Preventing Burnout in Health Care in 9 Steps

By Ben Boulden

Editors Note: This was first posted as an Employee Blog on Inside UAMS.

Interest in burnout in health care professionals is trending nationally – and for good reason. Data shows that physician burnout, specifically, is staggeringly high and continues to increase – now affecting more than half of doctors nationwide.

We’re not immune to burnout here at UAMS, of course. Fortunately, initiatives are underway to assess and deal with burnout and its implications.

The National Library of Medicine defines professional burnout as “an excessive stress reaction to one’s occupational or professional environment. It is manifested by feelings of emotional and physical exhaustion coupled with a sense of frustration and failure.” Other definitions include “a syndrome characterized by exhaustion, cynicism, and reduced effectiveness.”

As disconcerting as those problems are, the consequences of burnout are even more far-reaching. Burnout is associated with decreased patient satisfaction, lower quality of care, and higher staff turnover in health care institutions. It also impacts our ability to teach and train the next generation of physicians and other health professionals.

In response, several programs have been launched across the country, including WellMD at Stanford University and the American Medical Association’s Physician Wellness Program. The National Academy of Medicine is launching “A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care.”

In January, the Mayo Clinic published in its online proceedings a report by the director of physician wellbeing, and co-authored by Mayo’s CEO, on nine organizational strategies to promote positive engagement and reduce burnout. The strategies target seven key drivers among physicians: workload and job demands, efficiency and resources, meaning at work, culture and values, control and flexibility, social support and community at work, and work-life integration. For each of these, Mayo identified individual factors, work unit factors, organizational factors, and broader national and global factors that need consideration.

Mayo’s nine strategies provide a good model for academic medical centers like ours as we implement our own burnout prevention and clinician satisfaction programs. Here’s an overview, along with a few notes about associated efforts here at UAMS:

1. Acknowledge and assess the problem. This is where surveys on the level of burnout and facets of burnout such as exhaustion, cynicism and inefficacy, are so important. A number of scales have been validated including the internationally used Copenhagen Burnout Inventory, which is being used at UAMS to gather information about burnout and the sense of “meaningful work” for those who work in our Integrated Clinical Enterprise (ICE).

More than 6,000 faculty physicians, residents and other clinical professionals have been invited by email to participate in this survey, which is a very important step for our institution. If you work in ICE and haven’t taken this confidential, anonymous survey yet, please do so by July 31, when the survey closes. It will only take 5-10 minutes of your time. We expect to be able to share results this fall.

2. Harness the power of leadership. Engagement of an institution’s decision makers is key to having an effective program. At UAMS, both Executive Vice Chancellor and College of Medicine Dean Pope L. Moseley, M.D., and Medical Center CEO Richard Turnage, M.D., actively support addressing physician burnout and staff satisfaction.

In addition to the survey mentioned above, a  couple of good examples at the campus level are the recent decisions to foster UAMS’ nursing workforce and to comprehensively address and improve staff compensation. Other levels of leadership are committed to addressing burnout as well.

In the College of Medicine, James Graham, M.D., Associate Dean for Undergraduate Medical Education, and Sara Tariq, M.D., Assistant Dean for Undergraduate Clinical Education, are developing and implementing strategies to prevent burnout among medical students, particularly through the Academic Houses. Meanwhile, Jim Clardy, M.D., Associate Dean for Graduate Medical Education (GME) and Molly Gathright, M.D., Assistant Dean for GME, are working with others on the Integrated Clinical Enterprise burnout and meaningful work survey.

The UAMS Faculty Center, led by Associate Provost Jeannette M. Shorey II, M.D., is committed to helping faculty and colleges across campus address issues related to burnout. As the College of Medicine’s Associate Dean for Faculty and the COM’s liaison to the Faculty Center, I will work closely with the Dean and our leadership to honor the full diversity of our faculty and help each develop to their full potential at UAMS.

3. Develop and implement targeted intervention. A key insight in the Mayo report is that clinicians work in small work units, and each work unit has unique challenges and opportunities. As such, these interventions should be tailored to realities on the ground.

4. Cultivate community at work. Recognizing the importance of peer interaction and camaraderie, some organizations have created space – both physical and temporal – to help foster a sense of community. Mayo created a program called COMPASS (Colleagues Meeting to Promote and Sustain Satisfaction). Participating physicians join groups of six to seven colleagues who share a meal together at a restaurant every two weeks. Colleagues spend the first 20 minutes of each gathering discussing a question that explores the virtues and challenges of being a physician.

5. Use rewards and incentives wisely. Rather than financial incentives, evidence points to the power of implementing rewards, such as greater flexibility or protected time to pursue meaningful aspects of work, to increase fulfillment for physicians.

6. Align values and strengthen culture. As Arkansas’ only comprehensive academic medical center, UAMS intrinsically offers a meaningful work environment. Our institutional core values are integrity, respect, diversity and health equity, teamwork, creativity, excellence, and safety. UAMS’ mission to improve the health, health care and well-being of Arkansans and others in the region, nation and the world anchors our professional lives. These values and our culture of caring, learning and teaching should serve as our daily compass at work.

7. Promote Flexibility and Work-Life Integration. Technology has disrupted how we traditionally organized our “work” and “personal” lives. Physicians are nearly twice as likely to be dissatisfied with work-life integration as other U.S. workers. Organizations should look for ways to address this challenge. Creativity and flexibility – the proverbial “thinking outside of the box” – will be needed.

8. Provide resources to promote resilience and self-care. UAMS can be proud of its wellness resources. We have an excellent Employee Assistance Program (EAP), and faculty members have access to a dedicated Faculty Wellness Program. Beyond these measures, we will also invest in burnout prevention by exploring potential initiatives such as skills training in resilience, positive psychology, and mindfulness.

9. Facilitate and fund organizational science. Surveying, monitoring, implementing and measuring outcomes related to burnout and interventions implemented to address the problem requires an institutional commitment.  With our leadership’s commitment to addressing burnout, and our mission to create knowledge, UAMS can be in the forefront to create this culture of wellness and work satisfaction, and to influence others in health care around the state.

The full report on the Mayo Clinic’s organizational strategies is available online. Here at UAMS, we have a strong commitment to address these challenges. Our efforts will create a more fulfilling and meaningful work and learning environment for faculty, staff and students while increasing satisfaction and improving outcomes for our patients.