Five Ways Healthcare Organizations Can Confront Burnout and Build Cultures of Well-Being and Resiliency
Laura M. Cascella, MA, CPHRM
The impact of organizational culture on productivity, morale, staff retention, patient outcomes, safety, security, and overall well-being in healthcare is profound. A toxic culture can enable or even encourage a range of inappropriate and harmful behaviors, such as bullying, sexual harassment, and abuses of power. In these situations, the cultural deficiencies and their consequences might be conspicuous. In other circumstances, though, cultural problems might not be toxic in an overt way. Rather, more discreet issues — such as suboptimal processes, workload fatigue, loss of autonomy, and work–life imbalance — can compound to produce a pernicious effect, such as clinician and staff burnout.
Burnout might not always be as discernable as other cultural problems, but it is no less concerning and should be approached with the same level of resolve. Yet, how healthcare organizations address burnout can be tricky because of its diverse causes and the ways in which individuals react to stress and cope with negative emotions. As a recent study explains, "Different factors specific to the workplace can set the stage for burnout onset, while the nature of personality influences the interpretation of work characteristics, the different strategies to cope with the stressors, and the interactions with the work environment."1
Because of the broad nature and unpredictability associated with burnout, a single or narrowly targeted approach is not likely to offer a blanket solution. Rather, healthcare organizations should consider implementing strategies that support a comprehensive culture of well-being and resiliency. This article describes five ways that organizations can begin to work toward that goal.
1. Engage Organizational Leaders in Cultural Improvements
Organizational leaders typically set the tone for organizational culture, so strong leadership support to combat burnout and develop wellness initiatives is imperative. The pervasive and costly effects of burnout can help support the business case for investing financial and human resources in efforts to improve well-being. Research suggests that more than half of physicians experience at least one symptom of burnout (an increase from years past), and a 2017 study showed that nearly half of nurses working in the United States have considered leaving the field due to symptoms of burnout."2
Further, burnout can result in medical errors, loss of productivity, and staff turnover — all of which can have serious financial and reputational implications. Some healthcare organizations have noted that it costs between $250,000 and $1 million to replace a physician depending on specialty and rank,3 and the National Task Force for Humanity in Healthcare estimates that burnout-related physician turnover could be costing U.S. hospitals and health systems as much as $17 billion each year.4
With leadership awareness and support, organizations can begin to address the emotional, financial, and safety impacts of burnout through programs and outreach that build the foundation for a culture of well-being and resiliency.
2. Involve Clinicians and Staff Members in Decision-Making, Planning, and Implementation
Once organizational leaders have been engaged and their support is procured, work can begin to develop plans and strategies for diminishing burnout, enhancing wellness, and improving resiliency. Involving key stakeholders — clinicians and staff members — from various areas within the organization can help garner important insight, convey the importance and seriousness of the burnout problem, and inspire buy-in for initiatives.
The consensus study report, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being, from the National Academies of Sciences, Engineering, and Medicine (NASEM) recommends creating a leadership role at the executive level that is responsible for improving and sustaining well-being throughout the organization. That leader, with a support team, can provide oversight of the institution's burnout programs and assist other teams throughout the organization with coordinating improvement processes.5
Additionally, both NASEM and the Institute for Healthcare Improvement (IHI) recommend using multidisciplinary teams working in partnership to identify factors and situations that can contribute to burnout and to develop strategies that help address these issues across disciplines and units.6
3. Consider and Assess the Different Dimensions of Wellness and Well-Being
How individuals define well-being can vary and might include wellness and satisfaction related to physical health, spirituality, personal and work environment, mental and emotional health, finances, social interactions and support, intellectual fulfillment, and occupational factors.7 These dimensions are subjective and will likely vary across different departments, specialties, provider types, and individuals.
Understanding the many facets of wellness and how burnout can affect them is pivotal for developing a comprehensive approach to well-being and resiliency. To address this challenge, organizations should survey clinicians and staff members to determine their:
- Current levels of burnout (using a validated tool, such as the Maslach Burnout Inventory)
- Perceptions of general or overall wellness
- Perceptions of wellness in various domains
- Beliefs and impressions about the factors that contribute to burnout and barriers that prevent well-being and joy in work
Data collected from the surveys can help identify areas in which clinicians and staff members feel satisfied or are struggling, and analysis of the results can help improvement leaders and teams focus and manage their initiatives.
4. Prioritize Improvement Activities
As mentioned previously, identifying and implementing effective solutions for reducing burnout can be complicated because of its various causes and how individuals internalize and cope with the emotional aspects of burnout. However, the information gathered from surveying clinicians and staff will help improvement leaders and teams identify predominant areas of concern and prioritize how to develop and implement solutions.
