Hospitals and health systems may perceive the intensifying challenges of change, uncertainty, and complexity in healthcare as opportunities. However, these challenges also may be major stressors that lead to burnout, which can result in negative performance such as poor quality and financial outcomes, low productivity, safety issues, and decreased staff morale and retention.
Any stakeholder in every healthcare organization can experience burnout. It is a serious, systemwide issue, and yet a lack of understanding and attention persists. Is burnout difficult to diagnose and measure? Are we dealing only with symptoms and not the root causes? These are questions an organization faces when dealing with significantly poor performance. But what if the leaders themselves are experiencing burnout? Organizations must employ comprehensive strategies to deal with burnout and develop resilience if they are to confront the enormous pressures of meeting the many demands of healthcare today.
The first step is to become aware that burnout exists and acknowledge its extent. Determining its systemic root causes, understanding the issues, and preventing it are the next steps. Executive leadership and culture are necessary elements for preventing burnout among clinicians and the entire team of healthcare professionals. Although caregivers have drawn the most attention because of their direct impact on quality, safety, and cost, we cannot exclude board members, who carry many responsibilities for major policy and strategy decisions. They must recognize burnout in themselves and in executive leaders. Denial is not an option because the risks are too great. Burnout requires a total organizational focus.
Developing a culture of caring and safety, designing work processes to decrease stress, eliminating factors that contribute to burnout, educating stakeholders, and providing and promoting wellness resources are key strategies to address and prevent burnout and to produce effective and positive outcomes. Burnout is a crisis and an epidemic, and the time to act is now.
In this issue of Frontiers of Health Services Management, feature article author Jameson Norton, FACHE, reviews the science of motivation in combating burnout and explains how autonomy, mastery, and purpose can drive those efforts. He describes how Vanderbilt University Medical Center applies these three drivers in a systemic approach to engage clinicians, decrease stressors, and move toward joy and passion in the delivery of healthcare. Norton writes, “Although turnover and burnout vary across markets and organizations and although new policies and disruptors come and go, the role of leadership in engaging clinicians and designing participative systems to harness motivation as a force multiplier will endure.”
Feature article authors Page West, RN, and Perry M. Gee, PhD, RN, offer valuable perspicacity in sharing their multifaceted approach to addressing burnout. They describe enhanced resilience as one antidote, along with evidence-based interventions that are scalable through partnerships and sustained by leadership. “As leaders at Dignity Health,” the authors note, “we believe in the power of ‘humankindness.’ . . . It is about our love for other people—the people we serve and the people we work with every day.”
In her commentary on the feature articles, Kathleen R. Krusie, FACHE, outlines the foundational elements of Community Health Network’s efforts to reduce and prevent burnout, which include current-state assessments, identification of root causes, robust process improvement systems, and integration of organizational structures and approaches with prevention tactics. She describes several initiatives and programs that can increase well-being and resilience and thereby reduce burnout.
In their commentary, Adrienne Boissy, MD, and Susan Rehm, MD, of the Cleveland Clinic, emphasize both system and individual approaches to reducing burnout even as they make the salient point that, although healthcare executives suffer from burnout too, very little research and attention has been devoted to this important subject. They conclude, “No one is coming to rescue healthcare. It is on us. We can do it. We can do it together by focusing thoughtful efforts that support both individuals and the system. As we face the complex question of burnout, meaningful answers begin and end with empathy.”
Commentator Michael D. Williams, LFACHE, focuses on awareness and attention to burnout among leaders. He provides valuable insight gleaned from his experience with strategies to address the issue at several leading healthcare organizations. He concludes, “These efforts can abate both executive and frontline employee burnout to create a healthier healthcare system for all.”
Frontiers of Health Services Management is committed to providing its readers with compelling, in-depth features and commentaries that are of current importance to the practice of health services management by drawing on the expertise of the best practitioners and scholars.