Burnout among clinicians is not new in healthcare due to the demands of the job. However, the issue increased amid the COVID-19 pandemic and remains a crucial challenge for hospitals to address, particularly as organizations are focused on recruitment and retention and as workers may face a greater potential for animosity from some patients.
Hospitals and health systems have rolled out an array of initiatives to address the issue, from establishing a well-being community of practice to a "days of gratitude" program, leaders from organizations told Becker's. Leaders also noted that there is not one fix, and addressing burnout needs a multifaceted approach.
"The solution is not to make already borderline superhuman people even more superhuman," said Colin West, MD, PhD, director of the Mayo Clinic Program on Physician Well-Being. "It's to take almost superhuman people and put them in environments where they can be human. And that's where I think the evolution is pushing."
Here, health system leaders share their initiatives to combat burnout.
Debra Albert, DNP, RN. Chief Nursing Officer and Senior Vice President for Patient Care Services at NYU Langone Health (New York City): The pandemic reinforced something we already knew: Healthcare workers often have to face stressful, even traumatic, situations. We have to put the days of "putting on a brave face" in the past. That's why teams of staff volunteers organized at each of NYU Langone Health's campuses are trained to help front-line workers through the emotionally challenging moments they face on the job every day, providing them with a caring, comforting presence. The Lavender Response Team comprises specially trained volunteers from different disciplines who serve as a kind of psychological first aid unit for hospital employees. Anyone in the hospital can summon a Lavender response, but most calls are spurred by a stressful care situation or patient death. When a call comes in, a volunteer responds on-site within 30 minutes to provide support. The ultimate goal is for employees to know that the institution cares for them and that we are going to be physically present for them.
Julie Ann Alvarado-Dubek. Chief Human Resources Officer for Banner Health (Phoenix): The burden of the pandemic is still weighing on health system clinicians and other front-line staff, and we know we will continue to see its effects on the workforce for some time. We all owe it to them to help alleviate some of that burden. Banner's mission is to make healthcare easier, so life can be better, and this applies to our team members as well as our patients. This includes providing the support they need to be at their best professionally and offering resources that can help them cultivate a meaningful personal life as well.
To fight burnout, we launched several initiatives, including MyWell-Being, a holistic program for all Banner Health team members that encompasses health, wealth, growth, community and purpose. More than 26,000 team members actively participate in this award-winning program that brings support from a dedicated group of health and well-being experts to help them be their best selves.
This is just one of the many ways we have targeted reducing burnout for our front-line teams and all team members. Supported by generous donations from our foundation, these programs have allowed us to create respite areas and our very popular respite rooms at many of our acute care facilities. Banner has also retained on-site mental health counselors for team members to access at 29 acute care facilities or virtually, and we have trained over 300 team member volunteers in mental health first aid to provide ongoing support. Our total nurse burnout levels have remained steady from 2021 to 2022 at 9.4 percent, despite significant headwinds facing the nursing workforce nationally. We know this work is continuous and will require our focused effort well into the future.
Luis Garcia, MD. President of Sanford Clinic and Sanford World Clinics (Sioux Falls, S.D.): Sanford Health recognizes the need to provide highly tailored and more nuanced support to our clinicians based on factors like the stage of their career and their unique practice challenges. Our clinician wellness councils bring together different compatible groups including midcareer clinicians, international clinicians and women in medicine, among others, to share their personal experiences with each other and challenges that have shaped their practice. By creating meaningful connections, the clinician wellness councils have offered our caregivers emotional and mental health support as well as a strong sense of purpose.
Members of the wellness councils also serve as ambassadors to promote a culture of well-being, resiliency and work-life integration across our organization and as a liaison between clinicians and leaders on well-being priorities. Our goal is to find different ways to reduce professional burnout and increase "joy in work."
Gwen Gnam, MSN, RN. Vice President of Patient Care Services and Chief Nursing Officer at Henry Ford Hospital (Detroit): At Henry Ford Hospital in Detroit, our team members can relax and reset in our recharge rooms. We unveiled these rooms last year to help combat burnout and improve well-being. The spaces offer a calming environment where team members spend 10 to 15 minutes in immersive experiences meant to virtually transport them to beaches, mountain ranges and other peaceful locations. Over the past year, the impact has been remarkable. After a single 15-minute experience in a recharge room, team members report an average 50 percent increase in positive mood and a 60 percent reduction in stress.
Jacqueline Moline, MD. Vice President of Occupational Medicine, Epidemiology and Prevention at Northwell Health (New Hyde Park, N.Y.): A program of Northwell Health's Center for Traumatic Stress, Resilience and Recovery is Stress First Aid. The program is a self-care and peer support approach to managing stress, and it can be used by any team member. It's being rolled out in our hospitals. It's being rolled out in our ambulatory practices and in different departments. It is to help people recognize workers' stress levels and make people more aware of the fact that they can ask people how they're doing and expect a real response and to familiarize themselves with different resources for people who may be having stress.
We've updated our website to make sure that there are a number of tools for folks ranging from employee assistance to behavioral health counseling and behavioral health treatment for those who need it. But really, Stress First Aid is to have people who work with other people, learn how to work cohesively, to understand that stress is affecting all of us, and to speak up about it and to try to mitigate it in whatever way we can. If someone's having a bad day, say, "Hey, it looks like you're having a bad day. Is there something I can do?" or "Do you need a break?" or "How can we get your stress level down?" It's a valuable program that we've been doing where we've been having training throughout our hospitals, working with physicians, with nursing, and we're working with emergency medical services, on understanding that they have various stressors and how it can be described so that it can be better managed.
