​About two years ago, I had an experience that opened my mind to the wider possibilities of professional coaching. After interviewing one of its founders, I participated in the Novant Health Leadership Development Program, which involves small group coaching in a 3-day, off-site retreat. I saw that coaching can change individual clinicians’ lives AND organizations. When cohorts of physicians received formal coaching in small groups, the process eventually reshaped the organization. Physicians and staff became more collegial and more willing to talk about how they’re doing. And, because they had more energy and bandwidth, they started engaging in improvement and fixing system problems, creating an EHR optimization team, for example.

Before participating in the Novant program, I was steadfast in my belief that the only way to reverse the epidemic of physician burnout is to fix our broken health care system—the toxic culture, the inefficient processes, the work arounds, miscommunication, errors, gaps, and chaos.
Coaching, to my mind, was one of those individual solutions that organizations tend to throw first at the problem of burnout. Like mindfulness training, yoga, and meditation, coaching could help folks become more resilient to chaotic workplaces but it didn’t change the chaos. While valuable, it failed to fix the real problem. Or so I thought.

When my co-author and I interviewed Christina Maslach, PhD, social psychologist and professor emerita of psychology at the University of California, Berkeley, for our book, I was struck by her observation that of the six domains she and her colleagues had identified as drivers of professional burnout, one seemed to be the most potent. It was community. She told us that workers who feel like their team mates or peers “have their back” are less likely to experience burnout, whereas workers in a toxic, competitive environment are at significantly higher risk. Interesting, but how do we build work environments that embody community? I recently learned about an innovative program to do just that.
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Sunit Mistry, MD, a pulmonologist and assistant area medical director at Kaiser Permanente South Bay in Southern California, a 500-physician medical center, was inspired to launch a collegiality initiative after he personally experienced the downstream effects of an ineffective connection between physician colleagues. Weekends that a certain rather unhelpful colleague was on call, Mistry would arrive on Monday to find an onslaught of new cases. Referring physicians had delayed calling for a consult (and their patients’ care was delayed) because he or she didn’t want to tangle with that particular physician. Mistry was told, “I will never consult that doctor again…they always yell at me.” Hence he began searching for ways to bring collegiality back. 

Health care organizations are moving to address clinician burnout with a real sense of urgency. It is now commonly accepted that burnout is widespread among health care professionals and has serious repercussions for patient safety and the quality of care. A report released last week by several major Massachusetts health care organizations labeled the situation “a public health crisis” and warned about the adverse impact “on the health and well-being of the American public.”

And though there is currently little evidence about how to effectively tackle the problem, the experience of hospitals and physician practices with various initiatives – and the lessons learned – provide a roadmap for beginning to address a crisis that is having a profound effect on the health care system.

While the term “burnout” is often used informally to indicate fatigue or boredom, it has been defined by psychologists as including three components: emotional exhaustion, depersonalization, and inefficacy, or a low sense of personal accomplishment in one’s work. 
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The definition may be relatively clear, but there is little agreement about how to identify individual clinicians with burnout. The most commonly used survey tool was developed for research into causal factors, not for the diagnosis of burnout in individuals and the term burnout is often loosely used to include other associated but distinct conditions, such as depression, professional dissatisfaction, moral distress, and substance misuse. As Steven Adelman, M.D., Director of Physician Health Services in Massachusetts, notes, “Several different diagnoses have been conflated into the term ‘burnout.’ The word is often used as a catchall.”