Organizational Solutions May Hold Key to Preventing Clinician Burnout
By Megan Headley
The World Health Organization has recently defined burnout as an official medical diagnosis, explaining it as a syndrome that results “from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one‘s job; and reduced professional efficacy.”
According to Laura Hamill, PhD, chief science officer and chief people officer for the Limeade Institute, an evidence-based research firm, this problem is unique to the workplace—meaning that solving it should fall squarely on the workplace’s shoulders.
“As organizations, we have to start making the changes that are causing our employees to burn out in the first place. Organizations must understand and own up to their responsibility in causing burnout,” Hamill says. “Let‘s not just put this as one more burden that we give to employees.”
Hamill’s position comes from the Limeade Institute’s work in employee engagement and well-being through its employee experience software brand, Limeade. From that perspective, Hamill has seen burnout across virtually all workplaces and lived it herself. In healthcare, however, the risks of burnout are uniquely high and the consequences are severe. Research indicates that anywhere from 44% to 78% of American physicians suffer from burnout—drastically higher than the 28% among the general working population.
Plus, burnout among healthcare providers is on the rise. A June survey from the American Society of Hospital Pharmacists found 74% of U.S. adults are concerned about burnout among healthcare professionals, including nearly one in four (23%) who are very concerned. Eighty percent of Americans reported that when their doctor, pharmacist, nurse, or other healthcare professional is feeling burned out, the quality of their care decreases.
While healthcare’s burnout risks may be unique, Hamill suggests that the solution is not. “We‘re starting to see this is a real important psychological phenomenon that has its roots in organizational causes,” she explains. As such, it’s up to organizations to address the problem before burnout drives up turnover and drives down care.
Need for external intervention
There are a growing range of resources available to address physician burnout, but resources that target physicians, helping them to “heal thyself,” can be problematic.
As Sharmila Dissanaike of the Texas Tech University Health Sciences Center wrote in “How to Prevent Burnout (Maybe)” for the American Journal of Surgery, “[There] is a recurring theme that I see in physicians with severe burnout—their perspective has narrowed so dramatically that they don‘t even realize what options for help might be available. … The lesson here is that drowning people can‘t usually save themselves—by the time someone reaches this point, it requires an external intervention to prevent a tragedy.”
The most powerful allies for physicians, nurses, and other healthcare providers are actually their own organizations, even though those organizations can have problematic practices that contribute to burnout (EHR maintenance and other administrative requirements are among the more frequently cited stressors). However, as Hamill points out, “There are some pretty clear reasons why organizations don‘t take more responsibility.”
For starters, burnout often feels like a personal problem rather than an organizational one, because it frequently goes hand in hand with challenges such as substance abuse, anxiety, depression, or divorce. Those types of problems can exacerbate burnout or stem from it.
In addition, Hamill points out, burnout tends to lead people to become negative and cynical. “It’s very natural for people to feel that way, but it’s easy for us to just say that that person’s hard to work with or they’re toxic,” she points out. “It’s easy to dismiss our role in that as an organization when somebody’s going through that.”
At an organizational level, Hamill finds that while burnout overlaps well-being and employee engagement, the departments handling those areas are typically distinct. “In order to burn out, you have to start with high levels of engagement but low levels of well-being. What’s tricky in most organizations is there’s a team that owns well-being—the benefits team—and then there’s another team that owns engagement—the talent management team. They don’t talk to each other or work together very much,” she comments. As a result, it can be unclear who “owns” an organization’s responsibility for burnout prevention.
Identifying scalable solutions
Fortunately, there’s growing awareness that burnout is a problem, and awareness is the first step toward identifying solutions. Hamill says that in many cases, helping physicians, nurses, and other healthcare staff put a name to the challenges they’re undergoing can promote greater understanding.
“I think there’s this idea of reducing the stigma around this topic and understanding it for what it is and how natural it is for people to go through those stages,” Hamill suggests. “The primary thing is increasing the awareness and reducing the stigma so that we can start talking about it.”
Limeade’s Burnout Consortium was developed with that idea in mind. It brought together customers to discuss ways to create awareness, reduce the stigma around burnout, and start creating scalable solutions to prevent it. The Caregiver Burnout Consortium was co-created by the Limeade Institute in partnership with several healthcare organizations. Since 2018, the consortium has discussed new research and shared best practices around burnout through quarterly webinars.
Corey Martin, MD, lead physician for physician resiliency training and burnout prevention at Allina Health, a not-for-profit health system based in Minneapolis, is one of the consortium contributors. Organizational issues take time to fix, he points out, so it’s important to have other supports in place for caregivers. “We have to keep the personal resiliency going since it takes much longer to roll out organizational changes,” he says.
