Leaders Eat Last is a fantastic book. It taught me not only about leadership, but also the sad state of medicine and why doctors burn out.
Today’s classic will be republished by The doctor philosopher You can see the original Huhe.
A book was recently recommended to me by one of my residents. It was written by Simon Sinek and is called Leaders Eat Last. I already knew I agreed with a lot of what Sinek said because I saw Sinek’s You Tube videos that felt like he had reached into my head and ripped my ideas right out of my head.
I don’t want to give you a book review today. Instead, I want to discuss what I learned from this book. In particular, I want to talk about how the lessons of this book apply to the morally injured doctors our burned-out medical system creates.
Managers eat last
The premise – and title – of Leaders Eat Last comes from Marine Corp., where executives are the last to enjoy their meals. When the soldiers approach the exhibition hall where they are to have their next meal, the youngest soldiers line up first. Then the next oldest. After all, the leaders eat last … if there is anything left to eat.
This is more than a tradition. It is a system that tells all soldiers that they are important to those who oversee their work. It creates trust, trust and loyalty. And it is very much by design.
This culture is created in the military so that soldiers are ready not only to do the command of their superior, but also to risk life and limb for their fellow soldiers. It’s a powerful example of effective leadership. When we feel like we are a sure fit with those around us, there is very little that people cannot do to prove their loyalty. They will work until they can’t take it anymore and will be proud to say that you are a member of the team.
Do hospital administrators eat last?
Compare military experience with that of most medical professionals. Do we have the same experience with our administrators in hospitals? It seems we’ve learned that the hospital won’t love us back forever.
In the book, Sinek argues that those endowed with the power to make changes do not speak to those on the front lines and do not have the information needed to make helpful changes. When those on the front lines have the information it needs but don’t have the power, necessary changes are ignored.
Instead, administrators who run very large organizations rely on metrics and numbers to make decisions. You can’t possibly know everyone. You have to trust your middle management.
Those of us on the front lines who are affected by these metric-based decisions seem unreal to those who lead. We’re just going to be numbers in a table. Metric-Based Leadership doesn’t know your spouse about how many children you have or the fact that your grandmother has Lewy body dementia.
This is a human phenomenon. We need to know people in order to care for them and lead them effectively.
The further we are from someone and the more “statistical” they become, the less we care about their well-being. It’s easy to fire hundreds of people you don’t know using tables that show the company’s margin. This quote, referenced in Leaders Eat Last, captures it well:
“If only one man dies of starvation, it’s a tragedy. When millions die, these are just statistics. “~ Joseph Stalin
Unfortunately, when decisions are based on metrics and statistics, rather than the people who are affected by those decisions, there is no drive or desire for leaders to protect those who lead them. We are not in their “circle of security”, as Sinek calls it.
This inevitably leads to a situation where people lose loyalty, feel less secure about their job security, and decrease productivity.
Leaders who eat first cause moral harm
Despite the ability and desire to do the best for our patients, many clinicians experience an environment where they have too little time to see patients and they are forced to spend too much time in front of an electronic health record system to spend.
Or have you been moved into an environment where it’s more about RVU production, shift requirements, or academic expectations? All of this goes against our desire to be good doctors. It also prevents us from being a good spouse, parent, and friend at times.
This situation is not sustainable.
Should doctors spend the extra two hours at home? Or do you have dinner with your family? Are you doing the additional surgery to achieve your RVU goal? Or are you planning to take part in your child’s tea ball game?
These metric-based goals can systematically affect the well-being of doctors. They also seem to have created a system that is more concerned with the bottom line than the moral harm inflicted on the front line doctors.
Open and honest cultures
One of the biggest reasons medicine is currently in a sad life is because of culture.
Instead of feeling safe to share our thoughts, beliefs and opinions; Many of us live in constant fear that during the next economic downturn we will be laid off from work, paid less, or that our services will be curtailed or used. Why should we feel this way? Because it happened to us or to our close friends.
Unlike well-run organizations that create a culture where trust comes first, many doctors feel like cogs in the wheels of huge machines. They feel like they can be easily replaced. You are just a number. Does anyone in the C-Suite even know our names, who we are and what we do?
It doesn’t take many meetings with coworkers to find out what makes our aversion to the current system. However, I know many people who have never seen executives and administrators in their hospitals. Far fewer have actually attended meetings where they were encouraged to speak openly and honestly about what is bothering them.
Yes, surveys are carried out to “improve” the organization. These are the same surveys that many of us are forced to complete. This “checks the box” to worry the people on the front lines, but none of us are really being fooled.
A first approach for employees
An open, honest and just culture must be created.
We can shape ours according to the culture created in the aviation industry after airplane crashes. They fixed the problem by fixing the culture. And we can too.
We need to create a culture that will not tolerate retaliation, and we are encouraged – perhaps even honored – when we point out problems that need to be corrected. A culture where we feel like our voice is actually being heard. Or maybe a culture where the almighty dollar bill isn’t what we focus on most.
Instead, we focus on making our employees feel happy, safe and secure. Why? Because good leaders know that this type of culture will produce loyal and hardworking doctors.
If a drug is to be repaired, it must be done top-down. While I believe that ultimately power rests with those who control our work, I also believe that it is the responsibility of employees to stand up for what they believe is right.
We must be ready to be courageous and concerned about our brothers and sisters who are waging the good fight by our side. It is our responsibility not to sit idly while doctors go into deep and dark burnout. Or worse, sitting still while doctors silently commit suicide at epidemic rates.
I encourage you to stand up for what is right. Keep our administrators sticking to the standards we would want the executives who represent us to be. Be willing and courageous to speak when others cannot or will not.
Strive for financial independence so that you have the ultimate asset in a broken system. It will help you find your way from the broken road to burnout.
Take it home with you
I have found for some time that the main solution to the current problems we face in medicine lies in correcting our culture. I often see the aviation industry as a shining example of what that might look like, but Leaders Eat Last also provided an excellent picture of how our flawed system could be saved.
Our leaders must stand up and lead. However, it also challenges us to force our leaders to act as a leader should do.
It remains my dream that there will be a group of doctors who, through financial independence, will find the courage to stand up and repair this sinking ship that is the business-based medical model we currently live in.
Do your leaders eat last? Did you feel empowered to express yourself? Or are you completely satisfied with your current situation? Leave a comment below.