Clinical Burnout

EXECUTIVE SUMMARY

Burnout; physical or mental collapse caused by overwork or stress. Clinical burnout is what is being called today as a national crisis. With clinicians and healthcare executives alike experiencing symptoms of burnout, healthcare leaders need to look into the root causes and implement changes systemwide in order to better improve the patient experience and patient care in their hospital settings. Burnout can be experienced for a number of reasons but a majority of burnout symptoms can be measured by allowing your employees to communicate through surveys. Once burnout causes are measured, only then can healthcare leaders address how to help their team and lead them to  healthier lifestyles which in turn will make for a healthier environment for our patients.

INTRODUCTION

Burnout; physical or mental collapse caused by overwork or stress. More medical staff personal are feeling the effects of burn out annually. With most physicians and nurses alike testifying to experiencing symptoms of burnout. According to Mark Linzer, the director of general internal medicine at Hennepin County Medical Center in Minneapolis, it’s [clinician burnout] somewhere between 30% and 50% nationally in physicians and it is rising” (Thew, 2017). After completing a study where researchers surveyed 6,880 physicians in 2014, the Mayo Clinic found that 54.4% reported experiencing at least one of the three components of burnout. Burnout is assessed using what is known as the Maslach Burnout Inventory with three components including, “emotional exhaustion, depersonalization and low personal accomplishment” (Wellwork, N.D.).

Previous Approaches

In the past there has been little done to understand burnout. According to Karen Weiner, a Chief Medical officer and CEO of a physician owned group of around 140 healthcare providers after completing a survey said, 86% of CEOs (chief executive officers), 86% of CMOs (chief medical officers), and 81% of COOs (chief operating

Clinical Burnout

With burnout symptoms on the rise it begins to become clear that it is not just a problem for clinicians but for healthcare executives as well. With more than half of our clinicians and executives experiencing some form of burnout, one must question how this effects the organization as a whole.

Linzer states, “With 50% of people experiencing at least one component of burnout nationally, you’re looking at problems with morale and turnover.

There are risks to patient safety, quality, and patient satisfaction, not necessarily from the burned-out physician, but from the adverse work conditions that led to the burnout”.

In order to understand and attempt fixing burnout, one must asses what causes these symptoms to begin with. Leaders in the healthcare field also need to find ways to eliminate the causes of these burnout symptoms and implement changes

systemwide before the effect of burnout is too great.

officers) thought they had an issue with clinician burnout. However out of those, only 21% of CEOs, 18% of CMOs, and 21% of COOs said they were doing anything about it (Thew, 2017). It may not have previously been an issue of hospital executives not realizing that burnout was a very serious issue in their organization but rather more so that they did not understand how to fix it. Previously,

some burnout causes seem to stem from a lack of communication from the clinician and the executives or management team, overworking due to lack of staff, not creating easily accessible stress management strategies, and a lack of trust of management to clinicians. According to Christina Maslach, the inventor of the Maslach Burnout Inventory, burnout most always stem from these six avenues (Thew, 2017):

• Workload – amount of work to be done in the amount of time allotted
• Control – the ability to make decisions
• Reward – appreciation for work done
• Community- feeling as if you’re apart of something, you belong
• Fairness – “just” and fair rules
• Values- matching values of employee and

New findings

Most healthcare leaders are now truly attempting to understand what exactly causes burnout and once they have they are now putting into place ways to help their clinicians. Firstly, putting together an engagement survey is what is needed to asses the issues your employees are experiencing and measure what exactly your hospital staff is needing from you. Once time and effort is put into delivering these engagement surveys and thoroughly picked through you can establish  ways to help relieve the burnout symptoms in your hospital staff. Karen Weiner,   in her attempt to measure just how to solve their burnout crisis put to test an instrument their organization used, called the MBI, Maslach burnout Inventory, which was developed by a professor of psychology at the University of California, Berkeley, who has studied burnouts since the 1970s. The MBI is broken down  into three main components: emotional exhaustion explained by feeling emotionally drained and fatigued at work, cynicism explained by uncaring   feelings and even feeling angry towards coworkers or even patients and finally a feeling  of inadequacy and overall ineffectiveness towards  your work. This allowed their organization to realize that burnout was very real amongst their doctors and even 10% of their doctors struggled with all three components. Most organizations found success in finding the time for the healthcare leaders to meet with physicians and clinicians alike and start a new. By doing this it is thought   that the clinicians will feel as though their opinions matter and that the healthcare leaders are taking their wants and needs seriously. Most organizations are   finding that providing a wellness program for their employees to be the best fix   for these type of burnout issues. William Norcross, an executive director of a physician wellness program at U.C.S.D believes that mindfulness meditation and self awareness exercises are the key to bouncing back from burnout. According  to Work Well, a wellness program provider,

(Work Well, N.D.).

According to an article written in the Journal of Palliative Medicine, a study was used to find methods physicians could do in order to promote self-care and assist with burnout. Thirty different physicians were separated into 1 of 13 different thematic classes. The majority of physicians found physical activity to be the  most common strategy in regards to help with burnout and improving self-care (60%), followed closely by professional relationships (57%), changing to a more religious perspective (43%), communicating with others (43%), hobbies (40%), changing up daily tasks (37%),

personal relationships (37%), and personal boundaries (37%) (Swetz, et al, 2009). According to the American Hospital Association, “approximately 86% of hospitals have

Personal Boundaries

Physical Activity

Personal Relationships

implemented workplace wellness programs” (Work Well, N.D.). When the right causes are found there are several ways to reduce burnout

Variety at Work

Hobbies

Professional Relationships

Religious Perspective

amongst your staff members.

