In an article from the Agency for Healthcare Research and Quality burnout is described as a syndrome characterized by emotional exhaustion that results in depersonalization and decreased personal accomplishment at work. The emotionally exhausted clinician is overwhelmed by work to the point of feeling fatigued, unable to face the demands of the job, and unable to engage with others. In the past few years, the growing prevalence of burnout syndrome among health care personnel has gained attention as a potential threat to health care quality and patient safety.
According to an article from the Mayo Clinic, there are certain strategies healthcare organizational leadership can take to reduce physician burnout which I believe are also true for Nurse Practitioners and Physician Assistants. The following will highlight seven of the most important in the arcticle.
- Acknowledge the problem. Acknowledging the problem of burnout and demonstrating that the organization cares about the well-being of its providers is a necessary first step toward making progress. Staff appreciate open and candid dialogue directly with the chief executive officer (CEO) about the challenge of being a provider in today’s world. It is important that these discussions are not rushed and are repeated more often than one initially imagines would be necessary. Depending on the size of the organization, a variety of formats is typically necessary to reach the staff. Town halls, radio broadcasts, letters, and video interviews along with face-to-face meetings involving clinical divisions, work units, and small groups are formats for the leadership to reach the staff. Naming the issue and being willing to listen demonstrates that the problem is recognized at the highest level of the organization and creates the necessary trust for providers and leaders to work in partnership to make progress. Once the problem is acknowledged, it is necessary to measure provider well-being as a routine institutional performance metric along with patient volume, payer mix, quality/safety, patient satisfaction, and financial performance. Provider well-being is equally important to the health and long-term viability of the organization, and, thus, it should be measured.
- Leverage leadership Although the importance of leadership for organizational success is obvious, its direct effect on the professional satisfaction of individual providers is underappreciated. Recent evidence suggests that the leadership behaviors of the provider supervisor play a critical role in the well-being of the providers they lead. Harnessing the power of effective leadership to promote individual and organizational health requires several steps. First, the right leaders must be selected. This selection should focus on identifying individuals with the ability to listen to, engage, develop, and lead providers. Second, these individuals must themselves be developed, prepared, and equipped for their leadership role.
- Creating a community environment. Providers deal with unique challenges (eg, medical errors, malpractice suits). Peer support is critical to helping providers navigate these professional challenges. This support can be formal or informal and encompasses a wide range of activities, including celebrating achievements (eg, personal and professional milestones), supporting one another through challenging experiences (eg, loss of a patient, medical errors, a malpractice suit), and sharing ideas on how to navigate the ups and downs of a career in healthcare.
- Rewards and incentives. People can be motivated by rewards. To harness this principle, many health care organizations have linked providers’ financial compensation to productivity. In some settings, provider income is entirely based on productivity, and in others it is structured as a base salary with a productivity bonus. Although some variation in productivity (eg, patient volumes and relative value unit generation) can be attributed to experience, efficiency, and skill, such variation is relatively narrow. Providers in an equally efficient practice environment primarily increase productivity or revenue generation in 3 ways: (1) shortening the time spent per patient, (2) ordering more tests/procedures, or (3) working longer. The first 2 approaches may erode quality of care, and the third approach increases the risk of burnout and may, therefore, be self-defeating in the long run. Consistent with this notion, evidence suggests that productivity-based compensation increases the risk of burnout.
- Strengthening culture and aligning values. Most health care organizations have an altruistic mission statement that centers on serving patients and providing them the best possible medical care. An organization’s culture, values, and principles in large part determine whether it will achieve its mission. It is critical for organizations to (1) be mindful of factors that influence culture, (2) assess ways to keep values fresh, and (3) periodically take stock of whether actions and values are aligned. Organizations that implement strategies to decrease provider burnout in turn through second effect accomplish their mission and preserve their cultural values.
- Support and promote self care and resilience. Although the primary focus for organizations should be to optimize the practice environment and create a healthy organizational culture, they should also provide resources that make it easier for providers to implement individual strategies to prevent burnout, deal with distress, and promote well-being. These resources must be combined with sincere efforts to address the system-based issues contributing to burnout. It is important that such individual offerings are part of a broader strategy that demonstrates that the organization is also doing its part to address issues in the system and environment.
- Support and promote flexibility and life work integration. A host of organizational policies are linked to the drivers of burnout and can have a profound effect on provider well-being. Given their broad impact, the intended and unintended consequences of these policies must be thoughtfully considered and periodically reevaluated. Two aspects particularly important to provider well-being are policies related to flexibility and work-life integration. Providers are nearly twice as likely to be dissatisfied with work-life integration as US workers in other fields. Providing opportunity for flexible work schedule and hours should be incorporated. Institutions should also comprehensively examine the structure of their vacation benefits, coverage for life events (eg, birth of a child, illness/death in family), approach to scheduling, and strategy for coverage of nights and weekends. Compensation practices that disincentivize using vacation time are shortsighted and should be eliminated.
Addressing the problem of provider burnout is the shared responsibility of individual providers and the organizations in which they work. Having an engaged provider workforce is critical for health care organizations to meet institutional objectives and achieve their mission. Given the strong links to quality of care, patient safety, and patient satisfaction, there is a strong business case for organizations to reduce provider burnout and promote provider engagement.