Dousing clinician burnout
Slowly and surely, we’ve been burning out a generation of doctors and nurses. The numbers are startling: Over 50 percent of physicians report one or more symptoms of burnout. Over 50 percent of nurses are emotionally exhausted, and 25 percent are clinically depressed. Most doctors won’t recommend their profession to their children. According to numerous observers, the problem is getting worse.
Clearly, too many of our clinical colleagues are suffering. Burnout is directly correlated to the quality, safety and cost of health care. While misery should be reason enough for concern, the downstream impact on patient care, experience and cost compels us to fix this problem. Not surprisingly, over 90 percent of health systems have now concluded that clinician burnout is a top strategic priority.
We’ve known for a long time that human performance and business performance are correlated. Twenty years ago, James L. Heskett, W. Earl Sasser Jr. and Leonard A. Schlesinger published their now-famous book The Service Profit Chain and established the causal link between profitability and customer loyalty, and then to employee satisfaction, loyalty and productivity. But notwithstanding widespread acceptance of the conclusions, health systems have underinvested in human capital — the very people who care for our patients and on whom we depend to achieve our desired results.
Let’s assume you want to do something about this problem. You’ve witnessed burnout among your doctors and nurses and seen the effect in your employee engagement scores, staff turnover, patient experience scores and even clinical quality. Now what? How do you get started? How do you gain buy-in from doctors and nurses? How do you create real, lasting change? How do you scale efforts across an entire health system?
From our experience as leaders of large, successful health systems, we have specific suggestions for this critical problem. A successful burnout reduction strategy must include three initiatives:
- Removing hassles and scaling joys in the practice environment to ensure compassionate, safe and effective care.
- Increasing team communication with an emphasis on individual strengths, aligned values and shared goals.
- Enhancing individual resiliency and well-being by equipping clinicians to manage the intrinsic stress of their busy and hectic work using evidence-based skills.
Hassles and joys
There is no doubt that the practice environment we have created for our doctors and nurses has contributed significantly to burnout. Regulatory requirements, the constant need to do more with less and the accelerating pace of change are key culprits. But sometimes even the tools we use to help clinicians — such as electronic health records, certain work processes and organizational design decisions — increase stress and remove humanity from care rather than improve it.
The first step is to assess the practice environment and discover how that environment contributes to burnout. It is not hard to identify the burnout contributors — just ask your doctors and nurses; follow them around and see what happens. At Mission Health in Asheville, N.C., we did just that. In the first year alone, we identified more than 5,000 “hassles” and 1,500 “joys” in the care environment. A dedicated team now works every day to systematically eliminate or modify each hassle and scale every joy to transform the practice environment and promote compassion and joy.
That same work also frequently improves productivity and reduces costs. And, by asking doctors and nurses to help identify and fix problems, they feel invested in the process and more in control, the absence of which is a known, major contributor to burnout.
The second area of burnout reduction is team interaction. All work — successful or not — is a function of teams. It has been reliably demonstrated that the more frequently a team interacts, the higher the team's performance.
Weekly check-ins are an essential requirement for effective teams. Equally important, team members should spend the majority of their time working in their strengths. These two factors, along with active guidance by team leaders, lead directly to enhanced staff engagement. Mission Health followed these principles and experienced an 89 percent increase in employee engagement in just one year; the percentage of fully engaged employees is now nearly double the national average.
Communication is the lifeblood of teams, so communication skills training — particularly for stressful situations — is essential. Values are important, too. And yet, we rarely establish guiding principles for how we expect our doctors, nurses and team members to interact with one another and with patients. Explicitly establishing norms for these interactions and clear expectations that they will be followed is critical for any culture that promotes well-being and enhances joy for teams.
Finally, any effective burnout strategy must equip doctors and nurses with tools to handle the personal stress of their work. No clinical environment will ever be perfect, or chaos- or stress-free. Over the past 20 years, developments in neuroscience have shown that well-being is a skill that can be trained. We now know that we can train with evidence-based practices to enhance individual well-being — just like we train our bodies to achieve greater physical fitness.
Simple, science-based programs are now available to train well-being skills and reliably and accurately track the results. Those results can then be correlated with safety, retention, patient experience and clinical quality improvements. At Mission Health, we have begun to train these skills, and after just four months, we have seen significant increases in the well-being of trained staff, with more than 90 percent of participants reporting that it has improved their focus and productivity.
Going forward, health system leaders must measure their decisions against their impact on our clinicians’ well-being, and not just cost and quality. This is rare today, whether the decision involves a new technology, a new process or some other change affecting our clinicians. By demanding that “Well-being ROI” be evaluated along with financial returns and patient impact, well-being will be elevated in importance within the organization.
So how do health systems get started down this path? We think it’s pretty straightforward. First, name the problem. Second, commit to solving it. Third, enlist doctors and nurses as partners in finding solutions. And finally, measure your results, track your progress, and hold yourself and the system accountable for making the improvements that our doctors, nurses, team members and patients all deserve. The single most important thing: Get started.
Health system innovation comes in many forms. As we face unprecedented change and transformation in health care, we believe our next greatest innovations will be human capital innovation: innovation that improves the well-being of the people we rely on to deliver outstanding and efficient patient care and experience. Such innovation is essential to attracting and retaining the best and brightest and to achieving the necessary improvements in cost and quality that our nation so deserves.
We now have the science to improve well-being, and with the right kind of leadership, we have the ability to change the trajectory we are on, and restore joy and humanity to health care delivery. The transformation and sustainability of our health system depend on it.
Ronald A. Paulus, M.D., is president and CEO of Mission Health System in Asheville, N.C. David R. Strand is an operating partner with Abundant Venture Partners in San Francisco and the former chief operating officer of the Cleveland Clinic and Allina Health System.