WHEN STRUCTURES FAIL REAL TIME
FROM THE BEDSIDE
TO THE BOARDROOM.
I spent years inside a healthcare organization watching good clinicians leave. I know what drives them out, because I saw the structure fail in real time.
That experience showed me something I've carried into every engagement since. The structural conditions driving attrition are specific and diagnosable. And they are fixable.
What I Call
Structural Breakdown
For decades, I was a practicing physician and a physician leader, which meant I was effectively running two full-time jobs at the same time. That position gave me a unique view - I could see in real time what was happening both at the clinical level and at the leadership level. ​
What I was watching around me was a structural breakdown. The chain of command wasn't followed. People went around their supervisors to get the answers they wanted, and the people actually influencing decisions didn't have the authority to make them. Clinicians had almost no say over their day-to-day work. Compensation models were outdated; they didn't reflect what clinicians were actually doing.
Good people were leaving. And the prevailing assumption was that it was a people problem.
Good people were leaving. And the prevailing assumption was that it was a people problem.
I raised it internally. If we addressed these structural conditions up front, I argued, we could reduce turnover and save the organization significant money.
What followed was a set of concrete changes: how we communicated with clinicians, how compensation was explained and structured, how clinicians were given real input into their daily practice. We implemented new approaches such as stay interviews.
Turnover dropped by 30 percent. Engagement scores rose. And clinicians told us directly that they finally felt heard, that the things they had been asking for for years were starting to happen.
That experience showed me something I've carried into every engagement since. The structural conditions driving attrition are specific and diagnosable. And they are fixable.
It is fixable.
That's the work I do now, with health system
executives who are tired of watching good
clinicians leave.
Most consultants analyze healthcare
organizations from the outside. I've
worked inside them, as a practicing
physician, a physician leader, and an
organizational consultant. I know
where the breaks are because I've
seen them up close.
I'm a board-certified family physician
with more than 20 years of clinical and
leadership experience, an MBA, and a
Professional Certified Coach (PCC)
credential through the International
Coaching Federation.
