The Institute for Healthcare Excellence President and CEO William J. Maples M.D. Co-Founds National Taskforce for Humanity in Healthcare

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Turning the lever down on burnout and turning up resilience, well-being and joy (Part 1)

What you can do to build resilience – An individual approach

The feeling that “something’s got to give” is not uncommon. According to the National Taskforce for Humanity in Healthcare’s (NTH) paper showcasing the business case for humanity in healthcare, more than 50 percent of U.S. physicians report symptoms of burnout, ranging from emotional exhaustion to detachment. Twenty-four percent of ICU nurses have symptoms of post-traumatic stress disorder, and 26 percent of ER nurses have burnout.

How can we address a compounding problem that challenges physicians, nurses, care team members and health systems?

“Our task is to prevent burnout and to create an environment where people can thrive at their job,” says Patrick Kneeland, M.D. He is a member of NTH, a faculty member at The Institute for Healthcare Excellence (IHE), and the Executive Medical Director for Patient and Provider Experience at University of Colorado Health (UCHealth).

“We’re actively talking about environmental and structural changes we can make to prevent burnout. We want to find ways to prevent it before it happens.”

Dr. Kneeland points out that it’s also important to make the distinction between what individuals can do to mitigate burnout and enhance thriving versus what organizations and leadership can do.

“On the individual level, there are practices such as being present and mindful, and practicing gratitude. For example, it has been shown that if you recall three good things at the end of your day for 14 days, the effect of that practice will benefit you for the next year,” says Dr. Kneeland.

“We’ve learned that we’re hardwired to remember mostly the negative, and the practice of deliberately noticing the good things that are going on can really lift us up. This is sort of like building mental muscle so you can tackle your challenges and be able to thrive in what you love to do.”

Most experts take building resilience to heart. “When I think about how to avoid burnout, it starts with me. It’s about the relationships I have,” Jennifer Krippner, NTH member and Chief Experience Officer at IHE says.

“Communicating with other people and connecting with others at a personal level brings back joy into the work that I do.”

“The thing about the Three Good Things exercise that Dr. Kneeland mentioned is that you’re not only noticing the positive things that happened, you also begin to notice what your role was in making them happen,” Krippner reflects. “By noticing you can truly connect to positive emotions which is an important lever in building resilience and well-being.”

The role of effective communication cannot be understated. “You can use effective communication to establish deeper links and relationships with others,” Krippner says. “You find room for improvement in yourself – and see how your relationships flourish and your resilience increases.”

Building resilience at organizational level |The cost of physician burnout

Learn more about the National Taskforce for Humanity in Healthcare

Turning the lever down on burnout and turning up resilience, well-being and joy (Part 2)

What organizations can do to help build well-being in healthcare

As mentioned in part 1 of this series, it’s important to distinguish between what you can do as an individual and what organizations can do to help mitigate burnout and enhance thriving.

Doctors and nurses discuss difficult decisions with patients, often give bad news, and provide support for family members and fellow caregivers daily. In addition, as care complexity and external regulations have increased over the past decade, many unintended consequences have fallen on the shoulders of healthcare providers. For many healthcare professionals, including 50 percent of doctors and 26 percent of ER nurses in the U.S., striving to maintain top levels of performance can lead to burnout.

Patrick Kneeland, M.D., a member of the National Taskforce for Humanity of Healthcare (NTH), a faculty member at IHE and the Executive Medical Director for Patient and Provider Experience at University of Colorado Health (UCHealth), dedicates a good part of his time to finding solutions to the problem of burnout.

“For organizations to be able to tackle burnout collectively, it’s important to acknowledge that there is a stigma and a tendency to blame the individual,” says Dr. Kneeland.

“It’s almost like saying, if you’re not resilient you must be doing something wrong. It becomes a Catch-22 for caregivers when we blame the victim,” Dr. Kneeland points out.

The bulk of the work needed in avoiding burnout lies within leadership. The entire organization needs to combat the stigma that “if you’re not thriving, you’re weak or you’re not cut out for this type of work.” Most team members are highly resilient. The system is designed in a way that overwhelms resilience.

The need to optimize culture and give leaders the skills they need to create and nurture a healthy workforce is critical in all industries, including healthcare.

Workplace surveys consistently show that team dynamics significantly contribute to stress levels. Twenty-eight percent of workers cite “people issues” as a main source of stress.

A strategy used by some physician groups at UCHealth is to start including resilience questions in the annual review process. “We found that people were doing reviews as something to just check off a list. But here’s an example of a leadership skill that can be taught. Instead of checking the box, pause and truly check in with people,” says Dr. Kneeland.

In the hospital medicine group at UCHealth, the questions are open ended: In what ways are you thriving? What would it take to help you thrive more? What can we do to help you thrive? This opens the door for professionals to discuss burnout openly and without stigma.

