Paula explains why burnout is a real issue in healthcare & what organizations can do about it in her interview with Hospitals & Health Networks
Heavy patient loads, changes to healthcare via the Affordable Care Act, EMR requirements, smaller staffs, and higher stress levels are leading to burnout for medical professionals. Almost 75% of US physicians are now employed by hospitals, academic medical centers, HMO’s and large practice groups. Gone are the days of solo practitioners and small group practice models.
Physician and nursing burnout and job satisfaction have been linked to quality of care, attrition and turnover, and patient satisfaction in numerous studies (see Reference section below).
Burnout & Patient Safety
One study looking at surgical error rates found that for each 1-point increase on the exhaustion scale of the Maslach Burnout Inventory (MBI) there was a commensurate 5% increase in likelihood of a surgeon reporting an error; each 1-point increase on the cynicism scale of the MBI translated into an 11% increase in likelihood of reporting an error; and each 1-point increase on the personal efficacy scale of the MBI meant a 3.6% decrease in the likelihood of reporting an error.
Among healthcare professionals on critical care teams, higher levels of burnout correlated with lower team communication and team efficacy. Those teams with higher team efficacy saw fewer infections.
Poor Leadership Drives Burnout
Good leadership in healthcare organizations, whether in the form of an inspiring manager, getting regular feedback, or simply knowing that your leader has your back, can help prevent burnout. Research also suggests that bad leaders aren’t just toxic to an organization – they drive burnout and decrease job satisfaction. Respondents were asked to provide a detailed evaluation of the leadership qualities of their direct supervisor and to numerically rate the extent to which they agreed or disagreed with 12 statements about this person. For each 1-point increase in composite leadership score, there was a commensurate 3.3% decrease in likelihood of burnout and a 9.0% increase in the likelihood of job satisfaction. Think about how that translates into bottom line dollars – less attrition and turnover, higher patient/client satisfaction scores, and a reduced instance of errors.
Unfortunately, aspects of the medical culture haven’t changed much, and disruptive behavior by residents and attending physicians is often tolerated, teamwork isn’t a focus, and doctors and medical students simply have to deal with the stress, pressure, and extremely long hours in combination with a lack of sleep.
Physicians and Medical Students
Physicians who are burning out are more prone to errors, are viewed as less empathetic, are more likely to quit the practice of medicine and self-report more instances of suboptimal care.
Approximately 50% of medical students experience burnout and up to 75% of residents report feeling burnout at any given time, depending on specialty.
Burnout doesn’t have to be eradicated before organizations see quantifiable bottom line impact. One study showed that a 30% reduction in nurse burnout led to 6,239 fewer infections and an annual cost savings of approximately $68 million.
Research also shows that of the three burnout dimensions – exhaustion, cynicism, and inefficacy – cynicism plays a pivotal role in determining whether a nurse intends to leave his or her current position.
Resilience training programs can help alleviate and prevent burnout symptoms. The presence of psychological resilience was independently associated with a lower prevalence of burnout, anxiety and depression in ICU nurses. In addition, higher levels of optimism & proactive coping behavior have been associated with lower levels of burnout among nurses. These are skills that can be taught.
Caregivers and Burnout
The phrase caregiver burnout is often associated with medical professionals, but not all medical professionals burn out. As it turns out, there are different types of “givers” according to organizational psychologist, Dr. Adam Grant. Selfless givers are very other-interested; meaning, they focus all of their time and energy on other people. “Otherish” givers, on the other hand, care about benefiting others, but they also have ambitious goals for advancing their own interests. It is the selfless givers who tend to be more prone to burnout.
You Need to Feel Like You’re Making an Impact
It’s critical for professionals to feel like they’re making a difference. Simply attaching a patient’s picture to a CT exam increased diagnostic accuracy by 46%. When radiologists saw a patient’s photo, they felt more empathy. The pictures motivated the radiologists to be more careful in their diagnoses; in fact, their reports were 29% longer when the patient’s photo was included (Turner et al., 2008). When nurses assembling surgical kits met the health-care practitioners who would use their kits, the nurses worked 64% more minutes and made 15% fewer errors than those nurses who did not meet the “end user.” Impact reduces the burnout of givers.
7 Things Resilient Doctors Do Differently
If so many physicians are burning out, what are the ones who aren’t burning out doing? Research points to specific stress resilience strategies healthy doctors utilize on a regular basis:
1. They build in recovery time and re-charge their batteries more often than not
2. They cultivate high-quality connections and relationships
3. They say “I don’t know” and “I need help” (not an easy thing to do in the healthcare culture)
4. They make time for personal reflection
5. They set boundaries
6. They find the good stuff
7. They are realistically optimistic
All of these stress resilience strategies can be taught with science-based practices…
For more information about how to prevent burnout in healthcare and develop stress resilience at your organization, please visit our training/workshops page and our speaking page. For individuals in healthcare, please take a look at the coaching programs we offer.
Cimiotti, J., et al. (2012). Nurse staffing, burnout, and health care-associated infections. American Journal of Infection Control, 40(6), 486-490.
Grant, A. (2013). Give and Take. New York: Viking.
Shanafelt, T.D. et al. (2010). Burnout and medical errors among American surgeons. Annals of Surgery, 251(6), 995-1000.
Turner, Y.N., Hadas-Halperin, I., & Raveh, D. (2008). Patient Photos Spur Radiologist Empathy and Eye for Detail. Paper presented at the annual meeting of the Radiological Society of North America, Chicago, IL. See also, How to Be a Positive Leader, Jane E. Dutton and Gretchen M. Spreitzer (Eds). San Francisco, CA: Berrett-Koehler Publishers, Inc.
West, C.P. et al. (2009). Association of resident fatigue and distress with perceived medical errors. Journal of the American Medical Association, 302(12), 1294-1300.
West, C.P. et al. (2006). Association of perceived medical errors with resident distress and empathy; A prospective longitudinal study. Journal of the American Medical Association, 296(9), 1071-1078.