This is the third article in a series regarding process-based opportunities as the healthcare industry begins to emerge from the challenges of the pandemic. As noted in the introduction to this series, each of these articles will define an issue, consider the problem and its implications to healthcare, and then present potential solutions.
Clinician burnout has been one of the leading challenges faced in healthcare during the COVID-19 pandemic – parallel with a nursing shortage and a projected shortage of physicians looming not too far in the future.
While the majority of burnout studies and research have centered on physicians, burnout has long been recognized as an issue for the entire care team. Nothing has exposed this reality more starkly than the pandemic, with millions of Americans daily watching images on the news of hospital and health system staff being worked to death before their eyes.
As we begin to get a handle on the pandemic, things will go back to some semblance of normal in hospitals, health systems and physician practices, and care teams will return to their regular processes.
That means the seeds of burnout will still be there in those processes but may have much more fertile ground in which to grow after what we all have been through. It will be our job as healthcare leaders to turn this around.
First, let’s look at what burnout is and is not. Burnout is not depression or anxiety, though it can present some of the same symptoms. It is not something that quickly takes over your mind, but rather a gradual process that escalates over time, and one of its core causes is chronic stress. In 2019 the World Health Organization classified burnout as an “occupational phenomenon,” and defined it this way:
“Burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job.”
Implications for healthcare
In addition to the effects of burnout on the individual, there are major implications for healthcare overall. The National Academy of Medicine calls burnout among clinicians a serious threat to organizational health. One of the most recent and widely cited studies on provider burnout estimates the costs of physician burnout to the U.S. healthcare industry at $4.6 billion per year, mostly due to turnover and reduced clinical hours. That’s an annual cost of $7,600 per employed physician per year.
Nurses on the care team are also affected. A survey of 1,688 direct-care nurses in three hospitals conducted a year apart (2018 and 2019, with 3,135 total surveys) found that 54% of the nurses suffered from moderate burnout, and 28% experiencing high levels of burnout.
The surveys also found that emotional exhaustion scores increased 10% and cynicism scores increased 19% after 1 year. For each unit increase in the emotional exhaustion scale, the study showed that there was a 12% increase in turnover. These surveys were completed just before the pandemic. Imagine what has happened in the past two years.
The Medscape 2021 Physician Burnout & Suicide Report, released in January, shows that the pandemic has worsened burnout, according to the more than 12,000 physicians who participated in the study. In this year’s study, 42% of physicians reported they were burned out, with 21% of them reporting that their burnout symptoms began after the start of the COVID-19 pandemic.
The top six contributors to burnout cited by participants in the survey are familiar to those who study burnout in healthcare:
- Too many bureaucratic tasks
- Spending too many hours at work
- Lack of respect from administrators/employers, colleagues, or staff
- Insufficient compensation/reimbursement
- Lack of control/autonomy
- Increasing computerization of practice
Solutions to burnout in the workplace
The big takeaway from the earlier definition is that burnout is stress that has “not been successfully managed.” Just as there are ways that providers can manage their own chronic workplace stress individually, there are also solutions that organizations can put in place on a process level on the front end to reduce or eliminate those top contributors to burnout in the workplace and the impacts they have.
The common denominator that causes clinician burnout is too many tasks to do in a limited amount of time. The more we can do to automate and equip the clinician to be resilient, the better. In order to resolve the organizational and bottom-line effects of burnout in healthcare, emphasis needs to be placed on four areas:
Training. We often train clinicians once in a given technology, such as the EHR, and then we let them go forever. If you don’t refresh their knowledge as functionalities change and new upgrades happen, they are going to become overwhelmed.
Governance. Understanding when to roll out new processes and procedures and the impact it has on the rotation and the intake of patients and on productivity is what good governance is all about. Leaders need to comprehend the impact of their decisions so that they can efficiently and effectively manage the flow, so the stakeholders are not being inundated.
Communication. Engage the stakeholders early and communicate with them non-stop, ensuring they are always aware of what’s going on, using different channels and methods to communicate.
System building. The term system building may sound technical, but it is not about technology as much as it is about processes. Your goal is to build agile, effective processes that don’t require the clinician to do the same things multiple times. Anything we can do to decrease the number of clicks, the number of screens they open, or the number of places they have to go to for information will go a long way toward reducing their level of burnout.
Focusing on these areas can undo some of the human and financial damage done in healthcare organizations from years of inefficient operations, outdated technologies and lack of integration in care teams.
This will give care team members more time to concentrate their attention on something they care deeply about and that benefits the entire organization—providing high-quality patient care.
Sam Hanna is an executive-in-residence at American University. Prior roles include being a consulting practice leader, a chief strategy and innovations officer, and a digital strategist at global consulting firms such as PwC and Deloitte. He holds a PhD in Translational Health Sciences from The George Washington University and a MBA in Entrepreneurship from Babson College.