By Christopher Cheney
A Mayo Clinic expert says there are more than a dozen ways to promote well-being and limit burnout at healthcare organizations.
Healthcare worker burnout was at epidemic proportions before the coronavirus pandemic, and a Stanford Medicine burnout researcher expects a new national survey will show the pandemic has exacerbated the problem. A study published in October 2018 found burnout increases the odds of physician involvement in patient safety incidents, unprofessionalism, and lower patient satisfaction.
Last week, Liselotte “Lotte” Dyrbye, MD, MHPE, a professor of medicine and medical education at Rochester, Minnesota–based Mayo Clinic, was one of the keynote speakers at the second national Summit on Promoting Well-Being and Resilience in Healthcare Professionals. In her presentation, Dyrbye said there are at least 14 methods to address healthcare worker burnout:
- Appointing a chief wellness officer
- Securing commitment to tackle burnout from top leadership
- Having governing boards hold healthcare organizations responsible for creating a positive work environment
- Holding leaders at every level of healthcare organizations accountable for improving the work environment
- Creating a workplace culture that supports change management, psychological safety, and peer support
- Establishing clear alignment between organizational values and workforce values
- Including well-being in decisions, policies, mandates, and resource allocation
- Redesigning clinical systems so that they meet the needs of healthcare professionals
- Targeting known systems factors that affect the balance between job demands and job resources
- Building infrastructure and culture that supports accountability
- Improving electronic medical record usability
- Having strong relationships between healthcare professionals to increase social support
- Providing professional coaching for clinicians
- Promoting the ability of healthcare workers to seek help if they are experiencing burnout
After Dyrbye delivered her keynote presentation, she spoke with HealthLeaders in greater detail about some burnout prevention efforts. The following is a lightly edited transcript of that conversation.
HealthLeaders: How do healthcare organization leaders play a role in curbing burnout?
Liselotte “Lotte” Dyrbye: It is really systems factors that are contributing to workplace stress, which leads to burnout. So, healthcare organization leaders need to look at the work demands and the work resources, then get them into a better balance.
Practically, this means that healthcare organization leaders need to do some measurement using validated instruments, so they know what is going on. They need to find out about the levels of burnout and satisfaction. They need to understand the contributing factors for burnout in the workplace. Then leaders need to get that data down to the work units to help identify hotspots for burnout. They need to engage in a dialogue with the “boots on the ground” to identify the drivers of burnout and identify the solutions.
Other important factors that healthcare organization leaders can influence are culture, values, meaning in work, and leadership skills. We need to be thoughtful that the people we put in leadership roles have good leadership skills and seek opportunities to refine their leadership skills. Local leadership makes a difference.
HL: Give an example of how clinical systems can be redesigned to promote clinician well-being.
Dyrbye: One example is having a medical assistant in the exam room with the clinician in the primary care setting. Under this model, the medical assistant goes into the room first, collects the medical history, makes sure the patient’s medications are in the medical record, and gets the patient prepared for the visit.
When the clinician comes into the room, the medical assistant summarizes the medical history, the clinician can ask targeted questions, and the medical assistant can enter notes into the medical record as well as prepare any equipment that will be used during the visit such as throat swabs. The clinician and the medical assistant work together collaboratively to meet the needs of the patient. The clinician can focus on the patient, and the medical assistant can focus on clerical tasks.
At the end of the visit, the clinician can sign the medical orders that the medical assistant has put into the medical record, and the clinician can provide some counseling then leave the room. The medical assistant can finish up with patient education, make sure the patient understands the plan of care, then finish up the notes for the clinician to review and sign.
Under this model, the clinician is working at the top of his or her licensure, and the medical assistant is working at the top of his or her licensure. Patients are satisfied. Quality metrics go up. The medical assistant is satisfied. And the physician is more satisfied.
HL: Give examples of where electronic medical record usability needs improvement.
Dyrbye: These systems are incredibly complex. The interface has multiple different colors, font sizes, and there is so much busyness going on. It is hard to figure out where information is, where you need to enter information, and how to get tests done. The whole work process is very difficult.
I am fortunate. I work in one health system that has one electronic medical record. But there are many other healthcare professionals who work in multiple hospitals, and each hospital has its own electronic medical record that is set up differently. There is no standardization.
One concern is when nurses must enter data into different boxes, and they cannot advance to the next field if they leave a box blank. There are some situations where information is not available or not applicable. So, the nurses get stuck, which is incredibly frustrating.
There are innumerable opportunities to improve the usability of electronic medical records.
HL: How does professional coaching boost clinician well-being?
Dyrbye: We did a randomized controlled study where physicians received three-and-a-half hours of professional coaching over a six-month period. That coaching led to improvements in burnout, increased quality of life, and more resiliency.
This is a low-cost, feasible intervention that can be done during the pandemic. Physicians mostly get coached on factors that fall into the professional sphere. Although some physicians got coached on overcoming barriers to physical fitness and those types of issues, most were coached on how to have crucial conversations, how to lean into change at work, and how to make meaningful differences at work.
Coaching is different than mentoring. It is focused on listening, being curious, and not giving advice. The coach asks a series of open-ended questions that get clinicians to clearly identify their goals, help them to understand their options, and determine where there is the will to change.
HL: How can healthcare organizations encourage staff to seek help for burnout?
Dyrbye: Psychological safety is a big issue. Organizations must make seeking help safe. You must change the culture to make seeking help a sign of strength rather than weakness.
Many organizations have various versions of employee assistance programs that keep confidential records—these records are not part of an employee’s work file to try to reduce barriers to seeking help.
At Mayo Clinic, we have an Office of Staff Services, which is a place where clinicians can go and talk with a physician who can refer them to an internal psychologist if necessary, to help with burnout or other work-related issues.
What is great about the Office of Staff Services is I can go there for help with my 401(k) or I can go there because I am burned out. There are a variety of reasons why I would go to that office. So, it feels safe to go there.
Christopher Cheney is the senior clinical care editor at HealthLeaders.