“When we started doing this four years ago, we identified the domains of high performance culture. We want to encourage people to expand to obtain the results they desire personally and as a team. The idea is to reach a place where caregivers are achieving the results they desire in multiple domains (connect with purpose, professional development, collegial work environment and others),” says Dr. Kneeland. “As we committed to this approach and built strategies to foster such a culture, our burnout rates dropped even as trends such as patient volumes and care complexity continued to increase.”

This organizational approach contributes to preventing burnout before it takes hold. The Institute for Healthcare Excellence (IHE), working with the National Taskforce, has identified specific skills that can be learned and nurtured to effectively prevent burnout.

“Giving leaders, physicians and nurses the skills and tools to build resilience and well-being is a must for organizations,” says Jennifer Krippner, NTH member and Chief Experience Officer at IHE. “Resilience, well-being and joy enable the ability to thrive – enhancing the experience for caregivers, patients and families.”

Building individual resilience  |  The cost of physician burnout

Learn more about the National Taskforce for Humanity in Healthcare

 

Turning the lever down on burnout and turning up resilience, well-being and joy (Part 3)

The cost of physician burnout and why it’s urgent to find solutions

In a Harvard Business Review article, Eric Garton highlights that burnout signals a problem with the organization, not the person. In healthcare, leaders need a systemic approach to understand the joys and hassles of practicing medicine within their organization to best understand contributing factors and associated solutions for physician and nurse burnout.

The National Taskforce for Humanity in Healthcare (NTH) has identified the cost of burnout related to physician and nurse turnover. The taskforce also points out the need to address the problem at the organizational level – without placing blame on individuals.

“It’s important for organizations to have open conversations about the cost of burnout on patient and provider experience, and the toll burnout takes on their ability of provide services safely and efficiently,” says Jennifer Krippner, NTH member and Chief Experience Officer at IHE.

The taskforce report points out that beyond the psychological and physical problems of burned-out physicians and nurses, the costs of providing services can be far greater when you look at low productivity, high turnover, loss of talent, and lower quality.

Thirty-three percent of new RNs seek another job within a year of employment. Fifty percent of physicians have symptoms of burnout, and the turnover rate for burned-out physicians is 21 percent. Replacing and onboarding one physician costs more than $1 million. Extended to include the population of 954,000 U.S. doctors, the cost of burnout-related turnover is 17 billion.

For nurses, the burnout-related turnover cost for hospital-based nurses is estimated at $9 billion. Extrapolating to all 2.9 million nurses in the U.S., the total cost of nurse turnover in the U.S. is $14 billion.

“The loss in productivity, turnover and replacement cost is not only a gap in revenue, but a limitation on what we could be investing in improving the patient-family experience, and in helping care team members reach their highest healing potential,” says Liz Boehm, NTH member and Director of Research for the Experience Innovation Network.

“Any of that would be more productive than simply churning through physicians and nurses. It’s difficult to achieve culture transformation in healthcare if we’re in this mode,” says Boehm.

Boehm points out that, in healthcare, “you have people who are dedicated, smart, knowledgeable, and want to help others heal — and a system that chews them up. We’re not getting the full benefit of the healing and we’re burning through resources.”

Considering that every person is touched by healthcare in some shape or form during their life, the ripple effects through our economy cannot be overestimated.

“Right now we have a healthcare system that systematically breaks nurses, physicians and other care team members,” Boehm says. “We need to change the system – not just the individuals –  in order to give Americans the healing they need and strengthen everything else in our society.”

There’s a cost that is not widely talked about. The suicide rate of physicians is twice that of the general population, and many physicians fear seeking help over licensing issues and other punitive actions.

“The question becomes, how do we support the medical profession in a fundamentally different way? How do we detox the system and provide the tools and leadership our medical professionals need to make things better for all of us?”

In this article series, we’ve looked at the cost of burnout-related turnover, solutions to burnout from an organizational perspective, and solutions from an individual viewpoint. Members of the NTH are looking at burnout and well-being from a new angle necessary to address urgent, system-wide problems. Its members propose a three-pronged approach:

  1. Change the dialog around burnout from one that sees burnout as a personal psychological failing to acknowledgement of a system in distress. Through this reframing, shift the aim from burnout prevention to creation of a system that supports resilience, well-being, and joy.
  2. Adopt a metric for humanity that focuses less on deficit measurement (burnout), and more on understanding the causes and consequences of emotional thriving and emotional resilience.
  3. Create a blueprint for change that supports a systematic shift in culture towards a human-centered care system. Change must occur at all levels within organizations and cascade across all decisions related to people, processes, and technology.

Learn more about the work of the National Taskforce for Humanity in Healthcare by downloading the Business Case for Humanity in Healthcare.

Building individual resilience  |  Building resilience at organizational level