When analyzing survey results, it will likely become apparent that not every barrier is easily tackled, and not every strategy is straightforward. Some of the factors that contribute to burnout, such as regulatory burdens and dissatisfaction with elements of the external environment, cannot be addressed at the organizational level. Other factors — such as frustrations with technology, staffing, schedules, and workflows — might require extensive planning and resources to address.
In other situations, the individuals or teams leading improvement efforts might find that simple and low-cost approaches can contribute to well-being and joy in work. For example, an internal medicine residency program in Indiana found that simple innovations — such as a photo contest, enhanced social media engagement, an office fitness circuit, peer support interventions, fitness challenges, and increased social events — helped reduce burnout and promote well-being.8
Regardless of the scope of the strategy or initiative, coordination and transparency are crucial. For large-scale or long-term improvement efforts that might have a ripple effect throughout the organization (e.g., improving existing technologies or implementing new systems or workforce models), improvement leaders and teams should ensure close coordination across departments and among workers.
Additionally, clinicians and staff members should be aware of ongoing efforts to support cultural improvements and engaged as appropriate based on their roles and the impact of strategies on their workflows or responsibilities. Even if results are not immediate, knowledge of these efforts can help foster positive feelings and contribute to well-being.
5. Measure and Adjust Strategies and Initiatives
As with any quality or performance improvement activity, efforts to alleviate burnout, mitigate its consequences, and enhance well-being and resiliency should be monitored over time and adjusted to provide optimal results. Improvement teams can use various methods to provide periodic monitoring, including reviewing metrics associated with workflow modifications and technology improvements (e.g., reducing the number of clicks or the number of screens necessary to complete a task in the electronic health record), evaluating clinician and staff participation in different types of wellness initiatives, analyzing the breadth and quality of learning opportunities, and reviewing patient satisfaction surveys and patient complaints for trends that might be indicative of burnout issues.
Additionally, the organization should commit to administering periodic burnout assessments and wellness surveys. A NEJM Catalyst report on burnout advises that "Leaders should get in the habit of measuring clinician joy, camaraderie, engagement, and satisfaction, just as you would a patient's vital signs."9
The data gathered from monitoring will help identify programs and strategies that are working (and those that have minimal or no return), further define how to focus and prioritize efforts, and determine potentially new issues that arise as the healthcare landscape and the factors that contribute to burnout evolve.
In Summary
Burnout is a complex and widespread issue in healthcare that has serious workforce, patient care, and financial implications. A prudent approach for managing burnout involves developing broad initiatives and strategies that address its distinct causes and support comprehensive solutions. By engaging leaders, involving key stakeholders, considering the various dimensions of wellness and well-being, prioritizing improvement efforts, and continually monitoring and optimizing strategies, healthcare organizations can lay the foundation for a culture of well-being and resiliency.
Endnotes
1 Wiederhold, B. K., Cipresso, P., Pizzioli, D., Wiederhold, M., & Riva, G. (2018). Intervention for physician burnout: A systematic review. Open Medicine (Warsaw, Poland), 13, 253–263. doi:10.1515/med-2018-0039
2 Shanafelt, T. D., Hasan, O., Dyrbye, L. N., Sinsky, C., Satele, D., Sloan, J., & West, C.P. (2015). Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clinic Proceedings, 90(12), 1600-1613. doi: 10.1016/j.mayocp.2015.08.023; Nursing.org. (n.d.). Nurse burnout. Retrieved from www.nursing.org/resources/nurse-burnout/
3 Swensen, S., Strongwater, S., & Seth Mohta, N. (2018, April). Leadership survey: Immunization against burnout. NEJM Catalyst. Retrieved from https://catalyst.nejm.org/survey-immunization-clinician-burnout/
4 Berg, S. (2017, November 17). At Stanford, physician burnout costs at least $7.75 million a year. American Medical Association. Retrieved from https://www.ama-assn.org/practice-management/physician-health/stanford-physician-burnout-costs-least-775-million-year
5 National Academies of Sciences, Engineering, and Medicine. (2019). Taking action against clinician burnout: A systems approach to professional well-being. Washington, DC: The National Academies Press. https://doi.org/10.17226/25521
6 Ibid; Perlo, J., Balik, B., Swensen, S., Kabcenell, A., Landsman, J., & Feeley, D. (2017). IHI framework for improving joy in work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement.
7 Boston University Center for Psychiatric Rehabilitation. (n.d.) Eight dimensions of wellness. Retrieved from https://cpr.bu.edu/living-well/eight-dimensions-of-wellness/
8 Porter, S. (2019, December 4). Residency innovation creates path to physician well-being. AAFP News. Retrieved from www.aafp.org/news/focus-on-physician-well-being/20191204wellbeingstudy.html
9 Swensen, et al., Leadership survey: Immunization against burnout.
