Ideas to Reduce Burnout: A Word to Healthcare Leaders

In a recent post, we began exploring the topic of healthcare burnout. We are going to be spending some time periodically discussing burnout here. As we are emerging from a very pervasive and palpable viral pandemic, we as healthcare providers and leaders need to turn our attention to a silent pandemic that is causing a significant amount of morbidity and mortality to our health care system and to the providers themselves. Burnout and subsequent depression is causing providers to dread work, leave the profession and, sadly, in some extreme cases end their own lives.

So, what can be done about healthcare burnout? This is the critical question. Without proposing solutions, reporting burnout is just that. (i.e. complaining). It is akin to reporting a fire and watching it burn without taking active measures to put it out. We all got into this profession because we enjoyed healthcare and enjoyed helping people. Unfortunately, our patients, our hospitals, our families, and ultimately, we are suffering. And to the extent that healthcare is a team sport, it takes a team approach to mitigate and prevent burnout. We are tired of being told that the solution to burnout is more sleep, exercise, mindfulness, square breathing, and yoga. From the individual all the way to executive leadership, we must be honest with the problem and seek meaningful, effective, and multifaceted solutions. So, what can we do?

The Medscape report that we referenced in a previous post indicates that the top action items listed by respondents to fight burnout are as follows:

1. More manageable work schedules

2. Increased compensation

3. Greater respect from administrators/employers/colleagues/staff

4. Increased control/autonomy

5. Lighter patient loads

6. Increased staff

I find this list fascinating. While certainly not a comprehensive catalog of ways of combating burnout, hearing the priorities of those who are suffering burnout is rather insightful. And for me personally as I have been dealing with burnout, I would have to agree with the priorities on this list. Too much time doing the job, not enough staff/resources to get the job done, and feeling like a glorified data entry technician with the EHR, etc.

So, my word to any healthcare leaders who may be reading. We as the frontline workers are willingly putting ourselves in front of pain, suffering, death, and disease – often at risk to our own health. We have continued to do this through the entire COVID pandemic (pre and post vaccination) and we will continue to show up, no matter how miserable practicing medicine becomes; because that’s who we are. But we need your help and support to battle burnout.

1. Take a look at the schedules to make sure they are workable practically and not just on paper. Many of us are scheduled for 40 hours on paper but really work well over that. We would love to cut down our schedules to full time. Furthermore, 40+ hours of evenings, nights, weekends, and holidays feel very different than 40 hours of 8AM-4:30PM. It is hard to engage with family, be at my kids’ activities, hang out with friends, and be a part of my community when working a large number of shifts after 5PM or on weekends.
   

2. Consider post-nights days in calculating work hours. This one is similar to the previous idea. Probably the hardest part of being an emergency physician is night shifts. For one, it is hard to think clearly (not to mention perform life-saving interventions) between the hours of 3AM-6AM. It also takes an incredible amount of time to prep for and recover from night shifts. While, on paper we are on the clock for 8 hours, unlike a day shift, it takes time fighting the circadian rhythm; to sleep for and recover from a night shift. This is time that we cannot use to spend with our families or accomplish other necessary life tasks. So, consider allowing some of the required work hours to be used as recovery from night shifts.
   

3. Show up in the ED from time-to-time. Yes, round throughout the hospital. Meet the frontline staff. Learn our names. Ask us about our families, hobbies, why we went into medicine. Get to know us. And then when we pass in the halls, give us a head nod – anything to let us know that you know that we are here, appreciate that we are here and that you have our back. And don’t just do it at 10AM. Come at 3AM. You will see a very different side of the hospital, staff and patients. And it will send a loud signal that you care.
   

4. Watch the 2nd and 3rd order consequences of compensation. Incentives matter! That which gets rewarded gets repeated. That which gets penalized, gets avoided. This is definitely true when it comes to compensation. We all have agreed to trade our most valuable commodities (our time and talents) for money. One is replaceable the other is irreplaceable. At the outset, employers have a significant advantage over their employees – one which should be managed with the utmost respect and care for those in their employ. For this reason, when it comes to compensation, incentives between employers and employees should align. And the second & third order consequences of compensation plans should be examined so as to promote wellness among the employees who are devoting their precious time and expertise to the mission of the organization. For example, consider the model of physician compensation that is constructed on a base salary + RVU valued productivity-based incentive. I actually like this model because it guarantees the employee a minimum salary but incentivizes productivity. The hospital and employee interests are aligned. However, the RVU incentive is benchmarked against a fixed number of RVUs regardless of the number of clinical hours worked. Since taking days off or taking vacation decreases clinical productivity but has no effect on the benchmark, this has the unfortunate consequence of penalizing providers in the pocketbook for taking time for wellness. The recommendation to be well loses effectiveness when the practical consequence of taking days for wellness results in a disproportionate decrease in compensation. In this scenario, to realign interests, incentive productivity should be benchmarked against a calculated number of RVUs based on the quantity of clinical hours actually worked.
   

5. Communicate clearly and honestly! Good communication is a vital part of all human-human interaction. What’s true in the family room is especially true in the conference room. There are times when leaders must make decisions for the good of the organization that will ask a lot from the employees or affect certain employees negatively. This is at times unavoidable, and I would venture to say acceptable to some degree by most employees. So, when you make controversial or challenging decisions, communicate clearly and honestly. Don’t spin it. Be genuine. Sure, some employees will be upset. But most will get back to work and continue to give you the shirts of their backs. Though we may not like the decision, we will respect that you valued us enough to be honest.