance should tilt toward more work than life. Remind your workers the system is more important than family. The hospital is your family, 12+ hours a day. When you retire, you may find you have no family to go home to.

14. When doctors quit, don't perform exit interviews because you really don't care to know why they're leaving. You're just happy to get rid of them, so just show them the boot on the way out.

The lesson I learned was that I have to work in a Great Place, one that cares about its employees. If you are not in that great place, then leave. 
Organizations should avoid pushing employees to do more and more in a thankless environment. A hospital should focus more on caring for patients and their staff and less about meeting quotas and upper management happiness.


  1. Henry E. Butler III M.D., FACS says:

    Fabulous. Thank you. Will you help write model by-laws and contracts for doctors who choose to be independent of hospital employment?

    Henry E. Butler III M.D., FACS


  2. Judi says:

    Genius. Pure genius. Thank you for this.

  3. Steve C says:

    Have been there. Left my old job 3 years ago and I feel 20 years younger! I counted 12 out of 14 of your points in my old job, 0/14 in my new one!

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