"Burnout" has become a buzzword across hospitals and health systems, a snappy name for the exhaustion, depersonalization and loss of interest dragging down an overexerted workforce. But burnout is more than a well-worn descriptor for tired providers; its effects on the healthcare industry are palpable.
As burnout continues to increase, more healthcare workers look to exit the short-staffed profession. And hospitals and healthcare systems, recognizing the importance of invigorated providers, have elevated the discussion to the executive level.
Chief wellness officers are responsible for the well-being of their respective enterprises' workforces, and for many their work began long before they were named to the C-suite. Becker's connected with four chief wellness officers to discuss burnout — and strategies to reduce it.
Burnout blocks the path forward
"You can't do your best work when you're burnt out," said Bree Andrews, MD, chief wellness and vitality officer at University of Chicago Medicine and a neonatologist.
Physicians are "remarkably resilient," so identifying the signs — including exhaustion, depersonalization and inefficiency — can be difficult based on behavior alone, Dr. Andrews said. A lesser-known sign of burnout is a decline in innovation, according to Dr. Andrews.
"It's hard to do that one extra thing that's interesting or compelling when you're burnt out," she said. "My job is to get people to do their next best work."
Burnout has always plagued physicians — but it had been declining
Burnout is not new, according to Kristine Olson, M.D., chief wellness officer at Yale New Haven (Conn.) Hospital and an internal medicine and pediatrics physician. For many clinicians, it comes with the job.
"Physicians don't want to let people down, and there's the expectation that they're always 'ready,' never compromised," she said. "Because of the responsibilities they have, sometimes it's called a 'podium profession' because of the position they have to hold to maintain the trust they take on."
The conversation around burnout started to take shape when Tait Shanafelt, MD — now the chief wellness officer at Stanford Medicine — started a triennial survey of the American Medical Association's master files, according to Dr. Olson. In 2014, more than half the physicians Dr. Shanafelt surveyed reported emotional exhaustion, loss of meaning in their work and a lack of engagement with patients.
Dr. Shanafelt's early measures came four years into a wave of changes in the healthcare system: markets consolidated, physicians were integrated into large systems and EHRs were implemented with increasing quality metrics. Physicians had less control as they adapted to their shifting workplace, and financial difficulties facing industries across the U.S. could have been an added stressor, according to Dr. Olson.
Burnout reached a peak in 2014, Dr. Olson said. But there began an orchestrated effort to address it. The American Medical Association began its "Joy in Medicine" summit to gather thought leaders around the issue. In 2015, Yale New Haven Hospital completed its first assessment on burnout and, in tandem with partners including Mayo Clinic and Stanford Medicine, began paving a path toward organizational well-being.
"We knew that it was a health system problem because it was dynamic across the healthcare industry while static in the general population," Dr Olson said. "We knew that organizational interventions were more effective than individual interventions at fixing it, and also, because of the prevalence of the problem, we knew that it was an industry problem that had to be fixed by the industry."
And it was working. Year after year, burnout rates were coming down, Dr. Olson said.
Then COVID-19 hit.
The pandemic's toll — and doors it opened for healing
Healthcare workers' emotional exhaustion surged during the pandemic as COVID-19 patients overwhelmed hospitals and heightened infection control measures added barriers to care. The adjustment to a "hybrid world" has also proved difficult for some physicians, according to Dr. Andrews, as it has increased patients' access to them.
"I think the pandemic taught us that our physicians and our healthcare workers are strong and resilient. But we're also human," said Becky Lowry, MD, an internal medicine physician and chief wellness officer at Kansas City-based University of Kansas Health System.
"The pandemic really stretched people to a level that was different than the strain and stretch they had felt previously — and really forced us to reflect on where we're at as a profession and how we take care of ourselves and one another as healthcare workers," Dr. Lowry said.
Those reflections helped pave a path forward at health systems such as Newark, Del.-based ChristianaCare. The system already had a Center for WorkLife Wellbeing — founded to foster meaning, connection and joy within its caregivers — which was expanded to cover all the health system's employees in January 2020.
When those running the center recognized the collective struggle the pandemic brought upon the health system, it adjusted, according to Heather Farley, MD, an emergency medicine physician and chief wellness officer at ChristianaCare.
