Clinician burnout is a significant challenge for healthcare organizations, with the potential to negatively affect care quality and patient satisfaction.1,2 At the Becker's Hospital Review 10th Annual Meeting in Chicago, the Johnson & Johnson Medical Devices Companies sponsored an executive roundtable discussion including leaders from across the U.S. who came together to share strategies to reduce clinician burnout.
Clinician burnout has been correlated with decreased quality and safety indicators, decreased patient satisfaction, decreased job satisfaction, increased clinician intent to leave and decreased productivity, as well as increased indirect healthcare costs.3 Research published in the Mayo Clinic Proceedings has also found the likelihood of medical errors can increase when there are high rates of physician burnout.4
"We are all patients in the healthcare system, and we will all deal with the repercussions if we aren't able to address the issues arising in the care of our caregivers," said Kathryn Dougherty, Lead for the Healthy Workforce Program at the Johnson & Johnson Medical Devices Companies. "The prevalence of burnout in nurses and physicians is at an all-time high, reaching more than 50 percent in physicians, and almost three-quarters of nurses are experiencing symptoms."5,6
After conducting a survey of attendees*, Ms. Dougherty found 83 percent had reported that physician engagement and satisfaction was one of their top five organizational initiatives, but that only 50 percent had resources budgeted for those programs. "How can we help health systems align resources, whether people or systems, to make sure we are investing in the care of care providers?" Ms. Dougherty posed to the roundtable.
The panel agreed; a hospital or health system’s organizational environment is a major component of clinician satisfaction. Clinicians may feel technology becomes a barrier to their relationships with patients and colleagues, but the right balance of technology and human connection can make a difference. Research shows empathy training to improve communication with others can strengthen interpersonal relationships and reduce burnout.7
Raphaela O'Day, Ph.D., a behavior scientist and the Senior Performance Coach and Innovation Catalyst at Johnson & Johnson Human Performance Institute®, then moderated a roundtable discussion in which attendees highlighted the following key lessons and strategies to combat clinician burnout.
1. Instill a sense of purpose for individuals within the organization. Physicians and nurses are often mission-driven individuals who pursued careers in healthcare to make a difference. However, after entering into an employment contract with a hospital, physicians may be subject to volume and visit expectations – or other business management components – that heighten the risk of burnout.
"There is this disconnect of implementing physician burnout strategies and pressuring physicians for higher volume, productivity and income," said a California-based hospital administrator. "Even if there is money assigned to address clinician burnout, health systems still run into issues by pressing for more productivity."
Instead of the traditional contracts, representatives from hospitals across the country described entering into employment contracts with physicians that give more autonomy in the practice environment and additional time off.
2. Address clinician burnout from the top down. C-level executives who embrace solutions for clinician burnout understand how to limit the demands technology places on providers, while also delivering the right messaging to incite buy-in for the critical technologies that do make a difference in patient care, said the chief marketing officer of a 43-hospital health system based in the Northeast. "As leaders, it is important to prioritize how the message of adding technology is delivered to providers so they don’t feel like this is one more thing they have to do," said the CMO.
To live into these values and further support clinicians, healthcare leaders can structure time in their schedule to recognize team members and employees. The chief medical officer (CMO) of a Chicago-based health plan said all executive meetings in her organization begin with the C-level team writing personal handwritten thank you notes to team members, which are mailed to their houses. "People want to be recognized," she said. "A simple thank you makes a difference."
3. Breed a culture of respect and inclusion for contingent staff members. Hospitals may have a strong core of permanent staff with the appropriate training and orientation. However, when contingent staff are brought on for a short time, they often experience different treatment based on their temporary status.
"The contingent individuals come in and walk side-by-side with the core staff, but they are treated very differently," said the chief nursing officer (CNO) of a Texas-based behavioral health hospital. "Contingent staff members are demeaned because of their status, not their skill set…the staff need to move forward with acknowledging and recognizing each other."
The CNO of a New Mexico-based hospital said her organization addressed this issue by empowering permanent staff to serve as coaches and setting an environmental tone of cooperation and respect.
4. Negotiate healthcare professional "perks" and time during recruitment. Especially at rural and critical access hospitals where budgets are tight, physician recruitment is a challenge. The chief human resources officer of a California-based hospital said the hospital pays a premium for physicians and specialists to relocate. "The physicians have the ability to control their own environment," she said. "If the perk isn't important to them, they can take more money with less time off and do their own notetaking in the EHR."
5. Allow healthcare professionals to curate their work environment from the inside out. Multiple participants in the roundtable discussed how their organizations give physicians more control over their environment and ability to shape organizational culture.