Supporting personal resiliency, or encouraging physicians to take time for themselves, is the first part of Allina Health’s three-pronged approach to preventing burnout. To this end, the system has developed a physician burnout hotline that is meant to let physicians know that it’s OK to ask for help. But that puts the impetus on physicians to understand what they’re going through and to reach out for assistance. As Martin notes, about 80% of physicians calling in are already experiencing burnout symptoms so extreme that they’re looking for another job.
That’s where the second tactic comes in. Allina Health is seeking to transform its culture and leadership by demonstrating a top-down emphasis on the importance of reconnecting to the joy of caregiving.
Allina Health is helping nurses rediscover joy through a pilot program focused on relationship-based care that aims to get back to the meaning and purpose of work. In addition, the system hosts “Tuesdays With Corey,” named after the initiative’s lead physician. At a set time each week, interested physicians get breakfast together. Sometimes they share a discussion, a video, or a poem. Other times, they might hang out and read the paper. The goal is to bring back the social connections that were once a strong part of the caregiving culture.
Joy at work is a touchy-feely idea that has support from the Institute for Healthcare Improvement (IHI). Its 2017 white paper, IHI Framework for Improving Joy in Work, concludes that joy is what gives meaning to work, which builds the engagement that reduces turnover. And joy, the authors add, “is a system property. It is generated (or not) by the system and occurs (or not) organization-wide.”
The framework lays out four steps for leaders to create a path toward a more joyful organization:
- Leaders engage colleagues to identify what matters to them in their work. Simply asking, “What matters to you?” and then listening to the answers without judgment can go a long way toward finding the boulders in employees’ paths.
- Leaders identify the processes, issues, or circumstances that bar the achievement of joy at work.
- Multidisciplinary teams come together and share responsibility for removing these impediments, and for improving and sustaining joy. Keep in mind that when nursing staff or physicians share their concerns, they expect to see some type of action taken. So it’s important to have a team or processes in place to act upon barriers well before you begin identifying challenges.
- Leaders and staff use continuous improvement science together to test improvement suggestions, then either implement or adapt them. Putting metrics in place to track and measure success can help ensure that improvements make a lasting difference.
The steps aim to empower teams to identify and address barriers to change, while senior leaders prioritize and address larger systemwide issues that affect joy in work. As the white paper puts it, “This process converts the conversation from ‘If only they would …’ to ‘What can we do today?’ ”
Addressing those organizational issues is the third of Allina Health’s strategies for reducing burnout. As one example, Martin’s team found that physicians were spending an average of two hours each night on paperwork. To lighten the burden, Allina Health hired people to help with Epic and medical record input.
The business cost of burnout
Findings from the Limeade Institute show that when employees feel cared for, they are four times less likely to suffer from stress and burnout. Additionally, 50% feel low levels of stress, while 56% feel equipped to avoid burnout. Creating an organizational culture that takes simple steps to care for physicians can have big returns.
In fact, the 2017 JAMA article “The Business Case for Investing in Physician Well-Being” outlines those returns. The paper provides a worksheet to calculate the organizational cost of physician burnout. It factors in costs associated with turnover, lost revenue associated with decreased productivity, financial risk, and threats to the organization’s long-term viability due to the relationship between burnout and lower quality of care, decreased patient satisfaction, and problems with patient safety.
Moreover, paper authors Drs. Tait Shanafelt, Joel Goh, and Christine Sinsky point out that virtually all healthcare organizations have used evidence similar to what’s been discussed around burnout to justify investments in safety and quality. “This investment is based both on the moral and ethical imperative to improve safety and quality, as well as the risk to organizational viability if safety and quality are not improved (lower patient satisfaction, less favorable patient outcomes, effects on contracting, greater litigation risk),” the paper states.
Many organizations are focusing on burnout prevention, but in too many cases, the onus is still on the physician to reach out for help.
Hamill offers a saying she shares with her colleagues: “You can’t yoga your way out of burnout.” As she explains, “It is a way to remind people that we can offer all kinds of wonderful resources to our caregiver employees, but it can’t be just put on them as their responsibility to fix themselves. As organizations, we must start making the changes that are causing our employees to burn out in the first place.” *
Megan Headley is a freelance writer and owner of ClearStory Publications. She has covered healthcare safety and operations for numerous publications. Headley can be reached at firstname.lastname@example.org.
Create a Burnout Prevention Plan: Resources to Help Health Systems Strategically Reduce Burnout
> IHI Framework for Improving Joy in Work
> AHA’s Burnout Resource Page and Physician Well-Being Playbook
> AMA’s module for Creating the Organizational Foundation for Joy in Medicine
> The National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience
> Limeade Caregiver Burnout Consortium