While the topic of burnout among hospital CEOs is not new, there are new dynamics in play to consider as part of the discussion. Those in the role today encounter increased pressures ranging from financial to operational.
"There are new pressures that have emerged in the healthcare delivery world — everything from reimbursement cuts and escalating drug and supply costs, and labor expenses — that have created a lot of financial headwinds for organizations," said Scott Sette, a partner with Chicago-based executive search firm Heidrick & Struggles. "Plus, regulatory changes have forced CEOs to spend more resources on compliance, cybersecurity, EMR administration."
Additionally, "there have just been so many workforce challenges. Organizations are typically understaffed, their staff are working long hours. Then you have the impact of the remote and hybrid workforce and the impact of that on organizational culture. Plus, you've got many social issues going on. Clearly, [diversity, equity and inclusion] continues to be top of mind, but also you've got political unrest. You have mass shootings. You have gender-affirming care and other social issues that organizations have to address. And all of these topics [have] created even more pressures for hospitals and health systems to deal with, in addition to delivering high-quality care and delivering customer-centric experiences. There is a lot for CEOs to deal with on a daily basis."
Marc Boom, MD, has served as president and CEO of Houston Methodist, an eight-hospital system with more than 32,000 employees, since 2012. He acknowledged these pressures in a recent interview with Becker's. He also discussed the prevalence of burnout and shared advice for how leaders can reduce the potential for it.
What follows is that conversation with Dr. Boom, which has been lightly edited for concision and clarity.
Question: How prevalent do you believe stress and burnout are among hospital CEOs and executives, and what do you see as the primary contributing factors to this trend?
Dr. Marc Boom: Being a hospital CEO is an amazingly great job, so I preface it with that. Still, we all recognize that you can fight burnout and manage burnout and minimize burnout. But, of course, it doesn't mean those individuals are immune to burnout. There are things that can go on that can cause burnout.
Do I think there are a higher number of CEOs facing burnout now that there were?
Perhaps. Probably a little bit.
Why is that?
First and foremost, the pandemic was an exhausting couple of years, and that's a long period of time. And it's really hard to recharge your batteries, and I think some people have struggled with that, especially as a number of institutions came out of COVID. Then the next thing you know, you're dealing with a lot of difficult economic dynamics.
I think for most CEOs, some of the hardest times are certainly when you're facing tough strategic and tough financial challenges. I do know that halfway through 2022 into 2023, a lot of people felt almost powerless. They were facing these dynamics, and so many of them were so far out of their control. Flying high inflation, still dealing with staffing struggles post-COVID, staff burnout. You're the one needing to put on a good face and be in front of everybody and be in a good spot to help manage others through burnout. I think all of that is hard.
I can remember talking to a couple of colleagues, and literally hearing them say, "In other times I was facing financial struggles during my career, there was a playbook. You sort of roll up your sleeves. It's no fun, but you know how to focus on enhancing revenue, growing, coupled with being efficient, and focusing on length of stay." And they were saying to me the playbook isn't working because there are these weird dynamics. I think that was a definite factor for a number of people.
My sense, in my arc of being a CEO, is that this couple year period was the hardest I've seen. I think most people have worked their way through that. The industry's doing better. Not perfect, for sure. There are still very challenging dynamics. And I think a lot of people worked really hard to reconnect themselves to why they do what they do and recharge their batteries post COVID.
My general sense is people are doing somewhat better. That's not to say everybody is. That's not to say there's not some burnout. For some people the answer to that is retirement and shifting gears [Heidrick & Struggles reported 438 total CEO moves within its Healthcare/Life Sciences practice in the U.S. last year, and Rod Hochman, MD, CEO of Renton, Wash.-based Providence, and Peter Fine, CEO of Phoenix-based Banner Health have both recently announced their retirements]. There's nothing wrong with that either. We each have to answer that question for ourselves.
Q: How do you personally address and manage the key stressors you encounter in your role?
MB: First and foremost, you have to take a step back. I think the most important thing a leader can do if you feel a little tired, feel a little burned out, is connect yourself to why you're there. Connect yourself to the passion and purpose of why you do what you do. And honestly, if you can't connect yourself to that and you can't do that anymore, then maybe it's time for a break. And there's nothing wrong with that either, if that's where you are personally. I find that going out and talking to the front lines, talking to the patients, hearing patients stories, really connecting yourself to the fact that we're in a noble profession, and we're in a profession that is helping humanity, very invigorating and refreshing.
I think we all make the mistake sometimes of getting so busy that we don't shift gears. I always preach to the people I work with that when you take time off and recharge your batteries, you're a much more effective person working at our institution, whether you're a physician, a nurse, an administrator, or a CEO. I always know when I do get a little run down or feel a little burned out, a nice little vacation can affect a lot of that. And I come back, and I'm ready to go, because the job is a real privilege. It's amazing to get to do what we do.
Q: Do you have a specific mantra when it comes to vacations?
MB: Take it. Paid time off is not a retirement account bank to cash out when you leave. It's there to use. That's why you have PTO. Sometimes you have to use it for unforeseen circumstances, such as the death of a family member or health issues, so you want to keep some in there. But don't run your balance to where you've got 40 days in it. Run your balance where you have five or 10 where you can handle the unforeseen circumstances, but you take your time off and recharge.
The other thing I tell colleagues is, "You're going to be busier than you realize. You're going to be busy." And the hard thing in a job like CEO is you're going to be scheduled out sometimes six months in advance for things like board meetings and speaking engagements, and if you're not very purposeful and intentional about your calendar, you'll wake up one day saying, "I'm tired. I need a vacation. Let's go away." Then you look at your calendar and realize three times a week, you have something that's absolutely immovable. So what I tell people is to focus on the important things. So I block out my vacation a year in advance. If I don't know where I'm going, I at least know when I'm going. Also, when my kids' school calendar comes out, it goes straight to my assistant, and we sit down and say, "OK, three-day weekend here. Parent-teacher conferences this day. Block that afternoon." I know I'm going to be there for my child's conference. I'm not going to find myself saying "yes" to something I didn't intend to. Those are really important. You have to meet those priorities so you manage the time and manage the stress.
I also talk a lot about "work-life integration." If you are a CEO, and you are living and breathing the successes and challenges of an institution, that is partial to who you are as a person. You need to be able to have that passion, integrate that with your work. "Work-life balance" implies one is good and one is bad, and that's not the case. Work's great. Work should be something you enjoy doing. It should bring you fulfillment, and you do good things for others. But you also then, to balance yourself and life, have to have that outside interests. That's family, travel, that's hobbies. I feel like as a CEO, to not be burned out, you have to be able to look in a mirror and say, "If for some reason I'm not in this job tomorrow, I'm OK. I have lots of other interests. I can do lots of other good things in my life." I think all of those are important aspects. You need quiet time, reflection time. Those are important things. And like everything in life, you need to be purposeful and intentional about it. If you wait to sort of let it happen by accident, you don't do as good a job as if you sit there and say, "I'm running a marathon as a multiyear CEO, and I need to be able to recharge my batteries and regain stamina." And when you do that, you can avoid burnout, I firmly believe.
Q: How do you think the healthcare industry as a whole can better address the issue of stress and burnout among its top leaders?
MB: The intentionality really is my big message. No one is immune to mental health issues. Burnout oftentimes is inextricably linked to some mental health issues, from minor to significant. Whether it's a physician or executive, we're all human beings. We all have to recognize when to ask for help. If you need help, ask for it and go get it. Many times, you can be an example for others with that. Not different than if you are the CEO who one day finds out you have cancer or are dealing with a mental health struggle, and oftentimes how you handle that can make a difference in people's lives.