The CNO and vice president of patient care services at a New Orleans-based hospital described how his organization set culture from the inside out. "We are a relatively new hospital, just four years old, so our physicians have been around to create their own environment and invite their friends to come practice with us," he said. The hospital has become an attractive workplace for physicians because staff members are happy, and the administration supports them.
6. Address burnout in medical school and provide coaches trained in behavioral health. The associate chief nursing officer from an Alabama-based academic medical center has begun addressing burnout with medical students and investing resources in behavioral health specialists. The medical students go through simulation training to identify burnout and seek solutions. The health system also has a chief wellness officer who addresses clinician burnout.
7. Allow physicians to use CME money for a life coach. "Sometimes the individual doesn't know what is important to them. One of the solutions we have come up with this year is that the health system has elected to allow physicians to use up to half of their CME money on a life coach," said the CMO of a California-based hospital. "They look at what is important to them; is it more time off? Is it more financial stability? Some people really need help through that process, and the life coach is a good option."
8. Encourage ownership mentality among all physicians and staff members. "One of the things we've done in our organization is implement a culture of ownership," said the CNO of a New Mexico-based hospital. "For everyone throughout the organization, you can't come to work with a bad attitude. We all expect you to come to work as owners, not just renters in the organization." The team members communicate and hold one another accountable to ensure everyone arrives at work with joy, meaning and purpose. The rural hospital now includes 60 physicians and since implementing the "ownership mentality" culture, staff turnover fell from 30 percent to 5 percent.
Conclusion
Health Systems and clinicians are starting to see the benefits of addressing burnout, and there remains a tremendous need to support healthcare providers by reducing stress and other catalysts for disengagement.
"We really believe we need to have conversations with individuals around stress and burnout," said Dr. O'Day. "We also believe we need action among health system leaders to help shape the organizational environment and culture in a more profound way. Ultimately, we must work together to implement comprehensive employee engagement programs that help lead to improved purpose and greater health and wellbeing for clinicians.”
In May, Johnson & Johnson Medical Devices Companies launched its Healthy Workforce offerings to help meet the needs of health systems struggling with clinician burnout and excessive stress. Developed specifically for healthcare organizations, the offerings are designed to increase employee engagement and re-ignite the sense of purpose for care providers. The Healthy Workforce offerings focus on four critical categories for engagement, including health and wellbeing, interpersonal relationships, organizational environment and professional fulfillment.
* The survey was conducted among 23 U.S. health system leaders and executives at the Johnson & Johnson Medical Devices Companies sponsored executive roundtable during the Becker's Hospital Review 10th Annual Meeting in Chicago on April 1, 2019.
References
1. Lyndon A. "Burnout Among Health Professionals and its Effect on Patient Safety." Agency for Healthcare Research and Quality. February 2016: https://psnet.ahrq.gov/perspectives/perspective/190/burnout-among-health-professionals-and-its-effect-on-patient-safety
2. Panagioti M, Geraghty K, Johnson J, et al. Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis. JAMA Intern Med.Published online September 04, 2018 178(10):1317–1331. doi:10.1001/jamainternmed.2018.3713
3. Dyrbye, L. N., Shanafelt, T. D., Sinsky, C. A., Cipriano, P. F., Bhatt, J., Ommaya, A., ... & Meyers, D. (2017). Burnout among health care professionals: a call to explore and address this underrecognized threat to safe, high-quality care. NAM perspectives. https://medschool.ucsd.edu/som/hear/resources/Documents/Burnout-Among-Health-Care-Professionals-A-Call-to-Explore-and-Address-This-Underrecognized-Threat.pdf
4. Tawfik Daniel S, et al. "Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors." Mayo Clinic Proceedings. Vol. 93: 11, Nov. 2018 p. 1571-1580.
5. Alexander, AG, Ballou, KA. "Work-Life Balance, Burnout, and the Electronic Health Record." The American Journal of Medicine Aug 2018: Vol. 131, 8 p. 857-858. https://www.amjmed.com/article/S0002-9343(18)30286-9/fulltext
6. Zimmerman, B. “Survey: 70% of nurses report burnout in current position.” Becker’s Hospital Review. May 2017: https://www.beckershospitalreview.com/human-capital-and-risk/survey-70-of-nurses-report-burnout-in-current-position.html
7. Krasner, M. S., Epstein, R. M., Beckman, H., Suchman, A. L., Chapman, B., Mooney, C. J., & Quill, T. E. (2009). Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. Jama, 302(12), 1284-1293.
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