The Value of Learned Industriousness in Medical Practices

August 7, 2013

If you want greater productivity, profitability, and patient and physician satisfaction, look no further than "learned industriousness."

Learned industriousness (via Wikipedia) is an antidote to learned helplessness. A medical practice environment that promotes learned industriousness among staff creates a virtuous cycle that leads to higher and higher levels of satisfaction and productivity for everyone in the practice.

The environment has four main characteristics.

1. Staff has what they need to do a good job.

Industry requires at least a reasonable opportunity to be successful.

Success requires clear expectations and a definition of what constitutes good performance. Effective training is essential, and an up-to-date operations manual is a great tool for your practice. Success also requires reasonable staffing levels, good organization, and appropriate equipment and tools.

2. Staff feels safe from personal attacks and embarrassment.

When someone makes what is or seems to be a mistake, it is very important to avoid raised voices, blanket statements ("Why do you never …"), and remarks that would indicate the person is stupid or inept. Those behaviors force the person at fault into a defensive posture and shut down any attempt to find out what really happened. You may get excuses, but you are not likely to get a conversation that will help avoid the situation in the future.

In addition, everyone who witnesses the exchange will feel vulnerable to the same treatment and do whatever they can to avoid it. The most common response is extreme risk aversion. (read: lack of initiative)

If someone really needs to be called on the carpet, do this in private after emotions have cooled.

If a staff member is irremediable, dismissal is the only option. Good staff will appreciate both the action and the fact that it was handled with discretion and respect.

3. Physicians probe for context and supply additional information as needed.

One of the most important management lessons I ever learned was a happy accident. When someone had done something I perceived as extraordinarily bone-headed, I asked "What were you thinking?" The happy accident was that I asked it in a way that didn't presume blame. I really wanted to know what the person was thinking, and she told me. We still had a mess to deal with, but the event brought a serious misconception to the surface so that it could be addressed.

If at all possible, notice and remark on something the staff member did right or at least intended to do right. That reinforces initiative even if the outcome was sub-optimal, as long as you do not follow the positive comment with "but."

Supply additional information as appropriate, and ask how it might have changed the staff person's action. The objective is to give the staff member the tools to come up with the right answer.

4. Staff is held accountable for workable solutions.

Make it clear that complaining or blaming someone else is not acceptable. Explanations must stick to observable reality. "The chart was not in the file room" is fine. "Sally lost the chart" is not.

Require that any complaints be delivered with a possible solution to the root problem. You will be amazed at the ideas they come up with. Not all will be workable; but many will be. The effort of developing a solution actually becomes self-reinforcing.

Do not fall into the trap of supplying the answer. That reinforces the perception that you are the only one capable of independent thought. You probably are, however, the only one who can approve changes.

An environment that supports learned industriousness does take some time and effort. Those are quickly paid pack in productivity, profitability, decreased staff turnover, and satisfaction for patients, physicians, and staff.