ChristianaCare already had a heavily utilized peer support program. During the first month of the pandemic, it saw a threefold increase in requests for individual support and a tenfold increase in requests for group support, according to Dr. Farley.
'You have to change the coal mine'
To effectively fight burnout, the culture of health systems must shift, chief wellness officers repeatedly told Becker's.
"I like to make the analogy between the caregiver and a canary in a coal mine," Dr. Farley said. "You can't take a canary out of a coal mine, teach it to be more resilient, and stick it back in the same coal mine and expect it to survive. You have to change the coal mine — the environment the caregiver is in."
"We are not going to 'resilience' our way out of this."
When it comes to changing that "coal mine," health systems are taking various approaches.
At UChicago Medicine, Dr. Andrews aims to make wellness a key fixture of healthcare — and one that is fully integrated into the system. She attends all executive meetings to provide insights on how new policies could affect the workforce and visits different units to learn what wellness, teamwork and efficiency look like in different sectors.
Dr. Andrews said health systems must learn to ask good questions about burnout to fully understand it. For example, a physician may say they are burnt out from fighting with a broken printer, but the broken printer may point to a larger issue, such as a lacking repair department. Prioritizing wellness means identifying the actual problem, then providing feasible solutions, according to Dr. Andrews.
The University of Kansas Health System has seen success mitigating burnout with flexible scheduling, according to Dr. Lowry. Developed as a pilot program in 2019 and launched more extensively in 2021, the system allows providers to look at a menu of scheduling options, then choose what is best for them. This allows providers to work around childcare, exercise routines and other priorities, better integrating their home and work lives, according to Dr. Lowry.
Plus, the new scheduling system has proven beneficial to patients, Dr. Lowry said. Patient intake is staggered across a wider variety of times, allowing patients to schedule visits during previously unable hours, such as during lunch hours or evenings.
For Yale New Haven Hospital, the fight against burnout has a solid infrastructure. The hospital has had a clinical wellness council since 2016, and it is well-versed on remedying burnout, according to Dr. Olson. The hospital assesses burnout every 18 months through a variety of inventories. Then it identifies the stakeholders who can affect any issues they are seeing. The chief information officer may be notified if the EHR is inefficient, for example, or the clinical redesign and quality team may be pinged to improve practice efficiency.
Along with peer support programs, ChristianaCare's Center for WorkLife Wellbeing offers 24/7 mental health services and "oasis rooms," where caregivers can reflect and rejuvenate, according to Dr. Farley. This year, the health system aims to train 50 percent of its people leaders in psychological first aid.
Moving forward with awareness
But health systems cannot solve this issue alone, according to the experts who connected with Becker's. There must be an orchestrated effort at the federal level to improve conditions for providers.
"The American healthcare system has to work for Americans," Dr. Olson said. "It's a huge part of our quality of life and makes it possible to do everything we want to do in our lives. It's an important mission we have to commit to until it's what it should be."
As the fight against burnout wears on, it is also important to understand that not everyone is affected in the same way, chief wellness officers told Becker's.
Burnout and suicide rates among female physicians are double those of their male counterparts, Dr. Andrews said, and the stigma attached to people dealing with substance abuse and mental illness contributes to distress.
Burnout manifests differently across hospitals, units and professions, too.
Academic health systems such as the University of Kansas' face challenges associated with burnout that involve physicians balancing academic and medical careers, according to Dr. Lowry. Scholarships, grants and publications also come with pressures that can foster burnout.
Ambulatory specialties, like primary care and rheumatology, are heavy on communication; physicians are balancing checking on labs, answering messages and passing pre-approval processes while keeping heavy schedules. Burnout in these fields may show up differently than in intensive care units, where much of physicians' work comes from high volume, insufficient staff, a lack of beds and a focus on transportation, according to Dr. Olson.
But as Dr. Andrews has learned from moving across units at UChicago Medicine, burnout is everywhere — and everyone's eyes are on solutions.
"We have 13 departments," Dr. Andrews told Becker's. "Every department has said, 'We've been waiting for you, we've been waiting for [wellness to become a priority], and we're willing to put in the resources to make it happen for us.'"