Extensive research has identified the causes and consequences of burnout; now it’s time for solutions.
More than half of doctors, and almost as many nurses, have reported high degrees of burnout stemming from longer hours and increased workloads. Burnout, characterized by emotional exhaustion, cynicism, job dissatisfaction and sometimes depression, can negatively impact not only the health of the individuals involved, but also patient safety and satisfaction, turnover and healthcare costs. And yet pressures to cost-effectively care for a growing population of elderly patients with high rates of chronic disease and comorbidities, make it a difficult problem to address.
Burnout is nearly twice as prevalent among physicians as US workers in other fields, and those working at the front lines of care (emergency medicine, family medicine, general internal medicine and neurology) are at the greatest risk. In a recent Harvard Business Review study, doctors, nurses, and other medical personnel all had similar levels of emotional exhaustion and cynicism, but doctors were the group least able to withdraw from work, rest and recharge.
The implications of this are staggering:
Quality of Patient Care
According to a recent Stanford study, physician burnout might be a greater source of medical errors than unsafe workplace conditions. Medical errors are common in the US and responsible for between 100,000 to 200,000 patient deaths annually. Burned-out physicians have more than twice the odds of self-reported medical error, and 10 percent of physicians reported to have made at least one major medical error in the past three months alone. The same study also found that the rates of medical errors tripled in medical work units, even those ranked as the safest, if physicians reported high levels of burnout. Among nurses, higher levels of burnout are associated with patient mortality as well as dissemination of hospital-transmitted infections. Burnout also increases the likelihood of care deficiencies, lack of professionalism and lower patient satisfaction.
Turnover and Productivity
Burnout leads to job dissatisfaction and more than 200 percent increases the odds that the physician develops the intent to leave their job. Turnover substantially increases healthcare costs. The cost of turnover of RNs is estimated at 1.2 to 1.3 times their salary, whereas it can cost anywhere from hundreds of thousands of dollars to over $1 million to replace a physician. Additionally, burned-out physicians tend to make more referrals and order more tests, another costly byproduct of the epidemic — not to mention errors, malpractice claims, and absenteeism. Furthermore, a Mayo Clinic study found that every 1-point increase in exhaustion or 1-point decrease in job satisfaction was associated with a 28 percent and 67 percent greater likelihood, respectively, of reduction in professional effort, a national problem that’s exacerbating our struggle to meet the needs of an aging population.
Burnout leads to a 25 percent increase in alcohol use/dependence and 200 percent increased odds of suicidal thoughts among physicians. The suicide rate among male physicians is currently 40 percent higher than other males in the population, and the rate among female physicians is 130 percent higher than other females. It’s also been linked to other health risks, such as heart disease, high blood pressure, Type-2 diabetes and vulnerability to other illnesses.
Burnout has been associated with a number of factors: stress, process inefficiencies, excessive workloads, home and work-life balance issues, management dysfunction, increased administrative work due to Electronic Health Records initiatives and toxic organizational cultures. The Mayo Clinic defines causes of job burnout as comprising the following: a lack of control (over schedule, assignments, workload and other decisions affecting one’s job); unclear job expectations; toxic workplace dynamics (bullies, micromanagers, lack of teamwork); activity extremes such as the constant chaos of many hospitals; work-life imbalance; and a lack of support at work, at home, or both.
We already know that physicians and nurses are seeing too many patients, working too many hours, and receiving too little support from other medical staff. But with burnout negatively impacting productivity and turnover, what can be done? It is, no doubt, a complex and intimidating problem to address, but leadership can begin by soliciting honest feedback from staff on what workplace issues contribute to burnout and seek to create a holistic and systems-based approach to addressing those issues, as well as regional or practice-level initiatives. The drivers of burnout have been defined, and there’s a wealth of research indicating what they are, their consequences and what approaches can be taken to combat them. Each workplace is individual, with unique stressors, and how they manifest will vary, but there are still several universally beneficial places to begin the process:
Measure the Problem
Score physician depersonalization with other quality measures to help devise a comprehensive program to address patient safety and outcomes. Reporting and measurement should be standardized across the organization and all locations to develop the best understanding of the issues at hand. Programs should be aimed at identifying the root causes of burnout in your facilities, developing a full understanding of the issues and targeting prevention.
In instances where burnout triggers vary across a health system, prioritization can be a great starting point. You can do so by identifying the locations/divisions/departments with the highest burnout rates and the lowest satisfaction rates and start there. This will allow you to focus on specific issues within a local work unit and implement targeted intervention strategies.
Assist With Decompression
Get to the bottom of why physicians and nursing staff are unable to decompress and recharge. How is the inability manifesting itself? Is it in a decreased ability to sleep at night? Is it because they’re always on call or receiving work communications during free time? Find out what environmental stresses are prohibiting decompression and create programs to address them.
Seek to design initiatives that reconnect staff with the meaning inherent in their roles. Staff should be regularly shown and reminded how their efforts have saved and enhanced patient lives. Such initiatives would also contribute toward improving workplace culture, shifting the organizational tone to one that’s more positive and appreciative.
Promote Stress Reduction
This could take many forms, from providing stress reduction programs/activities such as yoga, meditation or tai chi, to employing massage therapists to provide short stress reduction massages to nurses and physicians throughout the workday. Also ensure that nurses and physicians are able to work reasonable schedules and take time off at regular intervals.
Better Support Residents and New Physicians
Investment in the wellness, values and healthy habits of residents will pay off in the decades ahead. Physician behavior, routines and customs are largely set during early career years and good practices early on can help stave off problems down the line.
Redesign Cumbersome Work Processes
Design work processes with an eye toward stress reduction. Find ways to relieve the administrative burdens of physicians and nursing staff. Process improvements need to work for the organization as a whole as well as its key players. Any developments that add to existing workloads should be avoided and, wherever possible, administrative strain should be trimmed.
Preventing burnout may also be a matter of ensuring you have the right leadership in place. Senior management has a direct effect on physician satisfaction. Great leadership listens, helps physicians and staff understand their job expectations, assists with career development, makes staff feel more appreciated and advocates for meaningful change.
Burnout is a national epidemic that needs to be addressed. Thankfully, it can be. By methodically eradicating its drivers across our organizations, we’ll improve the lives of countless healthcare workers, lower costs, save lives and assuage the impending physician shortage.