By Ted A James, MD, MHCM, FACS
March 29, 2018
Burnout is an all too common phenomenon that needs to be on the radar of all health care leaders. In addition to serious personal consequences, burnout poses a significant threat to patient care and negatively impacts organizational performance. Many approaches to addressing this problem focus on improving self-care and adopting practices like mindfulness and meditation. Although these activities are generally helpful for personal well-being and resiliency, they miss the true root cause of physician burnout. Burnout needs to be recognized as an organizational problem and primarily addressed at a systems level, rather than at an individual level.
Impact of Burnout on Health Care
Successful health care transformation requires engaged physicians working in collaborative teams to redesign care delivery. Burnout undermines these efforts. The classic triad of burnout consists of emotional exhaustion, depersonalization, and low personal fulfillment. Glen Gabbard, a professor of psychiatry at Baylor University, describes burnout as an “erosion of the soul caused by deterioration of one’s values, dignity, spirit and will….joyless striving.” The causes of burnout are not surprising, with increasing administrative tasks and growing clinical volume demands at the top of the list. Essentially, physicians are being asked to do more and more with less and less. The resulting stress can lead to cynicism, frustration, and ultimately a tragic downward spiral characterized by a sudden decrease in performance, displays of inappropriate behavior, and an inability to deliver adequate care. Sadly, substance abuse and suicidal ideation are other potential consequences. On an organizational level, burnout results in poor clinical outcomes, decreased patient satisfaction, diminished productivity, and increased physician turnover. In a 2016 survey of the NEJM Catalyst Insights Council composed of health care executives, clinical leaders, and clinicians, decreased quality was listed as the number one reason to address burnout, followed by the negative effect on team attitude.1
The Role of Health Care Leaders
Leaders can play an important role in reducing burnout and promoting physician engagement by making it a priority to monitor and benchmark physician wellness as a metric of institutional success. When organizations support quality improvement initiatives that address concerns of clinicians and adopt strategies that reduce clerical burdens that detract from patient care, physician well-being and performance improve. One example is implementing ‘top-of-license’ practice to allow physicians to focus on the work that only they can do, while delegating additional tasks to other team members. Leaders can also cultivate a sense of autonomy by promoting flexibility and input into work schedules and working conditions. Many organizations have formed physician wellness committees to spearhead these types of initiatives. Given the personal, professional, and organizational costs of burnout, these strategies can yield a significant, long-term return on investment.2
Leaders must also change the culture to one where the risk factors and warning signs of burnout can be discussed openly and safely. We have to make it easy for health care professionals to find help when needed and create appropriate support systems. These interventions can have a powerful and transformative effect.
Finally, the problem of burnout in health care must be brought into the public arena. The link between burnout and issues of patient safety and access must be made clear. Only when physician burnout is seen as an imminent public health crisis will we gain the political will to make meaningful changes.
- Leadership Survey: Why Physician Burnout Is Endemic, and How Health Care Must Respond. Insights Report · Stephen Swensen, Tait Shanafelt, Namita Seth Mohta. NEJM Catalyst, December 8, 2016
- The Business Case for Investing in Physician Well-being. Tait Shanafelt, Joel Goh, Christine Sinsky. JAMA Intern Med. 2017;177(12):1826-1832
Dr. Ted James is the Chief of Breast Surgical Oncology and Vice Chair of Academic Affairs at BIDMC/Harvard Medical School. Dr. James obtained a Master in Health Care Management degree and is involved internationally in leadership development and health care transformation. Follow Dr. James: LinkedIn / Twitter
*OPINIONS EXPRESSED BY OUR GUEST AUTHORS ARE VALUABLE TO US AT LEAN FORWARD, BUT DO NOT REPRESENT OFFICIAL POSITIONS OR STATEMENTS FROM HARVARD MEDICAL SCHOOL.