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The Hidden Healthcare Issue: Burnout

By Jen Volland, RN, D.H.A., CPHQ, NEA-BC, FACHE, NRC Health

Burnout is defined as “a longterm stress reaction marked by emotional exhaustion, depersonalization, and a lack of personal accomplishment.” In 2015, physician engagement was identified as the number one opportunity to improve the U.S. healthcare system and CEOs’ top strategic priority. In contrast, today it has become a focus on provider burnout. Clinicians are becoming increasingly apathetic during interactions due to caregiver fatigue and subsequently burnout. This leads to an inability to fully engage with patients.

While burnout is recognized within healthcare as important, the national trends show that the issue is on the rise—not improving. One in three physicians are experiencing burnout at any given time. One in four Americans have multiple chronic conditions, and older adults with multiple chronic conditions see 14 different providers per year on average. This equates to patients requiring the highest levels of medical management for complex conditions having on average at least four providers among

Signs of Burnout

  • Constant fatigue despite adequate
  • Increased sickness due to weakened
    immune system
  • Chronic headaches and pain
  • Increased/decreased sleep and/or
  • Feelings of self-doubt, helplessness,
    feeling trapped, or a sense of failure
  • Emotional detachment and feelings of
  • Lack of motivation
  • Decreased satisfaction in once
    pleasurable activities
  • Withdrawal from social obligations
    and personal responsibilities
  • Negative attitude and increased
  • Using food, drugs, or alcohol to cope

their care team potentially experiencing burnout  simultaneously. Additionally, a clinician’s ability to reliability determine their level of distress is poor. Among those with the lowest levels of well-being, most believed their well-being was at or above average levels. This lack of awareness can cause clinicians to ignore signs of burnout when it occurs.

The signs of burnout closely mirror chronic stress and other disorders (see sidebar “Signs of Burnout”). It also puts your organization at risk for lower satisfaction and quality of care, higher medical error rates and malpractice risk, higher physician and staff turnover, alcohol/drug abuse and addiction, and clinician suicide.

Burnout beyond Clinicians to the Boardroom Recently, at ACHE’s Congress on Healthcare Leadership, NRC Health had the opportunity to collect data from both senior executives and members of healthcare boards. The aggregated results are quite telling that burnout is a serious issue, not only for clinicians today but also for those serving on a board of directors (see Exhibit 1). While burnout is happening daily, we need to find ways to bring joy and well-being back to work for clinicians of all types, administrators, and board members.

What Can Be Done to Bring Back Well-Being to the Healthcare Setting? From the board level through the front-line staff, there are items that can help build well-being:

  • Engage: Clinicians need to be able to collaborate and have a sense of purpose in their work. Physician engagement should be fostered within the organization—it doesn’t happen on its own. A simple way to start is to create board–administration and administration–provider co-commitments. This helps reduce the feeling of hierarchy and embraces the relationships as a partnership. The co-commitments are documents that outline the organizational values and align the commitment of each group as a whole (e.g., administration and physicians).

Exhibit 1: Physician Well-Being Index

Question yes no
Have you felt burned out from your work? 83% 17%
Have you worried that your work is hardening you emotionally? 61% 39%
Have you often been bothered by feeling down, depressed, or hopeless? 42% 58%
Have you fallen asleep in traffic? 24% 76%
Have you felt that all the things you had to do were piling up so high that you could not overcome them? 51% 49%
Have you been bothered by emotional problems (such as feeling anxious, depressed, or irritable)? 57% 43%
Has your physical health interfered with your ability to do your daily work at home and/or away from home? 12% 88%

Source: Results of NRC Health polling executives and board members at the ACHE Congress on Healthcare Leadership, March 2019.

Individuals review and sign the document every one to two years as part of the promise to themselves, each other, and the organization, by aligning behavior with values.

  • Measure: Employee and physician engagement surveys are a start, but they unfortunately are only one-point in-time metrics. Important processes are monitored continuously throughout the year, and we should be thinking similarly when it comes to clinicians and patients. NRC Health recommends doing a well-being 7 M. Bridget Duffy, “Code Lavender: Transforming the Human Experience in Healthcare,” Vocera, 2010. survey at least six months after a physician/employee engagement survey to ensure you’re making improvements and that clinicians feel empowered and heard. The metrics used should align with both the organizational strategy and values.
  • Act: If you do nothing with the results because you’re waiting until there’s a unified plan, you lose precious time. To foster collaboration, clinicians need to be part of the building stage of the action plan. Delaying communication about the results does more damage to engagement than not surveying at all. Therefore, it’s important to get the results back to the individuals right away and enlist their help in creating the action steps towards an organization that provides better work–life balance and addresses well-being. This can also be included in board assessments. With the rate of burnout today, fostering well-being should be an item on everyone’s mind—including the board for ensuring everyone is engaged and not just “going through the motions.”
  • Help: Look for healthy ways to allow for decompression. Some organizations have adopted what’s termed a “code lavender.” This can be called by anyone when there are times of extreme stress such as a patient death. It’s the healing equivalent of a code blue that consists of a team of specialists who are called upon when an individual (patient, family, or employee) has reached their limit. Code lavender not only ensures an ability to move forward after a difficult case, diagnosis, or loss, it helps individuals cope with those situations. A code lavender may also include the board if it was, for example, a prominent individual in the community. The board can also help play a role by bringing forward additional ideas for ways to decompress or foster well-being that are emerging in areas outside of healthcare. Shifting from burnout to well-being starts at the top with the board and includes every level and area of the organization. When individuals lack a sense of purpose and an ability to deliver upon the reasons they went into healthcare, the ability to be fully present with patients and others quickly declines. Rather than annual surveys and hoping burnout will resolve itself, it starts with an accountability at the board level that maintaining wellbeing is everyone’s responsibility in healthcare, as much as casting a leg or making a diagnosis. Only by intentionally focusing on well-being as a part of the organizational culture that is owned by all, can individuals start to regain their joy and purpose while delivering exceptional care.