Physician burnout is in the news a lot these days. More than half of physicians report at least one sign of burnout,[i] and three out of four nurses cited the effects of stress and overwork as top job concerns.[ii]
The Experience Innovation Network, part of Vocera, just completed a market research study to understand the causes and consequences of burnout. The study delves into how forward-thinking organizations are building cultures and processes that support resilience, well-being, and joy among all members of the care team. We fielded a survey of more than 150 leaders and frontline staff, and conducted in-depth interviews with more than 40 healthcare executives, academics, and thought leaders.
Well Being: High Value, Low Priority
When we asked survey respondents how important the well-being of physicians, nurses, and staff is to their organizational success, 91% said it was very or extremely important. However, when we asked respondents to rank physician and nurse well-being among other critical priorities such as quality, safety, financial performance, and even patient-family experience, the well-being of both groups fell to the bottom of the list – by a lot. This isn’t an indictment of leaders’ views on the need to support their teams; it’s an indication of how important the priorities they juggle are. No one wants to pit the well-being of physicians, nurses, and staff against the quality and safety of care they provide.
This seeming contradiction is at the heart of what differentiates organizations that elevate resilience, well-being, and joy to a top strategic priority from those that try to address it in a more tactical way. The most strategic approaches recognize that the well-being of physicians, nurses, and staff is integral to quality, safety, financial success, and the patient-family experience. They view the Quadruple Aim as the unifying factors that must drive all strategic decision making, not as four separate initiatives.
Reducing Burnout Helps Improve Outcomes and Lower Costs
These leaders aren’t just taking a leap of faith. There’s strong evidence linking burnout with the incidence of medical errors, infection rates, and mortality rates
So what do healthcare executives do when they elevate resilience, well-being, and joy to a top strategic priority?. One study used multivariate analysis to show that nurse burnout rates are significantly associated with both urinary tract infections and surgical site infections. The same study showed that hospitals which reduced burnout rates by 30% had a total of 6,239 fewer infections, for an annual cost savings of up to $68 million.[i]
They take a multi-faceted approach to address burnout. They provide the individual and team-based tools that help physicians, nurses, and staff withstand the trauma of dealing with life-and-death responsibilities, and the pain and loss that come with providing care. But they don’t stop there.
They also seek to minimize trauma that can be inflicted by poorly designed processes, inefficient workflows, and non-supportive team dynamics. They do this while consistently reinforcing the purpose and meaning that can get buried when caregiving gets overly focused on tasks.
Infusing “Heart” and Regaining Purpose for Better Care
In our research, a few organizations stood out in their strategic focus on resilience, well-being, and joy:
- Leaders at Lakeland Health in southwest Michigan have worked to infuse human connection in leadership by infusing “heart” into everything they do. They’ve focused on relationships between patients and care team members, instructing team members to always introduce themselves and their roles with “the who, the what, and a heartfelt why.” They’ve strengthened relationships between leaders and front-line team members through townhall meetings and a culture of storytelling. And they’ve stressed listening with the heart as an approach to teamwork across physicians, nurses, and staff and with care teams and patients. As Lakeland Health CEO, Loren Hamel, MD, told us, “It doesn’t matter how you work to drive resilience, wellbeing, and joy. It matters if it is embedded in everything you do. It needs to be such a deeply held belief—such a consistently demonstrated value and inspiringly discussed attribute of the organization—that it’s who you are.”
- At Novant Health in North Carolina, rising physician leader Tom Jenike, MD, had his own run in with burnout and then found renewed purpose through personal coaching. He and his coach translated his experience into a program focused on rejuvenation, regaining purpose, self-awareness, and recognizing patterns and biases. Based on the success of an initial program aimed at his physician peers, and with the backing of CEO Carl Armato, Dr. Jenike has expanded the program to other advance practice clinicians (such as nurse practitioners, physician assistants, etc.) and leaders across the organization. The team is now rolling an abridged version of the program for frontline care team members. “We’re starting by getting really clear about what we’re committing to being,” said Dr. Jenike. “If we’re going to have integrity, our actions need to follow our commitment. We’re trying to be world class at caring for our people so they can be world class at caring for our patients.”
- Ascension, the largest Catholic health system in the U.S., is building a One Ascension experience that places persons and families, and the physicians and associates who serve them, at the center. “You can’t improve the engagement in person-family experience until you focus on the associate and provider first,” said Ann Hendrich, RN, PhD, Senior Vice President, Chief Quality, Safety, and Nursing Officer. As part of its approach, Ascension is using myVoice weekly pulse surveys of providers and associates, asking them to respond to a single question. The data collected on associates’ well-being and engagement filters up to the system’s balanced scorecard and leader metrics, as well as down to ministry-level improvement efforts.
- Mission Health in North Carolina is undertaking a multi-faceted cultural transformation in support of its top strategic priority, to “Become a Truly Great Place to Work and Practice.” A key component of that plan is Mission: reNEW, a recalibration of its continuous process improvement approach aimed at understanding and elevating caregiver joys while minimizing the daily hassles that make their caring work more challenging. “Mission: reNEWis more than a project, it is a core belief at Mission Health as we strive to cultivate an environment where the understanding, application, and accountability to the principles of just culture and continuous improvement are embraced by every team member,” stated Stephanie Baron, VP Performance Improvement and executive leader of Mission: eNEW. President and CEO, Ronald A. Paulus, MD, championed this frontline endeavor, building upon Mission’s strengths-based approach to increasing team member engagement that focuses on enabling team members to maximize the time spent working in their strengths, as well as personal well-being training for leaders and staff.
Five Steps Toward the Sustainable Care Systems of the Future
Addressing the challenges of burnout and building cultures and environments that support resilience, well-being, and joy takes a deep-seated commitment across an entire organization, as the examples above illustrate. Our research uncovered five key steps that leaders can take to solidify their own journeys build the sustainable care systems of the future:
- Address resilience, well-being, and joy at every level
- Design and diffuse a metric for humanity
- Elevate the office of human experience
- Build deeper partnerships with patients
- Promote accountability beyond the system
You can access the full report and read more about these forward thinking approaches here.
[i] Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Shanafelt, Tait D. et al. Mayo Clinic Proceedings , Volume 90 , Issue 12 , 1600 - 1613
[ii] 2011 ANA Health & Safety Survey. Hazards of the RN Work Environment
[iii] Cimiotti et al. Am J Infect Control. 2012;40(6):486-90