Communication

Thoroughly training new staff

(Thew, 2017)

According to Kristine Kilgore, RN, BSN, an administrative director at Surgical Care Center of Michigan, says that she has all new employees shadow the jobs for which they are getting hired for (Worried About Staff Burnout?, 2017). She also recommends tailoring the training of new employees to the new employee, rather than the employee being forced into how everyone else learns. Kilgore also recommends walking the trainee through all areas of their expected jobs ranging from the slowly paced jobs to the more detailed one’s in order to establish a good learning environment as well as making sure the job is the correct one for the new employee.

This hands on approach from day one of a new employee would leave them feeling as though

they would be taken care of from the very beginning and establish a solid ground of training to base their careers off of.

Wellness program activities

Adrienne Shultz, RN, HN-BC, assistant vice president of patient care services says that organizations can offer wellness programs that include several different activities that promote physical health, including gym membership discounts (Worried About Staff Burnout?, 2017). Work Well’s wellness program states that most classes should include self-awareness, stress- reduction, or mindfulness classes. Many researchers seem to think yoga would be a way to battle burnout by involving physical activity as well as mindfulness and breathing techniques (Work Well,

N.D.). According to Work Well, “yoga reduces stress by shifting the body away from fight-or-  flight into a more relaxed, parasympathetic response. In doing so, it lowers breathing and heart rate, decreases blood pressure, lowers cortisol levels, and increases blood flow to the intestines and vital organs” (Work Well, N.D.).

Overlap and stagger shifts and include breaks

One major stressor and complaint heard most often in surgical settings is that of not having enough nurses, too many call outs, or that nurses need to wait far too long to be able to take   their lunches. Kilgore states that a way around this is to stagger shifts (Worried About Staff Burnout?, 2017). By staggering nurses who come in between six thirty and nine she has the ability to sub nurses in and out and also gives her the ability to have one nurse always available to relieve others for lunches. A way to beat too many call outs would be to have a calling system that allows for calling in available nurses from different locations who may not be needed at   those locations. As well as having a number of varied shifts as in part time and full time employees where you are able to send full time employees who would like to leave early the opportunity to do so because of the part time staff that are available.

Listen to your employees

Shultz says that at the Cancer Treatment Centers of America, employees are encouraged to speak up about issues that are on their minds (Worried About Staff Burnout?, 2017). These meetings, according to Shultz, take place during lunch time therefor most people are able to attend. In these sessions, no topic is off limits and can even speak upon things that have personally effected them.    Reward your staff

Whether it just be addressing the entire team and praising them for their previous efforts or putting together a small lunch for everyone working late in the hours, finding ways to show special appreciation to others is a great way to encourage morale and a way to allow your team to feel appreciated. Also, some companies choose to have get togethers once or twice a year   as a way to create camaraderie amongst employees and employers alike as well as boosting morale.

Keep in touch with your staff

Many employers make the mistake of having a once of year function and never again returning to address your staff until a year later at the following function. This should not be the only time hospital leaders are addressing the issues that the staff has. Therefor, reviews should be done throughout the year in order to address the employee and the issues they might have. This could also be a way to establish bonds with your staff as well as get to understand their future goals in the company and how management can assist with achieving these goals.

In Conclusion

Burnout in the clinical setting can be an incredibly difficult problem to assess and quantify however if the leaders of healthcare can realize that burnout amongst their employees

dramatically hinders their success as an organization they might consider taking the steps to further understand it. Once measured and found necessary, organizations can take steps   toward a healthier organization. Research has found that this can be accomplished by creating   a successful wellness program that speaks to your employees and gives them the ability to  focus more on self-care. When most hospitals showed their employees that their health matters just as much, or more, than the patients its then that the staff seemed to feel less burnt out during their daily work duties. This was done by incorporating wellness activities, keeping in touch the staff, changing shifts in order to help your staff, as well as starting off new employees on the right foot.

References

Shanafelt, TD. (2009). Enhancing Meaning in Work: A prescription for preventing physician burnout and promoting patient- centered. American Medical Association.

Swetz, K., Harrington, S., Matsuyama, R., Shanafelt, T., & Lyckholm, L. (2009). Strategies for avoiding burnout in hospice and palliative medicine: peer advice for physicians on achieving longevity and fulfillment. Journal Of Palliative Medicine, 12(9), 773-777. doi:10.1089/jpm.2009.0050

Thew, J. (2017). Beating Clinician BURNOUT. (cover story). Healthleaders Magazine, 20(3), 10-21.

Work Well NW. (N.D.) Reducing clinical burnout with yoga and mindfulness training. Retrieved from https://www.experixllc.com/file_view.php? download_key=1cac95aacfc0287c62317431963e431b53d7e1f90574d7.31925572

Worried About Staff Burnout? Here Are Prevention Strategies. (2017). Case Management Advisor, 28(3), 32-34.