Physician Work-Life Balance: When Hard to Achieve, Docs Stop Trying

Jennifer Frank, MD

Why a standardized approach has to be flexible - or the standard has to change.

I’m coming to the end of my Lean for Healthcare training. As part of my class, I am working a performance improvement project. I needed to get data for this project, so I spent a few hours last week timing our medical assistants’ room patients. Our organization has standard work for rooming a patient that is 36 steps long. Not surprisingly, what I observed was a generally similar approach with multiple individual variations.

One way to interpret the variation in a standard process is that the medical assistants aren’t doing what they’re supposed to be doing. I would argue they’re not doing what they’re supposed to be doing in the same way that I intentionally and unintentionally deviate from clinical standard work (aka,  practice guidelines). Often, to get to the right goal, those of us in the trenches need to modify a “standard” approach so that it becomes a reasonable one. 

Another way to interpret this variation is that any process that includes 36 steps is bound to cause variation. Considering that rooming a patient is only one of several other tasks the medical assistants are asked to perform, memorizing and then dutifully performing all 36 steps every time is impractical. So adjustments are made. Over time the myriad adjustments result in a meaningless document - standard work that’s no one’s standard. Variation is introduced, which leads to waste and defects. 

What I’ve learned is that standard or standardized work is supposed to be flexible, changing, and written and edited by the people doing the work.  So, how can we use this lean tool to achieve work-life balance?

Well, one lesson is that any standardized approach has to be flexible. Some weeks when I have four patients deliver babies and parent-teacher conferences in the middle of flu season, I need to deviate from the standard, whether that’s being there to tuck my kids in at night or getting enough exercise. Beyond just deviating from it, I need to ask and answer why - why did I have to vary the standard?  If it’s just a bad week, then my standard still might be adequate and something I can go back to the next week. However, if I’m having “bad week” after “bad week” and I can hardly ever do my standard, then the standard has to change. 

Additionally, my standardized approach has to be my own. I can’t take someone else’s method for achieving work-life balance and hope to use it as the template for achieving my own.  While other people may have great ideas, my standard work must be individualized. 

Finally, my standard approach is not a rule book that I must blindly follow. It is a touchpoint of what I already should be doing. It describes rather than proscribes what I do well.