Health care systems world-wide and in Canada are facing significant reform, and physician leadership is key in that reform.1 Yet evidence shows that a critical proportion of physicians are suffering from low engagement and burnout, factors that limit their ability to be healthy receptors of change or to engage as partners in that change.2-4 Indeed, the collective state of physician health has become a significant threat to the viability of the Canadian health care system.3 Physician wellness is a prerequisite for any efforts to engage physicians in shaping health care systems of the future. Physician leadership must address issues of wellness before reform can happen.
Wellness, engagement, and burnout are multi-level issues
Based on two decades of research in organizations in the United States, Amy Edmondson16 has developed frameworks and leadership toolkits that can be used to create psychological safety in the workplace surrounding learning, innovation, and growth. Without psychological safety and wellness the organizational culture chasm cannot be crossed (Table 2), and people will not be able to become engaged.
The articles discussed above focus primarily on addressing the challenges of burnout rather than generating higher levels of engagement, the next step in creating wellness. For this step, the Spurgeon model for engagement is helpful.
Long-term solutions to improve the wellness of physicians must be implemented and maintained at all levels of health care delivery: individual, interpersonal, organizational, and systemic. A major premise of this paper is that leaders have both the responsibility and the skill set to create the conditions that will minimize burnout, improve engagement, and increase physician leadership. But, like our definition of wellness and our efforts to delineate what comprises burnout and engagement, leadership practice must also be defined. Earlier, the LEADS framework was introduced as a delineation of leadership practices with application at the individual, organizational, and systemic levels of the health care system. It also embraces leadership practices consistent with the Spurgeon25 and the Influencer models.30