“Burnout” continues to make headlines when it comes to the American workforce. A quick search of recent news shows reporting on burnout among entrepreneurs, pilots, freelancers, and more – including the pervasive problem of burnout in health care settings (see Florida Doctors Tapping Counseling For Burnout, Stress Management Help, Burnout Hits Oncologists Hard, But Healthcare Systems Can Help, Why C-Suites Need to Get a Grip on Physician Burnout, New Collaborative Tackles Clinician Burnout, and Reversing Physician Burnout While Increasing Physician Trust in Value-Based Care).
While burnout isn’t exactly a diagnostic term, it is generally defined as long-term exhaustion and diminished interest in work, and the symptoms of burnout are similar to those of clinical depression (see About Burnout Syndrome). Beyond the headlines, how pervasive is burnout in health and human services? A 2015 study from the Mayo Clinic found that half of physicians have at least one sign of burnout (see Burnout Among Health Professionals And Its Effect On Patient Safety); and the 2017 edition of the Medscape Physician Lifestyle Survey found that 59% of emergency physicians, 56% of obstetricians, and 55% of family and internal physicians, suffer from higher levels of burnout.
It’s not just a physician issue—caregivers, social workers, home care workers, nursing home care workers all experience burnout (see Recognizing Caregiver Burnout and Over Half Of Organizations Providing Wraparound Services Have Staff Turnover Above 25%). Leadership and management are also experiencing the stress of change. Provider organizations are facing new performance expectations that they are often structurally incapable of meeting in their current state; this requires executives to lead the way in building a new strategy for sustainability (see The Executive Body Is Business Relevant and How “Fit” Is Your Executive Athlete?). Turnover rates for chief executive officers (CEO) at hospitals average 18% and reach as high as 30% in some states (see Hospital CEO Turnover Rate Averages 18%).
A recent discussion paper at the National Academy of Medicine notes that the effects of burnout aren’t limited to just the individual staff member, but the repercussions extent to affect service quality, safety, consumer satisfaction, and staff turnover costs. The cost of turnover among registered nurses is estimated at 1.2 times their $88,000 salary; the costs to replace one physician could be as high as $1 million (see Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care).
The bigger management question is: Can leaders do anything about stress and, if so, what should they do? According to a report from NEJM Catalyst, the answer is yes, leaders can play a large role in shaping employee productivity, noting that “employees don’t tend to leave organizations, they leave their managers.” It’s clear that this is an issue facing just about every organization in the field—96% of survey respondents said burnout is a problem in their organization (see Leadership Survey: Immunization Against Burnout). Burnout is exacerbated by issues that can be addressed by managers—issues such as workload, work/life balance, and workplace culture.
The drivers of workplace stress also vary by position. For example, physician burnout is driven more by “work/life balance, cognitive dissonance, and clerical work,” while burnout among nurses driven by “compassion fatigue, moral distress, and work environment issues such as psychological safety and hostility.”
For more on addressing this, I reached out to OPEN MINDS Advisory Board Member and former Chief Executive Officer for The Pavilion at Williamsburg Place, Shirley Repta, Ph.D., who noted the importance of staff empowerment to off-set the high stress and burnout in health care settings. She explained:
In the current environment, the emphasis on outcomes continues to grow. As leaders, we can become focused on the outcome and not the underlying variables that drive the results. Provider organizations should work to make sure that all staff understand what the measures are, how their work impacts the results, and finally, elicit their ideas on how we can make adjustments to improve those outcomes. Keeping the conversations focused on consumer safety and quality also reinforces what we are here to do. I have found this to improve satisfaction, as staff feel empowered to do the right thing always.
Dr. Repta also noted that sometimes addressing burnout and stress can be more effective when handled on a program-by-program, or unit-by-unit basis. Issues affecting units and teams may vary throughout the organization, depending on roles and responsibilities and specific performance goals. This means there is no “one-size-fits-all” solution that will work throughout your organization, and it may be more beneficial to give managers and program directors the freedom to work with their teams to address performance and productivity. She noted:
Another significant initiative available is developing unit-specific programming. The process involves sitting down with the staff in each unit and identifying the issues related to performance. This process should be repeated every three months to evaluate staff and unit effectiveness, and make adjustments that would improve the programming. This allows for and improves staff engagement, empowerment, and investment in the programming.
For more on managing burnout within your organization, check out the upcoming PsychU virtual forum, Avoiding Burnout: Learning To Live & Work Well In Health Care, on May 17 at noon (EST), and featuring Madhukar Trivedi, M.D., Director of the Center for Depression Research & Clinical Care, Betty Jo Hay Distinguished Chair in Mental Health & Julie K. Hersh Chair in Depression Research and Clinical Care at UT Southwestern Medical Center in Dallas, Texas; and Gaurava Agarwal, M.D., Assistant Professor in the Department of Psychiatry and the Behavioral Sciences, Assistant Professor of the Department of Medical Education, Director of Undergraduate Medical Student Education in Psychiatry, and Director of Graduate Medical Education Wellness Programming at Northwestern University Feinberg School of Medicine.
To get your team on the right track, I hope you’ll join me at The 2018 OPEN MINDS Executive Leadership Retreat to take some time to retreat, refresh, and recharge in Gettysburg. The week will include in-depth coverage of the strategy insights, business practice models, and personal resiliency tools needed by health and human service leaders. And be sure to join OPEN MINDS Senior Associate Sharon Hicks on September 20 for her session, “Breathing Through Stress & Using The Principles Of Yoga To Manage People.”