Healthcare Burnout: What it is, and how to treat it.

At this point, more than 2 years after the start of the COVID-19 pandemic, who isn’t talking about provider burnout.  While I’m glad we are finally having this conversation, I’d be remise if I didn’t ask, “What took you so long?!”  And to that point, let’s make sure we aren’t ignoring the other members of the care-team.  Because, let’s be honest, burnout is contagious.⁽¹⁾  And yes, physician revenue is key to maintaining hospital and health center operations, but without a healthy care team, patient care just isn’t up to snuff.

So, what do I mean by burnout? This isn’t just the occasional “I’m not excited about going to work today” blah feeling.  Burnout is a psychological condition ⁽²⁾ of symptoms experienced across three domains: emotional exhaustion, depersonalization, and low personal achievement.  What does this look like in practice?  Everyone’s experience will be different, but as colleagues and administrators we have a responsibility to keep our eyes open to potential signs and symptoms.  Take for instance the empathic nurse who suddenly seems to be frustrated and overwhelmed with all their patients, or the care manager who begins to blame patients for their poor health.  Consider the medical provider who suddenly begins to make repeated medication errors, or the behavioral health provider who is calling in sick more than usual.  If you observe these behaviors, does it mean a care team member is burnt out?  Not necessarily. Sometimes we’re just in a bad mood, or we need a mental health day, or, heaven forbid, we make a mistake.  However, it’s the change from baseline that we have to be aware of, and its compassion that we have to bring.  Because without intervention, burnout, unchecked, can have tremendous quality and financial impacts.

Lost revenue per full-time physician is estimated at $990,000, ⁽³⁾ and the cost of recruiting and replacing a physician can range from $500,000 to $1,000,000 ⁽³⁾ bringing the total potential financial loss of one full-time provider to nearly $2million.  Yes, this marks the financial high end of care team burnout.  But now consider the turnover rate of support staff and providers in your health center.  Even if an RN represented say, a third of this loss, we are still looking at more than half a million dollars in financial loss.  Now think about what we could accomplish by reallocating those dollars into a comprehensive, and proactive, burnout strategy.  The long-term financial impact is extraordinary if we successfully retain healthy care team members for longer.  And this directly contributes to quality of patient care. Consider the organizational impact of minimizing depersonalization, decreasing burnout attributed medical errors, ⁽⁴⁾  and decreasing the disruption in care and continuity due to turnover.  And then consider the decreased risk of care team suicide.⁽⁵⁾   Seems like a win/win.

So what can be done to proactively intervene and support health care team members before it’s too late? And how do we make sure we aren’t just checking a compliance box?

• First, we must recognize that burnout isn’t just “part of the job.” It should never be assumed that providers or care team members agreed to take on a certain level of burnout, or vicarious trauma, because of the nature of their chosen profession.
• Second, we must identify the inefficiencies that contribute to burnout. Have we evaluated the composition of the interdisciplinary team to ensure they hold the expertise necessary to meet the needs of the populations we serve? Do our workflows allow everyone on the care team to work to the top of license, or are we overpaying highly qualified individuals to do administrative tasks more suitable for another member of the team?  And while, no matter how we allocate administrative duties they will exist for every role, have we done everything we can to sufficiently support and train to minimize the time allocated to these tasks?
• Finally, we must implement a comprehensive strategy that supports providers and care team members in the ways they want to engage. Employee assistance programs (EAP) are not enough, and they are very rarely utilized. ⁽⁶⁾  Stigma, ⁽⁷⁾ and fear related to professional impact, are real barriers to accessing support for burnout and the potential accompanying behavioral health needs.  A multipronged strategy of EAP, 24-hour digital behavioral health tools, and on-site confidential support and processing groups allow employees to seek the type of support they need, when they need it, and in the form that they most desire.

The most important takeaway is this.  The health and fiscal wellness of your organization relies on proactive identification and intervention for burnout contributors and strategies to care for your providers and care team members.

Sources

1. Shanafelt, T., Goh, J., & Sinsky, C. (2017). The Business Case for Investing in Physician Well-being. JAMA Internal Medicine.
2. Patel R S, Sekhri S, Bhimanadham N, et al. (June 03, 2019) A Review on Strategies to Manage Physician Burnout. Cureus 11(6): e4805. doi:10.7759/cureus.4805
3. Massachusetts Health and Hospital Association, Massachusetts Medical Society, & Harvard T.H. Chan School of Public Health. (2019). A Crisis in Health Care: A Call to Action on Physician Burnout.
4. White, T. (2018, July 8). Medical Errors May Stem More from Physician Burnout Than Unsafe Health Care Settings. Stanford Medicine News Center.
5. Patel, R., Bachu, R., Adikey, A., Malik, M., & Shah, M. (2018). Factors Related to Physician Burnout and Its Consequences: A Review. Behavioral Sciences, 8(11), 98. MDPI AG.
6. Agovino, T. (2020, February 27). Companies Seek to Boost Low Usage of Employee Assistance Programs. SHRM.
7. Milot, M. (2019). Stigma as a barrier to the use of Employee Assistance Programs. A Workreach Solutions research report.