And the peer support doesn't have to be only doctors to doctors or nurses to nurses. It can be to anybody and it can be, I take a look at my front desk person and I say, "Something's going on with you. How can we help?" or "What's your color today within the zones of stress?" Because it's a continuum. "Are you green, yellow, orange or red?" And making it OK for people to express how they're feeling so they don't have to hold it all in. The goal isn't for everyone to share their private issues with their colleagues, but it's to at least acknowledge that we're here to support you and see what we can do while giving you whatever privacy you need.
Denise Morris. Vice President of Inclusion, Belonging and Employee/Labor Relations for Yale New Haven (Conn.) Health System: YNHHS is rolling out a new program in May: "10 Days of Gratitude." Based on employee feedback from a variety of forums, and with input from our workforce, the program amplifies how we meaningfully recognize, reward, engage and support our diverse team — particularly in these stressful and challenging times. Multiple activities — across venues, shifts and for both onsite and remote staff — will convey appreciation, recognize and reignite employees' passion for their work, and support their well-being. Each day will feature a unique gratitude-inspiring activity, such as a motivational speaker on Zoom and recorded to maximize ease of viewing, blessing of staff hands on units across all shifts, and leadership rounding. There will also be wellness and mindfulness activities and time for reflection. Our goal is to ensure that our employees feel more appreciated, valued and connected. We believe that a culture of gratitude is essential in creating a positive, productive and rewarding work environment, and we are committed to fostering this culture within our organization.
Kathryn Schneider, MD. Physician at St. Luke's Wood River (Ketchum, Idaho) and System Medical Director for Provider Well-Being at St. Luke's Health System (Boise, Idaho): In support of our team members' well-being across all roles within St. Luke's Health System, we utilize a multicomponent approach, understanding that there is no one-size-fits-all to the prevention of employee burnout. From well-being programs such as robust peer-to-peer support for both employees and providers, leadership well-being workshops, free access to the Headspace app for mindfulness and meditation, these, and a host of other programs are readily available and promoted among our teams.
Another effort to support staff across the organization has involved establishing a well-being community of practice, which brings together leaders throughout St. Luke's Health System to bring best practice changes around well-being across the enterprise.
One example of how the CoP has supported change is through recently added well-being trainings that have been added to two of St. Luke's leadership development trainings, giving leaders the insight and direct access to the extensive menu of tools, programs and resources available through both the St. Luke's Employee and Provider Well-being centers of excellence
Specific to provider support, St. Luke's Health System offers free anonymous counseling, leadership well-being improvement planning tools, and both individual and team well-being coaching tailored to the specific needs and drivers of physician and advanced practice provider burnout.
One of St. Luke's four primary talent initiatives is well-being in support of workplace health and wellness — to this end, not only do we offer a variety of support opportunities for staff, but we also utilize assessment tools to help identify opportunities and to trend our progress and improvement over time. This helps ensure that we are offering meaningful programs and support outlets across all of our teams and our health system.
Nancy Sudak, MD. Chief Well-Being Officer and Director of the Integrative Health Department at Essentia Health (Duluth, Minn.): Pursuant to the results of each yearly burnout survey, our clinical teams are asked to determine at least one strategy at the unit level that they agree will improve their well-being. This might be enhancing interpersonal relationships, improving efficiency, reducing chaos and lowering work burden without compromising patient care, or any number of things. This is early work for Essentia Health, but the focus on local-level improvements is based on the awareness that unit-level strategies are the most potent and tailored means to navigate to an improved immediate work environment. This is relatively new work for Essentia, and the metrics aren't yet available to discern the positive impacts; this work is based on emerging best practices in the well-being sphere.
Colin West, MD, PhD. Director of the Mayo Clinic Program on Physician Well-Being (Rochester, Minn.): Colleagues Meeting to Promote and Sustain Satisfaction (COMPASS) groups at Mayo are built out of this idea that there are many drivers of either distress or well-being. One of those drivers is a sense of connection, a sense of community with your colleagues, with your work teams. And in medicine, increasingly, there's been this tenor out there that we're increasingly disconnected and this is a societal issue, but it's particularly an issue within medicine. It's something that the U.S. surgeon general has been talking about in recent years. And, before those discussions, we had identified that this was a potential target for interventions to get at a key driver of burnout.
The idea behind COMPASS groups is having small groups of physicians who meet together and commit every couple of weeks to meeting for an hour. They spend the first 15 minutes committed to talking about some assigned topic that's relevant to the physician experience. And then they can use the rest of their hour together however they want to. The core of the model, beyond getting the groups together, is that they start talking about the topic. It's relevant to something in medicine. They might talk about dealing with excessive work hours or they might talk about a medical error or how they balance work and home responsibilities. Then there can be a lot of different dimensions there. But it models that community builds connection over time, and the groups meet for six months every other week, for an hour. The same group, they build a connection across the individuals in the group.
But what's important about the approach is it models a shared responsibility. The individuals in the group are committing a small amount of their time to meet as a group with their colleagues. They're making a commitment to one another. And even though it's a small amount of time, that needs to be recognized because it is a commitment. That has to be balanced with an organizational commitment. And that's the shared responsibility. The organizational commitment is, "If you're going to participate in these groups, we're going to pay for your meals." They commit their time, and Mayo commits to paying them for the meals they're going to eat during the time that they meet together, and it builds community.
We've got an evidence base behind it that it reduces burnout, reduces social isolation, increases meaning in work because people are able to reconnect with colleagues who they learn are sharing similar experiences. Maybe they reconnect with people they've become disengaged from over time, and it brings them back together. And it's that reminder that we are part of a larger profession of like-minded individuals with similar values, similar objectives in terms of pushing for what's best for our patients. It's certainly not a fit for everybody. Not everyone can make an hour every two weeks. But we've seen a third to a half of our physicians across our entire institution engage in at least a 16-month block of these COMPASS groups.