Deciphering the drivers of burnout and how to prevent and alleviate it
Physician burnout is becoming a major challenge for healthcare organizations. It affects more than 50% of physicians, impacting every specialty, and reducing the capability to deliver safe and effective care
In addition, physician satisfaction with work life balance has decreased to 41%, far below the rate in the general public of 63%. Even more concerning, the vast majority (82%) of physicians believe that the executives in their health system don’t care enough to offer help.
Drivers of Burnout
To better understand what is happening, it’s key to recognize the manifestations and drivers of burnout.
According to researchers Maslach and Leiter, burnout is a result of a mismatch between the worker and the workplace that manifests as emotional exhaustion, depersonalization (also known as cynicism), and a sense of inefficacy (feeling that one’s work does not make a difference).
They identify six key mismatches that drive burnout:
- Work Overload – which is worsened for physicians by a chaotic work environment and constant time pressure
- Loss of Control – which relates to physicians’ deeply held value of professional autonomy
- Insufficient Rewards – lower reimbursements, decreasing prestige, and erosion of the joy of connecting personally with patients
- Breakdown of Community – less contact with colleagues as physicians are increasingly busy
- Absence of Fairness – erosion of trust, openness, and respect, and
- Conflicting Values – a greater focus on the bottom line than quality care.
When over 50% of physicians are experiencing burnout, the problem is not the physician’s personal inadequacy. Burnout is due to the interaction of three key components: the individual, the work environment, and the external influences that impact that work environment.
At the individual level, physicians are at unique risk. They are by necessity high achievers who work long hours, making life and death decisions with an ever-present threat of malpractice lawsuits.
Hospitals and clinics are complex organizations that provide a wide array of services from the mundane to extremely high tech. There is little standardization or predictability. The additional demands created by the EHR force physicians to spend significant time on tasks like data entry that supplant valued time with patients. The result is a workplace in which physicians provide quality patient care in spite of, rather than because of, the design of the workplace.
Why are hospitals such difficult places to work? Hospitals are impacted by multiple external factors that stymie physician effectiveness. These include the challenges of ICD-10, Meaningful Use, HCAHPS, changing reimbursement schemes, and patients with more complex chronic diseases and increasing cultural and linguistic diversity.
What to Do About Burnout
What are physicians and healthcare leaders to do about burnout? First, help those who need immediate support. Start or enhance a physician wellness program. Offer burnout coaches as well as mindfulness, relaxation techniques, and support for healthier living. Innovative health systems are providing dinner delivery, dry cleaning services, and additional days off after tough shifts.
Next, address the root causes of burnout – the overwork, lack of control, inadequate rewards, breakdown of community, fairness concerns, and misaligned values. This involves a two-step process to deeply understand the physicians’ situation and to support them to remove the barriers and frustrations that wear them down.
Partner with physicians, creating a culture of mutual respect:
- Develop a physician burnout advisory council led by the CEO, inviting both formal and informal physician leaders.
- Spend time with physicians in the clinical setting – shadow them to learn firsthand their challenges and frustrations.
- Do surveys of the medical staff, to learn which departments are at greatest risk and which drivers are most important in each department.
Lean, when done right, provides an excellent way to reduce the barriers and frustrations that drive physician burnout.
- Start with a commitment to Lean principles, especially Respect for People, empowering the physicians to lead the process of changing workflows.
- Charter a Value Stream in one or two departments, empowering the workers in those departments to improve their workflow.
- Develop a Daily Management System with huddles that solve problems at the front lines, and escalates problems that need additional support, up to the C-suite if necessary.
- Implement Strategy Deployment to clarify and align the organization’s goals, develop tactics that will achieve the goals, and identify the True North Metrics that measure progress toward the goals.
- Invest in the services that support all the above, including a Lean support team with experienced Lean coaches, HR policies that support your staff as they go through the changes, a decision support team that provides performance data, and a finance department that tracks financial performance proactively.
Lean management systems address key drivers of burnout and reduce the barriers and frustrations that physicians encounter every day as they care for their patients.
About the Author
Paul DeChant, MD, MBA, is a senior advisor at Simpler Consulting and the author of “Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine”, which is set to publish in December 2016.
