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Calling on Edge Leaders to Reduce Burnout

November 13, 2019

By H. Steven Moffic, MD
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

That we haven’t yet turned the corner on controlling and reducing the epidemic of mental healthcare burnout suggests that we may be missing something of potential help. Though administrators are the key to improving systems, they may be under constraint to whomever they are accountable regarding financials and productivity. Those who work in these mental healthcare systems have limited power and job security risks in speaking out. Moreover, both administrators and clinicians may not even realize they are burning out as it happens, due to denial and other psychological factors.

So-called “edge leaders” are different. In religious terms, they may be like prophets. As the Franciscan priest Richard Rohr has said: “They cannot be fully insiders, but they cannot throw rocks from the outside.”

Only with understanding and some respect for the rules can a prophet know how to potentially break those rules for the sake of a greater purpose. Modern idealistic examples may include Martin Luther King Jr., Gandhi and Nelson Mandela. Holding the tension of opposites and cognitive dissonance may be their most crucial skill. When on the edge of leadership, one can be freer from the system’s central seductions of power and thereby also more able to assess the core message in new ways. An edge leader also has to be willing to take the risk to fall off the edge or be in the crossfire between the status quo and the outside critics.

In my career, I’ve led large systems from the inside as well as being a faculty member under other leadership at medical schools. At times, I’ve been labelled a “gadfly” in my profession. That is supposed to mean that I buzz around sacred cows and want change. There seem to be similarities between being a “gadfly” and edge leadership. I once asked a mentor if I should continue to be one and he said: “by all means.” I did, but it took its toll. Nevertheless, now in retirement from such positions, I look back with much satisfaction as to what I helped change and continue to find other edges to sit or stand on.

In terms of burnout, what would edge leadership look like? You might serve on a wellness or burnout committee for a while, maybe even as the leader. You might be an informal leader of many of your colleagues, ones who others seek to vent their workplace frustrations under confidential circumstances. You might be the one who asks probing questions at meetings during which new administrative policies are presented, and even make predictions for the problems that may ensue. You might be a vice chair of something or other.

So, any of you “edge leaders” out there, we need you to help lead us away from burning out. You likely know who you are. If you aren’t one, you can try to become one. But be careful to not fall off the edge like Humpty Dumpty did.

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