Clinician Burnout: A Watershed Moment?

john-towner-177554-unsplash Photo by JOHN TOWNER on Unsplash

Physician burnout is not only bad for physicians; it is bad for the rest of the care team, quality of care, patient safety, patient experience, your bottom line and the organization as a whole.

Flying high, there I was again on a flight. However, before take-off, I heard the same line that we’ve all heard a million times over: “Should the cabin lose pressure, oxygen masks will drop from the overhead area.  Please place the mask over your own mouth and nose before assisting others.” It never gets old.

How can clinicians take care of others, if they are burned-out?  Approximately 30 to 50 percent of all clinicians are affected by burnout according to a number of sources.  The challenges in healthcare are not going away, at least not anytime soon.  As such, clinicians must personally find ways to relieve the stress and prevent burnout.  They don’t need to be told about the importance of social and leisure activities outside of work, however, they must learn to put the oxygen mask on first.  These activities should be systematic and if needed, be scheduled rather than taking a “let’s see how this week goes” approach.  As a bonus, this action has the added benefit of erasing that occasional cognitive dissonance some clinicians may feel when advising patients about stress-reduction.

Physicians rank too many bureaucratic tasks; spending too many hours at work; lack of respect from administrators and employers; and increasing computerization of practice atop the list of culprits for burnout.  According to a number of studies, there are big differences between the percent of CEOs, CMOs and COOs, who said they felt that they sufficiently understood the causes of burnout and the percent of the same groups who say that they are sufficiently addressing the problem-reflecting a considerable solution gap.

Understanding the data gives us insight about where to begin.

1) Surveys: Administering surveys that elicit, with some level of specificity, the reasons for burnout is a great starting point.

2) Champions:  Forming a task force or selecting a point person (in the cases of smaller organizations and physician practices) to champion the data analysis, and holding true to the Pareto principle, to identify the relative fewer issues that are usually causing most of the problems.  The same task force or a new committee (one that reflects the workplace diversity – personnel levels, departments, clinical and non-clinical disciplines, and social demographics) or the entire team (for smaller organizations and physician practices) can work on possible solutions.  It is good to assign an executive sponsor to the group in order to give its existence – credibility, its function – accountability and its recommendations – a priority with senior leaders.

Needless to say, understanding the numbers is not enough. The data should be used to inform targeted solutions. Based on the information uncovered, the instruments to facilitate effective and sustainable change could take many forms based on the culture, size, resource, and leadership commitment of an organization.

Change should be infrastructural such as those made to the culture (i.e. blame vs. no blame, teamwork orientation and leadership responsiveness etc.), systems, policies, and processes that allow for a less stressful and more fulfilling workplace.  It should also be person-centered to include solutions like employee welfare assistance programs, stress-reducing work models, training, counseling, therapeutic and well-care health services, professional development and coaching programs.

The solutions would need to be dynamic enough to address the 3 key dimensions of burnout as indicated by Christina Maslach, PhD, a professor of psychology at California, Berkeley who has studied the subject for over three decades:

1) Emotional exhaustion: Feeling fatigued at work or due to work.

2) Cynicism: Developing an indifference or even hostility towards others.

3) Inefficacy: Feeling under-accomplished, ineffective or un-impactful at work.

Many tools are available to help organizations regardless of size and resource to begin to address the issue of burnout.  These include physician survey tools like the Mayo Clinic-developed Physician Well-Being Index (PWBI) or Maslach Burnout Inventory (MBI);  professional organization guidelines like the Institute of Healthcare Improvement (IHI) framework for a healthy healthcare workforce;  training programs and workshops to combat burnout such as those facilitated by the National Academy of Medicine and the American Nursing Association; and many evidence-based interventions like Schwarz rounds, and a myriad of mental health and well-being services.

I bet if you implemented the following recommendation, you’d begin to see improvements especially for items that are considered to be low hanging fruits.  Take an identified problem and then ask “why” until you can no longer provide an answer to the question. Review the “response(s)” to the last “why” for possible change, and if indicated, address the issue with the specific brainstormed solution(s). If no change is indicated, go to the preceding “why” and corresponding “response(s),” and repeat the exercise. This is a Lean-Six Sigma tool known as “5 Whys” and it’s akin to conducting a root cause analysis exercise (RCA).

Oyinkansola Ogunrinde is the Founder and Chief Practice Transformation Officer of FUNMI Healthcare Consulting, LLC, a consultancy specializing in the management of physician practice and ambulatory services (www.funmihc.com).
References:
George, M., Rowlands, D., Price, M., and Maxey, J. The Lean Six Sigma Pocket Toolbook. NewYork: McGraw-Hill, 2005. Print.
Norton, J., West, P., Gee, P., Krusie K., Boissy, A., Rehm, S., Williams, M., Putnam, T., and King, N. “Fighting the Fire of Burnout in Healthcare” Frontiers of Health Services Management, vol. 35, no. 2, Winter 2018.
Peckham, C. “National Physician Burnout & Depression Report 2018” Medscape, January 17, 2018, http://www.medscape.com. Accessed 12 December 2018 and “Physician Lifestyle & Happiness Report 2018” Medscape, January 10, 2018, http://www.medscape.com.   Accessed 12 December 2018.
Thew, Jennifer. “Beating Clinician Burnout” HealthLeaders Media, April 2017, 11-21.
Van Dyke, Maggie, “Battling Clinician Burnout: Fighting the Epidemic from Within” Healthcare Executive, January/February 2019, 10-19.

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